Medical sciences (Basel, Switzerland)最新文献

{"title":"COPD Severity and Five-Year Mortality After Acute Myocardial Infarction in Patients with Chronic Obstructive Pulmonary Disease: A Retrospective Cohort Study.","authors":"Sagi Shashar, Tahel Cohen, Liora Boehm Cohen, Hezzy Shmueli, Arthur Shiyovich, Harel Gilutz, Ygal Plakht","doi":"10.3390/medsci14040486","DOIUrl":"10.3390/medsci14040486","url":null,"abstract":"<p><p><i>Background</i>: Chronic obstructive pulmonary disease (COPD) and acute myocardial infarction (AMI) frequently coexist and share several biological pathways and risk factors. Although COPD is associated with worse outcomes after AMI, the prognostic value of objective pulmonary function has not been well characterized. The aim of this study was to evaluate the association between airflow-obstruction severity and five-year all-cause mortality after AMI among patients with COPD. <i>Methods</i>: This single-center retrospective cohort study was restricted to adult post-AMI patients (2002-2017) with a background diagnosis of COPD and documented spirometry; therefore, the final cohort represents a selected subgroup of the source COPD-AMI population. Airflow obstruction was categorized according to forced expiratory volume in one second (FEV1) as Mild, Moderate, Severe, or Very Severe (according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD)). The outcome was all-cause mortality during up to five years of follow-up. <i>Results</i>: Among 1594 patients hospitalized with AMI and a COPD diagnosis, 169 patients with available spirometry were included in this selected analytical cohort (mean age 66.76 ± 9.86 years, 76.9% male). During follow-up, 65 patients died, corresponding to an overall five-year mortality rate of 38.5%. Mortality increased progressively across obstruction categories: 19.0%, 33.3%, 40.0%, and 70.8% in Mild, Moderate, Severe, and Very Severe, respectively (<i>p</i> for trend <0.001). In multivariable analysis, adjusted hazard ratios for mortality were: 2.49 (95% CI 0.86-7.24), 3.38 (95% CI 1.09-10.46), and 5.23 (95% CI 1.62-16.89) for Moderate, Severe, and Very Severe, compared with Mild obstruction. <i>Conclusions</i>: Among patients with COPD who survived hospitalization for AMI, more severe airflow obstruction was associated with substantially higher five-year all-cause mortality. These findings support the potential role of spirometry-based risk stratification and highlight the need for integrated cardiopulmonary follow-up after AMI.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835480","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":"Generative Modeling and Multispectral Imaging for Eye Fundus Classification.","authors":"Francisco J Burgos-Fernández, Buntheng Ly, Marina Bou-Marin, Fernando Díaz-Doutón, Jaume Pujol, Maxime Sermesant, Meritxell Vilaseca","doi":"10.3390/medsci14040488","DOIUrl":"10.3390/medsci14040488","url":null,"abstract":"<p><p><b>Background</b>: The early diagnosis of eye fundus pathologies is crucial, as they may go unnoticed until reaching advanced stages. To offer an improved screening methodology for this purpose, the effectiveness of a conditional variational autoencoder (CVAE) based on multispectral (MS) imaging and operating from the visible to the near-infrared range (416-1213 nm) has been assessed. <b>Methods</b>: A total of 2040 images from 102 patients (66 females, 36 males; aged 19-91 years) were acquired with an MS fundus camera to feed a fine-tuned CVAE for classifying eye fundus as healthy or diseased. The performance of the neural network was assessed for different image resolutions and spectral ranges. <b>Results</b>: The proposed deep generative model showed excellent results, reaching 100% of accuracy, sensitivity and specificity for the set of MS images from 416 nm to 955 nm at maximum resolution (1757 × 1757 pixels). Other instances with different image resolutions and spectral ranges led to good classifications (accuracy between 96% and 98%, sensitivity between 92% and 98%, and specificity between 97% and 100%). The CVAE exhibited robust performance with convergence of the accuracy and loss through the different epochs for training and validation in all instances. <b>Conclusions</b>: This study proves that a CVAE approach based on MS imaging is a highly effective tool for diagnosing eye fundus conditions and could potentially serve as a valuable clinical support tool for screening. The approach performs remarkably well when high spatial resolution MS images ranging from 416 nm to 955 nm are used. This underscores the importance of combining spatial and spectral information, particularly of wavelengths beyond the visible range.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Small Natural Molecule Targeting IL-23/IL-17 Axis Exerts Dual Effects on T-Cell Function and Breast Cancer Cell Migration.","authors":"Sara Bourdoukh, Khadija El Azhary, Sanaa Souat, Khouloud Ayed, Hamza Benthami, Said Byadi, Aziz Aboulmouhajir, Mohamed Elkarroumi, Asma Gati, Abdallah Badou","doi":"10.3390/medsci14040485","DOIUrl":"10.3390/medsci14040485","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Chronic inflammation in the tumor microenvironment (TME) promotes immune evasion and metastasis in breast cancer, where the IL-23/IL-17 axis is a key mediator. We investigated the expression of IL-23 in breast cancer and identified a small natural molecule therapeutically targeting this axis. <b>Methods:</b> IL-23 expression and its clinicopathological significance were assessed in a Moroccan breast cancer cohort and the METABRIC dataset. A High-throughput virtual screening of <i>Allium sativum</i> L. compounds was conducted to target the IL-23/IL-17 axis. In vitro, the selected candidate, IL-23RI, was evaluated for its effects on IL-17A and IFNγ production in human PBMCs using flow cytometry, as well as on the migration of MCF-7 and MDA-MB-231 breast cancer cells using wound-healing assays. <b>Results:</b> IL-23 was found to be overexpressed in aggressive breast cancer subtypes and correlated with unfavorable clinicopathological features and a poor prognosis. Elevated IL-23 expression was associated with an immunosuppressive TME, characterized by increased inhibitory immune checkpoints and immunosuppressive chemokines. In silico, IL-23RI demonstrates a high binding affinity for the IL-23 receptor, with a docking score of -7.482 kcal/mol and a binding free energy of -48.80 kcal/mol, stabilized by five hydrogen bonds. In vitro, IL-23RI selectively suppressed IL-17A production by CD4⁺ T cells without affecting IFNγ secretion by both CD4⁺ and CD8⁺ T cells. Furthermore, IL-23RI significantly inhibited the migration of MCF-7 and MDA-MB-231 breast cancer cells. <b>Conclusions:</b> These findings establish the IL-23/IL-17 axis as a critical therapeutic target and present IL-23RI as a promising dual-function agent for breast cancer treatment, concurrently modulating immunity and inhibiting tumor cell migration.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835281","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":"Matrix Metalloproteinase-9 (MMP-9) in Psoriasis: Integrating Extracellular Matrix Remodeling, Neutrophil-Endothelial Crosstalk and Biomarker Evidence.","authors":"Marta Wolosowicz, Slawomir Prokopiuk, Julia Nowowiejska-Purpurowicz, Tomasz W Kaminski","doi":"10.3390/medsci14040481","DOIUrl":"10.3390/medsci14040481","url":null,"abstract":"<p><p>Psoriasis is a chronic immune-mediated inflammatory disease in which cytokine-driven epidermal activation is accompanied by extensive remodeling of the extracellular matrix, basement membrane, and cutaneous microvasculature. Matrix metalloproteinase-9 (MMP-9; gelatinase B) may provide an important link between these structural alterations and several key features of psoriatic inflammation, including neutrophil activation, endothelial dysfunction, vascular hyperpermeability, and leukocyte recruitment. This review critically examines the biological and clinical relevance of MMP-9 across the spectrum of psoriatic disease. Particular focus is given to the cellular sources and regulation of MMP-9, its expression in lesional and non-lesional skin, and its interactions with the IL-23/Th17, IL-17, TNF-α, IL-36, MAPK, and NF-κB signaling pathways. Experimental studies support a functional neutrophil-MMP-9-endothelium axis in which MMP-9 can promote endothelial activation, vasodilation, vascular hyperpermeability, and leukocyte transmigration. However, this mechanistic evidence derives predominantly from experimental systems, whereas human studies mainly demonstrate associations between psoriasis and increased tissue or circulating MMP-9. The interpretation of circulating MMP-9 is further complicated by sample type, enzymatic activation state, assay heterogeneity, treatment exposure, and inflammatory and cardiometabolic confounders. Overall, MMP-9 represents a biologically possible contributor to psoriatic tissue remodeling and vascular inflammation, but its causal importance in human psoriasis remains insufficiently established. Future studies should determine whether MMP-9 can contribute to validated phenotype-specific multimarker models. At present, its clinical utility as either a biomarker or therapeutic target remains exploratory.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835487","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":"Predictors and Outcomes of In-Hospital Cardiac Arrest in University Medicine with Advanced Tertiary and Transplant Care.","authors":"Mohamad Amer Nashtar, Patrick Hjalmar Nekarda, Varnavas Varnavas, Asterios Tzalavras, Jan Best, Ali Canbay, Tim Rahmel, Jordi Rello, Antonios Katsounas","doi":"10.3390/medsci14040480","DOIUrl":"10.3390/medsci14040480","url":null,"abstract":"<p><strong>Background/objectives: </strong>In-hospital cardiac arrest (IHCA) remains associated with poor survival, while the contribution of arrest etiology and early physiological markers to outcome remains incompletely defined. We examined associations between clinical, neurological, metabolic, and etiological factors and sustained return of spontaneous circulation (ROSC) lasting >20 min, 28-day survival, and 60-day mortality.</p><p><strong>Methods: </strong>This retrospective single-center cohort included 134 adults with confirmed IHCA requiring cardiopulmonary resuscitation at a tertiary university hospital with advanced transplant care between 2011 and 2015. Sustained ROSC and 28-day survival were analyzed using parsimonious Firth penalized logistic regression models, and 60-day mortality using Cox proportional hazards regression. Selected neurological and biomarker analyses were considered exploratory.</p><p><strong>Results: </strong>Sustained ROSC was achieved in 91 patients (67.9%), 33 (24.6%) survived to day 28, and 30 (22.4%) survived to day 60. Initial non-shockable rhythm was associated with lower odds of sustained ROSC (aOR 0.26, 95% CI 0.09-0.69) and 28-day survival (aOR 0.27, 95% CI 0.10-0.68), and with higher 60-day mortality (aHR 1.96, 95% CI 1.25-3.08). The presence of a potentially reversible cause was associated with more favorable outcomes, whereas active hematologic malignancy was associated with higher 60-day mortality (aHR 1.89, 95% CI 1.15-3.10). Exploratory analyses also showed associations of initially dilated pupils with lower 28-day survival and higher lactate with 60-day mortality. Among patients who survived beyond 24 h, higher BNP was associated with subsequent mortality.</p><p><strong>Conclusions: </strong>Non-shockable rhythm and the presence of a potentially reversible cause were consistently associated with outcomes following IHCA, while active hematologic malignancy was associated with poorer longer-term survival. Exploratory findings from lactate, initial pupillary assessment, and BNP may provide complementary prognostic information, although the BNP analysis was limited to patients who survived beyond 24 h. These findings require confirmation in contemporary multicenter cohorts and do not establish validated clinical prediction tools.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835106","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":"Machine Learning-Based Prediction of Sleep Quality in Patients with Multiple Sclerosis.","authors":"Laura-Elena Cucu, Laura-Cristina Baciu, Oriana-Maria Onicescu, Bogdan-Emilian Ignat, Alina Săcărescu, Andra Oancea, Cristina Grosu, Costin Chirica, Gabriela Popescu, Alexandra Maștaleru, Robert-Valentin Bîlcu, Andreea Mustață, Mihai Roca, Maria-Magdalena Leon","doi":"10.3390/medsci14040483","DOIUrl":"10.3390/medsci14040483","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Sleep disturbances are common but frequently underrecognized in multiple sclerosis (MS), independently predicting reduced quality of life and worsening fatigue, cognitive impairment, and depression. While pain, nocturia, fatigue, and mood symptoms are established contributors, cardiometabolic, and inflammatory factors remain largely unexplored despite their known links to poor sleep in other populations. This study used interpretable machine learning to determine the relative contribution of disease-related, cardiometabolic, and inflammatory parameters to sleep quality, assessed by the PSQI, in patients with MS. <b>Methods</b>: This cross-sectional, observational, single-center cohort study enrolled adult patients with MS. Sleep quality (PSQI), daytime sleepiness (ESS), and restless legs syndrome severity (IRLS) were assessed alongside clinical, anthropometric, hemodynamic, and laboratory parameters, including inflammatory and metabolic indices. Three regression models, Support Vector Regression (SVR), Random Forest, and XGBoost, were trained on 28 predictors to predict PSQI global scores and evaluated on an internal test set, with feature contributions examined using SHAP analysis. <b>Results</b>: A total of 173 patients with MS were included (mean age 39.66 ± 11.86 years, 69.9% female, 90.2% RRMS), with 48.0% classified as poor sleepers (PSQI > 5) and a mean PSQI score of 6.06 ± 3.47. XGBoost achieved the best predictive performance (test R² = 0.451). SHAP analysis identified IRLS severity as the strongest predictor of PSQI across all three models, followed by EDSS score and depression in the Random Forest and XGBoost models, while daytime sleepiness (ESS) ranked consistently among the top predictors. Cardiometabolic and inflammatory parameters contributed inconsistently, with several showing effects opposite to physiological expectation. <b>Conclusions</b>: Sleep impairment in MS was most strongly associated with restless legs syndrome severity and neurological disability, with depression also contributing in the two best-performing models. Disease-related and symptomatic factors outweighed cardiometabolic and inflammatory contributions. These findings support the value of interpretable machine learning for identifying clinically relevant correlates of sleep quality in MS, though the exploratory design and modest sample size warrant confirmation in larger, independent cohorts.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835495","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":"Ethnic Differences in Pregnancy Complications Among Women with Gestational Diabetes.","authors":"Tiziana Filardi, Paola Galoppi, Stefania Gorini, Ilenia Mappa, Giuseppe Rizzo, Susanna Morano","doi":"10.3390/medsci14040482","DOIUrl":"10.3390/medsci14040482","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Gestational diabetes mellitus (GDM) is a metabolic disorder associated with an amplified risk of unfavorable pregnancy outcomes. This study aimed to compare clinical characteristics and pregnancy outcomes among GDM patients belonging to different ethnic groups. <b>Patients and Methods</b>: This retrospective analysis included <i>n</i> = 466 women with GDM (<i>n</i> = 167 Asian; <i>n</i> = 299 European). The impact of ethnicity on pregnancy outcomes was evaluated using multivariable logistic regression models, adjusting for confounding factors. <b>Results</b>: Asians were younger than Europeans (<i>p</i> < 0.001) and more frequently multiparous (<i>p</i> = 0.003). Fasting glucose at OGTT was higher in Asians, as well as HbA1c values at the end of pregnancy (<i>p</i> = 0.010 and <i>p</i> = 0.001, respectively). Asian ethnicity was associated with an increased likelihood of insulin therapy (OR = 3.36 [1.72-6.58] 95% CI, <i>p</i> < 0.001), in the adjusted model. The gestational week of delivery was lower in Asians compared to Europeans (<i>p</i> = 0.007). The Asian group had a higher occurrence of cesarean section (<i>p</i> = 0.048) and emergency cesarean section (<i>p</i> = 0.006) compared to the European group. Delivery complications were more frequent in the Asian cohort, adjusting for confounders (OR = 2.19 [1.11-4.32] 95% CI, <i>p</i> = 0.023). Newborns of the Asian group were more frequently small for gestational age (SGA) in adjusted models (OR = 2.36 [1.08-5.15] 95% CI, <i>p</i> = 0.031). <b>Conclusions</b>: Worse GDM outcomes were observed in the Asian cohort compared to the European cohort. Identifying risk factors for GDM-related complications is crucial for developing tailored interventions and reducing the overall disease burden.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835249","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":"From Valve Disease to Valve Replacement: Lipoprotein(a) Is Associated with Aortic Stenosis Severity but Not Prognosis After TAVI.","authors":"Nikolaus Clodi, Nikolaos Schörghofer, Christoph Knapitsch, Bernhard Scharinger, Maximilian Gressl, Gretha Hecke, Michael Lichtenauer, Moritz Brandt, Iris Kremser, Christian Reiter, Hermann Blessberger, Jürgen Kammler, Janne Cadamuro, Clemens Steinwender, Klaus Hergan, Uta C Hoppe, Martin Clodi, Vera Paar, Elke Boxhammer","doi":"10.3390/medsci14040484","DOIUrl":"10.3390/medsci14040484","url":null,"abstract":"<p><p><b>Background</b>: Lipoprotein(a) [Lp(a)] has emerged as a key mediator of calcific aortic valve disease and is strongly linked to the development and progression of aortic stenosis (AS). Whether elevated Lp(a) influences disease severity, long-term prognosis, or both in patients undergoing transcatheter aortic valve implantation (TAVI) remains uncertain. <b>Methods</b>: This multicenter study included 213 patients with severe symptomatic AS undergoing TAVI between 2016 and 2018. Pre-procedural Lp(a) concentrations were measured using a standardized immunoturbidimetric assay. Associations with long-term all-cause mortality were evaluated using Kaplan-Meier analyses and Cox proportional hazards models. The relationship between Lp(a) and AS severity was assessed using correlation analyses, multivariable linear regression models, and restricted cubic spline analyses. Anatomical and hemodynamic measures included aortic valve calcium score (AVCS), peak aortic jet velocity (AV Vmax), and transvalvular pressure gradients. <b>Results</b>: During a median follow-up of 7.58 years (IQR 4.33-8.66 years), Lp(a) was not associated with all-cause mortality, irrespective of whether it was analyzed as a continuous variable, according to established clinical thresholds, or across quartiles. In contrast, higher Lp(a) concentrations were associated with greater valvular calcification and more severe hemodynamic obstruction. These associations remained significant after adjustment for age, sex, diabetes mellitus, and renal function. Restricted cubic spline analyses suggested predominantly linear associations without evidence of significant non-linearity. <b>Conclusions</b>: Elevated Lp(a) concentrations were associated with greater anatomical and hemodynamic severity of AS but not with long-term mortality after TAVI. These findings suggest that elevated Lp(a) is associated with greater anatomical and hemodynamic severity of calcific aortic valve disease but was not linked to long-term mortality after TAVI.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835341","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":"Incidence and Risk Factors of Postoperative Bleeding After LLETZ.","authors":"Chiara Paternostro, Elmar Joura, Gustav Nowotny, Eva Maria Langthaler, Frederic Toemboel, Sophie Pils","doi":"10.3390/medsci14040478","DOIUrl":"10.3390/medsci14040478","url":null,"abstract":"<p><p><b>Background:</b> Large loop excision of the transformation zone (LLETZ) is an established surgical procedure for cervical intraepithelial neoplasia; however, secondary postoperative bleeding may lead to unplanned outpatient visits, hospitalization, or surgical intervention. This study aimed to evaluate the incidence and risk factors of postoperative bleeding after LLETZ. <b>Methods:</b> We conducted a retrospective single-center cohort study comprising 1493 patients who underwent LLETZ for the treatment of cervical dysplasia between January 2008 and May 2023 at the Medical University of Vienna. Postoperative bleeding was defined as an unscheduled outpatient presentation for bleeding from the operative site within eight weeks after LLETZ requiring additional treatment. Clinical, surgical and histopathological parameters were analyzed. Univariable logistic regression was performed to identify factors associated with postoperative bleeding, with additional stratified analyses according to the use of intraoperative cervical infiltration. <b>Results:</b> Postoperative bleeding occurred in 56 patients (3.8%). The median time to bleeding was 13.5 days (IQR 9.0-17.0). Among patients with postoperative bleeding, 20 (35.7%) required hospitalization, 10 (50.0%) underwent operative intervention, and 2 (10.0%) required blood transfusion. In logistic regression, increasing cone length was associated with higher odds of postoperative bleeding (OR 1.83 per cm, 95% CI 1.06-3.18, <i>p</i> = 0.031). Anticoagulation and/or antiplatelet therapy was also associated with an increased bleeding risk (OR 3.61, 95% CI 1.46-8.96, <i>p</i> = 0.006). Higher BMI was associated with lower odds of postoperative bleeding (BMI per +5 kg/m²: OR 0.62, 95% CI 0.43-0.90, <i>p</i> = 0.011). <b>Conclusions:</b> LLETZ is associated with a low risk of clinically relevant postoperative bleeding, with an unplanned outpatient re-presentation rate of 3.8% and a re-operation rate of 0.7%. Increased cone length and anticoagulation and/or antiplatelet therapy were associated with higher bleeding rates. Larger prospective studies are needed to validate these findings and improve individualized perioperative risk assessment.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835404","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":"Associations Between Musculoskeletal Structural Parameters and Pulmonary Function in Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study.","authors":"Kanogwun Thongchote, Panda Chainiramol, Pornpimol Muanjai, Sarawut Lapmanee","doi":"10.3390/medsci14040476","DOIUrl":"10.3390/medsci14040476","url":null,"abstract":"<p><p><b>Background/Objectives</b>: This study aimed to compare structural and functional parameters between chronic obstructive pulmonary disease (COPD) patients and healthy controls, assess associations with pulmonary function, and identify factors independently associated with COPD status. <b>Methods</b>: A cross-sectional study was conducted in 89 participants (COPD: <i>n</i> = 45; controls: <i>n</i> = 44). Structural parameters included forward shoulder posture (FSP), scapular rotation, scapular distance (SD), and pectoralis minor index, measured bilaterally. Functional parameters included maximum inspiratory and expiratory pressures (MIP/MEP), chest expansion at three thoracic levels, spinal angles, and spirometry (%FVC, %FEV1, FEV1/FVC, FEF_25-75%, PEFR). Univariate and stepwise multivariate logistic regression identified variables independently associated with COPD. <b>Results</b>: COPD patients were older and exhibited lower anthropometric measures. Scapular rotation was greater in COPD (<i>p</i> < 0.05 bilaterally), while SD was significantly reduced (<i>p</i> < 0.001 bilaterally). MIP, MEP, and chest expansion at all three levels were significantly impaired in COPD (<i>p</i> < 0.05). All spirometric parameters were markedly lower in COPD (all <i>p</i> < 0.001). SD was positively associated with spirometric indices on both sides (<i>p</i> < 0.01). FSP was inversely associated with MIP, MEP, and chest expansion (<i>p</i> < 0.05). In multivariate logistic regression, age (OR 1.280, <i>p</i> = 0.018), %FVC (OR 0.875, <i>p</i> = 0.029), and FEF_25-75% (OR 0.909, <i>p</i> < 0.001) were independently associated with COPD status. <b>Conclusions</b>: Patients with COPD demonstrated reduced SD and increased scapular rotation. SD was significantly associated with pulmonary function, whereas FEF_25-75% and %FVC emerged as independently associated variables of COPD status. Collectively, these findings underscore the clinical relevance of integrating targeted scapulothoracic and respiratory rehabilitation strategies to optimize functional outcomes and support overall respiratory health and well-being.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835357","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}