Medicina (Kaunas, Lithuania)最新文献

{"title":"Clinical Outcomes and Factors Associated with Response to Fluoroscopy-Guided Cervical Medial Branch Pulsed Radiofrequency in Chronic Cervical Facet Joint Pain: A Retrospective Cohort Study.","authors":"Nevcihan Şahutoğlu Bal, Şükriye Dadalı, Ali Çoştu, Gülçin Babaoğlu, Ülkü Sabuncu, Emel Başar, Erkan Yavuz Akçaboy","doi":"10.3390/medicina62091770","DOIUrl":"10.3390/medicina62091770","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Pulsed radiofrequency (PRF) of the cervical medial branches is a non-destructive neuromodulatory option for chronic cervical facet joint pain, yet evidence regarding the durability of clinical response and factors associated with sustained benefit remains limited. This study aimed to characterize the 6-month trajectory of pain and disability after fluoroscopy-guided cervical medial branch PRF and to explore baseline factors associated with meaningful pain relief (MPR). <i>Materials and Methods</i>: In this retrospective single-center cohort study, 75 patients with chronic cervical facet joint pain who achieved ≥50% temporary pain relief following a diagnostic medial branch block underwent fluoroscopy-guided cervical medial branch PRF, followed by injection of local anesthetic and corticosteroid at the treated levels. Numeric Rating Scale (NRS) and Neck Disability Index (NDI) scores were evaluated at baseline and at 1, 3, and 6 months. MPR was defined as ≥50% reduction in NRS from baseline. Global Perceived Effect (GPE) and changes in analgesic medication use were assessed as complementary clinical outcomes. An exploratory multivariable logistic regression analysis was performed to examine factors independently associated with MPR at 6 months. <i>Results</i>: Median NRS scores decreased from 7.0 at baseline to 4.0, 4.0, and 5.0 at 1, 3, and 6 months, respectively, while median NDI scores decreased from 30.0 to 14.0, 16.0, and 20.0 (both overall <i>p</i> < 0.001). Despite sustained improvement relative to baseline, MPR progressively declined from 57.3% at 1 month to 49.3% at 3 months and 36.0% at 6 months (overall <i>p</i> < 0.001). Favorable GPE and reduced analgesic medication use showed parallel declines, supporting attenuation of overall clinical benefit over time. In the exploratory multivariable model, fibromyalgia was independently associated with 75% lower odds of 6-month MPR (OR = 0.25, 95% CI: 0.088-0.709; <i>p</i> = 0.009). Age, sex, and baseline NRS were not significantly associated with 6-month MPR. No serious acute periprocedural adverse events were documented during the 2 h observation period. <i>Conclusions</i>: Fluoroscopy-guided cervical medial branch PRF, combined with post-procedural corticosteroid and local anesthetic administration, was associated with clinically meaningful improvements in both pain and neck-related disability, with the greatest benefit during the first 3 months and partial attenuation by 6 months. The progressive decline across pain response, patient-reported global improvement, and analgesic-use outcomes highlights the time-dependent nature of the benefit associated with the combined intervention. Fibromyalgia was independently associated with substantially lower odds of 6-month MPR in this exploratory analysis; this association should be interpreted cautiously and requires prospective validation before it can inform patient selection, although it may be relevant when ","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/PMC13609532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067258","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":"Diagnostic Efficacy of Clinico-Pathological Parameters in Predicting Nodal Positivity in Oral Cavity Squamous Cell Carcinoma: A Multivariate Risk Assessment.","authors":"Deniz Baklacı, Gökhan Furkan Kılıç, Hüseyin Işık, Aleyna Şivetoğlu, Duygu Erdem","doi":"10.3390/medicina62091772","DOIUrl":"10.3390/medicina62091772","url":null,"abstract":"<p><p><i>Background and Objectives</i>: This study investigated clinicopathological factors associated with occult cervical lymph node metastasis in clinically node-negative oral cavity squamous cell carcinoma (OCSCC). <i>Materials and Methods</i>: This retrospective study included 108 patients who underwent primary tumor resection and elective neck dissection. Depth of invasion (DOI), lymphovascular invasion (LVI), perineural invasion, and histological grade were evaluated. Receiver operating characteristic analysis and multivariable logistic regression were used to assess associations with pathological nodal positivity. <i>Results</i>: Occult nodal metastasis was identified in 27 patients (25%). The cohort-derived DOI threshold was 8.5 mm, with an area under the curve of 0.841. LVI and histological grade were associated with nodal positivity in the multivariable analysis, although the adjusted estimates were imprecise. <i>Conclusions</i>: Histopathological characteristics were associated with occult nodal metastasis in this selected surgical cohort. However, the limited number of nodal events and the postoperative availability of key variables restrict clinical applicability. These exploratory findings require independent validation and should not be used to determine whether elective neck dissection can be omitted.</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/PMC13609575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067129","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":"Rhabdomyolysis Reported in Association with SARS-CoV-2 Infection and COVID-19 Vaccination: A Systematic Review.","authors":"Fernando M Runzer-Colmenares, Nelson Luis Cahuapaza-Gutierrez, Cielo Cinthya Calderon-Hernandez, Mariam Miyanay Umeres-Bravo, Ruth Angélica Rojas-De la Cruz, Tatiana Vanessa Villavicencio-Escudero, Renzo Pajuelo-Vasquez, Nathaly Enciso","doi":"10.3390/medicina62091769","DOIUrl":"10.3390/medicina62091769","url":null,"abstract":"<p><p><i>Background and Objectives</i>: The association between SARS-CoV-2 infection, COVID-19 vaccination, and the development of rhabdomyolysis remains unclear. This systematic review aimed to comprehensively synthesize and analyze the available evidence on the occurrence of rhabdomyolysis in the context of SARS-CoV-2 infection and COVID-19 vaccination. <i>Materials and Methods</i>: A literature search was conducted in PubMed, Scopus, EMBASE, and Web of Science. The review followed PRISMA 2020 guidelines, assessing methodological quality. Statistical analyses were performed using STATA v18. <i>Results</i>: A total of 133 patients with rhabdomyolysis associated with SARS-CoV-2 infection were identified from 93 case reports and 7 case series; the median age was 45.5 years (IQR: 24-62), with a predominance of males (72.9%). Additionally, 13 observational studies comprising 818 patients with rhabdomyolysis associated with SARS-CoV-2 infection were included. Among cases associated with SARS-CoV-2 vaccination, 20 patients were identified from 20 case reports; the median age was 52.5 years (IQR: 22.5-76.5), with a predominance of males (75%). These cases were primarily associated with mRNA-based vaccines, particularly Pfizer-BioNTech BNT162b2 (50%) and Moderna (20%), and occurred predominantly after the first and second doses. The most frequent clinical manifestations in both groups were fever, myalgia, and dark urine. Clinical outcomes were favorable in most patients, both among infection-associated cases (72.2%) and vaccination-associated cases (80%). <i>Conclusions</i>: Rhabdomyolysis has been documented during SARS-CoV-2 infection, although its true frequency remains uncertain, whereas cases following COVID-19 vaccination do not establish causality or platform-specific risks.</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/PMC13608938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067206","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":"Prognostic Value of Preoperative Inflammatory, Hematological, and Metabolic Blood Indices in Endometrioid-Type Endometrial Cancer: A Retrospective Cohort Study.","authors":"Gorkem Ulger, Kasim Akay, Hamza Yildiz, Pelin Aytan, Sevki Goksun Gokulu, Tolgay Tuyan Ilhan","doi":"10.3390/medicina62091767","DOIUrl":"10.3390/medicina62091767","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Peripheral blood indices have been proposed as prognostic biomarkers in endometrial cancer, but most reports include mixed histological subtypes, do not control for benign uterine pathology that independently alters hematological profiles, and evaluate these indices in isolation. We evaluated all three categories head-to-head in a histologically homogeneous endometrioid cohort and formally tested whether they add prognostic information beyond established clinicopathological variables. <i>Materials and Methods</i>: Of 195 patients operated for endometrioid-type endometrial cancer between 2018 and 2024, 142 were included; adenomyosis or leiomyoma on final histopathology, active infection and hematological disease were exclusion criteria. Fourteen preoperative blood-derived indices spanning the three categories were analyzed as continuous variables. A pre-specified clinical model (age category, grade, FIGO stage) was compared with models adding the biomarkers using likelihood-ratio tests, Harrell's concordance index, time-dependent areas under the curve, bootstrap internal validation, and influence diagnostics. <i>Results</i>: Median follow-up was 52.5 months; 34 patients (23.9%) died and 5-year overall survival was 74.1%. None of the conventional inflammatory ratios were associated with survival (SII <i>p</i> = 0.893; all others <i>p</i> ≥ 0.26). In the multivariable model, histologic grade and NRBC% remained associated with survival (NRBC% HR 3.30 per 1%, 95% CI 1.09-9.97, <i>p</i> = 0.034). Adding NRBC% to the clinical model improved fit (likelihood-ratio <i>p</i> = 0.039) but not discrimination (ΔC 0.006, 95% CI -0.041 to 0.053, <i>p</i> = 0.814), and no index retained significance after Benjamini-Hochberg adjustment. The NRBC% association disappeared on dichotomization at the detection limit and could not be estimated once the five patients with values above 0.30% were excluded. <i>Conclusions</i>: In a predominantly early-stage endometrioid endometrial cancer cohort, preoperative blood-derived indices added no measurable discriminatory information beyond established pathological variables. The NRBC% association rests on very few observations at the upper end of its distribution and is hypothesis-generating only.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067019","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":"Bailout Stenting After Drug-Coated Balloon Angioplasty: Clinical Outcomes and Implications for Contemporary PCI-A Systematic Review and Meta-Analysis.","authors":"Marcello Marchetta, Branislav Crnomarković, Lucio Giuseppe Granata, Giuseppe Massimo Sangiorgi, Mila Kovačević","doi":"10.3390/medicina62091765","DOIUrl":"10.3390/medicina62091765","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Drug-coated balloon (DCB) angioplasty represents an established stentless strategy in percutaneous coronary intervention (PCI), although bailout stenting (BOS) is frequently required in the presence of suboptimal angiographic results. The clinical impact of BOS following DCB remains incompletely defined. <i>Materials and Methods</i>: We performed a systematic review and single-arm meta-analysis of studies reporting clinical outcomes after BOS following DCB angioplasty, with quantitative synthesis restricted to studies reporting BOS-specific clinical outcomes. Pooled event rates for cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), and target lesion revascularization (TLR) were estimated using random-effects models. Heterogeneity was assessed using standard heterogeneity statistics. <i>Results</i>: Five studies were included in the systematic review; four studies reporting BOS-specific clinical outcomes contributed to the quantitative synthesis, whereas REC-CAGEFREE I was retained as strategy-level supportive evidence. BOS after DCB angioplasty was associated with low pooled rates of cardiac death (1%), MI (3%), TLR (5%) and TVR (5%), with minimal or moderate heterogeneity across analyses. Overall, pooled outcomes were within the range reported in contemporary drug-eluting stent (DES) trials. <i>Conclusions</i>: BOS following DCB angioplasty was associated with generally low short- to mid-term event rates that were broadly consistent with selected historical DES benchmarks. However, because these comparisons are indirect, comparable safety or efficacy cannot be inferred. BOS may therefore be considered a pragmatic contingency within DCB-based strategies rather than necessarily representing procedural failure.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066878","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 Evidence on Endoscopic Biliary Drainage in the Era of Surgically Altered Anatomy: A Narrative Review.","authors":"Davide Scalvini, Carlo Ciccioli, Angelo Bruni, Marco Valvano, Gianmaria La Rosa, Michele Dota, Alessandro Cappellini, Giulio Massetti, Guglielmo Aprile, Francesca Torello Viera, Letizia Veronese, Gianluca Franchellucci, Stefano Mazza, Aurelio Mauro, Marco Bardone, Alessandro Fugazza, Marco Spadaccini, Alessandro Repici, Andrea Anderloni","doi":"10.3390/medicina62091766","DOIUrl":"10.3390/medicina62091766","url":null,"abstract":"<p><p>Endoscopic retrograde cholangiopancreatography (ERCP) remains the reference standard for biliary drainage, yet it fails in up to 15% of cases, most notably when a surgically altered anatomy (SAA) is present. The expanding use of bariatric and oncologic gastrointestinal surgery has increased the number of patients in whom the papilla is displaced, unreachable, or replaced by a biliodigestive anastomosis, making conventional access difficult or impossible. This narrative review appraises the current evidence on endoscopic biliary drainage in SAA, focusing on procedural efficacy, anatomical peculiarities, adverse-event profiles and technical considerations to guide clinical decision-making. Available strategies include luminal techniques, duodenoscope-assisted ERCP, forward-viewing (cap-assisted colonoscope) ERCP, and enteroscope-assisted ERCP, as well as endoscopic ultrasound-guided biliary drainage (EUS-BD), encompassing EUS-guided hepaticogastrostomy, EUS-guided antegrade stenting, EUS-guided rendezvous and EUS-directed transgastric/transenteric ERCP (EDGE/EDEE), and laparoscopic-assisted ERCP (LA-ERCP). No single approach is universally superior and available comparative data is mainly retrospective and affected by major selection bias. Technique selection should be tailored to the reconstruction type, indication (benign vs. malignant), limb length, expected survival, and local expertise, ideally within a multidisciplinary, high-volume setting. Adequately powered randomized trials incorporating quality-of-life and cost-effectiveness endpoints are still needed to define the optimal first-line strategy. This literature review encompasses the multiple strategies to achieve biliary drainage in surgically altered anatomy, highlighting strengths and weaknesses of each technique, as well as the preferred approach for each type of anatomical reconstruction.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067083","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":"Determinants of Chemical Pleurodesis Recurrence in Malignant Pleural Effusion: Mechanical Apposition or Systemic Inflammation? A Retrospective Cohort Study.","authors":"Caner İşevi, Mehmet Gökhan Pirzirenli, Eren Yılmaz, Yavuz Karaca, Burçin Çelik, Yasemin Büyükkarabacak","doi":"10.3390/medicina62091763","DOIUrl":"10.3390/medicina62091763","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;i&gt;Background and Objectives:&lt;/i&gt; Malignant pleural effusion (MPE) severely impairs quality of life; chemical pleurodesis is the standard palliative modality, but the relative contributions of systemic inflammation, tube caliber, and mechanical pleural apposition to failure remain controversial. This study evaluated independent determinants of pleurodesis recurrence, hospital length of stay, and 30-day mortality using causal inference and mediation modeling. &lt;i&gt;Materials and Methods:&lt;/i&gt; We conducted a retrospective cohort study of 140 patients undergoing chemical pleurodesis for symptomatic MPE. Pre-procedural inflammatory biomarkers, including the Neutrophil-to-Lymphocyte Ratio (NLR), tube caliber, administration method (bedside slurry vs. Video-Assisted Thoracoscopic Surgery [VATS] poudrage), and lung re-expansion status were recorded. Multivariable logistic regression with nomogram construction, 1:1 propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and bootstrap structural equation modeling (SEM) mediation analysis were performed. &lt;i&gt;Results:&lt;/i&gt; Pleurodesis recurrence occurred in 28.6% (&lt;i&gt;n&lt;/i&gt; = 40) and 30-day mortality in 16.4% (&lt;i&gt;n&lt;/i&gt; = 23) of patients. Non-expandable lung (adjusted odds ratio [aOR] = 9.89, 95% CI: 3.98-26.29, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and suboptimal catheter position (aOR = 3.80, 95% CI: 1.11-14.84, &lt;i&gt;p&lt;/i&gt; = 0.407) were the strongest independent predictors of recurrence (C-index = 0.851); non-expandable lung also increased mortality 5.21-fold (&lt;i&gt;p&lt;/i&gt; = 0.036). Large-bore tubes reduced matched odds of catheter malposition (OR = 0.096) and recurrence (OR = 0.405, &lt;i&gt;p&lt;/i&gt; = 0.493) in the propensity-matched cohort, and VATS poudrage shortened hospital stay by 6.40 days (&lt;i&gt;p&lt;/i&gt; = 0.074) versus slurry after weighting. Exploratory mediation analysis showed NLR's direct effect on recurrence was non-significant (β = 0.0147, &lt;i&gt;p&lt;/i&gt; = 0.5897); although summed indirect pathways accounted for a numerically larger share of the total effect, the bootstrap confidence interval for the total indirect effect crossed zero (β = 0.0330, 95% CI: -0.0155 to 0.0742), with only the pathway via catheter malposition individually excluding zero (β = 0.0126, 95% CI: 0.0014-0.0416), suggesting a plausible but unconfirmed mechanical-mediation trend. Patients with no comorbidities unexpectedly had higher mortality than those with multiple comorbidities (25.0% vs. 7.1%, &lt;i&gt;p&lt;/i&gt; = 0.19), reflecting younger age and greater cachexia (albumin 28.14 ± 4.54 g/L) rather than comorbidity itself. &lt;i&gt;Conclusions:&lt;/i&gt; Pleurodesis efficacy in MPE appears to be governed primarily by mechanical visceroparietal apposition; systemic inflammation showed no significant direct effect on recurrence, and its possible indirect, mechanically mediated contribution should be regarded as hypothesis-generating pending prospective confirmation. Clinicians managing high-risk patients (elevated NLR, non-expandable lung, or cachexia) should","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13608950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Toe Walking and Repetitive Behaviors in Children with Autism Spectrum Disorder: A Cross-Sectional Phenotypic Analysis.","authors":"Martina Gnazzo, Giuditta Bargiacchi, Beatrice Gallai, Giulia Spoto, Gabriella Di Rosa, Valentina Baldini, Lucia Parisi, Agata Maltese, Michele Roccella, Eva Germanò, Maria Esposito, Marco Carotenuto","doi":"10.3390/medicina62091764","DOIUrl":"10.3390/medicina62091764","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Toe walking (TW) is frequently observed in children with Autism Spectrum Disorder (ASD), yet its clinical significance remains incompletely understood. While previous studies have linked TW to ASD severity and multisystem involvement, its relationship with the behavioral phenotype of repetitive behaviors has not been systematically explored. <i>Materials and Methods</i>: This study analyzed a cohort of 289 children with ASD who underwent comprehensive clinical assessment, including motor evaluation, sleep assessment using the Sleep Disturbance Scale for Children (SDSC), feeding behavior using the Brief Autism Mealtime Behavior Inventory (BAMBI), and detailed behavioral characterization through the Repetitive Behavior Scale-Revised (RBS-R) at the item level. Statistical analyses included non-parametric group comparisons, Spearman correlation analyses, and multivariable regression models. <i>Results</i>: TW was observed in 27.3% of participants. Children with TW showed significantly higher scores in stereotyped behaviors (7.71 ± 2.09 vs. 4.26 ± 2.06, r = 0.756, <i>p</i>_FDR < 0.001), ritualistic/sameness behaviors (11.78 ± 3.21 vs. 7.05 ± 3.03, r = 0.709, <i>p</i>_FDR < 0.001), and total RBS-R scores (25.52 ± 4.51 vs. 15.88 ± 4.64, r = 0.867, <i>p</i>_FDR < 0.001). Correlation analyses revealed a strong association between TW and stereotyped behaviors (ρ = 0.588, <i>p</i> < 0.001) and a moderate association with ritualistic/sameness behaviors (ρ = 0.549, <i>p</i> < 0.001). RBS-R total scores were also correlated with sleep disturbances (ρ = 0.532, <i>p</i> < 0.001). In the multivariate linear model, TW was associated with an adjusted mean increase of 7.77 points in the RBS-R Total Score (B = 7.771, 95% CI 6.603-8.939, <i>p</i> < 0.001, β = 0.551). In the multivariate logistic model, the combined Ritualistic/Sameness behavior domain independently predicted the presence of TW (OR = 1.549, 95% CI 1.366-1.757, <i>p</i> < 0.001). <i>Conclusions</i>: In children with ASD, TW was associated with specific domains of repetitive behavior, particularly stereotyped and ritualistic/sameness patterns. These cross-sectional findings suggest a phenotypic association between motor and behavioral features, without establishing specificity, causality, or a shared underlying mechanism. This multidimensional perspective may support future studies investigating the clinical and biological correlates of TW in ASD.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065992","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":"Salivary Melatonin and MMP-9 Levels in Stage III Periodontitis: A Pilot Study Using Standardized Pre-Sleep Saliva Collection.","authors":"Ivan Ivanov, Emilia Naseva, Antoaneta Mlachkova, Velitchka Dosseva-Panova, Zdravka Pashova-Tasseva, Hristina Maynalovska, Boyan Kirilov, Viktoria Petrova, Nikolay Ishkitiev, Sonia Apostolova","doi":"10.3390/medicina62091762","DOIUrl":"10.3390/medicina62091762","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Periodontitis is a chronic multifactorial inflammatory disease characterized by progressive destruction of the tooth-supporting tissues. Although periodontal diagnosis is primarily based on clinical and radiographic parameters, salivary biomarkers may provide additional biological information on inflammatory activity and host-response regulation. Matrix metalloproteinase-9 (MMP-9) is involved in extracellular matrix degradation and periodontal tissue destruction, whereas melatonin is a circadian-related molecule with antioxidant, anti-inflammatory, and immunomodulatory properties. However, evidence regarding the simultaneous assessment of salivary MMP-9 and melatonin using standardized pre-sleep saliva collection remains limited. This pilot study aimed to evaluate salivary melatonin and MMP-9 concentrations in periodontal health and stage III periodontitis, to assess their interrelationship, and to explore their preliminary in-sample ability to distinguish periodontal health from stage III periodontitis. <i>Materials and Methods</i>: This cross-sectional pilot study included 18 systemically healthy non-smoking adults: 9 periodontally healthy participants and 9 patients with stage III periodontitis. Pre-sleep unstimulated saliva was collected between 23:00 and 24:00 h or immediately before sleep, following a standardized protocol. Salivary MMP-9 and melatonin concentrations were determined using enzyme-linked immunosorbent assay. Periodontal diagnosis was established according to the 2017 World Workshop classification. Group comparisons, correlation analyses, and receiver operating characteristic curve analyses were performed as exploratory analyses. <i>Results</i>: Salivary melatonin concentrations were significantly lower in patients with stage III periodontitis than in periodontally healthy participants (<i>p</i> = 0.019), with a large effect size (Hedges' g = 1.261). Salivary MMP-9 concentrations were higher in the periodontitis group, but the difference was not statistically significant (<i>p</i> = 0.465). No significant correlation was found between salivary melatonin and MMP-9 levels. Receiver operating characteristic analysis suggested preliminary in-sample discriminatory ability for melatonin (AUC = 0.827; <i>p</i> = 0.019), whereas MMP-9 showed limited and non-significant discriminatory ability (AUC = 0.593; <i>p</i> = 0.508). <i>Conclusions</i>: In this pilot sample, lower pre-sleep salivary melatonin levels were associated with stage III periodontitis, whereas MMP-9 showed limited standalone discriminatory ability. These findings should be interpreted as preliminary and hypothesis-generating. The present study does not establish a clinically applicable diagnostic cut-off or validated diagnostic utility for salivary melatonin. Larger, independently validated studies are needed to confirm these observations.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13608926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149067257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Postoperative Drainage Strategy with Persistent Urinary Leakage and Clinical Outcomes Following Percutaneous Nephrolithotomy.","authors":"Anıl Eker, Kemal Züngün, Muhammet Bilal Nart, Muhammet Halil Dağaşan, Serkan Yarımoğlu, Murat Şahan, İbrahim Halil Bozkurt, Tansu Değirmenci","doi":"10.3390/medicina62091759","DOIUrl":"10.3390/medicina62091759","url":null,"abstract":"<p><p><i>Background and Objectives:</i> Persistent postoperative urinary leakage may delay recovery after percutaneous nephrolithotomy (PCNL). This study evaluated the association between postoperative drainage strategy, persistent urinary leakage, and clinical outcomes following prone PCNL. <i>Materials and Methods:</i> This retrospective, non-randomized cohort analysis included 606 consecutive eligible patients undergoing prone PCNL between 2015 and 2026 from a prospectively maintained institutional database. Patients received either an external ureteral catheter (<i>n</i> = 529) or primary antegrade double-J (DJ) stent (<i>n</i> = 77). Perioperative outcomes were compared, and factors associated with persistent urinary leakage were evaluated in the ureteral-catheter group. <i>Results:</i> Operative and nephroscopy times were longer in the DJ-stent group (110.4 ± 47.2 vs. 100.6 ± 37.9 min, <i>p</i> = 0.041; 50.0 vs. 40.0 min, <i>p</i> = 0.002). Persistent urinary leakage occurred in 39 patients (7.4%) with ureteral catheters and in none with primary DJ stents (<i>p</i> = 0.006). After stabilized IPTW, the risk difference for primary DJ stenting versus ureteral-catheter drainage was -7.45 percentage points (95% bootstrap CI, -9.77 to -5.33). The distributions of nephrostomy tube removal time and hospital stay differed between the drainage groups (DJ stent vs. ureteral catheter: 2.0 [IQR, 2.0-2.0] vs. 2.0 [IQR, 2.0-2.5] days, <i>p</i> = 0.028; and 3.0 [IQR, 2.0-3.0] vs. 3.0 [IQR, 3.0-4.0] days, <i>p</i> = 0.004, respectively), although the corresponding Hodges-Lehmann estimated differences were small (0 days [95% CI, 0 to 0] and 0 days [95% CI, 0 to 1], respectively). In multivariable analysis, residual stone presence was associated with higher odds of persistent urinary leakage (adjusted OR 2.16, 95% CI 1.09-4.28; <i>p</i> = 0.027). <i>Conclusions:</i> Primary antegrade DJ stenting was associated with lower urinary leakage rates. Although the distributions of nephrostomy tube removal time and hospital stay also favored the DJ-stent group, the absolute between-group differences were small. Residual stone presence remained independently associated with higher odds of persistent urinary leakage.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 9","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149066562","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}