Čeponis, Jonas

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a public health threat in Europe. With an estimated 30.4% prevalence among the adult population in the European Union and United Kingdom, it is the most common chronic liver disease and is closely linked to obesity and type 2 diabetes, which can be considered as indicator conditions. Despite the scale of the burden, the spectrum of MASLD, including its advanced form, metabolic dysfunction-associated steatohepatitis (MASH), is weakly represented—or even absent—from health policy and development agendas. Further, the extent to which regional and national clinical practice guidelines (CPGs) on other liver diseases and related fields incorporate information on MASLD/MASH prevention or management is unclear. In this Series paper, we reviewed policy attention to MASLD/MASH across the European Union and the United Kingdom. We report low policy readiness across European countries to address MASLD/MASH. Only two (7.1%), Romania and Sweden, had a subnational strategy, while 13 (46.4%) referenced MASLD/MASH in other national or subnational action plans, predominantly those for liver disease and obesity. No country included MASLD/MASH in its priority non-communicable disease list. Additionally, 15 (53.6%) countries had national MASLD/MASH CPGs, while 25 (89.3%) mentioned MASLD/MASH in other national CPGs, most often those for obesity, diabetes, cirrhosis, liver transplantation, and primary care, respectively. We conclude that MASLD/MASH remains insufficiently addressed from a policy perspective, which contributes to low readiness to address this public health threat.

Nutukimas - viena aktualiausių dabartinės visuomenės problemų, neigiamai veikianti daugelį organizmo sistemų ir trikdanti sergančiojo šia liga gyvenimo kokybę, darbingumą bei trumpinanti gyvenimą. Tai - metaboliškai aktyvi ir recidyvuojanti liga, kurios metu kūno masė didėja riebalinio audinio sąskaita. Nutukimą kaip ligą Amerikos medicinos asociacija oficialiai pripažino 2013 metais. Nutukimas pastaruoju metu yra labiausiai aptarinėjama tema tiek medicinos, tiek plačiojoje visuomenėje. Kalbant apie nutukimą, dažnai ši būklė siejama su asmeniniu kaltės priskyrimu: „reikia tik noro“, „reikia suimti save į rankas“ ir t. t. Įvairiais istoriniais laikotarpiais požiūris į žmogaus kūno formas keitėsi nuo Rubenso tipo moterų iki anoreksinių mados manekenių formų. Menamų kūno formų standartų neatitinkantis žmogus gali būti pavadintas putliu, stambiu, apkūniu, didelio dydžio ar net storuliu ar apsileidusiu. Medicinos bendruomenėje vyrauja terminai: antsvoris, hipotalaminis, pilvinis, centrinio tipo, kušingoidinis, morbidinis nutukimas ir kt. Nutukimas turi kompleksines pasekmes - skatina lėtines ligas, galinčias sutrumpinti žmogaus amžių 10-15 metų. Per pastaruosius 5 dešimtmečius nutukimo paplitimas pasaulyje padidėjo daugiau nei 3 kartus, ir dabar tai įvardijama kaip nutukimo pandemija. Klinikinėje praktikoje nustatomos įvairiausios nutukimo priežastys - nuo genetinių (Prader-Willi sindromas, Aistrom sindromas, LEPR (leptino receptoriaus) ar LEP (leptino) geno mutacijos ir kt.), endokrininių (hipotirozė, hiperkorticizmas, hipogonadizmas ir kt.) iki valgymo priklausomybių. Skirtingos yra ir nutukusių kūno formos bei kūno kompozicija. Todėl kūno masės indeksas (KMI) klinikiniu požiūriu jau nebetenka prasmės. KMI tikslinga naudoti populiaciniams, palyginamiesiems tyrimams. Statistiniais duomenimis (HIS Lietuva, Eurostat, 2019-2022 m.), pagal KMI nutukusių suaugusių Lietuvoje buvo 21-23 proc. Skaičiuojama, kad apie 60 proc. suaugusiųjų Lietuvoje turi antsvorio ar yra nutukę. Tai - tik statistika, neatspindinti konkrečios individo būklės. 2025 m. pasaulio 58 ekspertų grupė, atstovaujanti įvairioms medicinos specialybėms ir šalims, išanalizavo turimus įrodymus ir, pritarus 75 medikų ir pacientų organizacijoms, rekomendavo klasifikaciją, kurioje išskiriamas ikiklinikinis ir klinikinis nutukimas. Pagal epidemiologinius ir klinikinius duomenis, nutukimas susijęs su daugiau nei 200 skirtingų ligų ir sveikatos sutrikimų. [...]

Background/Objectives: Erectile dysfunction (ED) is a common sexual disorder in men, frequently linked to endothelial dysfunction affecting penile vasculature. Accumulating evidence suggests that vitamin D (VD) status may influence endothelial function and, consequently, erectile function. VD deficiency has also been associated with cardiovascular risk factors, which are well-known contributors to ED. Methods: A systematic review following PRISMA guidelines was conducted, analyzing studies from PubMed and Cochrane databases published between 2010 and 2025. Randomized controlled trials, observational studies, and pilot clinical trials examining the relationship between VD levels and ED in the general male population were included. Results: Out of 1335 identified articles, 10 studies met inclusion criteria, encompassing over 13,000 men. Observational studies consistently showed that men with moderate-to-severe or arteriogenic ED had significantly lower serum VD levels and poorer erectile function scores compared to those with mild ED. VD deficiency was independently associated with higher ED prevalence, irrespective of lifestyle, cardiovascular risk, or sex hormone levels. Although several observational studies suggested a potential optimal vitamin D threshold, definitive recommendations cannot be established due to the heterogeneity of available evidence and conflicting findings from randomized controlled trials. The latter demonstrated inconsistent effects of vitamin D supplementation on erectile dysfunction outcomes, with the largest trial reporting no significant reduction in disease prevalence. These findings underscore the critical need for rigorously designed trials targeting populations with severe VD deficiency and arteriogenic ED. Conclusions: This systematic review highlights an association between vitamin D status and erectile dysfunction, particularly in men with moderate-to-severe or arteriogenic ED. However, most of the evidence is derived from low-certainty observational studies. While observational data suggest potential benefits of adequate VD levels for sexual health, well-designed randomized controlled trials are essential to delineate causal relationships and potential for therapeutic efficacy.

Background/Objectives: The aim of this study was to identify systemic, metabolic, and host-related prognostic factors for long-term outcomes in patients with a diabetic foot ulcer (DFU). Methods: One hundred patients were selected from a high-risk cohort of 426 individuals with a DFU (January 2021–January 2023) based on predefined inclusion and exclusion criteria. Clinical, laboratory, and imaging data were collected. Outcomes were categorized as favorable (healing) or unfavorable (non-healing, re-ulceration, amputation, or death). Prognostic factors were analyzed using random forest and categorical boosting models, with SHAP values to determine the importance of individual predictors. Results: The median age of participants was 65 years (interquartile range [IQR], 57–69.25), and the median duration of diabetes was 18 years (IQR, 12–26). Over a mean 2.1-year follow-up, unfavorable outcomes occurred in 53% of the whole cohort and in 36% of survivors. The strongest predictors of poor prognosis were prior amputation, elevated inflammatory markers, reduced eGFR, and dyslipidemia. Triglycerides showed a U-shaped association with outcomes. A lower BMI and shorter diabetes duration paradoxically were also linked to poorer prognosis. Glycemic control, comorbidities, and local foot characteristics had limited predictive value. Conclusions: Long-term DFU prognosis is driven mainly by systemic and host-related factors rather than by ulcer characteristics alone. Inflammation, renal dysfunction, dyslipidemia—particularly triglycerides—and prior amputation were the strongest predictors of unfavorable outcomes.

Background/Objectives: While it is known that Hashimoto’s thyroiditis (HT), goiter, thyroid nodules, and thyroid dysfunction may affect women’s reproductive health through hormonal and metabolic mechanisms, data are limited regarding the specific impacts on female sexual function. This study evaluated sexual function in women with thyroid disorders and examined its associations with thyroid function, age, menopausal status, and body mass index (BMI). Methods: A population-based survey was conducted in Kaunas, Lithuania, within the WHO MONICA framework. A random sample of 1569 women aged 25–69 years was included in the final analysis after applying the exclusion criteria. Anthropometric measurements were taken using standardized procedures, and the BMI was calculated. Sexual function was assessed using the 19-item Female Sexual Function Index (FSFI). Thyroid structure was evaluated by a team of trained physicians using ultrasound, while thyroid function was assessed via serum analysis (ELISA-based assays for TSH, fT4, and anti-TPO antibodies). Results: Of the 1569 women analyzed, 64.1% had sexual dysfunction (SD) (FSFI ≤ 26.55). Age and BMI showed significant negative correlations with all FSFI domains, with the strongest associations for arousal, lubrication, and total FSFI score (p < 0.01). SD was more prevalent among postmenopausal (43.6%) women than in premenopausal women (22.6%, p < 0.001) and increased with a higher BMI (p < 0.001). HT was found in 28.3% of participants. Compared with the reference group, women with HT were older, had higher BMI, higher TSH levels, and more hypothyroidism (p < 0.001). SD was more common in the HT group (71.7% vs. 64.2%, p < 0.001), with significantly lower lubrication and higher pain scores. In the multivariate analysis, only goiter remained an independent predictor of SD (p = 0.04). Conclusions: In conclusion, women with HT were older; had a higher BMI; and more frequently experienced SD, particularly reduced lubrication and increased pain, compared with the reference group. Although several thyroid conditions were associated with sexual dysfunction, only goiter remained an independent predictor after adjusting for age and BMI.

Background: Acute Myocardial Infarction (AMI) represents a significant clinical challenge with diverse outcomes. Predicting patient-oriented composite endpoints (POCE) (all-cause death, any stroke, any AMI, or any revascularization) can significantly enhance post-AMI care. Incorporating clinical data with neuroendocrine biomarkers may offer improved prognostic capabilities. Objective: To develop and validate a machine learning model to predict POCE in AMI patients, utilizing clinical parameters and neuroendocrine biomarkers. Methods: There was prospective, observational, single-center study. Three approaches have been used to obtain the predictions for POCE event. First, as the dataset was imbalanced, an adaptive synthetic (ADASYN) sampling approach was used to generate synthetic instances, particularly focusing on those that are difficult-to-learn by using a weighted distribution. Then, random forest classifier (RF) was used to build a machine learning model to predict POCE. The model was tuned via a grid-search algorithm for optimal hyperparameters and validated using a 10-fold stratified cross-validation. Finally, the feature importance was determined by Shapley Additives, which measure the average marginal contribution of a feature value across all potential feature combinations. For the comparative purpose, the Gini index, which also shows the feature importance but in terms of mean decrease in impurity, was calculated. Results: The study incorporated data from 315 patients, examining 47 variables and identifying 72 instances of POCE. After applying the ADASYN algorithm, the class distribution within the dataset was effectively equalized, facilitating the training of a robust RF model. Upon training with 252 instances, the model distinguished POCE with an accuracy of 83.8%, demonstrating a sensitivity of 80% and a specificity of 86%. During 10-fold cross-validation, the model's accuracy slightly dipped to 75%, with a sensitivity of 56% and specificity of 82%, indicating a balance between generalizability and overfitting. Testing mirrored these results, underscoring the model’s consistent performance. Notably, SHAP value analysis highlighted C-Reactive Protein (CRP) and alanine transaminase (ALT) as the most influential features, underscoring their significance in the context of AMI (Figure 1-2). The predictive power of each feature was further demonstrated by the mean decrease in Gini index (Figure 1-2). Conclusion: Our study highlights the feasibility of employing machine learning to predict POCE post-AMI using an integrative dataset of clinical and neuroendocrine markers. The predictive model has the potential to revolutionize post-AMI care by allowing clinicians to identify high-risk patients early, tailor interventions, and allocate resources efficiently. Future research could explore the integration of this model into clinical workflows and its impact on patient outcomes.

Pirmosios tarptautinės policistinių kiaušidžių sindromo diagnostikos ir gydymo gairės, prie kuriu ruošimo prisidėjo šešių pasaulio kontinentų įvairių specialybių eskpertai, buvo išleistos 2018 m. Šios gairės apimė medicininius, gyvensenos, psichologinius bei socialinius aspektus. 2023 m. rugpjūčio mėn. publikuotos atnaujintos rekomendacijos. Svarbiausi 2023 m. rekomomendacijų aspektai aptariami šioje apžvalgoje. Aprašoma širdies ir kraujagyslių ligų, angliavandenių tolerancijos sutrikimo, 2 tipo cukrinio diabeto, obstrukcinės miego apnėjos ir endometriumo vėžio rizika policistinių kiaušidžių sindromu sergančioms pacientėms. Pabrėžiamas būtinumas daugiau dėmesio skirti pacienčių psichologinei sveikatai. Taip pat aptariamas gyvensenos intervencijų būtinumas, medikamentinio gydymo veiksmingumo įrodymų lygmuo. Pateikiama informacija apie naujus hirsutizmo gydymo būdus, rekomendacijos dėl nutukimo gydymo medikamentais ir bariatrinės chirurgijos. Aptariami nevaisingumo gydymo, esant policistinių kiaušidžių sindromui, principai. Policistinių kiaušidžių srityje būtini tolesni moksliniai tyrimai, nes daugelio gairėse pateikiamų įrodymų lygmuo yra žemas.

Pirmosios tarptautinės policistinių kiaušidžių sindromo diagnostikos ir gydymo gairės, kurių ruošime dalyvavo 6 pasaulio kontinentų įvairių specialybių ekspertai, apimančios tiek medicininius, tiek gyvensenos, psichologinius, socialinius aspektus, išleistos 2018 metais. [...].