Balkan Medical Journal最新文献

{"title":"Land Leech Bite Associated <i>Rickettsia japonica</i> Infection in an Elderly Woman in Zhejiang, China.","authors":"Keye Xu, Fanfan Yang, Yuhui Liu, Jiaqi Qiu, Chenjun Zeng","doi":"10.4274/balkanmedj.galenos.2026.2026-4-220","DOIUrl":"10.4274/balkanmedj.galenos.2026.2026-4-220","url":null,"abstract":"","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":" ","pages":"481-482"},"PeriodicalIF":4.5,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13425046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148161465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning-Based Magnetocardiography Model Aids in Diagnosing Non-ST-Segment Elevation Acute Coronary Syndrome in Acute Chest Pain.","authors":"Junting Li, Yuheng Zhou, Ruizhe Wang, Jiaojiao Pang, Min Xiang, Xiaolin Ning","doi":"10.4274/balkanmedj.galenos.2026.2026-1-319","DOIUrl":"10.4274/balkanmedj.galenos.2026.2026-1-319","url":null,"abstract":"<p><strong>Background: </strong>Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is a leading cause of acute chest pain in clinical practice. Magnetocardiography (MCG) is a non-invasive and rapid functional imaging technique with high sensitivity to early, subtle electrophysiological changes associated with myocardial ischemia.</p><p><strong>Aims: </strong>To develop and validate a machine learning (ML)-based diagnostic model for NSTE-ACS using MCG-derived features.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>Patients presenting with acute chest pain and admitted between September 2023 and May 2024 were consecutively enrolled. Pretreatment cardiac magnetic signals were collected using a 36-channel optically pumped magnetometer-based MCG system. A total of 13 feature categories (188 parameters) were extracted from the ST segment and T wave. Three feature selection methods [Boruta, least absolute shrinkage and selection operator (LASSO), and maximum relevance minimum redundancy], along with hyperparameter tuning and unbiased performance estimation for five ML algorithms, were implemented within a nested cross-validation (CV) framework. Model performance was assessed using the area under the curve (AUC). The optimal model was further validated in an independent test set. SHapley Additive exPlanations (SHAP) were used to interpret the final model.</p><p><strong>Results: </strong>A total of 578 patients were included (366 with NSTE-ACS and 212 without NSTE-ACS). The support vector machine (SVM) model, based on nine LASSO-selected features, demonstrated the best performance, achieving an AUC of 0.91 ± 0.01 in nested CV. In the independent test set, the model achieved an AUC of 0.89 (95% confidence interval: 0.81-0.95), with an accuracy of 0.84, sensitivity of 0.89, and specificity of 0.77. Exploratory subgroup analyses showed consistent performance across age, sex, body mass index, and comorbidity groups. SHAP analysis identified the minimum magnetic field strength at the T-peak time (T_min_mag) as the most influential predictor.</p><p><strong>Conclusion: </strong>The SVM-based MCG model showed strong potential as an auxiliary tool for identifying NSTE-ACS. Its application may improve chest pain management and reduce misdiagnoses.</p>","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":" ","pages":"460-470"},"PeriodicalIF":4.5,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13425047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology and Clinical Characteristics of Pediatric Acute Postinfectious Glomerulonephritis in Montenegro: A Nationwide Retrospective Study.","authors":"Željka Rogač, Dragana Majiċ, Brankica Spasojeviċ","doi":"10.4274/balkanmedj.galenos.2026.2026-1-139","DOIUrl":"10.4274/balkanmedj.galenos.2026.2026-1-139","url":null,"abstract":"","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":" ","pages":"404-406"},"PeriodicalIF":4.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147353536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A \"Beret-Like\" Giant Congenital Melanocytic Nevus of the Scalp with Nodal Nevus on a Girl: A Surgical Challenge.","authors":"Zequn Qiu, Zhang Rundong, Guocheng Zhang, Hao Chen, Yan Wang","doi":"10.4274/balkanmedj.galenos.2026.2025-12-224","DOIUrl":"10.4274/balkanmedj.galenos.2026.2025-12-224","url":null,"abstract":"","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":" ","pages":"400-401"},"PeriodicalIF":4.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drivers of Inflammation; Clonal Hematopoiesis: Clinical Implications.","authors":"Tuğcan Alp Kırkızlar, Mutlu Arat","doi":"10.4274/balkanmedj.galenos.2026.2026.240426","DOIUrl":"10.4274/balkanmedj.galenos.2026.2026.240426","url":null,"abstract":"","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":" ","pages":"357-359"},"PeriodicalIF":4.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147986367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nailfold Videocapillaroscopy in Pediatric Rheumatology: Established Roles, Emerging Applications, and Future Perspectives.","authors":"Kübra Öztürk, Fatih Haslak, Mehmet Yıldız, Amra Adrovic, Özgür Kasapçopur","doi":"10.4274/balkanmedj.galenos.2026.2026-5-58","DOIUrl":"10.4274/balkanmedj.galenos.2026.2026-5-58","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Nailfold videocapillaroscopy (NVC) provides direct, non-invasive access to the peripheral microcirculation and has become a central tool in adult rheumatology. Its primary clinical value lies in the evaluation of patients presenting with signs of Raynaud phenomenon (RP) and scleroderma-spectrum disorders. In particular, NVC facilitates the differentiation between primary and secondary (scleroderma-related) RP. The characteristic scleroderma pattern observed on NVC, including giant capillaries, capillary loss, microhemorrhages, and architectural disorganization, supports the diagnosis of scleroderma-spectrum disorders. International standardization efforts have further improved the reliability and interpretability of these findings, particularly in adult populations with RP and systemic sclerosis (SSc). In children, the clinical utility of NVC is now well established for similar indications; however, interpretation requires age-specific reference data. Pediatric capillary density, diameter, and length vary throughout childhood, and minor findings such as tortuosity, crossing, and isolated microhemorrhages may also be observed in healthy individuals. Without normative pediatric data, these features may be overinterpreted as pathological findings. Beyond RP and juvenile SSc, evidence supporting the use of NVC is accumulating across a range of pediatric rheumatic diseases. NVC abnormalities have been reported in juvenile dermatomyositis (JDM), mixed connective tissue disease, childhood-onset systemic lupus erythematosus, juvenile Sjögren disease, and juvenile localized scleroderma. Among these conditions, JDM demonstrates the strongest association between NVC abnormalities-including reduced capillary density, dilatation, abnormal morphology, and microhemorrhages-and disease activity. In contrast, findings in juvenile idiopathic arthritis remain non-specific. More recent studies involving pediatric patients with Behçet disease, psoriatic arthritis, and certain autoinflammatory and vasculitic disorders suggest that NVC may detect subtle microvascular alterations; however, disease-specific patterns have not been established outside the scleroderma spectrum. Selected non-rheumatologic conditions, particularly diabetes mellitus, severe acute respiratory syndrome coronavirus 2 infection, multisystem inflammatory syndrome in children, and long coronavirus disease, further highlight the potential of NVC to reflect systemic endothelial dysfunction and non-specific microvascular injury, although these applications remain exploratory. Despite its promise, several limitations continue to restrict the broader clinical application of NVC. Pediatric reference data remain heterogeneous, scoring systems are largely adapted from adult protocols, and longitudinal evidence linking capillaroscopic changes to disease progression, treatment response, or long-term outcomes remains limited. Standardized image acquisition and reporting, multicenter cohort studies, and v","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":"43 7","pages":"360-371"},"PeriodicalIF":4.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13319727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Additional PML and RARA Rearrangements Accompanying PML::RARA in a Case of Acute Promyelocytic Leukaemia with Myeloblast Morphology.","authors":"Zhan Su, Wei Wang, Lingjie Sun, Ying Li, Xiangcong Yin, Hongguo Zhao","doi":"10.4274/balkanmedj.galenos.2026.2025-12-103","DOIUrl":"10.4274/balkanmedj.galenos.2026.2025-12-103","url":null,"abstract":"","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":" ","pages":"411-413"},"PeriodicalIF":4.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Time-to-Peak of Renal Blood Flow with Outcomes in Heart Failure: An Exploratory Comparative Analysis with Conventional Predictors.","authors":"Yue Li, Zhiqiang Yang, Pei Yin, Lizhuo Li, Qingzhen Zhao, Chao Liu","doi":"10.4274/balkanmedj.galenos.2026.2026-1-32","DOIUrl":"10.4274/balkanmedj.galenos.2026.2026-1-32","url":null,"abstract":"<p><strong>Background: </strong>Time-to-peak of renal blood flow (TTPr), derived from Tc-99m diethylenetriaminepentaacetic acid (DTPA) renal scintigraphy, is a novel parameter for assessing renal perfusion.</p><p><strong>Aims: </strong>To evaluate the prognostic significance of TTPr in patients with heart failure (HF).</p><p><strong>Study design: </strong>Retrospective, observational cohort study.</p><p><strong>Methods: </strong>We analyzed 304 patients with HF who underwent Tc-99m DTPA renal scintigraphy to assess TTPr. TTPr values were compared between deceased and surviving patients. Cox regression analyses evaluated the prognostic value of TTPr. Model performance was assessed using the C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Bootstrap internal validation (200 repetitions) generated optimism-corrected estimates, and the Holm-Bonferroni correction accounted for multiple testing in secondary analyses.</p><p><strong>Results: </strong>During a median follow-up of 790 days, 79 patients (26.0%) died. For short-term outcomes (3-month mortality, n = 7), deceased patients showed a trend toward prolonged TTPr compared with survivors (59 s vs. 27 s, <i>p</i> = 0.008); multivariable analysis was not performed due to limited events. For long-term prognosis, TTPr was an independent predictor, demonstrating the highest corrected C-index among individual predictors (<i>p</i> < 0.001). After bootstrap correction, models incorporating TTPr [BM + TTPr and Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) + TTPr] showed modest but significant C-index improvements for all-cause and cardiovascular mortality (BM + TTPr: corrected ΔC-index = +0.018 and +0.020, both <i>p</i> < 0.01; MAGGIC + TTPr: corrected ΔC-index = +0.040 and +0.062, both <i>p</i> < 0.001), with reduced AIC. After Holm-Bonferroni correction, MAGGIC + TTPr significantly improved IDI at 1, 3, and 5 years for both endpoints (all adjusted <i>p</i> = 0.012), whereas NRI improvements were not statistically significant. Survival analysis using exploratory cut-offs (35 s for all-cause mortality, 33 s for cardiovascular mortality) revealed lower cumulative survival in the prolonged TTPr group (<i>p</i> < 0.05); these cut-offs require external validation.</p><p><strong>Conclusion: </strong>Time-to-peak of renal blood predicted long-term outcomes in this HF cohort, showing potential incremental value. Prospective validation in broader populations is warranted before clinical implementation.</p>","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":" ","pages":"394-399"},"PeriodicalIF":4.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147509332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Downregulation of <i>IL16</i> Expression Induces Chemotherapeutic Drug Sensitivity via Increased Degradation of Mutant <i>TP53</i> in Acute Myeloid Leukemia Cells.","authors":"Heng Zhang, Pengfei Qin, Anqiao Li, Zhenqian Huang, Sida Peng, Haiming Li, Lihua Xu","doi":"10.4274/balkanmedj.galenos.2026.2025-12-245","DOIUrl":"10.4274/balkanmedj.galenos.2026.2025-12-245","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Interleukin 16 (&lt;i&gt;IL16&lt;/i&gt;) is a pleiotropic cytokine that does not belong to any interleukin family and functions as a CD4&lt;sup&gt;+&lt;/sup&gt; T-cell chemokine, a regulator of T-cell activation, and an inhibitor of human immunodeficiency virus replication in acquired immunodeficiency syndrome. Studies in the hemato-oncological disease multiple myeloma have demonstrated that &lt;i&gt;IL16&lt;/i&gt; plays an important role in promoting tumor cell growth and is associated with tumor burden and prognosis. However, the role of &lt;i&gt;IL16&lt;/i&gt; in acute myeloid leukemia (AML) remains largely unexplored.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;To investigate the potential role of &lt;i&gt;IL16&lt;/i&gt; in AML.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;&lt;i&gt;In vitro&lt;/i&gt; experiments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Bioinformatic analyses were conducted using online databases, including gene expression profiling interactive analysis 2, to evaluate &lt;i&gt;IL16&lt;/i&gt; expression and its prognostic significance in patients with AML. Transcriptome data from AML samples were used for gene function enrichment analysis, gene set enrichment analysis (GSEA), survival analysis, and other related bioinformatic assessments. In addition, a single-cell dataset was analyzed using the R programming language to identify specific &lt;i&gt;IL16&lt;/i&gt; expression subgroups in AML patients. The expression and secretion of &lt;i&gt;IL16&lt;/i&gt; in various AML cell lines were assessed using Western blot and ELISA. &lt;i&gt;IL16&lt;/i&gt; knockdown AML cell lines were generated and evaluated for proliferation, apoptosis, and multidrug resistance to chemotherapy using cell-based assays and protein immunoblotting to determine the effects of &lt;i&gt;IL16&lt;/i&gt; on AML biological behavior. Furthermore, transcriptome sequencing analysis was performed to elucidate the molecular mechanisms underlying the effects of &lt;i&gt;IL16&lt;/i&gt; on the biological functions of AML cells.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;&lt;i&gt;IL16&lt;/i&gt; expression levels were significantly elevated in patients with AML and were associated with poorer prognosis. &lt;i&gt;IL16&lt;/i&gt; was predominantly expressed in T cells, malignant hematopoietic stem cells, malignant progenitor cells, and malignant mononuclear precursor cells in AML patients. Knockdown of &lt;i&gt;IL16&lt;/i&gt; expression significantly inhibited proliferation and promoted chemotherapy-induced apoptosis in AML cells &lt;i&gt;in vitro&lt;/i&gt;. Downregulation of &lt;i&gt;IL16&lt;/i&gt; also reduced cell viability and decreased the IC&lt;sub&gt;50&lt;/sub&gt; of cytarabine (Ara-C) across different concentrations. Furthermore, reduced &lt;i&gt;IL16&lt;/i&gt; expression may induce degradation of mutated &lt;i&gt;TP53&lt;/i&gt; in AML cells, resulting in increased apoptosis and enhanced sensitivity to multiple chemotherapeutic agents.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;High &lt;i&gt;IL16&lt;/i&gt; expression was observed in malignant cells from patients with AML. Downregulation of &lt;i&gt;IL16&lt;/i&gt; promotes degradation of mutant &lt;i&gt;TP53&lt;/i&gt; and induces apoptosis, thereby increasing the sensitivity of AML cells to various chemoth","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":" ","pages":"383-393"},"PeriodicalIF":4.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147637847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genotype-Phenotype Correlation in Tuberous Sclerosis Complex: Insights from North Macedonia","authors":"Marija Gjorgjievska, Gjorgji Bozhinovski, Lejla Muaremoska Kanzoski, Marija Babunovska, Emilija Cvetkovska, Irena Rambabova-Bushljetik, Dijana Plaseska-Karanfilska","doi":"10.4274/balkanmedj.galenos.2026.2025-12-307","DOIUrl":"10.4274/balkanmedj.galenos.2026.2025-12-307","url":null,"abstract":"","PeriodicalId":8690,"journal":{"name":"Balkan Medical Journal","volume":" ","pages":"407-410"},"PeriodicalIF":4.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13320258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147643700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}