Medicina (Kaunas, Lithuania)最新文献

{"title":"Vitamin D Deficiency in Hip Fracture Patients: Outcome-Specific Associations and Post-Fracture Management-A Narrative Review.","authors":"Hannah Lee, Jaehee Lee, Yejun Lee, Suk-Kyoon Song","doi":"10.3390/medicina62091794","DOIUrl":"10.3390/medicina62091794","url":null,"abstract":"<p><p><i>Background and Objectives:</i> Vitamin D deficiency is common in older adults with hip fracture and has been associated with adverse postoperative outcomes. However, heterogeneity in deficiency thresholds, outcome definitions, and patient populations has complicated the interpretation and clinical application of existing evidence. This narrative review aimed to summarize current evidence regarding perioperative vitamin D status, its associations with postoperative complications, mortality, functional recovery, and secondary fracture, and the role of vitamin D supplementation after hip fracture. <i>Materials and Methods:</i> Relevant studies were identified through PubMed searches and manual screening of reference lists. Cohort studies, randomized controlled trials, systematic reviews, meta-analyses, and clinical guidelines addressing vitamin D status, supplementation, hip fracture outcomes, fracture prevention, or postoperative recovery in older adults were narratively synthesized. <i>Results:</i> Low serum 25-hydroxyvitamin D was associated with selected early medical complications, mortality, impaired functional recovery, and secondary hip fracture, although these associations varied across outcomes. The strongest prognostic associations with mobility were observed in patients with severe deficiency (approximately ≤10-12 ng/mL), whereas mild insufficiency showed less consistent associations. Heterogeneity among studies reflected differences in deficiency thresholds, sampling timing, outcome definitions, follow-up duration, study populations, and adjustment for frailty and comorbidity. Vitamin D supplementation consistently increased serum 25-hydroxyvitamin D concentrations but did not consistently improve gait, postoperative complications, mortality, or recurrent fracture. Favorable outcomes reported with exercise- and nutrition-based multimodal interventions could not be attributed to vitamin D supplementation alone. <i>Conclusions:</i> Vitamin D deficiency should be interpreted within the broader context of frailty, nutritional status, muscle function, and skeletal health after hip fracture. Vitamin D assessment and correction should be integrated into comprehensive post-fracture care alongside osteoporosis treatment, adequate calcium and protein intake, rehabilitation, and fall prevention. However, clinical benefits of supplementation beyond correction of deficiency remain uncertain, and future studies should focus on patients with severe deficiency and clinically meaningful, patient-centered outcomes.</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/PMC13609279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067266","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":"Augmented Reality, Mixed Reality, Computer Vision, and Three-Dimensional Modeling in Fertility-Preserving Minimally Invasive Gynecologic Surgery: A Scoping Review with Narrative Synthesis.","authors":"Eleni Karatrasoglou, Alexandros Rodolakis, Themistoklis Grigoriadis, Athanasios Protopapas","doi":"10.3390/medicina62091790","DOIUrl":"10.3390/medicina62091790","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Augmented reality (AR), mixed reality (MR), computer vision, artificial intelligence (AI), and three-dimensional (3D) modeling may be particularly relevant in fertility-preserving gynecologic surgery, where disease must be treated while uterine architecture, reproductive anatomy, and future fertility potential are preserved. This scoping review mapped and appraised the current evidence, with emphasis on myomectomy, adenomyomectomy, and endometriosis surgery. <i>Materials and Methods</i>: A scoping review with narrative synthesis was conducted and reported according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR). PubMed/MEDLINE, Scopus, and Google Scholar were searched from database inception to 16 May 2026. Records were appraised with design-appropriate instruments: Joanna Briggs Institute (JBI) principles, Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I), randomized-trial risk-of-bias domains, and structured feasibility criteria. <i>Results</i>: Of 528 records identified, 20 were included. Eleven involved application of the technology in the care of patients; of these, only two were comparative-one retrospective matched case-control study of AR-assisted myomectomy and adenomyomectomy, and one single-center randomized controlled trial of 3D-printed model-assisted myomectomy. The remaining nine were enabling technologies validated on image datasets, operative video, ex vivo models, or animal models. Only one study reported a reproductive outcome-pregnancy rates in a retrospective matched series of 34 patients, which did not differ between groups-and no study reported live birth, obstetric, or long-term reproductive-safety outcomes. <i>Conclusions</i>: Current evidence supports technical feasibility and preoperative planning value but does not demonstrate improvement in reproductive outcomes; here \"fertility-preserving\" denotes the clinical context of the surgery rather than a demonstrated reproductive benefit. Adequately powered controlled studies reporting fertility-relevant endpoints are required.</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/PMC13609672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066898","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":"Perioperative Hydrogen Inhalation and Postoperative Pain After Endoscopic Discectomy: A Pilot Non-Randomized Clinical Study with Exploratory Murine Data.","authors":"Chao-Hsien Sung, Wen-Chin Ko, Chia-Chi Kung, Chi-Feng Hung","doi":"10.3390/medicina62091785","DOIUrl":"10.3390/medicina62091785","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Postoperative pain after endoscopic discectomy may reflect acute surgical nociception superimposed on pre-existing radicular symptoms. Molecular hydrogen (H₂) has antioxidant and anti-inflammatory properties, but clinical evidence for perioperative analgesia is limited. We evaluated the association between perioperative H₂ inhalation and postoperative pain and analgesic requirements. <i>Materials and Methods</i>: This open-label, non-randomized pilot study enrolled 37 patients in two consecutive periods (H₂, <i>n</i> = 25; control, <i>n</i> = 12). Because original outcome records for 12 H₂-period participants could no longer be retrieved at the time of manuscript preparation, the complete-case clinical analysis included 25 source-verifiable participants (H₂, <i>n</i> = 13; control, <i>n</i> = 12). H₂ was delivered via nasal cannula as a 66.7% H₂/33.3% O₂ source gas at 2 L/min (estimated inspired H₂ approximately 4%). Pain was evaluated with a numerical rating scale (NRS) preoperatively, at post-anesthesia care unit (PACU) arrival, at 1, 6, 12, and 24 h, and at 1 month. Longitudinal scores were analyzed using generalized estimating equations with Holm-adjusted comparisons. A parallel exploratory murine chronic constriction injury (CCI) experiment (<i>n</i> = 6/group) assessed mechanical allodynia over 14 days of daily H₂ inhalation. <i>Results</i>: The group-by-time interaction was significant (Wald χ²(6) = 56.68, <i>p</i> < 0.001). After Holm adjustment, pain scores were lower with H₂ at PACU arrival (difference, -3.21; adjusted <i>p</i> = 0.002), 1 h (-2.42; adjusted <i>p</i> = 0.004), and 1 month (-3.45; adjusted <i>p</i> < 0.001). Intraoperative fentanyl use and rescue analgesic use were also lower in the H₂ group; no adverse events were documented in the analyzed cohort. In the murine CCI experiment, H₂-treated mice showed higher ipsilateral paw withdrawal thresholds than air-exposed controls. <i>Conclusions</i>: Perioperative H₂ inhalation was associated with lower pain scores at selected time points and reduced analgesic requirements. These preliminary findings require confirmation in randomized trials. Trial registration: ClinicalTrials.gov NCT05476575.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067181","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":"Treatment Gaps in Women Aged 65 Years and Older with Stress or Stress-Predominant Mixed Urinary Incontinence: Age-Stratified Patterns of Active Therapy, Containment Use, Frailty, and Anxiety.","authors":"Doğucan Nuri Uğur, Kadir Böcü","doi":"10.3390/medicina62091778","DOIUrl":"10.3390/medicina62091778","url":null,"abstract":"<p><p><i>Background and Objectives:</i> Older women with stress or stress-predominant mixed urinary incontinence may rely on pads or diapers despite bothersome symptoms. We examined age-stratified treatment patterns and whether age remained associated with a treatment gap after accounting for frailty and symptom burden. <i>Materials and Methods:</i> This single-center observational study combined record review (December 2023-April 2026) with a questionnaire assessment (19 June-3 August 2026). Within the 65-74, 75-84, and ≥85-year strata, 185, 182, and 183 women were screened; after 25, 22, and 23 exclusions or incomplete assessments, respectively, 160 evaluable women remained in each stratum. The treatment gap required International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) score ≥ 8, daily pad/diaper use, pad/diaper-only management, and no active treatment in the previous 12 months. Frailty and anxiety were assessed with the fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale and Geriatric Anxiety Inventory. <i>Results:</i> Treatment-gap prevalence was 33.8%, 44.4%, and 55.0%. Supervised pelvic floor muscle training declined from 55.0% to 40.0% and 25.0%; recent active treatment from 50.0% to 35.0% and 20.0%; and previous continence surgery from 30.0% to 18.1% and 8.1%. After adjustment, age was not independently associated. Higher ICIQ-UI SF scores [adjusted odds ratio (aOR) 1.10 per point, 95% confidence interval (CI) 1.02-1.19] and stress-predominant mixed incontinence (aOR 1.53, 95% CI 1.03-2.25) remained associated. <i>Conclusions:</i> Containment dependence increased and active-treatment exposure decreased with age, but symptom burden and phenotype explained more adjusted risk than age. Regular reassessment may distinguish appropriate containment from remediable under-treatment.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067210","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":"Artificial Intelligence for Precision Antiarrhythmic Drug Therapy in Atrial Fibrillation: From Recurrence Prediction to Comparative Treatment Selection.","authors":"Alina Scridon, Vasile-Bogdan Halațiu, Dan-Alexandru Cozac","doi":"10.3390/medicina62091783","DOIUrl":"10.3390/medicina62091783","url":null,"abstract":"<p><p>Rhythm control therapy has an important role in atrial fibrillation (AF) management, and antiarrhythmic drugs (AADs) remain essential for pharmacological cardioversion, maintenance of sinus rhythm, reduction in AF burden, and treatment before or after catheter ablation. However, their efficacy varies substantially among patients, while proarrhythmia, organ toxicity, drug interactions, and treatment discontinuation frequently limit their use. Current drug selection therefore relies mainly on safety-based exclusion based on structural heart disease, ventricular function, coronary disease, renal or hepatic function, and baseline conduction and repolarization characteristics, rather than on individualized prediction of comparative therapeutic benefit. This narrative review examines the potential role of artificial intelligence (AI), machine learning (ML), computational electrophysiology, and cardiac digital twins across the AAD treatment pathway. Particular attention is given to patient selection, comparative drug choice, prediction of cardioversion success and sinus-rhythm maintenance, dose optimization, proarrhythmia assessment, extracardiac toxicity, and longitudinal safety surveillance. AI can potentially integrate clinical, electrocardiographic (ECG), imaging, wearable, genomic, and pharmacological data to estimate patient-specific efficacy and toxicity. ML models have already demonstrated the feasibility of predicting drug-induced QT prolongation from electronic health records and detecting ECG signatures associated with drug-induced arrhythmic risk. Moreover, patient-specific AF digital twins have been used to simulate electrophysiological responses to amiodarone and identify patients with different subsequent rhythm outcomes. Nevertheless, most available applications remain retrospective, single-center, non-comparative, or proof-of-concept, and few directly support selection among alternative AADs. Most are prognostic, estimate outcomes under observed care, or predict drug-specific toxicity; models that estimate outcomes under alternative AADs remain the essential missing element. AI-supported antiarrhythmic therapy represents a promising transition from population-based prescribing toward individualized estimation of efficacy, toxicity, and monitoring requirements. Its clinical adoption will require multicenter external validation, causal treatment-effect modeling, prospective workflow evaluation, randomized impact trials, transparent uncertainty reporting, and continued clinician oversight.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067047","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":"Current Diabetes Self-Management and the Number of Documented Complications in Adults with Type 2 Diabetes: A Cross-Sectional Study.","authors":"Paula-Alexandra Popovici, Andreea Diana Igna, Bianca-Lăcrimioara Petca, Timea Claudia Ghitea, Mihaela Simona Popoviciu","doi":"10.3390/medicina62091777","DOIUrl":"10.3390/medicina62091777","url":null,"abstract":"<p><p><i>Background and Objectives</i><i>:</i> Current self-management behavior may not reflect the long-term exposures that led to established complications in people with type 2 diabetes (T2D). To assess whether Diabetes Self-Management Questionnaire (DSMQ) scores were associated with the number of documented diabetes-related and cardiovascular conditions and whether the finding was robust to alternative outcome constructions. <i>Materials and Methods:</i> This single-center cross-sectional reanalysis included 262 adults with T2D. The DSMQ was re-calculated from item-level responses. The primary outcome was an unweighted count of seven database-recorded conditions. Spearman correlation and multivariable Poisson regression with HC3 robust standard errors were used. Sensitivity analyses excluded heart failure, separated microvascular and cardiovascular counts, and substituted estimated glomerular filtration rate <60 mL/min/1.73 m² for the recorded chronic kidney disease field. <i>Results:</i> Median DSMQ Sum Scale was 5.10 (IQR 3.13-7.08), and median condition count was 3 (IQR 2-3). No evidence of an unadjusted association was identified (ρ = -0.056; <i>p</i> = 0.368). In the adjusted model (<i>n</i> = 260), the DSMQ estimate was IRR 0.988 per point (95% CI 0.962-1.014; <i>p</i> = 0.355). The result remained nonsignificant after excluding heart failure (IRR 0.993; 95% CI 0.960-1.027), for the microvascular count (IRR 0.993; 95% CI 0.964-1.024), and for the cardiovascular count including heart failure (IRR 0.980; 95% CI 0.945-1.015). Pearson dispersion was 0.587, providing no evidence of overdispersion. <i>Conclusions:</i> No evidence of an association between current DSMQ-measured self-management and the number of recorded conditions was identified in this cohort. The result does not demonstrate equivalence and does not imply that sustained self-management is unrelated to long-term complication risk. In practice, contemporary DSMQ scores should guide cur-rent education and support needs, not be used as a proxy for historical com-plication exposure.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067063","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 Outcomes of Ultrasound-Guided Stellate Ganglion Block in Highly Treatment-Resistant Chronic Migraine: A 6-Month Prospective Single-Group Interventional Study.","authors":"Sukriye Dadali, Emel Basar, Ulku Sabuncu, Gulcin Babaoglu, Ali Costu, Erkan Yavuz Akcaboy","doi":"10.3390/medicina62091784","DOIUrl":"10.3390/medicina62091784","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Chronic migraine (CM) remains a major cause of neurological disability, and a subset of patients remains highly treatment-resistant despite previous preventive and interventional treatments. Stellate ganglion block (SGB) has been proposed as a sympathetic neuromodulatory intervention, but evidence in this population remains limited. This study evaluated 6-month clinical outcomes and tolerability after a structured ultrasound-guided SGB protocol. <i>Materials and Methods</i>: This prospective, single-center, uncontrolled, single-group interventional study enrolled 42 adults with CM who had experienced insufficient benefit from prior preventive migraine treatment and previous interventional headache procedures. After an initial ultrasound-guided SGB to assess anatomical suitability and procedural tolerability, all participants proceeded to four additional weekly ultrasound-guided SGB sessions using 5 mL of 1% lidocaine, for five protocol-defined sessions in total. The primary outcome was the change in monthly headache days (MHD) from baseline to 6 months. <i>Results</i>: All 42 participants (mean age: 44.4 ± 7.4 years) completed the 6-month follow-up. Median MHD decreased from 29.0 days at baseline to 6.0 days at 6 months (Kendall's W = 0.643, <i>p</i> < 0.001), corresponding to a median within-participant reduction of 17.0 days (BCa 95% CI: 13.0-19.0). A ≥50% reduction in MHD was achieved by 73.8% of participants (95% CI: 58.9-84.7) at 6 months, whereas 14.3% (95% CI: 6.7-27.8) achieved a ≥50% reduction in mean pain intensity. HIT-6 and MIDAS scores also improved significantly (<i>p</i> < 0.001). Six participants (14.3%) reported mild, self-limited adverse effects; no serious adverse events were documented. <i>Conclusions</i>: Ultrasound-guided SGB was associated with sustained reductions in headache frequency, analgesic use, and migraine-related disability over 6 months. Because this was an uncontrolled single-group study, the findings should be considered preliminary and hypothesis-generating. The frequency-dominant pattern of improvement and favorable tolerability support further controlled evaluation of SGB as a potential adjunctive neuromodulatory strategy in highly treatment-resistant CM.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067248","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":"Recurrence of Benign Vocal Fold Lesions: Risk Factors and an Exploratory Comparison of Cold-Instrument and CO₂ Laser Surgery in a Retrospective Cohort.","authors":"Alexandru Vlase, Octavian Dragos Palade, Dragoș Munteanu, Ionut Andrei Roman, Stefan Moscalu, Ana Doina Roxana, Andreea Rusescu, Ruxandra Oana Aliuș, Catalina Voiosu","doi":"10.3390/medicina62091779","DOIUrl":"10.3390/medicina62091779","url":null,"abstract":"<p><p><i>Background and Objectives:</i> Benign vocal fold lesions (BVFLs) are common causes of persistent dysphonia, but recurrence estimates are influenced by lesion type, outcome definition, and follow-up. We evaluated recurrence after documented lesion resolution and explored clinical factors and surgical technique. <i>Materials and Methods:</i> We performed a single-center retrospective cohort study of 214 adults with a first documented BVFL diagnosis between January 2022 and December 2024. Clinical records were reviewed through January 2026. Recurrence was defined as lesion reappearance after documented resolution at the initial post-treatment laryngeal assessment; persistent lesions were classified separately. <i>Results:</i> Follow-up was documented in 142 patients (66.4%). Initial lesion resolution was documented in 135 patients, of whom 23 developed recurrence (17.0%); 7 patients had persistent disease at the initial post-treatment assessment. No evaluated demographic or clinical factor was significantly associated with recurrence in univariate analyses. In the secondary exploratory surgical analysis, recurrence occurred in 7/29 patients treated with cold instruments (24.1%) and 3/27 treated with CO₂ laser (11.1%; OR 2.55, 95% CI 0.58-11.08; Fisher exact <i>p</i> = 0.299). <i>Conclusions:</i> Documented recurrence after initial lesion resolution occurred in 17.0% of patients. The surgical technique comparison was underpowered and unadjusted and does not establish superiority of either technique. Variable follow-up and differential attrition should be considered when interpreting the recurrence proportion.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067189","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":"Left Atrial Strain as an Integrative Marker of Diastolic Dysfunction and Atrial Fibrillation in Hypertrophic Cardiomyopathy: A Retrospective Cross-Sectional Study.","authors":"Eglė Tamulėnaitė-Stuokė, Joana Ažukaitė, Marius Šukys, Eglė Ereminienė","doi":"10.3390/medicina62091787","DOIUrl":"10.3390/medicina62091787","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Echocardiographic assessment of left ventricular diastolic dysfunction (LVDD) in hypertrophic cardiomyopathy (HCM) is challenging, as conventional parameters correlate poorly with left ventricular filling pressure. Emerging evidence suggests that left atrial (LA) strain is associated with atrial fibrillation (AF). This study aimed to compare LA reservoir strain (LASr)-based and conventional LVDD grading, evaluate associations between LA strain and clinical and echocardiographic parameters, and explore its relationship with AF. <i>Materials and Methods</i>: This retrospective cross-sectional single-center study included 109 adult HCM patients with comprehensive echocardiographic data. LVDD was graded using conventional echocardiographic parameters and LASr-based thresholds (≥35% (grade 0), ≥24% to <35% (grade 1), ≥19% to <24% (grade 2), and <19% (grade 3)). <i>Results:</i> LASr-based grading revealed a significantly greater prevalence of advanced LVDD compared with conventional assessment (grade 3: 39% vs. 3%, <i>p</i> < 0.001), with poor intermethod agreement (κ = 0.07). Overall, approximately 45% of patients were reclassified into higher LVDD grades using LASr, particularly among nonobstructive HCM patients. Higher LASr-based LVDD grades were associated with worse conventional diastolic indices, reduced biventricular strain parameters, and higher natriuretic peptide levels. Reduced LA reservoir and conduit strain were independently associated with documented AF after adjustment for age, LA volume index, and left ventricular mass index. <i>Conclusions</i>: LASr provides additional information on diastolic dysfunction in HCM patients and is associated with documented AF. LASr-based grading assigned more patients to advanced LVDD grades than conventional assessment. The observed association with AF requires prospective validation before LA strain can be used for risk stratification.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065979","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":"Sex-Related Differences in Clinical Characteristics and Outcomes Among Patients Clinically Managed for Suspected Bacterial Infection in the Emergency Department.","authors":"Daian-Ionel Popa, Larysa Alexandra Bălulescu, Ovidiu Alexandru Mederle, Codrina Mihaela Levai, Tiberiu Buleu, Anca Tudor, Ion Petre, Raluca Ibănescu, Carmen Gabriela Williams, Dumitru Sutoi, Dragos Fortofoiu, Cătălina Băzăvan, Adelin Ciudoiu, Răzvan Roșca, Florina Buleu","doi":"10.3390/medicina62091776","DOIUrl":"10.3390/medicina62091776","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;i&gt;Background and Objectives&lt;/i&gt;: Suspected bacterial infection is one of the leading presentations to the Emergency Department (ED) and is still associated with considerable morbidity and mortality. There is increasing evidence that biological sex may influence host immune responses, disease manifestations, therapeutic requirements, and clinical outcomes in infectious diseases. However, sex-specific differences among patients clinically managed for suspected bacterial infection in ED remain incompletely defined. This study, therefore, aimed to assess demographic characteristics, clinical presentation, and clinical management as well as short-term outcomes related to sex among these patients. &lt;i&gt;Materials and Methods&lt;/i&gt;: This retrospective single-center observational study included consecutive adults presenting with suspected bacterial infection to the ED between 1 June and 31 August 2025. Demographic, clinical, laboratory, treatment, infection-source, and outcome data were extracted from medical records. Between-group comparisons were followed by planned age-adjusted analyses and multivariable logistic regression. &lt;i&gt;Results&lt;/i&gt;: A total of 213 patients were included, comprising 100 women (46.9%) and 113 men (53.1%). Women were older than men (median 77.0 vs. 67.0 years, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), had lower diastolic blood pressure (70 vs. 75 mmHg, &lt;i&gt;p&lt;/i&gt; = 0.004), and lower hemoglobin concentrations (11.79 vs. 12.45 g/dL, &lt;i&gt;p&lt;/i&gt; = 0.004). Cardiovascular disease was more frequent among women than men (72.0% vs. 52.2%, &lt;i&gt;p&lt;/i&gt; = 0.003), although this difference was attenuated and no longer significant after adjustment for age. A documented urinary source of infection was more frequent among women (51.0% vs. 34.5%, &lt;i&gt;p&lt;/i&gt; = 0.015) and remained significantly associated with female sex after age adjustment (OR 2.14, 95% CI 1.20-3.81, &lt;i&gt;p&lt;/i&gt; = 0.010; Benjamini-Hochberg-adjusted &lt;i&gt;p&lt;/i&gt; = 0.039). No significant difference was detected in Emergency Department treatment: supplemental oxygen, vasopressors and broad-spectrum antibiotics were given with similar frequency to women and men (all &lt;i&gt;p&lt;/i&gt; ≥ 0.139). Direct intensive care unit (ICU) admission from the ED occurred in 14 of 100 women (14.0%) and 21 of 113 men (18.6%; OR 0.71, 95% CI 0.34-1.49), and in-hospital mortality in 7 women (7.0%) and 9 men (8.0%; OR 0.87, 95% CI 0.31-2.43). After adjustment, female sex was not independently associated with direct ICU admission (OR 0.64, 95% CI 0.29-1.39; &lt;i&gt;p&lt;/i&gt; = 0.257) or in-hospital mortality (OR 0.80, 95% CI 0.27-2.35; &lt;i&gt;p&lt;/i&gt; = 0.690). &lt;i&gt;Conclusions&lt;/i&gt;: In this single-center retrospective cohort of adults clinically managed for suspected bacterial infection in the emergency department, women were older and more frequently had a documented urinary source of infection. After adjustment for age, female sex remained associated with a documented urinary source of infection. The study did not provide precise evidence that sex was independently ","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067251","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}