Medical sciences (Basel, Switzerland)最新文献

{"title":"Orthopaedic Trauma in Patients with Documented Alcohol Use: Injury Mechanisms, Clinical Characteristics, and Geriatric Vulnerability.","authors":"Irina Sirbu, Bianca-Ana Dmour, Stefan-Dragos Tîrnovanu, Bogdan Puha, Eliza-Geanina Cogian, Mariana Zubenschi, Alexandru Filip, Ioana-Dana Alexa, Mihaela-Camelia Tîrnovanu, Popescu Dragos-Cristian, Adrian-Claudiu Carp, Awad Dmour","doi":"10.3390/medsci14040504","DOIUrl":"10.3390/medsci14040504","url":null,"abstract":"<p><strong>Background: </strong>Alcohol-related conditions may influence both injury patterns and in-hospital management in orthopaedic trauma. This study evaluated the clinical characteristics, injury mechanisms, treatment patterns, and hospital outcomes of adults with acute orthopaedic trauma and documented alcohol use, with particular attention to geriatric vulnerability and alcohol withdrawal.</p><p><strong>Methods: </strong>This retrospective single-centre cohort included adults admitted between January 2018 and December 2025 with acute musculoskeletal trauma and an alcohol-related diagnosis during the same hospitalisation. Patients were classified according to their predominant recorded alcohol-related presentation. Geriatric patients, defined as those aged 65 years or older, were compared with younger adults. Injury mechanisms, comorbidities, operative treatment, intensive care unit involvement, hospital length of stay, mortality, and recorded hospitalisation costs were analysed.</p><p><strong>Results: </strong>The final cohort comprised 294 patients, including 87 geriatric patients. Geriatric patients more frequently sustained same-level or low-energy falls than younger adults (46.0% versus 25.6%; Holm-adjusted <i>p</i> = 0.005) and had a higher prevalence of proximal femoral fractures (40.2% versus 21.7%; OR 2.42, 95% CI 1.41 to 4.16). Any recorded ICU involvement was more frequent among geriatric patients, although prolonged ICU stays of 24 h or longer did not differ significantly between age groups. Alcohol withdrawal was documented in 46 patients and was associated with longer hospitalisation and a longer admission-to-surgery interval. In-hospital mortality occurred in 5 of 46 patients with documented withdrawal (10.9%) and 5 of 248 without withdrawal (2.0%; unadjusted OR 5.93, 95% CI 1.64 to 21.37; <i>p</i> = 0.010).</p><p><strong>Conclusions: </strong>Orthopaedic trauma patients with documented alcohol use represent a clinically heterogeneous population. Geriatric patients showed greater vulnerability to low-energy trauma, proximal femoral fracture, comorbidity, and intensive care involvement, while alcohol withdrawal identified patients with a more complex hospital course. Early recognition of withdrawal risk and enhanced inpatient safety measures may improve orthopaedic care. These findings support careful assessment of alcohol-related risk, early recognition of withdrawal, and heightened inpatient safety precautions.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833970","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":"Integrated Cardiopulmonary Profile as an Additive Signal in Patients Evaluated for Suspected Newly Detected Atrial Fibrillation.","authors":"Nilima Rajpal Kundnani, Abhinav Sharma, Ciprian Ilie Rosca, Milan Daniel Velimirovici, Ariana Violeta Nicoras, Dana Emilia Velimirovici, Dragos Cozma, Doina Georgescu","doi":"10.3390/medsci14040507","DOIUrl":"10.3390/medsci14040507","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Atrial fibrillation (AF) is associated with atrial remodelling, hemodynamic stress, and complex cardiopulmonary interactions. While natriuretic peptides and echocardiographic abnormalities are established markers of AF-related substrate, the contribution of spirometry changes, as a landmark of pulmonary impairment, remains less clearly defined. This study evaluated whether AF is associated with an integrated cardiopulmonary profile characterized by altered spirometry, increased NT-proBNP, and conventional echocardiographic markers of left atrial structure and function.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a retrospective, single-center observational study based on an existing clinical database of adult patients referred for 24 h 12-lead Holter ECG monitoring because of palpitations and/or chest pain. None of the included patients had a previously documented diagnosis of atrial fibrillation before Holter monitoring. Because a single 24 h Holter recording cannot establish spontaneous termination or long-term temporal pattern with certainty, AF documented for the first time during this recording is referred to throughout as \"newly detected AF\" rather than \"paroxysmal AF\". During Holter monitoring, no ECG changes suggestive of myocardial ischemia were detected. From 536 records of patients without previously known AF who underwent 24 h 12-lead Holter ECG monitoring for palpitations and/or chest pain, 164 patients were retained for the main comparison, including 48 with newly detected paroxysmal AF and 116 without AF. Demographic, biochemical, spirometric, and echocardiographic variables were analyzed. The main respiratory parameters were forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow (PEF). NT-proBNP was the primary biomarker, while conventional left atrial structural and functional variables were used for echocardiographic assessment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;NT-proBNP was markedly higher in the AF group (684.5 vs. 62.3 pg/mL, &lt;i&gt;p&lt;/i&gt; = 0.001), even when accounting for confounders like age, CKD, or CPD, showing by far the largest between-group difference among the biomarkers assessed (formal discrimination statistics such as ROC/AUC were not computed). The exploratory inflammatory markers assessed (hs-CRP, neutrophil/lymphocyte ratio, homocysteine) showed only modest, non-significant differences. Conventional echocardiographic parameters did not differ significantly between groups. In the strict complete-case comparison, spirometric indices did not reach statistical significance; however, preliminary project-level analysis showed lower FVC, FEV1, and PEF in AF patients, but without supporting the COPD diagnosis, and exploratory correlations suggested a relationship between spirometric performance and left atrial function.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this cohort, AF was most strongly associated with NT-proBNP, while the respiratory signal was wea","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835409","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":"Image Quality as an Important Confounder in Quantitative OCT Angiography: A Review with Quantitative Synthesis.","authors":"Lilla István, Cecilia Czakó, Róbert Debreczeni, Péter Sótonyi, András Horváth, Nóra Szentmáry, Zoltán Zsolt Nagy, Illés Kovács","doi":"10.3390/medsci14040498","DOIUrl":"10.3390/medsci14040498","url":null,"abstract":"<p><strong>Background: </strong>Optical coherence tomography angiography (OCTA) provides quantitative metrics of the retinal microvasculature, most prominently vessel density (VD), that are increasingly used as biomarkers in ocular, systemic, and cerebrovascular disease. Because OCTA relies on the detection of flow-related motion contrast, image quality has emerged as a pervasive determinant of these metrics, yet its effect has been reported in fragmentary and non-comparable ways across the literature.</p><p><strong>Methods: </strong>We identified OCTA studies indexed in PubMed that examined the relationship between image quality and quantitative OCTA parameters, and we summarised their methods and findings across the macular, foveal avascular zone, and peripapillary regions and across vascular layers. We integrated directly comparable per-unit scan-quality effects using random-effects meta-analysis and separately synthesized direct cross-sectional Pearson correlations between manufacturer-reported image quality and macular vessel-density outcomes from independent healthy cohorts.</p><p><strong>Results: </strong>Higher image quality was associated with higher measured vessel density in every contributing dataset. On the Optovue scan-quality (SQ, 0-10) scale, superficial macular VD increased by 3.46% (95% CI 1.85-5.07) per SQ unit in controlled signal-attenuation experiments and by covariate-adjusted observational estimates ranging from 0.90% to 2.16% per SQ unit; a combined order-of-magnitude estimate across both estimator types was 1.64% (95% CI 1.15-2.12). Peripapillary estimates were heterogeneous and derived from only two independent cohorts; they were therefore summarised descriptively rather than pooled. Across three independent externally authored healthy cohorts reporting direct cross-sectional Pearson correlations, higher image quality was strongly associated with higher macular vessel-density outcomes (random-effects pooled r = 0.64, 95% CI 0.50-0.75; <i>I</i>² = 49%).</p><p><strong>Conclusions: </strong>Image quality is an important, directional confounder of VD-based OCTA metrics whose magnitude can rival the biological or physiological signal of interest. Platform-appropriate standardisation, transparent reporting, and consideration of image quality in acquisition and analysis are therefore important for the valid interpretation of vessel-density measurements, particularly in functional and longitudinal studies.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835413","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":"Lifestyle Interventions During Radiotherapy: A Scoping Review of Their Effects on Toxicity and Patient-Centered Outcomes.","authors":"Anastasia Stergioula, Mavra Antiochou-Plexida, Marietina Giannoutsou, Eleni Gotsopoulou, Stamatina Karavopoulou, Ioanna Kitsou, Chrysovalantou Manolopoulou, Maria Pantelidi, Chrysanthi Pontiki, Panagiotis Plotas","doi":"10.3390/medsci14040501","DOIUrl":"10.3390/medsci14040501","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Lifestyle interventions may alleviate treatment-related toxicity and improve patient-centered outcomes during radiotherapy (RT). This scoping review mapped randomized evidence on lifestyle interventions delivered during RT, summarized reported outcomes, and identified evidence gaps. <b>Methods</b>: PubMed and Web of Science were searched for randomized controlled trials (RCTs) published from April 2016 to April 2026. Eligible studies included adults who received exercise, nutritional, psychological, combined, or multimodal lifestyle interventions during their RT treatment. Study characteristics, intervention details, and outcomes were charted and narratively synthesized. <b>Results</b>: Twenty-three RCTs were included. Exercise interventions were evaluated in 12 studies, nutrition in five, psychological in one, combined exercise-and-nutrition in two, combined nutrition-and-psychological in two, and multimodal interventions comprising all three components in one study. Breast, head and neck, and prostate cancers were most frequently represented. QoL, fatigue, and functional capacity were the most commonly assessed outcomes. Exercise interventions were most consistently associated with improvements in fatigue and functional capacity, whereas effects on QoL were less consistent. Nutritional interventions showed favorable findings for nutritional status and treatment-related toxicity. Psychological, combined, and multimodal interventions showed favorable findings for selected QoL, fatigue, nutritional, and psychological outcomes. Key evidence gaps included heterogeneous intervention protocols and outcomes assessment, limited evidence for non-exercise interventions and underrepresentation of several cancer populations. <b>Conclusions</b>: Lifestyle interventions delivered during RT may improve selected patient-centered and treatment-related toxicity outcomes. Exercise comprised the largest body of evidence, whereas other intervention types were less frequently evaluated. Heterogeneity across studies limits conclusions regarding optimal approaches. Further RT-specific studies using standardized intervention programs and comparable outcome measures are required to inform supportive-care delivery.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835521","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":"Temperature as a Regulator of Red Blood Cell Fate: From Membrane Dynamics to Cellular Clearance.","authors":"Gregory Barshtein, Ivana Pajić-Lijaković, Alexander Gural","doi":"10.3390/medsci14040503","DOIUrl":"10.3390/medsci14040503","url":null,"abstract":"<p><p>Fever-range hyperthermia (38-41 °C) is a typical physiological response to infection, inflammation, and systemic stress. Although increased temperatures are known to affect blood rheology and erythrocyte activity, their comprehensive impact on red blood cell (RBC) structure, mechanics, and lifespan remains incompletely understood. This review summarizes current understanding of how moderate hyperthermia affects RBC membrane structure, internal behavior, mechanical properties, and clearance cues. Evidence shows that brief exposure to febrile temperatures primarily induces reversible biophysical modifications, including heightened membrane fluidity, increased membrane fluctuations, changes in hemoglobin-water interactions, and short-term improvements in deformability. These changes reflect adaptive adjustments within the membrane-cytosol-cytoskeleton system, potentially temporarily boosting microcirculatory flow. On the other hand, prolonged or repeated heat stress causes oxidative damage, hemoglobin auto-oxidation, accumulation of membrane-bound hemoglobin, band 3 clustering, cytoskeletal restructuring, calcium imbalance, and disruption of membrane lipid asymmetry. These effects weaken membrane stability and lead to vesiculation, shape changes, increased cell fragility, altered aggregation, enhanced adhesion, and activation of clearance mechanisms. A primary focus is the transition from reversible membrane softening to permanent structural damage over time. The research supports a model in which temperature affects RBC mechanics and related membrane, cytosolic, and signaling processes that influence RBC viability. We propose interpreting febrile hyperthermia as a dynamic factor that shifts RBCs from an adaptive phase to accelerated aging and removal during prolonged heat exposure. This perspective enhances our understanding of RBC behavior during fever and systemic inflammation and underscores the role of temperature in shaping erythrocyte function and lifespan.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835429","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":"Comparative Classification Performance of Anthropometric, Body Composition, and Cardiometabolic Indices for Identifying ALAD-Defined Metabolic Syndrome in Panamanian Adults.","authors":"Griselda Arteaga, Xenia Hernandez Adames, Ivonne Torres-Atencio, Ana Espinosa De Ycaza, Maria Fabiana Piran Arce, Ana Tejada Espinosa, Orlando Serrano Garrido","doi":"10.3390/medsci14040500","DOIUrl":"10.3390/medsci14040500","url":null,"abstract":"<p><strong>Background: </strong>Composite anthropometric and cardiometabolic indices have emerged as practical tools for identifying metabolic syndrome (MetS), but their comparative classification performance against ALAD-defined MetS has not been comprehensively evaluated in Panamanian adults. This study compared the classification performance of selected anthropometric, body composition, and cardiometabolic indices for identifying metabolic syndrome defined according to the Latin American Diabetes Association (Asociación Latinoamericana de Diabetes [ALAD]) criteria in non-diabetic Panamanian adults.</p><p><strong>Methods: </strong>This cross-sectional study included 262 adults without diabetes (110 men and 152 women). Clinical and laboratory measurements were used to calculate the body mass index (BMI), waist-to-height ratio (WHtR), visceral adiposity index (VAI), lipid accumulation product (LAP), triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C), atherogenic index of plasma (AIP), cardiometabolic index (CMI), and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). Classification performance was evaluated using receiver operating characteristic (ROC) curve analysis, optimal cut-off values, and DeLong's test. Age-adjusted logistic regression assessed associations between each index and ALAD-defined MetS.</p><p><strong>Results: </strong>Composite indices integrating anthropometric and metabolic parameters showed high classification performance. CMI had the highest observed AUC in men (AUC = 0.933; 95% CI: 0.887-0.979), whereas LAP had the highest observed AUC in women (AUC = 0.854; 95% CI: 0.778-0.931).</p><p><strong>Conclusions: </strong>CMI and LAP showed high classification performance for identifying ALAD-defined MetS in Panamanian adults without diabetes, with the highest observed AUCs in men and women, respectively. These simple, inexpensive indices may have potential utility as screening tools for identifying ALAD-defined MetS in primary healthcare settings. The proposed cut-off values are exploratory and require external validation in independent Panamanian and Latin American populations before clinical implementation.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835518","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 Evaluation of the Clinical Effectiveness and Safety of Biologic Therapies in Psoriasis-Real-World Evidence up to 64 Weeks of Therapy.","authors":"Patrycja Lemiesz, Julia Nowowiejska-Purpurowicz, Tomasz W Kaminski, Iwona Flisiak","doi":"10.3390/medsci14040502","DOIUrl":"10.3390/medsci14040502","url":null,"abstract":"<p><p><b>Background</b>: Biological treatment of psoriasis has revolutionized the therapy of this disease, in most cases enabling complete remission of skin lesions. <b>Methods</b>: This study aimed to analyze real-world evidence from 165 patients (mean age 38.1 ± 5.66) treated with 11 biological drugs at our Dermatology Department. <b>Results</b>: Skin lesion severity, expressed by Psoriasis Area and Severity Index (PASI) and Body Surface Area (BSA), improved significantly throughout the treatment, along with the quality of life, expressed by Dermatology Life Quality Index (DLQI) (all <i>p</i> < 0.0001). We observed a statistically significantly higher reduction in skin lesion severity and life quality improvement with IL-23 and IL-17 inhibitors compared to TNFα inhibitors (both <i>p</i> < 0.0001). Secondary loss of response was observed in 26.7% of patients treated with anti-TNF agents, compared to 15.0% in the anti-IL-23 group and 8.3% in the anti-IL-17 group (χ² test, <i>p</i> = 0.0683). Patients who had been treated in the past with biologics had significantly higher PASI and BSA at week 16 of therapy compared to those who were bio-naïve. A positive correlation was demonstrated between PASI at 16 weeks and BMI (R = 0.15; <i>p</i> = 0.0396). There was no correlation between the duration of psoriasis, sex, or age of patients when introducing biologics and PASI at any of the timepoints (<i>p</i> > 0.05). The most frequent side effects were infections, occurring mainly in patients on anti-TNFα agents and bimekizumab. <b>Conclusions</b>: IL-17 and IL-23 inhibitors demonstrated superior efficacy compared to TNFα inhibitors, with higher rates of complete skin clearance and a lower tendency toward loss of response. The worst efficacy and the highest rate of loss of response were observed in case of adalimumab. These findings support the increasing role of IL-17 and IL-23 inhibitors as preferred therapeutic options in psoriasis. Previous biologic exposure and higher BMI seem to be associated with poorer therapeutic outcomes. Overall, biological treatment is an effective, rapid, and safe therapeutic option.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835473","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":"Cumulative Life Course Impairment in Atopic Dermatitis: A Comprehensive Review.","authors":"Claudio Brescia, Chiara Palagiano, Martina Turco, Luca Potestio, Francesca di Vico, Maddalena Napolitano","doi":"10.3390/medsci14040499","DOIUrl":"10.3390/medsci14040499","url":null,"abstract":"<p><p><b>Background</b>: Atopic dermatitis (AD) is a chronic inflammatory skin disease with a relapsing course and a substantial multidimensional burden. Conventional clinical and patient-reported outcome measures mainly provide cross-sectional evaluations and may not fully capture the long-term impact of the disease. The concept of cumulative life course impairment (CLCI) has been proposed to describe the progressive and lifelong consequences of chronic dermatologic conditions. <b>Methods</b>: This narrative review is based on a non-systematic literature search conducted in PubMed/MEDLINE and Embase up to July 2026. Relevant studies addressing quality of life, mental health, comorbidities, and economic burden in AD were identified and narratively synthesized, with particular focus on evidence supporting the CLCI framework. <b>Results</b>: AD exerts a cumulative burden across multiple domains. Pruritus and sleep disturbance emerge as key drivers, contributing to a self-reinforcing cycle involving psychological distress and impaired daily functioning. Increased rates of anxiety and depression, along with social stigmatization, negatively affect interpersonal relationships, educational attainment, and work productivity. Comorbidities and the chronic relapsing nature of AD further amplify long-term impairment. Economic burden, including both direct and indirect costs, acts as both a consequence and a driver of cumulative disadvantage. Recurrent disease flares play a central role in sustaining and amplifying this trajectory over time. <b>Conclusions</b>: AD should be considered a life-course disease in which interacting biological, psychological, and social factors shape long-term outcomes. A CLCI-oriented approach may improve patient stratification and support earlier, multidisciplinary, and proactive management strategies aimed at reducing long-term burden and improving overall outcomes.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835466","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 PD Effluentome-A Multi-Omics Atlas Defining the Composition, Transport Dynamics, and Molecular Origin of Peritoneal Dialysis Effluent.","authors":"Rebecca Herzog, Fabian Eibensteiner, Florian M Wiesenhofer, Lisa Daniel-Fischer, Anja Wagner, Markus Unterwurzacher, Isabel J Sobieszek, Juan Manuel Sacnun, Michael Böhm, Andreas Vychytil, Christoph Aufricht, Klaus Kratochwill","doi":"10.3390/medsci14040496","DOIUrl":"10.3390/medsci14040496","url":null,"abstract":"<p><p><b>Background</b>: Peritoneal dialysis (PD) effluent of kidney failure patients represents an accessible liquid biopsy of the peritoneal cavity, yet the mechanisms determining its molecular composition remain poorly understood. We applied an integrative multi-omics approach to characterize the composition, transport dynamics, and molecular origin of the PD effluentome. <b>Methods</b>: Cell-free effluent, effluent cells, and plasma were collected from stable PD patients during standardized peritoneal equilibration tests in a randomized clinical trial. Targeted metabolomics, proteomics, and transcriptomic profiling were integrated with a reference human plasma proteome to investigate temporal molecular changes, peritoneal transport characteristics, and protein origin. <b>Results</b>: A total of 207 metabolites and 2970 proteins were identified in PD effluent. Metabolites exhibited distinct class-specific transport kinetics, with rapid equilibration of amino acids and biogenic amines, whereas lipids remained markedly underrepresented despite prolonged dwell times, indicating that transport is governed by physicochemical properties beyond molecular size alone. The effluent proteome underwent concordant alteration, with dwell time-dependent enrichment of pathways related to extracellular matrix organization, angiogenesis, coagulation, and tissue repair. Integrative analysis of the effluent proteome, effluent-cell transcriptome, and human plasma proteome resolved distinct plasma-associated, effluent cell-associated, resident peritoneal tissue-associated, and mixed-origin protein populations. <b>Conclusions</b>: This study establishes the first systems-level approach describing the composition, transport dynamics, and molecular origin of the PD effluentome. By transforming PD effluent into a biologically interpretable molecular readout of peritoneal membrane biology, this work provides a reference for the mechanistic interpretation of effluent-derived biomarkers and supports future therapeutic monitoring and precision medicine in PD.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835535","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":"Pancreas Transplant Recipients with and Without Pretransplant Alcohol Use Disorder: A Real-World Cohort Study.","authors":"Arkadeep Dhali, Jyotirmoy Biswas, Sajjad Ahmed Khan, Fayaz Khan, Saikat Mandal, Ashish Sharma, Dushyant Singh Dahiya, Manideepa Maji","doi":"10.3390/medsci14040497","DOIUrl":"10.3390/medsci14040497","url":null,"abstract":"<p><p><b>Background:</b> Alcohol use disorder (AUD) is generally regarded as a relative contraindication to pancreas transplantation. Yet the effect of documented AUD before transplantation on long-term results after pancreas transplantation is still poorly understood. Therefore, we used a large real-world electronic health records database to compare the three-year outcomes among pancreas transplant recipients who had and who had not had documented AUD before transplantation. <b>Methods:</b> We carried out a retrospective cohort study involving propensity score matching using the TriNetX US Collaborative Network. Each adult patient who had a documented case of alcohol use disorder (ICD-10-CM codes F10.1/F10.2) before transplantation was paired one to one with a patient who did not have such a disorder, matching them on demographic characteristics, comorbidities, transplant-related factors, medications, body mass index, and glycated hemoglobin. The outcomes were evaluated from one day after transplantation up to three years later and comprised all-cause mortality, emergency visits, transplant complications, cachexia, severe protein-calorie malnutrition, pain, vitamin deficiencies, iron deficiency anaemia, diarrhea, and adult failure to thrive. <b>Results:</b> Out of 14,367 eligible recipients, propensity score matching resulted in 439 patients in each group. Pretransplant AUD was linked to a significantly higher rate of all-cause mortality (15.1% compared with 8.5%; risk ratio [RR] 1.78, 95% CI 1.22-2.60; hazard ratio [HR] 1.86, 95% CI 1.25-2.78; <i>p</i> = 0.002). Cachexia affected 5.2% rather than 2.5% (RR 2.09, 95% CI 1.03-4.24; HR 2.16, 95% CI 1.06-4.44; <i>p</i> = 0.036), while diarrhea occurred in 39.6% compared with 28.2% (RR 1.40, 95% CI 1.16-1.69; HR 1.54, 95% CI 1.22-1.94; <i>p</i> < 0.001). There were no significant differences in the case of emergency visits (49.0% versus 44.6%; <i>p</i> = 0.199), transplant complications (11.1% versus 14.4%; <i>p</i> = 0.163), severe protein-calorie malnutrition (12.1% versus 8.9%; <i>p</i> = 0.123), pain (59.0% versus 54.7%; <i>p</i> = 0.195), vitamin deficiencies (31.4% versus 29.4%; <i>p</i> = 0.509), iron deficiency anemia (21.2% versus 21.9%; <i>p</i> = 0.805), or adult failure to thrive (7.3% versus 4.3%; <i>p</i> = 0.061). <b>Conclusions:</b> The presence of a history of alcohol use disorder (AUD) before transplantation was found to be independently linked to a higher three-year mortality rate, as well as the occurrence of cachexia and diarrhea after pancreas transplantation, but it was not associated with an increased number of coded transplant complications or most of the other adverse outcomes following the procedure. These results indicate that pancreas transplant recipients with a history of AUD should have enhanced monitoring in the areas of nutrition, the gastrointestinal system, and addiction.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834910","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}