Medicina (Kaunas, Lithuania)最新文献

{"title":"Integrative Multi-Database Bioinformatics Characterization of <i>FANCE</i> in Hepatocellular Carcinoma: Prognostic, Epigenetic, Immune, and ncRNA Associations.","authors":"Yeong Chae Kim, Kyu-Shik Lee, Hye-Ran Kim, Jongwan Kim","doi":"10.3390/medicina62101988","DOIUrl":"https://doi.org/10.3390/medicina62101988","url":null,"abstract":"<p><p><i>Background and Objectives:</i> The Fanconi anemia complementation group E (FANCE) is a protein component of the Fanconi anemia (FA) DNA repair complex and contributes to genome integrity. However, its molecular and clinical relevance in liver hepatocellular carcinoma (LIHC) remains incompletely understood. This study characterized the <i>FANCE</i> expression, prognosis, epigenetics, immune responses, noncoding RNA (ncRNA) networks, and other related molecular processes in LIHC. <i>Materials and Methods:</i> An integrative multi-database bioinformatics analysis was conducted using public databases and web-based platforms. FANCE expression, DNA methylation, co-expression profiles, and functional enrichment; immune cell infiltration; miRNA-ncRNA, chemical-gene, and protein-protein interactions; treatment response; and survival were evaluated. <i>Results: FANCE</i> expression was higher in LIHC than in non-tumor liver tissues, and this was linked to shorter survival duration. Promoter methylation was lower in LIHC, and select CpG sites were related to <i>FANCE</i> expression and survival. Immune analyses identified heterogeneous relationships between FANCE and inferred immune cell populations. hsa-miR-101-3p was reduced in LIHC, negatively correlated with FANCE, and linked to prolonged survival; subsequent network analysis identified candidate lncRNAs, small ncRNAs, circRNA-linked genes, and pseudogenes. FANCE-related transcriptional profiles were enriched in the cell cycle, DNA replication, FA, and other DNA-repair processes, whereas negatively correlated genes were mainly linked to hepatic metabolic functions. Exploratory treatments identified drug-dependent survival patterns related to FANCE expression and elevated levels in responders to specific immune-checkpoint inhibitors, although the discriminatory performance was modest. <i>Conclusions:</i> Increased <i>FANCE</i> expression in LIHC was linked to molecular features involving DNA methylation, immune cell composition, ncRNA-related interactions, and DNA repair programs as well as shorter survival. These findings provide an integrated molecular context for <i>FANCE</i> in LIHC but do not establish a causal regulation or therapeutic predictive value. Independent clinical and experimental validation studies are warranted to determine its biological and clinical significance.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 10","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149280856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supramalleolar Osteotomy for Varus Ankle Osteoarthritis: A Contemporary Narrative Review.","authors":"Silvio Caravelli, Marco Di Ponte, Luca Berveglieri, Giammarco Gardini, Hassan Zmerly, Edoardo Cassanelli, Emanuele Vocale, Stefano Zaffagnini, Massimiliano Mosca","doi":"10.3390/medicina62101983","DOIUrl":"https://doi.org/10.3390/medicina62101983","url":null,"abstract":"<p><p><i>Background and Objectives:</i> Varus ankle osteoarthritis (OA) is most commonly post-traumatic and is characterized by asymmetric degeneration and medial overload of the tibiotalar joint. Supramalleolar osteotomy (SMOT) is a joint-preserving procedure that aims to restore mechanical alignment, redistribute joint contact forces, and delay, or potentially avoid, total ankle replacement (TAR) or ankle arthrodesis (AA). However, the optimal choice of technique and amount of correction remain debated, particularly in complex multiplanar deformities. <i>Materials and Methods:</i> This narrative review summarizes current evidence on SMOT for varus ankle OA. Relevant clinical, radiographic, biomechanical, imaging, and surgical studies were selected and synthesized narratively, with particular emphasis on deformity classification, location of the center of rotation of angulation (CORA), joint congruency, surgical technique, clinical outcomes, complications, and treatment planning. <i>Results:</i> SMOT provides reliable pain relief and functional improvement in patients with Takakura-Tanaka stage 2-3A ankle OA, with reported mid-term survival rates of 88-93%. The choice of technique should be guided by the location of the deformity, the degree of talar tilt, and overall limb alignment. In selected cases, a concomitant fibular osteotomy improves talar reduction and medial unloading. Three-dimensional planning and patient-specific instrumentation may improve the accuracy of correction. <i>Conclusions:</i> SMOT is an effective joint-preserving treatment for varus ankle OA, provided that the deformity is accurately analyzed and patients are carefully selected. This review proposes a simplified, stepwise treatment algorithm, supported by illustrations, to help surgeons select the most appropriate osteotomy technique according to the deformity pattern.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 10","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149280995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Denervation and Reinnervation After Heart Transplantation: Assessment and Clinical Impact.","authors":"Antonella Galeone, Gina Mazzeo, Michele Moretti, Enrico Munari, Alessia Gambaro, Teresa Maria Capovilla, Matteo Brunelli, Giovanni Battista Luciani","doi":"10.3390/medicina62101987","DOIUrl":"https://doi.org/10.3390/medicina62101987","url":null,"abstract":"<p><p>The heart is innervated by an intricate network involving sympathetic, parasympathetic, and sensory afferent pathways, which together regulate heart rate, contractility, and vascular tone in response to physiological demands. This innervation is anatomically organized along the neurocardiac axis, from the intrinsic cardiac ganglia to central autonomic centers, and molecularly shaped during development by neurotrophic and repulsive signaling cues. Orthotopic heart transplantation inevitably severs all afferent and efferent neural connections between the donor heart and the recipient, producing a state of complete cardiac denervation that manifests as resting tachycardia, blunted heart rate variability, and abolished reflex chronotropic responses. Over time, a variable degree of sympathetic and, less consistently, parasympathetic reinnervation may occur in a subset of recipients, predominantly in the anterior wall of the left ventricle, typically beginning after the first post-transplant year and progressing gradually, with a characteristic base-to-apex and epicardium-to-endocardium pattern that often remains incomplete even at long-term follow-up. Reinnervation is currently assessed through complementary non-invasive approaches: heart rate variability analysis provides an indirect functional readout of autonomic modulation, while nuclear imaging techniques (including ¹²³I-metaiodobenzylguanidine scintigraphy and ¹¹C-metahydroxyephedrine positron emission tomography) allow direct visualization and quantification of regional sympathetic nerve density and integrity. The extent and pattern of reinnervation appear clinically relevant, as denervation and its recovery have been associated with exercise capacity, arrhythmic risk, silent myocardial ischemia, and long-term prognosis after transplantation, although findings across studies remain heterogeneous. This narrative review summarizes current knowledge of cardiac autonomic anatomy and neurotransmission, the molecular determinants of innervation patterning, the physiological consequences of heart transplant-related denervation, the evidence on post-transplant reinnervation and its non-invasive assessment, and the impact of reinnervation on clinical outcomes.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 10","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149280880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Two-Year Outcomes of Three Different Three-Piece Intraocular Lenses in Flanged Intrascleral Fixation.","authors":"Burhan Başkan, Yusuf Evcimen","doi":"10.3390/medicina62101985","DOIUrl":"https://doi.org/10.3390/medicina62101985","url":null,"abstract":"<p><p><i>Background and Objectives</i>: To compare 2-year positional stability, endothelial preservation, and visual outcomes of three three-piece intraocular lenses (IOLs) implanted by the Yamane technique: Eyecryl (polypropylene haptics, 5° haptic angulation), Sensar OptiBlue AR40e (polymethyl methacrylate [PMMA] haptics, 5° haptic angulation), and AcrySof MA60AC (PMMA haptics, 10° haptic angulation). <i>Materials and Methods</i>: Records of 192 consecutive patients (one eye per patient; no bilateral implantation) receiving a study IOL were reviewed; 145 patients (75.5%) completed 24 months of follow-up (Eyecryl 48 eyes, Sensar 48 eyes, MA60AC 49 eyes). Endothelial cell density (ECD) loss and anterior segment OCT measures of decentration, tilt, and anatomical anterior chamber depth (ACD) were modelled with mixed-effects models weighted by stabilised inverse probability of treatment weights, using cluster-robust standard errors. <i>Results</i>: Visual acuity gain was equivalent within the prespecified ±0.15 logMAR margin (two one-sided tests, <i>p</i> = 0.009). Operative time differed (Eyecryl 12.9 ± 3.4 versus MA60AC 24.1 ± 7.6 min; <i>p</i> < 0.001), as did the proportion of eyes requiring repeat cautery of at least one haptic (Eyecryl 4.2%, Sensar 22.9%, MA60AC 42.9%; <i>p</i> < 0.001). MA60AC showed greater decentration (0.75 ± 0.21 versus 0.56 ± 0.20 mm) and shallower ACD (3.42 ± 0.38 versus 3.61 ± 0.35 mm); tilt did not differ (omnibus <i>p</i> = 0.312). Unadjusted 24-month ECD loss, expressed as a percentage of baseline ECD, was 4.92 ± 1.52% (Eyecryl), 6.18 ± 1.87% (Sensar), and 7.45 ± 2.01% (MA60AC) (all pairwise <i>p</i> < 0.0167). After operative duration, ACD, and decentration were entered, the MA60AC-versus-Eyecryl difference in ECD loss fell by 81.4%, from 2.1 to a non-significant 0.4 percentage points; this attenuation is descriptive, not causal mediation. <i>Conclusions</i>: All three platforms gave equivalent 2-year visual outcomes. Eyecryl showed better positional stability and lower unadjusted endothelial loss than MA60AC, with shorter surgery and a less anterior optic. Because haptic material and angulation vary together here, comparisons concern whole platforms, not individual attributes.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 10","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149280922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Kidney Injury in Childhood Nephrotic Syndrome: From Hemodynamic Vulnerability and Tubular Stress Toward Biomarker-Guided Management.","authors":"John Dotis, Nikoleta Printza","doi":"10.3390/medicina62101979","DOIUrl":"https://doi.org/10.3390/medicina62101979","url":null,"abstract":"<p><p>Acute kidney injury (AKI) is a clinically important, mechanistically heterogeneous complication of childhood nephrotic syndrome. Similar increases in serum creatinine may reflect reduced effective arterial volume, extracellular volume expansion with pressure-associated dysfunction, acute tubular stress or injury, infection or sepsis, drug toxicity or acute interstitial nephritis, vascular thrombosis, or underlying glomerular disease. These mechanisms often coexist or evolve, so edema and creatinine alone cannot direct therapy. This focused narrative review links the nephrotic substrate and precipitating exposures to predominant or mixed AKI phenotypes, multimodal assessment, and phenotype-guided management. Serum creatinine, urine output, and cystatin C are considered alongside urinary neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and the cellular stress product of tissue inhibitor of metalloproteinases-2 and insulin-like growth factor-binding protein 7 [TIMP-2]·[IGFBP7]. These biomarkers may help distinguish functional filtration loss from tubular stress or damage, but nephrotic-syndrome-specific validation and evidence of therapeutic utility remain limited. Management should integrate serial assessment of perfusion, congestion, fluid balance, urine findings, drug exposures, infection, and vascular or intrinsic kidney disease. Biomarkers are therefore adjuncts, not an established basis for management.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 10","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149280877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protective Effects of Prophylactic and Therapeutic Erythromycin Administration in Ovarian Ischemia-Reperfusion Injury in Rats.","authors":"Sümeyye Akyüz, Necip Gökhan Taş, Murat Günay, Nezahat Kurt, Fikret Altındağ","doi":"10.3390/medicina62101977","DOIUrl":"https://doi.org/10.3390/medicina62101977","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Ovarian ischemia-reperfusion (I/R) injury involves oxidative stress, inflammation, and structural tissue damage that may impair ovarian function. This study investigated the effects of prophylactic and therapeutic erythromycin administration on biochemical and histopathological injury in a rat model of ovarian I/R. <i>Materials and Methods</i>: Forty adult female Wistar albino rats were divided into five groups (n = 8 per group): sham (SG), I/R, erythromycin alone (E), prophylactic erythromycin plus I/R (I/R+ERP), and therapeutic erythromycin plus I/R (I/R+ERT). Ovarian ischemia was induced by clamping the right ovarian vascular pedicle for 3 h, followed by 3 h of reperfusion. Erythromycin (50 mg/kg, intraperitoneally) was administered 30 min before ischemia in the I/R+ERP group and at the onset of reperfusion in the I/R+ERT group. Inflammatory and oxidative stress markers in serum and ovarian tissue, serum anti-Müllerian hormone (AMH) levels, and ovarian hemorrhage and necrosis were evaluated. <i>Results:</i> Compared with the sham group, ovarian I/R increased inflammatory and oxidative stress markers and histopathological injury, and decreased serum AMH and ovarian tissue glutathione (GSH) and superoxide dismutase (SOD) levels. Compared with the untreated I/R group, both erythromycin regimens were associated with lower serum and ovarian tissue tumor necrosis factor-α (TNF-α) and malondialdehyde (MDA) levels and lower ovarian necrosis scores. The I/R+ERT group also had lower ovarian tissue interleukin-1β (IL-1β), higher ovarian tissue GSH and SOD levels, and a lower hemorrhage score than the untreated I/R group. In the direct comparison between the two erythromycin regimens, serum MDA was lower (false discovery rate [FDR]-adjusted <i>q</i> < 0.001), ovarian tissue SOD was higher (<i>q</i> = 0.014), and the ovarian necrosis score was lower (Holm-adjusted <i>p</i> < 0.001) in the I/R+ERT group. Direct comparisons for serum TNF-α (<i>q</i> = 0.055), ovarian tissue IL-1β (<i>q</i> = 0.127), and ovarian tissue GSH (<i>q</i> = 0.105) did not meet the FDR-adjusted significance threshold. The hemorrhage score did not differ significantly between the two erythromycin regimens (Holm-adjusted <i>p</i> = 0.057). Neither regimen significantly increased serum AMH compared with the untreated I/R group. <i>Conclusions</i>: Erythromycin attenuated several biochemical and histopathological indicators of acute experimental ovarian I/R injury. Administration at the onset of reperfusion was associated with more favorable findings than prophylactic administration for selected outcomes. These short-term findings do not establish preservation of ovarian reserve or fertility, or clinical efficacy in ovarian torsion.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 10","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149281025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Competing Mortality, Not Breast-Cancer Mortality, Explains the Survival Deficit of Breast Cancer After a Prior Non-Breast Cancer: A SEER Competing-Risks Analysis.","authors":"İsmail Zihni, Burcu Zihni, İmren Mutlu, Demet Sarıdemir Ünal, Mehmet Zafer Sabuncuoğlu","doi":"10.3390/medicina62101975","DOIUrl":"https://doi.org/10.3390/medicina62101975","url":null,"abstract":"<p><p><i>Background and Objectives:</i> Women who develop breast cancer after a previous cancer of another site have poorer overall survival, yet it is unsettled whether the breast cancer itself is more lethal or whether the deficit reflects competing causes of death in an older, previously treated population. We decomposed this survival deficit by cause of death, defining every endpoint identically across groups. <i>Materials and Methods:</i> Using the Surveillance, Epidemiology, and End Results (SEER) database (17 registries, 2010 to 2020), we studied women with invasive breast cancer as a single primary (<i>n</i> = 473,073), as a second or later primary after a non-breast index cancer (second primary breast cancer, SPBC; <i>n</i> = 26,832), and as a second breast primary (<i>n</i> = 40,252). Cause of death was assigned from the SEER cause-of-death-to-site recode, applied identically across cohorts. Cohorts were compared using cause-specific and Fine-Gray models weighted by an inverse-probability propensity score for age, race and ethnicity, subtype, grade, stage, nodal status, year, marital status, income, and rurality. <i>Results:</i> Breast-cancer mortality was not higher in SPBC than in single-primary disease, and was if anything lower (10-year cumulative incidence 12.0 versus 13.6 percent; weighted cause-specific hazard ratio 1.06). The deficit fell almost entirely to competing, non-breast mortality (35.3 versus 13.5 percent). In a five-way decomposition, cardiovascular disease was not the leading competing cause; non-cancer causes and the index cancer each accounted for more deaths. Once patient factors were balanced, cardiovascular and other non-cancer hazards were near unity (1.05 and 1.07), leaving further cancer death as the main excess. <i>Conclusions:</i> A breast cancer arising after a non-breast cancer is not intrinsically more lethal. Its survival deficit is competing mortality, driven mainly by further cancer death and, to a smaller and largely age-explained degree, by cardiovascular and other non-cancer causes.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 10","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149280806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Demographic Characteristics of Patients with Pulmonary Large-Cell Neuroendocrine Carcinoma: A Single-Center Experience.","authors":"Yeşim Özufacık Bölükbaşı, Aydın Aytekin","doi":"10.3390/medicina62101980","DOIUrl":"https://doi.org/10.3390/medicina62101980","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Pulmonary large-cell neuroendocrine carcinoma (pLCNEC) is a rare malignancy, accounting for approximately 2-3.5% of surgically resected primary lung cancers. Given its rarity, pLCNEC has been less extensively studied than other, more common lung cancer subtypes. In this study, we evaluated and compared the diagnostic and therapeutic approaches to pLCNEC. <i>Materials and Methods</i>: Patients with pLCNEC were evaluated with respect to age, sex, smoking history, primary tumor site, surgical history, tumor stage, histological subtype, metastatic sites at initial diagnosis and during follow-up, first- and second-line chemotherapy regimens, and disease survival parameters. <i>Results</i>: A total of 55 patients diagnosed between 2012 and 2024 were retrospectively analyzed. The median age at diagnosis was 63 years, the mean smoking exposure was 45.8 pack-years, and the median overall survival (mOS) for the entire cohort was 9 months (95% CI, 7-11). At presentation, 12.7% of the patients had stage I-II, 29.1% had stage III, and 58.2% had stage IV disease. Primary tumors were located peripherally in 85.5% of cases and centrally in 14.5%. A platinum plus etoposide regimen-standard for small-cell lung cancer (SCLC)-was the most commonly administered first-line chemotherapy (<i>n</i> = 40). Among all patients, 19 had undergone upfront surgical resection, whereas 36 had not. In univariate analysis, patients with a history of surgery (<i>n</i> = 19) had a significantly longer mOS than those without surgery (<i>n</i> = 36): 16 months (95% CI, 8-NR) versus 7 months (95% CI, 3-9), respectively (<i>p</i> = 0.003). On multivariate analysis, stage IV disease, ECOG PS ≥ 2, and advanced age were independently associated with poorer survival. In multivariable analyses, surgery showed a borderline association with survival that did not reach statistical significance (<i>p</i> = 0.052). Furthermore, median survival was significantly longer in patients with T1 stage disease compared with those with T3 and T4 stage, and in those with T3 compared with T4 stage (<i>p</i> = 0.045). <i>Conclusions</i>: Overall, early-stage diagnosis and surgical intervention may be associated with favorable clinical outcomes and a survival benefit.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 10","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149280886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Outcomes of Dorsal Onlay Buccal Mucosal Graft Urethroplasty for Female Urethral Stricture Disease: A Single-Center Experience.","authors":"Hilmi Sarı, Murat Can Karaburun, Arif Huseynli, Samet Kipik, Fatih Yalçınkaya","doi":"10.3390/medicina62101976","DOIUrl":"https://doi.org/10.3390/medicina62101976","url":null,"abstract":"<p><p><i>Background and Objectives</i>: To evaluate the surgical, functional, and perioperative outcomes of Dorsal Onlay Buccal Mucosal Graft Urethroplasty (DO-BMGU) in women with Female urethral stricture (FUS) disease. <i>Materials and Methods</i>: A retrospective analysis was performed including women who underwent DO-BMGU for FUS at a single tertiary referral center between January 2018 and October 2025. The primary outcome was freedom from reintervention for symptomatic recurrence. Secondary outcomes included perioperative outcomes, complications, and changes in maximum urinary flow rate (Qmax) and postvoid residual urine volume (PVR). <i>Results</i><b>:</b> Twenty women with a mean age of 52.9 ± 14.7 years were included. The median stricture length was 2 cm (IQR 2-3), and all patients had undergone previous urethral dilatation. Median operative time was 65 min (IQR 60-80), with a median hospital stay of 3 days (IQR 3-4). During a median follow-up of 12 months (IQR 12-24), 18 patients (90%) remained free from reintervention for symptomatic recurrence. Two patients developed recurrent symptomatic narrowing and were successfully managed with urethral dilatation. At the 3-month objective functional assessment, mean Qmax improved significantly from 6.1 ± 2.3 to 20.4 ± 5.8 mL/s (<i>p</i> < 0.001), while median PVR decreased from 125 mL (IQR 94.5-155) to 10 mL (IQR 10-40) (<i>p</i> < 0.001). No patient experienced major bleeding or urethrovaginal fistula. One patient (5%) developed mild de novo stress urinary incontinence, and postoperative complications were generally minor and managed conservatively. <i>Conclusions</i>: DO-BMGU was associated with favorable early objective functional outcomes and a high rate of freedom from reintervention for symptomatic recurrence, with few clinically significant complications in this small cohort. Larger prospective studies with longer follow-up are warranted to confirm the long-term durability of this technique.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 10","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149280888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pretreatment Body Composition and Its Association with Pathologic Complete Response and Survival in Breast Cancer Patients Undergoing Neoadjuvant Chemotherapy: A Retrospective Cohort Study.","authors":"Erhan Tükel, Süleyman Özkan Aksoy, Ali İbrahim Sevinç, Muhammet Berkay Sakaoğlu, Caner Bektaş, Pınar Balcı, Işıl Başara Akın, Rabia Sümeyye Arslan, Gamze Gültekin, Elif Atağ Akyürek, Yasemin Çakır, Merih Güray Durak","doi":"10.3390/medicina62101978","DOIUrl":"https://doi.org/10.3390/medicina62101978","url":null,"abstract":"<p><p><i>Background and Objectives</i>: We investigated how pretreatment body-composition parameters relate to pathologic complete response (pCR), disease-free survival (DFS), and overall survival (OS) in women with non-metastatic breast cancer who received neoadjuvant chemotherapy (NAC). <i>Materials and Methods</i>: We retrospectively analyzed 278 women treated with NAC at a single institution between January 2010 and December 2022. On computed tomography (CT) or PET-CT, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), skeletal muscle mass (SMM), and skeletal muscle density (SMD) were measured at the third lumbar vertebra (L3) with a semi-automated technique. Receiver operating characteristic (ROC) analysis was used to define optimal SMM cut-offs, and survival was examined by Kaplan-Meier estimation and Cox proportional-hazards regression. <i>Results</i>: The median follow-up was about 62 months. BMI was correlated with VAT (r = 0.449) and SAT (r = 0.482) but not with SMM (r = 0.075; <i>p</i> = 0.211). SMM was higher in women who attained pCR (107.4 ± 14.4 vs. 101.1 ± 16.1; <i>p</i> = 0.003). Derived by ROC analysis against distant metastasis-the event defining DFS-the SMM cut-off was 105 cm² (AUC = 0.725); values below it predicted poorer DFS on both univariable (HR = 4.80; <i>p</i> < 0.001) and multivariable testing (adjusted HR = 3.83; 95% CI 1.78-8.26; <i>p</i> = 0.001). The recurrence/metastasis rate was far higher among sarcopenic obese women (<i>n</i> = 34) than non-sarcopenic obese women (<i>n</i> = 56) (41.2% vs. 10.7%; log-rank <i>p</i> = 0.0004). With adjustment for molecular subtype, greater SMM remained an independent correlate of pCR (adjusted OR 1.26 per 10-cm² increment; 95% CI 1.04-1.53; <i>p</i> = 0.020). SMM was not significantly related to OS (univariable HR 1.75; <i>p</i> = 0.081). Sensitivity and specificity of the 105-cm² cut-off were 92.3% and 48.2%, respectively. <i>Conclusions</i>: In this retrospective cohort, greater pretreatment skeletal muscle area was independently linked to pathologic complete response and lower area to worse disease-free survival, while no significant link emerged with overall survival. Since BMI captures muscle mass poorly, body composition obtained from CT/PET-CT may add complementary prognostic information; nevertheless, because the design was observational and the cut-offs internally derived, these hypothesis-generating results need prospective external validation before clinical adoption.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 10","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149280889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}