Diseases (Basel, Switzerland)最新文献

{"title":"Factors Associated with Ever Undergoing Colorectal Cancer Testing Among Adults in the United States.","authors":"Kingsley Kalu, Elizabeth Ayangunna, Bushra Shah, Gulzar Shah","doi":"10.3390/diseases14090350","DOIUrl":"10.3390/diseases14090350","url":null,"abstract":"<p><strong>Background: </strong>There is a growing incidence of colorectal cancer and related deaths in the United States, despite screening recommendations. This study analyzed the factors associated with having ever undergone endoscopic colorectal cancer testing among adults aged 45-85 years.</p><p><strong>Methods: </strong>This study analyzed data from the 2023 National Health Interview Survey (N = 17,087 participants). A multivariable logistic regression analysis was conducted to assess the relationship between sociodemographic and healthcare-related factors and the likelihood of having ever (a) undergone a colonoscopy or sigmoidoscopy and (b) taken a fecal immunochemical test (FIT).</p><p><strong>Results: </strong>The majority of the respondents had undergone an endoscopic colorectal exam (66%) vs. FIT (22%) in their lifetime. Compared to respondents aged 45-49 years, those in older age groups (50-85 years) were more likely to have ever undergone an endoscopic colorectal exam or FIT testing. African Americans were more likely to have ever undergone an endoscopic colorectal exam (Adjusted Odds Ratio (AOR) = 1.26, CI = 1.07-1.48), while American Indian/American Native and others (AOR = 1.35, CI = 1.02-1.80) were more likely to have ever undergone a FIT compared to White people. While education and health insurance were associated with having ever undergone an endoscopic colorectal exam, neither was associated with FIT. Compared to married respondents, widowed, separated, or divorced respondents (AOR = 0.88, CI = 0.79-0.98), and unmarried respondents (AOR = 0.70, CI = 0.60-0.82) were less likely to have ever undergone an endoscopic colorectal exam.</p><p><strong>Conclusions: </strong>Variations in factors associated with having ever undergone endoscopic colorectal cancer testing can help to understand disparities in screening uptake better and guide the development of targeted public health interventions to improve colorectal cancer prevention and early detection.</p>","PeriodicalId":72832,"journal":{"name":"Diseases (Basel, Switzerland)","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13605064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042425","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 Vitamin D Levels and Systemic Inflammation in Patients with Hashimoto's Thyroiditis.","authors":"Dean Kaličanin, Vanna Žnidar, Ivana Listeš, Maja Cvek, Ana Barić Žižić, Marko Vuletić, Sanda Sladić, Vivian Eneas Micek, Vesela Lovrić Torlak, Ante Punda, Vesna Boraska Perica","doi":"10.3390/diseases14090349","DOIUrl":"10.3390/diseases14090349","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Vitamin D is an important regulator of immune and inflammatory processes, while its deficiency is frequently observed in Hashimoto's thyroiditis (HT). The relationship between Vitamin D and systemic inflammation in HT remains insufficiently understood, particularly across different disease stages. <b>Methods</b>: We used the Olink Target 96 Inflammation panel to investigate this association. Inflammatory proteins and serum 25(OH)D levels were measured in 257 HT patients and 173 controls from the CROHT biobank. Participants were categorized as Vitamin D deficient (<20 ng/mL) or non-deficient (≥20 ng/mL), with HT patients further stratified as euthyroid, hypothyroid, or levothyroxine-treated. Associations between 25(OH)D and 92 inflammatory proteins were assessed using multivariable linear regression adjusted for age, sex, BMI, smoking, and season of blood sampling, followed by interaction testing and meta-analysis. <b>Results</b>: Vitamin D deficiency was prevalent in both HT patients and controls. Among Vitamin D-deficient HT patients, higher 25(OH)D levels showed nominal inverse associations with the previously reported HT-associated inflammatory proteins IL-17C, CCL20, and CCL11, as well as with GDNF. Among non-deficient HT patients, a nominal positive association with CD6 was observed. None of these associations or interaction terms remained statistically significant after false discovery rate correction. <b>Conclusions</b>: These findings should therefore be considered exploratory and hypothesis-generating. Nevertheless, the observed Vitamin D status-specific patterns suggest that the relationship with inflammatory profiles in HT may differ according to Vitamin D status and warrant validation in prospective and mechanistic studies.</p>","PeriodicalId":72832,"journal":{"name":"Diseases (Basel, Switzerland)","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13605515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Correlates of Type 2 Diabetes Self-Management in Adults: A Cross-Sectional Study.","authors":"Paula-Alexandra Popovici, Andreea Diana Igna, Bianca-Lăcrimioara Petca, Timea Claudia Ghitea, Mihaela Simona Popoviciu","doi":"10.3390/diseases14090348","DOIUrl":"10.3390/diseases14090348","url":null,"abstract":"<p><strong>Background: </strong>Diabetes self-management is essential for type 2 diabetes care, but cross-sectional associations may be distorted when questionnaire scores are incorrectly derived or converted into arbitrary categories. We evaluated clinical and sociodemographic correlates of the continuous Diabetes Self-Management Questionnaire (DSMQ) total score in a secondary analysis of an outpatient clinical database.</p><p><strong>Methods: </strong>The analysis included 262 adults with type 2 diabetes recruited between 1 November 2025 and 1 May 2026. DSMQ total and subscale scores were independently recalculated from the 16 item-level responses using the published scoring algorithm. The primary analysis retained the DSMQ score as a continuous outcome. The database provided a participant-level count of documented glucose measurements > 250 mg/dL. This operational count was not treated as a standardized clinical event or severity category; individual measurement timestamps, participant-specific observation duration, and the total number of glucose measurements were unavailable.</p><p><strong>Results: </strong>The recalculated DSMQ score was 5.26 ± 2.35 (median 5.10; interquartile range 3.12-7.08). Among 261 participants with an interpretable sex code, 144 (55.2%) were women. In univariable analyses, lower DSMQ scores were concurrently associated with longer diabetes duration, a higher recorded severe-hyperglycemia count, higher HbA1c, and higher fasting glucose. In the adjusted model (<i>n</i> = 261), the recorded severe-hyperglycemia count remained negatively associated with DSMQ score (adjusted coefficient -0.412 points per recorded episode; 95% confidence interval -0.621 to -0.203; <i>p</i> < 0.001). Individualized versus hospital-based education was not independently associated with the corrected score. A beta-regression sensitivity analysis produced a concordant direction of association (coefficient -0.152 on the logit mean scale; <i>p</i> < 0.001). The linear model explained 17.2% of observed variance (adjusted R² = 0.136), with an optimism-corrected R² of 0.099.</p><p><strong>Conclusions: </strong>The recorded severe-hyperglycemia count was a concurrent correlate of lower DSMQ score. Because the study is cross-sectional and glucose-measurement counts were preaggregated without observation-time or monitoring-frequency data, the findings do not establish temporal direction, causality, or individual-level clinical prediction. Item-level score verification and continuous-outcome analysis materially changed the interpretation of the dataset.</p>","PeriodicalId":72832,"journal":{"name":"Diseases (Basel, Switzerland)","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13605858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042097","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":"Suicide Risk and Associated Factors in Patients with Pancreatic Cancer: A Systematic Review.","authors":"Maxence Chicoisneau, Christelle Bouchart, Matthieu Hein","doi":"10.3390/diseases14090346","DOIUrl":"10.3390/diseases14090346","url":null,"abstract":"<p><strong>Background/objectives: </strong>Pancreatic cancer (PC) is characterized by poor survival and a substantial psychological burden. Growing evidence suggests that individuals diagnosed with PC are at an increased risk of suicide. This systematic review aimed to synthesize the available evidence on suicide risk among patients with PC and to identify factors associated with increased vulnerability.</p><p><strong>Methods: </strong>Following the PRISMA 2020 guidelines, a systematic review of the PubMed/MEDLINE and Scopus databases was conducted in August 2026. Of the 1015 records initially identified, 23 studies published between 2010 and July 2026 were included. Eligible studies specifically examined suicide risk among patients with PC using registry-based, administrative, or death certificate data. Risk of bias was assessed using the ROBINS-E tool.</p><p><strong>Results: </strong>Most included studies reported a higher suicide risk among patients with PC compared with the general population and, in many analyses, compared with patients with other cancer types. Large population-based studies generally reported standardized mortality ratios of approximately 2 to 11, although substantially higher estimates were observed in selected populations and specific subgroups. Suicide risk was particularly elevated during the early post-diagnosis period (with several studies identifying the greatest excess risk within the first two months following diagnosis), remained elevated throughout the first year and gradually declined thereafter. Male sex emerged as the most consistently demonstrated risk factor for suicide, while associations with unmarried status were observed across several studies but were derived largely from partially overlapping SEER-based cohorts. Additional evidence suggests a potential role for social vulnerability and poor prognostic factors.</p><p><strong>Conclusions: </strong>Despite the predominantly observational nature of the available evidence, the consistency of the findings highlights the importance of increased awareness of suicide vulnerability among patients with PC and supports consideration of psychosocial assessment and mental health support within routine pancreatic cancer care. Future prospective studies are needed to better characterize high-risk patients and to inform targeted suicide prevention strategies.</p>","PeriodicalId":72832,"journal":{"name":"Diseases (Basel, Switzerland)","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13605502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Traditional Prognostic Scores: Associations of Organ Dysfunction and Metastatic Malignancy with Mortality in Fournier's Gangrene.","authors":"Pantelie Nicolcescu, Alina Bereanu, Ionela Mihai, Manuela Arbune, Mihai Sava, Nicolae Grigore, Adrian Hasegan","doi":"10.3390/diseases14090347","DOIUrl":"10.3390/diseases14090347","url":null,"abstract":"<p><p><b>Background</b>: Fournier's gangrene (FG) is a severe necrotizing infection requiring urgent resuscitation, empirical broad-spectrum antimicrobials, and radical debridement. We evaluated established severity scores, Sepsis-3-defined organ dysfunction, and malignancy status in a single-center cohort with surgically confirmed FG. <b>Methods</b>: This retrospective observational study analyzed 21 consecutive adult patients treated between 1 January 2019 and 31 January 2025 at a Romanian tertiary referral center. Pre-treatment baseline FGSI, SFGSI, LRINEC, NLR, SOFA, and qSOFA were calculated. All patients received intravenous antimicrobials within 90 min and underwent surgical debridement within 6 h. In-hospital mortality was assessed via ROC curves, Fisher's exact test, Haldane-Anscombe odds ratios (ORs), and Firth penalized logistic regression. <b>Results</b>: In-hospital mortality was 19.0% (4/21). Admission Sepsis-3 sepsis (SOFA ≥ 2) was present in 7/21 patients (33.3%) and accounted for all four deaths, whereas zero deaths occurred among the 14 patients without organ dysfunction (Fisher's exact <i>p</i> = 0.006; OR 37.33, 95% CI 1.60-866.90). All nine qSOFA-positive patients without SOFA dysfunction (42.9%) and five patients without organ dysfunction (23.8%) survived. FGSI showed the highest discrimination (AUC 0.934, 95% CI 0.76-1.00), followed by SFGSI (AUC 0.919, 95% CI 0.78-1.00) and LRINEC (AUC 0.860, 95% CI 0.68-0.99); NLR showed poor discrimination (AUC 0.574, 95% CI 0.13-1.00). Metastatic solid malignancy was present in 2/4 non-survivors versus 0/17 survivors (Fisher's exact <i>p</i> = 0.029; OR 35.00, 95% CI 1.27-961.40). All four non-survivors met Sepsis-3 criteria (two with and two without metastases). Seven patients required ICU admission (all four non-survivors and three survivors). <b>Conclusions</b>: Admission Sepsis-3-defined organ dysfunction was strongly associated with in-hospital mortality. FGSI and SFGSI demonstrated the highest point-estimate discrimination, LRINEC also showed good discrimination, and NLR demonstrated limited standalone discriminative value. Metastatic malignancy occurred exclusively among non-survivors but overlapped with Sepsis-3-defined sepsis. These findings support the combined assessment of Sepsis-3-defined organ dysfunction and established severity scores for early risk stratification, warranting validation in larger cohorts.</p>","PeriodicalId":72832,"journal":{"name":"Diseases (Basel, Switzerland)","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13605571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042323","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":"Cardiovascular-Cognitive Associations During Physiological Challenges in Relapsing-Remitting Multiple Sclerosis.","authors":"Juan M Racosta, Jorge Arocha-Perez, Da Hee Seo, Samin Ayromlou, Patricia M Riccio","doi":"10.3390/diseases14090343","DOIUrl":"10.3390/diseases14090343","url":null,"abstract":"<p><strong>Background: </strong>Cognitive impairment, particularly reduced information processing speed (IPS), is a clinically meaningful manifestation of multiple sclerosis (MS). The Symbol Digit Modalities Test (SDMT) is a sensitive, validated measure of IPS widely used in MS research. While vascular and hemodynamic factors are increasingly recognized as contributors to cognitive performance in MS, their relationship with IPS across distinct physiologic challenges remains unexplored.</p><p><strong>Objective: </strong>This pilot study examined IPS and cardiovascular responses in ten people with MS (PwMS), all of whom had relapsing-remitting MS (RRMS), and ten age- and sex-matched healthy participants during four acute physiologic challenges: head-up tilt, head-down tilt, isometric handgrip, and aerobic cycling.</p><p><strong>Methods: </strong>Beat-to-beat blood pressure and heart rate were continuously recorded; IPS was assessed using the oral SDMT.</p><p><strong>Results: </strong>Baseline SDMT scores were lower in PwMS than in healthy participants (<i>p</i> < 0.05). A between-group effect was observed for cycling-related SDMT change (<i>r</i> = 0.49, 95% CI 0.05-0.76; <i>p</i> = 0.03). Despite comparable training impulse (TRIMP)-standardized workloads, systolic blood pressure during cycling was higher in PwMS (<i>p</i> < 0.05), and the cycling-related systolic blood pressure response showed a between-group effect of <i>r</i> = 0.46 (95% CI 0.02-0.75; <i>p</i> = 0.04). In healthy participants, baseline SDMT performance was correlated with resting heart rate and blood pressure, and cycling-related SDMT change was inversely correlated with the blood pressure response.</p><p><strong>Conclusions: </strong>These exploratory findings suggest possible differences in the relationship between cardiovascular measures and IPS during acute physiologic challenges, particularly aerobic exercise. However, the small sample size and wide confidence intervals preclude firm conclusions regarding an exercise-specific effect or differences in cardiovascular-cognitive coupling.</p>","PeriodicalId":72832,"journal":{"name":"Diseases (Basel, Switzerland)","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13605707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041562","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":"Thyrotoxic Hypokalemic Periodic Paralysis in Colombia: From a Single Case to a Review of the National Experience.","authors":"H A Nati-Castillo, Alin Abreu Lomba, Juan David Urrea Ospina, Jhan S Saavedra-Torres, Sebastián Lozano Ciro, Juliana Vela Paz, Nelly Johana Alvis Linero, Juan S Izquierdo-Condoy","doi":"10.3390/diseases14090345","DOIUrl":"10.3390/diseases14090345","url":null,"abstract":"<p><p>Thyrotoxic periodic paralysis (TPP) is a reversible but potentially severe complication of thyrotoxicosis characterized by acute muscle weakness and hypokalemia resulting predominantly from intracellular potassium redistribution. Although classically associated with Asian populations, TPP is increasingly recognized in Latin America. We report a 38-year-old Colombian man with recurrent nocturnal proximal quadriparesis, preserved deep tendon reflexes, serum potassium of 2.3 mEq/L, and biochemical thyrotoxicosis secondary to Graves disease. In parallel, we conducted a structured review of published Colombian cases identified through searches of PubMed/MEDLINE, Scopus, Web of Science, SciELO, and Google Scholar from inception through 1 May 2026. Fourteen previously published cases were identified, yielding 15 cases including the index patient. All patients were male, with a mean age of 31.4 ± 7.4 years. Deep tendon reflexes were normal in 4/13 (30.8%) cases in which they were documented, demonstrating that preserved reflexes do not exclude TPP. TSH was suppressed below 0.05 mIU/L in 14/15 (93.3%) patients. Electrocardiographic findings were reported in only 7/15 cases, and antithyroid drug doses in 6/15, highlighting substantial heterogeneity in reporting. All reported patients recovered muscle strength following acute management. TPP should therefore be considered in patients presenting with acute proximal weakness and hypokalemia even when deep tendon reflexes are preserved or overt manifestations of thyrotoxicosis are absent. Standardized reporting of biochemical, electrocardiographic, therapeutic, and follow-up data is needed to improve characterization of TPP in underrepresented populations.</p>","PeriodicalId":72832,"journal":{"name":"Diseases (Basel, Switzerland)","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13605459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042228","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":"Can Diagnostic Delay Amplify Drug Resistance in Tuberculosis? A Critical Integrative Reflection on Bacterial Adaptation, Persistence, Within-Host Evolution, and Heteroresistance.","authors":"Ariel Torres, Paloma González, Gisselle Trujillo, Martha Fors","doi":"10.3390/diseases14090344","DOIUrl":"10.3390/diseases14090344","url":null,"abstract":"<p><strong>Background/objectives: </strong>Drug resistance in tuberculosis remains one of the major challenges to global disease control. Traditionally, its emergence has been attributed to factors such as treatment interruption, poor adherence, and the selective pressure exerted by antimicrobial agents. However, recent advances in bacterial genetics, within-host evolution, cellular persistence, and heteroresistance suggest that relevant biological processes may develop before treatment initiation. The aim of this critical integrative reflection was to explore the biological plausibility that diagnostic delay may act as an amplifying factor for adaptive and evolutionary mechanisms potentially associated with drug resistance in Mycobacterium tuberculosis.</p><p><strong>Methods: </strong>A structured documentary search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar. Of the 86 documents initially identified, 29 studies were selected using predefined inclusion and exclusion criteria. The evidence was analysed through a conceptual convergence matrix, which enabled the organisation of findings into five analytical categories: diagnostic delay and programmatic determinants; mechanisms of resistance, bacterial adaptation, and clinical implications; persistence and drug tolerance; within-host evolution and genetic diversity; and heteroresistance and resistant subpopulations. In addition, four institutional reports were incorporated to contextualise the issue from a global perspective.</p><p><strong>Results: </strong>The reviewed evidence suggests that extended persistence of infection before diagnosis may favour biological opportunities for bacterial adaptation, the persistence of tolerant subpopulations, the accumulation of genetic diversity, and the emergence of variants with distinct drug susceptibility profiles. Although the available studies do not demonstrate a direct causal relationship, they support the plausibility of an evolutionary trajectory capable of influencing the dynamics of drug resistance.</p><p><strong>Conclusions: </strong>An expanded model of drug resistance in tuberculosis is proposed, in which diagnostic delay does not constitute a direct cause of resistance but rather a potential amplifying factor for biological adaptation and evolutionary change occurring before treatment initiation. This hypothesis generates new avenues for research on the interaction between timely diagnosis, bacterial evolution, and drug resistance.</p>","PeriodicalId":72832,"journal":{"name":"Diseases (Basel, Switzerland)","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13605300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics, ERCP Management, and Early Adverse Events Among Patients with Choledocholithiasis at a Romanian Tertiary Referral Center: A Retrospective Cohort.","authors":"Cristina Angelescu, Ioana Anca Bădărău, Radu Bogdan Mateescu","doi":"10.3390/diseases14090340","DOIUrl":"10.3390/diseases14090340","url":null,"abstract":"<p><strong>Background: </strong>Choledocholithiasis is a common cause of biliary obstruction and may lead to acute cholangitis, pancreatitis, and other serious complications. Despite the widespread use of endoscopic retrograde cholangiopancreatography (ERCP), data describing the clinical profile and management of patients with choledocholithiasis in Romania remain limited.</p><p><strong>Objectives: </strong>This study aimed to describe demographic characteristics, diagnostic work-up, procedural characteristics of ERCP, microbiological findings, and early clinical outcomes of patients with choledocholithiasis undergoing ERCP at a high-volume tertiary referral center.</p><p><strong>Methods: </strong>We conducted a retrospective, observational, single-center cohort study of adults with confirmed choledocholithiasis who underwent ERCP between January 2021 and September 2025. During the study period, 2514 ERCP procedures were performed at our center for all indications, of which 631 unique patients with choledocholithiasis fulfilled the eligibility criteria and were included in the final cohort. Demographic characteristics, comorbidities, clinical presentation, laboratory findings, imaging results, ERCP-related variables, and early procedural outcomes were analyzed descriptively.</p><p><strong>Results: </strong>The cohort included 631 patients with a median age of 68 years (IQR 56-77), and 59.9% were women. Abdominal pain (59.3%) and jaundice (48.2%) were the most common presenting symptoms. Acute cholangitis was present in 57.7% of patients; among these patients, severity according to the Tokyo Guidelines 2018 was mild in 52.7%, moderate in 10.7%, and severe in 36.6%. Computed tomography was the most frequent imaging modality confirming the diagnosis (42.5%), followed by magnetic resonance cholangiopancreatography (30.7%) and ultrasonography (26.8%). Median common bile duct diameter was 14 mm and median stone diameter was 7.9 mm; multiple stones or sludge were present in 56.7%. Difficult cannulation occurred in 10.8% of patients, mechanical lithotripsy in 19.5%, biliary stent placement in 18.9%, and post-ERCP pancreatitis in 10.8%. Intraprocedural bleeding occurred in 4.9% of patients, while post-ERCP bleeding occurred in 1.9% and no perforations were recorded. In-hospital mortality occurred in 2 patients (0.3%). Bile cultures were obtained in 52 patients (8.3%), of which 37 (71.2%) yielded bacterial growth, with <i>Escherichia coli</i> being the most frequently isolated microorganism.</p><p><strong>Conclusions: </strong>This study provides real-world evidence on the epidemiology, diagnostic evaluation, ERCP management, and early outcomes of choledocholithiasis in a Romanian tertiary referral center.</p>","PeriodicalId":72832,"journal":{"name":"Diseases (Basel, Switzerland)","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13605875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041962","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":"Endothelial Injury as a Potential Contributor to Cardiovascular Toxicity in Hematologic Malignancies.","authors":"Aladin Altić, Nikola Jovanovic, Dario Vucic, Nikolaos Katsivelos, Lydia Giannakou, Jongyeob Kim, Ali Maaz, Una Tonkovic, Aleksandar Sič, Marko Baralic","doi":"10.3390/diseases14090342","DOIUrl":"10.3390/diseases14090342","url":null,"abstract":"<p><p>Cardiovascular toxicity is an important complication of treatment for hematologic malignancies, but it is often discussed mainly in terms of direct myocardial injury. Endothelial injury may provide a common link between several cardiovascular complications seen in these patients. Endothelial dysfunction may already be present because of the malignancy itself and can be further increased by anticancer treatment, immune activation and haematopoietic stem cell transplantation. Oxidative stress, reduced nitric oxide availability, inflammation, increased vascular permeability and activation of coagulation can shift the endothelium from a protective to a pro-inflammatory and prothrombotic state. These changes could contribute to hypertension, thrombosis, atherosclerotic disease, coronary microvascular dysfunction, arterial stiffness and myocardial dysfunction. The role of endothelial injury is particularly relevant with BCR-ABL inhibitors, proteasome inhibitors, CAR-T-cell therapy, bispecific antibodies and transplantation, although the mechanisms and strength of evidence differ between treatments. Several circulating biomarkers and tools, including angiopoietin-2, von Willebrand factor, soluble thrombomodulin, adhesion molecules and the Endothelial Activation and Stress Index, may help identify endothelial injury, but their clinical roles still remain unclear. This review examines endothelial injury across hematologic malignancies and their treatments and discusses its role in cardiovascular toxicity, current approaches to vascular protection and the main gaps that need to be addressed before endothelial assessment can become part of routine cardio-oncology care.</p>","PeriodicalId":72832,"journal":{"name":"Diseases (Basel, Switzerland)","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13605519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042296","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}