Medicina

Background and Objectives: Despite modern therapy algorithms, ST-elevation myocardial infarction (STEMI) substantially contributes to cardiovascular morbidity and mortality worldwide. Early Risk assessment is crucial to guide therapy allocation, especially in countries with limited healthcare resources. Electrocardiographic parameters such as QRS fragmentation (fQRS) evolved as an important prognostic marker. The underlying mechanisms and specific risk factors for the occurrence of fQRS in patients with STEMI undergoing PCI have not been analyzed yet. Materials and Methods: Between 09/2020 and 06/2021, out of 179 consecutive patients with STEMI undergoing primary percutaneous coronary intervention (pPCI), 122 patients were included in this study. The occurrence of fQRS was analyzed and correlated to clinical as well as biochemical parameters. Results: In this population, the fQRS pattern was present in 33.6% (n = 41) of patients. Besides gender, no statistically significant differences in baseline characteristics or comorbidities were observed between the two groups. In univariable logistic regression analysis, both glomerular filtration rate (GFR) (p = 0.050) and C-reactive protein (CRP) (p = 0.014) were significantly associated with the presence of fQRS. However, in the multivariable logistic regression model, only CRP levels on admission remained independently associated with fQRS (OR = 3.44, 95% CI: 1.95; 6.05), (p = 0.029). Conclusions: In this analysis, a correlation between fQRS and CRP levels in patients with STEMI undergoing pPCI could be demonstrated. Consequently, fQRS might serve as a marker for extensive inflammation in the context of myocardial ischemia. Full article

Background and Objectives: Cancer cachexia is a debilitating metabolic syndrome highly prevalent in colorectal cancer (CRC), characterized by progressive skeletal muscle wasting. The myostatin–FOXO signaling pathway contributes to this process by activating the E3 ubiquitin ligases MuRF-1 and Atrogin-1. Exercise is a promising non-pharmacological strategy, but its effects on this pathway in CRC cachexia remain unclear. This review aimed to synthesize preclinical evidence on the impact of exercise on the myostatin–FOXO axis. Materials and Methods: A comprehensive search was performed in PubMed/MEDLINE, Scopus, Web of Science, and Science Direct from inception through August 2025. Eligible studies included murine CRC models (C26 or Apc^Min/+) exposed to aerobic, resistance, or combined exercise interventions, with outcomes assessing myostatin, FOXO, MuRF-1, or Atrogin-1. Study quality was appraised using the CAMARADES 10-item checklist. Results: eleven studies met the criteria, with quality scores ranging from 6 to 8. Aerobic exercise, particularly voluntary wheel running, most consistently reduced MuRF-1 expression and systemic inflammation, whereas resistance and eccentric training exerted stronger inhibitory effects on FOXO and Atrogin-1. Myostatin was directly measured in two studies, yielding inconsistent results. Resistance and eccentric training promoted anabolic signaling (e.g., mTORC1), whereas aerobic protocols improved oxidative capacity. Variability in exercise type, intensity, and duration contributed to heterogeneity across findings. Conclusions: Exercise attenuates skeletal muscle catabolism in CRC-induced cachexia, mainly through modulation of the myostatin–FOXO pathway and downstream ligases. However, limited direct data on myostatin and methodological heterogeneity underscore the need for standardized protocols and translational studies. This review provides the first focused synthesis of exercise-mediated regulation of this pathway in CRC cachexia. Full article

Background and Objectives: Abdominal obesity significantly impacts postural control and fall risk, yet its specific association with stepping reaction time (SRT), a critical component of balance recovery, remains underexplored in obese individuals. This study investigated the relationship between abdominal circumference (AC) and SRT while considering gender and body mass index (BMI). Materials and Methods: Cross-sectional observational study conducted at Majmaah University Virtual Reality Laboratory using advanced motion capture technology. In this cross-sectional study, 199 adults (104 males, 89 females) underwent AC measurement and SRT assessment using the Stability and Balance Learning Environment Apparatus (STABLE) with motion capture technology. Multiple linear regression analyses were performed to identify associations between the variables. Results: The regression model for right SRT was statistically significant (F(8, 184) = 10.24, p < 0.001), explaining 30.8% of variance. Limits of stability with legs apart was negatively associated with right SRT (β = −0.144, p = 0.039), while left SRT was strongly associated (β = 0.451, p < 0.001). AC did not show any association with either right or left SRT. Males demonstrated significantly faster left SRT than females (b = −0.061, p = 0.048), and age was positively associated with left SRT (β = 0.203, p = 0.002). Conclusions: While AC shows correlation with overall obesity measures, it is not significantly associated with stepping reaction time when evaluated concurrently with balance performance and demographic factors. Limits of stability, age, and gender were more consistently associated with stepping reaction time. The cross-sectional design of this study precludes causal inference; longitudinal investigations are necessary to confirm these associations before implementing targeted fall prevention strategies. Full article

Background and Objectives: Systemic inflammation plays a critical role in cancer progression and prognosis. The Systemic Inflammation Response Index (SIRI), a novel marker integrating neutrophil, monocyte, and lymphocyte counts, has been suggested as a prognostic indicator in various malignancies. This study aimed to evaluate the prognostic significance of SIRI in patients with metastatic pancreatic cancer receiving first-line chemotherapy. Materials and Methods: This retrospective study included 147 patients with metastatic pancreatic cancer who received first-line chemotherapy or best supportive care between 2010 and 2024. Clinical and laboratory data were collected from medical records. Overall survival (OS) and progression-free survival (PFS) were assessed using the Kaplan–Meier method, and prognostic factors were identified by univariate and multivariate Cox regression analyses. Results: The median OS and PFS were 7 and 4 months, respectively. Multivariate analysis revealed that ECOG ≥ 2 (HR: 2.094, p = 0.019), liver metastasis (HR: 2.039, p = 0.027), and each unit increase in SIRI (HR: 1.156, p < 0.001) were independent predictors of poorer OS. Patients with SIRI > 1.86 had significantly shorter OS compared to those with SIRI ≤ 1.86 (median OS: 4 vs. 9 months, p = 0.019). Conclusions: SIRI is an independent prognostic marker for survival in metastatic pancreatic cancer patients undergoing first-line and subsequent lines of chemotherapy. These inflammation-based markers are simple, cost-effective tools that could be integrated into routine clinical practice to aid in risk assessment and treatment planning. Full article

Intravascular imaging has revolutionized the assessment and management of coronary artery disease, providing unparalleled insights into plaque morphology, lesion severity, and percutaneous coronary intervention (PCI) optimization. This comprehensive review explores the current landscape of intravascular imaging, detailing the principles and clinical utility of intravascular ultrasound (IVUS) and optical coherence tomography (OCT). We discuss the role of these technologies in various clinical scenarios, ranging from stable coronary artery disease to acute coronary syndromes, emphasizing their ability to refine diagnostic accuracy and therapeutic decision-making. A key focus is placed on their application in identifying vulnerable plaques, a critical step in preventing adverse cardiovascular events. Furthermore, we highlight the role of intravascular imaging in guiding PCI, improving stent deployment, and reducing procedural complications. Finally, we explore emerging imaging modalities and technological advancements poised to further enhance coronary assessment, including hybrid imaging techniques. In addition to established modalities, this review examines emerging imaging technologies and the growing integration of artificial intelligence (AI) and hybrid imaging systems, which hold promise for automated plaque characterization, improved reproducibility, and enhanced decision support during PCI. By summarizing the latest evidence and future directions, this review aims to provide a comprehensive reference for clinicians and researchers seeking to optimize the use of intravascular imaging in contemporary cardiovascular practice. Full article

Background and Objectives: The use of cementless total knee arthroplasty (TKA) is increasing, but established methods for assessing bone quality to prevent early failure remain undefined. Current preoperative assessments using central bone mineral density (BMD) do not accurately reflect peripheral bone quality, and intraoperative evaluation is subjective. This study aimed to establish objective assessment methods by analyzing the correlations between a novel visual grading system, CT Hounsfield units (HU), and actual bone strength. Materials and Methods: This prospective study included 131 patients undergoing posterior-stabilized TKA. We developed a novel visual grading system (Excellent, Good, Fair, Poor) based on femoral cutting surface characteristics. CT HUs were measured preoperatively by an assisting surgeon in the box bone area. Femoral box specimens underwent indentation testing to determine their actual bone strength. Minimum Required Strength (MRS) was defined at 2.5-fold the patient’s body weight, and Estimated Withstanding Strength (EWS) was determined by scaling first failure load using area ratios. Patients were classified as “cementless suitable” (EWS > MRS) or “cemented mandatory” (EWS < MRS). Correlations were assessed using Spearman’s rank correlation for visual grade and Pearson correlation for Hounsfield units. ROC curve analysis determined diagnostic accuracy. Results: Visual grade exhibited an exceptionally robust relationship to bone strength (Spearman ρ = 0.903, p < 0.01), whereas HU showed substantial correlation (Pearson r = 0.660, p < 0.01, R² = 0.435). Visual grading achieved excellent diagnostic accuracy (AUC = 0.974, sensitivity 95.1%, specificity 95.9%) using “Good” grade as cutoff. HU demonstrated AUC of 0.938 with 92.7% sensitivity and 81.6% specificity at a cutoff value of 65.2. Conclusions: Our novel visual grading system and CT HU demonstrated excellent correlations with actual distal femoral bone strength and outstanding diagnostic performance for identifying cementless TKA candidates. Unlike traditional subjective intraoperative assessments such as the “thumb test”, this system provides objective visual criteria directly correlated with actual bone strength. Preoperative HU screening with intraoperative visual grading can help prevent early failure. Full article

The rapidly advancing field of gut microbiota research has revealed its pivotal role in human health, with growing evidence implicating microbial dysbiosis in the development of metabolic diseases, particularly type 2 diabetes mellitus (T2DM). This narrative review synthesizes recent findings on the complex, bidirectional relationship between the gut microbiota–metabolic axis and T2DM, drawing upon data from human and experimental studies published in the past decade. Patients with T2DM consistently demonstrate marked gut dysbiosis, characterized by reduced microbial diversity and depletion of beneficial butyrate-producing taxa such as Faecalibacterium prausnitzii and Roseburia intestinalis. In contrast, increases in pro-inflammatory bacteria including Escherichia-Shigella and Lactobacillus are commonly observed. Such compositional changes are linked to metabolic dysfunction through altered microbial metabolites, including elevated trimethylamine N-oxide (TMAO), which has been associated with insulin resistance and increased diabetes risk. Moreover, gut microbiota imbalances correlate with systemic inflammation, as indicated by higher levels of cytokines such as IFN-γ and IL-6. These findings underscore the gut microbiota’s central role in energy metabolism and inflammation in T2DM. Understanding these mechanisms could inform novel therapeutic and preventive strategies—such as microbiota-targeted dietary, probiotic, or pharmacologic interventions—to improve metabolic outcomes and enhance clinical management of diabetes. Full article

Background and Objectives: Estrogen deficiency after menopause accelerates bone loss through oxidative stress and inflammatory cytokines. Sodium phenylbutyrate (SP), a histone deacetylase inhibitor, exhibits antioxidative and anti-inflammatory effects, but its impact on postmenopausal osteoporosis remains unclear. Materials and Methods: Thirty female Wistar rats were divided into control, ovariectomy (OVX), and OVX+SPB groups (n = 10 each). After 12 weeks, bone mineral density (BMD), histomorphometry, bone marrow biomarkers (MDA, TNF-α, IL-6, RANKL), and plasma Cathepsin K were evaluated. Results: OVX induced trabecular deterioration with reduced number, area, and thickness (all p < 0.001), increased separation (p < 0.001), and decreased femoral and lumbar BMD (p < 0.001). SPB significantly improved these indices (TN, p < 0.05; TA, p < 0.01; TH, p < 0.05; femoral BMD, p < 0.05; lumbar BMD, p < 0.001; TS, p = 0.001). OVX elevated MDA, TNF-α, IL-6, RANKL, and Cathepsin K (all p < 0.001), which were significantly reduced by SPB (MDA, p < 0.001; TNF-α, p < 0.01; IL-6, p < 0.01; RANKL, p < 0.001; Cathepsin K, p < 0.001). Conclusions: SPB mitigates OVX-induced oxidative stress, inflammatory cytokine release, and osteoclast-mediated resorption, resulting in partial but significant improvements across biochemical, structural, and histomorphometric parameters in estrogen-deficient rats. Given its established clinical safety profile, SPB emerges as a cost-effective candidate for repurposing in postmenopausal osteoporosis, warranting further translational and clinical studies. Full article

Background and Objectives: Left ventricular diastolic dysfunction (LVDD) is a known precursor of heart failure with preserved ejection fraction (HFpEF), particularly in patients with metabolic comorbidities. Acute coronary syndrome (ACS) and percutaneous coronary interventions (PCI) may exacerbate LVDD via systemic inflammation. This study aimed to explore the association between post-procedural systemic inflammation and the severity of diastolic dysfunction in patients with ACS and metabolic comorbidities. Materials and Methods: A retrospective observational study was conducted in 181 patients with ACS who underwent PCI. Inflammatory markers (leukocytes, neutrophils, and C-reactive protein [CRP]) measured at 24–48 h post-intervention were analyzed in relation to diastolic dysfunction, assessed by echocardiography. Multivariable ordinal logistic regression and correlation analyses were performed. Results: CRP showed a non-significant trend toward association with more advanced diastolic dysfunction (p = 0.081). Hypertension had a positive but nonsignificant coefficient. Other metabolic comorbidities (diabetes, dyslipidemia, and obesity) were not significantly associated. The correlation between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and troponin was exploratory. NT-proBNP was the only marker significantly correlated with high-sensitivity troponin (TrHS) at 48 h, indicating a link between myocardial injury and wall stress. Conclusions: CRP may be weakly associated with the severity of diastolic dysfunction post-PCI. However, classical metabolic comorbidities were not independently predictive. Post-PCI inflammation showed only modest, non-significant trends toward diastolic impairment, warranting confirmation in larger prospective studies. Full article

Background and Objectives: The Hepatitis E Virus (HEV) is increasingly recognized as a cause of chronic infection in immunocompromised patients, but its precise role in cryptogenic cirrhosis (CC) is unclear. CC is defined as liver cirrhosis in which all known causes, including viral, autoimmune, metabolic, and alcohol-related etiologies, have been meticulously excluded. We aimed to address this gap by definitively assessing HEV’s etiological contribution in CC through seroprevalence comparison and evaluating its long-term prognostic impact on disease progression and adverse clinical outcomes. Materials and Methods: This is a retrospective, single-center, observational, and longitudinal cohort study, conducted between July 2017 and June 2025. The study included 52 CC patients, whose diagnosis was strictly confirmed by excluding all known etiologies, and 900 healthy blood donors from the same region. CC patients were retrospectively followed for five years to assess long-term clinical outcomes. We compared HEV seropositive and seronegative patients for accelerated disease progression (assessed by follow-up MELD-Na scores) and cirrhosis-related death. We employed multivariable logistic regression to adjust for demographic confounders in the prevalence comparison and multivariable COX regression for survival analysis to determine the independent prognostic role of HEV seropositivity. Results: The anti-HEV IgG seroprevalence in CC patients (42.3%) was significantly higher than in healthy donors (12.8%) (p < 0.001). Multivariable logistic regression confirmed CC status as an independent predictor of HEV seropositivity (Adjusted OR = 6.142, p < 0.001). During the five-year follow-up, the cirrhosis-related death rate was significantly higher in the anti-HEV IgG positive group (36.4% vs. 13.4%; p = 0.047), and their follow-up MELD-Na score was significantly higher (p = 0.029). However, multivariable COX analysis did not sustain anti-HEV IgG positivity as an independent risk factor for death (p = 0.294). Conclusions: HEV exposure is independently and significantly higher in CC patients. While anti-HEV IgG positivity correlates with higher mortality and accelerated disease progression in univariable analysis, its lack of independent prognostic significance suggests it may primarily function as a marker for a more advanced stage of CC or underlying immune dysfunction. Further rigorous prospective studies are necessary to precisely define HEV’s long-term prognostic role and evaluate its impact on disease progression. Full article

DNA is continuously exposed to endogenous and exogenous factors that induce oxidative modifications leading to mutations and genomic instability. Oxidative DNA damage plays a dual role, contributing to physiological signaling at low levels while promoting mutagenesis, carcinogenesis and degenerative diseases when unpaired. Among various lesions, an oxidized base, such as 8-oxo-2′-deoxyguanosine (8-oxodG), is one of the major biomarkers of oxidative stress and genomic damage. Cells have evolved sophisticated repair processes, including base excision repair (BER), nucleotide excision repair (NER), and mismatch repair (MMR), to maintain genomic integrity. Dysregulation or polymorphism of these repair genes has been linked with cancer, neurologic, and cardiovascular disorders. This review discusses an overview of what is presently known concerning oxidative DNA damage and repair mechanisms, particularly emphasizing their molecular players, signaling routes, and human disease implications. It further refers to the latest advances in CRISPR-based technologies and multi-omics approaches that are redefining our understanding of DNA damage response (DDR) networks and creating new frontiers for therapeutic interventions. Full article

Background and Objectives: Osteoporotic vertebral compression fractures (OVCFs) are a common cause of morbidity in the elderly, often resulting in pain, reduced mobility, and diminished quality of life. Treatment options include conservative management, vertebroplasty (VP), and kyphoplasty (KP). This study aimed to compare the clinical outcomes and complication rates of patients treated with kyphoplasty/vertebroplasty versus conservative methods and identify risk factors associated with the development of new fractures. Materials and Methods: This retrospective cohort study included patients diagnosed with OVCFs who were treated either surgically (KP/VP) or conservatively between January 2020 and January 2025. Inclusion criteria encompassed vertebral height loss on CT, STIR hyperintensity on MRI, and a T-score below −2.5. Patients were followed for at least one year. Clinical evaluations included pain scores (VAS), functional status (ODI), and quality of life assessments. Complications and new fracture rates were recorded. Logistic regression analysis was performed to identify risk factors influencing fracture recurrence. Results: A total of 132 patients were analyzed: 65 in the KP/VP group and 67 in the conservative treatment group. The KP/VP group achieved better postoperative pain results (3.2 ± 1.0 vs. 4.0 ± 1.2) with a significant difference of −0.8 (95% CI: −1.2 to −0.4, p = 0.032) and better mobility results (ODI: 4.5 ± 0.8 vs. 3.9 ± 0.9) with a significant difference of 0.6 (95% CI: 0.3–0.9, p = 0.047) and improved quality of life scores (6.7 ± 1.1 vs. 5.9 ± 1.3) with a significant difference of 0.8 (95% CI: 0.4–1.2, p = 0.041). The incidence of new fractures was similar between groups (15.4% vs. 17.9%, p = 0.678). Overall complication rates were 7.7% in the KP/VP group versus 11.9% in the conservative group (p = 0.435). The results from logistic regression analysis showed that age (adjusted OR: 2.48, 95% CI: 1.20–5.13), low bone mineral density (adjusted OR: 0.31, 95% CI: 0.15–0.63), and cement leakage (adjusted OR: 3.10, 95% CI: 1.21–7.99) were identified as risk factors for new fractures. The study found that outdoor activity (adjusted OR: 0.38, 95% CI: 0.20–0.73) and anti-osteoporosis treatment (adjusted OR: 0.17, 95% CI: 0.04–0.79) acted as protective factors against new fractures. The KP/VP group required half the time to recover from their injuries because they used their braces for 3.0 ± 0.5 months instead of 6.0 ± 1.0 months (p < 0.001). Conclusions: Kyphoplasty and vertebroplasty were more effective than conservative treatment in improving pain, mobility, and quality of life in patients with OVCFs. Although the incidence of new fractures did not differ significantly between groups, surgical treatment demonstrated lower complication rates and significantly faster recovery, as evidenced by reduced brace use duration. These findings support the use of KP/VP as a viable option for managing OVCFs in appropriately selected patients. Full article

Background and Objectives: The present study evaluates documentation and control of cardiovascular risk factors (RFs) in patients with coronary heart disease (CHD) during routine outpatient visits at a single tertiary center in western Romania and places these findings in descriptive context relative to SURF-CHD reports from Europe. Materials and Methods: We have enrolled 136 consecutive patients between 18 and 80 years old with coronary artery disease attending routine outpatient clinic check-ups between May 2019 and July 2020. All patients had been diagnosed with acute coronary syndrome or stable angina pectoris and had been treated either by PCI or CABG. Comparisons with SURF-CHD were primarily descriptive due to non-harmonized denominators and lack of patient-level data; inferential testing was limited to variables with clear n/N in both cohorts. Results: Most patients (81%) were males with a mean age of 61.7 years. 93.4% of the patients had undergone PCI, and 4.4% had coronary artery bypass graft (CABG). Regarding risk factors, 25% were current smokers, while 50% were former smokers and the mean BMI value was 29.9 (±6.07). While most patients (80.1%) revealed no previous history of dyslipidemia, 62.5% had no previous history of arterial hypertension, and 84.6% had no previous history of diabetes mellitus. Mean LDL cholesterol levels after a major coronary event remained 93.55 (±43.52) mg/dL, mean HbA1c levels were 7.86 (±1.40)%, while mean systolic blood pressure was 129 (±14.9) mmHg. Conclusions: In this single-center audit, several modifiable RFs remained suboptimally controlled despite established CHD. These results should not be generalized nationally; rather, they highlight center-level opportunities for improving secondary prevention and underscore the need for multicenter, nationally representative registries in Romania. Full article

Background and Objectives: Breast cancer invasiveness significantly impacts treatment strategies and prognosis. Combining ultrasound imaging modalities with serum biomarkers may improve diagnostic accuracy. We aimed to develop and validate a multimodal diagnostic model integrating ultrasound B-mode, Doppler imaging, and serum biomarkers for assessing breast cancer invasiveness. Materials and Methods: A multimodal diagnostic model was developed using ultrasound B-mode, Doppler imaging, and serum biomarkers from patients with invasive and non-invasive breast cancer. Machine learning algorithms, including Logistic Regression, Random Forest, and XGBoost, were applied to predict invasiveness, with performance evaluated using accuracy, precision, recall, F1-score, and AUC. Results: The multimodal model outperformed single-modality approaches, with XGBoost achieving the highest accuracy (88.90%) and AUC (0.930). The inclusion of specific serum biomarkers (e.g., CA125, CA15-3, CEA, and CA19-9) significantly enhanced diagnostic accuracy for breast cancer invasiveness. Conclusions: The proposed multimodal diagnostic model integrating ultrasound imaging and serum biomarkers provides a highly accurate and reliable method for assessing breast cancer invasiveness, offering potential to improve clinical decision-making and patient outcomes. Full article

Background and Objectives: This study aims to comparatively evaluate the outcomes of glaucoma surgeries performed by a single surgeon during the non-pandemic period (2019, 2021, and the first quarter of 2022) versus the pandemic year (2020). The analysis focuses on key surgical outcomes, including intraocular pressure (IOP) reduction, intraoperative and postoperative complications, surgical success and failure rates, and their broader clinical implications. Materials and Methods: Out of a total of 66 patients admitted between November 2019 and March 2022, 45 met the inclusion and exclusion criteria and were enrolled in the study. All patients underwent glaucoma surgery conducted by the same surgeon employing a standardized technique (trabeculectomy ± iridectomy ± mitomycin C). The evaluated clinical parameters included preoperative and postoperative IOP values (with specific assessment on the first postoperative day), early and late intraoperative and postoperative complications, as well as postoperative success and failure rates. Results: The majority of glaucoma cases—particularly those of primary open-angle glaucoma—were recorded in 2021 and 2022, in contrast to 2019 and 2020, when pseudoexfoliative and secondary closed-angle glaucomas predominated. Over the observation period, retrobulbar anesthesia was more frequently utilized in 2019. Statistical analysis indicated that the surgical failure rate was not significantly influenced by the presence of complications, patient age, associated comorbidities, or the specific surgical variant performed. Conclusions: The conduct of glaucoma surgery during the pandemic period was marked by substantial operational and clinical constraints when compared to non-pandemic years, primarily as a consequence of decreased patient accessibility and the reprioritization of healthcare resources, despite the acknowledged emergency status of these procedures. Nonetheless, the overall incidence of early intraoperative and postoperative complications remained minimal, with transient intraocular hypotony emerging as the predominant adverse event, observed in ten cases. Across all study cohorts, more than 80% of patients achieved qualified surgical success, while only 18% exhibited surgical failure, underscoring the robustness of standardized operative protocols under variable healthcare conditions. Consistent with the directives of the American Academy of Ophthalmology (AAO) and the European Glaucoma Society (EGS), glaucoma must be regarded as a genuine ophthalmic emergency necessitating prompt surgical intervention when intraocular pressure cannot be adequately managed through pharmacological or laser-based therapies. The current findings reinforce the imperative of timely glaucoma surgery, irrespective of pandemic or non-pandemic circumstances, as a critical measure for averting irreversible optic nerve damage, mitigating functional visual loss, and sustaining long-term ocular integrity. Full article

Background and Objectives: Odontogenic infections are common emergencies in oral and maxillofacial surgery. They are typically polymicrobial, with aerobes guiding initial empirical therapy. However, regional data on their microbiology and resistance patterns in Romania are limited. This study aimed to characterize the aerobic microbial profile of odontogenic infections in Southwestern Romania and assess the antimicrobial susceptibility of isolated pathogens. Materials and Methods: A prospective observational study was conducted over 12 months at a tertiary referral hospital. Pus samples collected intraoperatively were cultured aerobically. Bacterial identification used biochemical methods and the VITEK 2 system. Antimicrobial susceptibility was determined by disk diffusion and automated MIC testing, interpreted according to EUCAST v13.0 (2023). Results: Of 110 patients, 96 (87.3%) yielded positive aerobic cultures, producing 97 isolates. Streptococcus spp. were predominant (49.5%), followed by coagulase-negative staphylococci (24.7%), Staphylococcus aureus (14.4%), Enterobacterales (7.2%), and Pseudomonas aeruginosa (3.1%). Streptococcus spp. remained susceptible to penicillin G (82.3%), amoxicillin–clavulanate (76.4%), and clindamycin (70.5%), but only 55.0% to erythromycin. Most S. aureus isolates were methicillin-susceptible (92.9%), while coagulase-negative staphylococci showed high methicillin resistance (59.3%) yet full susceptibility to linezolid, vancomycin, and teicoplanin. Enterobacterales were resistant to ampicillin (90%) and amoxicillin–clavulanate (65%) but remained susceptible to ceftriaxone (80%) and ciprofloxacin (85%). P. aeruginosa isolates were fully susceptible to piperacillin–tazobactam, ceftazidime, cefepime, and meropenem. Conclusions: This study provides regional data on aerobic pathogens in odontogenic infections. High resistance to penicillin and macrolides limits empirical use. Amoxicillin–clavulanate and clindamycin retain moderate activity, while glycopeptides, linezolid, and carbapenems preserved full efficacy. Surgical drainage remains central to management, and antibiotic therapy should be guided by local susceptibility patterns. These data provide baseline information to inform empirical therapy and stewardship efforts and highlight the need for multicenter studies including anaerobic and molecular analyses. Full article

Background: Cervical cancer remains a major cause of cancer-related morbidity and mortality worldwide, with limited therapeutic options for advanced disease. As we better understand the fine mechanisms involved in the interaction between tumor cells and the tumor microenvironment, new paths and opportunities will emerge. Recent evidence highlights the prognostic and predictive roles of immune checkpoint markers and tumor-infiltrating lymphocytes (TILs), especially CD8⁺ TILs, in shaping treatment outcomes. Objectives: This study investigated the immunohistochemical expression of PD-L1 and CD8⁺ TILs in 48 newly diagnosed, treatment-naive cervical cancer cases and analyzed their associations with clinicopathological features and survival outcomes. Results: In our cohort, we observed that PD-L1 positivity was identified in 68.8% of cases, most frequently in advanced FIGO stages and in tumors with lympho-vascular invasion or with a high proliferation rate evaluated by the Ki-67 index. High levels of intra-tumoral CD8⁺ TILs were observed in 52.1% of cases and correlated positively with stromal TILs, lower proliferation rates, and absence of vascular invasion. A significant inverse relationship was found between PD-L1 expression and the density of CD8⁺ TILs (p = 0.047). Survival analysis showed that patients exhibiting a “cold” immunophenotype with low levels of CD8⁺ TILs and PD-L1-positive tumors had worse outcomes, while high levels of CD8⁺ TILs played a protective role. Conclusions: Our study highlights the importance of the immunohistochemical assessment of PD-L1 and CD8⁺ TILs biomarkers, which have a complementary inter-relationship and have a significant prognostic impact on cervical squamous cell carcinoma. PD-L1 positivity marks aggressive disease features, while higher intra-tumoral CD8⁺ TIL density is protective. Their combined evaluation may improve patient stratification and inform immunotherapy strategies. Full article

Background and Objectives: Ultrasound (US)-guided peripheral regional anesthesia (pRA) is gaining increasing importance in emergency medicine as an effective, low-ridsk alternative to general anesthesia (GA), procedural sedation (PS), or opioid therapy. By enabling rapid, direct pain management in the emergency department (ED), pRA can help preserve scarce surgical and anesthetic resources and, in some cases, avoid inpatient admissions. The aim of this study was to analyze the indications, techniques, and clinical impact of pRA in the orthopedic-focused ED of an affiliated hospital. Materials and Methods: All pRA and PS procedures performed over a six-year period were retrospectively reviewed among 35,443 orthopedic-trauma emergency patients. pRA was carried out under US guidance with standardized monitoring. Diagnoses, block techniques, effectiveness, and complications were analyzed descriptively. Results: A total of 1292 patients (3.7%) underwent either pRA (n = 1117; 3.2%) or PS (n = 175; 0.5%). pRA was performed in 22% of cases for interventions such as reductions or extensive wound management. In 78%, pRA was applied for analgesia, for example, in the diagnostic work-up and treatment of non-immediately operable fractures, lumbago, or arthralgia. The most common pRA techniques were brachial plexus blocks (54%) and femoral nerve blocks (25%). Fascial plane blocks (6.1%) and paravertebral blocks (1.5%) were rarely used. PS was performed in 175 of 1292 patients (13%), although pRA would have been feasible in 159 of these cases. No complications of pRA were observed, and GA could routinely be avoided. Conclusions: US-guided pRA proved to be an effective and safe alternative to PS, GA, or systemic analgesia for selected indications, allowing immediate treatment without the need for operative capacities. To ensure safe application, these techniques should be an integral part of the training curriculum for ED personnel. Full article