No.4 / 2026, Vol. CXXIX, July
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y₁₂ inhibitor is the pharmacological cornerstone of ST-segment elevation myocardial infarction (STEMI) management. The evolution from clopidogrel to the more potent agents prasugrel and ticagrelor has improved ischaemic outcomes in PCI-treated patients, while cangrelor provides an intravenous alternative when oral absorption is compromised. Direct comparative data from ISAR-REACT 5 have established a hierarchy favoring prasugrel in patients proceeding to invasive management, although methodological limitations temper definitive conclusions. Beyond agent selection, contemporary practice increasingly emphasizes calibrated therapy: DAPT duration, de-escalation strategies — guided by CYP2C19 genotyping, platelet function testing, or applied empirically — and P2Y₁₂ monotherapy after short DAPT have been validated as approaches that preserve ischaemic protection while reducing bleeding. Special populations, including elderly patients, those with renal impairment, concomitant oral anticoagulation, or cardiogenic shock, require individualized decision-making that exceeds what any single trial provides. Emerging approaches, including subcutaneous selatogrel for patient self-administration and anti-GPVI strategies, signal a shift toward precision antiplatelet therapy. This review synthesizes current evidence across agent pharmacology, duration modulation, special population management, and future directions, framing the transition from potency to precision as the defining trajectory of the field.
Bereavement constitutes a shared environmental exposure that may result in distinct psychopathological outcomes, including prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and major depressive disorder (MDD). The objective of this research was to construct a transdiagnostic conceptual model for interpreting bereavement-related pathologies that integrates core psychopathological data. A structured conceptual synthesis of the literature was conducted, focusing on diagnostic, epidemiological, pathophysiological, clinical, and therapeutic findings related to PGD and associated disorders. Shared and disorder- specific mechanisms were identified and mapped across diagnostic categories in order to construct an integrative framework. The proposed model suggests that bereavement-related psychopathology can be conceptualized as a spectrum of partially overlapping syndromes organized around three principal domains: attachment dysregulation and separation distress (PGD), trauma- and threat- processing abnormalities (PTSD, acute stress disorder, adjustment disorder), and depressive-cognitive vulnerability (MDD). This framework provides a clinically relevant perspective on the relationship between grief-, trauma-, and depression-related disorders following loss. More research is needed to empirically validate this model, but at a theoretical level, it can serve as an orienting aid for mapping bereavement-related diagnoses and treatments.
Introduction: Heart rate variability (HRV) reflects autonomic nervous system (ANS) activity and emotional responsiveness. Music influences autonomic regulation through the heart–brain axis, yet sex-specific autonomic responses to different musical genres remain insufficiently characterized. Materials and methods: HRV parameters were recorded in 24 healthy young adults (17 females, 7 males; mean age 27.04 ± 1.97 years) at rest and during exposure to six musical genres: Baroque, Jazz, Heavy Metal, Romantic, Traditional Romanian, and Ambient. Time-domain and frequency-domain HRV parameters, including low frequency (LF), high frequency (HF), normalized LF (nLF), normalized HF(nHF), LF/HF ratio, and normalized coherence (NCoh), were analyzed. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS).Results: Heart rate did not differ between rest and musical sessions. In contrast, significant changes were observed in HRV parameters, particularly in the frequency domain. Compared with rest, nLF and LF/HF increased, and nHF decreased during all musical sessions, with more pronounced effects in males. Differences between musical genres were limited, whereas sex-related differences were consistent across sessions. rMSSD and HF were strongly correlated in all conditions except Jazz in males. LF/HF correlated directly with nLF and NCoh and inversely with nHF. Conclusion: Music modulates cardiac autonomic balance without altering heart rate. Autonomic responses are predominantly sex-dependent rather than genre-dependent, underscoring the importance of sex-specific analysis in studies investigating music-induced autonomic modulation.
Background: Head and neck keratinocyte carcinomas are frequently managed surgically; anatomic constraints may increase the risk of incomplete excision and influence reconstructive choices. Objectives: To describe the clinicopathological characteristics of head and neck non-melanoma skin cancers (NMSC) treated in a tertiary care dermatology department and to explore factors associated with resection status (R0 vs R1) and reconstructive approach after conventional excision. Methods: We performed a retrospective observational study of 117 patients undergoing excision of 134 primary head and neck NMSC between September 2025 and January 2026. Demographic, clinical, histopathological, and procedure-related variables were extracted from medical records and pathology reports. Margin status was assessed for conventionally excised lesions. Results: Most lesions were basal cell carcinomas (113/134, 84.3%) and were located on the cheek (31.3%) or nose (29.8%). Conventional excision was performed in 126/134 lesions (94%). Among conventionally excised lesions, 92% had complete resection (R0) and 8% had positive margins (R1), most commonly involving the lateral margin. Conclusions: In this single-center cohort, head and neck NMSC clustered in high-risk anatomic regions, and a small proportion of conventionally excised tumors showed positive margins. Clear reporting of margin involvement and reconstruction patterns may support quality improvement and guide future prospective follow-up.
Helicobacter pylori (H. pylori) is recognized as a human gastric pathogen that is a major risk factor for the development of peptic and duodenal ulcers, gastric adenocarcinoma, and lymphoma in humans. Antibiotic treatment is not completely effective due to antibiotic resistance. Probiotics play an important role in regulating the immune system and exert antibacterial effects by producing metabolites. Probiotic strains were administered to infected mice, and immune responses were monitored to investigate their immunomodulatory effects. Pathogen-free male C57BL/6 mice were divided into 6 groups of 5, and treatments were administered. Fourteen days after the last treatment, their spleens were removed, and IFN-γ and IL-4 expression levels were measured by real-time PCR. After treatment of L. acidophilus ATCC4356 and L. rhamnosusPTCC1607, the expression of INF-γ increased, but IL-4 expression was decreased. It can be concluded that the functions of probiotic strains differ. Two probiotics, L. acidophilus ATCC4356 and L. rhamnosus PTCC1607, stimulate interferon-gamma production to increase the phagocytic activity of macrophages and facilitate the differentiation of T cells to Th1.
Objective: Currently, the global epidemiologic impact of obesity requires continuous seeking of practical biomarkers; hence, this current study aimed to address the gap of chemerin assays in obese versus non-obese females and to analyze its circulating levels in relationship with the glucose profile and other circulating adipokines. Methods: This is an exploratory, prospective, cross-sectional analysis in females aged between 50 and 80 years. We excluded individuals with diabetes, cancers, endocrine, kidney, cardiovascular, and bone conditions. Enzyme-linked immunosorbent assay-based circulating adipokines testing was performed. The final analysis was focused on circulating chemerin (ng/mL) in the obese [body mass index (BMI) ≥ 30 kg/sqm] versus non-obese (BMI < 30 kg/sqm) group. Results: The obesity (N=12) versus the non-obesity (N=12) group showed a statistically significantly higher HOMA-IR (p=0.04), fasting insulin (p=0.01), but similar circulating chemerin. Chemerin positively correlated with BMI only in the obesity group (r=0.881, p=0.0039), but not with patients’ age and glucose profile-based features in any group. Chemerin showed a statistically significant positive, strong correlation with VEGF-A level (r=0.857, p=0.0065) and an inverse statistically significant strong association with circulating leptin (r= -0.713, p=0.0092) and circulating IL-12 p40 (r= -0.829, p=0.0416) in the obesity group. Conclusion: As a potential hypothesis-generating analysis, this pilot study showed different statistical results in BMI-based groups, despite the fact that direct comparison of circulating chemerin and even leptin, VEGF-A, and IL-12 p40 did not reach between-group statistical significance. A larger sample size and a multimodal integration of the adipokines panel might serve for practical points in addressing obesity. Citation: Schipor SV, Manda D, Ciobica ML, Sima OC, Preda EM, Ciuche A, et al. Exploratory results of circulating chemerin testing in humans. R. J. Mil. Med. 2026, CXXIX(4): 404-412 https://doi.org/10.55453/rjmm.2026.129.4.6 Academic Editor: Raluca Mititelu
Abstract Cervical cancer remains a major global public health challenge, especially affecting women of reproductive age. In the context of a societal shift towards delayed childbearing, fertility preservation has become an integral component of oncologic care for early-stage disease. Radical trachelectomy has emerged as a viable fertility-sparing surgical option in carefully selected patients. This review aims to assess the role of fertility-sparing radical trachelectomy in the modern management of early-stage cervical cancer by emphasizing the evolving criteria for patient selection, advances in surgical techniques, and the critical balance between oncologic safety and reproductive potential. An analysis of the literature from the past two decades shows that radical trachelectomy, whether performed via vaginal or abdominal routes, provides excellent oncologic control for early-stage lesions. Therefore, optimal results of such a technique depend on careful patient selection along with a multidisciplinary approach in order to reduce obstetrical complications.
(1) Background: Severe COVID-19 frequently leads to intensive care unit-acquired weakness (ICU-AW), a complex neuromuscular syndrome that may result in enduring disability, delayed functional recovery, and extended mechanical ventilation. Conventional clinical assessment tools capture only a limited scope of this multifactorial condition and often fail to accurately depict the nonlinear dynamics of physiological deterioration and recovery observed in critically ill patients. (2) Methods: This study presents an integrative framework that combines Physical and Rehabilitation Medicine (PRM) with analytical tools derived from nonlinear dynamics and fractal physiology. A prospective observational design and a long-term clinical evaluation were used along with nonlinear signal analysis. Fractal complexity metrics, including Higuchi fractal dimension (HFD) and detrended fluctuation analysis (DFA), were utilized to characterize the dynamics of neuromuscular and cardiorespiratory signals during rehabilitation. Clinical outcomes included the Medical Research Council (MRC) muscle strength score, the Functional Status Score for the ICU (FSS-ICU), and measures of respiratory performance. (3) Results: Early PRM intervention was associated with a consistent increase in neuromuscular strength, functional mobility, and respiratory muscle performance. Fractal analysis showed that physiological complexity was restored at the same time, as shown by large increases in HFD and DFA values. The recovery paths were not linear, and clustering analysis identified three distinct recovery phenotypes. (4) Conclusions: The integration of fractal biomarkers and nonlinear modeling into ICU rehabilitation may enable early risk stratification, improve the monitoring of functional recovery, and strengthen personalized rehabilitation strategies for patients with ICU-acquired weakness following severe COVID-19.
Background: Behavioral addictions (BAs), including gambling disorder, gaming disorder, problematic pornography use, compulsive sexual behavior, and problematic internet use, have received increasing attention because of their potential impact on mental health, occupational functioning, and military readiness. Objectives: To identify military-specific risk factors, clinical and operational consequences, barriers to detection and treatment, and gaps in prevention strategies related to BAs among active-duty personnel and veterans, and to propose a framework for prevention and early intervention. Methods: A narrative evidence synthesis was conducted using studies evaluating BAs in military and veteran populations, and data were extracted regarding prevalence, risk factors, psychiatric comorbidities, functional outcomes, help-seeking barriers, and intervention approaches. Findings were analyzed thematically to identify common patterns across different BAs and to inform the development of a military-specific prevention framework. Results: Evidence consistently indicated that military personnel and veterans are at increased risk of confronting multiple vulnerability factors for BAs, including trauma exposure, deployment-related stress, social isolation, boredom, sleep disruption, risk- taking tendencies, and barriers to help-seeking. Gambling disorder and problematic gaming were the most extensively studied conditions and were associated with depression, anxiety, posttraumatic stress disorder, substance use disorders, suicidality, impaired occupational functioning, financial difficulties, and reduced operational readiness. Also, emerging evidence suggests similar associations for problematic pornography use, compulsive sexual behavior, and problematic internet use. Across studies, stigma, concerns about career repercussions, and limited awareness of available services represented important obstacles to treatment engagement. Conclusions: BAs represent an under-recognized challenge to military health and force readiness, while the available evidence supports implementing integrated prevention strategies that include routine screening, psychoeducation, commander training, confidential referral pathways, and early intervention programs. A comprehensive military-specific framework targeting behavioral addictions may improve individual well-being while reducing operational and organizational consequences.
Background: Degenerative aortic stenosis (AS) and transthyretin cardiac amyloidosis (ATTR-CM), particularly wild-type ATTR (ATTRwt), are age-associated disorders that frequently converge in elderly patients. Their coexistence may obscure diagnosis, amplify heart-failure burden, and complicate risk stratification before and after aortic valve replacement. Methods: This narrative review was conducted using a structured literature search focused on ATTR-CM, AS, transcatheter aortic valve implantation/replacement (TAVI/TAVR), and nuclear cardiology. Priority was given to cohort studies, systematic reviews, consensus documents, and guideline statements. Main findings: Across observational cohorts and meta-analyses, ATTR-CM is consistently identified in a clinically meaningful minority of older patients with severe AS, especially among those referred for TAVI. Reported prevalence varies with age, referral pathway, diagnostic protocol, and whether equivocal grade 1 uptake is included, but most contemporary TAVI-oriented cohorts place definite ATTR-CM in the high single-digit to mid-teen percentage range. Clinical suspicion should increase in patients with disproportionate left-ventricular wall thickening, low-flow low-gradient AS, restrictive physiology, elevated cardiac biomarkers, conduction disease, atrial fibrillation, or extracardiac ATTR clues such as bilateral carpal tunnel syndrome. Conclusions: Bone-avid tracer scintigraphy with 99mTc-pyrophosphate, 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid, or 99mTc-hydroxymethylene diphosphonate, interpreted with SPECT or SPECT/CT and combined with mandatory exclusion of a monoclonal protein, enables robust non-biopsy diagnosis of ATTR-CM. In severe AS, nuclear diagnosis should be embedded in a pragmatic, multidisciplinary pathway that identifies patients likely to benefit from valve intervention, ATTR-specific therapy, genetic testing, and tailored follow-up.