Nándor Ács

Background/Objectives: Nutritional preparations are used by women with polycystic ovary syndrome (PCOS), but their short-term metabolic effects are uncertain. Methods: MEDLINE, Embase and the Cochrane Library were searched up to 4 December 2025 (PROSPERO: CRD42023424883). Between-group mean differences (MDs) in change from baseline were pooled separately for each intervention–comparator pair (restricted maximum likelihood, modified Hartung–Knapp 95% confidence intervals [CIs]). Risk of bias was assessed with the Cochrane risk-of-bias tool for randomized trials, version 2 (RoB 2) and certainty with GRADE (Grading of Recommendations Assessment, Development and Evaluation). Several analyses were post hoc. Results: Of 40 reports of 38 trials, 28 reports (26 trials) entered the primary analyses. Of 62 pooled estimates, two excluded no difference: 25-hydroxyvitamin D (25(OH)D) increased with vitamin D3 (five trials, 298 participants, MD +15.19 ng/mL, 95% CI 8.36 to 22.02, very low certainty) and homeostatic model assessment of insulin resistance (HOMA-IR) decreased with cinnamon (three trials, 185 participants, MD −1.03, 95% CI −1.97 to −0.09, low certainty), but this was not robust to omitting any single trial. Vitamin D3 did not clearly change fasting insulin or glucose. D-chiro-inositol estimates were highly imprecise. Of 176 graded estimates, 67 were of low and 109 of very low certainty. Conclusions: Apart from the expected rise in 25(OH)D, nutritional preparations showed no robust short-term metabolic effect in PCOS. The evidence does not support ranking preparations or treatment recommendations.

Background: Congenital heart defects (CHDs) are a major cause of infant morbidity and mortality. Identifying modifiable maternal exposures during early pregnancy is important for CHD prevention and maternal and child health. Objectives: To examine associations between first-trimester maternal active smoking and alcohol consumption and offspring CHDs, and to explore associations of selected maternal diseases and related treatments with CHD outcomes. Methods: This population-based case–control study used data from the Hungarian Case–Control Surveillance of Congenital Abnormalities (1980–2009), including 7,362 CHD cases and 56,894 controls. Overall CHDs were the primary outcome, with ventricular septal defect (VSD) and atrial septal defect (ASD) examined as secondary outcomes. Complete-case multivariable logistic regression estimated odds ratios (ORs) for smoking and alcohol consumption, with mutual adjustment and additional adjustment for maternal age, socioeconomic status, and offspring sex. Multiple imputation was performed as a sensitivity analysis. Maternal disease and treatment analyses were crude and exploratory. Results: First-trimester maternal smoking was associated with higher odds of overall CHDs (adjusted OR 1.50, 95% confidence interval [CI] 1.30–1.71), VSD (1.36, 1.11–1.66) and ASD (1.62, 1.35–1.93). Multiple-imputation estimates were similar to the complete-case estimates. No statistically significant associations were observed between maternal alcohol consumption and CHD outcomes in either the adjusted complete-case analysis or the multiple-imputation analysis. Maternal epilepsy, migraine, anxiety disorder and anemia showed positive crude associations with one or more CHD outcomes. Conclusion: Maternal smoking reported during the first trimester was associated with higher odds of overall CHDs, VSD, and ASD, supporting smoking cessation before conception and during pregnancy as a prevention priority. Exploratory associations involving maternal diseases and treatments require further investigation and should not be used to infer treatment effects or guide treatment decisions.

Background: Prognosis in vulvar squamous cell carcinoma (VSCC) is strongly influenced by lymph node involvement and adverse clinicopathological features. Systemic inflammatory indices derived from blood counts may reflect tumor–host interactions associated with adverse pathological phenotypes. Objective: To assess associations of preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) with nodal metastasis, lymphovascular space invasion (LVSI), and tumor size. Methods: This retrospective single-center study included 93 surgically treated patients between March 2017 and February 2026. Results: NLR was associated with nodal metastasis (unadjusted p = 0.015; false discovery rate [FDR]-adjusted q = 0.047) and LVSI (unadjusted p < 0.001; FDR-adjusted q = 0.006). NLR showed modest discrimination for nodal metastasis (area under the receiver operating characteristic curve [AUC] = 0.647). For LVSI, NLR had the highest AUC among the evaluated markers (AUC = 0.789; 95% confidence interval [CI]: 0.683–0.894), but 16 cases were positive and the positive predictive value (PPV) was low (0.378). Nominal MLR findings for LVSI and large tumor size did not remain significant after FDR correction (both q = 0.308), while PLR showed no consistent associations. Elevated NLR was associated with nodal metastasis in univariable analysis (odds ratio [OR] = 3.291; p = 0.012) but not in multivariable models including LVSI (adjusted OR = 1.296; p = 0.654) or excluding LVSI (adjusted OR = 1.823; p = 0.261). Conclusions: NLR was associated with adverse pathological features but was not independently associated with nodal metastasis and should not be used as a standalone predictive or clinical decision-making tool.

Objective: To perform a head‐to‐head comparison of the diagnostic performance of ultrasonography (US) vs magnetic resonance imaging (MRI) for the preoperative detection of endometriosis using the #Enzian classification system. Methods: This was a prospective observational study of postmenarchal premenopausal women who underwent laparoscopy between 1 April 2021 and 31 May 2024 in a tertiary referral center for clinical suspicion of endometriosis. All women underwent both transvaginal and transabdominal US imaging, according to the International Deep Endometriosis Analysis (IDEA) protocol, as well as MRI evaluation. The sonologist and the radiologist were blinded to each other's results. The diagnostic performance of US and MRI were determined for the following #Enzian compartments: O (ovarian endometriosis), T (adhesions at the level of the tubo‐ovarian unit), A (deep endometriosis (DE) in the vagina, rectovaginal septum and torus uterinus), B (DE in the uterosacral ligament, cardinal ligament, parametrium and pelvic sidewall), C (DE in the rectosigmoid bowel), FI (lesions in other intestinal locations), FB (urinary bladder involvement), FU (ureteric involvement) and FO (lesions in other extragenital locations). The sensitivity and specificity were compared between imaging modalities using McNemar's test. Concordance between preoperative imaging and surgical assessment of #Enzian severity grade for endometriotic lesions/adhesions in #Enzian compartments O, T, A, B and C was assessed. Results: In total, 463 women who underwent laposcopy for diagnosis and excisional treatment of endometriosis were enrolled in the study. For the detection of endometriotic lesions/adhesions in #Enzian compartments O _left , O _right , T _left , T _right , A, B _left , B _right , C, FI, FU, FB and FO, US had a sensitivity of 97.52%, 97.22%, 85.15%, 85.26%, 92.66%, 88.81%, 86.79%, 95.79%, 75.00%, 76.19%, 83.72% and 60.00%, respectively, and a specificity of 96.77%, 97.73%, 96.63%, 94.79%, 91.02%, 96.66%, 96.92%, 95.60%, 98.77%, 97.96%, 99.05% and 99.56%, respectively. For MRI, the corresponding values for sensitivity were 95.04%, 94.44%, 77.23%, 74.74%, 90.37%, 88.06%, 90.57%, 94.21%, 83.93%, 71.43%, 74.42% and 90.00%, and those for specificity were 95.89%, 95.75%, 92.70%, 89.86%, 93.47%, 96.05%, 94.96%, 94.14%, 97.05%, 99.10%, 98.57% and 98.90%. US had significantly higher specificity in #Enzian compartment T on both the left ( P = 0.0336) and right ( P = 0.0153) sides compared with MRI, but no other comparisons of sensitivity or specificity between US and MRI showed statistically significant differences. US showed higher exact concordance with surgical assessment in severity grading for lesions/adhesions in the adnexa than did MRI (O _left , 96.3% vs 94.8%; O _right , 97.2% vs 94.6%; T _left , 93.9% vs 89.0%; T _right , 92.6% vs 86.7%). For DE nodules, US showed a 3.1 percentage point higher exact concordance with laparoscopy compared with MRI in #Enzian compartment C (94.0% vs 90.9%). Conclusions: US evaluation following the IDEA protocol has significantly higher specificity compared with that of MRI for pelvic adhesions in #Enzian compartment T. However, US and MRI have similarly high sensitivity and specificity for diagnosing DE in all relevant #Enzian compartments. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Introduction: Optimal systemic treatment for recurrent or advanced endometrial cancer (EC) remains uncertain, particularly in the second-line setting. While first-line chemotherapy with paclitaxel and carboplatin is widely used, its efficacy is limited. Recent evidence suggests that adding immune checkpoint inhibitors (ICIs) to chemotherapy (ChT) can improve progression-free survival (PFS). In addition, hormonal therapies (such as progestins and aromatase inhibitors), targeted therapies and ICIs used alone or in combination are emerging as potential treatment options. Objectives: Our objective was to systematically evaluate the efficacy and safety of systemic therapies beyond standard ChT for patients with recurrent or advanced EC, focusing on progression-free survival (PFS), overall survival (OS), and treatment-related adverse events (TRAEs). Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), prospective studies, and retrospective studies up to June 2024 on PubMed, Embase, and CENTRAL. Studies evaluating systemic therapies—chemotherapy, hormonal therapy, targeted agents, and ICIs—in recurrent or advanced EC were included. Primary outcomes were PFS and OS; secondary outcomes included grade ≥ 3 treatment-related adverse events. Risk of bias was assessed using the Cochrane RoB 2 and MINORS tools, and GRADE was applied to evaluate the certainty of evidence. Results: Five RCTs evaluated the addition of ICI to conventional ChT. In mismatch repair-deficient (MMRd) patients, the addition of ICI significantly improved PFS and OS compared to the ChT-only group. In mismatch repair-deficient (MMRd) patients, the median PFS (mPFS) was 8.39 months in the ChT group and 22.73 months in the ICI group (HR: 0.34, p < 0.001). OS results were 26.48 and 41.36 months, respectively. In mismatch repair-proficient (MMRp) patients, mPFS was 9.4 months in the ChT group and 10.18 months at the ICI group (HR: 0.72, p = 0.002). OS was 27.37 and 27.79 months, respectively. We conducted several exploratory single-arm subgroup analyses and multiple individual patient data (IPD) meta-analyses across several clinically relevant subgroups, including patients treated with progestins, lenvatinib plus pembrolizumab, PI3K/AKT/mTOR inhibitor monotherapy, and PI3K/AKT/mTOR inhibitors in combination with aromatase inhibitors. Detailed descriptive analyses were performed for each subgroup. Conclusions: Combining chemotherapy with ICIs appears to show the most favorable survival outcomes, especially in MMRd tumors. Taking into account the methodological limitations inherent in the elaboration of lower-level evidence and IPD, hormonal and targeted therapies might be considered viable options, with efficacy and safety profiles dependent on tumor biology. Better stratification of the EC patient cohort is warranted.

Chronic exercise induces functional adaptations in skeletal muscle microcirculation, but whether these are accompanied by sex-specific histological remodeling of arterioles remains unclear. This study examined gracilis muscle arterioles in trained (Ex) and sedentary (Se) female (F) and male (M) Wistar rats after a 12-week intensive swimming program (Mex = 6, FEx = 6; MSed = 6, FSed = 5). Histological remodeling was assessed by quantitative colorimetry analysis of resorcin-fuchsin (elastica; n = 661) and SMA-DAB (smooth muscle actin; n = 692) staining, focusing on elastic fiber density, internal elastic lamina (IEL) characteristics, and smooth muscle density in intramuscular and intermuscular vessels. Elastic fiber density and IEL thickness were generally greater in female animals than in males (p < 0.05). IEL staining intensity showed significant effects of sex (p = 0.043), exercise (p = 0.021), and a significant sex-by-exercise interaction (p = 0.037), with exercised females exhibiting the highest IEL staining intensity. Smooth muscle density did not differ significantly by sex or training status, although it was higher in intermuscular than intramuscular arterioles (p < 0.001), and increased with vessel diameter primarily in the intermuscular group. These findings demonstrate exercise-induced, sex-specific histological remodeling of skeletal muscle arterioles, primarily affecting elastic components, with more pronounced elastic adaptation in females.