Medical sciences (Basel, Switzerland)最新文献

{"title":"Lifestyle and Psychosocial Determinants of Type 2 Diabetes Risk Across Adulthood: The Role of Burnout in a Large Occupational Cohort.","authors":"Aina Gabriela Valiente Pizá, Pedro Juan Tárraga López, Ángel Arturo López-González, Irene Coll Campayo, Carla Busquets-Cortés, José Ignacio Ramírez-Manent","doi":"10.3390/medsci14050546","DOIUrl":"10.3390/medsci14050546","url":null,"abstract":"<p><strong>Background: </strong>Lifestyle behaviors and psychosocial factors are key determinants of cardiometabolic health across the life course. Beyond traditional risk factors, emerging evidence suggests that chronic stress and burnout may influence metabolic risk through behavioral pathways such as physical inactivity and poor diet. However, their joint contribution to type 2 diabetes risk in working populations remains insufficiently understood.</p><p><strong>Objectives: </strong>Our objectives were to examine the joint contribution of lifestyle habits, sociodemographic factors, and burnout to type 2 diabetes risk, and to explore potential behavioral pathways linking psychosocial stress to metabolic risk in a large adult population.</p><p><strong>Methods: </strong>A cross-sectional study was conducted in 92,480 Spanish workers undergoing routine occupational health assessments between 2021 and 2023. Type 2 diabetes risk was assessed using validated tools (FINDRISC, QDScore, CANRISK). Lifestyle indicators included adherence to the Mediterranean diet and physical activity levels; burnout was assessed using the Burnout Assessment Tool (BAT). Multivariable logistic regression models were used to evaluate associations between determinants and diabetes risk. Mediation analyses were performed to assess the contribution of lifestyle behaviors to the association between burnout and diabetes risk, and predictive performance analyses evaluated the incremental value of burnout.</p><p><strong>Results: </strong>Burnout was independently associated with a higher probability of moderate-to-high diabetes risk across all screening tools. Exploratory cross-sectional mediation analyses indicated that lifestyle behaviors, particularly physical inactivity and low adherence to the Mediterranean diet, statistically accounted for approximately 45% of the observed association. Adding burnout to the models significantly improved discrimination and reclassification of moderate-to-high diabetes-risk classification. In addition, higher diabetes risk was consistently observed among individuals from lower socioeconomic groups and those with unhealthy lifestyle profiles.</p><p><strong>Conclusions: </strong>Lifestyle behaviors and psychosocial stress were associated with estimated diabetes risk across adulthood. Burnout was independently associated with a higher probability of moderate-to-high diabetes-risk classification, with exploratory analyses suggesting that lifestyle behaviors may statistically account for part of this association. These cross-sectional findings highlight the potential relevance of considering both behavioral and psychosocial factors when studying cardiometabolic risk in working populations, while prospective studies are needed to establish temporal and causal relationships.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042341","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 Neonatal History to Adult Cardiovascular Risk: Preterm Birth as a Lifelong Risk Enhancer.","authors":"Mohamedanas Mohamedfaruk Patni, Malek Nasrallah, Dana Ja'afer Al Tarawneh, Mohamed El-Tanani, Khalid Ahmed Ibrahim, Abdullah Mohamad Hajjo, Mhd Munzer Zaher Hussin Alali, Ibrahim Alabid, Wasim Iyad Alghoul, Sakina Abdeali Sehrawala, Imran Rangraze, Ramya Kundayi Ravi","doi":"10.3390/medsci14050543","DOIUrl":"10.3390/medsci14050543","url":null,"abstract":"<p><strong>Background: </strong>Preterm birth is increasingly recognized as an early-life exposure with potential cardiovascular consequences across the lifespan. Although improved neonatal care has increased survival among individuals born very and extremely preterm, birth history remains rarely incorporated into cardiovascular risk assessment.</p><p><strong>Objective: </strong>This review synthesizes current evidence linking preterm birth with cardiovascular risk and proposes a practical birth-history-informed framework for preventive cardiology.</p><p><strong>Methods: </strong>A narrative review was conducted to evaluate evidence from population-based cohort studies, sibling-comparison analyses, cardiovascular imaging studies, physiologic exercise studies, Mendelian randomization analyses, mechanistic studies, and selected reviews. The review focused on cardiovascular outcomes, blood pressure trajectories, cardiac remodeling, pulmonary vascular disease, renal and metabolic pathways, autonomic regulation, exercise physiology, and clinical prevention.</p><p><strong>Results: </strong>Preterm birth is most consistently associated with higher blood pressure across life stages and with altered cardiac structure or reserve, particularly among individuals born very or extremely preterm or with complicated neonatal courses. Population-based evidence also links preterm birth with later heart failure, ischemic heart disease, stroke, atrial fibrillation, chronic kidney disease, and diabetes, although absolute risks in young adulthood remain low and associations vary by gestational age, fetal growth, and neonatal complications. Pulmonary vascular, right-heart, and autonomic findings appear most relevant to selected high-risk or symptomatic survivors rather than to all individuals born preterm. Current evidence supports targeted prevention rather than universal advanced testing.</p><p><strong>Conclusions: </strong>Preterm birth should be viewed as an early-life cardiovascular risk enhancer rather than a forgotten neonatal detail. Incorporating gestational age, birth weight, and neonatal complications into cardiovascular history-taking may improve early risk recognition, guide blood pressure and cardiometabolic surveillance, and support individualized prevention across the lifespan.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Kidney Function: A Neuro-Renal Perspective on Personalized Care in Pediatric Chronic Kidney Disease.","authors":"Aarish Manzar, Una Tonkovic, Svetozar Mijuskovic, Aleksandar Sic, Aladin Altic, Jelena Pavlovic, Marko Baralic","doi":"10.3390/medsci14050544","DOIUrl":"10.3390/medsci14050544","url":null,"abstract":"<p><p>Pediatric chronic kidney disease (CKD) is traditionally viewed as a disorder of impaired renal function, yet its effects extend far beyond the kidneys. Growing evidence indicates that CKD may disrupt brain development through interconnected biological, vascular, inflammatory, and psychosocial mechanisms, with lasting consequences for cognition, mental health, and educational attainment. In this perspective, we propose the kidney-brain axis as a neuro-renal framework for understanding these neurological consequences of pediatric CKD. We discuss current evidence linking CKD with neurocognitive impairment, structural brain abnormalities, psychosocial burden, and adverse educational outcomes, while examining the biological mechanisms that may underlie these associations. We also consider the role of kidney transplantation, emphasizing that restoration of renal function does not necessarily restore normal neurodevelopmental trajectories. Finally, we outline the clinical implications of integrating routine neurodevelopmental assessment into pediatric nephrology care and highlight priorities for future research. Recognizing neurodevelopment as a core component of pediatric CKD may help redefine disease burden and support more comprehensive, lifelong care for affected children.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041630","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":"Precision Diagnostics in Prostate Cancer: Integrating Biomarkers, Imaging, Genomics, and Artificial Intelligence in Contemporary United States Practice.","authors":"Moustafa Kardjadj","doi":"10.3390/medsci14050541","DOIUrl":"10.3390/medsci14050541","url":null,"abstract":"<p><p>Prostate cancer is the most commonly diagnosed non-cutaneous malignancy among men in the United States and remains a leading cause of cancer-related mortality. Its marked biological, molecular, and histopathological heterogeneity creates a central diagnostic challenge: identifying clinically significant disease while limiting unnecessary biopsy and overdiagnosis of tumors unlikely to affect survival or quality of life. Although prostate-specific antigen (PSA) remains the foundation of early detection, its limited cancer specificity has driven the development of increasingly risk-adapted diagnostic pathways. Contemporary evaluation integrates clinical risk assessment and PSA-derived measures with selectively used blood- and urine-based biomarkers, multiparametric magnetic resonance imaging (mpMRI), image-guided biopsy, histopathological classification, genomic risk assessment, and molecular imaging. Biomarkers such as the Prostate Health Index, 4Kscore, IsoPSA, MiCheck, SelectMDx, and ExoDx may refine biopsy decisions in appropriately selected patients but should be interpreted according to the clinical setting, decision threshold, and surrounding diagnostic pathway. Prostate MRI and PI-RADS-based assessment have become central to pre-biopsy evaluation, while MRI-targeted biopsy improves detection of Grade Group ≥ 2 disease. Increasing use of the transperineal biopsy route offers comparable cancer detection with a lower infectious risk. Following diagnosis, Grade Group, adverse histological features, clinical risk models, and selected tissue-based genomic classifiers provide complementary prognostic information. PSMA PET/CT has further improved staging of selected patients with higher-risk disease and localization of biochemical recurrence. Precision diagnostics must also account for disease phenotypes that may not be adequately represented by conventional PSA- and imaging-based pathways, including intraductal carcinoma, cribriform architecture, ductal adenocarcinoma, and neuroendocrine prostate cancer. Emerging approaches, including artificial intelligence-assisted MRI interpretation, digital pathology, high-frequency micro-ultrasound, liquid biopsy, alternative molecular radiotracers, and multi-omic integration, show increasing potential but remain at different stages of validation and clinical adoption. This review critically examines contemporary prostate cancer diagnostics within United States clinical practice, distinguishing established guideline-supported approaches from selectively used adjuncts and emerging technologies. Particular emphasis is placed on diagnostic performance in context, clinical utility, external validation, healthcare equity, regulatory considerations, and the need to demonstrate that increasing diagnostic complexity translates into meaningful improvements in patient care.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042516","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 Measurement Properties and Applications of WHODAS 2.0 in Multiple Sclerosis: A Systematic Review.","authors":"Amelia Rizzo, Maria Grazia Maggio, Andrea Calderone, Federica Impellizzeri, Giulia Pistorino, Claudia Pitrone, Aldo Sitibondo, Fabrizio Meus, Rita Mazziotti, Raffaele Migliorini, Diego Burzomati, Rocco Salvatore Calabrò","doi":"10.3390/medsci14050542","DOIUrl":"10.3390/medsci14050542","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Multiple sclerosis (MS) affects motor, cognitive, psychological, and social functioning that impairment-based scales do not fully capture. This systematic review evaluated the measurement properties and applications of the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 in adults with MS across research and clinical contexts. <b>Methods:</b> PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library were searched from inception to 25 May 2026. Eligible peer-reviewed studies reported extractable WHODAS data in adults with MS. Evidence was organized into measurement, clinical-association, participation/employment, intervention, digital-monitoring, and longitudinal streams. Design-appropriate critical-appraisal tools and outcome-specific certainty assessments were applied; quantitative pooling was assessed but was not justified. <b>Results:</b> Of the 677 records identified, 28 reports were included. Five reports evaluated measurement properties; moderate-certainty evidence supported reliability and construct validity, although precision differed among 12-, 32-, and 36-item forms. Associations with quality of life and clinical severity were supported by low-certainty evidence. Evidence concerning fatigue, mood, cognition, participation, and employment was of low or very low certainty because most studies were cross-sectional, used heterogeneous metrics, or involved overlapping cohorts. Intervention evidence was of very low to low certainty: WHODAS was secondary, and interventions, time points, and scoring methods were not comparable. Eight reports arose from one overlapping research program. <b>Conclusions:</b> WHODAS 2.0 provides a multidimensional patient-reported account of functioning in MS and may complement, but not replace, the Expanded Disability Status Scale. Evidence supports measurement use more strongly than prognostic, treatment-response, or benefit-determination claims. Standardized version selection, scoring, domain reporting, and prespecified longitudinal endpoints are required.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042628","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 Wearable-Derived Autonomic Component Is Associated with Cardiovascular Health in Community-Dwelling Adults: A Cross-Sectional Analysis from the Longevity Check-Up 8+ Study.","authors":"Riccardo Calvani, Fabrizio Sollazzo, Luca Maria Sarti, Antonella Gallo, Anna Picca, Hélio José Coelho-Júnior, Andrea Russo, Sara Salini, Massimiliano Bianco, Emanuele Marzetti, Vincenzo Palmieri, Francesco Landi, Matteo Tosato","doi":"10.3390/medsci14050540","DOIUrl":"10.3390/medsci14050540","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Wearable devices provide multidimensional measures of cardiometabolic health. We aimed to derive latent physiological dimensions from ECG and motion variables collected by a wearable device and evaluate their associations with the individual health metrics of the Longevity Check-Up 8+ (LC8+) programme. <b>Methods</b>: Community-dwelling adults voluntarily participating in four Longevity Check-Up 8+ (LC8+) events underwent 24-h multiparameter recording using a wearable device. Eight wearable-derived variables were entered into principal component analysis (PCA) to derive latent physiological dimensions. Component scores were subsequently evaluated for associations with overall LC8+ health, while exploratory analyses examined associations with individual health metric domains. <b>Results</b>: Ninety-seven participants (mean age 51.3 ± 13.4 years; 36% female) were enrolled. Among the 96 participants with complete data for the PCA, three latent physiological components were identified, explaining 70.1% of the total variance. PC1, which was characterised by high SDNN, high RMSSD, and low nocturnal heart rate, was independently associated with overall LC8+ health (LM: B = +0.402, 95% CI [+0.103, +0.700], <i>p</i> = 0.009). Among the eight LC8+ domains, only the association between PC1 and glycaemic health remained statistically significant after Benjamini-Hochberg correction in the primary fixed-effects analysis (95% CI [1.32, 4.62], adjusted <i>p</i> = 0.039). <b>Conclusions</b>: A wearable-derived autonomic component was associated with overall cardiometabolic health in community-dwelling adults. Among the individual LC8+ domains, the strongest association was observed for glycaemic health. These preliminary findings support further investigation of wearable device monitoring as a complementary tool for cardiovascular health assessment in preventive medicine.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042351","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":"Inhibition of eCIRP Attenuates Inflammation and Gut Injury After Radiation Combined Injury with Sepsis.","authors":"Fangming Zhang, Gaifeng Ma, Hui Jin, Asha Jacob, Max Brenner, Ping Wang","doi":"10.3390/medsci14050539","DOIUrl":"10.3390/medsci14050539","url":null,"abstract":"<p><strong>Background: </strong>Radiation-induced sepsis resulting from intestinal inflammation and injury is a severe complication of high-dose radiation exposure. High-dose radiation compromises the integrity of the intestinal lining, causing bacterial translocation, systemic inflammation, and sepsis. Extracellular cold-inducible RNA-binding protein (eCIRP), a damage-associated molecular pattern, plays a pivotal role in the pathogenesis of inflammatory diseases and contributes to organ injury. C23, a small molecular peptide antagonist of eCIRP, has demonstrated anti-inflammatory and organ-protective effects during organ-injury indications. However, its role in radiation-induced inflammation and injury is not known. The objective of this study is to evaluate whether C23 mitigates inflammation and injury, leading to improved survival in a murine model of partial-body irradiation (PBI) combined with sepsis.</p><p><strong>Methods: </strong>Mice were exposed to 10 Gy PBI, and at 48 h, they were subjected to cecal ligation and puncture (CLP), a well-established model of sepsis. C23 (8 mg/kg body weight [BW]) or vehicle (saline) was administered subcutaneously at 24 h and 48 h after PBI. Blood and intestinal tissue samples were collected 20 h after CLP (i.e., 68 h post-PBI) for various analyses. In another set of mice after PBI-sepsis, intestinal permeability was also assessed. In an additional cohort of mice subjected to the same experimental procedure, 10-day survival was monitored.</p><p><strong>Results: </strong>Our findings demonstrate that administration of C23 attenuated systemic inflammatory responses, intestinal permeability, intestinal injury, and apoptosis; increased crypt cell proliferation and improved survival after PBI-sepsis.</p><p><strong>Conclusions: </strong>These results reveal a novel protective role of the eCIRP antagonist, C23, in mitigating PBI-sepsis-induced inflammation and injury and represents a promising therapeutic candidate for the treatment of radiation combined injury with sepsis.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042559","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 Six-Week Multimodal Functional Training Program Improves Physical Function and Modulates Redox Homeostasis in Older Women.","authors":"Gábor Papp, Attila Csaba Arany, Ádám Diós, Ágnes Gyetvai, Andrea Nagy, Zoltán Csiki, László Balogh","doi":"10.3390/medsci14050538","DOIUrl":"10.3390/medsci14050538","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Age-related increases in oxidative stress and chronic low-grade inflammation contribute to skeletal muscle deterioration, impaired physical performance, and loss of functional independence in older adults. Regular exercise may counteract these processes by improving both musculoskeletal function and systemic redox homeostasis; however, the effects of multimodal functional exercise on antioxidant defence mechanisms and innate immune redox regulation remain incompletely understood. Therefore, the aim of the present study was to investigate changes associated with a six-week multimodal functional exercise program in body composition, muscle strength, physical performance, antioxidant defence and phagocyte oxidative burst activity in older women. <b>Methods</b>: Seventeen physically inactive women aged over 65 years participated in a six-week functional training program consisting of aerobic, resistance, balance, coordination, and proprioceptive exercises performed twice weekly. Body composition, handgrip strength, and Short Physical Performance Battery (SPPB) scores were assessed before and after the intervention. In addition, serum antioxidant enzyme activities, total antioxidant capacity, lipid peroxidation markers, nitrite/nitrate concentrations, and phagocyte oxidative burst activity were determined. <b>Results</b>: Following the intervention, improvements were observed in skeletal muscle mass, muscle percentage, handgrip strength, and SPPB scores, while body fat mass and body fat percentage decreased. Catalase activity increased, whereas superoxide dismutase activity, glutathione peroxidase activity, and lipid peroxidation markers remained unchanged. Serum nitrite/nitrate concentrations increased following the intervention. Although neutrophil counts did not change, phagocyte oxidative burst activity decreased significantly. <b>Conclusions</b>: These findings indicate that a six-week multimodal functional exercise program was associated with favourable changes in body composition, enhanced muscle strength, and improved functional performance in previously inactive older women. In parallel, favourable changes in antioxidant defence, nitric oxide metabolism, and immune-related redox regulation were also observed following the intervention, supporting the potential role of multimodal functional training as an effective non-pharmacological strategy for promoting healthy ageing.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042337","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 Prevention of Hallux Valgus Recurrence After Primary Surgical Correction: A Structured Narrative Review.","authors":"Awad Dmour, Ahmed Mansour, Aya Riba, Liliana Savin, Mihaela-Camelia Tîrnovanu, Dragoș-Cristian Popescu, Ștefan-Dragoș Tîrnovanu, Bogdan Puha, Ilie Onu, Norin Forna, Paul-Dan Sirbu, Bianca-Ana Dmour","doi":"10.3390/medsci14050537","DOIUrl":"10.3390/medsci14050537","url":null,"abstract":"<p><p>Hallux valgus recurrence remains one of the most important causes of unsatisfactory outcomes following corrective surgery, with reported rates varying widely because of differences in patient selection, surgical techniques, follow-up duration, and recurrence definitions. Although numerous operative procedures have been described, growing evidence indicates that durable correction depends less on the specific procedure performed than on appropriate patient selection and complete correction of the underlying deformity. A structured literature search was conducted in PubMed from database inception to 4 August 2026 and supplemented by reference-list screening. Adult primary surgical studies reporting recurrence or factors associated with recurrence were eligible when they provided an explicit recurrence definition and at least 12 months of follow-up. Forty candidate primary studies were assessed in full text, of which 30 were included in the core evidence synthesis. Findings were synthesized narratively within predefined domains covering recurrence definitions, preoperative factors, procedure selection, technical correction, postoperative alignment, patient-related factors, and clinical consequences. Particular attention is given to the role of three-dimensional deformity correction, soft-tissue balancing, sesamoid realignment, and radiographic parameters including the hallux valgus angle, intermetatarsal angle, distal metatarsal articular angle, and metatarsal rotation. Contemporary surgical techniques, including Chevron, Scarf, Lapidus, first metatarsophalangeal joint fusion, and minimally invasive procedures, are reviewed with respect to their indications, recurrence mechanisms, and technical considerations. Based on the available evidence, recurrence prevention requires a comprehensive strategy integrating accurate preoperative assessment, procedure selection tailored to the underlying pathology, meticulous surgical technique, and structured postoperative follow-up. Standardized recurrence definitions and greater use of weight-bearing three-dimensional imaging may further improve future research and clinical decision making.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13608915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042503","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":"Developmental Timing of Alcohol Initiation as a Marker of Adult Clinical Complexity in Alcohol Use Disorder: A Cross-Sectional Study.","authors":"María Flores-López, Raquel Reviriego, Nuria García-Marchena, Nerea Requena-Ocaña, Juan Jesús Ruiz-Ruiz, Jesús Herrera-Imbroda, Antonio Bordallo, Juan Suarez, Patricia Moreno-Peral, Juan Ángel Bellón, Fernando Rodríguez de Fonseca, Francisco Javier Pavón-Morón, Antonia Serrano","doi":"10.3390/medsci14050535","DOIUrl":"10.3390/medsci14050535","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Age at alcohol initiation is consistently associated with later alcohol use disorder (AUD), but it remains uncertain whether initiation across distinct developmental stages identifies clinically different adult phenotypes. We examined whether alcohol initiation during early, middle, or late adolescence was associated with graded differences in addictive, psychiatric, and treatment-related complexity among adults with AUD. <b>Methods</b>: This cross-sectional study included 436 treatment-seeking adults with lifetime AUD recruited from addiction programs in Spain. Primary analyses included 409 participants who reported alcohol initiation during early (10-13 years; <i>n</i> = 85), middle (14-16 years; <i>n</i> = 182), or late adolescence (17-21 years; <i>n</i> = 142). Participants underwent structured assessment with the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). Between-group comparisons, ordinal logistic regression, and exploratory latent class analysis (LCA) were performed. <b>Results</b>: Earlier initiation was associated with graded increases in comorbid non-alcohol substance use disorders (67.1%, 64.8%, and 47.2% across early, middle, and late initiation; FDR-adjusted <i>p</i> = 0.003), childhood conduct disorder (21.2%, 9.3%, and 4.2%; FDR-adjusted <i>p</i> < 0.001), and higher rates of lifetime therapeutic community treatment and mutual-support participation. Median age at AUD diagnosis was 19.0, 23.5, and 30.5 years, respectively (<i>p</i> < 0.001). In the model including age at AUD diagnosis, childhood conduct disorder (OR = 3.42, 95%CI 1.50-7.76) and mood disorder (OR = 2.13, 95%CI 1.41-3.21) were associated with earlier initiation. LCA identified a high externalizing/polysubstance complexity class (15.2%) enriched for earlier initiation (<i>p</i> < 0.001). <b>Conclusions</b>: Developmental timing of alcohol initiation was associated with a multidomain adult AUD phenotype. These findings suggest that initiation age could serve as a simple historical prompt for broader assessment; however, its incremental clinical utility was not tested, and it should not be interpreted as evidence of causality or a validated prediction tool.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042501","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}