Medicina (Kaunas, Lithuania)最新文献

{"title":"Post-Pancreatectomy Acute Pancreatitis in Pancreatic Cancer: A Single-Center Experience.","authors":"Ewa Grudzińska, Magdalena Gajda, Karolina Majewska, Wojciech Dubaj, Sławomir Mrowiec","doi":"10.3390/medicina62091788","DOIUrl":"10.3390/medicina62091788","url":null,"abstract":"<p><p><i>Background and Objectives</i>: In 2022, the International Study Group of Pancreatic Surgery (ISGPS) introduced a definition of postoperative acute pancreatitis (PPAP). This study aimed to assess the perioperative factors associated with clinically relevant PPAP (CR-PPAP) after pancreatoduodenectomy (PD) due to pancreatic ductal adenocarcinoma (PDAC) and to present the real-world treatment strategies for this complication. <i>Materials and Methods</i>: We performed a retrospective single-center analysis of 282 patients who underwent pancreatoduodenectomy for PDAC between 2010 and 2023. <i>Results</i>: CR-PPAP was diagnosed in 13.1% of patients. This group had significantly higher CRP (219 vs. 42 mg/L) and more frequently elevated drain amylase activity (97.3% vs. 18%). CR-PPAP was associated with significantly higher rates of reoperation (37.8% vs. 3.3%), delayed gastric emptying (73% vs. 16.3%), hemorrhage (21.6% vs. 0.8%) and pancreatic fistula (97.3% vs. 0.8%), as well as longer hospitalization (15 vs. 13 days). Antibiotics were administered significantly more often in the CR-PPAP group (86.5% vs. 6.5%), while somatostatin was used in all CR-PPAP patients and octreotide in 62.2%. Thirty-day mortality did not differ significantly between groups. In multivariate analysis, a small main pancreatic duct was the only independent factor associated with CR-PPAP. <i>Conclusions</i>: PPAP, as defined by the ISGPS 2022 criteria, is a relatively common complication following PD for malignancy, with a small pancreatic duct being a major risk factor. PPAP is strongly associated with other major postoperative complications and prolonged hospitalization, but not with increased mortality. Despite the frequent use of antibiotics, octreotide, and somatostatin in clinical practice, evidence-based treatment recommendations for CR-PPAP remain lacking, highlighting the need for management guidelines.</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/PMC13609901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067151","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":"Myocardial Injury and Predictors of In-Hospital Mortality in Severe or Critical COVID-19: A Single-Center Observational Cohort Study.","authors":"Valentina Negrea, Septimiu Toader Voidazan, Adina Huțanu, Vlad Adrian Pop, Anca Meda Văsieșiu","doi":"10.3390/medicina62091775","DOIUrl":"10.3390/medicina62091775","url":null,"abstract":"<p><p><i>Background and Objectives</i>: In-hospital mortality remains high among patients with severe or critical COVID-19. This study aimed to identify independent predictors of in-hospital mortality and assess the prognostic value of myocardial injury in this high-risk population. <i>Materials and Methods</i>: This single-center observational cohort study included 172 adults hospitalized with severe or critical COVID-19 across multiple pandemic waves. Mortality-associated factors were assessed using logistic regression and receiver operating characteristic curve analysis. Myocardial injury was defined as hs-cTnT > 14 ng/L, measured on days 3-5 after admission. <i>Results</i>: Of 172 patients, 60 died during hospitalization (34.9%). In the primary multivariable model, based on 126 complete cases and 37 deaths, age (aOR = 2.55 per 10-year increase; 95% CI, 1.55-4.22), pre-existing cardiovascular disease (aOR = 3.06; 95% CI, 1.03-9.07), LDH (aOR = 6.31 per doubling; 95% CI, 2.70-14.78), and CT pulmonary involvement (aOR = 1.34 per 10% increase; 95% CI, 1.01-1.80), were independently associated with in-hospital mortality. In a separate analysis of 121 patients with 35 deaths, myocardial injury remained independently associated with mortality after adjustment for age, cardiovascular disease, and pulmonary involvement (aOR = 5.19; 95% CI, 1.82-14.77). Among 131 patients with complete phenotype data, mortality was 6.7% (2/30) in patients with neither component, 19.6% (11/56) with isolated respiratory involvement, 50.0% (3/6) with isolated myocardial injury, and 56.4% (22/39) with both components. The primary multivariable model had an apparent AUC of 0.898 (95% CI, 0.828-0.968). <i>Conclusions</i>: Age, LDH, and myocardial injury were independently associated with in-hospital mortality, while the associations of cardiovascular disease and CT involvement were attenuated in the multiple-imputation sensitivity analysis. Combined assessment of clinical, pulmonary, and cardiac factors may improve risk stratification, but these findings require validation in independent cohorts.</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/PMC13608992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067161","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":"Improvements in Gait Function Following Integrative Korean-Western Medicine Treatment in Older Adults with Chronic Stroke: A Retrospective Exploratory Study.","authors":"Hyangyu Park, Yeonghun Wi, Cheol-Hyun Kim","doi":"10.3390/medicina62091781","DOIUrl":"10.3390/medicina62091781","url":null,"abstract":"<p><p><i>Background and Objectives:</i> Patients with chronic stroke aged 65 years or older and who are more than 6 months post-onset are generally considered to have reached a rehabilitation plateau, beyond which further functional improvement is difficult to achieve. This study aimed to evaluate changes in gait function before and after integrative Korean-Western medicine treatment in older adults with chronic stroke. <i>Materials and Methods:</i> In this single-center, retrospective, single-group pre-post observational study, we analyzed the medical records of 15 patients with chronic stroke aged ≥65 years who received integrative Korean-Western medicine treatment five times per week for 4 weeks. The primary outcome was the step length ratio, reflecting gait symmetry. Secondary outcomes included walking velocity, lateral symmetry, center of pressure (COP)-related parameters, manual muscle test (MMT) scores, and Fugl-Meyer Assessment (FMA) scores. <i>Results:</i> The step length ratio increased significantly from 0.61 [0.50-0.70] before treatment to 0.86 [0.62-0.94] after treatment (<i>p</i> = 0.009, <i>r</i> = 0.675). Walking velocity (<i>p</i> = 0.006, <i>r</i> = 0.715) and mean COP velocity (<i>p</i> = 0.007, <i>d</i> = -0.822) also improved significantly. In contrast, no significant changes were observed in MMT or FMA scores, and no treatment-related adverse events were recorded. <i>Conclusions:</i> In this retrospective, uncontrolled, single-group study, significant improvements in gait symmetry, walking velocity, and postural control were observed following integrative Korean-Western medicine treatment in older adults with chronic stroke. The improvement in gait function without a corresponding change in FMA-based motor function-although both MMT and FMA scores were relatively high at baseline, potentially limiting sensitivity to detect further motor improvement-raises the hypothesis that other mechanisms, potentially including enhanced sensorimotor integration, may have contributed to these changes; however, this mechanistic interpretation remains speculative and was not directly tested. Randomized controlled trials with appropriate control groups are warranted to further verify these findings.</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/PMC13609465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067174","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":"Beyond Pain Intensity: Central Sensitization and Psychosocial Symptom Burden in Women with Rheumatoid Arthritis.","authors":"Maja Vučković, Dragana Kožul, Tamara Popović, Ivan Soldatović, Sandra Trivunović, Tatjana Nožica Radulović, Daria Ćupurdija, Snežana Tomašević Todorović","doi":"10.3390/medicina62091780","DOIUrl":"10.3390/medicina62091780","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Persistent pain in rheumatoid arthritis (RA) may reflect mechanisms not fully captured by systemic inflammatory markers. This study estimated the frequency of elevated Central Sensitization Inventory (CSI) scores in women with RA and examined associations with pain, fatigue, depressive symptoms, function, inflammatory markers, and disease activity. <i>Materials and Methods</i>: This prospective single-center observational cohort included 97 female inpatients who completed a standardized three-week rehabilitation program. The CSI was used as a symptom-based screening instrument. Pain, function, fatigue, and depressive symptoms were assessed with the Visual Analog Scale (VAS), Health Assessment Questionnaire (HAQ), FACIT-Fatigue scale, and Beck Depression Inventory-II (BDI-II), respectively. <i>Results</i>: Fifty-seven participants (58.8%) had CSI scores ≥ 40. Higher CSI scores were associated with greater pain, more depressive symptoms, more fatigue, and higher DAS28-CRP scores, but not with ESR, CRP, IL-6, or disease duration. In adjusted baseline models, the association with VAS pain was statistically significant but modest (unstandardized beta = 0.024 per CSI point; standardized beta = 0.273). Across the three-week follow-up, VAS pain decreased by 2.53 points; mean FACIT-Fatigue and HAQ changes were smaller than commonly cited clinically important thresholds, and CSI changed only modestly. In adjusted multivariable models, higher CSI scores remained independently associated with VAS pain, FACIT-Fatigue, and BDI-II scores, whereas no significant association was found with HAQ. CSI was not associated with CRP, IL-6, or disease duration. <i>Conclusions</i>: In this cohort of women with RA, elevated CSI scores identified a greater self-reported symptom burden and were independently associated with pain, fatigue, and depressive symptoms after adjustment, though the pain association remained modest in magnitude. No meaningful association was found with functional disability. The uncontrolled, single-arm design and restricted inflammatory-marker range preclude causal conclusions or proof that symptoms were independent of inflammation.</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/PMC13608978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067021","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":"Predictive Value of On-Treatment Alpha-Fetoprotein Change for Lenvatinib Response in Patients with Hepatocellular Carcinoma: A Real-World Retrospective Study in Vietnam.","authors":"Ngoc-Tan Hoang, Van-Quang Le, Thang Tran, Thi-Que Pham, Thi-Dung Nguyen, Thi-Cuc Hoang, Thanh-Phuong Pham, Thi-Hoa Nguyen","doi":"10.3390/medicina62091774","DOIUrl":"10.3390/medicina62091774","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Changes in alpha-fetoprotein (AFP) after initiating lenvatinib may reflect response in patients with hepatocellular carcinoma (HCC), but the optimal assessment time point and AFP decline threshold remain unstandardized. This study evaluated the association between AFP change at the first post-treatment measurement and imaging response according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST). <i>Materials and Methods</i>: This retrospective study included 191 patients with HCC treated with lenvatinib. The primary analysis population comprised patients with pretreatment AFP ≥ 20 ng/mL and ≥1 post-treatment AFP measurement. AFP response was defined as a ≥40% decrease from pretreatment levels. The primary endpoints were the objective response rate (ORR) and disease control rate (DCR) according to mRECIST; progression-free survival (PFS) and overall survival (OS) were exploratory. Associations were assessed using multivariable logistic regression adjusted for AFP timing, albumin-bilirubin (ALBI) score, macrovascular invasion, and tumor number ≥ 5. Sensitivity and 2-month landmark analyses were also performed. <i>Results</i>: Of 124 patients, 47 (37.9%) achieved an AFP response. ORR was 44.7% versus 6.5% in the non-response group (OR 11.36; 95% confidence interval [CI] 3.68-42.67; <i>p</i> < 0.001); DCR was 83.0% versus 57.1% (OR 3.62; 95% CI 1.42-10.19; <i>p</i> = 0.003). After adjustment, AFP response remained independently associated with ORR (aOR 12.96; 95% CI 3.85-43.66; <i>p</i> < 0.001) and DCR (aOR 5.76; 95% CI 1.95-17.00; <i>p</i> = 0.002); findings were unchanged when restricted to cycle-1 measurements (aOR 12.27). In exploratory analyses, median PFS was 8.51 versus 4.30 months and median OS 18.53 versus 10.15 months; landmark analysis gave concordant estimates (PFS HR 0.38; OS HR 0.45). <i>Conclusions</i>: A ≥40% AFP decline at the first post-treatment measurement was independently associated with ORR and DCR according to mRECIST in patients with HCC and pretreatment AFP ≥ 20 ng/mL. These findings are hypothesis-generating and require confirmation in prospective, multicenter studies with independent validation before AFP kinetics can be considered in routine practice.</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/PMC13609512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067160","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":"Initial Experience with Standalone Thoracoscopic Left Atrial Appendage Occlusion Using AtriClip Pro2: A Single-Center Retrospective Cohort Study in Latvia.","authors":"Diāna Kalniņa, Kaspars Kupics, Renāta Rimdjonoka, Inga Urtāne, Daniels Siļčonoks, Andrejs Ērglis, Pēteris Stradiņš","doi":"10.3390/medicina62091786","DOIUrl":"10.3390/medicina62091786","url":null,"abstract":"<p><p><i>Background and Objectives:</i> Left atrial appendage (LAA) closure is an established strategy for stroke prevention in selected patients with atrial fibrillation (AF), particularly when long-term oral anticoagulation (OAC) is contraindicated. Thoracoscopic epicardial LAA occlusion using the AtriClip Pro2 device provides a minimally invasive surgical approach; however, evidence for standalone use remains limited. This study aimed to describe the initial feasibility and early clinical outcomes of standalone thoracoscopic LAA occlusion using AtriClip Pro2 in Latvia. <i>Materials and Methods:</i> We performed a single-center retrospective observational study including all consecutive patients who underwent standalone thoracoscopic LAA occlusion at the Department of Cardiac Surgery, Pauls Stradins Clinical University Hospital, between December 2024 and March 2026. Baseline characteristics, procedural outcomes, perioperative complications, rehospitalizations, and antithrombotic therapy status were assessed. LAA closure was assessed by transesophageal echocardiography (TEE). <i>Results:</i> Fourteen patients were included. Mean age was 63.6 ± 16.7 years (median 67.0; IQR 54.8-76.8), and 64.3% were female. Thoracoscopic completion was achieved in 13/14 patients (92.9%; 95% CI 68.5-98.7%); one patient (7.1%) required conversion to median sternotomy because of intraoperative bleeding. Complete LAA exclusion without residual flow or stump was documented in all 14 patients (100%; 95% CI 78.5-100%). No perioperative stroke or mortality occurred. At three months, follow-up data were available for all patients, and antithrombotic therapy had been discontinued in 12/14 patients (85.7%). <i>Conclusions:</i> This small, heterogeneous, single-center series supports the technical feasibility of standalone thoracoscopic AtriClip Pro2 implantation in selected patients. These encouraging early findings warrant further evaluation in larger cohorts with longer clinical follow-up and standardized postoperative imaging.</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/PMC13608897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067212","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":"Management and Clinical Outcomes of Liver Hemangiomas: A Retrospective Comparative Study of Transcatheter Arterial Embolization and Surgery.","authors":"Sefa Ergün, Fadime Kutluk, Rauf Hamid, Yasemin Pekmezci, Seyfullah Halit Karagöz, Mehmet Velidedeoğlu, Server Sezgin Uludağ, Ahmet Baş, Fatih Gülşen, Salih Pekmezci","doi":"10.3390/medicina62091782","DOIUrl":"10.3390/medicina62091782","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Hemangiomas are the most common benign tumors of the liver. Surgical options such as enucleation, segmentectomy, and hepatectomy are the primary treatment choices, though the morbidity and complication rates remain high. Transcatheter arterial embolization (TAE) has emerged as a safe and effective alternative treatment option that has gained popularity in recent years. <i>Materials and Methods</i>: We retrospectively evaluated data from patients who underwent either surgical intervention (<i>n</i> = 19) or transarterial embolization (62 lesions in 61 patients; analyses performed per treated lesion) for liver hemangioma between 2003 and 2021. Outcomes were assessed separately for each modality without a composite efficacy endpoint: clinical success (relief of the presenting symptoms, assessed in patients symptomatic at baseline), technical success and radiological response for embolization, treatment-related complications, length of hospital stay, and the need for reintervention. <i>Results</i>: There was no significant difference in the pretreatment size of the lesions between the TAE and surgery groups (median of 10.0 [IQR 7.8-13.9] versus 10.0 [IQR 9.0-17.0] cm; <i>p</i> = 0.100). The length of hospital stay was shorter in the TAE group (median of 1 versus 6 days; <i>p</i> < 0.001), although era-related differences in perioperative care may contribute to this difference, and follow-up was longer in surgically treated patients, reflecting the later adoption of embolization at our institution. Postoperative mortality did not occur in either group. In the embolization group, there were significant reductions in lesion size and volume and the complication rate was low, with no serious complications, supporting the safety profile of TAE. <i>Conclusions</i>: In this retrospective, non-randomized, single-center series, transarterial embolization was found to be a safe and effective minimally invasive treatment for liver hemangiomas and was associated with a shorter hospital stay. Because treatment allocation was not randomized, we cannot establish therapeutic equivalence between the two modalities, and the comparison should be regarded as descriptive; TAE represents an effective minimally invasive treatment option in appropriately selected patients and may be considered within a multidisciplinary treatment strategy, while surgery remains necessary in selected cases such as embolization failure, complicated lesion vascularization, or localization.</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/PMC13609660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066901","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":"Ocular Surface Symptoms, Objective Redness, and Intraocular Pressure After a Switch from Fixed Dorzolamide/Timolol to Netarsudil in Latanoprost-Treated Glaucoma and Ocular Hypertension: A Prospective Real-World Cohort Study.","authors":"Virginia Zanutigh, Celina Logioco, Leila Galetto, Franco Perrone, Noelia Podesta, Florencia Valvecchia","doi":"10.3390/medicina62091768","DOIUrl":"10.3390/medicina62091768","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Conjunctival hyperemia is common with netarsudil, but redness may not reflect the overall patient experience when treatment burden is reduced. We evaluated ocular surface symptoms, objective redness, tear-film parameters, intraocular pressure (IOP), and treatment preference after a routine-care switch from twice-daily fixed dorzolamide/timolol to once-daily netarsudil 0.02%, while continuing latanoprost. <i>Materials and Methods</i>: This prospective, single-center observational cohort included 30 consecutive adults with primary open-angle glaucoma or ocular hypertension and controlled IOP. Outcomes were assessed at baseline and months 1 and 2. The primary outcome was the Ocular Surface Disease Index (OSDI). Continuous eye-level outcomes were analyzed using mixed-effects models accounting for fellow-eye and repeated-measures correlation; grade ≥ 2 hyperemia was analyzed using participant-clustered logistic regression. <i>Results</i>: Twenty-seven participants (54 eyes) completed evaluable 2-month follow-up. Median OSDI decreased from 7.50 at baseline to 6.25 at month 1 and 5.00 at month 2 (Friedman <i>p</i> = 0.0015). The mean baseline-to-month 2 change was -2.95 points (95% CI, -4.80 to -1.10), and 6/27 participants (22.2%) improved by at least 7 points. Serle grade ≥ 2 hyperemia increased from 7.4% of eyes at baseline to 51.9% at month 1 and 44.4% at month 2. Estimated mean bulbar redness index increased from 1.57 to 2.14 (<i>p</i> < 0.0001), tear meniscus height increased modestly, and non-invasive keratograph break-up time showed no significant longitudinal change. Estimated mean IOP changed from 14.50 to 13.65 mmHg (<i>p</i> = 0.0083), with no eye showing an increase of at least 4 mmHg. Burning improved after multiplicity adjustment, and 17/27 participants with available month-2 preference data (63.0%) preferred netarsudil. <i>Conclusions</i>: The switch was associated with modest OSDI improvement and maintained short-term IOP control despite increased objective redness. Patient preference appeared to reflect factors beyond redness alone.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067140","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":"A Common Language for Post-Transplant Anastomotic Biliary Strictures: Standardized Endoscopic Outcome Definitions and a Failure-Mode Roadmap.","authors":"Daniele Balducci, Michele Montori, Marco Marzioni, Giuseppe Tarantino, Antonio Benedetti, Gianluca Svegliati-Baroni, Emanuele Bendia, Enrico Palmeri, Matteo Ghisa, Luca Maroni","doi":"10.3390/medicina62091773","DOIUrl":"10.3390/medicina62091773","url":null,"abstract":"<p><p><i>Background and Objectives</i><b>:</b> Anastomotic biliary stricture (AS) is the most frequent biliary complication after duct-to-duct liver transplantation (LT) and a leading indication for post-transplant endoscopic retrograde cholangiopancreatography (ERCP). Because inconsistent outcome definitions hamper cross-study comparisons, we also propose standardized outcome definitions and a minimum reporting dataset. <i>Materials and Methods:</i> This narrative review covers pathogenesis and risk factors, diagnosis and timing, balloon dilation and stenting, the management of treatment failure, procedure-related safety, and graft outcomes. <i>Results:</i> ERCP is the established first-line treatment and achieves durable resolution in most patients. Randomized evidence shows comparable resolution with multiple plastic stents (MPS) and fully covered self-expandable metal stents (FCSEMS), the latter reducing procedures and treatment duration at the cost of migration and possible recurrence. Evidence is weaker for recurrent or refractory strictures, sequential stent addition versus complete exchange, and Roux-en-Y anatomy or a completely obstructed anastomosis. We define technical success, treatment success, recurrence, refractory disease, and durable stent-free resolution, and organize advanced management as a roadmap matching four modes of endoscopic failure to salvage techniques. <i>Conclusions:</i> Endoscopic therapy is central to graft-preserving management of post-transplant AS; adopting these harmonized definitions should make outcomes comparable and rescue algorithms evidence-based.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067057","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":"Beyond Sequencing: Integrating MLPA Reveals Hidden Structural <i>PKD2</i> Variants and Enhances Mutation Detection in a Highly Selected ADPKD Greek Cohort.","authors":"Akrivi Papachristopoulou, Angeliki Margoni, Aimilios Christos Simoudis, Aristea Mylona, Olga-Irini Kroupi, Petros Nikolopoulos, Athanasios G Papavassiliou, Demetrios V Vlahakos, Christos Kroupis","doi":"10.3390/medicina62091771","DOIUrl":"10.3390/medicina62091771","url":null,"abstract":"<p><p><i>Background and Objectives</i>: The genetic architecture of late-onset autosomal dominant polycystic kidney disease (ADPKD) remains incompletely defined. Pathogenic mutations in two genes that encode polycystin proteins, <i>PKD1</i> and <i>PKD2</i>, prevail among these patients. Detection of <i>PKD1</i> alterations by a sequencing method is challenging as this is a large gene with high GC content and multiple pseudogenes. Although next-generation sequencing (NGS) has become the cornerstone of molecular diagnosis, its limited availability in several settings and its limited sensitivity for structural variants may create a diagnostic blind spot, particularly for <i>PKD2</i>. Because <i>PKD2</i>-associated ADPKD follows a milder clinical course with delayed progression to end-stage renal disease (ESRD), its contribution to late-onset disease may be systematically underestimated. We hypothesized that a phenotype-driven strategy integrating copy number analysis would uncover clinically relevant <i>PKD2</i> variants overlooked by DNA sequencing methods. <i>Materials and Methods</i>: Six well-characterized consecutive ADPKD patients that entered KRT (kidney replacement therapy) above 70 years old underwent targeted <i>PKD2</i> analysis using bidirectional Sanger DNA sequencing of all coding exons and exon-intron boundaries, complemented by multiplex ligation-dependent probe amplification (MLPA) for copy number variant detection. <i>Results</i>: Pathogenic <i>PKD2</i> variants were identified in 33% of the patients in this limited cohort. These included the recurrent nonsense variant p.Arg872Ter and a previously undescribed multi-exonic deletion encompassing exons 1-9 that was detectable exclusively by MLPA. Additionally a novel variant of unknown significance (VUS) (p.Leu273Gln) was detected. The high diagnostic yield in this phenotypically highly enriched cohort highlights the value of targeted structural variant analysis. <i>Conclusions</i>: Our findings identify structural <i>PKD2</i> variation as an under-recognized cause of genetically unresolved late-onset ADPKD and demonstrate that phenotype-guided incorporation of copy number analysis can overcome limitations of NGS alone. A combined sequencing-MLPA approach may therefore provide a more complete and clinically informative molecular diagnosis, particularly in carefully selected patients with late-onset ADPKD.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067060","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}