Medicina (Kaunas, Lithuania)最新文献

{"title":"Intralesional Epidermal Growth Factor and Its Association with Reamputation and Level-Up Amputation in Diabetic Foot Patients with Post-Amputation Flap Necrosis: Clinical Outcomes and Macrophage Dynamics.","authors":"Ali Murat Basak, Kubra Canarslan Demir, Adile Begum Bahcecioglu, Munire Kubra Ozgok Kangal, Yasin Hatipoglu, Hamdullah Yanik, Omer Levent Karadamar, Yasin Gulap, Mehmet Mert Hidiroglu, Simay Akyuz, Kerim Bora Yilmaz","doi":"10.3390/medicina62091800","DOIUrl":"10.3390/medicina62091800","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Post-amputation flap necrosis in diabetic foot patients is associated with a high risk of reamputation, level-up amputation, and limb loss. Intralesional epidermal growth factor (iEGF) has been shown to promote wound healing in diabetic foot ulcers; however, its role in the management of post-amputation tissue defects and flap necrosis remains unclear. This study aimed to evaluate the association between iEGF use and clinical outcomes in diabetic foot patients with post-amputation flap necrosis and to characterize longitudinal changes in wound macrophage-associated cell populations. <i>Materials and Methods</i>: This single-center observational cohort study, with retrospective identification of eligible patients and longitudinal follow-up, included 164 diabetic foot patients who developed flap necrosis, wound-healing disorders, or tissue defects following transmetatarsal, Lisfranc, Chopart, or below-knee amputations. Eighty-four patients received an iEGF-containing multidisciplinary limb-salvage strategy, while 80 patients received a multidisciplinary limb-salvage strategy without iEGF. The primary endpoint was treatment success, defined as preservation of the original amputation level without reamputation or proximal level-up amputation, together with satisfactory wound healing at the last available clinical follow-up. Secondary endpoints included mortality during follow-up and, in a flow cytometry sub-study of 12 iEGF-treated patients with available paired wound samples, changes in CD38<sup>+</sup> and CD209<sup>+</sup> cell proportions within the CD45<sup>+</sup>CD14<sup>+</sup> macrophage-enriched population in paired wound-tissue samples. <i>Results</i>: Overall treatment success was 68.3% (112/164), and the observed crude cumulative mortality proportion was 21.3% (35/164). Treatment success was higher in the iEGF group than in the control group (95.2% [80/84] vs. 40.0% [32/80], <i>p</i> < 0.001), whereas the observed crude cumulative mortality proportion was lower (2.4% [2/84] vs. 41.3% [33/80], <i>p</i> < 0.001). In the flow-cytometry sub-study (<i>n</i> = 12), CD38<sup>+</sup> cell proportions within the CD45<sup>+</sup>CD14<sup>+</sup> macrophage-enriched population increased from 10.8% to 20.3%, whereas CD209<sup>+</sup> cell proportions increased from 14.5% to 25.7% in paired samples collected before and after the iEGF treatment cycle (both <i>p</i> < 0.001). <i>Conclusions</i>: In this observational cohort of high-risk diabetic foot patients with post-amputation flap necrosis, wound-healing disorders, or tissue defects, iEGF administered as part of a multidisciplinary limb-salvage strategy was associated with higher treatment success, while a lower crude cumulative mortality proportion was also observed in the iEGF group. The mortality difference represents a crude cumulative comparison and should not be interpreted as evidence of a time-adjusted or treatment-associated survival benefit. Given t","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067254","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":"Psoriasis and Chronic Viral Infections (HIV, HBV, and HCV): Therapeutic Approach and Safety.","authors":"Gustavo Almeida-Silva, Diogo Couto-Sousa, Inês Tribolet-Abreu, Filipe Monteiro, João Ferreira, Joana Antunes, Paulo Filipe","doi":"10.3390/medicina62091796","DOIUrl":"10.3390/medicina62091796","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Psoriasis is a chronic immune-mediated inflammatory disease that often requires long-term systemic therapy. Coexisting human immunodeficiency virus (HIV), hepatitis B virus (HBV), or hepatitis C virus (HCV) infection complicates treatment selection because clinicians must balance control of skin and joint inflammation against risks of opportunistic infection, viral replication or reactivation, hepatotoxicity, and drug interactions. <i>Materials and Methods</i>: This narrative review summarizes evidence from guidelines, systematic reviews, cohort studies, case series, expert recommendations, and regulatory sources. <i>Results</i>: In patients with suppressed HIV RNA, stable or reconstituted CD4 counts, no active opportunistic infection, and reliable follow-up, selected systemic agents, including biologics, may be considered after individualized risk assessment. In HBV infection, reactivation prevention through antiviral prophylaxis or close monitoring is central. In HCV infection, fibrosis stage, active hepatitis, drug interactions, and timing of direct-acting antivirals should guide management. <i>Conclusions</i>: Chronic viral infection should not be regarded as an absolute barrier to modern psoriasis therapy.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067196","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":"Prospective Evaluation of Peripheral Arterial Intervention Using Air Plethysmography.","authors":"Anastasios G Potouridis, Dimitrios A Chatzelas, Apostolos G Pitoulias, Maria D Velikoudi, Georgios A Pitoulias","doi":"10.3390/medicina62091795","DOIUrl":"10.3390/medicina62091795","url":null,"abstract":"<p><p><i>Background and Objectives:</i> Air plethysmography (APG), also referred to as pulse volume recording, provides a physiological assessment of lower-extremity perfusion, but its role in contemporary surveillance after peripheral arterial revascularization remains uncertain. This prospective study aimed to evaluate the ability of APG to monitor hemodynamic recovery and predict procedural failure after open and endovascular interventions. <i>Materials and Methods:</i> Consecutive patients undergoing infrainguinal revascularization for symptomatic peripheral arterial disease were prospectively enrolled and followed for 24 months. Standardized clinical assessment, ankle-brachial index, Duplex ultrasonography, and APG were performed preoperatively and at 1, 6, 12, and 24 months. Longitudinal hemodynamic changes, diagnostic accuracy for restenosis, patency, and predictors of procedural failure were analyzed. <i>Results:</i> A total of 120 patients were included, of whom 108 (90.0%) completed a 24-month follow-up. Mean pulse volume amplitude increased from 5.8 ± 2.3 mm preoperatively to 14.6 ± 4.1 mm at one month (<i>p</i> < 0.001) and remained significantly improved throughout follow-up. Systolic upstroke time decreased from 192 ± 31 to 128 ± 24 ms (<i>p</i> < 0.001), while waveform morphology also improved substantially. Longitudinal analysis demonstrated a significant effect of time (<i>p</i> < 0.001) and group-by-time interaction (<i>p</i> = 0.031). Among secondary outcomes, APG deterioration preceded fulfillment of the predefined Duplex criteria for significant restenosis in 26 of 34 failures, with a mean observed interval of 3.8 ± 1.2 months. A ≥25% reduction in pulse volume amplitude showed good discrimination for restenosis, while APG deterioration was independently associated with procedural failure (HR = 2.80, 95% CI 1.65-5.37; <i>p</i> < 0.001). <i>Conclusions:</i> APG is a reproducible, non-invasive surveillance adjunct that objectively reflects hemodynamic recovery and may identify physiological deterioration before fulfillment of predefined Duplex criteria for significant restenosis. These findings support further evaluation of APG as a complementary physiological modality within structured surveillance following lower-extremity revascularization.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067221","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":"Combined Antegrade-Retrograde Cardioplegia for Myocardial Protection During Coronary Artery Bypass Grafting in Patients with Left Main Coronary Artery Disease: The CARDIOPROTECT-LMCAD Randomised Trial.","authors":"Jelena Lesanovic, Milan Milojevic, Djordje Nikolic, Ivan Soldatovic, Dragana Unic-Stojanovic, Igor Zivkovic, Miroslav Milicic, Petar Vukovic, Ivana Petrovic, Sinisa Jagodic, Milovan Bojic, Slobodan Micovic","doi":"10.3390/medicina62091799","DOIUrl":"10.3390/medicina62091799","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Myocardial protection during on-pump coronary artery bypass grafting (CABG) limits ischaemic injury, particularly in patients with left main coronary artery disease (LMCAD), in whom severe proximal stenosis may compromise antegrade cardioplegia delivery. We investigated whether combined antegrade-retrograde blood cardioplegia reduces postoperative high-sensitivity cardiac troponin I (hs-cTnI) concentrations, a marker of perioperative myocardial injury. <i>Materials and Methods</i>: We conducted a prospective, single-centre, randomised trial involving 60 adults undergoing elective isolated on-pump CABG for significant LMCAD. Patients were assigned (1:1) to antegrade-only or combined antegrade-retrograde blood cardioplegia. Cardiac biomarkers were measured after induction and at 4, 12, 24, and 48 h after ICU admission. The primary endpoint was peak hs-cTnI within 48 h; key secondary endpoints included the hs-cTnI area under the concentration-time curve, CK-MB, immediate myocardial electrical recovery and 30-day outcomes. <i>Results</i>: All patients received the assigned cardioplegia strategy, with no crossover. Peak hs-cTnI did not differ significantly between the antegrade-only and combined groups (median 529.1 [IQR 829.9] vs. 394.1 [503.4] ng/L; <i>p</i> = 0.21), nor did the hs-cTnI area under the concentration-time curve from 4 to 48 h (12,910.6 [23,127.4] vs. 8112.2 [11,686.2] ng·h/L; <i>p</i> = 0.16). Serial hs-cTnI, CK-MB, total creatine kinase, serum creatinine, immediate myocardial electrical recovery, and 30-day outcomes also did not differ significantly. No deaths, coronary sinus injuries, or other cardioplegia-related complications occurred. <i>Conclusions</i>: In patients undergoing isolated on-pump CABG for significant LMCAD, combined antegrade-retrograde blood cardioplegia did not significantly decrease peak hs-cTnI levels compared to the antegrade-only method. The combined approach was feasible with no cardioplegia-related complications, suggesting that an individualised strategy may be preferable to a routine one. Larger prospective studies are needed to determine whether higher-risk patients may derive greater benefit.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066726","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":"Hemoglobin-to-Red Cell Distribution Width Ratio Independently Predicts Survival in Non-Metastatic Gastric Cancer: A Retrospective Cohort Study.","authors":"Sevgi Bilmez Altay, İlker Nihat Ökten, Çağlar Köseoğlu, Ertürk Yiğit, Mehmet Uzun, Oğuzhan Kesen","doi":"10.3390/medicina62091797","DOIUrl":"10.3390/medicina62091797","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Gastric cancer is one of the most common malignancies worldwide and continues to be associated with high mortality. The hemoglobin-to-red cell distribution width (HGB/RDW) ratio has emerged as a promising hematological prognostic biomarker in various cancers. However, its prognostic significance in patients with curative-intent resection of non-metastatic gastric cancer remains insufficiently investigated. This study aimed to evaluate the association between the pretreatment HGB/RDW ratio and progression-free survival (PFS) as well as overall survival (OS) in patients with non-metastatic gastric cancer. <i>Materials and Methods</i>: In this multicenter study, a total of 175 patients with non-metastatic gastric cancer who received perioperative FLOT chemotherapy (four preoperative and four postoperative cycles) and underwent curative-intent surgical resection were retrospectively analyzed. A cut-off value for the HGB/RDW ratio was calculated using receiver operating characteristic (ROC) curve analysis. Survival outcomes, including progression-free survival (PFS) and overall survival (OS), were analyzed using the Kaplan-Meier method. Multivariate Cox proportional hazards regression analysis was performed to identify independent prognostic factors. <i>Results</i>: Patients with an HGB/RDW ratio > 0.85 demonstrated significantly superior 2-year and 5-year OS rates (76.2% vs. 59.6% and 51.6% vs. 27.7%, respectively; <i>p</i> = 0.003) and PFS rates (69.4% vs. 49.6% and 53.7% vs. 36.4%, respectively; <i>p</i> = 0.047) compared to those with HGB/RDW ≤ 0.85. Multivariate analysis identified HGB/RDW ≤ 0.85 as an independent predictor of both increased mortality risk (HR: 1.88, 95% CI: 1.16-3.06; <i>p</i> = 0.011) and disease progression risk (HR: 1.79, 95% CI: 1.18-2.72; <i>p</i> = 0.006). <i>Conclusions</i>: The pretreatment HGB/RDW ratio is an independent prognostic factor for OS and PFS in patients with curative-intent resection of non-metastatic gastric cancer and may be considered a practical marker that could contribute to treatment planning in this patient population.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067156","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":"Nasal Cavity Dimensions and Pharyngeal Airway Space in Simple Snoring: A Cross-Sectional CT-Based Study.","authors":"Jeong-Whun Kim, Sung-Woo Cho, Hyun Jung Kim","doi":"10.3390/medicina62091798","DOIUrl":"10.3390/medicina62091798","url":null,"abstract":"<p><p><i>Background and Objectives:</i> The anatomical relationship between nasal cavity dimensions and the pharyngeal airway space (PAS) in simple snoring remains poorly defined. We investigated the association between nasal cavity dimensions and the PAS in adults with simple snoring using computed tomography (CT), focusing on anatomical correlations. <i>Materials and Methods</i>: This cross-sectional study included 83 adults with simple snoring and nasal obstruction and a confirmed apnea-hypopnea index (AHI) < 2, enrolled between 2007 and 2022. Polysomnography and CT were performed to measure nasal and pharyngeal airway dimensions. The minimum cross-sectional areas (mCSAs) of three nasal cavity segments and pharyngeal airway dimensions were measured on awake CT images. Multivariable linear regression, adjusted for age, sex, and BMI, was used to evaluate the association between the nasal and pharyngeal airway dimensions. <i>Results:</i> A larger bilateral narrowest nasal cross-sectional area was significantly associated with a larger PAS mCSA in the full cohort (standardized β = 0.26, <i>p</i> = 0.012), after adjustment for age, sex, and BMI. A 10-mm² larger nasal area corresponded to a 3.6% larger PAS mCSA (95% CI, 0.8-6.5%), and the model explained a modest share of the variance (adjusted R² = 0.17). The association did not differ by sex (interaction <i>p</i> = 0.25), indicating no evidence of effect modification. <i>Conclusions:</i> In individuals with simple snoring, smaller nasal cavity dimensions were associated with a narrower PAS on static CT imaging, although this association was modest and explained only a small fraction of the variation in pharyngeal calibre. These findings reflect anatomical associations and should not be interpreted as evidence of functional airway collapse or disease progression.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609348/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067158","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":"Retzius-Sparing Robot-Assisted Radical Prostatectomy: Analysis of Functional and Oncological Outcomes.","authors":"Fırat Akdeniz, Sıtkı Ün, Uğur Boylu, Aylin Köseler","doi":"10.3390/medicina62091792","DOIUrl":"10.3390/medicina62091792","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) has emerged as an alternative surgical approach designed to preserve pelvic anatomical structures involved in urinary continence. This study aimed to evaluate the perioperative, pathological, functional, and early postoperative oncological findings of RS-RARP in patients with clinically localized prostate cancer. <i>Materials and Methods</i>: This retrospective single-cohort study included 132 consecutive patients who underwent RS-RARP at a single institution between January 2017 and February 2020. Demographic, perioperative, pathological, functional, and postoperative oncological data were retrospectively collected. The primary functional outcome was postoperative urinary continence recovery. Pathological outcomes included final ISUP Grade Group and positive surgical margin status, while postoperative prostate-specific antigen (PSA) measurements and treatment-related oncological follow-up data were evaluated where available. <i>Results</i>: The median operative time was 170 min (IQR, 160-200), and the median estimated blood loss was 100 mL (IQR, 70-150). Blood transfusion was required in one patient (0.8%), and no Clavien-Dindo grade ≥ III complications were observed. Final pathological examination demonstrated ISUP Grade Group 2 disease in 64.9% of patients, and the overall positive surgical margin rate was 33.6%. The median time to both social continence (0-1 pad/day) and complete continence (0 pad/day) was 30 days. Among 130 patients with available current pad-use data, 108 (83.1%) were completely pad-free, 13 (10.0%) required one safety pad per day, and 9 (6.9%) required two or more pads per day. The median oncological follow-up was 12 months. Follow-up data were available for 131 patients; postoperative PSA measurements were available for 79 patients and last PSA measurements for 122 patients. No salvage therapy or biochemical recurrence was documented in the available clinical records. However, incomplete longitudinal PSA data precluded reliable assessment of biochemical recurrence-free survival. <i>Conclusions</i>: In this retrospective single-cohort study, RS-RARP was associated with low perioperative morbidity, acceptable pathological outcomes, and favorable early urinary continence recovery. However, the absence of a conventional RARP comparator group, the relatively short follow-up period, and incomplete longitudinal PSA and recurrence-related data preclude conclusions regarding comparative effectiveness and long-term oncological efficacy. Prospective multicenter comparative studies with standardized functional assessment, systematic PSA monitoring, and longer oncological follow-up are warranted.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067213","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":"Ultrasound Sliding Sign Assessed by Transvaginal or Transrectal Route for Predicting Complete Pouch of Douglas Obliteration in Patients with Ovarian Endometriomas: An Exploratory Retrospective Study.","authors":"Dong Liu, Huanli He, Yuebo Yang, Qingjian Ye","doi":"10.3390/medicina62091791","DOIUrl":"10.3390/medicina62091791","url":null,"abstract":"<p><p><i>Background and Objective</i>: The ultrasound sliding sign dynamically assesses pouch of Douglas (POD) obliteration in suspected endometriosis. Transvaginal (TVS) and transrectal (TRS) ultrasound are used in patients with and without a self-reported history of vaginal intercourse, respectively, and thus in clinically distinct populations. We evaluated sliding sign performance for predicting surgically confirmed complete POD obliteration in patients with ovarian endometriomas and described findings in route-defined TVS and TRS groups. <i>Materials and Methods</i>: This retrospective cohort study enrolled 318 patients with surgically and pathologically confirmed ovarian endometriomas; intraoperative POD status was evaluable in 309. Patients with and without a self-reported history of vaginal intercourse underwent TVS (n = 247) and TRS (n = 71), respectively. A negative sliding sign (absent movement between the uterus and rectum) was the positive index test result for complete POD obliteration. The unadjusted full-cohort diagnostic accuracy analysis was the primary analysis. Because no parous patient underwent TRS (a lack of overlap in examination-route assignment among parous patients), exploratory adjusted analyses were restricted to nulliparous patients, using overlap weighting (principal adjusted analysis) and 1:1 propensity score matching (sensitivity analysis). <i>Results</i>: In the primary unadjusted analysis of the full cohort (n = 309), the negative sliding sign showed limited to moderate discriminative ability (sensitivity 0.71, 95% CI 0.63-0.78; specificity 0.60, 95% CI 0.52-0.67; PLR 1.78, 95% CI 1.44-2.20; NLR 0.48, 95% CI 0.36-0.64) and was associated with complete POD obliteration (<i>p</i> < 0.001). The between-route sensitivity difference was inconclusive (0.19, 95% CI -0.01 to 0.38). In the exploratory overlap-weighted analysis of nulliparous patients (n = 217), the association remained significant (weighted OR = 2.80, 95% CI 1.17-6.69; <i>p</i> = 0.021), without significant sliding sign-by-route interaction (<i>p</i> = 0.302); findings were consistent in the matching sensitivity analysis (66 pairs). <i>Conclusions</i>: The sliding sign was associated with surgically confirmed complete POD obliteration in patients with ovarian endometriomas, but evidence that this association differed between route-defined groups was inconclusive. Route-specific findings are exploratory because the examination route was determined by sexual history rather than randomization. Whether TRS offers performance comparable to TVS remains undetermined, because the two techniques were not evaluated in the same population and TRS feasibility was not formally assessed.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067203","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":"Patterns of Care in the Final Week of Life: A Comparative Analysis of Aggressive Treatment Versus Comfort-Centered Care Across Healthcare Settings.","authors":"Camelia Ancuta, Nicoleta Mitrea, Mariana Sporis, Flavia Hurducas, Daniela Mosoiu","doi":"10.3390/medicina62091793","DOIUrl":"10.3390/medicina62091793","url":null,"abstract":"<p><p><i>Background and Objectives</i>: End-of-life care in oncology demands a holistic, multidisciplinary framework that pivots clinical priorities from disease-directed therapies toward symptom optimization, comfort, and patient dignity. Within this context, the present study investigated care delivery patterns among advanced cancer patients during their final week of life. <i>Materials and Methods</i>: A retrospective medical record review was conducted, comparing an oncology ward, an intensive care unit, an inpatient palliative unit, and a home-based palliative care setting. We analyzed aggressive interventions, end-of-life care pathways, symptom management, medication use and rationalization, and transitions between care settings. <i>Results</i>: Among the 306 patients studied, diagnostic testing and artificial hydration were universally administered in the oncology and intensive care unit (<i>p</i> < 0.001), where prescriptions focused primarily on pain management. Conversely, palliative care settings addressed a wider range of terminal symptoms. The rationalization of non-essential medications took place between 1.8 and 2.9 days before death, varying significantly across medication classes and clinical settings (<i>p</i> < 0.001). Additionally, intensive care unit admissions were more prevalent among patients with advanced cancer, while home-based patients underwent the greatest number of care transitions. <i>Conclusions</i>: These findings highlight substantial differences in care across settings, emphasizing the need for coordinated planning, continuity, and patient-centered approaches to ensure comfort and dignity in the final week of life.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067209","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":"Individualizing Perioperative Analgesia: Patient-Specific Determinants of Postoperative Pain and Opioid-Related Outcomes.","authors":"Sarah Kazemeini, Ryan Shih, Sunny Zhang, Raphael Cohen, Nathaniel LaBarre, Moonis Ghani, George Tsao","doi":"10.3390/medicina62091789","DOIUrl":"10.3390/medicina62091789","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Postoperative pain and opioid requirements can vary widely, even among patients undergoing similar procedures. This narrative review examines how biological sex, age, frailty, chronic pain, preoperative opioid exposure, and psychological factors may affect postoperative pain, opioid response, and recovery. <i>Materials and Methods</i>: PubMed and Google Scholar were searched from database inception through 18 June 2026. Relevant systematic reviews, meta-analyses, clinical guidelines, randomized trials, and observational studies involving adult surgical patients were included, with a focus on postoperative pain, opioid use, adverse effects, persistent pain, and functional recovery. Human perioperative evidence was prioritized, while experimental and preclinical evidence was used selectively to explain relevant biological mechanisms. <i>Results</i>: The available evidence was heterogeneous across patient populations, surgical procedures, analgesic techniques, and outcome definitions. No single patient characteristic consistently predicts postoperative pain or opioid requirements. Female sex is associated with a greater risk of postoperative nausea and vomiting, but reported differences in pain and opioid efficacy are inconsistent. Older and frail patients may be more susceptible to sedation, respiratory depression, delirium, and other opioid-related adverse effects. Patients with chronic pain or prior opioid exposure often have more difficult postoperative pain control because of tolerance, dependence, or possible opioid-induced hyperalgesia. Anxiety, depression, and pain catastrophizing may also contribute to greater pain and poorer recovery, although their relationship with opioid consumption is less consistent. <i>Conclusions</i>: Perioperative analgesia should be based on the patient's overall clinical picture rather than any single risk factor. The proposed framework is conceptual and has not been clinically validated. Considering these characteristics together may help clinicians select appropriate multimodal treatments, anticipate analgesic needs, monitor for adverse effects, and support recovery.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067162","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}