The Tartu University Clinic (Estonian: Tartu Ülikooli Kliinikum) is a healthcare and medical teaching service in Tartu, Estonia, and a subsidiary of the Tartu University. Its administrative services are located in two buildings on Puusepa Street; its buildings are located throughout the city of Tartu. As an exception, the Clinic's andrology clinic has a facility in Tallinn, on Gonsiori Street.The clinic is the largest employer in Tartu.[citation needed]The clinic had a pioneering role in the study of mental illnesses, as it was the world's first university clinic with a psychiatry department. Famous German psychiatrist Emil Kraepelin worked there.The surgery of the clinic is connected with works of famous Russian surgeons Nikolay Pirogov (worked there in 1836–1840) and Nikolai Burdenko (worked there in 1906–1918).
To present and contextualise the 2025 revision of the European Training Requirements (ETR) for the Specialty of Geriatric Medicine, developed under the auspices of the European Union of Medical Specialists-Geriatric Medicine Section (UEMS-GMS), and to summarise its main innovations in structure, content, and pedagogical approach. The 2025 ETR strengthens the 2020 version by further developing Entrustable Professional Activities (EPAs) to harmonise postgraduate geriatric training across Europe. It updates and expands the content and recommends the knowledge-based European Geriatric Medicine Specialty Exam (EGeMSE) as part of the certification standards. The 2025 ETR reflects the continued evolution of European geriatric medicine education, uniting scientific progress and competency-based pedagogy within a coherent, evidence-informed framework that promotes excellence, mobility, and comparability of specialist training across Europe. It establishes a forward-looking standard designed to remain fit for purpose over the next 5 years. To describe the process, content, and significance of the 2025 revision of the European Training Requirements (ETR) for the Specialty of Geriatric Medicine, developed under the auspices of the European Union of Medical Specialists-Geriatric Medicine Section (UEMS-GMS). The revision aims to update European postgraduate training standards to reflect current scientific, clinical, and educational advances. The revision followed the official UEMS procedure for ETR development and was conducted by the UEMS-GMS ETR Review Committee between September 2024 and October 2025. Building on the 2019 European Postgraduate Curriculum in Geriatric Medicine and the 2020 ETR, the committee incorporated stakeholder feedback, expert consultation, and international endorsement. The final document was reviewed and formally approved by the UEMS-GMS and endorsed by the European Geriatric Medicine Society (EuGMS), the European Academy for Medicine of Ageing (EAMA), the International Association of Gerontology and Geriatrics (IAGG), and the European Interdisciplinary Council on Ageing (EICA). The 2025 ETR retains the established UEMS three-part structure (for trainees, trainers, and training institutions) whilst introducing a modernised, competency-based education framework. The updated syllabus expands and refines theoretical content to reflect the latest scientific, clinical, and pedagogical advances. The revised ETR further elaborates the use of Entrustable Professional Activities (EPAs) as core instruments for assessing competence. Assessment standards now feature an expanded toolkit, incorporating the knowledge-based European Geriatric Medicine Specialty Exam (EGeMSE). The 2025 ETR for Geriatric Medicine represents a further step toward harmonised, competency-based specialist training across Europe and beyond. Reflecting global public health priorities, including the UN Decade of Healthy Ageing (2021–2030), the revision reinforces educational excellence and the delivery of high-quality, integrated, person-centred care for older adults. It also supports the continued development of the specialty of Geriatric Medicine in countries where it is not yet established or remains emerging. LINK to ETR 2025: https://www.uems.eu/european-training-requirements (Geriatric Medicine, 2025/29).
BACKGROUND AND AIMS:Clonal haematopoiesis of indeterminate potential (CHIP) has been associated with cardiovascular risk, but its prognostic relevance and mechanistic role in coronary artery disease (CAD) remains incompletely understood. This study investigated the association between CHIP and all-cause mortality in CAD and explored the cellular and molecular mechanisms, focusing on TET2 mutations. METHODS:Targeted deep sequencing of 13 CHIP driver genes in 8612 patients with angiographically confirmed CAD was performed. Clonal haematopoiesis of indeterminate potential carriers (variant allele frequency ≥2%) were propensity-score matched 1:1 to non-carriers. Mortality was assessed over 3 years. Mechanistic insights were derived from post-mortem high-sensitivity plaque proteomics (MISSION), RNA sequencing from carotid plaques (Athero-Express), monocyte-derived macrophage transcriptomes (STARNET), and CRISPR/Cas9-generated TET2+/- macrophages in vitro. RESULTS:Clonal haematopoiesis of indeterminate potential was associated with increased 3-year mortality (hazard ratio 1.39, 95% confidence interval 1.16-1.65, P < .001) in 2389 matched pairs. Mutations in TET2, ASXL1, DNMT3A, JAK2, PPM1D, SF3B1, SRSF2, and U2AF1 individually conferred higher mortality risk. In human plaques, CHIP mutations were found in lesional macrophages. TET2 CHIP carriers showed increased necrotic core size, inflammation, and reduced plaque stability. Multi-omics profiling revealed up-regulation of lipid metabolism and inflammatory pathways. TET2+/- macrophages exhibited increased LDLR expression and lipid uptake, linked to enhanced chromatin accessibility at the LDLR promoter. These findings were confirmed in carotid plaques, which showed increased LDLR and inflammasome-related gene expression in TET2 CHIP carriers. CONCLUSIONS:Clonal haematopoiesis of indeterminate potential is a predictor of mortality in CAD patients. TET2 mutations promote a pro-atherogenic macrophage phenotype via LDLR up-regulation and inflammatory activation, linking epigenetic dysregulation to adverse outcomes in CAD.
Importance:The Apgar score, the first clinical assessment to direct measures to stabilize newborn infants, is also used for risk assessment. Its accuracy in estimating outcomes remains poor among very preterm (VPT) infants. Objective:To assess the utility of the combined 5-minute Apgar score and umbilical artery pH (UA-pH) for estimating risks of mortality and severe neonatal morbidity among VPT infants. Design, Setting, and Participants:This cohort study (Effective Perinatal Intensive Care in Europe [EPICE]) analyzed infants born at less than 32 weeks' gestation between April 2011 and September 2012 across 11 European countries. All liveborn VPT infants with Apgar scores and UA-pH data were included. Data were analyzed between February and December 2025. Exposures:Apgar score at 5 minutes and UA-pH. The Apgar score was classified as lower than 7 and 7 or higher, and the UA-pH values were categorized as low (<7.20) and normal (≥7.20). Four groups that combined these 2 measures were defined: Apgar score lower than 7 and low UA-pH; Apgar score lower than 7 and normal UA-pH; Apgar score 7 or higher and low UA-pH; and Apgar score 7 or higher and normal UA-pH. Main Outcomes and Measures:Combined outcome of mortality and/or any adverse morbidity (intraventricular hemorrhage [IVH] >grade 2, cystic periventricular leukomalacia, moderate or severe bronchopulmonary dysplasia [BPD], retinopathy of prematurity ≥stage 2, and necrotizing enterocolitis). Modified Poisson regression was used to estimate relative risks (RRs) between the exposure and the combined mortality and morbidity outcome and 3 individual components: mortality, IVH, and BPD. Models were adjusted for perinatal variables associated with Apgar score and UA-pH and adverse neonatal outcomes. Results:Of 7900 liveborn infants in the EPICE cohort, 4174 (52.8%) had information on Apgar score and UA-pH. These infants included 2249 males (53.9%) and had a median [IQR] gestational age of 29.9 [27.9-31.0] weeks and median [IQR] birth weight of 1240 [960-1520] g. A total of 367 infants (8.8%) had an Apgar score 7 or higher but a low UA-pH, 558 (13.4%) had an Apgar score lower than 7 but a normal UA-pH, and 196 (4.7%) had an Apgar score lower than 7 and a low UA-pH. Infants with an Apgar score lower than 7 had a higher frequency of the combined outcome among those with a normal UA-pH (270 [48.4%] vs 596 [19.5%]) and a low UA-pH (108 [55.1%] vs 596 [19.5%]), with similar adjusted RRs (ARRs; low: 1.4 [95% CI, 1.2-1.7]; normal: 1.4 [95% CI, 1.3-1.6]). For mortality risk, associations were robust for an Apgar score lower than 7 and a low UA-pH (ARR, 2.4; 95% CI, 1.7-3.3) and absent with an Apgar score of 7 or higher and a low UA-pH (ARR, 1.2; 95% CI, 0.8-1.8). IVH risk was increased in all 3 subcategories, including an Apgar score of 7 or higher with a low UA-pH (ARR, 2.0; 95% CI, 1.3-3.0). BPD risk was associated only with an Apgar score lower than 7 and a normal UA-pH (ARR, 1.4; 95% CI, 1.2-1.7). Conclusions and Relevance:In this cohort study of VPT infants, combining information on UA-pH with the 5-minute Apgar score was associated with improved accuracy in estimating the risk of some adverse outcomes-notably mortality and IVH, which occurred soon after birth. These results highlight the importance of exploring the associations of early markers of risk with neonatal mortality and key neonatal morbidities separately.
BACKGROUND AND HYPOTHESIS:Kidney replacement therapy (KRT) practices in Europe are heterogeneous, with apparent differences between Western and Central/Eastern Europe. However, time trends in KRT incidence and prevalence in Central and Eastern Europe have not been previously reported. Therefore, we aimed to describe trends in incidence and prevalence of KRT in Central and Eastern Europe from 2010 to 2021. METHODS:Data on incident and prevalent KRT patients from 19 Central and Eastern European countries between the years 2010 and 2021 were derived from the European Renal Association (ERA) Registry. Time trends were calculated using JoinPoint regression. RESULTS:Overall, KRT incidence increased at 1.5% [95% confidence interval (CI): +0.7 to +2.6%] per year from 106.3 per million population (pmp) in 2010 to 119.6 pmp in 2019. However, trends differed within the region. While in Bosnia and Herzegovina KRT incidence significantly decreased from 2010 to 2019, it remained stable in nine and increased in eight countries. The overall KRT prevalence increased at 5.1% (95% CI: +4.5 to +5.7%) per year from 426.2 pmp in 2010 to 651.2 pmp in 2019. KRT prevalence increased in all countries, except for Belarus where it remained stable, and was mainly attributable to increases in the prevalence of kidney transplantation. The COVID-19 pandemic did not have a major impact on KRT incidence and prevalence in the region, as most trends remained until 2021. CONCLUSIONS:Although we found an overall increase in KRT incidence and prevalence in the region, large country variations remain, much larger than observed in Western Europe. The results of this study can help to define country-specific priorities for the optimization of KRT care in Central and Eastern Europe.
BackgroundHereditary angioedema (HAE) is a rare, potentially life-threatening disorder characterised by recurrent episodes of localised oedema caused by bradykinin overproduction. Accurate epidemiological data are essential for optimising diagnosis and treatment, particularly in underrepresented regions such as the Baltic states. This study aimed to examine the prevalence, clinical characteristics, genetic variants, and treatment accessibility for patients with HAE in the Baltic states of Estonia, Latvia, and Lithuania.MethodsThis retrospective study included HAE patients diagnosed according to the WAO/EAACI 2021 criteria between 2004 and 2024. Demographic, clinical, and genetic data were collected and evaluated. Descriptive statistical analysis was performed using Jamovi (version 2.3).ResultsA total of 78 patients were identified in Estonia (n=30), Latvia (n=12) and Lithuania (n=36) from 2004 till 2024. In Lithuania, 7 patients had died and 3 were lost to follow-up, resulting in 26 patients remaining under active observation. While the total number of HAE cases identified across the three countries was reported, detailed clinical data and analyses were limited to the 68 patients who were alive and actively followed at the time of data collection. Estonia exhibited the highest point prevalence (2.19 per 100, 000), while Latvia had the lowest (0.65). The median diagnostic delay was longest in Latvia (24 years) and shortest in Estonia (9.5 years). SERPING1 gene pathogenic variants predominated. Estonia had the broadest availability of treatments, whereas Latvia had restricted access to modern therapies.ConclusionConsiderable variation exists in HAE prevalence, diagnosis, and treatment across the Baltic states. Estonia exemplifies best practices, while Latvia remains underserved. Regional collaboration and standardised care protocols are urgently needed.
