Previous Issue
Volume 61, October
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
4.1
2.4
Journals
Medicina
Volume 61
Issue 11
medicina-logo

Journal Menu

► Journal Menu

Journal Browser

► Journal Browser
share announcement

Medicina, Volume 61, Issue 11 (November 2025) – 30 articles

  • Issues are regarded as officially published after their release is announced to the table of contents alert mailing list.
  • You may sign up for e-mail alerts to receive table of contents of newly released issues.
  • PDF is the official format for papers published in both, html and pdf forms. To view the papers in pdf format, click on the "PDF Full-text" link, and use the free Adobe Reader to open them.
Order results
Result details
Section
Show export options expand_more Show export options expand_less
Select all
Export citation of selected articles as:
13 pages, 4962 KB  
Article
Differential Expression of S100A8 in Tumor and Immune Compartments of Endometrial Carcinoma and Its Clinical Relevance
by Dae Hyun Song, Min Hye Kim, Juseok Yang, Hyen Chul Jo, Ji Eun Park and Jong Chul Baek
Medicina 2025, 61(11), 1918; https://doi.org/10.3390/medicina61111918 (registering DOI) - 25 Oct 2025
Abstract
Background and Objectives: S100A8 regulates inflammatory responses and immune cell activation and is overexpressed in several solid tumors. However, its clinicopathological significance in endometrial carcinoma (EC) remains unclear. This study aimed to evaluate the expression patterns of S100A8 in both tumor and immune [...] Read more.
Background and Objectives: S100A8 regulates inflammatory responses and immune cell activation and is overexpressed in several solid tumors. However, its clinicopathological significance in endometrial carcinoma (EC) remains unclear. This study aimed to evaluate the expression patterns of S100A8 in both tumor and immune cells of EC and examine its association with clinicopathological features. Materials and Methods: Fifty-two formalin-fixed, paraffin-embedded EC specimens were analyzed using tissue microarray-based immunohistochemistry. S100A8 expression was assessed in tumor and immune cells. The tumor proportion score (TPS), tumor staining intensity (TI), and immune proportion score (IPS) were dichotomized into low and high categories (TPS/IPS: ≤30% vs. ≥31%; TI: 0–1+ vs. 2–3+). Correlations with clinicopathological parameters were examined using the chi-square and Fisher’s exact tests. Results: A low TPS, high TI, and high IPS were observed in 51.9%, 63.5%, and 57.7% of patients, respectively. TPS and TI showed no significant correlation with clinicopathological variables, including age, tumor size, invasion depth, histologic grade, T stage, and N stage (all p > 0.05). By contrast, IPS was significantly associated with patients’ age (p = 0.044) and histologic grade (p = 0.012), with older patients and those with higher-grade tumors demonstrating a higher IPS. A positive correlation was observed between TPS and IPS (p = 0.044), whereas TI did not correlate with IPS (p = 0.253). Conclusions: S100A8 expression in immune cells, but not in tumor cells, is associated with age and tumor grade in EC. Therefore, immune-related S100A8 expression may serve as a biomarker of the tumor immune microenvironment, warranting further investigation into its prognostic and therapeutic implications. Full article
(This article belongs to the Section Obstetrics and Gynecology)
12 pages, 864 KB  
Article
EEG Microstate Differences Between Alzheimer’s Disease, Frontotemporal Dementia, and Healthy Controls Using 4 and 7 Clustering Classes with a Ratio Approach
by Jinwon Chang
Medicina 2025, 61(11), 1917; https://doi.org/10.3390/medicina61111917 (registering DOI) - 25 Oct 2025
Abstract
Background and Objectives: Alzheimer’s disease (AD) and frontotemporal dementia (FTD) present overlapping clinical and neuroanatomical features, complicating early diagnosis. Therefore, this study evaluated whether EEG microstate analysis can provide reliable markers to distinguish patients with dementia from healthy controls. Materials and Methods [...] Read more.
Background and Objectives: Alzheimer’s disease (AD) and frontotemporal dementia (FTD) present overlapping clinical and neuroanatomical features, complicating early diagnosis. Therefore, this study evaluated whether EEG microstate analysis can provide reliable markers to distinguish patients with dementia from healthy controls. Materials and Methods: Resting-state EEG was recorded from 36 AD patients, 23 FTD patients, and 29 healthy controls. Preprocessing and microstate analysis were conducted using the MICROSTATELAB pipeline in EEGLAB. Clustering solutions ranging from four to seven classes were tested, with grand mean fitting and variance thresholds. Temporal parameters (duration, occurrence, and coverage) and their ratio-normalized forms were compared across groups using ANCOVA and nonparametric tests. Associations with Mini-Mental State Examination (MMSE) scores were assessed by regression analyses. Results: The four- and seven-class clustering solutions achieved high variance overlap with published microstate templates. In the four-class solution, temporal parameters of microstates B and D significantly differentiated controls from dementia groups, while in the seven-class solution, microstates C and G were the most informative. Ratio-normalized parameters improved group discrimination and were associated with MMSE scores. Conclusions: EEG microstates capture disease-related alterations in large-scale brain dynamics that differentiate patients with dementia from healthy individuals. Full article
(This article belongs to the Section Neurology)
►▼ Show Figures

Figure 1

10 pages, 275 KB  
Article
Risk Factors for Complications and 90-Day Mortality After Percutaneous Endoscopic Gastrostomy: The Role of Nutritional and Inflammatory Markers
by Nermin Mutlu Bilgiç, Güldan Kahveci, Hüseyin Aykut, Yasemin Özer, Ekmel Burak Özşenel and Sema Basat
Medicina 2025, 61(11), 1916; https://doi.org/10.3390/medicina61111916 (registering DOI) - 25 Oct 2025
Abstract
Background and Objectives: Percutaneous endoscopic gastrostomy (PEG) is a widely accepted method for long-term enteral nutrition, but procedure-related complications and early mortality remain major concerns. Nutritional and inflammatory indices such as serum albumin, C-reactive protein (CRP), Prognostic Nutritional Index (PNI), and Nutrition [...] Read more.
Background and Objectives: Percutaneous endoscopic gastrostomy (PEG) is a widely accepted method for long-term enteral nutrition, but procedure-related complications and early mortality remain major concerns. Nutritional and inflammatory indices such as serum albumin, C-reactive protein (CRP), Prognostic Nutritional Index (PNI), and Nutrition Risk Screening (NRS-2002) may provide prognostic value, yet comparative data in PEG cohorts are limited. This study aimed to identify predictors of complications and 90-day mortality after PEG and to compare the prognostic performance of nutritional indices. Materials and Methods: A retrospective cohort of 122 consecutive adult patients undergoing PEG between January and December 2024 was analyzed. Demographic, clinical, and laboratory parameters were collected, including albumin, CRP, PNI, and NRS-2002. Complications were categorized as early (≤30 days) or late (>30 days), and all-cause mortality was assessed at 30 and 90 days. Univariate and multivariate logistic regression models were used to evaluate predictors of complications and 90-day mortality. To address multicollinearity, albumin, PNI, and NRS-2002 were separately tested in adjusted models, with model performance assessed by AIC, BIC, Nagelkerke R2, and C-index. Results: Early complications occurred in 4.9% and late complications in 8.2% of patients, for a total complication rate of 13.1%. Thirty-day mortality was 4.1%, 90-day mortality 17.2%, and total in-hospital mortality during the study year 30.3%. Neuromuscular indication was independently associated with increased risk of complications (aOR 5.0, 95% CI 1.2–20.0, p = 0.028) but reduced 90-day mortality (aOR 0.15, 95% CI 0.03–0.80, p = 0.025). Lower baseline albumin independently predicted higher 90-day mortality (aOR 0.92, 95% CI 0.86–0.99, p = 0.034). Elevated CRP demonstrated a borderline association with mortality (p = 0.051), while NRS-2002 ≥5 and Δ-PNI showed borderline trends toward increased mortality risk. In model comparison, none of the nutritional indices achieved independent statistical significance, but all demonstrated similar performance (AIC = 114, C-index 0.72–0.74). Conclusions: PEG outcomes are strongly influenced by baseline indication and nutritional–inflammatory status. Neuromuscular patients and patients with dysphagia face higher complication risk but lower short-term mortality, while hypoalbuminemia, elevated CRP, and high NRS-2002 or declining PNI identify patients at greater risk of death. Systematic integration of albumin, CRP, PNI, and NRS-2002 may improve risk stratification and management in PEG candidates. Full article
(This article belongs to the Section Gastroenterology & Hepatology)
16 pages, 1249 KB  
Systematic Review
Uterine Ectopic Pregnancies and Live Births: Systematic Review of the Literature and Concepts Underlying Favorable Outcomes
by Guglielmo Stabile, Laura Vona, Stefania Carlucci, Anna Pitsillidi, Stefano Restaino, Giuseppe Vizzielli and Luigi Nappi
Medicina 2025, 61(11), 1915; https://doi.org/10.3390/medicina61111915 (registering DOI) - 25 Oct 2025
Abstract
Background and Objectives: Uterine ectopic pregnancy includes uterine extraendometrial forms such as cervical, intramural, and interstitial pregnancies, whose incidence is increasing with prior uterine surgery and assisted reproduction. Unlike cesarean scar pregnancy, which is known to occasionally progress to term, the potential [...] Read more.
Background and Objectives: Uterine ectopic pregnancy includes uterine extraendometrial forms such as cervical, intramural, and interstitial pregnancies, whose incidence is increasing with prior uterine surgery and assisted reproduction. Unlike cesarean scar pregnancy, which is known to occasionally progress to term, the potential for these other types to continue beyond the first trimester remains poorly defined. This review evaluates reported cases carried to viability, focusing on maternal and neonatal outcomes and identifying prognostic factors influencing progression. Materials and Methods: This systematic review was conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251070864). Comprehensive searches of PubMed, Scopus, and Web of Science up to June 2025 identified English-language case reports of uterine ectopic pregnancies (cervical, intramural, or interstitial) resulting in live birth. Data on maternal characteristics, clinical presentation, pregnancy course, delivery outcomes, and neonatal parameters were extracted. Study quality was assessed using the Joanna Briggs Institute checklist for case reports. Results: Uterine ectopic pregnancies were frequently misdiagnosed, with definitive diagnosis established only at delivery in 85% of cases. The majority of patients presented with abdominal pain or vaginal bleeding, and maternal morbidity was considerable: two-thirds required hysterectomy, and blood transfusions were often necessary due to severe hemorrhage. Fourteen live births were reported (nine interstitial, four cervical, and one intramural). Neonatal survival was primarily dependent on gestational age at delivery, while successful continuation of pregnancy appeared favored by implantation in more distensible myometrial regions and the presence of residual endometrial tissue. Conclusions: An increased amount of endometrium and greater myometrial distensibility at the implantation site enhance the likelihood of uterine ectopic pregnancies progressing to viability. These factors should guide early diagnosis, patient counseling, and individualized management, considering gestational age, implantation type, and future fertility goals. Full article
(This article belongs to the Section Obstetrics and Gynecology)
►▼ Show Figures

Figure 1

18 pages, 741 KB  
Review
Immunopathogenesis and Therapeutic Implications in Basal Cell Carcinoma: Current Concepts and Future Directions
by Helen C. Steel, Theresa M. Rossouw, Ronald Anderson, Lindsay Anderson, Daniel van Tonder, Teresa Smit and Bernardo Leon Rapoport
Medicina 2025, 61(11), 1914; https://doi.org/10.3390/medicina61111914 (registering DOI) - 25 Oct 2025
Abstract
This review is focused on understanding the reasons why basal cell carcinoma (BCC), the most common, increasingly prevalent cancer, is classified as an “immune excluded” malignancy. It is, despite manifesting one of the highest tumor mutational burdens of any solid human malignancy, considered [...] Read more.
This review is focused on understanding the reasons why basal cell carcinoma (BCC), the most common, increasingly prevalent cancer, is classified as an “immune excluded” malignancy. It is, despite manifesting one of the highest tumor mutational burdens of any solid human malignancy, considered to be a biomarker of enhanced tumor immunogenicity and efficacy of tumor-targeted immunotherapy. Following a brief clinical overview, the balance of the review addresses important translational issues based on recent insights into the mechanisms underpinning immune exclusion/evasion in BCC. These include, firstly, the role of infectious agents and non-infectious potential causes of predisposition for and/or exacerbation of disease development and progression. Secondly, an overview of existing and emerging novel therapeutic strategies to ameliorate immune exclusion in BCC based on targeting several key immunosuppressive mechanisms. These are (i) inappropriate activation of the hedgehog signaling pathway (HHSP) due to formation of key driver mutations; (ii) interference with the presentation of tumor-specific antigens/neoantigens to cytotoxic T-cells; (iii) attenuation of the influx of anti-tumor natural killer cells; (iv) the recruitment and activation of immune suppressive regulatory T-cells; and (v) localized and systemic immune dysfunction achieved via elevated levels of soluble co-inhibitory immune checkpoint proteins (ICPs). The final section is focused on current and emerging pharmacologic and immune-based therapies. Full article
(This article belongs to the Special Issue Updates on the Changing Landscape of Immunotherapy and Targeted Therapy in Cancer)
►▼ Show Figures

Figure 1

19 pages, 3424 KB  
Article
Physical Activity Levels in Kazakhstan: A Cross-Sectional Nationwide Study on Demographic, Socioeconomic, and Regional Factors
by Anel Ibrayeva, Marat Shoranov, Talgat Muminov, Yerlan Ismoldayev, Shynar Tanabayeva and Ildar Fakhradiyev
Medicina 2025, 61(11), 1913; https://doi.org/10.3390/medicina61111913 (registering DOI) - 25 Oct 2025
Abstract
Background and Objectives: Physical inactivity contributes to high rates of cardiovascular disease, diabetes, and obesity in Kazakhstan, yet national data remain scarce. The primary objective of this study was to assess the level of physical activity among the adult population of Kazakhstan. [...] Read more.
Background and Objectives: Physical inactivity contributes to high rates of cardiovascular disease, diabetes, and obesity in Kazakhstan, yet national data remain scarce. The primary objective of this study was to assess the level of physical activity among the adult population of Kazakhstan. The secondary objectives were to identify demographic, socioeconomic, and regional factors associated with physical activity, to determine risk groups, and to develop recommendations aimed at increasing physical activity and improving public health. Materials and Methods: We conducted a cross-sectional nationwide survey (December 2021–May 2022) including 6720 adults aged 18–69 years from all 17 regions. Data were collected using the WHO STEPS questionnaire and the Global Physical Activity Questionnaire. Results: Overall, 19.7% of adults did not meet WHO recommendations. Average weekly activity was 7108 min, mainly from transport (42.1%) and work (28.9%). Men and young adults were more likely to be sufficiently active. Lower levels were observed among women, individuals over 35, married respondents, civil servants, students, and the unemployed. Significant regional and ethnic disparities were identified. Conclusions: One in five adults in Kazakhstan has insufficient physical activity. Targeted, multisectoral interventions are needed, with special focus on women, older adults, and urban populations. Full article
(This article belongs to the Section Epidemiology & Public Health)
►▼ Show Figures

Figure 1

19 pages, 4610 KB  
Article
The Immediate Effects of Instrument-Assisted Soft Tissue Mobilization on Pain and Function in Female Runners with Patellofemoral Pain
by Seong Chan Cho and Young Kyun Kim
Medicina 2025, 61(11), 1912; https://doi.org/10.3390/medicina61111912 (registering DOI) - 24 Oct 2025
Abstract
Background and Objectives: Patellofemoral pain (PFP) is the most prevalent running-related injury due to underlying biomechanical factors, particularly among female runners. Although instrument-assisted soft tissue mobilization (IASTM) is a popular therapeutic technique, the optimal application site for the short-and long-term outcomes of [...] Read more.
Background and Objectives: Patellofemoral pain (PFP) is the most prevalent running-related injury due to underlying biomechanical factors, particularly among female runners. Although instrument-assisted soft tissue mobilization (IASTM) is a popular therapeutic technique, the optimal application site for the short-and long-term outcomes of PFP has not been well established. This aim of this study was to compare the immediate and short-term (1-week) effects of a single IASTM treatment applied to the hip and knee versus the knee alone on running-related pain. Range of motion (ROM), muscle strength, and functional performance were also assessed to compare change between the two treatment conditions. Materials and Methods: Twenty-eight female runners with PFP were randomly assigned to either the Hip and Knee (HK) group (n = 14) or the knee-only (K) group (n = 14). The HK group received a 7-min IASTM treatment targeting the quadriceps, patella, iliotibial band (ITB), and gluteus medius, whereas the K group received a 3-min treatment targeting the quadriceps and patella. Visual analog scale (VAS), hip adduction ROM, hip abduction/external rotation strength, and step-down test scores were measured at baseline, immediately post-intervention, and 1 week later. Results: Running-related pain significantly decreased in both groups (main effect of time, p < 0.001) from baseline (HK: 5.49 ± 2.14 [95% CI: 4.78–6.68]; K: 5.30 ± 1.45 [95% CI: 4.69–5.91]) to week 1 (HK: 1.30 ± 1.08 [95%CI: 0.69–1.90]; K: 1.57 ± 1.20 [95%CI: 0.93–2.21]). However, no significant difference was found between the groups. Significant improvement was also observed in hip adduction ROM (p < 0.001), hip abduction strength (p = 0.02), step-down pain (p < 0.001), and patellofemoral function (p < 0.001) immediately after the intervention, which was sustained at the 1-week follow-up. However, no significant difference was found between the groups. Also, hip external rotation strength showed no significant change over time or between groups (p = 0.737). Conclusions: A single IASTM session effectively reduced pain and improved function in female runners with PFP. However, the hip treatment did not show a significant additional benefit compared with knee treatment alone. IASTM can provide immediate and short-term relief of pain and functional limitations. Full article
(This article belongs to the Special Issue Sports Injuries: Prevention, Treatment and Rehabilitation)
20 pages, 3002 KB  
Article
High-Sensitivity Troponin T as a Prognostic Factor of Conventional Echocardiographic Parameters in Cancer Patients: A Prospective Observational Study
by Svetoslava Elefterova Slavcheva, Sevim Ahmed Shefket, Yana Bocheva and Atanas Angelov
Medicina 2025, 61(11), 1911; https://doi.org/10.3390/medicina61111911 (registering DOI) - 24 Oct 2025
Abstract
Background and Objectives: Cardiac injury caused by cancer therapy can be detected early using high-sensitivity cardiac troponins (hs-cTns), and this is crucial for preventing irreversible consequences. Clinically relevant issues regarding hs-cTns in oncologic settings—such as reliable cut-off values, the optimal assessment timeframe, [...] Read more.
Background and Objectives: Cardiac injury caused by cancer therapy can be detected early using high-sensitivity cardiac troponins (hs-cTns), and this is crucial for preventing irreversible consequences. Clinically relevant issues regarding hs-cTns in oncologic settings—such as reliable cut-off values, the optimal assessment timeframe, factors influencing their levels, and their prognostic ability in relation to functional echocardiographic parameters—require further investigation. In this study, we aimed to examine the determinants of hs-cTnT variations during cancer therapy and the relationship between the biomarker and functional conventional echocardiographic parameters. Materials and Methods: We prospectively evaluated adult patients scheduled for chemotherapy for either breast or gastrointestinal cancers, excluding those with pulmonary and cardiac disorders. We enrolled 40 patients who underwent a minimum of one cycle of potentially cardiotoxic regimens containing at least one of the following agents: anthracyclines, cyclophosphamide, taxanes, 5-fluorouracil, platinum compounds, trastuzumab, or bevacizumab. We observed two-dimensional and tissue Doppler echocardiographic parameters and hs-cTnT levels for a median of 360 days (IQR 162, 478) following the start of chemotherapy. Results: The generalised estimating equation (GEE) analysis revealed significant elevations in hs-cTnT levels at three months (β = 1.2; p = 0.005) and six months (β = 2.3; p = 0.02) from baseline, influenced by anthracycline treatment (p = 0.009), renal function (p = 0.003), and increased cardiotoxicity risk (high: p = 0.013; medium: p < 0.001). Elevated hs-cTnT levels independently predicted the deterioration of the LV longitudinal myocardial function, measured by the systolic tissue velocities, according to the GEE analysis. The receiver operating characteristic curve-derived hs-cTnT thresholds—of 8.23 ng/L and 8.08 ng/L—had a high negative predictive value for identifying Average and Lateral LVS′ decreases, respectively. Conclusions: Our research supports the use of baseline and continuing hs-cTnT testing in cancer patients, showing the dependence of the biomarker on renal function, cardiovascular toxicity risk level, and anthracycline treatment. The hs-cTnT cut-off value of approximately 8 ng/L may suggest a low probability of longitudinal myocardial function impairment and this observation needs further validation in larger cohorts. Full article
(This article belongs to the Section Cardiology)
►▼ Show Figures

Figure 1

18 pages, 645 KB  
Review
Thermal Ablation as a Non-Surgical Alternative for Thyroid Nodules: A Review of Current Evidence
by Andreas Antzoulas, Vasiliki Garantzioti, George S. Papadopoulos, Apostolos Panagopoulos, Vasileios Leivaditis, Dimitrios Litsas, Platon M. Dimopoulos, Levan Tchabashvili, Elias Liolis, Konstantinos Tasios, Panagiotis Leventis, Nikolaos Kornaros and Francesk Mulita
Medicina 2025, 61(11), 1910; https://doi.org/10.3390/medicina61111910 (registering DOI) - 24 Oct 2025
Abstract
Thyroid nodules, prevalent in 2% to 65% of the general population depending on diagnostic methodology, represent a significant clinical concern despite a low malignancy rate, typically 1% to 5%. A substantial proportion of thyroid cancers are small, indolent lesions, allowing for conservative management [...] Read more.
Thyroid nodules, prevalent in 2% to 65% of the general population depending on diagnostic methodology, represent a significant clinical concern despite a low malignancy rate, typically 1% to 5%. A substantial proportion of thyroid cancers are small, indolent lesions, allowing for conservative management with favorable prognoses. Nodule detection commonly occurs via palpation, clinical examination, or incidental radiological findings. Established risk factors include advanced age, female gender, obesity, metabolic syndrome, and estrogen dominance. Despite conservative management potential, a considerable number of thyroid nodules in Europe are unnecessarily referred for surgery, incurring unfavorable risk-to-benefit ratios and increased costs. Minimally invasive techniques (MITs), encompassing ethanol and thermal ablation modalities (e.g., laser, radiofrequency, microwave), offer outpatient, nonsurgical management for symptomatic or cosmetically concerning thyroid lesions. These procedures, performed under ultrasound guidance without general anesthesia, are associated with low complication rates. MITs effectively achieve substantial and sustained nodule volume reduction (57–77% at 5 years), correlating with improved local symptoms. Thermal ablation (TA) is particularly favored for solid thyroid lesions due to its precise and predictable tissue destruction. Optimal TA balances near-complete nodule eradication to prevent recurrence with careful preservation of adjacent anatomical structures to minimize complications. Radiofrequency ablation (RFA) is widely adopted, while microwave ablation (MWA) presents a promising alternative addressing RFA limitations. Percutaneous laser ablation (LA), an early image-guided thyroid ablation technique, remains a viable option for benign, hyperfunctioning, and malignant thyroid pathologies. This review comprehensively evaluates RFA, MWA, and LA for thyroid nodule treatment, assessing current evidence regarding their efficacy, safety, comparative outcomes, side effects, and outlining future research directions. Full article
(This article belongs to the Special Issue Surgical Approaches in Thyroid, Breast, and Other Endocrine Cancers: Advances and Challenges)
►▼ Show Figures

Figure 1

12 pages, 505 KB  
Article
Validation of Sarcopenic Obesity Screening Tools: A Cross-Sectional Analysis Based on ESPEN and EASO Criteria
by Seongmin Choi, Miji Kim, Yunsoo Soh and Chang Won Won
Medicina 2025, 61(11), 1909; https://doi.org/10.3390/medicina61111909 (registering DOI) - 24 Oct 2025
Abstract
Background and Objectives: Sarcopenic obesity, characterized by sarcopenia and obesity, is associated with adverse outcomes. The recent consensus from the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) proposed a diagnostic algorithm [...] Read more.
Background and Objectives: Sarcopenic obesity, characterized by sarcopenia and obesity, is associated with adverse outcomes. The recent consensus from the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) proposed a diagnostic algorithm (screening, diagnosis, and staging) for sarcopenic obesity. However, the effectiveness of recommended screening tools for sarcopenic obesity remains unclear. This study aimed to assess the performance of SARC-F questionnaire (Strength, walking Assistance, Rise, Climb, and Falls), calf circumference (CC), and SARC-CalF (SARC-F combined with CC), combined with obesity indicators, as screening tools for sarcopenic obesity. Materials and Methods: This cross-sectional study analyzed 2020 community-dwelling older adults from the Korean Frailty and Aging Cohort Study. Sarcopenic obesity was defined according to ESPEN and EASO criteria. Screening tools included SARC-F, CC, and SARC-CalF in combination with high body mass index (BMI; ≥25 kg/m2) or high waist circumference (WC; men, ≥90 cm; women, ≥85 cm). The diagnostic performance was evaluated using sensitivity, specificity, and predictive value. Results: SARC-F (≥4) with high BMI or WC demonstrated low sensitivity (men, 5.68%; women, 17.82%) but high specificity (men, 99.03%; women, 94.35%) and negative predictive value (NPV) (men, 91.68%; women, 91.09%). Lowering the SARC-F cutoff improved sensitivity but reduced specificity. CC combined with a high BMI or WC showed modest sensitivity (men, 34.09%; women, 34.65%) but moderate specificity (men, 59.48%; women, 59.91%). SARC-CalF (≥11) combined with high BMI or WC showed slightly higher sensitivity (men, 13.64%; women, 19.80%) but lower specificity (men, 95.04%; women, 86.93%) than SARC-F. Conclusions: SARC-F combined with obesity indicators may serve as a case-finding tool with high specificity and NPV, supporting its usefulness in ruling out sarcopenic obesity in the clinical setting. Meanwhile, CC was not an effective screening tool, and SARC-CalF did not substantially improve sensitivity or accuracy compared with SARC-F. Full article
►▼ Show Figures

Figure 1

12 pages, 552 KB  
Article
Labor Induction with Synthetic Oxytocin and Infantile Colic: A Case–Control Study
by Cristina Suárez-Fraga, Óscar Rodríguez-Nogueira, Arrate Pinto-Carral, Raquel Leirós-Rodríguez and María José Álvarez-Álvarez
Medicina 2025, 61(11), 1908; https://doi.org/10.3390/medicina61111908 (registering DOI) - 24 Oct 2025
Abstract
Background and Objectives: Infantile colic affects 15–40% of infants ≤ 5 months, burdening families and health systems. While the effects of intrapartum oxytocin on neonatal outcomes have been widely investigated, its potential link with infantile colic remains poorly understood. We evaluated whether [...] Read more.
Background and Objectives: Infantile colic affects 15–40% of infants ≤ 5 months, burdening families and health systems. While the effects of intrapartum oxytocin on neonatal outcomes have been widely investigated, its potential link with infantile colic remains poorly understood. We evaluated whether synthetic oxytocin is associated with infantile colic during the first five months of life and explored neonatal head circumference, feeding type and epidural anesthesia as additional factors. Materials and Methods: Prospective 1:1 matched case–control study in three Spanish pediatric outpatient clinics. Parents of 76 term infants aged 0–5 months (38 cases, 38 controls) completed face-to-face structured interviews documenting synthetic oxytocin and epidural use, infant anthropometry and feeding pattern. Infantile colic was diagnosed by Rome IV criteria. Associations were estimated with conditional logistic regression, producing adjusted odds ratios and 95% confidence intervals. Results: Synthetic oxytocin was used in 57.9% of deliveries and epidural anesthesia in 81.6 %. Synthetic oxytocin showed no association with infantile colic (aOR 1.24; 95% CI 0.50–3.09). Epidural strongly predicted synthetic oxytocin exposure (aOR 4.55; 95% CI 1.28–16.20) but had no independent link to infantile colic. Infants with colic had a smaller mean head circumference at birth, although this difference did not remain significant after adjusting for gestational age, likely reflecting limited sample size. Synthetic oxytocin was not associated with breastfeeding status. Conclusions: In this cohort, intrapartum synthetic oxytocin was not related to infantile colic or to feeding difficulties. Smaller head circumference among colic cases may warrant further investigation as a potential risk marker. The high co-use of synthetic oxytocin and epidural underscores the need for larger longitudinal studies to clarify their peripartum–neonatal interactions. Full article
(This article belongs to the Section Obstetrics and Gynecology)
12 pages, 496 KB  
Article
Urinary Tract Infections Caused by Extended-Spectrum Beta-Lactamase-Producing and Carbapenem-Resistant Enterobacterales in Saudi Arabia: Impact of Catheterization
by Asma Ali Sawan, Nada S. Alghamdi, Shahad A. Alzahrani, Muzn S. Alharbi, Nora Alabdulkareem, Dana Ahmed Alnufaily, Sajidah Jaffar Alalwan, Tajammal Mustafa, Maher Alqurashi and Ayman A. El-Badry
Medicina 2025, 61(11), 1907; https://doi.org/10.3390/medicina61111907 (registering DOI) - 24 Oct 2025
Abstract
Background and Objectives: Catheter-associated urinary tract infections (CAUTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing and carbapenem-resistant Enterobacterales (CRE) significantly contribute to global rates of UTI. This study aimed to compare the prevalence and trends of ESBL-producing Enterobacterales and CRE in patients with CAUTIs [...] Read more.
Background and Objectives: Catheter-associated urinary tract infections (CAUTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing and carbapenem-resistant Enterobacterales (CRE) significantly contribute to global rates of UTI. This study aimed to compare the prevalence and trends of ESBL-producing Enterobacterales and CRE in patients with CAUTIs and non-CAUTIs. Materials and Methods: A retrospective review of 4262 UTI-positive urine cultures was conducted at King Fahad Hospital of the University, Al Khobar, Saudi Arabia (January 2022–November 2023). Demographic, clinical, and microbiological data were obtained from hospital records. Antimicrobial susceptibility was tested using the Vitek® System; ESBL and CRE were identified using Ezy MIC™ strips and Xpert® Carba-R assay, respectively. Results: ESBL-producing Enterobacterales accounted for 11.3% of cases; CRE comprised 1.8%. ESBL was significantly more prevalent in non-catheterized patients and those in emergency care. CRE was significantly associated with catheterized patients and inpatient settings. Escherichia coli and Klebsiella pneumoniae were the predominant ESBL-producing and CRE isolates, respectively. bla-OXA-48 was the most frequently detected carbapenemase gene (66.7%). ESBL was prevalent in younger, non-catheterized females, suggesting increasing community transmission. Conversely, CRE were primarily observed in older, catheterized inpatients, emphasizing the role of invasive devices in resistance spread. Conclusions: These findings highlight the importance of targeted infection control and early catheter removal to mitigate resistance trends. Full article
(This article belongs to the Section Infectious Disease)
9 pages, 265 KB  
Article
Association of Apathy with Poor Sleep Quality in Patients with Early Parkinson’s Disease
by Hak-Loh Lee, Seong-Min Choi, Soo Hyun Cho and Byeong C. Kim
Medicina 2025, 61(11), 1906; https://doi.org/10.3390/medicina61111906 (registering DOI) - 24 Oct 2025
Abstract
Background and Objectives: Apathy and sleep problems are frequently observed among non-motor symptoms (NMSs) in Parkinson’s disease (PD), but the relationship between the two has not been well investigated. This study aimed to determine the extent to which apathy and sleep disturbances [...] Read more.
Background and Objectives: Apathy and sleep problems are frequently observed among non-motor symptoms (NMSs) in Parkinson’s disease (PD), but the relationship between the two has not been well investigated. This study aimed to determine the extent to which apathy and sleep disturbances are present in people with early PD and whether apathy affects sleep quality. Materials and Methods: Patients diagnosed with early PD, defined as modified Hoehn and Yahr (mHY) stages 1-3 and a disease duration of no more than 5 years, were included in the study. Demographic characteristics were collected, and motor and NMSs including apathy and sleep disturbance were investigated with relevant scales. Results: Of 302 patients with PD, apathy was found in 97 (32.1%) patients. Patients with apathetic PD had significantly less formal education, a more advanced mHY stage, and higher scores on the Unified Parkinson’s Disease Rating Scale (UPDRS) part II, total Non-Motor Symptom Scale (NMSS), Beck Depression Inventory (BDI), Apathy Evaluation Scale (AES), and Pittsburgh Sleep Quality Index (PSQI) global scores than patients with non-apathetic PD. The PSQI global score showed significant associations with years of education, UPDRS-II, total NMSS, Mini-Mental State Examination, BDI, and AES scores. For each component of the PSQI, only sleep latency was different between patients with apathetic and non-apathetic PD. Partial correlation analyses for determining the association between apathy and sleep disturbance revealed a significant positive correlation. Conclusions: Apathy is common and associated with poor sleep quality in patients with early PD. These findings suggest that recognizing and addressing apathy may be relevant for managing sleep disturbances in this population. Full article
(This article belongs to the Section Neurology)
14 pages, 581 KB  
Review
Surgical Ovarian Suppression and Breast Cancer—What Do We Know About It?
by Angel Yordanov, Ihsan Hasan, Mariela Vasileva-Slaveva, Eva Tsoneva, Stoyan Kostov and Vesselina Yanachkova
Medicina 2025, 61(11), 1905; https://doi.org/10.3390/medicina61111905 (registering DOI) - 24 Oct 2025
Abstract
Breast cancer (BC) is the most common malignancy in women worldwide, with incidence projected to rise, particularly among younger patients. In premenopausal women with hormone receptor-positive disease, ovarian suppression is an established component of systemic therapy, most often achieved pharmacologically with gonadotropin-releasing hormone [...] Read more.
Breast cancer (BC) is the most common malignancy in women worldwide, with incidence projected to rise, particularly among younger patients. In premenopausal women with hormone receptor-positive disease, ovarian suppression is an established component of systemic therapy, most often achieved pharmacologically with gonadotropin-releasing hormone agonists (GnRHas). Bilateral salpingo-oophorectomy (BSO) represents a surgical alternative that ensures definitive suppression, eliminates compliance issues, and is more cost-effective in the long term. Despite these advantages, BSO induces irreversible menopause, associated with vasomotor symptoms, cardiovascular morbidity, bone loss, cognitive decline, and reduced quality of life. Evidence suggests that BSO is most appropriate in selected cases, including women unable to tolerate or adhere to medical suppression, those with inadequate estradiol suppression, patients approaching natural menopause, individuals with metastatic hormone receptor-positive disease, and carriers of BRCA1 mutations, especially with triple-negative tumors. Conversely, data on its benefit in BRCA2 carriers remain limited. Overall, BSO provides oncologic outcomes comparable to medical suppression but at the cost of permanent systemic effects. The decision between surgical and medical ovarian suppression should be individualized, balancing oncologic efficacy, comorbidities, genetic background, and patient preference. Further studies are needed to define the optimal duration of medical suppression and clarify the role of BSO in hereditary breast cancer. Full article
(This article belongs to the Section Obstetrics and Gynecology)
►▼ Show Figures

Figure 1

10 pages, 268 KB  
Article
A Novel Therapeutic Target for Pediatric Pneumonia: Sestrin2
by Hatice Uygun, Zeynep Nur Çiçek, Kenan Ercan and Seyithan Taysi
Medicina 2025, 61(11), 1904; https://doi.org/10.3390/medicina61111904 - 24 Oct 2025
Abstract
Background and Objectives: The mechanisms underlying pneumonia-associated complications are not yet fully understood. Emerging evidence indicates that Sestrin2 (SESN2), a component of the antioxidant defense system, may play a significant clinical role in various diseases. However, the relationship between Sestrin2 expression and pneumonia [...] Read more.
Background and Objectives: The mechanisms underlying pneumonia-associated complications are not yet fully understood. Emerging evidence indicates that Sestrin2 (SESN2), a component of the antioxidant defense system, may play a significant clinical role in various diseases. However, the relationship between Sestrin2 expression and pneumonia in pediatric patients is unclear. Materials and Methods: In this study, the relationship between Sestrin2 expression and pneumonia was investigated in children hospitalized for pneumonia between 1 January and 1 April 2024. Results: The study involved 39 patients with a median age of 48 months (range: 12–84) diagnosed with pneumonia and treated at our hospital’s pediatric wards, as well as 37 healthy controls with a median age of 86 months (range: 48–132). In the patient group, the level of reactive oxygen species (ROS) was higher than that in the control group, but the difference was non-significant (394.35 [322.61–586.14] vs. 380.99 [320.03–410.54], p = 0.057). Conversely, the SESN2 level was significantly lower in the patient group than in the control group (2.89 [1.94–4.1] vs. 3.58 [2.94–4.38], p = 0.039). Correlation analysis indicated a strong positive correlation between SESN2 and ROS in the patient group (r = 0.743, p = 0.001), along with a moderate negative correlation between SESN2 and age (r = −0.467, p = 0.003). Conclusions: The decreased SESN2 levels, as observed in the patient group, may contribute to the clinical manifestations of the disease. Mitigating oxidative stress, blocking the elevated ROS levels, and increasing SESN2 levels may be an important step in reducing pneumonia-related complications. For this purpose, SESN2 can be used as a clinical biomarker and prognostic factor in pediatric pneumonia. Full article
(This article belongs to the Section Infectious Disease)
35 pages, 1089 KB  
Review
SGLT2 Inhibitors in the Management of Cardio-Renal-Metabolic Syndrome: A New Therapeutic Era
by Konstantinos Grigoriou, Paschalis Karakasis, Athina Nasoufidou, Panagiotis Stachteas, Aleksandra Klisic, Efstratios Karagiannidis, Barbara Fyntanidou, Djordje S. Popovic, Dimitrios Patoulias, Antonios P. Antoniadis and Nikolaos Fragakis
Medicina 2025, 61(11), 1903; https://doi.org/10.3390/medicina61111903 - 23 Oct 2025
Abstract
Cardiovascular (CV) disease, chronic kidney disease, obesity, and diabetes mellitus have reached epidemic proportions over the past few decades. Accumulating evidence highlights the strong interconnection between these conditions, leading to the definition of a broader disease entity known as cardio-renal-metabolic (CRM) syndrome. This [...] Read more.
Cardiovascular (CV) disease, chronic kidney disease, obesity, and diabetes mellitus have reached epidemic proportions over the past few decades. Accumulating evidence highlights the strong interconnection between these conditions, leading to the definition of a broader disease entity known as cardio-renal-metabolic (CRM) syndrome. This newly recognized clinical entity presents important challenges in identifying the optimal treatment strategy within a holistic, patient-centered framework. In line with this, sodium glucose cotransporter 2 inhibitors (SGLT2is), owing to their multifaceted pharmacological effects, have been suggested as possible treatment options in the management of CRM. SGLT2is exert their antihyperglycemic effects by impeding the renal reabsorption of sodium and glucose, causing glycosuria and natriuresis. Research has confirmed that their unique beneficial effects extend beyond glycemic control, reducing CV death and hospitalizations in patients with heart failure, and the incidence of kidney failure in dedicated kidney outcome studies—regardless of diabetes status. Furthermore, these agents contribute to weight loss and blood pressure reduction. Their benefits appear to stem from a combination of factors, which include reduced oxidative stress, lower levels of inflammation, regulated neurohormonal activation, improved endothelial function, and enhanced metabolic efficiency. This review aims to provide a comprehensive analysis of the pathophysiological mechanisms underlying the effects of SGLT2is in CRM syndrome, synthesize evidence from landmark clinical trials, evaluate current experimental and diagnostic approaches, and provide the emerging role of SGLT2is in the treatment of this new clinical entity. Full article
(This article belongs to the Special Issue Diabetes, Hypertension, and Cardiovascular Diseases: New Insights, Risk Factors, and Drug Therapies)
►▼ Show Figures

Figure 1

21 pages, 414 KB  
Review
Small-Molecule GLP-1 Receptor Agonists: A Promising Pharmacological Approach
by Oana Cristina Șeremet, Ciprian Pușcașu, Corina Andrei, Georgiana Nițulescu, Cristina Elena Zbârcea and Octavian Tudorel Olaru
Medicina 2025, 61(11), 1902; https://doi.org/10.3390/medicina61111902 - 23 Oct 2025
Abstract
Glucagon-like peptide-1 receptor (GLP-1R) agonists are injectable peptide-based therapies that have become a focal point in the medical community due to their significant therapeutic efficacy in type 2 diabetes and obesity treatment. Recent advancements in medicinal chemistry have enabled the development of small-molecule [...] Read more.
Glucagon-like peptide-1 receptor (GLP-1R) agonists are injectable peptide-based therapies that have become a focal point in the medical community due to their significant therapeutic efficacy in type 2 diabetes and obesity treatment. Recent advancements in medicinal chemistry have enabled the development of small-molecule GLP-1R agonists, presenting advantages such as oral administration, improved patient adherence, and cost-effectiveness. These compounds demonstrate promising efficacy in enhancing insulin secretion and promoting weight loss, in a similar way to peptide agonists. This narrative review focuses on the pharmacodynamic profiles and the current progress in clinical and preclinical research on small-molecule GLP-1R agonists. As this class of agents continues to evolve, it represents a compelling therapeutic alternative with the potential to reshape the treatment for metabolic disorders. Full article
(This article belongs to the Special Issue Breakthroughs in Clinical Diabetes, Obesity and Metabolic Diseases)
12 pages, 291 KB  
Article
Improvement of Cancer Care—Analysis of ESGO Quality Indicators for the Surgical Treatment of Endometrial Cancer in Slovenian and Croatian Gynaecologic Oncology Departments
by Maja Pakiž, Marko Klarić, Andraž Dovnik, Gabrijela Sopta Primorac, Jure Knez, Đuro Despot, Leyla Al Mahdawi, Marina Pranjic, Aleks Brumec, Tadej Turković and Andrej Cokan
Medicina 2025, 61(11), 1901; https://doi.org/10.3390/medicina61111901 - 23 Oct 2025
Abstract
Background and Objectives: This study aims to analyze ESGO quality indicators for the surgical treatment of endometrial cancer patients at two gynecologic oncology departments in Slovenia and Croatia, providing insights for improving cancer care. Materials and Methods: We conducted a retrospective analysis of [...] Read more.
Background and Objectives: This study aims to analyze ESGO quality indicators for the surgical treatment of endometrial cancer patients at two gynecologic oncology departments in Slovenia and Croatia, providing insights for improving cancer care. Materials and Methods: We conducted a retrospective analysis of clinical data to evaluate ESGO quality indicators for surgical treatment of endometrial cancer patients from 2020 to 2022. ESGO quality indicators were calculated, and the results were discussed to formulate suggestions for enhancing cancer care. Institutional review board approval was obtained for the analysis. Results: The analysis reveals that the Slovenian Department for Gynecology and Breast Oncology in Maribor achieved compliance with 24 out of 26 quality indicators, while the Department of Obstetrics and Gynecology in Rijeka met 18 out of 26. The disparity may be partly attributed to Maribor’s status as an ESGO-accredited center in training since 2014, which facilitates more rapid updates in care practices. Conclusions: Based on our findings and epidemiological data, we recommend several actions to enhance cancer care in both countries: (a) advance initiatives for the centralization of care (2 to 3 centers in Slovenia and 5 to 6 in Croatia), (b) implement a national system for the prospective measurement of quality indicators, and (c) pursue center accreditation and gynecologist certification in subspecialty care by international societies such as ESGO, given the small size of both countries. Our results confirm that the analysis of ESGO quality indicators is a viable method for all stakeholders involved in enhancing cancer care. Full article
(This article belongs to the Special Issue Endometrial Cancer: Biomarkers and Management)
9 pages, 279 KB  
Article
Efficacy of JOINS Tablet for Lumbar Spinal Stenosis: Prospective, Randomized, Open-Label Clinical Trial
by Sangbong Ko and Heechan Kim
Medicina 2025, 61(11), 1900; https://doi.org/10.3390/medicina61111900 - 23 Oct 2025
Abstract
Background and Objectives: Spinal stenosis, low back pain, and radiating pain to the lower extremities are caused by inflammation of the spinal canal and impaired blood flow around the nerves. Because JOINS tablets are known to have anti-inflammatory, pain-relieving, and blood circulation-enhancing [...] Read more.
Background and Objectives: Spinal stenosis, low back pain, and radiating pain to the lower extremities are caused by inflammation of the spinal canal and impaired blood flow around the nerves. Because JOINS tablets are known to have anti-inflammatory, pain-relieving, and blood circulation-enhancing properties, this research was conducted based on the assumption that they could improve spinal stenosis. Materials and Methods: This was a prospective, randomized, single-center, open-label clinical trial with a 6-month follow-up period. A total of 100 patients with lumbar spinal stenosis were randomized into two groups: 50 patients in the test group and 50 patients in the control group. The control group was prescribed the usual spinal stenosis medications (Naproxen, Limaprost, and Pregabalin), while the test group was prescribed JOINS tablets in addition to the usual medications. Results: The severity of low back pain and radiating leg pain was assessed using a Visual Analog Scale. Spinal functional outcomes were assessed using the Oswestry Disability Index (ODI) and Roland-Morris Disability Questionnaire (RMDQ), and quality of life was assessed using the Short Form 36 (SF-36), with division into Physical Component Score (PCS) and Mental Component Score (MCS). At 6 months, the JOINS group showed a greater reduction in low back pain compared with controls (p < 0.001). At all follow-up periods, the functional outcomes did not show statistically significant differences between the test and control groups. Conclusions: The significant reduction in pain suggests that JOINS tablets may be an effective adjunct for pain relief, particularly in patients at high risk of adverse effects from long-term NSAID use. Full article
(This article belongs to the Section Orthopedics)
18 pages, 1492 KB  
Article
Why and When ICD Leads Are Extracted: Does the ICD Lead Model Influence Lead Survival?
by Andrzej Kutarski, Wojciech Jacheć, Paweł Stefańczyk, Łukasz Tułecki, Tomasz Kukulski and Dorota Nowosielecka
Medicina 2025, 61(11), 1899; https://doi.org/10.3390/medicina61111899 - 23 Oct 2025
Abstract
Background and Objectives: There is limited knowledge on ICD lead lifespan, the reasons for lead failure, and the influence of lead models. Our aim in this study was to compare the lifetime of individual lead models and the reasons for their extraction. [...] Read more.
Background and Objectives: There is limited knowledge on ICD lead lifespan, the reasons for lead failure, and the influence of lead models. Our aim in this study was to compare the lifetime of individual lead models and the reasons for their extraction. Materials and Methods: We analyzed 3929 transvenous lead extractions (TLEs) (including 1068 ICD lead extractions). Results: The median age of an ICD lead removed (for all causes) was 61 months, three years shorter than that of PM leads. Old models with thick leads survived almost twice as long as thin and modern leads. ICD leads were removed due to infection (35.6%), mechanical damage (33.6%), and dysfunction (including perforation) (20.8%). Riata leads presented higher resistance to mechanical damage compared to Sprint Fidelis and Linox (dwell time medians; 124.0, 47.0 and 70.0 months). However, Durata leads presented higher resistance to mechanical damage compared to Sprint Fidelis and Linox (dwell time medians; 81.0, 68.0 and 70.0 months). Riata leads lasted almost twice as long as Sprint Fidelis. Linox leads lasted as long as theoretically fail-safe Sprint Quatro leads. Conclusions: 1. The median of ICD lead survival was three years shorter than that of PM leads. 2. ICD leads were most commonly removed due to infection, mechanical lead damage, and undamaged lead dysfunction (including perforation). 3. Old models of thick leads (Sprint, Ventritex, and Kainox) survived almost twice as long as thin leads from the transition period (Riata and Sprint Fidelis) and modern leads. Despite advances in the design of ICD leads, their lifetime has not changed significantly. Full article
(This article belongs to the Section Cardiology)
►▼ Show Figures

Figure 1

13 pages, 419 KB  
Article
The Associations Between Physical Activity, Body Perception, and Self-Rated Health in Korean Adults: An Analysis of the 2023 Korean Community Health Survey
by Geun-Kook Kim, Su-Yeon Roh and Sung-Ho Hwang
Medicina 2025, 61(11), 1898; https://doi.org/10.3390/medicina61111898 - 23 Oct 2025
Abstract
Background and Objectives: This study examined associations between physical activity, body perception, and self-rated health (SRH) in a nationally representative sample of Korean adults. Materials and Methods: This study analyzed data from the 2023 Korea Community Health Survey (n = 228,249 [...] Read more.
Background and Objectives: This study examined associations between physical activity, body perception, and self-rated health (SRH) in a nationally representative sample of Korean adults. Materials and Methods: This study analyzed data from the 2023 Korea Community Health Survey (n = 228,249 adults aged ≥19). Variables included Body Mass Index (BMI), body perception, and participation in walking and stretching. Complex sample t-tests and one-way ANOVA were used to examine group differences in BMI, body perception, and self-rated health (SRH). Comparisons were made across gender, age groups, residential environment (metropolitan vs. non-metropolitan), and household size. Results: Mean BMI was highest in individuals in their 30s and was lowest in those aged 80 and above (p < 0.001). Females reported lower BMIs and more positive SRH than males (p < 0.001). Metropolitan residents and individuals in larger households showed higher physical activity rates and more favorable SRH (p < 0.001). SRH and physical activity declined with age, while exercise participation was higher among individuals with higher BMI or self-perceived overweight status (p < 0.001). Although the direction of this association should be interpreted with caution. Conclusions: Age, gender, residence, and household composition significantly influenced physical activity and SRH. These findings highlight the need to prioritize interventions for older adults, single-person households, and non-metropolitan populations. Full article
(This article belongs to the Section Epidemiology & Public Health)
►▼ Show Figures

Figure 1

10 pages, 429 KB  
Brief Report
Hereditary Angioedema Prophylaxis Therapy: Berotralstat and Lanadelumab Safety Profile
by Mattia Donadoni, Leyla La Cava, Emanuele Bizzi, Valentina Popescu Janu, Alessia Meschia, Federica Cirigliano, Chiara Cogliati and Antonio Gidaro
Medicina 2025, 61(11), 1897; https://doi.org/10.3390/medicina61111897 - 23 Oct 2025
Viewed by 31
Abstract
Background and Objectives: Hereditary angioedema caused by C1 inhibitor deficiency (HAE-C1-INH) is a rare genetic condition characterized by recurrent, potentially life-threatening episodes of angioedema. Long-term prophylaxis (LTP) is essential for decreasing the frequency and severity of attacks. This study aims to compare [...] Read more.
Background and Objectives: Hereditary angioedema caused by C1 inhibitor deficiency (HAE-C1-INH) is a rare genetic condition characterized by recurrent, potentially life-threatening episodes of angioedema. Long-term prophylaxis (LTP) is essential for decreasing the frequency and severity of attacks. This study aims to compare the safety profiles of two first-line LTP therapies, both of which inhibit kallikrein: berotralstat (oral) and lanadelumab (subcutaneous), using data from the WHO’s VigiBase pharmacovigilance database. Materials and Methods: The study employed a retrospective quantitative design, utilizing the World Health Organization’s pharmacovigilance database, VigiAccess, which contains individual case safety reports of adverse drug reactions (ADRs) to identify cases of ADRs associated with HAE-C1-INH long-term prophylaxis. Results: A total of 644 reports for berotralstat and 3432 reports for lanadelumab were analyzed. Berotralstat was mainly associated with gastrointestinal adverse events (47.9%), while lanadelumab was linked to injection site reactions (45.9%), infections (23.3%), musculoskeletal and connective tissue disorders (10%), immune system disorders (5.3%), vascular disorders (4.7%), and metabolic issues (3.9%). Female patients were more frequently affected in both groups. Statistically significant differences were observed, reflecting the differences in administration methods and pharmacological profiles between the two drugs. Limitations include the self-reported nature of the data and the absence of detailed clinical information. Conclusions: The results confirmed the literature’s data on the gastrointestinal adverse effects of berotralstat, as well as site reactions and infections associated with lanadelumab. Notably, musculoskeletal and connective tissue disorders, immune system disorders, vascular disorders, and metabolic issues occurred more frequently in patients using lanadelumab. Full article
(This article belongs to the Special Issue Updates on Allergies and Immunodeficiencies)
►▼ Show Figures

Figure 1

13 pages, 512 KB  
Article
DeepCARS-Identified High-Risk Patients: Clinical Interventions and Outcomes During the Korean Healthcare Crisis
by Hyojin Jang, Wanho Yoo, Sora Hwang and Kwangha Lee
Medicina 2025, 61(11), 1896; https://doi.org/10.3390/medicina61111896 - 22 Oct 2025
Viewed by 181
Abstract
Background and Objectives: Timely recognition of deteriorating ward patients is critical to prevent adverse outcomes. The Deep learning–based Cardiac Arrest Risk Score (DeepCARS), an AI-based early warning system developed in Korea, has demonstrated high sensitivity and specificity, but its impact on real-world [...] Read more.
Background and Objectives: Timely recognition of deteriorating ward patients is critical to prevent adverse outcomes. The Deep learning–based Cardiac Arrest Risk Score (DeepCARS), an AI-based early warning system developed in Korea, has demonstrated high sensitivity and specificity, but its impact on real-world physician decision-making remains unclear, especially under healthcare resource constraints. Materials and Methods: We retrospectively analyzed 830 adult ward patients (March 2024–February 2025) who triggered DeepCARS alerts (score ≥ 91) at a tertiary hospital during a nationwide workforce shortage. Physician responses were classified as active intervention (ICU transfer, life-sustaining treatment [LST] decision, or specialty consultation) versus observation. Results: Among patients with DeepCARS ≥ 91, 58.9% received active intervention, with higher in-hospital mortality compared with those observed only (34.8% vs. 9.7%). ROC analysis suggested a cutoff of ≥94 for better intervention discrimination (AUC = 0.708). In multivariable analysis, DeepCARS ≥ 94 (OR 3.52) and chronic liver disease (OR 1.78) independently predicted active intervention. Multinomial analysis showed that patients admitted to medical departments were more often directed toward LST decisions rather than ICU transfer. Hemato-oncologic comorbidities were associated with both ICU transfer and LST decisions, while elevated respiratory rate consistently predicted either ICU transfer or LST discussions. Conclusions: DeepCARS alerts effectively triggered physician-driven decisions regarding ICU transfer and end-of-life care during a healthcare crisis. However, the ultimate clinical responses were shaped by comprehensive clinical judgment that integrated AI-generated risks with patient-specific factors, such as functional status and frailty, not captured by the algorithm. This underscores the indispensable role of individualized clinical assessment in interpreting and acting upon AI-based alerts in high-risk ward patients. Full article
(This article belongs to the Section Intensive Care/ Anesthesiology)
►▼ Show Figures

Figure 1

17 pages, 6752 KB  
Review
ITAC and Non-ITAC Sinonasal Adenocarcinoma: Classification, Etiopathogenesis, Diagnosis and Therapy Focusing on Interdisciplinarity
by Miriam Sciacca, Federico Chillari, Stefano Pergolizzi, Valeria Venuti, Giuseppe Iatì, Silvana Parisi, Giuliana Ciappina, Fabio Minutoli, Vincenzo Fiorentino, Guido Fadda, Antonio Bottari and Giacomo Ferrantelli
Medicina 2025, 61(11), 1895; https://doi.org/10.3390/medicina61111895 - 22 Oct 2025
Viewed by 86
Abstract
Sinonasal adenocarcinomas are rare malignant tumors arising from the epithelial lining of the sinonasal tract. They are classified into intestinal-type (ITAC) and non-intestinal-type adenocarcinomas (non-ITAC), with different histopathological features, aetiologies, and prognostic outcomes. Occupational exposure, particularly to wood and leather dust, is strongly [...] Read more.
Sinonasal adenocarcinomas are rare malignant tumors arising from the epithelial lining of the sinonasal tract. They are classified into intestinal-type (ITAC) and non-intestinal-type adenocarcinomas (non-ITAC), with different histopathological features, aetiologies, and prognostic outcomes. Occupational exposure, particularly to wood and leather dust, is strongly linked to ITAC. Diagnosis requires a combination of clinical evaluation, imaging, histology, and immunohistochemical profiling. Due to the complexity of the sinonasal anatomy and the aggressive behaviour of these tumors, an early and accurate diagnosis is fundamental. Treatment usually involves surgical resection, often followed by radiotherapy, while the role of chemotherapy remains limited. This review outlines the classification, etiopathogenesis diagnosis and management strategies for sinonasal adenocarcinomas, emphasizing the importance of multidisciplinary approaches for optimal outcomes. Full article
(This article belongs to the Section Oncology)
►▼ Show Figures

Figure 1

18 pages, 3888 KB  
Article
Decoding SIGLEC12 in Bladder Cancer: In Silico Profiling of Expression, Tumor–Immune Interactions, and Prognostic Impact
by Varsha Rathore and Wan-Wan Lin
Medicina 2025, 61(11), 1894; https://doi.org/10.3390/medicina61111894 - 22 Oct 2025
Viewed by 78
Abstract
Background and Objectives: Siglec-XII, encoded by SIGLEC12, is a unique sialic acid-binding immunoglobulin-like lectin. It lacks a highly conserved R122 residue for sialic acid recognition in humans. Although it is upregulated in bladder cancer (BCa), its role in tumorigenesis remains largely unexplored. This [...] Read more.
Background and Objectives: Siglec-XII, encoded by SIGLEC12, is a unique sialic acid-binding immunoglobulin-like lectin. It lacks a highly conserved R122 residue for sialic acid recognition in humans. Although it is upregulated in bladder cancer (BCa), its role in tumorigenesis remains largely unexplored. This study aims to investigate the expression patterns of SIGLEC12 in BCa and its correlation with disease features. Materials and Methods: An integrated analysis of transcriptomic data and clinical profiles was conducted using various databases and tools, including UALCAN, GEPIA, TIMER, CAMOIP, and CPADs. The analyses encompassed SIGLEC12 expression, survival rates, immune infiltration levels, promoter methylation, and correlation with drug response. Results: SIGLEC12 expression was higher in both low-grade papillary and high-grade invasive non-papillary BCa. Higher SIGLEC12 expression resulting from low promoter hypomethylation was detected at the stage II-IV of BCa, and was unrelated to disease stages and metastatic stages. Elevated SIGLEC12 expression correlated with increased immune cell infiltration, higher expression of oncogenic and immune checkpoint blockade-related genes, and drug resistance signatures. Mutation analysis confirmed the absence of the canonical R122 missense mutation, indicating that the structural integrity and potential functionality of Siglec-XII are preserved in BCa. Conclusions: SIGLEC12 may have sialic acid recognition functions and serve as a potential early biomarker of BCa. Full article
(This article belongs to the Special Issue New Advances in Urology and Nephrology Disease: From Diagnosis to Treatment—2nd Edition)
►▼ Show Figures

Figure 1

16 pages, 1099 KB  
Article
Comparative Long-Term Outcomes of Pulsed and Lesion Radiofrequency of the Greater Occipital Nerve in Chronic Migraine: A 12-Month Cohort Study
by Ahmet Yilmaz and Cagatay Kucukbingoz
Medicina 2025, 61(11), 1893; https://doi.org/10.3390/medicina61111893 - 22 Oct 2025
Viewed by 135
Abstract
Background and Objectives: Chronic migraines are a disabling neurological disorder with limited response to preventive pharmacological treatments. Greater occipital nerve (GON)-targeted radiofrequency (RF) procedures have emerged as promising interventions, yet long-term comparative data between pulsed RF (PRF) and continuous-lesion RF (LesionRF) remain scarce. [...] Read more.
Background and Objectives: Chronic migraines are a disabling neurological disorder with limited response to preventive pharmacological treatments. Greater occipital nerve (GON)-targeted radiofrequency (RF) procedures have emerged as promising interventions, yet long-term comparative data between pulsed RF (PRF) and continuous-lesion RF (LesionRF) remain scarce. This study evaluated the 12-month efficacy and safety of PRF versus LesionRF. Materials and Methods: A single-center cohort of 211 patients with chronic migraine diagnosed by ICHD-3 criteria (PRF = 107; LesionRF = 104) was analyzed. All patients had a positive diagnostic block and ≥12 months of follow-up. Interventions were performed under ultrasound guidance with standardized protocols (PRF: 42 °C, 4 min, 45 V; LesionRF: 80 °C, 90 s). The primary outcome was a change in monthly migraine days (MMD), while secondary outcomes included responder rates (≥50% MMD reduction), pain intensity (VAS), functional outcomes (HIT-6, MIDAS), quality of life (SF-36, EQ-5D), medication use, retreatment, and complications. Results: Both groups improved, but LesionRF showed greater benefit. At 12 months, LesionRF achieved a larger MMD reduction (−4.8 days vs. PRF, p < 0.001), higher responder rates (83% vs. 65%, p = 0.01), and greater VAS decreases (−1.6, p < 0.001). Functional and quality-of-life scores improved more with LesionRF, with MIDAS reductions surpassing MCID and responder rates meeting PASS. Retreatment was less frequent with LesionRF (8% vs. 19%; HR 2.15, p = 0.037), and two LesionRF patients (1.9%) developed hematomas that resolved conservatively. Conclusions: Compared with PRF, LesionRF provided more sustained and clinically meaningful benefits for chronic migraines. Both approaches appeared to be safe, though confirmation in larger randomized trials is warranted. Full article
(This article belongs to the Special Issue Clinical Updates and Future Perspectives on the Chronic Pain Management)
►▼ Show Figures

Figure 1

10 pages, 436 KB  
Article
Lower Myeloperoxidase-ANCA Titres at Diagnosis Are Associated with End-Stage Kidney Disease Progression During Follow-Up in Rituximab-Treated Patients with Microscopic Polyangiitis
by Oh Chan Kwon, Jang Woo Ha, Yong-Beom Park and Sang-Won Lee
Medicina 2025, 61(11), 1892; https://doi.org/10.3390/medicina61111892 - 22 Oct 2025
Viewed by 112
Abstract
Background and Objectives: To investigate whether myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody (ANCA) titres at diagnosis are associated with the risk of end-stage kidney disease (ESKD) progression in patients with microscopic polyangiitis (MPA) treated with rituximab. Materials and Methods: This retrospective cohort study [...] Read more.
Background and Objectives: To investigate whether myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody (ANCA) titres at diagnosis are associated with the risk of end-stage kidney disease (ESKD) progression in patients with microscopic polyangiitis (MPA) treated with rituximab. Materials and Methods: This retrospective cohort study included 34 patients with MPA who received rituximab. Clinical data, including MPO-ANCA titres at diagnosis and ESKD progression during follow-up, were assessed. Receiver operating characteristic (ROC) curve analysis was performed to assess whether MPO-ANCA titres could predict ESKD progression. The optimal cut-off value of MPO-ANCA titres was determined where the sum of sensitivity and specificity was at a maximum. Based on this cut-off value, patients were categorised into two groups, and the relative risk (RR) of ESKD progression was estimated. Results: During a median follow-up of 39.5 months, seven patients (20.6%) progressed to ESKD. ROC curve analysis showed a significant inverse association between MPO-ANCA titres and ESKD progression (AUC 0.254, 95% confidence interval [CI] 0.046, 0.462 p = 0.048). The optimal cut-off of MPO-ANCA titres was 81.0 IU/mL, which yielded a sensitivity and specificity of 70.4% and 85.7%, respectively. The RR of ESKD progression was significantly higher in those with MPO-ANCA titres ≤ 81.0 IU/mL than in those with MPO-ANCA titres > 81.0 IU/mL (42.9% vs. 5.0%, RR 14.250, 95% CI 1.469, 138.271). Conclusions: Lower MPO-ANCA titres at diagnosis may be associated with a higher risk of ESKD progression in rituximab-treated MPA patients. These findings suggest that MPO-ANCA titres may be useful in guiding therapeutic decisions for MPA. Full article
(This article belongs to the Section Hematology and Immunology)
►▼ Show Figures

Figure 1

15 pages, 851 KB  
Article
The Burden of Esophageal Cancer and Its Correlation with Dietary, Metabolic, and Behavioral Risk Factors in 204 Countries and Territories: Results from the Global Burden of Disease Study 2021
by Zeinab Almasi, Afrooz Mazidimoradi, Zahra Shahabinia, Leila Allahqoli, Hamid Salehiniya and Do-Youn Lee
Medicina 2025, 61(11), 1891; https://doi.org/10.3390/medicina61111891 - 22 Oct 2025
Viewed by 135
Abstract
Background and Objectives: Esophageal cancer (EC) remains a major global public health challenge due to its aggressiveness and poor survival rates. Therefore, this study aims to summarize the incidence, mortality, prevalence, and global burden of EC based on sex, age, and geographical [...] Read more.
Background and Objectives: Esophageal cancer (EC) remains a major global public health challenge due to its aggressiveness and poor survival rates. Therefore, this study aims to summarize the incidence, mortality, prevalence, and global burden of EC based on sex, age, and geographical divisions and to investigate the correlation of some risk factors including the Sociodemographic Index (SDI) and important health indicators to identify high-risk populations. Materials and Methods: We extracted the number and age-standardized rates (ASRs) of EC incidence, mortality, disability-adjusted life years (DALYs), and targeted risk factors for 204 countries and territories from the Global Burden of Disease 2021 study. Correlations between the ASRs of incidence, death, and DALYs and risk factors were investigated using SPSS 22 with Spearman’s correlation coefficient at a 0.05 significance level. Results: In 2021, the global age-standardized incidence rate (ASIR), death rate (ASDR), and DALY rate for EC were 6.65 (95% UI: 5.88–7.45), 6.25 (95% UI: 5.53–7.00), and 148.56 (95% UI: 131.71–166.82) per 100,000, respectively. Middle-SDI and high–middle-SDI regions showed the highest and lowest ASIR, ASDR, and DALY ASRs of EC. SDI correlated negatively with ASIR (–0.363), ASDR (–0.414), and DALY ASRs (–0.422). Male-to-female ratios for ASIR, ASDR, and DALY ASRs were 3.32, 3.37, and 3.51, respectively. As age increased, the incidence, death, and DALYs of EC also increased. East Asia recorded the highest incidence, death, and DALY values and ASRs of EC. The ASIR, ASDR, and DALY ASRs also increased with dietary risks, including the low intake of calcium, fruits, omega-6 polyunsaturated fatty acids, seafood omega-3 fatty acids, and vegetables. Conclusions: Considering the incidence, mortality, and high burden of EC in some regions, alongside the presence of modifiable risk factors, major interventions are needed to reduce these risks. Therefore, identifying high-risk areas and factors of EC, promoting lifestyle changes, and lowering the screening age could enable earlier detection and reduce the mortality of EC. Full article
(This article belongs to the Special Issue Advances and Perspectives in Esophageal Cancer Treatment)
►▼ Show Figures

Figure 1

20 pages, 2034 KB  
Review
The Role of FGFR2 as a Novel Biomarker for Treatment of Gastric Cancer—A Literature Review
by João Lages dos Santos, Rui Caetano Oliveira and João Martins Gama
Medicina 2025, 61(11), 1890; https://doi.org/10.3390/medicina61111890 - 22 Oct 2025
Viewed by 102
Abstract
Background: Gastric cancer currently has the third highest mortality rate worldwide among cancer types. Despite gradual declines in mortality rates attributed to improvements in early detection and treatment, outcomes for advanced-stage disease are still poor. The identification of new biomarkers such as fibroblast [...] Read more.
Background: Gastric cancer currently has the third highest mortality rate worldwide among cancer types. Despite gradual declines in mortality rates attributed to improvements in early detection and treatment, outcomes for advanced-stage disease are still poor. The identification of new biomarkers such as fibroblast growth factor receptor 2 (FGFR2) has opened new pathways for directed therapy in gastric cancer. Objective: This review aims to synthesize the current evidence on the role of FGFR2 in gastric cancer, focusing on its biological function and oncogenic mechanisms, diagnostic and prognostic modification, therapeutic targeting, and possible roadblocks in clinical application. Methods: A comprehensive literature search was conducted, selecting studies published between 2015 and 2025 using the MeSH terms “FGFR2 protein, human” [Supplementary Concept]) AND “Stomach Neoplasms”. Articles were screened based on relevance to gastric cancer, language (English), and availability of full text, yielding a final selection of 75 studies, including preclinical research, clinical trials, and reviews. Findings: We compiled and reported the evidence on FGFR2 detection methods, intra-tumoral heterogeneity of FGFR2 expression, effects of FGFR2 expression on prognosis, current therapy options targeting FGFR2, and challenges in pursuing this modality of treatment. Conclusion: FGFR2 represents a promising biomarker and therapeutic target in gastric cancer. Full article
(This article belongs to the Special Issue Emerging Therapies for Gastric Cancer)
►▼ Show Figures

Figure 1

4 pages, 192 KB  
Editorial
Editorial for Recent Advances in Autoimmune Rheumatic Diseases: 2nd Edition
by Diana Mieliauskaitė
Medicina 2025, 61(11), 1889; https://doi.org/10.3390/medicina61111889 - 22 Oct 2025
Viewed by 106
Abstract
This Special Issue of Medicina, entitled “Recent Advances in Autoimmune Rheumatic Diseases”, is dedicated to the state of the art in autoimmune rheumatic diseases, with the expectation that it will be highly beneficial in clinical practice and enhance public health, and provide [...] Read more.
This Special Issue of Medicina, entitled “Recent Advances in Autoimmune Rheumatic Diseases”, is dedicated to the state of the art in autoimmune rheumatic diseases, with the expectation that it will be highly beneficial in clinical practice and enhance public health, and provide the latest information on innovations in the field of autoimmune rheumatic diseases [...] Full article
(This article belongs to the Special Issue Recent Advances in Autoimmune Rheumatic Diseases: 2nd Edition)
Show export options expand_more Show export options expand_less
Select all
Export citation of selected articles as:
 
Displaying articles 1-30
Previous Issue
Back to TopTop