Medical sciences (Basel, Switzerland)最新文献

{"title":"Chemotherapy Before Radiotherapy in Adjuvant Breast Cancer: The Origins of a Convention and the Case for Revisiting Sequence in the Era of Hypofractionation.","authors":"Mihai-Teodor Georgescu","doi":"10.3390/medsci14040477","DOIUrl":"10.3390/medsci14040477","url":null,"abstract":"<p><p>Guidelines in early breast cancer place adjuvant chemotherapy before radiotherapy, permit radiotherapy concurrently with endocrine and anti-HER2 agents, but discourage it before or during cytotoxic chemotherapy. This narrative review asks whether that convention remains defensible. Its historical basis, a single randomised trial whose distant-metastasis signal did not survive long-term follow-up, is weaker than is commonly assumed. Its contemporary basis is stronger and is stated here explicitly: an asymmetry of absolute benefit, in which a two-point gain in locoregional control yields roughly half a percentage point of mortality benefit once the EBCTCG four-to-one relationship is applied, whereas degradation of systemic therapy reaches mortality undiscounted. We specify three conditions under which a sequencing change could be justified and note that the absolute loss from a short chemotherapy delay cannot presently be quantified from randomised data. Meanwhile, chemotherapy has lengthened while radiotherapy has contracted to a one- to three-week whole-breast schedule, potentially extended when a sequential tumour-bed boost is required. The retrospective evidence is limited: one cohort offers a hypothesis-generating locoregional signal qualified by an unexpectedly high control-arm event rate and an unplanned subgroup analysis, while another supports only short-term feasibility and tolerability; neither demonstrates benefit in distant control or survival. We further argue that the population in which the question remains clinically live is narrow and probably contracting, since genomic de-escalation withdraws from chemotherapy the phenotypes with the most favourable arithmetic. Adjuvant sequencing is best regarded as an open, testable question within a defined population rather than a general case for change.</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/PMC13515723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835506","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":"Immunohistochemical Characterization of the Androgen Receptor in Breast Cancer and Its Relationship with Breast Cancer Subtypes.","authors":"María Luisa Sánchez-Ferrer, Alexandra Esteban Pedreño, Julián J Gonzalo-Arense, Inmaculada Ruiz Boluda, Micaela Llamas Sarriá, Jose Luis Alonso Romero, Domingo Sánchez Martínez, Carlos Manuel Martínez-Cáceres, Jaime Mendiola, Alberto M Torres Cantero","doi":"10.3390/medsci14040479","DOIUrl":"10.3390/medsci14040479","url":null,"abstract":"<p><strong>Background/objectives: </strong>Breast cancer is the most frequent malignant neoplasm in women and presents marked biological heterogeneity. The androgen receptor (AR) has emerged as a biomarker with important prognostic and therapeutic implications, its effect varying according to the molecular subtype. The objective of this study was to analyze AR expression in breast carcinoma samples and its relationship with the different molecular subtypes and clinicopathological variables.</p><p><strong>Methods: </strong>An observational, descriptive, cross-sectional, and prospective study was conducted based on the immunohistochemical analysis of 215 formalin-fixed, paraffin-embedded breast carcinoma samples. AR expression was digitally evaluated as the percentage of positive tumor cells after incubation with an anti-AR monoclonal antibody.</p><p><strong>Results: </strong>A high frequency of AR expression was demonstrated in the cohort, with a median of 53.3%. There were statistically significant differences between molecular subtypes (<i>p</i> < 0.001), detecting greater expression in luminal tumors and markedly low levels in triple-negative breast cancer (TNBC) (median 0.41%). A significant negative correlation was evidenced between AR expression and the Ki-67 proliferation index (ρ = -0.272; <i>p</i> < 0.001), both in the overall sample and in the TNBC subgroup.</p><p><strong>Conclusions: </strong>The androgen receptor is associated with specific molecular subtypes and lower tumor proliferation, suggesting a less aggressive phenotype and supporting its role as a biological biomarker and potential therapeutic target in the management of breast cancer.</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/PMC13515587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835393","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":"Regional Disparities in Stroke Hospitalization and Mortality Associated with Long-Term Fine Particulate Matter Exposure: A Nationwide Ecological Study in Spain.","authors":"José María Ramírez-Moreno, Víctor Martín Hernández, Andrea Parejo Olivera, Noelia Valverde Mata, Marina Mesa Hernández, Pablo Macías Sedas, Ana Maria Roa Montero, María José Gómez Baquero, David Ceberino Muñoz, David Tena Mora","doi":"10.3390/medsci14040475","DOIUrl":"10.3390/medsci14040475","url":null,"abstract":"<p><strong>Background/objectives: </strong>Stroke remains a leading cause of death and disability globally, with considerable regional heterogeneity in incidence and mortality reflecting differences in classical vascular risk factors and environmental determinants. Fine particulate matter (PM2.5) is an established modifiable environmental risk factor, yet its association with regional stroke disparities remains understudied in Mediterranean European contexts. We examined regional differences in stroke hospitalization and mortality and their ecological associations with long-term air-pollution exposure across Spain's 17 autonomous communities from 2013 to 2021.</p><p><strong>Methods: </strong>We conducted a nationwide longitudinal ecological study using aggregated stroke indicators from INCLASNS and ambient air-pollution data from MITECO. The dataset comprised 306 sex-specific region-year observations. The primary outcome was the age-standardized hospitalization rate (ASHR); secondary outcomes were CHR, CMR, ASMR, CFR, and IMI. Associations were assessed using correlation analyses, temporal trends, regional comparisons, and multivariable regression. Sex-stratified analyses were considered exploratory because pollutant concentrations were measured at the regional-year level and were not sex-specific.</p><p><strong>Results: </strong>Mean ASHR was 20.1 ± 5.4 per 10,000 population, with marked regional variation. PM2.5 showed the largest positive ecological correlation with ASMR among all pollutants examined (r = 0.264, <i>p</i> < 0.001), although the correlation remained weak. Overall pollutant-outcome correlations were weak and heterogeneous in direction. Regional variation in stroke burden was not adequately explained by the available air-pollution indicators.</p><p><strong>Conclusions: </strong>PM2.5 was weakly associated with ASMR, whereas associations with hospitalization and other pollutants were small and inconsistent. These ecological findings do not support causal or individual-level inference and warrant confirmation using higher-resolution exposure and individual-level data.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835138","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":"Exercise-Based Interventions for the Management of Low Back Pain in Adolescents in School Settings: A Systematic Review.","authors":"Gismael M Tarão, João Pedro R Afonso, Alex S Ribeiro, Marieli R Stocco, Adriana Bovi, Ludymilla V Barbosa, André L Pinto, Claudia S Oliveira, Karla C N de Carvalho, Miriã C Oliveira, Fernanda S P Quirino, Glauber A Oliveira, Andréia C R I Sampaio, Dunya O Masri, Luís V F Oliveira, Tiago V Fernandes, Hustênio A A Filho, Paolo Capodaglio, Luciana P Maia, Rodrigo A C Andraus","doi":"10.3390/medsci14040473","DOIUrl":"10.3390/medsci14040473","url":null,"abstract":"<p><strong>Background/objectives: </strong>To synthesize the effects of school-based exercise interventions in adolescents with nonspecific low back pain.</p><p><strong>Methods: </strong>PubMed/MEDLINE, Scopus, Web of Science, CENTRAL, PEDro, ScienceDirect, and supplementary sources were searched through 21 May 2026. Randomized and quasi-randomized controlled trials involving adolescents aged 10-19 years and delivering exercise wholly or substantially within schools were eligible. Risk of bias was assessed using Cochrane RoB 1, and findings were synthesized narratively.</p><p><strong>Results: </strong>Of 1935 records, two randomized trials and one quasi-experimental controlled trial (194 allocated participants) were included. Fanucchi et al. reported between-group reductions in past-month pain of 2.2 cm on a 10-cm visual analogue scale (95% CI 1.0-3.5) at 3 months and 2.0 cm (95% CI 0.5-3.5) at 6 months; absolute reductions in 3-month low back pain prevalence were 24% (95% CI 4-41) and 40% (95% CI 18-57), respectively. Jones et al. reported a large effect size for pain severity after 8 weeks (ES = 1.47). Javadipour et al. reported favorable pain and motor-function outcomes, but incomplete and internally inconsistent reporting limited interpretation. No study assessed low-back-pain-related disability using a validated instrument. All studies had high risk of bias in at least one domain, most commonly blinding. Heterogeneity precluded meta-analysis.</p><p><strong>Conclusions: </strong>Limited evidence suggests that school-based exercise may reduce pain intensity and pain prevalence over six months and improve selected physical outcomes in adolescents aged 12-15 years. The small, heterogeneous evidence base and risk of bias preclude conclusions or recommendations regarding modality or dosage.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835428","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":"Real-World Data on Characteristics and Management of Patients with Actinic Keratosis: A Cancer Center Experience.","authors":"Flavia Silvestri, Francesca Pepe, Sara Gandini, Aurora Gaeta, Paola Queirolo, Giulio Tosti","doi":"10.3390/medsci14040474","DOIUrl":"10.3390/medsci14040474","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Actinic keratosis is an intraepithelial lesion that may progress into squamous cell carcinoma; therefore, all lesions should be treated. The study aimed to investigate the potential correlations between patient and lesion characteristics, treatment option choice, and clinical outcomes, analyzing long-term real-world data. <b>Methods</b>: A retrospective study was conducted in a specialized hospital in Milan. Data on patients with actinic keratoses were collected from January 2018 to July 2024. <b>Results</b>: A total of 369 patients were included, with normal weight (58%), higher educational level (83%), personal skin cancer history (51%), childhood sunburns (68%), and face localization (70%), with multiple contiguous distribution (54%) of lesions. In total, 45.5% received multiple treatments. Field-directed therapies were prescribed in 84% of cases (32% of complete clearance). A total of 43% were lost to follow-up. Higher educational level, personal and familiar skin cancer history, previous atypical naevus excision, higher naevus count, and multiple treatments (<i>p</i> < 0.05) were associated with regularity in visit attendance. In multivariable analysis, immunosuppression (OR = 5.01 [0.97, 29.5], <i>p</i> = 0.056) and multiple contiguous lesions (OR = 4.62 [1.75, 14.7], <i>p</i> = 0.004) were found to be significantly associated with incomplete clinical response. <b>Conclusions</b>: Real-world data on patients with actinic keratoses may help identify more personalized management strategies that influence treatment outcomes and adherence to follow-up.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835129","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":"More than Fluid: AI-Derived Pleural Effusion Volume as a Marker of Cardiovascular Congestion in Transcatheter Aortic Valve Implantation.","authors":"Nikolaos Schörghofer, Nikolaus Clodi, Gretha Hecke, Matthias Hammerer, Alexander Kupferthaler, Bernhard Scharinger, Uta C Hoppe, Klaus Hergan, Elke Boxhammer, Christoph Knapitsch","doi":"10.3390/medsci14040472","DOIUrl":"10.3390/medsci14040472","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Pleural effusions are frequently encountered on pre-procedural computed tomography (CT) scans in patients undergoing transcatheter aortic valve implantation (TAVI). While often regarded as a marker of congestion and advanced cardiovascular disease, their clinical and prognostic significance in contemporary TAVI populations remains poorly understood. This study investigated the relationship between AI-derived pleural effusion volume, cardiovascular dysfunction, and long-term mortality after TAVI. <b>Methods:</b> Consecutive patients undergoing transfemoral TAVI between 2016 and 2022 who had available pre-procedural CT imaging were retrospectively included. Pleural effusion volume was quantified using an artificial intelligence-based segmentation workflow and analyzed as categorical, continuous, log-transformed, and threshold-based variables. Associations with clinical and echocardiographic characteristics were evaluated using Spearman correlation analyses. Long-term mortality was assessed using Kaplan-Meier analysis, Cox proportional hazards regression, and restricted cubic spline models. <b>Results:</b> A total of 470 patients were included (median age 82 years, 50.9% male). Pleural effusion was present in 124 patients (26.38%), including 73 (15.53%) with small, 26 (5.53%) with moderate, and 25 (5.32%) with larger effusions. Increasing pleural effusion volume was associated with atrial fibrillation (AF) (rho = 0.189, <i>p</i> < 0.001), higher systolic pulmonary artery pressure (rho = 0.224, <i>p</i> < 0.001), lower tricuspid annular plane systolic excursion (rho = -0.236, <i>p</i> < 0.001), impaired right ventricular-pulmonary arterial coupling (rho = -0.267, <i>p</i> < 0.001), lower stroke volume index (rho = -0.229, <i>p</i> < 0.001), and reduced left ventricular ejection fraction (rho = -0.221, <i>p</i> < 0.001). Despite these associations, pleural effusion volume was not associated with long-term mortality in univariable analyses, multivariable Cox regression models, or restricted cubic spline analyses. In the fully adjusted model, log-transformed pleural effusion volume was not independently associated with mortality (HR 1.00, 95% CI 0.93-1.08; <i>p</i> = 0.976). <b>Conclusions:</b> AI-derived pleural effusion volume is associated with markers of cardiovascular congestion and adverse hemodynamic remodeling in patients undergoing TAVI. However, pleural effusion burden does not independently predict long-term mortality, suggesting that its value lies primarily in phenotyping cardiovascular disease severity rather than risk stratification.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835444","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":"Initial Ward Admission Followed by Early Respiratory Intermediate Care Transfer and In-Hospital Mortality.","authors":"Txomin Zabala Hernández, Susana García Gutierrez, Amaia Aramburu Ojembarrena, Amaia García Loizaga, Myriam Aburto, Francisco Javier Moraza Cortes, Cristobal Esteban Gonzalez, María Gascón Pérez, María José Legarreta Olabarrieta, Ane Uranga","doi":"10.3390/medsci14040470","DOIUrl":"10.3390/medsci14040470","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Respiratory intermediate care units (RICUs) manage patients with severe respiratory disease requiring advanced monitoring and non-invasive respiratory support. Early identification of patients requiring RICU care after emergency department (ED) assessment remains challenging. This study assessed whether initial admission to a conventional hospital ward followed by early RICU transfer was associated with in-hospital mortality among patients ultimately admitted to a RICU. <b>Methods:</b> We conducted a 10-year prospective observational cohort study including consecutive patients admitted to the RICU of a tertiary hospital after ED assessment. Patients admitted directly from the ED to the RICU were classified as the direct RICU admission group. Patients initially admitted to a conventional ward and transferred to the RICU within 48 h were classified as the early ward-to-RICU transfer group. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included ICU admission and hospital length of stay. Multivariable logistic regression was used to assess the association between admission pathway and in-hospital mortality. <b>Results:</b> A total of 1784 patients were included: 1285 (72%) in the direct RICU admission group and 499 (28%) in the early ward-to-RICU transfer group. In-hospital mortality was higher in the early ward-to-RICU transfer group than in the direct RICU admission group (13.43% versus 5.76%; <i>p</i> < 0.0001), as were ICU admission rates (6.01% versus 2.57%; <i>p</i> = 0.0004). In the complete-case multivariable model, early ward-to-RICU transfer remained associated with higher in-hospital mortality after adjustment for sex, ECOG performance status, APACHE II score at ED presentation, Charlson Comorbidity Index, heart failure, and interstitial lung disease (OR 2.99, 95% CI 1.96-4.56; <i>p</i> < 0.0001). <b>Conclusions:</b> Among patients ultimately admitted to a RICU after ED assessment, initial ward admission followed by early RICU transfer was associated with higher in-hospital mortality. These findings suggest that initial ward admission followed by early RICU transfer may help identify a clinically vulnerable subgroup among patients ultimately requiring respiratory intermediate care. However, because admission pathway may be influenced by evolving severity, diagnostic uncertainty, treatment decisions, and organisational factors, no causal inference can be made from this observational study.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835416","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 Role of Autophagy in Cancer Evolution and Prognosis, Highlighting Its Role in PCa and Its Interaction with Apoptosis and Epigenetic Regulation by miRNAs.","authors":"Magdalena Kurkiewicz, Aleksandra Moździerz, Anna Rzepecka-Stojko, Jerzy Stojko","doi":"10.3390/medsci14040471","DOIUrl":"10.3390/medsci14040471","url":null,"abstract":"<p><strong>Background: </strong>Autophagy is a process that diversely impacts the stages of both tumor initiation and progression. Elucidating the molecular mechanisms underlying autophagy and its role in tumorigenesis is a key component of anticancer strategies in both prostate cancer and other malignancies. Because advanced prostate cancer frequently exploits enhanced autophagy as a defense mechanism against therapy-induced stress (e.g., from abiraterone), the pharmacological modulation of miRNA levels presents a tremendous opportunity to block the tumor's escape route and overcome drug resistance.</p><p><strong>Methods: </strong>A comprehensive literature review was conducted to evaluate the molecular pathways determining cancer cell survival and death. The analysis focused on the dual nature of autophagy (functioning as a 'double-edged sword') within the tumor microenvironment, microRNA (miRNA) regulatory networks, and the efficacy of synergistic therapeutic strategies in overcoming treatment resistance.</p><p><strong>Results: </strong>The primary focus of this paper is the dual and complex role of autophagy, which serves, on the one hand, as a cellular protective shield against metabolic stress-thereby facilitating metastasis-and, on the other hand, as a potential pathway leading to autophagic cell death. The progression of this crucial process is regulated by intricate interactions (crosstalk) with apoptotic pathways, mediated by Bcl-2 family proteins, key kinases (such as mTOR, JNK, and DAPK), and transcription factors, such as p53. Furthermore, the autophagic machinery is precisely regulated by specific miRNA molecules (e.g., miR-21, miR-141, and miR-375). These not only act as crucial intracellular modulators of autophagy but also serve as promising circulating biomarkers, enabling the monitoring of this process's activity throughout disease progression.</p><p><strong>Conclusions: </strong>Autophagy, and in particular its modulation via miRNA signaling networks, represents a major and highly promising translational target. By directly impairing this autophagic survival mechanism, 'double-hit' combination therapies-integrating autophagy inhibitors (such as hydroxychloroquine or VPS34 inhibitors) with standard antiandrogen or cytotoxic agents-demonstrate promising preclinical potential in overcoming treatment resistance and favorably modulating the immune microenvironment in advanced prostate cancer.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835581","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":"Sodium Butyrate Therapy in Ulcerative Colitis: A Systematic Review of Preclinical and Clinical Evidence.","authors":"George Ionuț Golea, Radu Alexandru Ilieș, Alexandra Caziuc, David Andraș, Alexandru Ilie-Ene, Radu Seicean, Radu Mircea Neagoe, Ștefana Dăscălescu, Luca Simionescu, Ștefan Cristian Vesa, George Călin Dindelegan, Florin Zaharie","doi":"10.3390/medsci14040469","DOIUrl":"10.3390/medsci14040469","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Sodium butyrate, a short-chain fatty acid produced by gut microbial fermentation of dietary fiber, has attracted increasing interest as a potential adjunctive therapy for ulcerative colitis (UC) because of its anti-inflammatory, barrier-protective, and immunomodulatory properties. This systematic review aimed to evaluate the current clinical and preclinical evidence regarding the efficacy and mechanisms of sodium butyrate in UC. <b>Methods</b>: A systematic review was conducted in accordance with the PRISMA 2020 guidelines and registered in PROSPERO (CRD420261437741). PubMed/MEDLINE, Scopus, Web of Science, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched from February through April 2026. Eligible clinical and experimental studies investigating oral or rectal administration of sodium butyrate in UC or experimental colitis were included. Risk of bias was assessed using RoB 2, ROBINS-I, or the SYRCLE tool according to study design. <b>Results</b>: Twenty-two studies were included, comprising ten clinical trials, one prospective observational study and eleven preclinical animal studies. In adults diagnosed with UC, oral sodium butyrate, particularly microencapsulated formulations, demonstrated encouraging effects as an adjunct to standard therapy by improving clinical remission rates, quality of life and reducing disease activity and inflammatory biomarkers. Evidence in pediatric inflammatory bowel disease remained inconsistent. Studies evaluating rectal sodium butyrate enemas reported variable clinical efficacy despite evidence of local biological activity. Preclinical studies consistently demonstrated reduced intestinal inflammation, improved epithelial barrier integrity, modulation of oxidative stress, favorable alterations of the gut microbiota, and regulation of several mechanistic pathways identified across individual preclinical studies, including PI3K/AKT/mTOR, WNT/ERK, ERK/STAT3, autophagy and ferroptosis. <b>Conclusions</b>: Current evidence suggests that sodium butyrate represents a promising adjunctive therapeutic strategy for UC, supported by consistent mechanistic findings and encouraging clinical results, particularly with oral formulations. However, the available clinical evidence remains heterogeneous, and larger, well-designed randomized controlled trials with standardized formulations and treatment protocols are required before its routine clinical implementation can be considered.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835432","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 Distinct Bronchoalveolar Lavage Cytokine Signature Characterizes Nontuberculous Mycobacterial Pulmonary Disease.","authors":"Norio Kodaka, Kayo Watanabe, Chihiro Nakano, Saeko Shinozawa, Takatomo Hirouchi, Yuto Yoshida, Yuka Yamada, Go Yoshizawa, Rubina Morimoto, Hiroto Matsuse","doi":"10.3390/medsci14040468","DOIUrl":"10.3390/medsci14040468","url":null,"abstract":"<p><p><b>Background:</b> Although diagnosis of pulmonary nontuberculous mycobacterial (NTM) disease typically relies on bronchoscopic sampling, microbiologic testing, and histopathologic evaluation, definitive diagnosis is often difficult. This study investigated whether cytokine profiling of bronchoalveolar lavage (BAL) fluid can help differentiate NTM pulmonary disease (NTM-PD) from other diffuse lung disorders. <b>Methods:</b> From January 2023 to July 2025, we prospectively evaluated 50 patients presenting with undiagnosed micronodular or diffuse pulmonary opacities. BAL fluid was collected during bronchoscopy and analyzed for cytokines and related biomarkers. Eleven patients were clinically diagnosed with NTM-PD based on American Thoracic Society/Infectious Diseases Society of America criteria. Cytokine and cellular profiles were compared between patients with NTM-PD and those with other diffuse lung disorders. A secondary analysis compared infectious granulomatous disease (NTM-PD; <i>n</i> = 11) with noninfectious granulomatous disease (e.g., sarcoidosis; <i>n</i> = 8). <b>Results:</b> BAL fluid from patients with NTM-PD showed significantly higher levels of interleukin-8 (IL-8), interleukin-13 (IL-13), YKL-40, and neutrophils compared to those with other diffuse lung disorders. In subgroup analysis, IL-8, IL-13, and neutrophil proportions remained significantly elevated in infectious granulomatous NTM-PD compared with noninfectious granulomatous disorders. <b>Conclusions:</b> NTM-PD is associated with a distinct BAL cytokine profile characterized by elevated IL-8, IL-13, YKL-40, and neutrophil proportions.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835316","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}