Medical sciences (Basel, Switzerland)最新文献

{"title":"Renal Failure and Systolic Heart Failure Have Synergistic Effect on In-Hospital All-Cause Mortality in Patients with Normotensive Acute Pulmonary Embolism.","authors":"Mirjana Mijuskovic, Brankica Terzic, Sonja Salinger, Jovan Matijasevic, Sandra Pekovic, Tamara Preradovic-Kovacevic, Ljiljana Kos, Bjanka Bozovic, Irena Mitevska, Bojan Mitrovic, Aleksandar Neskovic, Ema Jevtic, Vladimir Miloradovic, Boris Dzudovic, Slobodan Obradovic","doi":"10.3390/medsci13030183","DOIUrl":"10.3390/medsci13030183","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Renal failure (RF) and systolic heart failure (sHF) are very often associated with each other, and their synergistic influence can affect the prognosis of acute pulmonary embolism (aPE) patients. The aim of this study is to evaluate the associations between RF, sHF, and in-hospital mortality in patients with normotensive aPE. <b>Methods</b>: We analyzed data from the Regional PE Registry (REPER), and 1968 patients with CT pulmonary angiography-confirmed aPE who had a systolic blood pressure of 100 mmHg and higher, and for whom creatinine blood levels and left ventricular ejection fraction (LVEF) were measured at admission to hospital were enrolled. The patients were divided into four groups: the first group comprised patients without renal and systolic heart failure, the second those with RF (creatinine clearance less than 60 mL/min), the third those with sHF (LVEF less than 50%), and the fourth those with both RF and sHF. The primary endpoint of this study was in-hospital all-cause mortality. <b>Results</b>: There are significant differences between in-hospital mortality among the groups: 38/1247 (3.0%) vs. 63/514 (12.9%) vs. 10/99 (10.1%) vs. 20/108 (18.5%) (<i>p</i> < 0.001). In the multivariable regression model adjusted for age, right ventricular dysfunction, and troponin levels, the presence of renal failure, sHF, and both were independently associated with in-hospital all-cause mortality with ORs of 3.59 (95%CI 2.04-6.30, <i>p</i> < 0.001) vs. 3.97 (1.71-9.25, <i>p</i> = 0.001) vs. 6.39 (3.15-12.99, <i>p</i> < 0.001), respectively. <b>Conclusions</b>: The association of renal failure and systolic heart failure has a deleterious prognosis in patients with normotensive aPE.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12452358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115165","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":"Mitral Valve Prolapse and Sudden Cardiac Death-A Puzzle with Missing Pieces: Review of the Literature and Case Report.","authors":"Diana Roxana Opris, Marius Mihai Harpa, David-Emanuel Anitei, Paul Calburean, Roxana Rudzik","doi":"10.3390/medsci13030185","DOIUrl":"10.3390/medsci13030185","url":null,"abstract":"<p><p><b>Background:</b> Mitral valve prolapse is a common valvular heart disorder, usually associated with a benign prognosis in the absence of significant mitral regurgitation. However, a subset of patients is at increased risk for complex ventricular arrhythmias and sudden cardiac death. Identifying these high-risk individuals remains a major clinical challenge. <b>Case Summary:</b> We present the case of a 71-year-old female patient with recurrent syncopal episodes, a strong family history of sudden cardiac death, and complex ventricular ectopy. Multimodality imaging revealed bileaflet mitral valve prolapse, severe mitral regurgitation, mitral annular disjunction, and the Pickelhaube sign, with no evidence of myocardial fibrosis on cardiac magnetic resonance imaging. The patient underwent minimally invasive mitral valve repair and received an implantable cardioverter-defibrillator for primary prevention of sudden cardiac death. Follow-up revealed significant reverse cardiac remodeling, marked reduction in arrhythmic burden, and restoration of mitral valve function. Family screening identified mitral annular disjunction in both of her daughters, who were asymptomatic and without arrhythmias. <b>Discussion:</b> Mitral annular disjunction has emerged as a potentially arrhythmogenic substrate, especially in patients with familial clustering, raising the possibility of a genetic predisposition. Risk stratification remains difficult, as no individual clinical, electrocardiographic, or imaging marker has demonstrated consistent predictive value. Surgical correction of mitral valve prolapse with associated mitral annular disjunction may lead to a reduction in arrhythmic risk and promote favorable structural remodeling. <b>Conclusions:</b> This case-based review emphasizes the importance of advanced imaging techniques in the identification and management of high-risk mitral valve prolapse phenotypes. Early surgical intervention and close arrhythmic surveillance may improve outcomes, although further research is necessary to define risk assessment tools and explore the genetic background of arrhythmogenic mitral valve disease.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12452400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114864","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":"Proteome Differences in Smooth Muscle Cells from Diabetic and Non-Diabetic Abdominal Aortic Aneurysm Patients Reveal Metformin-Induced Mechanisms.","authors":"Tara A R van Merrienboer, Karlijn B Rombouts, Albert C W A van Wijk, Jaco C Knol, Thang V Pham, Sander R Piersma, Connie R Jimenez, Ron Balm, Kak K Yeung, Vivian de Waard","doi":"10.3390/medsci13030184","DOIUrl":"10.3390/medsci13030184","url":null,"abstract":"<p><p><b>Aims</b>: Surgery remains the only definitive treatment option for abdominal aortic aneurysms (AAA), as no conclusive evidence supports drug effectiveness in preventing AAA growth. Although type 2 diabetes (T2D) is an important cardiovascular risk factor, patients with T2D show reduced AAA presence and growth, associated with metformin use. We aimed to investigate the potential benefits of metformin on AAA using proteomics and in vitro experiments. <b>Methods</b>: Proteomics analysis using tandem mass spectrometry was performed on aortic smooth muscle cells (SMCs) from non-pathological controls (C-SMC, <i>n</i> = 8), non-diabetic (ND, <i>n</i> = 19) and diabetic (D, <i>n</i> = 5) AAA patients. Key findings were subsequently validated in aortic tissue using mass spectrometry-based proteomics. SMCs were cultured with/without metformin and analyzed. <b>Results</b>: Comparison of the proteome of SMCs from ND-AAA patients with controls revealed a reduction in proteins associated with metabolic processes and mitochondrial function. Cytoskeletal and extracellular matrix (ECM) proteins were elevated in ND-AAA-SMCs versus C-SMCs, with a similar cluster of mechanosensitive proteins being increased in ND-AAA-SMCs versus D-AAA-SMCs. D-AAA-SMCs showed an improved metabolic and antioxidant profile, enriched in pentose phosphate pathway proteins responsible for NAD(P)H generation (G6PD, PGD) and NAD(P)H-dependent antioxidants (NQO1, CBR1, AKR1C1, AKR1B1, GSTM1), all regulated by NRF2, an antioxidant transcription factor. Over half of the proteins identified in the protein-protein interaction network, constructed from proteins with higher expression in D-AAA SMCs versus ND-AAA SMCs, were verified in D-AAA aortic tissue. In vitro, metformin causes a shift from aerobic to anaerobic metabolism, increased AMPK activation and elevated mitochondrial biogenesis, indicated by increased <i>PGC-1α</i> expression. Metformin increased the gene expression of <i>PGD</i>, <i>CBR1</i> and the protein expression of NQO1, with enhanced translocation of pNRF2 to the nucleus, due to reduced KEAP1 as negative regulator of NRF2. Consequently, metformin enhanced the gene expression of well-known antioxidant regulators <i>SOD2</i> and <i>CAT</i>. <b>Conclusions</b>: This study identified significant differences in the proteome of SMCs derived from controls, ND-AAA and D-AAA patients. It highlights distinct pathways in relation to mechanosensing, metabolism and redox balance as therapeutic targets of metformin that may underlie its inhibition of AAA progression.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12452731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115053","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":"Obesity and Pregnancy: Impact on Childbirth Timing, Delivery Mode, and Maternal Recovery: An Update.","authors":"Angeliki Gerede, Maria Danavasi, Sofoklis Stavros, Anastasios Potiris, Athanasios Zikopoulos, Efthalia Moustakli, Charikleia Skentou, Ekaterini Domali, Nikolaos Nikolettos, Makarios Eleftheriades","doi":"10.3390/medsci13030182","DOIUrl":"10.3390/medsci13030182","url":null,"abstract":"<p><p>This review explores the impact of maternal obesity on pregnancy outcomes, emphasizing its significant global health challenge and profound implications for both mothers and infants. It influences the timing and mode of childbirth, elevating the risk of conditions like hypertensive disorders, cesarean delivery, and gestational diabetes mellitus. The review focuses on analyzing how maternal obesity affects postpartum recovery, birth timing, and delivery methods. Relevant studies were identified using PubMed and Scopus. Findings indicate that obese pregnant women are at higher risk for medically indicated preterm birth, scheduled and emergency cesarean sections, and labor induction. Postpartum recovery is often prolonged due to breastfeeding challenges, infection risks, and delayed wound healing. Additionally, maternal obesity increases the likelihood of fetal complications such as macrosomia and long-term metabolic disorders. These results highlight the importance of personalized treatments and early weight control to improve the health of both mother and baby. A comprehensive approach integrating clinical care, public health initiatives, and policy measures is essential to reduce pregnancy complications associated with obesity.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12452747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114892","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 Genomic Analysis Reveals the Synergistic Role of PNPLA3 and ABCC8 Variants in Diabetic MASLD in Pakistan.","authors":"Asma Shabbir, Ambrina Khatoon, Zaigham Abbas, Sucheta Srivastava, Talat Mirza","doi":"10.3390/medsci13030178","DOIUrl":"10.3390/medsci13030178","url":null,"abstract":"<p><p><b>Introduction</b>: Metabolic dysfunction associated steatotic liver disease (MASLD), previously termed as nonalcoholic fatty liver disease (NAFLD), is a growing global health concern, particularly in South Asia. While PNPLA3 is a well-recognized genetic contributor to MASLD, the role of other metabolic genes, such as ABCC8, remains unexplored in South Asian populations. In this study, we aim to investigate the genetic association and potential synergy between PNPLA3 (rs738409) and ABCC8 (rs146378237) variants in MASLD pathogenesis in a Pakistani cohort. <b>Methods</b>: A two-phased case-control study was conducted. Whole Exome Sequencing (WES) was performed on 6 MASLD cases and 6 healthy controls to identify relevant variants, followed by validation via Sanger sequencing in an extended MASLD cohort (<i>n</i> = 52). Variant frequencies were compared with 96 ethnically matched controls from the 1000 Genomes Project. Furthermore, the association of the variants with clinical, biochemical, and fibrotic parameters was assessed. <b>Results</b>: The PNPLA3 rs738409 G allele (MAF = 0.47) and ABCC8 rs146378237 T allele (MAF = 0.36) were significantly enriched in MASLD cases and strongly associated with cirrhosis. The TT genotype of ABCC8 was also linked to T2DM and low HDL levels. Importantly, eight MASLD patients harbored both GG (PNPLA3) and TT (ABCC8) genotype, and all were known cases of diabetes, suggesting a synergistic genetic interaction. <b>Conclusions</b>: This is the first report of ABCC8 rs146378237 in a South Asian MASLD cohort, revealing population-specific risk and a gene-gene interaction that may inform targeted screening and personalized management of MASLD in high-risk diabetic individuals.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12452525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115319","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":"Metabolic Reprogramming Through Polyphenol Networks: A Systems Approach to Metabolic Inflammation and Insulin Resistance.","authors":"Shakila Jahan Shimu, Jawad Ul Karim Mahir, Fardin Al Fahad Shakib, Arafath Amin Ridoy, Ratin Al Samir, Nadia Jahan, Md Fahim Hasan, Sadman Sazzad, Shamima Akter, Mohammad Sarif Mohiuddin, Md Jalal Ahmed Shawon, Mohammad Hossain Shariare, Mohammad Mohabbulla Mohib, Mohammad Borhan Uddin","doi":"10.3390/medsci13030180","DOIUrl":"10.3390/medsci13030180","url":null,"abstract":"<p><p>Obesity-induced insulin resistance and type 2 diabetes mellitus (T2DM) represent complex systemic disorders marked by chronic inflammation, oxidative stress, mitochondrial dysfunction, and endoplasmic reticulum (ER) stress. These pathophysiological processes disrupt insulin signaling and β-cell function, leading to impaired glucose homeostasis across multiple organs. Conventional therapies often target isolated pathways, overlooking the intricate molecular crosstalk and organelle-level disturbances driving disease progression. Citrus-derived polyphenols-including hesperidin, naringenin, nobiletin, and tangeretin-have emerged as promising agents capable of orchestrating a multi-targeted \"metabolic reprogramming.\" These compounds modulate key signaling pathways, including AMPK, PI3K/Akt, NF-κB, and Nrf2, thereby enhancing insulin sensitivity, reducing pro-inflammatory cytokine expression, and restoring redox balance. Furthermore, they improve mitochondrial biogenesis, stabilize membrane potential, and alleviate ER stress by modulating the unfolded protein response (UPR), thus supporting cellular energy homeostasis and protein folding capacity. Evidence from preclinical studies and select clinical trials suggests that citrus polyphenols can significantly improve glycemic control, reduce oxidative and inflammatory markers, and preserve β-cell function. Their pleiotropic actions across molecular and organ-level targets position them as integrative metabolic modulators. This review presents a systems-level synthesis of how citrus polyphenols rewire metabolic signaling networks and organelle resilience, offering a holistic therapeutic strategy to mitigate the root causes of obesity-induced insulin resistance.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12452514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114923","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":"Decoding Fear: Analysis and Prognosis of Preoperatory Stress Level Through Advanced Statistical Modelling-A Prospective Study Across Multiple Surgical Specialties.","authors":"Cristina Gena Dascălu, Andrei Ionut Cucu, Andreea Vovciuc, Sorin Axinte, Serban Turliuc, Amelian Madalin Bobu, Camelia Tamas, Vlad Porumb, Emilia Patrascanu, Catalin Mihai Buzduga, Paula Alexandra Blanaru, Anca Petruta Morosan, Iulian Prutianu, Roxana Covali, Andreea Ioana Pruteanu, Claudia Florida Costea, Alexandru Carauleanu","doi":"10.3390/medsci13030181","DOIUrl":"10.3390/medsci13030181","url":null,"abstract":"<p><p><b>Background:</b> Preoperative stress is a multifactorial phenomenon shaped by physiological, psychological, and social influences, with a substantial impact on postoperative recovery. This study aimed to quantify preoperative stress levels, identify associated factors, and rank their predictive importance. <b>Methods:</b> A prospective study was conducted on 197 patients scheduled for general surgery, orthopedics, neurosurgery, or otorhinolaryngology procedures between December 2024 and June 2025 at Suceava County Emergency Clinical Hospital. Stress levels were assessed using the Brief Measure of Emotional Preoperative Stress (B-MEPS), translated and culturally adapted into Romanian. Statistical analyses included nonparametric tests, generalized linear modeling, and Random Forest regression. <b>Results</b>: The mean B-MEPS score was 21.42 ± 6.04 (range: 11-34), indicating a moderate level of preoperative stress. Higher stress scores were significantly associated with female sex (<i>p</i> < 0.001), lower educational attainment (<i>p</i> = 0.003), divorced marital status (<i>p</i> = 0.007), a history of cancer (<i>p</i> = 0.002), and the type of surgical intervention (<i>p</i> = 0.003). Random Forest analysis identified the type of surgery, educational level, and sex as the strongest predictors. <b>Conclusions:</b> Preoperative stress is chiefly influenced by the type of surgical procedure, educational level, and sex, with potential synergistic effects among these factors. Early identification of high-risk patients enables targeted, personalized interventions to mitigate anxiety and improve perioperative outcomes. Further research should include formal validation of the Romanian version of B-MEPS and the integration of additional psychosocial variables.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12452544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115278","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":"Pediatric Medication Prescribing Across Urgent Care Visits: An Epidemiologic View from a Primary Care Setting in the Kingdom of Saudi Arabia.","authors":"Reem S AlOmar, Nouf A AlShamlan, Ahmed A Al Yateem, Abdulrahman A Al-Abdulazeem, Ahmed M Al-Turki, Reema J Alghamdi, Najla A Alhamed, Sameerah Motabgani, Adam F Aldhawyan, Malak A Al Shammari","doi":"10.3390/medsci13030177","DOIUrl":"10.3390/medsci13030177","url":null,"abstract":"<p><p><b>Background:</b> Urgent care clinics (UCCs) embedded within primary healthcare settings play a vital role in managing acute, non-life-threatening conditions in children. However, limited data exist on medication prescribing patterns in such settings in the Kingdom of Saudi Arabia (KSA), particularly regarding antibiotic use. This study aimed to describe the epidemiology of pediatric urgent care visits and identify factors associated with prescribing within a model primary healthcare (PHC) center. <b>Methods:</b> A retrospective chart review was conducted for all urgent care visits made by pediatric patients (<14 years) at a model PHC center in the KSA for all visits in 2024. Sociodemographic variables, visit timing, diagnosis, and prescription data were extracted from electronic health records. Multivariable logistic regression was used to analyze predictors of medication prescribing. <b>Results:</b> Of the 1016 pediatric urgent care visits, 62.5% resulted in medication prescriptions, and 23.62% of those visits included at least one antibiotic, primarily penicillins (71.33%). Cephalosporins and tetracyclines were not prescribed. Prescriptions were 67% more likely among adolescents and 70% less likely among infants when compared to school-aged children (95% CI = 1.04-2.67 and 95% CI = 0.15-0.61, respectively). Respiratory and ENT-related diagnoses accounted for most prescriptions. No significant sex-based differences in prescribing were observed. <b>Conclusions:</b> The epidemiological patterns observed indicate that respiratory and ENT conditions, as well as seasonal peaks in autumn and winter, are the main drivers of prescribing in pediatric urgent care. These findings have implications for strengthening disease surveillance, anticipating service demand, guiding preventive interventions such as vaccination and health education, and supporting evidence-based planning of primary care resources.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12452787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115111","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":"Total-Arterial Revascularization Is Superior in Heart Failure Patients with Reduced Ejection Fraction-A Propensity Score Matched Retrospective Multicenter Analysis.","authors":"Christian Jörg Rustenbach, Julia Schano, Christoph Salewski, Helene Häberle, Kristian-Christos Ngamsri, Ilija Djordjevic, Stefanie Wendt, Tulio Caldonazo, Ibrahim Saqer, Shekhar Saha, Philipp Schnackenburg, Lina Maria Serna-Higuita, Torsten Doenst, Christian Hagl, Thorsten Wahlers, Christian Schlensak, Stefan Reichert","doi":"10.3390/medsci13030179","DOIUrl":"10.3390/medsci13030179","url":null,"abstract":"<p><p><b>Background:</b> Total arterial revascularization (TAR) may improve outcomes in patients with ischemic cardiomyopathy and heart failure with reduced ejection fraction (HFrEF). <b>Methods:</b> We retrospectively screened 574 adults with HFrEF (LVEF < 40%) undergoing isolated CABG across four German centers (2017-2023). After 1:1 propensity score matching, 240 patients were analyzed (120 TAR vs. 120 NTAR). The primary endpoint was in-hospital MACCE (death, MI, stroke). Key secondary endpoints included ICU/hospital length-of-stay, ventilation time, delirium, transfusion requirements, and acute kidney injury. <b>Results:</b> MACCE occurred in 4.1% (TAR) vs. 14.2% (NTAR) (<i>p</i> = 0.007). TAR was associated with shorter ICU stay (median 44.5 h vs. 90 h, <i>p</i> < 0.001), shorter hospital stay (10 d vs. 12 d, <i>p</i> = 0.002), reduced ventilation time (8 h vs. 12 h, <i>p</i> < 0.001), lower delirium (5.0% vs. 14.2%, <i>p</i> = 0.016), and fewer RBC transfusions intra-operatively (0.13 ± 0.45 vs. 0.31 ± 0.58 units, <i>p</i> = 0.028) and during the entire stay (0.70 ± 1.33 vs. 1.77 ± 2.91 units, <i>p</i> < 0.001). <b>Conclusions:</b> In this multicenter propensity-matched cohort, TAR was associated with lower in-hospital MACCE and more favorable perioperative outcomes compared with NTAR. Prospective studies are warranted to confirm causality and long-term benefits.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12452580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115140","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":"Minimally Invasive Left Ventricular Assist Device Implantation: A Systematic Review of Current Evidence on Clinical Outcomes and Surgical Approaches.","authors":"Baglan Turtabayev, Seitkhan Joshibayev, Umit Kervan, Samat Zharmenov, Yerbol Ustemirov, Almas Begdildayev, Gali Iskakbayev","doi":"10.3390/medsci13030173","DOIUrl":"10.3390/medsci13030173","url":null,"abstract":"<p><strong>Background/objectives: </strong>Minimally invasive cardiac surgical (MICS) approaches to the implantation of left ventricular assist devices (LVADs) have gained increasing interest as alternatives to full median sternotomy (FS), particularly in patients with prior cardiac surgeries or elevated surgical risk. However, evidence regarding their safety, feasibility, and clinical outcomes remains fragmented. This systematic review aimed to evaluate the effectiveness and safety of minimally invasive techniques for LVAD implantation in comparison to standard sternotomy, with a focus on mortality, perioperative complications, intensive care unit (ICU) stay, and infection rates.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in PubMed, Web of Science, Science Direct, Cochrane Library, and Google Scholar up to 1 January 2025. Studies were included if they reported on adult patients undergoing LVAD implantation via minimally invasive thoracotomy or sternotomy-sparing approaches, with or without comparator groups. Data were extracted and synthesized qualitatively; the Newcastle-Ottawa Scale (NOS) was applied to assess the methodological quality of the included cohort and retrospective comparative studies.</p><p><strong>Results: </strong>A total of 12 studies involving 1448 patients were included (584 received MICS and 862 received FS). MICS techniques have demonstrated comparable short and mid-term survival outcomes, with trends toward reduced ICU stay, fewer reoperations for bleeding, and lower incidence of driveline infections. Some studies reported longer operative and cardiopulmonary bypass times in the MICS group. Among high-risk cohorts, such as patients with prior sternotomies or significant comorbidities, MICS was associated with lower morbidity and acceptable safety profiles. However, heterogeneity in patient selection, surgical protocols, and outcome definitions limited quantitative synthesis.</p><p><strong>Conclusions: </strong>Minimally invasive LVAD implantation is a viable alternative to conventional sternotomy in selected patient populations. While current data suggest favorable perioperative outcomes and equivalent survival, high-quality prospective studies are needed to confirm long-term benefits and to guide patient selection. MICS approaches should be considered within multidisciplinary teams experienced in advanced heart failure surgery.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12452320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114902","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}