Medicina (Kaunas, Lithuania)最新文献

{"title":"Periodontal Indices and Cytokines of Ex-Smokers/Non-Smokers After Bleaching.","authors":"Mehmet Durdu, Derya Gursel Surmelioglu, Gorkem Kervancioglu, Merve Yilmaz, Zeyneb Merve Özdemir, Hasan Ulusal","doi":"10.3390/medicina62091818","DOIUrl":"10.3390/medicina62091818","url":null,"abstract":"<p><p><i>Background and Objectives:</i> Smoking is known to modulate the periodontal inflammatory response, and dental bleaching agents can transiently alter local and systemic cytokine levels. The aim of this study was to evaluate cytokine levels in both saliva and gingival crevicular fluid (GCF) in non-smoking and ex-smoking patients, before and after in-office dental bleaching performed using chemically activated or diode-laser-activated protocols. <i>Materials and Methods:</i> This prospective, longitudinal, split-mouth clinical study included 40 participants allocated to two smoking-status groups (non-smokers and ex-smokers, cessation ≥ 5 years). For each participant, one maxillary hemi-arch received chemically activated bleaching and the contralateral side received diode-laser-activated bleaching, applied in two sessions one week apart. Plaque index (PI), gingival index (GI), and bleeding index (BI) were recorded, and IL-6 and TNF-α levels were measured in saliva and GCF using ELISA at baseline, after each session, and two weeks after treatment. <i>Results:</i> A non-significant increase was observed in GI and BI after two weeks compared with baseline (<i>p</i> > 0.05), while a significant decrease was observed in PI in the ex-smoker group (<i>p</i> < 0.05). A transient increase in TNF-α and IL-6 levels was observed in saliva and GCF samples following bleaching, and TNF-α/IL-6 levels were consistently lower in the ex-smoker group across all measurements. <i>Conclusions:</i> Bleaching was associated with a temporary alteration of periodontal indices and cytokine levels irrespective of smoking history. Smoking history was independently associated with lower cytokine levels, regardless of bleaching application, supporting the relevance of considering smoking history when interpreting the inflammatory impact of bleaching activation methods.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13608967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polydeoxyribonucleotide Enhances Liver Regeneration Following Partial Hepatectomy in Rats in Association with Growth Factor and A_2A Receptor Signaling.","authors":"Il-Gyu Ko, Hyoung Il Choi, Su Bee Park, Hyun Phil Shin, Jung Won Jeon, SeungHwan Lee","doi":"10.3390/medicina62091819","DOIUrl":"10.3390/medicina62091819","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Liver regeneration following partial hepatectomy (PHx) is essential for restoring hepatic function. Polydeoxyribonucleotide (PDRN), an adenosine A_2A receptor (A_2AR) agonist, has demonstrated regenerative and proangiogenic properties in various tissues. However, its therapeutic potential for promoting liver regeneration after PHx has not been fully elucidated. The primary objective was to evaluate the effect of PDRN on liver regeneration after PHx, and the secondary objective was to examine associated changes in proliferation-related proteins and A_2AR/cAMP, HGF/c-Met, and VEGF/VEGFR2 signaling. <i>Materials and Methods</i>: A rat model of 70% PHx was established, and PDRN (8 mg/kg) was administered intraperitoneally once daily for 5 consecutive days with or without the A_2AR antagonist 3,7-dimethyl-1-propargylxanthine (DMPX; 8 mg/kg). Liver regeneration was evaluated using biochemical, histological, and molecular analyses. <i>Results</i>: PDRN enhanced liver regeneration following PHx, as demonstrated by reduced serum liver enzyme levels, enhanced recovery of liver mass, and improved histological architecture. PDRN also increased the expression of the proliferation-associated proteins proliferating cell nuclear antigen (PCNA) and cyclin D1. These effects were accompanied by increased A_2AR expression and cyclic adenosine monophosphate (cAMP) levels, elevated hepatocyte growth factor (HGF) and vascular endothelial growth factor (VEGF) levels, and enhanced phosphorylation of c-Met and VEGFR2. Co-administration of DMPX attenuated the regenerative and molecular effects of PDRN, suggesting a potential involvement of A_2AR-related signaling. <i>Conclusions</i>: Collectively, these findings suggest that PDRN may facilitate liver regeneration following PHx in association with increased expression of proliferation-associated proteins and changes in HGF/c-Met and VEGF/VEGFR2 signaling, supporting its potential as a therapeutic strategy following hepatic resection.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Profile of Documented Diabetic Peripheral Neuropathy by GLP-1-Based Medication Status: A Cross-Sectional Study.","authors":"Anca Cristina Ferician, Timea Claudia Ghitea, Mihaela Simona Popoviciu","doi":"10.3390/medicina62091816","DOIUrl":"10.3390/medicina62091816","url":null,"abstract":"<p><p><i>Background and Objectives</i>: This exploratory single-center retrospective cross-sectional study characterized patients with documented diabetic peripheral neuropathy (DPN) according to documented GLP-1-based medication status. GLP-1-based medication status was defined by a hospital medication-field entry for exenatide, dulaglutide, semaglutide, a fixed-ratio insulin/GLP-1 receptor agonist combination, or tirzepatide, a dual GIP/GLP-1 receptor agonist. <i>Materials and Methods</i>: Medication-level records from a hospital-defined February 2024-February 2026 reporting window were aggregated by PatID for 4120 unique patients in active-patient exports from the Clinical County Emergency Hospital Bihor. The files lacked patient-level encounter, diagnosis, and treatment dates; therefore, they were analyzed as an undated reporting snapshot. DPN and diabetes type were defined from export fields and were not independently clinically validated. <i>Results</i>: GLP-1-based medications were documented in 852 patients (20.7%). Patients with these medications in their records had longer documented diabetes duration (14.85 ± 8.64 vs. 11.72 ± 8.73 years; <i>p</i> < 0.001) and a higher documented comorbidity count (2.64 ± 1.65 vs. 1.89 ± 1.55; <i>p</i> < 0.001). Heart failure was documented in 35.7% versus 22.2%, and any lower-limb amputation in 3.3% versus 1.2%. For heart failure, the adjusted odds ratio was 1.68 (95% CI 1.41-1.99) in the primary model and 1.37 (1.12-1.67) in the expanded exploratory model; the corresponding robust Poisson prevalence ratio was 1.45 (1.30-1.63). Because only 66 amputations were recorded, amputation was retained as a descriptive, unadjusted outcome and was not modeled multivariably. <i>Conclusions</i>: A GLP-1-based medication record identified a clinically complex subgroup with documented DPN. The findings are exploratory and hypothesis-generating; because treatment and outcome dates were unavailable, they do not establish temporality, treatment benefit, or treatment harm.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Active Case Finding of Chronic Obstructive Pulmonary Disease in Romanian Primary Care.","authors":"Andreea Narcisa Iana, Daniela Gurgus, Roxana Folescu","doi":"10.3390/medicina62091820","DOIUrl":"10.3390/medicina62091820","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;i&gt;Background and Objectives&lt;/i&gt;: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide and represents a major contributor to the global burden of disease. According to the World Health Organization it is the third leading cause of death worldwide and the seventh leading cause of poor health worldwide. Our aim was to evaluate the effectiveness of active case finding of COPD in Romanian primary care through the COPD Assessment Test (CAT) and the Modified Medical Research Council (mMRC) dyspnea scale and post-bronchodilator (post-BD) spirometry. &lt;i&gt;Materials and Methods&lt;/i&gt;: A prospective active case-finding study was conducted among 220 proactively selected patients with an age over 40 years and a documented history of at least one major respiratory risk factor. The study enrolled patients from one General Practitioner (GP) office. The exclusion criteria were malignancies and previously diagnosed obstructive disease. Demographics, tobacco exposure, clinical history and validated case-finding questionnaires (CAT and mMRC) were recorded. All participants underwent diagnostic post-bronchodilator spirometry. Airflow limitation was defined as a post-bronchodilator FEV&lt;sub&gt;1&lt;/sub&gt;/FVC &lt;0.70. The statistical analysis was performed with The Statistical Package for the Social Sciences version 27 (SPSS, Chicago, IL, USA). &lt;i&gt;Results&lt;/i&gt;: Spirometry confirmed a positive COPD diagnosis in 48.2% &lt;i&gt;(n&lt;/i&gt; = 106) of the study cohort. Severity staging revealed that 34.9% met criteria for GOLD 1 (Mild), 49.1% for GOLD 2 (Moderate), 15.1% for GOLD 3 (Severe), and 0.9% for GOLD 4 (Very Severe). Smoking history (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) was significantly higher in the COPD group. While the mMRC scale at a cut-off ≥2 demonstrated excellent diagnostic specificity (82.5%), its low sensitivity (41.5%) means that relying solely on breathlessness in primary care questionnaires would result in missing probably more than half of the patients with a positive diagnosis. In contrast, the CAT score at a threshold ≥17 offers a more balanced trade-off (64.2% sensitivity, 74.6% specificity) for active case finding of COPD patients. &lt;i&gt;Discussion&lt;/i&gt;: The findings of this study acknowledge the clinical utility of using validated questionnaires in active case finding of COPD in Romanian primary care. A comprehensive evaluation of symptoms-incorporating cough, sputum production, and sleep impact-provides a much more reliable clinical trigger for diagnostic spirometry than dyspnea alone. While tobacco smoking remains the predominant driver of airflow limitation in our cohort, the identification of obstruction in 4.7% of never-smokers acknowledges the clinical necessity of accounting for non-smoking risk factors, occupational dust, environmental exposures and documented histories of recurrent winter bronchitis, persistent morning cough, or unexplained sputum production. In the study cohort, a CAT score ≥17 showed the best observed balance between s","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Mobility as a Prognostic Marker in Geriatric Oncology: A Prospective Study Using Gait Speed.","authors":"Beyza Ünlü, Hacer Demir, Sena Ece Davarcı, Yaşar Culha, Meltem Baykara","doi":"10.3390/medicina62091815","DOIUrl":"10.3390/medicina62091815","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Functional impairment is common in older adults with cancer and may influence treatment outcomes. This study aimed to evaluate the prognostic value of objectively measured functional mobility, with gait speed as the primary analytical variable, for survival, treatment response, and chemotherapy-related toxicity in geriatric cancer patients. <i>Materials and Methods:</i> In this single-center prospective study, 102 patients aged 65 years and older who were chemotherapy-naive were enrolled. Before treatment initiation, functional mobility was assessed using a 3-m gait-speed test at the patient's usual pace. Gait speed was analyzed primarily as a continuous variable; the sample-median cutoff was retained for secondary descriptive analyses, and 0.8 m/s was evaluated in a sensitivity analysis. Associations with survival, treatment response, and toxicity were evaluated using survival and regression analyses. <i>Results:</i> The mean gait speed was 0.481 ± 0.176 m/s. Among patients with metastatic disease, higher continuous gait speed was associated with lower mortality in univariable analysis (HR = 0.752, 95% CI: 0.605-0.934, <i>p</i> = 0.010) and after adjustment for age, sex, and ECOG performance status (adjusted HR = 0.647, 95% CI: 0.490-0.853, <i>p</i> = 0.002). Gait speed was not significantly associated with metastatic PFS, non-metastatic OS or DFS, or grade ≥ 3 toxicity. The 0.8 m/s sensitivity analysis was limited by marked group imbalance. <i>Conclusions:</i> Higher baseline gait speed was associated with lower mortality in metastatic geriatric cancer patients, whereas statistically significant associations were not detected for PFS, non-metastatic survival outcomes, or grade ≥ 3 toxicity. These exploratory findings require validation in larger and more homogeneous cohorts.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Monocyte Subsets with Carotid Artery Stenosis Severity.","authors":"Levent Deniz, Derya Sonmez, Mehmet Semih Cakir, Eren Ozgur, Ozlem Akdogan, Zahide Adiyaman, Hale Aral","doi":"10.3390/medicina62091817","DOIUrl":"10.3390/medicina62091817","url":null,"abstract":"<p><p><i>Background and Objectives</i>: This study aimed to investigate the association between circulating monocyte subset profiles and carotid artery stenosis (CAS) severity and to examine their relationships with inflammatory and atherosclerosis-related parameters. <i>Materials and Methods</i>: This cross-sectional study included 73 adult patients who underwent carotid Doppler ultrasonography. Participants were classified according to internal CAS severity as <50% (n = 44) or ≥50% (n = 29). Monocyte subsets were analyzed using flow cytometry and categorized as classical (CD14++CD16-), intermediate (CD14++CD16+), and non-classical (CD14+CD16++) monocytes. Serum MCP-1 concentrations were measured using an enzyme-linked immunosorbent assay. Clinical characteristics, biochemical parameters, inflammatory indices, and carotid intima-media thickness (cIMT) were compared between the groups. Multivariate logistic regression analyses were performed to identify independent associations with significant stenosis. <i>Results</i>: Patients with CAS ≥50% exhibited significantly higher classical monocyte percentages and lower non-classical monocyte percentages than those with CAS < 50% (<i>p</i> = 0.044 and <i>p</i> = 0.027, respectively). Intermediate monocyte percentages did not differ significantly between the groups. Significant stenosis was also associated with a higher white blood cell count, neutrophil count, systemic inflammatory response index, fibrinogen, and HbA1c levels. Non-classical monocyte percentages showed a significant inverse correlation with cIMT (r = -0.320, <i>p</i> = 0.006). In a multivariable model adjusted for age, sex, and systolic blood pressure, lower non-classical monocyte percentage was associated with significant CAS (OR 0.872, 95% CI 0.765-0.994; <i>p</i> = 0.040). However, this association was no longer statistically significant after further adjustment for fibrinogen, neutrophil count, and HbA1c, whereas fibrinogen remained independently associated with significant CAS. <i>Conclusions</i>: Lower circulating non-classical monocyte percentages were associated with significant CAS and inversely correlated with cIMT and inflammatory markers. However, the attenuation of this association after adjusting for inflammatory parameters suggests that monocyte subset distribution should be interpreted within the broader inflammatory context that accompanies advanced carotid atherosclerosis.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13608980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potentially Inappropriate Medication Use in Older Adults in Primary Care According to Four Explicit Criteria: Associations with Patient Factors.","authors":"Mihaela Paraschiv, Alexandru Vasincu, Răzvan-Nicolae Rusu, Oana Irina Gavril, Bogdan Andrei Trandabăț, Andrei Ciobîcă, Veronica Bild","doi":"10.3390/medicina62091813","DOIUrl":"10.3390/medicina62091813","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Potentially inappropriate medication (PIM) use is associated with adverse clinical outcomes in older adults. Several explicit screening tools are available for identifying PIMs, but Romanian data regarding the application of updated criteria remain limited. This study aimed to assess PIM identification according to the STOPP v3, Beers, EU(7)-PIM criteria and PRISCUS v2, to compare PIM counts and PIM presence across criteria, and to explore associations between PIM counts and selected patient characteristics. <i>Materials and Methods</i>: A retrospective observational study with a cross-sectional design was conducted in a single family medicine practice in Iasi, Romania, including 100 patients aged ≥ 65 years with at least one chronic condition and receiving at least two medications. Medications documented between January and June 2024 were assessed using the four explicit PIM criteria. One-way ANOVA with Bonferroni correction, repeated-measures ANOVA, agreement analyses, and Poisson regression models were used to examine differences between criteria and associations with patient characteristics, multimorbidity, and medication burden. <i>Results</i>: Mean PIM counts ranged from 0.75 for PRISCUS to 1.31 for STOPP. At least one PIM was identified in 73% of participants according to STOPP, 62% according to Beers, 60% according to EU(7)-PIM, and 53% according to PRISCUS. STOPP identified significantly more PIMs than each of the other three criteria (<i>p</i> < 0.001), while pairwise kappa coefficients ranged from 0.506 to 0.777. Among the 16 one-way ANOVA comparisons, only the association between obesity and EU(7)-PIM counts remained significant after Bonferroni correction (<i>p</i> < 0.001). In adjusted Poisson models, medication burden was associated with PIM counts according to STOPP (<i>p</i> < 0.001), Beers (<i>p</i> = 0.016), and EU(7)-PIM (<i>p</i> = 0.018). Obesity remained associated with EU(7)-PIM counts (<i>p</i> = 0.001), multimorbidity with STOPP PIM counts (<i>p</i> = 0.049), and sex with PRISCUS PIM counts (<i>p</i> = 0.030). Age, type 2 diabetes mellitus, and dyslipidemia were not independently associated with PIM counts. <i>Conclusions</i>: PIM identification varied according to the explicit criteria applied, with STOPP identifying the highest mean PIM count. Medication burden was the factor most consistently associated with PIM counts in adjusted analyses, while other patient characteristics showed criterion-specific associations. Given the small sample, single-practice setting, and non-probability sampling approach, these findings should be considered exploratory and require confirmation in larger, multicenter primary care studies.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Meiotic Spindle, Mechanisms of Chromosome Segregation and Aneuploidy in Aging Human Oocytes: An Update Review.","authors":"Romualdo Sciorio, Gyongyver Teglas, Luca Tramontano, Laszlo Nanassy, Laura Girardi, Steven Fleming","doi":"10.3390/medicina62091810","DOIUrl":"10.3390/medicina62091810","url":null,"abstract":"<p><p>The meiotic spindle is essential for accurate chromosome segregation during oocyte maturation and fertilization, and its alteration might be considered a major contributor to age-related aneuploidy and reproductive failure. Spindle formation is inherently vulnerable to errors and contributes to the unusually high frequency of chromosome segregation defects observed in human eggs. Human oocytes are particularly prone to aneuploidy; the presence of an abnormal chromosome number, which represents one of the leading causes of infertility, recurrent pregnancy loss, implantation failure, and congenital disorders in neonates. Previous studies have reported a U-shaped relationship between maternal age and aneuploidy rates, with relatively higher rates observed in both very young females and in women of advanced maternal age. Conversely, aneuploidy rates appear comparatively lower during the intervening reproductive-age period, particularly between approximately 25 and 35 years of age. Because most aneuploid embryos fail to develop successfully after fertilization, chromosome segregation errors in oocytes have profound consequences for female reproductive success. Aneuploidy primarily arises from defects during meiotic chromosome segregation. Faithful chromosome segregation depends on the accurate assembly and function of the meiotic spindle, a dynamic microtubule-based structure that aligns and separates homologous chromosomes during meiosis I and sister chromatids during meiosis II. Growing evidence indicates that chromosome mis-segregation results from the combined effects of impaired sister chromatid cohesion, altered kinetochore architecture, defective microtubule dynamics, weakened spindle assembly checkpoint activity, and age-related metabolic decline. Together, these defects compromise spindle integrity and reduce the fidelity of chromosome separation. Furthermore, the intrinsic instability of the acentrosomal spindle increases the likelihood of incorrect microtubule-kinetochore attachments, a defect that becomes more prevalent with maternal aging due to progressive deterioration of chromosome organization and kinetochore function. This review summarizes the current understanding of the molecular mechanisms regulating meiotic spindle assembly and function in human oocytes and examines how their disruption contributes to chromosome segregation errors and embryonic aneuploidy. We discuss the interplay between spindle abnormalities and upstream cellular defects, distinguish meiotic from post-zygotic origins of chromosomal abnormalities, and evaluate the clinical significance of spindle assessment in assisted reproductive technologies. Finally, we critically examine emerging strategies aimed at preserving chromosome segregation fidelity, including approaches targeting mitochondrial function and spindle regulation, while distinguishing interventions supported by mechanistic evidence from those that remain preclinical or speculative.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behavioral and Psychosocial Effects of Participant-Visible Continuous Glucose Monitoring in Adults Without Diabetes: A Systematic Review.","authors":"Hima Bindu Makkena, Yasaswini Nimmagadda, Navya Boinapelly, Anju George, Nagasravani Daruvuri, Ramesh Raj Sunar, Srinayani Guda","doi":"10.3390/medicina62091814","DOIUrl":"10.3390/medicina62091814","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Continuous glucose monitoring (CGM) is increasingly used beyond diabetes care, but whether participant-visible feedback changes behavior or psychosocial outcomes in adults without diabetes remains uncertain. We evaluated dietary behavior/adherence, physical activity, psychosocial outcomes, and device burden. <i>Materials and Methods</i>: This PROSPERO-registered systematic review (CRD420261356163) searched seven bibliographic databases and two trial registries, followed by citation searching. Randomized and nonrandomized intervention studies and qualitative/mixed-methods evidence were eligible. RoB 2, ROBINS-I, MMAT 2018, and GRADE were applied. Clinical and methodological heterogeneity precluded meta-analysis. <i>Results</i>: Searches yielded 6265 database/registry records; 2627 unique records were screened. Citation searching added 431 new records and two eligible studies, giving 12 studies. Two randomized dietary comparisons suggested selected improvements; one 8-week trial comparing CGM plus low-glycemic-index/load education with education alone reported between-group reductions in carbohydrate intake (-15.2 g; 95% CI -20.9 to -9.5), glycemic index (-10.0; 95% CI -13.1 to -6.9), and glycemic load (-19.9; 95% CI -29.0 to -10.7). Physical activity showed no clear difference (-28.5 MET-min/week; 95% CI -171.9 to 114.8). Psychosocial evidence was insufficient to establish benefit or exclude harm; device burden evidence was sparse. Certainty was low for dietary outcomes and very low for the other domains. <i>Conclusions</i>: Participant-visible CGM may support selected dietary changes as a biofeedback adjunct within structured education or lifestyle interventions, but large, durable benefits and stand-alone efficacy are not established.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lower Admission CALLY Index Is Associated with Contrast-Associated Acute Kidney Injury in Patients with STEMI Undergoing Primary PCI.","authors":"Emre Eynel, Direnç Yılmaz, Arslan Nyyazov, Eren Eynel, Ibrahim Kocayiğit, Muhammed Necati Murat Aksoy","doi":"10.3390/medicina62091811","DOIUrl":"10.3390/medicina62091811","url":null,"abstract":"<p><p><i>Background and Objectives</i>: The C-reactive protein-albumin-lymphocyte (CALLY) index integrates inflammatory, nutritional, and immune information, but its relationship with contrast-associated acute kidney injury (CA-AKI) in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) remains uncertain. This study evaluated the association between admission CALLY and CA-AKI and compared its discriminatory performance with other inflammatory indices. <i>Materials and Methods</i>: This retrospective, single-center cohort included 903 patients with STEMI who underwent primary PCI between January 2018 and December 2024. CA-AKI was defined as an increase in serum creatinine of ≥0.3 mg/dL or ≥1.5-fold from baseline within 48-72 h after contrast exposure. Multivariable logistic regression assessed the independent association between CALLY and CA-AKI. Receiver operating characteristic analyses compared CALLY with the C-reactive protein-to-albumin ratio (CAR), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII). <i>Results</i>: CA-AKI occurred in 139 patients (15.4%). Median CALLY was lower in patients with than without CA-AKI (0.635 [IQR, 0.193-1.529] vs. 1.536 [IQR, 0.891-2.356]; <i>p</i> < 0.001). Each 50% decrease in CALLY was independently associated with higher odds of CA-AKI (adjusted OR, 1.587; 95% CI, 1.367-1.843; <i>p</i> < 0.001). CALLY yielded an AUC of 0.734 (95% CI, 0.683-0.782). Its discrimination was greater than that of CRP, NLR, and SII but was not significantly different from that of CAR (AUC, 0.707; DeLong <i>p</i> = 0.163). <i>Conclusions</i>: Lower admission CALLY was independently associated with CA-AKI and showed moderate discriminatory ability. Prospective multicenter studies are needed to validate these findings and establish clinical utility.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}