Medicina (Kaunas, Lithuania)最新文献

{"title":"Comparison of 24-2 and 24-2C Visual Field Testing in Eyes with Ocular Hypertension.","authors":"Berire Şeyma Durmuş Ece, Kaan Özkan, Halime Kübra Şahin, Musab Özdere","doi":"10.3390/medicina62101962","DOIUrl":"10.3390/medicina62101962","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Ocular hypertension (OHT) is associated with a variable risk of progression to primary open-angle glaucoma, and early detection of functional abnormalities is important during follow-up. The 24-2C visual field pattern was designed to improve central sampling by adding 10 test locations to the conventional 24-2 grid. This study aimed to compare central visual field findings obtained with the 24-2 and 24-2C protocols in patients with OHT. <i>Materials and Methods</i>: This prospective, single-center, paired comparative study included 60 eyes of 60 patients with OHT. Each eye underwent 24-2 and 24-2C testing using the SITA Faster strategy during the same visit, with randomized test order. Global indices, test duration, the number of abnormal points within the central 10°, central mean sensitivity, and the presence of abnormal central clusters were compared between protocols. Peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (mGCC) thicknesses were measured using spectral-domain optical coherence tomography, and structure-function relationships were explored. <i>Results</i>: Mean deviation, pattern standard deviation, visual field index, false-positive rate, and central mean sensitivity did not differ significantly between protocols. Test duration was longer with 24-2C than with 24-2 (167.4 ± 39.2 vs. 141.6 ± 31.9 s; <i>p</i> < 0.001). The number of abnormal points at <i>p</i> < 0.05 within the central 10° was higher with 24-2C (3.81 ± 3.6 vs. 2.35 ± 2.4; <i>p</i> = 0.006). Abnormal central clusters were detected in 19 eyes (31.7%) with 24-2C and 9 eyes (15.0%) with 24-2 (<i>p</i> = 0.031). Among eyes classified as normal on 24-2, 14 of 51 (27.5%) showed a central cluster on 24-2C. No significant correlations were found between central functional parameters and average RNFL or mGCC thicknesses. <i>Conclusions</i>: 24-2C detected more central abnormalities than 24-2 in eyes with OHT, while global visual field indices remained similar. Longitudinal studies are needed to establish the reproducibility and prognostic relevance of these additional findings.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 10","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13707127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149280511","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":"Ophthalmology: New Diagnostic and Treatment Approaches (Second Edition).","authors":"Stephen G Schwartz, Andrzej Grzybowski, Victor M Villegas, Christopher T Leffler, Krishna S Kishor","doi":"10.3390/medicina62101961","DOIUrl":"10.3390/medicina62101961","url":null,"abstract":"<p><p>Many advances have been achieved in the diagnosis and treatment of eye diseases [...].</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 10","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13707237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149280964","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 Stepwise Preclinical Microvascular Training Model Based on the Superficial Inferior Epigastric Vessel Flap in the Rat: A Pilot Study.","authors":"Florin-Vlad Hodea, Stefan Cacior, Andreea-Maria Fira, Vladut-Alin Ratoiu, Eliza-Maria Bordeanu-Diaconescu, Ioan Lascar, Andreea Grosu-Bularda","doi":"10.3390/medicina62101963","DOIUrl":"10.3390/medicina62101963","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Transitioning from non-living simulation to clinical free-tissue transfer remains challenging. This pilot study aimed to develop and evaluate a staged in vivo microsurgical training protocol based on the rat superficial inferior epigastric (SIE) flap, in which the anatomical substrate is held constant and only technical demand varies between stages. <i>Materials and Methods</i>: Twenty male Wistar rats were used in five stages of increasing difficulty, progressing from orthotopic replantation and contralateral inguinal transfer to cervical transfer with end-to-end and end-to-side anastomoses using different donor vessel preparations. Outcomes were immediate patency, patency at 10 min, anastomotic leakage, procedural success (immediate patency without moderate-to-severe leakage) and anastomosis time. Proportions are reported with Wilson 95% confidence intervals; groups were compared with Fisher's exact test, trends across stages with the Cochran-Armitage test, and individual anastomosis times with separate arterial and venous linear regressions on stage number, using HC3 confidence intervals unadjusted for within-animal clustering. <i>Results</i>: Fifty-six anastomoses were performed (30 arterial, 26 venous). Immediate patency was 83.3% (25/30) for arterial and 61.5% (16/26) for venous anastomoses, patency at 10 min 70.0% and 46.2%, and procedural success 80.0% and 57.7% (<i>p</i> = 0.087). The arterial-venous difference was of similar magnitude at every endpoint (21.8, 23.8 and 22.3 percentage points) and was already established at declamping: among initially patent anastomoses, attrition by 10 min was 16.0% for arteries and 25.0% for veins (<i>p</i> = 0.69). No significant trend across stages was detected for success (arterial <i>p</i> = 0.38; venous <i>p</i> = 0.94) or patency. Individual anastomosis time increased with stage, with slopes of 2.08 min per stage for arteries (95% HC3 CI 1.46-2.71; R² = 0.703) and 2.69 min per stage for veins (95% HC3 CI 2.18-3.19; R² = 0.821). Mean venous time was higher at every stage. <i>Conclusions</i>: Even considering the limitations of the present study, the staged SIE flap model provides a graded, quantifiable, and standardised framework for preclinical free flap training within a single anatomical substrate.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 10","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13707335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149280840","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":"Cell-Free Immune-Conditioned Products in Advanced Solid Tumors: A Source-Aware Translational Framework.","authors":"Ramón Gutiérrez-Sandoval, Francisco Gutiérrez-Castro, Natalia Muñoz-Godoy, Ider Rivadeneira, Andy Lagos, Jordan Iturra, Francisco Krakowiak, Ignacio Muñoz, Cristián Peña-Vargas, Andrés Toledo","doi":"10.3390/medicina62101964","DOIUrl":"10.3390/medicina62101964","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Cell-free immune-conditioned products represent an emerging class of complex biological preparations with potential relevance to cancer immunotherapy. Their translation requires clear source definition, reproducible product characterization, mechanism-linked testing, and prospective clinical evaluation. This review aimed to develop a source-aware translational framework for their assessment in advanced solid tumors. <i>Materials and Methods</i>: PubMed/MEDLINE, consensus statements, professional-society documents, regulatory resources, and reporting guidelines were reviewed through 2 August 2026. Seventy-one references were integrated using a structured critical-review approach aligned with the Scale for the Assessment of Narrative Review Articles (SANRA), covering product identity, analytical quality, mechanism, delivery, human-relevant nonclinical evidence, clinical assessment, and evidence governance. <i>Results</i>: The framework separates biological source from recovered product class and organizes development through progressively stronger evidence layers spanning analytical qualification, mechanism-linked potency, human biological engagement, patient-centered assessment, tumor-level activity, and comparative validation. Mechanistic concepts such as membrane microdomain reorganization are positioned as testable intermediate evidence rather than clinical surrogates. Intradermal administration and new approach methodologies are incorporated as product-specific translational tools, while a published dendritic cell-conditioned evidence lineage illustrates how the framework can be operationalized. <i>Conclusions</i>: This source-aware framework provides an integrated and testable architecture for advancing complex cell-free immune-conditioned products from product qualification toward prospective clinical evaluation and comparative validation.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 10","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149280921","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":"Cell Viability of the Administered Product Predicts Response to Stromal Vascular Fraction in Patients with Erectile Dysfunction Unresponsive to Phosphodiesterase Type 5 Inhibitors.","authors":"Ahmet Semih Güleser, Atakan Eren, Fatih Altunrende, Ufuk Çağlar, Faruk Özgör","doi":"10.3390/medicina62101966","DOIUrl":"10.3390/medicina62101966","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Stromal vascular fraction (SVF) is increasingly used for erectile dysfunction (ED), but published human data are very limited and no study has related the cellular composition of the administered product to clinical outcomes. We evaluated the outcomes of SVF added to phosphodiesterase type 5 inhibitors (PDE-5I) in patients unresponsive to PDE-5I alone, and identified factors associated with treatment response. <i>Materials and Methods</i>: Records of 93 consecutive patients with vasculogenic ED who underwent autologous SVF injection in addition to PDE-5I at a single andrology clinic were reviewed retrospectively. Total nucleated cell concentration and viability were measured in every product. International Index of Erectile Function-5 (IIEF-5), Erection Hardness Score (EHS) and penile colour Doppler ultrasonography were assessed at baseline and at 6 and 12 months. The primary outcome was an EHS of 3 or 4 at 6 months. Multivariate logistic regression and receiver operating characteristic (ROC) analysis were used to identify factors associated with response. <i>Results</i>: A total of 66 of 93 patients (71.0%, 95% CI 61.1-79.2) reached an EHS of 3 or 4 at 6 months; no patient had reached this threshold at baseline. Mean IIEF-5 rose from 10.1 at baseline to 16.2 at 6 months and 15.1 at 12 months (<i>p</i> = 0.001); peak systolic velocity and end-diastolic velocity both improved at 6 months (<i>p</i> = 0.001 for both). Non-responders were older (63.8 vs. 52.7 years), had longer ED duration (6.7 vs. 3.0 years), higher HbA1c (6.8 vs. 6.3) and more diabetes (66.7% vs. 42.4%). Product cell concentration (2.5 vs. 1.8) and viability (88.0% vs. 82.5%) were higher in responders (<i>p</i> = 0.001 for both). On multivariate analysis, older age (OR 1.88 per year, 95% CI 1.19-2.96), higher HbA1c (OR 13.23 per unit, 95% CI 1.65-105.87) and lower product cell viability (OR 0.38 per percentage point, 95% CI 0.20-0.73) were independently associated with non-response. On exploratory ROC analysis, cell viability discriminated responders from non-responders with an area under the curve of 0.925 (95% CI 0.872-0.977) at a threshold of 85.3%. <i>Conclusions</i>: In this uncontrolled retrospective series, SVF added to PDE-5I was associated with improved erectile function in approximately seven of ten patients. The cell viability of the administered product was independently associated with outcome, a finding that cannot be attributed to placebo response and that identifies product quality as a modifiable variable. These hypothesis-generating results require confirmation in controlled prospective studies.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 10","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13707008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149280872","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":"Factors Associated with Amblyopia Among the Elderly in the CA Medicare Population.","authors":"Ricardo Oregon Guzman, Victoria L Tseng, Ken Kitayama, Fei Yu, Anne L Coleman","doi":"10.3390/medicina62101956","DOIUrl":"10.3390/medicina62101956","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Amblyopia is traditionally considered a pediatric condition; however, it may persist into adulthood and remain underrecognized. We examined the associations between sociodemographic and systemic factors and claims-documented amblyopia prevalence in the 2019 California (CA) Medicare population. <i>Materials and Methods</i>: This cross-sectional study used 2019 CA Medicare claims data for 2,649,107 beneficiaries aged ≥65 years, with Part A and B coverage, and valid ZIP codes for Social Vulnerability Index (SVI) values. Amblyopia was identified using ICD-10-CM diagnosis codes (H53.0x) in Medicare claims. Exposures included age, sex, race and ethnicity, systemic disease burden measured by Charlson Comorbidity Index (CCI) score, and Centers for Disease Control and Prevention SVI quartile. Logistic regression assessed associations between these factors and amblyopia diagnosis; descriptive statistics characterized refractive error and strabismus distribution by amblyopia status. <i>Results</i>: Amblyopia was present in 8460 (0.3%) beneficiaries. The largest proportions were aged 65-69 (n = 737,527; 27.8%), identified as female (n = 1,509,401; 57.0%), and were non-Hispanic White (n = 1,660,167; 62.7%). In adjusted models, increased odds of amblyopia were associated with ages 70-84 years, with the highest odds at ages 75-79 (age 75-79 vs. 65-69 adjusted odds ratio [aOR]: 1.42, 95% CI: 1.33-1.51), female sex (aOR: 1.10, 95% CI: 1.05-1.15), and a higher CCI score (CCI score ≥ 5 vs. 0 aOR: 1.30, 95% CI: 1.21-1.40). Decreased odds were associated with age ≥ 85 years (aOR: 0.88, 95% CI: 0.81-0.95), racial and ethnic minoritization (Black vs. Non-Hispanic White aOR: 0.51, 95% CI: 0.44-0.59), and a higher SVI quartile (Q4 vs. Q1 aOR: 0.67, 95% CI: 0.62-0.71). <i>Conclusions</i>: Ages 70-84 years, female sex, and higher systemic disease burden were associated with increased likelihood of amblyopia, while age ≥ 85 years, racially and ethnically minoritized groups, and those with higher social vulnerability had a decreased likelihood of documented amblyopia. Further research is needed to examine factors affecting amblyopia screening, diagnosis, and treatment in conjunction with comorbid ocular diseases in the elderly, including whether these differences reflect disparities in healthcare access and diagnostic coding rather than true differences in prevalence.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 10","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149280896","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":"The LAI-Oral Antipsychotic Efficacy-Effectiveness Paradox in Schizophrenia.","authors":"Kaloyan Stoychev, Sara Begum, Sheraz Nazar","doi":"10.3390/medicina62101960","DOIUrl":"10.3390/medicina62101960","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;i&gt;Background and Objectives&lt;/i&gt;: Long-acting injectable (LAI) antipsychotics are associated with reduced hospitalization and relapse in real-world observational studies of schizophrenia; however, randomized controlled trials (RCTs) demonstrate no statistically significant advantage over oral antipsychotics for relapse prevention. This efficacy-effectiveness paradox has remained unresolved in the literature for decades and has directly contributed to the persistent underutilization of LAIs in clinical practice. &lt;i&gt;Objective&lt;/i&gt;: To examine the methodological sources of the LAI efficacy-effectiveness paradox and to propose four conceptual, precision-medicine-informed methodological solutions, including artificial intelligence (AI)-supported neuroimaging, to guide the design of future comparative effectiveness research. &lt;i&gt;Materials and Methods&lt;/i&gt;: This report comprises two components: Part I, a scoping review of existing comparative studies, conducted and reported in accordance with the PRISMA extension for scoping reviews (PRISMA-ScR); and Part II, a conceptual methodological framework proposed by the authors on the basis of gaps identified in Part I, which is not itself a product of systematic scoping-review methodology. For Part I, we searched PubMed, EMBASE, PsycINFO, and the Cochrane Library from January 2000 to March 2026. Search terms included 'long-acting injectable antipsychotics,' 'oral antipsychotics,' 'schizophrenia,' 'medication adherence,' 'confounding by indication,' 'pharmacogenomics,' 'CYP2D6,' 'digital medicine,' 'pragmatic trials,' 'positron emission tomography,' 'functional magnetic resonance imaging,' 'neuroimaging,' 'machine learning,' and 'artificial intelligence. &lt;i&gt;Results:&lt;/i&gt; The paradox is primarily explained by confounding by indication in observational studies and inadequate adherence measurement across all study designs (Part I). On this basis, we propose, as a conceptual framework rather than a validated finding, four methodological solutions (Part II): (1) objective digital adherence monitoring via ingestible sensor or equivalent technology, subject to explicit informed consent and comprehensive ethical safeguards; (2) pharmacogenomic stratification using CYP2D6, CYP3A4, and CYP2C19 metaboliser phenotyping to control for pharmacokinetic confounding specific to antipsychotic drug metabolism; (3) pragmatic RCT designs with real-world eligibility criteria and objective primary adherence endpoints; and (4) artificial intelligence-supported neuroimaging positron emission tomography (PET)-derived dopamine receptor occupancy and machine learning analysis of functional magnetic resonance imaging (fMRI) connectivity data as an objective pharmacodynamic and predictive complement to the three adherence- and pharmacokinetics-focused solutions. &lt;i&gt;Conclusions:&lt;/i&gt; Current evidence on LAI versus oral antipsychotic superiority cannot be considered definitive. Integration of digital monitoring, pharmacogenomics, pragmatic t","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 10","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149280946","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":"Long-Term Major Adverse Kidney and Cardiovascular Events in Predialysis Chronic Kidney Disease: A Real-World Cohort Study.","authors":"Ayşe Karaduru Avcı, Ayca Inci, Rauf Avcı, Uğur Büyükokudan, Fatih Sargin, Lütfullah Zahit Koç, Üstün Yılmaz","doi":"10.3390/medicina62101957","DOIUrl":"10.3390/medicina62101957","url":null,"abstract":"<p><p><i>Background and Objectives:</i> Long-term renal and cardiovascular outcomes represent major clinical burdens in predialysis chronic kidney disease (CKD). This study aimed to evaluate the long-term incidence of and clinical factors associated with major adverse kidney events (MAKEs) and incident major adverse cardiovascular events (MACEs) in patients with predialysis CKD. <i>Materials and Methods:</i> This retrospective cohort included 263 adults with predialysis CKD followed for at least five years. Patients with baseline dialysis, kidney transplantation, coronary artery disease, heart failure, stroke, or malignancy were excluded. MAKE was defined as chronic dialysis, kidney transplantation, or a ≥50% decline in baseline eGFR. MACE comprised nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. Separate multivariable Cox regression models were constructed for MAKE and MACE, with treatment exposures modeled as time-dependent covariates. Fine-Gray competing-risk regression was performed as a sensitivity analysis. <i>Results:</i> During a median follow-up of 2829 days, MAKE occurred in 97 patients (36.9%) and MACE in 53 (20.2%), corresponding to incidence rates of 47.8 and 26.0 per 1000 person-years, respectively. In multivariable Cox models for MAKE, lower baseline eGFR (HR per 10 mL/min/1.73 m² increase 0.84, 95% CI 0.72-0.98; <i>p</i> = 0.024) and greater albuminuria severity were independently associated with risk. Compared with normal albuminuria, microalbuminuria and macroalbuminuria were associated with approximately fourfold and eightfold higher hazards, respectively (HR 4.15, 95% CI 1.91-9.00; and HR 7.73, 95% CI 4.01-14.90; both <i>p</i> < 0.001). For MACE, older age (HR per 10 years 1.52, 95% CI 1.12-2.06; <i>p</i> = 0.007) and diabetes mellitus (HR 3.00, 95% CI 1.60-5.62; <i>p</i> < 0.001) were independently associated with higher risk, while higher baseline eGFR was associated with lower risk in the treatment-adjusted models (HR per 10 mL/min/1.73 m² 0.76; <i>p</i> = 0.032-0.037). Neither time-dependent SGLT2 inhibitor nor ACE inhibitor/ARB use was significantly associated with MAKE or MACE. Fine-Gray competing-risk analyses yielded broadly consistent results. SGLT2 inhibitor exposure occurred in 75 patients (28.5%), and treatment-related findings should be interpreted cautiously given the limited exposure and observational design. <i>Conclusions:</i> MAKE and MACE were common in predialysis CKD. Lower baseline kidney function and albuminuria severity were associated with adverse kidney outcomes, whereas older age, diabetes mellitus, and lower baseline kidney function were associated with incident cardiovascular events. These findings highlight distinct renal and cardiovascular risk profiles in predialysis CKD.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 10","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149280876","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":"Pretreatment Lactate Dehydrogenase-to-Albumin Ratio Identifies an Early Adverse Prognostic Profile in IDH-Wildtype Glioblastoma: A Real-World Cohort Study.","authors":"Hayrani Kaya, Asim Armagan Aydin, Abdullah Umit, Ozan Deniz Guven, Ahmet Unlu, Fahriye Merve Balcioglu, Banu Ozturk, Mustafa Yildiz, Murat Kocer","doi":"10.3390/medicina62101958","DOIUrl":"10.3390/medicina62101958","url":null,"abstract":"<p><p><i>Background and Objectives</i>: Clinical outcomes remain markedly heterogeneous in glioblastoma, isocitrate dehydrogenase (IDH)-wildtype, despite contemporary molecular classification and established clinicopathological risk factors. We investigated whether the pretreatment lactate dehydrogenase-to-albumin ratio (LAR), an accessible circulating index integrating systemic disease- and host-related information, provides complementary prognostic information. <i>Materials and Methods</i>: We retrospectively evaluated 134 patients with glioblastoma, IDH-wildtype, central nervous system (CNS) World Health Organization (WHO) grade 4. An exploratory, cohort-specific LAR threshold was derived for 12-month overall survival (OS) and retained without re-optimization across subsequent analyses. Associations with OS and progression-free survival (PFS) were evaluated using Cox regression, and incremental prognostic performance was assessed against a baseline clinicopathological model. Temporal and continuous associations with survival, internal model validation, and the relationship between LAR and treatment response during adjuvant temozolomide therapy were also examined. <i>Results</i>: The cohort-derived LAR threshold was 5.718. High pretreatment LAR was associated with shorter median OS (5.5 vs. 16.0 months) and PFS (5.2 vs. 10.6 months; both <i>p</i> < 0.001) and remained independently associated with OS (adjusted hazard ratio [HR], 4.51; 95% CI, 2.84-7.18) and PFS (adjusted HR, 3.60; 95% CI, 2.33-5.56). Adding LAR to the clinicopathological model increased Harrell's C-index from 0.699 to 0.760 for OS and from 0.690 to 0.759 for PFS (both likelihood ratios, <i>p</i> < 0.001), with optimism-corrected C-indices of 0.743 and 0.742, respectively. Prognostic discrimination and adjusted effect estimates were greatest early in the follow-up period and attenuated over time, whereas continuous LAR showed nonlinear associations with both endpoints. Among the 104 patients who received adjuvant temozolomide, a high LAR was independently associated with progressive disease (adjusted odds ratio, 3.72; 95% CI, 1.28-10.81). <i>Conclusions</i>: Pretreatment LAR identified patients with IDH-wildtype glioblastoma who experienced poorer survival, and the prognostic effect was concentrated predominantly in the early disease course. Its incremental contribution beyond conventional clinicopathological characteristics supports the further evaluation of LAR as an accessible component of baseline risk characterization. However, independent external validation is required before clinical application.</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 10","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13707135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149280859","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 Diagnosis of Infertility and Recurrent Abortions in Obstetrics and Gynecology.","authors":"Sofoklis Stavros, Anastasios Potiris, Peter Drakakis","doi":"10.3390/medicina62101955","DOIUrl":"10.3390/medicina62101955","url":null,"abstract":"<p><p>Infertility and recurrent pregnancy loss (RPL) remain major challenges in reproductive medicine because of their complex and frequently multifactorial etiology [...].</p>","PeriodicalId":520709,"journal":{"name":"Medicina (Kaunas, Lithuania)","volume":"62 10","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149280916","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}