Medical sciences (Basel, Switzerland)最新文献

{"title":"Acute Respiratory Distress Syndrome in Hospital-Acquired/Ventilator-Associated Pneumonia.","authors":"Davide Calabretta, Claudia Accetturo, Antoni Torres","doi":"10.3390/medsci14050514","DOIUrl":"10.3390/medsci14050514","url":null,"abstract":"<p><p>Acute respiratory distress syndrome (ARDS) represents a major cause of morbidity and mortality in critically ill patients and is most frequently triggered by severe respiratory infections, including nosocomial pneumonia. Hospital-acquired and ventilator-associated pneumonia (HAP/VAP) are highly prevalent in intensive care units and share overlapping pathophysiological mechanisms with ARDS. Despite this close interrelationship, the proportion of patients with nosocomial pneumonia who subsequently develop ARDS remains poorly defined, underscoring the need to identify potential predisposing factors and improve early recognition of patients at risk. While the development of pneumonia in patients with an established diagnosis of ARDS has been extensively investigated, limited data are available on patients who develop ARDS as a complication of HAP/VAP. This narrative review summarizes the limited direct evidence on this topic and discusses potential clinical characteristics, risk factors, and predictive tools, while considering indirect evidence from CAP and broader ARDS populations.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042346","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":"Exploratory Modeling of Postoperative Atrial Fibrillation After Cardiac Surgery with Cardiopulmonary Bypass Using Inflammatory Biomarkers and Clinical-Surgical Factors.","authors":"Rosa Michel Martínez-Contreras, Marina María de Jesús Romero-Prado, Karla Mayela Bravo-Villagra, Aneth Karine Sánchez-Soto, Eliseo Portilla-de Buen, Guillermo Alejandro Muñoz-Benavides, Ramón Arreola-Torres, José Marco Medina-Carrillo, Jorge Straffon-Castañeda, Joel Regalado-Silva, Ana Rebeca Jaloma-Cruz","doi":"10.3390/medsci14050513","DOIUrl":"10.3390/medsci14050513","url":null,"abstract":"<p><strong>Background/objectives: </strong>Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery with cardiopulmonary bypass (CPB), increasing morbidity and prolonging hospitalization. This study aimed to develop and validate an exploratory prediction model that integrates perioperative inflammatory biomarkers with clinical and surgical variables to identify patients at risk of early POAF.</p><p><strong>Methods: </strong>A prospective exploratory cohort of 89 patients undergoing coronary artery bypass grafting (CABG; <i>n</i> = 36), valve surgery (<i>n</i> = 40), or CABG-valve surgery (<i>n</i> = 13) was evaluated. Clinical, surgical, and proinflammatory serum biomarkers (IL-6, IL-8, IL-10, and CRP) were recorded preoperatively (T1) and at 24 h (T2) and 48 h (T3) postoperatively. Multiple-comparison adjustments were made using the Benjamini-Hochberg false discovery rate. Predictor selection was based on bootstrap-derived stability using LASSO-penalized logistic regression, and the final model was estimated using Firth's bias-reduced logistic regression.</p><p><strong>Results: </strong>POAF incidence was 8.3% in CABG, in contrast to 22.5% and 30.8% in valve and CABG-valve surgeries, respectively. After multiple-comparison corrections, only IL-6 at T2 postoperatively was significantly higher in patients who subsequently developed POAF. Bootstrap-based stability selection retained T2 postoperative IL-10 and magnesium concentrations in the final model, which achieved an apparent AUC of 0.776 and a bootstrap optimism-corrected AUC of 0.728, with acceptable calibration (Brier score = 0.103), negligible multicollinearity (VIF = 1.04), and a negative predictive value of 95.5% at the optimal Youden threshold.</p><p><strong>Conclusions: </strong>Our findings support an exploratory prediction model with moderate discrimination for POAF after cardiac surgery with CPB, providing a methodological foundation for future multicenter validation studies.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042541","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":"Subvalvular Aortic Stenosis: Current Insights into an Often Overlooked Cause of Left Ventricular Outflow Tract (LVOT) Obstruction.","authors":"Vasileios Leivaditis, Athanasios Papatriantafyllou, Francesk Mulita, Vasiliki Androutsopoulou, Elias Liolis, Konstantinos Tasios, Andreas Antzoulas, Dimitrios Litsas, Theodora Skoura, Konstantinos Nikolakopoulos, Spyros Papadoulas, Nikolaos G Baikoussis","doi":"10.3390/medsci14050515","DOIUrl":"10.3390/medsci14050515","url":null,"abstract":"<p><strong>Background: </strong>Subvalvular aortic stenosis (SAS) is an important cause of fixed left ventricular outflow tract obstruction and the second most common form of aortic stenosis. Although traditionally considered a congenital lesion, increasing evidence suggests that SAS often behaves as a progressive condition influenced by anatomical and hemodynamic factors. The disease may lead to significant complications, including left ventricular hypertrophy and progressive aortic regurgitation.</p><p><strong>Materials and methods: </strong>A narrative review of the current literature was performed to summarize contemporary knowledge regarding the epidemiology, pathophysiology, clinical presentation, diagnostic evaluation, and management of subvalvular aortic stenosis. Relevant studies were identified through searches of major medical databases and were critically analyzed to provide an overview of current concepts and clinical practice.</p><p><strong>Results: </strong>Subvalvular aortic stenosis demonstrates considerable anatomical and clinical heterogeneity, ranging from discrete subaortic membranes to fibromuscular tunnel-type obstruction. The condition often progresses over time, with increasing LVOT gradients and a high incidence of associated aortic regurgitation. Echocardiography remains the primary diagnostic modality, while advanced imaging techniques provide additional anatomical detail and assist in surgical planning. Surgical resection remains the cornerstone of treatment when significant obstruction or related complications develop.</p><p><strong>Conclusions: </strong>Subvalvular aortic stenosis is a complex and progressive disease requiring careful imaging assessment and timely surgical management. Although surgical outcomes are generally excellent, recurrence and progressive aortic valve involvement remain important long-term considerations. Ongoing research aimed at improving risk stratification and optimizing surgical strategies may further enhance patient outcomes.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042557","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":"Switching from Vitamin K Antagonists to Direct Oral Anticoagulants in Frail Elderly Patients with Atrial Fibrillation: Systematic Review and Meta-Analysis.","authors":"Paschalis Karakasis, Ricardo Gómez-Huelgas, Stylianos Tzeis, Konstantinos Vlachos, Konstantinos C Siontis, Alberto M Marra, Konstantinos Pamporis, Antonios P Antoniadis, Eleftheria Lefkou, Valentin A Kokorin, Dimitrios Patoulias, Nikolaos Fragakis","doi":"10.3390/medsci14050516","DOIUrl":"10.3390/medsci14050516","url":null,"abstract":"<p><p><b>Background</b>: Frailty complicates anticoagulation management in older patients with atrial fibrillation (AF), particularly when long-term vitamin K antagonist (VKA) therapy is already established. Whether switching to a direct oral anticoagulant (DOAC) improves outcomes in this setting remains uncertain, and guideline recommendations are limited. We performed a systematic review and meta-analysis comparing outcomes of VKA-to-DOAC switching versus VKA continuation in frail elderly patients with AF. <b>Methods</b>: MEDLINE, Scopus, and the Cochrane Library were systematically searched from inception through 4 April 2026. Studies enrolling frail elderly patients with AF receiving VKA therapy and directly comparing switching to a DOAC versus continued VKA treatment were eligible. The primary outcome was a composite of stroke/systemic embolism, major bleeding, or all-cause mortality. Adjusted hazard ratios (HRs) were pooled using three-level random-effects models. <b>Results:</b> Four studies (five treatment comparisons) comprising 57,099 patients were included. Overall, switching from VKA to DOAC therapy was not associated with a significant difference in the composite outcome compared with continued VKA treatment (HR 1.18, 95% CI 0.84-1.67). No significant differences were observed for major bleeding (HR 1.13, 95% CI 0.80-1.60), thromboembolism (HR 1.03, 95% CI 0.63-1.68), or all-cause mortality (HR 0.95, 95% CI 0.77-1.16). In analyses restricted to randomized trials, results remained neutral across all outcomes. <b>Conclusion</b>: In frail elderly patients with AF receiving VKA therapy, switching to a DOAC was not associated with significant reductions in thromboembolism, major bleeding, mortality, or the composite outcome compared with continued VKA treatment.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042622","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":"Prognostic Value of a Novel Risk Score Combining Psoas Muscle Density and ALBI Grade in Localized Renal Cell Carcinoma.","authors":"Tomoyuki Makino, Kouji Izumi, Ryunosuke Nakagawa, Taiki Kamijima, Suguru Kadomoto, Renato Naito, Hiroaki Iwamoto, Hiroshi Yaegashi, Kazuyoshi Shigehara, Takahiro Nohara, Atsushi Mizokami","doi":"10.3390/medsci14050509","DOIUrl":"10.3390/medsci14050509","url":null,"abstract":"<p><p><b>Background:</b> Sarcopenia, systemic inflammation, and malnutrition are established poor prognostic factors in renal cell carcinoma (RCC). This study investigated the utility of a novel preoperative score combining psoas muscle density (PMD)-an imaging-based indicator of muscle quality-and the albumin-bilirubin (ALBI) grade-a blood-based biomarker of liver reserve and systemic nutritional status-for predicting disease-free survival (DFS) and overall survival (OS) in patients undergoing curative surgery for RCC. <b>Methods:</b> This retrospective observational study included 274 patients with non-metastatic RCC treated with radical or partial nephrectomy. Preoperative computed tomography was utilized to measure PMD, defining \"low PMD\" as a value below the sex-specific median (males: 47.75 Hounsfield Units [HU]; females: 46.25 HU). \"Worsened ALBI\" was defined as an ALBI grade ≥ 2. Patients were stratified into three risk categories: Score 0 (both normal, <i>n</i> = 122), Score 1 (either abnormal, <i>n</i> = 114), and Score 2 (both abnormal, <i>n</i> = 38). <b>Results:</b> Kaplan-Meier analysis revealed a highly significant, stepwise decline in both DFS and OS as the risk score increased (log-rank <i>p</i> < 0.001 and <i>p</i> = 0.004, respectively). Multivariate Cox regression identified the combined risk score as a robust, independent prognostic factor for DFS (Score 1: HR 1.93, 95% CI 1.11-3.37, <i>p</i> = 0.020; Score 2: HR 3.58, 95% CI 1.82-7.02, <i>p</i> < 0.001). Furthermore, after adjusting for age and comorbidities, the score remained an independent predictor of poor OS (Score 1: HR 2.35, 95% CI 1.08-5.13, <i>p</i> = 0.032; Score 2: HR 3.01, 95% CI 1.16-7.82, <i>p</i> = 0.024). The combined model synergistically enhanced risk stratification accuracy compared to evaluating either factor independently. <b>Conclusions:</b> The concurrent presence of preoperative low PMD and a worsened ALBI grade is a powerful, independent predictor of poor prognosis in localized RCC. Derived solely from routine preoperative imaging and laboratory tests, this straightforward scoring system effectively captures the structural and immunometabolic dimensions of cancer cachexia and host vulnerability. This tool can significantly aid in personalizing postoperative surveillance strategies and identifying high-risk patients who may warrant closer postoperative surveillance or who might be considered as high-risk candidates for adjuvant therapy discussions.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042607","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":"Twenty-Five-Year Trends in Mortality Associated with <i>Clostridioides difficile</i> Infection Among Patients with Inflammatory Bowel Disease in the United States: A Population-Based Analysis of Demographic and Geographic Disparities.","authors":"Ayesha Asghar, Abdullah Sultany, Shubhendu Bajpai, Amlish Gondal, Eshal Amir, Ayesha Kashaf, Sheeza Nawaz, Sahil Grover, Solomon Anighoro, Rahul Zain, Rewanth Katamreddy, Adam Breslin, Michelle Bernshteyn","doi":"10.3390/medsci14050511","DOIUrl":"10.3390/medsci14050511","url":null,"abstract":"<p><strong>Background: </strong>Individuals with inflammatory bowel disease (IBD) are at substantially increased risk for <i>Clostridioides difficile</i> infection (CDI), which leads to significantly higher morbidity and mortality compared to the general population. However, comprehensive national-level analyses of long-term mortality trends in this population remain limited. This study examines mortality trends associated with IBD and CDI in the United States from 1999 to 2023.</p><p><strong>Methods: </strong>This descriptive study utilized the CDC WONDER Multiple Cause-of-Death database. Deaths involving IBD (ICD-10: K50, K51) and CDI (A04.7) were identified among adults aged 25 years and older. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated with 95% confidence intervals and stratified by sex, race/ethnicity, urbanization, and census region. Joinpoint regression was applied to estimate the annual percent change (APC) in mortality.</p><p><strong>Results: </strong>Between 1999 and 2023, 76,084 deaths were recorded. Medical facilities accounted for 46% of deaths, followed by decedents' homes (28.3%) and nursing home/long-term care facilities (16.5%). Overall mortality declined gradually from 1999 to 2018 (APC: -0.23, <i>p</i> < 0.05), increased sharply through 2021 (APC: +12.75, <i>p</i> < 0.05), and was then followed by a non-significant change through 2023 (APC: -2.69; 95% CI: -8.24 to 3.19), consistent with a plateau. Men consistently exhibited higher AAMRs than women. Non-Hispanic White individuals had the highest AAMRs (1.844 in 2023), while Non-Hispanic Black individuals experienced a sustained increase from 2016 onward (APC: +7.11, <i>p</i> < 0.05). Hispanic mortality increased steadily throughout the study period (APC: +1.31, <i>p</i> < 0.05). Rural populations had higher overall AAMRs than urban populations. The Midwest recorded the highest regional AAMRs by 2023 (1.867).</p><p><strong>Conclusions: </strong>Mortality increased significantly between 2018 and 2021, coinciding with the COVID-19 pandemic, though our study design cannot prove causation. Disparities by race/ethnicity, urbanization, and region persisted. These findings underscore the need for ongoing antibiotic stewardship, equitable healthcare access, and targeted public health interventions for this vulnerable population.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042059","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":"Bilateral Intercostal Cryoanalgesia After Sternotomy for Coronary Artery Bypass Grafting.","authors":"Shahzad G Raja, Amina Khalil, Jezerene Ronquillo, Maria Alberici, Charlotte Sear, Katarina Lenartova, Nandor Marczin","doi":"10.3390/medsci14050510","DOIUrl":"10.3390/medsci14050510","url":null,"abstract":"<p><strong>Background: </strong>Effective opioid-sparing analgesia after median sternotomy remains an unmet need in cardiac surgery. We evaluated whether bilateral intercostal cryoanalgesia, added to standard multimodal analgesia, was associated with postoperative pain, opioid consumption, recovery and early hospital-resource use after isolated coronary artery bypass grafting (CABG).</p><p><strong>Methods: </strong>This single-centre, non-randomised comparative service evaluation included 60 patients undergoing isolated CABG through median sternotomy between 1 November 2025 and 30 May 2026 (30 cryoanalgesia; 30 standard care). The prespecified primary endpoint was cumulative movement-evoked pain burden, quantified as the area under the curve (AUC) for scores recorded on postoperative days 1-3. Secondary endpoints included rest-pain AUC, opioid consumption expressed as oral morphine equivalents (OME), time to first bowel opening, postoperative length of stay and an exploratory break-even calculation.</p><p><strong>Results: </strong>Cryoanalgesia was associated with lower movement-pain AUC (adjusted mean difference -3.56 score-days, 95% confidence interval [CI] -4.62 to -2.50; <i>p</i> < 0.001) and rest-pain AUC (-3.16 score-days, 95% CI -4.19 to -2.14; <i>p</i> < 0.001). Total observed opioid consumption was lower by 112.9 mg OME (95% CI -192.8 to -33.1; <i>p</i> = 0.006), length of stay by 1.32 days (95% CI -1.93 to -0.71; <i>p</i> < 0.001), and time to first bowel opening by 0.49 days (95% CI -0.92 to -0.06; <i>p</i> = 0.027).</p><p><strong>Conclusions: </strong>In this small non-randomised evaluation, bilateral intercostal cryoanalgesia was associated with lower early pain and opioid exposure and faster recovery. Selection, temporal and residual confounding preclude causal or cost-effectiveness conclusions. Prospective randomised evaluation with fixed observation periods and longer-term safety follow-up is required.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042243","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 Nutraceuticals and Biomarkers of Healthy Aging: A Scoping Review of Human Studies on Nutrigenomic-Based Interventions.","authors":"Andrea Vanessa Llanos-Díaz, Moisés Apolaya-Segura, Orlando R Sevillano, Obert Marín-Sanchez, Jacinto Joaquín Vértiz Osores, Alexis Germán Murillo Carrasco, Sophie Nicole Llanos-Diaz, Daysi Zulema Diaz-Obregón","doi":"10.3390/medsci14050508","DOIUrl":"10.3390/medsci14050508","url":null,"abstract":"<p><strong>Background: </strong>Precision nutrition and nutrigenomics have emerged as promising strategies to personalize dietary interventions according to individual genetic, metabolic, and molecular characteristics. However, the potential of nutrigenomic-guided nutraceutical interventions to modulate biological aging pathways remains poorly characterized.</p><p><strong>Objective: </strong>This study aimed to map and synthesize the available evidence from human studies evaluating personalized nutraceutical interventions based on nutrigenomic approaches and their effects on biomarkers associated with biological aging.</p><p><strong>Methods: </strong>A scoping review was conducted following the Joanna Briggs Institute methodology and PRISMA-ScR guidelines. PubMed/MEDLINE, Embase, Scopus, and Web of Science were searched for studies published between 2021 and 2026. Eligible studies included adults aged ≥18 years receiving personalized nutraceutical interventions informed by genetic, genomic, metabolomic, or other molecular data. Outcomes included biomarkers of cellular aging, inflammation, oxidative stress, immunometabolism, and related pathways.</p><p><strong>Results: </strong>Twenty-one studies were included. Interventions involved omega-3 fatty acids, polyphenols, Nigella sativa, vitamin D, methyl-donor micronutrients, fermented papaya preparation, and other nutraceutical preparations and functional food-based interventions. Four major themes emerged: multi-omic stratification approaches, biological aging biomarkers, redox-inflammatory modulation, and applications in metabolic disorders. Most studies demonstrated favorable effects on intermediate molecular biomarkers, including inflammatory cytokines, oxidative stress markers, lipid metabolism, endothelial function, and DNA methylation signatures. However, evidence directly demonstrating slowing of biological aging through validated biomarkers such as epigenetic clocks or telomere dynamics remains limited.</p><p><strong>Conclusions: </strong>Personalized nutraceutical interventions exhibit biological plausibility for modulating pathways associated with healthy aging. Nevertheless, robust longitudinal studies incorporating validated biomarkers of biological aging and clinically meaningful outcomes are needed before their widespread implementation in precision medicine.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042480","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":"Five-Year Cardiorenal Outcomes and Longitudinal Chronic Kidney Disease Screening in People with Type 2 Diabetes Managed by Endocrinologists: A Nationwide Retrospective Cohort Study.","authors":"José Ignacio Martínez-Montoro, José Juan Aparicio-Sánchez, Belén Pimentel, Mónica Juárez-Campo, Maria Luisa Alamillo, Yesika Díaz, José Carlos Fernández-García","doi":"10.3390/medsci14040506","DOIUrl":"10.3390/medsci14040506","url":null,"abstract":"<p><strong>Background/objectives: </strong>Type 2 diabetes (T2D) is a major risk factor for cardiovascular disease and chronic kidney disease (CKD), yet the extent of longitudinal CKD screening in routine clinical practice remains unclear. This study aimed to assess long-term cardiorenal outcomes and CKD screening practices in patients with T2D managed across primary care and endocrinology settings, evaluating the feasibility of risk stratification in real-world practice.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using anonymized data from the Telotrón database (2.2 million patients). Adults with T2D attended across primary and endocrinology care were followed from 1 January 2018 to 31 December 2022. Frequency of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) measurements, and cumulative proportion of kidney and cardiovascular events, hospitalizations, and mortality were assessed.</p><p><strong>Results: </strong>Among 13,600 individuals, 31.1% experienced a kidney event and 18.6% a cardiovascular event over 5 years. All-cause hospitalization occurred in 24.9% and 16.1% died. First occurrence of an abnormal eGFR or UACR measurement occurred in 37.0% of participants without baseline CKD, and 45.4% with baseline CKD showed progression. Annual monitoring was limited, with 39.1% and 16.6% undergoing at least one yearly assessment, and 2.9 and 1.5 mean number of measurements per patient for eGFR and UACR, respectively.</p><p><strong>Conclusions: </strong>Despite receiving endocrinology care, kidney disease progression and cardiovascular events remain a major concern in T2D, and yet suboptimal albuminuria and eGFR assessment limit early detection and risk stratification, thereby hindering risk-directed management.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835349","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":"Mechanism-Base Pharmacokinetic-Pharmacodynamic Modeling of Cefquinome Against <i>Streptococcus suis</i> Serotype 2 Under Different Inoculum and Susceptibility Conditions.","authors":"Aktham H Mestareehi","doi":"10.3390/medsci14040505","DOIUrl":"10.3390/medsci14040505","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background&lt;/b&gt;: &lt;i&gt;Streptococcus suis&lt;/i&gt; serotype 2 is a major zoonotic pathogen responsible for severe systemic infections in pigs and humans, including septicemia, meningitis, and high mortality outcomes. Cefquinome, a fourth-generation β-lactam antibiotic widely used in veterinary medicine, is commonly applied for the treatment of &lt;i&gt;S. suis&lt;/i&gt; infections. However, optimized dosing strategies remain insufficiently defined, particularly under conditions of varying bacterial burden, inoculum size, and reduced susceptibility or resistance phenotypes. These factors may significantly alter pharmacodynamic responses and compromise the predictive value of conventional MIC-based approaches. &lt;b&gt;Objectives&lt;/b&gt;: This study aimed to characterize the pharmacokinetics (PK) and pharmacodynamics (PD) of cefquinome against &lt;i&gt;S. suis&lt;/i&gt; serotype 2 using an integrated ex vivo serum time-kill experiments and semi-mechanistic PK/PD modeling. A secondary objective was to evaluate optimized dosing regimens across different inoculum levels and susceptibility phenotypes, including a cefquinome-resistant mutant. &lt;b&gt;Methods&lt;/b&gt;: Cefquinome pharmacokinetics following intramuscular administration at 2 and 4 mg/kg in piglets were described using a two-compartment model. Dose proportionality, exposure linearity, and clearance parameters were assessed. Ex vivo serum time-kill experiments were conducted using a parental strain and a cefquinome-resistant mutant (M1) under normal-inoculum (NI), high-inoculum (HI), and mutant/resistant (MS) conditions. A semi-mechanistic PK/PD model incorporating logistic bacterial growth, sigmoidal Emax killing, nutrient limitation, and a time-delay function was developed to describe dynamic bacterial responses. Model parameters (k&lt;sub&gt;0&lt;/sub&gt;, k&lt;sub&gt;max&lt;/sub&gt;, EC&lt;sub&gt;50&lt;/sub&gt;) were estimated using nonlinear least-squares regression (Scientist v2.0), and simulations were performed by integrating time-varying PK input functions. &lt;b&gt;Results&lt;/b&gt;: Cefquinome demonstrated linear pharmacokinetics with dose-proportional increases in Cmax and AUC between 2 and 4 mg/kg, with comparable clearance across doses. Ex vivo studies revealed time-dependent antibacterial activity with a pronounced inoculum effect. Higher bacterial burdens significantly reduced bactericidal efficiency and promoted regrowth during declining drug exposure. No tested concentrations achieved ≥3-log&lt;sub&gt;10&lt;/sub&gt; killing in HI or MS conditions, whereas the NI group achieved a maximal reduction of 3.5-log&lt;sub&gt;10&lt;/sub&gt; CFU/mL. MIC values in serum and medium were consistent (0.03, 0.06, and 0.24 µg/mL for NI, HI, and MS, respectively), indicating minimal protein binding influence. The semi-mechanistic model accurately described observed bacterial dynamics (R&lt;sup&gt;2&lt;/sup&gt; &gt; 0.99; MSC &gt; 1.5), capturing delayed drug effects, inoculum-dependent growth suppression, and regrowth phenomena. Growth rates were reduced under serum conditions, reflecting nutrient limitation. Importantly,","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 4","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13515438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148835454","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}