Medicina

3 pages, 215 KiB

Open AccessEditorial

Latest Advances in Pancreatobiliary Endoscopy

by Marco Spadaccini and Alessandro Fugazza

Medicina 2025, 61(3), 550; https://doi.org/10.3390/medicina61030550 - 20 Mar 2025

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The field of biliopancreatic endoscopy has witnessed transformative advancements, driven by technological innovations, novel techniques, and an evolving understanding of disease processes [...] Full article

(This article belongs to the Special Issue Latest Advances in Pancreatobiliary Endoscopy)

19 pages, 3467 KiB

Open AccessArticle

The Incidence and Clinical Characteristics of Interstitial Lung Disease Associated with CDK4/6 Inhibitors in Breast Cancer Patients: A Retrospective Multicenter Study

by Nurullah İlhan, Akif Doğan, Hande Nur Erölmez, Fatih Atalah, Süleyman Baş, Servan Yasar, Hatice Odabaş and Mahmut Gümüş

Medicina 2025, 61(3), 549; https://doi.org/10.3390/medicina61030549 - 20 Mar 2025

Viewed by 439

Abstract

Background and Objectives: CDK4/6 inhibitors (CDK4/6i) have revolutionized the treatment of hormone receptor-positive HER2 negative (HR(+)/HER2(-)) breast cancer. Despite their efficacy, interstitial lung disease (ILD) remains a rare but potentially fatal adverse effect. This study aims to evaluate the incidence and clinical characteristics [...] Read more.

Background and Objectives: CDK4/6 inhibitors (CDK4/6i) have revolutionized the treatment of hormone receptor-positive HER2 negative (HR(+)/HER2(-)) breast cancer. Despite their efficacy, interstitial lung disease (ILD) remains a rare but potentially fatal adverse effect. This study aims to evaluate the incidence and clinical characteristics of ILD associated with CDK4/6 inhibitors in breast cancer patients in Turkey. Materials and Methods: A retrospective multicenter analysis included 464 breast cancer patients treated with CDK4/6 inhibitors between January 2017 and April 2024. Patients receiving ribociclib or palbociclib were evaluated for the development of ILD. Radiological assessments were performed to confirm ILD and exclude other conditions. Clinical characteristics, treatment regimens, and outcomes were analyzed. Results: ILD was identified in 10 patients (2.1%). The average age of the affected patients was 62.5 ± 9.85 years. Hypersensitivity pneumonitis and nonspecific interstitial pneumonia (NSIP) were the most common radiological patterns. Palbociclib was implicated in six cases, while ribociclib was associated with four cases. Grade 3 pulmonary toxicity was observed in eight patients, and Grade 4 toxicity in two patients. One patient who was on palbociclib died due to ILD. No significant correlation was found between ILD and age, smoking status, lung metastases, or prior thoracic radiotherapy. Conclusions: The incidence of CDK4/6 inhibitor-associated ILD in Turkish breast cancer patients appears higher than previously reported in clinical trials. More robust, long-term studies are necessary to identify potential risk factors and mitigate ILD-related mortality. Full article

(This article belongs to the Collection Frontiers in Breast Cancer Diagnosis and Treatment)

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16 pages, 353 KiB

Open AccessArticle

SGLT-2i—A Useful Tool for Real-Life Metabolic and Body Weight Control in Type 2 Diabetes Mellitus Patients

by Mihaela-Simona Popoviciu, Teodor Salmen, Delia Reurean-Pintilei, Vlad Voiculescu and Anca Pantea Stoian

Medicina 2025, 61(3), 548; https://doi.org/10.3390/medicina61030548 - 20 Mar 2025

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Abstract

Background and Objectives: Elevated blood sugar poses an increasingly significant challenge to healthcare systems worldwide. We aimed to assess the efficacy of the SGLT-2i class in achieving metabolic control in patients with T2DM within a real-world standard-of-care regimen. Material and Methods: A prospective [...] Read more.

Background and Objectives: Elevated blood sugar poses an increasingly significant challenge to healthcare systems worldwide. We aimed to assess the efficacy of the SGLT-2i class in achieving metabolic control in patients with T2DM within a real-world standard-of-care regimen. Material and Methods: A prospective analysis was conducted over 6 months including individuals receiving care in an outpatient department, with baseline assessments and follow-ups at 3 and 6 months. Results: A total of 280 patients were assessed, with a mean age of 63.69 ± 9.16, 53.9% of which were males, with a mean DM duration of 9.06 ± 5.64 years, and a DM duration varying from 6 months to 24 years. Discussion: Real-world evidence bridges the gap between guidelines and practice. It emphasizes the need to overcome clinical inertia in order to optimize patient outcomes and contributes to the body of evidence supporting the efficacy of fixed-dose SGLT-2i combinations in managing T2DM and associated comorbidities. Conclusions: We demonstrate the significant clinical and therapeutic impact of SGLT-2i in T2DM patients in a real-world setting. This class of medication not only positively influences glycemic and weight control but also reduces CV risk factors and visceral adiposity. Full article

(This article belongs to the Special Issue Novel Innovations in Diabetes Mellitus Prevention, Screening and Management)

41 pages, 1234 KiB

Open AccessReview

Targeting Neural Oscillations for Cognitive Enhancement in Alzheimer’s Disease

by Federica Palacino, Paolo Manganotti and Alberto Benussi

Medicina 2025, 61(3), 547; https://doi.org/10.3390/medicina61030547 - 20 Mar 2025

Viewed by 785

Abstract

Alzheimer’s disease (AD), the most prevalent form of dementia, is marked by progressive cognitive decline, affecting memory, language, orientation, and behavior. Pathological hallmarks include extracellular amyloid plaques and intracellular tau tangles, which disrupt synaptic function and connectivity. Neural oscillations, the rhythmic synchronization of [...] Read more.

Alzheimer’s disease (AD), the most prevalent form of dementia, is marked by progressive cognitive decline, affecting memory, language, orientation, and behavior. Pathological hallmarks include extracellular amyloid plaques and intracellular tau tangles, which disrupt synaptic function and connectivity. Neural oscillations, the rhythmic synchronization of neuronal activity across frequency bands, are integral to cognitive processes but become dysregulated in AD, contributing to network dysfunction and memory impairments. Targeting these oscillations has emerged as a promising therapeutic strategy. Preclinical studies have demonstrated that specific frequency modulations can restore oscillatory balance, improve synaptic plasticity, and reduce amyloid and tau pathology. In animal models, interventions, such as gamma entrainment using sensory stimulation and transcranial alternating current stimulation (tACS), have shown efficacy in enhancing memory function and modulating neuroinflammatory responses. Clinical trials have reported promising cognitive improvements with repetitive transcranial magnetic stimulation (rTMS) and deep brain stimulation (DBS), particularly when targeting key hubs in memory-related networks, such as the default mode network (DMN) and frontal–parietal network. Moreover, gamma-tACS has been linked to increased cholinergic activity and enhanced network connectivity, which are correlated with improved cognitive outcomes in AD patients. Despite these advancements, challenges remain in optimizing stimulation parameters, individualizing treatment protocols, and understanding long-term effects. Emerging approaches, including transcranial pulse stimulation (TPS) and closed-loop adaptive neuromodulation, hold promise for refining therapeutic strategies. Integrating neuromodulation with pharmacological and lifestyle interventions may maximize cognitive benefits. Continued interdisciplinary efforts are essential to refine these approaches and translate them into clinical practice, advancing the potential for neural oscillation-based therapies in AD. Full article

(This article belongs to the Special Issue Efficacy of Transcranial Electrical Current and Magnetic Stimulation Treatment Options for Alzheimer’s Disease)

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16 pages, 846 KiB

Open AccessArticle

Evaluation of the Effectiveness of Proprioceptive Training According to Radiological Stages in Patients with Knee Osteoarthritis

by Sibel Gayretli Atan, Esra Pehlivan and Sinan Bağçacı

Medicina 2025, 61(3), 546; https://doi.org/10.3390/medicina61030546 - 20 Mar 2025

Viewed by 503

Abstract

Background and Objectives: The aim of the study was to compare the effectiveness of proprioceptive studies according to radiological stages in patients with knee osteoarthritis and to determine at which stage of the disease it should be added to the rehabilitation program. [...] Read more.

Background and Objectives: The aim of the study was to compare the effectiveness of proprioceptive studies according to radiological stages in patients with knee osteoarthritis and to determine at which stage of the disease it should be added to the rehabilitation program. Materials and Methods: This study is a prospective clinical trial. The study was registered with ClinicalTrials.gov (name of the registry: Evaluation of the Effectiveness of Proprioceptive Training According to Radiological Stages in Patients with Knee Osteoarthritis; trial registration number: NCT06150170; date of registration: 21 November 2023). The patients were divided into two groups, which were Grade 1–2 (Group 1) and Grade 3–4 (Group 2) knee osteoarthritis. Both groups underwent a strengthening plus proprioception exercise 3 times a week for 4 weeks. Our primary scale was the Western Ontario and McMaster Universities Arthritis (WOMAC) scale. The secondary outcome measures were pain intensity level, proprioception, range of motion, muscle strength, physical performance, physical activity, quality of life and patient satisfaction. All evaluations were performed twice, before treatment and after 4 weeks of treatment. Conclusions: After treatment, there were significant improvements in pain, range of motion, proprioception, muscle strength, functionality, physical performance and quality of life in both groups (p < 0.05). There was no significant difference between the total WOMAC scores among groups after treatment (p = 0.086). There was more improvement in hip external rotation range of motion in Group 1 (p = 0.022). No significant difference was found in other secondary outcomes (p > 0.05). As a result of this study, we found that proprioceptive training was effective on pain, joint position sense, range of motion, muscle strength, functionality, physical performance and quality of life in patients with knee osteoarthritis in all radiological stages. However, there was no difference between the groups, except for hip external rotation angles. Full article

(This article belongs to the Topic New Trends in Physiotherapy Care: Improvements in Functionality, Pain Management, and Quality of Life)

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13 pages, 1926 KiB

Open AccessArticle

Effect of Global Longitudinal Strain at Discharge Period on Predicting Cardiac Defibrillator Implantation in STEMİ Patients with Impaired Left Ventricle Systolic Functions

by Ömer Ferudun Akkuş and Muhammet Gürdoğan

Medicina 2025, 61(3), 545; https://doi.org/10.3390/medicina61030545 - 20 Mar 2025

Viewed by 271

Abstract

Background and Objectives: Contemporary studies have shown that low ejection fraction (EF) is a significant predictor of sudden cardiac death in ischemic heart failure. However, relying solely on EF and waiting 90 days for ICD implantation is inadequate for preventing sudden death [...] Read more.

Background and Objectives: Contemporary studies have shown that low ejection fraction (EF) is a significant predictor of sudden cardiac death in ischemic heart failure. However, relying solely on EF and waiting 90 days for ICD implantation is inadequate for preventing sudden death in STEMI patients. Materials and Methods: This study aims to explore if left ventricular global longitudinal strain (GLS) measured at discharge can predict EF < 35% at the third-month follow-up in STEMI patients with impaired systolic function (EF < 35%). The study involved 69 patients diagnosed with STEMI. The results from 29 patients with EF ≤ 35% and 40 patients with EF between 36 and 49% were compared. Echocardiographic images were recorded, and the LV GLS value was measured. Results: In both univariate and multivariate regression analyses, LV GLS at discharge was the only independent predictor of EF ≤ 35% after three months. An LV GLS value below 9.55% at discharge predicted an EF below 35% at 90 days, with 75% sensitivity and 76.5% specificity (AUC = 0.814, p = 0.005). Conclusions: Current guidelines recommend waiting three months before ICD implantation in STEMI patients with EF ≤ 35%, but this study suggests that low GLS can help identify high-risk patients earlier, potentially reducing the waiting period for ICD implantation. Full article

(This article belongs to the Section Cardiology)

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12 pages, 2047 KiB

Open AccessArticle

Attitudes and Barriers Toward Antiretroviral Therapeutic Drug Monitoring Among Infectious Disease Providers

by Hongmei Wang, Cecilia M. Torres, Thomas P. Giordano, Bich N. Dang and Dong Liang

Medicina 2025, 61(3), 544; https://doi.org/10.3390/medicina61030544 - 20 Mar 2025

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Abstract

Background/Objectives: Effective HIV treatment and prevention rely heavily on patient adherence to the prescribed regimen. Therapeutic drug monitoring (TDM), which involves measuring medication concentrations in blood circulation, offers an objective method to evaluate toxic or ineffective drug levels. TDM is not routinely [...] Read more.

Background/Objectives: Effective HIV treatment and prevention rely heavily on patient adherence to the prescribed regimen. Therapeutic drug monitoring (TDM), which involves measuring medication concentrations in blood circulation, offers an objective method to evaluate toxic or ineffective drug levels. TDM is not routinely used in HIV treatment in clinical practice. Therefore, the purpose of this study is to survey infectious disease providers’ attitudes and barriers toward therapeutic drug monitoring for antiretroviral therapy in people living with HIV. Materials and Methods: A 15-item online survey was distributed to infectious disease providers in the Greater Houston area, including physicians, pharmacists, and mid-level practitioners involved in HIV patient care. The survey was disseminated via the Houston Citywide Infectious Disease Provider Network and the Houston AIDS Education and Training Center. The survey employed close-ended questions to evaluate providers’ attitudes, perceptions, practices, and barriers toward antiretroviral drug level monitoring. Responses were recorded using a five-point Likert scale. Demographic characteristics and information regarding research involvement were collected to contextualize the findings. The survey results were analyzed using descriptive statistics, with categorical variables expressed as frequencies and percentages using SAS software. Results: A total of 139 responses were received, with 89 participants meeting the inclusion criteria; the majority were female (62.9%), nearly half were aged 34 or younger (53.4%), 50% were physicians and 36.3% pharmacists, and most worked in hospitals (52.3%) or clinics (35.2%). The findings demonstrate participants’ predominantly positive attitudes toward TDM. Nearly 70% agree (agree or strongly agree) that TDM will be helpful and will positively impact improving drug efficacy and medication adherence. The results revealed barriers to implementing TDM, including a lack of evidence supporting TDM’s impact on HIV outcomes, and the absence of clinical guidelines. The results indicated that >90% were ambivalent or agreed that there was not enough evidence to support the use of TDM, and nearly all recognized that the guidelines do not endorse it or did not know if they do not endorse it. Conclusions: This study highlighted positive attitudes and significant barriers to implementing therapeutic drug monitoring, including a lack of evidence supporting TDM’s impact on HIV outcomes and the absence of clinical guidelines supporting TDM’s widespread use. The findings emphasize the need for clinical trials and longitudinal studies to establish definitive evidence on the effectiveness of TDM in improving HIV treatment outcomes. Full article

(This article belongs to the Section Epidemiology & Public Health)

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9 pages, 1980 KiB

Open AccessCase Report

A Novel Surgical Technique for the First Case of Neglected Bilateral Severe Congenital Genu Recurvatum Combined with Bilateral Talipes Equinocavovarus

by Kuan-Lin Liu, Ting-Yu Hung, Xin-Le Eng and Ing-Ho Chen

Medicina 2025, 61(3), 543; https://doi.org/10.3390/medicina61030543 - 20 Mar 2025

Viewed by 333

Abstract

Congenital genu recurvatum (CGR) is a rare congenital knee deformity that can be diagnosed pre- or postnatally. Most CGR cases are treated during infancy by manipulation and serial casting or splinting. Only a few neglected cases of CGR in adults with the necessity [...] Read more.

Congenital genu recurvatum (CGR) is a rare congenital knee deformity that can be diagnosed pre- or postnatally. Most CGR cases are treated during infancy by manipulation and serial casting or splinting. Only a few neglected cases of CGR in adults with the necessity of surgical treatment have been reported. This study presents the first case of neglected bilateral severe CGR combined with bilateral talipes equinocavovarus (BTE) in a 25-year-old woman. This case is unique, because BTE is secondary to CGR with persistent progression into adulthood. The patient underwent two-stage surgeries with 1.5-month intervals to correct the knee and foot/ankle deformities. For CGR, a novel technique that combines posterior closing and anterior open wedge osteotomy was carried out to separately address the issues of 80° and 60° deformity, achieving a total correction of 140° for both knee hyperextension deformities. For BTE, the modified Lambrinudi triple arthrodesis and almost complete plantar fascia release were performed for the treatment of foot/ankle deformities. The patient had no neurovascular problems, and the wounds healed well. After 1 year of hospital-based rehabilitation training, the patient could stand and walk without the help of any walking-assist devices. The outcomes of the three- and nine-year follow-ups were highly satisfactory. Our patient represents a technically challenging case for orthopaedic surgeons because of the complexity of the surgical plan and techniques for the treatment of a patient concurrently having CGR and BTE. Full article

(This article belongs to the Section Orthopedics)

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15 pages, 1251 KiB

Open AccessPerspective

Breaking Barriers—The Promise and Challenges of Limb Osseointegration Surgery

by Agnieszka Wnuk-Scardaccione and Jan Bilski

Medicina 2025, 61(3), 542; https://doi.org/10.3390/medicina61030542 - 20 Mar 2025

Viewed by 404

Abstract

Limb amputation remains a significant global health issue, affecting millions of individuals annually. A substantial proportion of these patients struggle with the inadequate fit and discomfort of conventional prosthetic sockets, leading to diminished quality of life. Osseointegration surgery, a promising alternative, offers the [...] Read more.

Limb amputation remains a significant global health issue, affecting millions of individuals annually. A substantial proportion of these patients struggle with the inadequate fit and discomfort of conventional prosthetic sockets, leading to diminished quality of life. Osseointegration surgery, a promising alternative, offers the direct skeletal attachment of bone, implant, and prosthetic, providing a more stable and functional interface. Osseointegration remains an emerging procedure, and while exact global figures are difficult to pinpoint, estimates suggest that over 10,000 patients worldwide have received osseointegration implants since the technique was first introduced. This perspective article analyzes recent advancements in the field of limb osseointegration, highlighting key achievements such as improved implant materials, surgical techniques, and comprehensive prosthetic integration strategies. Additionally, it explores future directions for development and discusses the latest research trends shaping the evolution of this field. Despite these developments, the widespread adoption of osseointegration faces significant barriers, including complications, limited access to multidisciplinary care, economic constraints, and the need for further long-term clinical evidence. In this paper, we present an extensive perspective on the current state of osseointegration, discuss the challenges impeding its broader implementation, and offer recommendations to address these obstacles, with the goal of enhancing patient outcomes and facilitating the integration of osseointegration into mainstream clinical practice. Full article

(This article belongs to the Section Orthopedics)

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14 pages, 2091 KiB

Open AccessArticle

PyGlaucoMetrics: A Stacked Weight-Based Machine Learning Approach for Glaucoma Detection Using Visual Field Data

by Mousa Moradi, Saber Kazeminasab Hashemabad, Daniel M. Vu, Allison R. Soneru, Asahi Fujita, Mengyu Wang, Tobias Elze, Mohammad Eslami and Nazlee Zebardast

Medicina 2025, 61(3), 541; https://doi.org/10.3390/medicina61030541 - 20 Mar 2025

Viewed by 362

Abstract

Background and Objectives: Glaucoma (GL) classification is crucial for early diagnosis and treatment, yet relying solely on stand-alone models or International Classification of Diseases (ICD) codes is insufficient due to limited predictive power and inconsistencies in clinical labeling. This study aims to [...] Read more.

Background and Objectives: Glaucoma (GL) classification is crucial for early diagnosis and treatment, yet relying solely on stand-alone models or International Classification of Diseases (ICD) codes is insufficient due to limited predictive power and inconsistencies in clinical labeling. This study aims to improve GL classification using stacked weight-based machine learning models. Materials and Methods: We analyzed a subset of 33,636 participants (58% female) with 340,444 visual fields (VFs) from the Mass Eye and Ear (MEE) dataset. Five clinically relevant GL detection models (LoGTS, UKGTS, Kang, HAP2_part1, and Foster) were selected to serve as base models. Two multi-layer perceptron (MLP) models were trained using 52 total deviation (TD) and pattern deviation (PD) values from Humphrey field analyzer (HFA) 24-2 VF tests, along with four clinical variables (age, gender, follow-up time, and race) to extract model weights. These weights were then utilized to train three meta-learners, including logistic regression (LR), extreme gradient boosting (XGB), and MLP, to classify cases as GL or non-GL. Results: The MLP meta-learner achieved the highest performance, with an accuracy of 96.43%, an F-score of 96.01%, and an AUC of 97.96%, while also demonstrating the lowest prediction uncertainty (0.08 ± 0.13). XGB followed with 92.86% accuracy, a 92.31% F-score, and a 96.10% AUC. LR had the lowest performance, with 89.29% accuracy, an 86.96% F-score, and a 94.81% AUC, as well as the highest uncertainty (0.58 ± 0.07). Permutation importance analysis revealed that the superior temporal sector was the most influential VF feature, with importance scores of 0.08 in Kang’s and 0.04 in HAP2_part1 models. Among clinical variables, age was the strongest contributor (score = 0.3). Conclusions: The meta-learner outperformed stand-alone models in GL classification, achieving an accuracy improvement of 8.92% over the best-performing stand-alone model (LoGTS with 87.51%), offering a valuable tool for automated glaucoma detection. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Therapies of Ocular Diseases)

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12 pages, 525 KiB

Open AccessArticle

Relationship Between Dyspnoea Scales and Quality of Life in Stroke Survivors: A Retrospective Analysis

by Abdurrahim Yildiz, Rustem Mustafaoglu and Ayse Nur Bardak

Medicina 2025, 61(3), 540; https://doi.org/10.3390/medicina61030540 - 19 Mar 2025

Viewed by 293

Abstract

Background and Objectives: The purpose of the study was to evaluate the relationship between different dyspnoea scales and clinical and physical parameters of stroke patients and to identify the most appropriate scale for stroke patients. Materials and Methods: This study, designed as [...] Read more.

Background and Objectives: The purpose of the study was to evaluate the relationship between different dyspnoea scales and clinical and physical parameters of stroke patients and to identify the most appropriate scale for stroke patients. Materials and Methods: This study, designed as a retrospective analysis, involved 203 patients diagnosed with stroke. Dyspnoea intensity was evaluated using four different scales: Oxygen Cost Diagram (OCD), Basic Dyspnoea Index (BDI), Modified Medical Research Council (mMRC), and Visual Analogue Scale (VAS). Respiratory muscle strength (maximal inspiratory pressure (MIP) and quality of life (Stroke Impact Scale 3.0 (SIS)) were also assessed. Results: The regression model explained only 20.2% of the variance in SIS total scores (R² = 0.202), indicating that key predictors might be missing. Additionally, dyspnoea scales showed statistically significant but modest correlations with SIS total scores (r = 0.248–0.397), suggesting limited clinical significance. There was a statistically significant relationship between age and dyspnoea scales, except for OCD (r = −0.153, p = 0.056). A statistically significant relationship was found between the MIP and OCD scales (r = 0.290, p < 0.001) and BDI scale (r = 0.195, p = 0.014). However, only the BDI showed a statistically significant relationship with the other three dyspnoea scales in stroke patients. Conclusions: The OCD and BDI can evaluate dyspnoea ratings during day-to-day activities; therefore, these scales were significantly correlated with inspiratory muscle strength in stroke patients. Our findings suggest that while BDI and OCD are valuable tools for dyspnoea assessment in stroke patients, the overall predictive power of dyspnoea scales for quality of life is limited. Future studies should consider additional variables, such as comorbidities and rehabilitation intensity, to improve predictive accuracy and clinical relevance. Full article

(This article belongs to the Section Neurology)

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11 pages, 1449 KiB

Open AccessArticle

Racquet Mammoplasty as an Oncoplastic Technique in the Management of Lateral Quadrant Breast Cancer: A Prospective Controlled Study of Oncologic and Cosmetic Outcomes

by Amr G. Mohamed, Emad M. Abdelrahman, Sherief M. Mohsen, Mostafa S. Abdeen, Mohamed A. Elsayed, Zizi M. Ibrahim, Osama R. Abdelraouf and Ebtesam N. D. Attia

Medicina 2025, 61(3), 539; https://doi.org/10.3390/medicina61030539 - 19 Mar 2025

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Abstract

Background and Objectives: The incorporation of oncoplastic surgery techniques into the management of breast cancer has become more popular and offers both oncological safety and good cosmetic results. However, it is challenging for surgeons to obtain good oncological control and acceptable cosmetic [...] Read more.

Background and Objectives: The incorporation of oncoplastic surgery techniques into the management of breast cancer has become more popular and offers both oncological safety and good cosmetic results. However, it is challenging for surgeons to obtain good oncological control and acceptable cosmetic results. This study aims to evaluate racquet mammoplasty in patients managing lateral quadrant breast tumors. Materials and Methods: In total, 59 female patients with lesions in their lateral breast quadrants were operated upon using the racquet mammoplasty technique. Their intraoperative data and postoperative outcomes were assessed and analyzed. Follow-up was planned for at least 1 year later. Results: In the current study, 59 females were enrolled, with a mean age of 38.6 ± 4.3 years. Tumors were located in the lateral upper quadrant in most of the patients (74.4%). The mean size of the tumors was 2.7 ± 1.8. The surgical margins were free of malignancy in all cases. A total of 5.1% of cases reported a wound infection. A single patient developed loco-regional recurrence. Concerning the cosmetic outcomes, 89.8% of patients reported excellent outcomes and none reported poor or bad results. Conclusions: The racquet mammoplasty technique, when used as an oncoplastic technique, provides oncological safety as well as good cosmetic results for tumors in the lateral breast quadrants. Full article

(This article belongs to the Special Issue Surgical Approaches in Thyroid, Breast, and Other Endocrine Cancers: Advances and Challenges)

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12 pages, 528 KiB

Open AccessArticle

Association of Inflammatory and Metabolic Markers with Mortality in Patients with Postoperative Femur Fractures in the Intensive Care Unit

by Metin Kilinc, Enes Çelik, Ibrahim Demir, Semih Aydemir and Hakan Akelma

Medicina 2025, 61(3), 538; https://doi.org/10.3390/medicina61030538 - 19 Mar 2025

Viewed by 326

Abstract

Background and Objectives: Postoperative femur fracture in elderly patients is associated with high morbidity and mortality, especially in the intensive care unit (ICU). Various factors, including demographic and laboratory parameters, may influence mortality in this population. The aim of this study was [...] Read more.

Background and Objectives: Postoperative femur fracture in elderly patients is associated with high morbidity and mortality, especially in the intensive care unit (ICU). Various factors, including demographic and laboratory parameters, may influence mortality in this population. The aim of this study was to evaluate the association of inflammatory and metabolic markers with mortality in ICU patients with postoperative femur fractures and to identify key predictors to enhance risk stratification and improve patient outcomes. Materials and Methods: In this retrospective single-center study, we analyzed 121 patients aged over 65 years with postoperative femur fractures who were admitted to the ICU between January 2023 and January 2024. Demographic and clinical data, including comorbidities, Charlson Comorbidity Index (CCI), and Acute Physiology and Chronic Health Evaluation (APACHE II) score, were collected. Laboratory parameters such as white blood cell count (WBC), albumin, C-reactive protein (CRP), D-dimer, Pan-Immune-Inflammation Value (PIV), CRP-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and others were analyzed. Linear regression, logistic regression, and Receiver Operating Characteristic (ROC) analyses were performed to determine the predictive value of these markers for ICU mortality. Results: The mean age of the patients was 76.3 ± 9.6 years, and 52.1% were female. The most common comorbidities were hypertension (67.8%) and diabetes (49.6%). ICU mortality occurred in 24 patients (20%). Significant predictors of mortality included higher CRP (>62.8 mg/L), NLR (>10.0), PIV (>450), and APACHE II scores (>23) (p < 0.001 for all). Lower albumin levels (<2.5 g/dL) were strongly associated with increased mortality (p < 0.001). ROC analysis demonstrated that the APACHE II score had the highest predictive accuracy for mortality (AUC = 0.83), followed by albumin (AUC = 0.79) and PIV (AUC = 0.76). Extended ICU stay (>10 days) was also significantly correlated with increased mortality (p < 0.001). Conclusions: This study successfully demonstrates the utility of combining traditional clinical markers, such as APACHE II score, with novel inflammatory markers, such as PIV, CAR, and NLR, in predicting mortality in ICU patients following femur fracture surgery. The integration of emerging biomarkers with well-established scoring systems offers enhanced predictive accuracy and provides valuable insights into patient management. Full article

(This article belongs to the Section Intensive Care/ Anesthesiology)

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15 pages, 762 KiB

Open AccessSystematic Review

Vaping-Associated Pneumothorax: A Systematic Review of Case Reports and Case Series

by Moneeb Al-Taj, Alameen Alsabbah, Tariq Ma’ali, Mohammad Abu Suilik, Jehad Feras AlSamhori, Ahmad Alloubani, Ali Madha, Anita V. Goyal and Abeer Gharaibeh

Medicina 2025, 61(3), 537; https://doi.org/10.3390/medicina61030537 - 19 Mar 2025

Viewed by 635

Abstract

Background and Objectives: Pneumothorax is a medical condition characterized by the accumulation of air in the pleural cavity, leading to lung collapse. While cigarette smoking is a well-known risk factor, the role of electronic cigarettes is less understood. This systematic review aimed [...] Read more.

Background and Objectives: Pneumothorax is a medical condition characterized by the accumulation of air in the pleural cavity, leading to lung collapse. While cigarette smoking is a well-known risk factor, the role of electronic cigarettes is less understood. This systematic review aimed to evaluate the outcomes of vaping-associated pneumothorax, in addition to its clinical features and management strategies, by compiling published case reports and case series. Materials and Methods: The choice to use case reports and case series was due to the limited availability of other types of studies on this emerging condition, as vaping-associated pneumothorax is relatively rare and primarily reported in isolated cases. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic search of six databases for case reports and case series. Data extraction and quality assessment were performed independently by multiple reviewers. Results: Seven case reports and four case series with a total number of 16 patients were included. Most patients were young, underweight men who presented with chest pain and shortness of breath. Conventional cigarette and cannabis use were commonly reported alongside vaping. The main treatment was the insertion of a chest tube, with surgical interventions reserved for severe cases. Patients who were treated non-surgically exhibited a higher recurrence rate. Additionally, specific symptoms such as chest pain radiating to the ipsilateral shoulder were associated with a higher recurrence rate. Conclusions: Clinicians should be vigilant for pneumothorax in at-risk individuals, consider targeted screening for symptomatic vapers, and prioritize early surgical intervention in recurrent cases to reduce complications. Further research is needed to understand the pathophysiology of vaping-associated spontaneous pneumothorax and optimal management strategies. Full article

(This article belongs to the Section Pulmonology)

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12 pages, 3873 KiB

Open AccessArticle

Continuous Non-Invasive Hemodynamic Monitoring in Cirrhotic Patients—Friend or Foe?

by Mirela Crihan, Alexandru Leonard Alexa, Dan Valean and Daniela Ionescu

Medicina 2025, 61(3), 536; https://doi.org/10.3390/medicina61030536 - 19 Mar 2025

Viewed by 272

Abstract

Background and Objectives: Liver cirrhosis leads to significant hemodynamic changes, particularly portal hypertension and a hyperdynamic circulatory state. Traditional invasive methods for hemodynamic monitoring, while accurate, carry risks such as infection and hemorrhage in a patient predisposed to these conditions. This study [...] Read more.

Background and Objectives: Liver cirrhosis leads to significant hemodynamic changes, particularly portal hypertension and a hyperdynamic circulatory state. Traditional invasive methods for hemodynamic monitoring, while accurate, carry risks such as infection and hemorrhage in a patient predisposed to these conditions. This study evaluates the accuracy of non-invasive continuous hemodynamic monitoring compared to a minimally invasive method in patients with decompensated liver cirrhosis. Materials and Materials and Methods: The study enrolled 51 patients with decompensated liver cirrhosis requiring continuous hemodynamic monitoring in the ICU. Patients underwent simultaneous monitoring via the minimally invasive FloTrac system and continuous non-invasive ClearSight sensor over 24 h, with measurements registered at 6 h intervals. Hemodynamic parameters measured included cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke volume variation (SVV), systemic vascular resistance (SVR), and mean arterial pressure (MAP). Results: Significant discrepancies were observed between the two monitoring methods for most parameters, particularly CO, CI, and MAP, at most time intervals. However, SVV measurements showed no significant differences, indicating similar efficacy in assessing fluid responsiveness between the devices. Conclusions: The ClearSight system, although a valuable non-invasive alternative, demonstrated lower accuracy compared to the FloTrac system for hemodynamic measurements in patients with decompensated liver cirrhosis. Its effectiveness in assessing fluid responsiveness, particularly by SVV, suggests it could play a role in the monitoring of these patients, especially when invasive techniques have increased risks. Full article

(This article belongs to the Section Gastroenterology & Hepatology)

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12 pages, 1969 KiB

Open AccessArticle

Comparison of Margin Quality for Intersegmental Plan Identification in Pulmonary Segmentectomy

by Selcuk Gurz, Yurdanur Sullu, Leman Tomak, Necmiye Gul Temel and Aysen Sengul

Medicina 2025, 61(3), 535; https://doi.org/10.3390/medicina61030535 - 19 Mar 2025

Viewed by 322

Abstract

Background and Objectives: Insufficient margin in lung cancer is associated with an increased locoregional recurrence rate. In pulmonary segmentectomy, two commonly used methods for identifying the intersegmental plane are inflation–deflation and indocyanine green dyeing. The aim of this study was to compare these [...] Read more.

Background and Objectives: Insufficient margin in lung cancer is associated with an increased locoregional recurrence rate. In pulmonary segmentectomy, two commonly used methods for identifying the intersegmental plane are inflation–deflation and indocyanine green dyeing. The aim of this study was to compare these two methods in terms of quality margins and to evaluate their superiority. Materials and Methods: A total of 63 patients who underwent segmentectomy via video-assisted thoracoscopic surgery (VATS) for pulmonary nodules and underwent preoperative planning with 3D modeling between October 2020 and February 2024 were included in this study. The location of the nodule and the distance to the intersegmental margins were virtually measured preoperatively using an open-source 3D modeling system. Patients were grouped according to the method of identifying the intersegmental margins. Group 1 included segmentectomies performed by the inflation–deflation method (n = 42), and Group 2 included segmentectomies performed by systemic indocyanine green (ICG) injection (n = 21). The area where the histopathological nodule was measured closest to the intersegmental margin was recorded. Values within (+/−10 mm) compared to the value measured in the three-dimensional model were considered successful. The obtained data were statistically compared between the groups. Results: There was no difference between the groups in terms of virtual and pathological margins. However, in terms of margin quality, the rate of deviation detected in the pathological margin compared to the measured virtual margin was significantly different between the groups (p = 0.04). Accordingly, the success rate was 64.3% in Group 1 and 90.5% in Group 2 (p = 0.05). In Group 1, the failure rate was highly against the adjacent parenchyma. There was no significant difference between the groups in the analysis of simple and complex segmentectomies. Conclusions: Intersegmental plane identification with indocyanine green increases the margin quality by defining resection margins closer to the virtual margins. In the inflation–deflation method, unnecessary parenchymal loss occurs due to disadvantages in identifying intersegmental margins. Full article

(This article belongs to the Section Surgery)

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11 pages, 694 KiB

Open AccessReview

Granulomatosis with Polyangiitis: A Focus on Differences and Similarities Between Child and Adult Patients

by Vincenzo Calabrese, Romina Gallizzi, Alessandra Spagnolo, Mariateresa Zicarelli, Diana Sutera, Alessandra Farina, Valeria Cernaro and Domenico Santoro

Medicina 2025, 61(3), 534; https://doi.org/10.3390/medicina61030534 - 18 Mar 2025

Viewed by 299

Abstract

Wegener’s granulomatosis (WG), or granulomatosis with polyangiitis (GPA), is a rare autoimmune disease that can cause inflammation in various organs, including the kidneys. Renal involvement in GPA is a major cause of morbidity and mortality in both adults and children, and early detection [...] Read more.

Wegener’s granulomatosis (WG), or granulomatosis with polyangiitis (GPA), is a rare autoimmune disease that can cause inflammation in various organs, including the kidneys. Renal involvement in GPA is a major cause of morbidity and mortality in both adults and children, and early detection and effective treatment are essential for preventing renal failure. This review aims to summarize the current evidence on the incidence, clinical features, treatment, and outcomes of renal involvement in children with Wegener’s granulomatosis. The incidence of renal involvement in children with GPA ranged from 26% to 56%. Renal involvement is a common and serious complication of GPA in children, and early detection and effective treatment are crucial for preventing renal failure. The most common clinical features were proteinuria, hematuria, and reduced glomerular filtration rate. The majority of children with renal involvement in GPA required treatment with corticosteroids and immunosuppressive agents. The treatment outcomes varied among the studies, with some children achieving remission of renal involvement while others developed end-stage renal disease. Although most features are the same in children and adult patients, this review summed up some important differences between these two different populations. Further studies are needed to identify the most effective treatment strategies for renal involvement in children with GPA. Full article

(This article belongs to the Section Urology & Nephrology)

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9 pages, 813 KiB

Open AccessSystematic Review

Malignant Lacrimal Sac Tumours—Review of the Literature and Report of Own Experience

by Olga Karłowska-Bijak, Grażyna Stryjewska-Makuch, Marta Michalak-Kolarz, Magdalena Marków and Grażyna Lisowska

Medicina 2025, 61(3), 533; https://doi.org/10.3390/medicina61030533 - 18 Mar 2025

Viewed by 272

Abstract

Background and Objectives: Tumours of the lacrimal drainage system are rare and most located in the lacrimal sac. The authors of this study aimed to conduct a literature review to find out which malignant tumours most often occurred in the lacrimal sac [...] Read more.

Background and Objectives: Tumours of the lacrimal drainage system are rare and most located in the lacrimal sac. The authors of this study aimed to conduct a literature review to find out which malignant tumours most often occurred in the lacrimal sac and what symptoms patients reported in the early stages of the disease. Materials and Methods: The PubMed database was searched for papers published between 2019 and 2024. The inclusion criteria were presence of an abstract, malignant lacrimal sac tumours, papers written in English, studies on humans, and case reports. The exclusion criteria were lack of an abstract, pathologies other than malignant tumours, including benign tumours of the lacrimal drainage system, malignant tumours of a part of the drainage system other than the lacrimal sac, papers in languages other than English, studies not involving humans, and no case report. No gender criterion was used. Results: Based on the data available in the literature, 31 studies were included in the article, describing 34 cases of malignant lacrimal sac tumours. Moreover, a case of a 58-year-old patient diagnosed with non-Hodgkin lymphoma was presented. Conclusions: As a result of the literature analysis, it was impossible to find any symptoms reported by patients with lacrimal sac tumours that would clearly suggest their diagnosis. Full article

(This article belongs to the Section Ophthalmology)

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15 pages, 574 KiB

Open AccessArticle

The Significance of OCTA in Studying Vessel Density and Retinal Thickness in Individuals with Myopia

by Marija Veselinović, Marija Trenkić, Vladimir Čanadanović, Predrag Jovanović, Aleksandar Veselinović, Maja Petrović and Aida Kasumović Bećirović

Medicina 2025, 61(3), 532; https://doi.org/10.3390/medicina61030532 - 18 Mar 2025

Viewed by 302

Abstract

Background and Objectives: This study explores the relationship between retinal structure, vascular densities (VD), and the progression of myopia, aiming to identify novel biomarkers for assessing myopia severity. Materials and Methods: A total of 260 eyes were divided into four groups: [...] Read more.

Background and Objectives: This study explores the relationship between retinal structure, vascular densities (VD), and the progression of myopia, aiming to identify novel biomarkers for assessing myopia severity. Materials and Methods: A total of 260 eyes were divided into four groups: Emmetropia (EM) (n = 74), Low Myopia (LM) (n = 68), Moderate Myopia (MM) (n = 64), and High Myopia (HM) (n = 54). VD and retinal thickness (RT) in the macular and peripheral quadrants were measured using optical coherence tomography-angiography (OCTA). SVD and DVD were analyzed across the paranasal, peritemporal, perisuperior, and peri-inferior quadrants. Results: Significant differences in superficial vessel density (SVD) were found in the paranasal (EM vs. MM, p = 0.017; EM vs. HM, p = 0.001), peritemporal (EM vs. MM, p = 0.006; EM vs. HM, p = 0.001; LM vs. HM, p = 0.004; MM vs. HM, p = 0.032), perisuperior (EM vs. MM, p = 0.005; EM vs. HM, p = 0.001; LM vs. HM, p = 0.027), and perifoveal quadrants (EM vs. MM, p = 0.003; EM vs. HM, p = 0.008; LM vs. HM, p = 0.004; MM vs. HM, p = 0.012). Deep vessel density (DVD) showed significant differences in the paranasal (p = 0.012–0.022), peritemporal (p = 0.002–0.026), perisuperior (p = 0.003–0.034), perifoveal (p = 0.002–0.017), and peri-inferior (p = 0.002–0.022) quadrants. Retinal thickness was significantly reduced in HM eyes, with the most pronounced reduction in the peritemporal quadrant (mean difference: 16.7 ± 3.2 µm; p < 0.001). Conclusions: Structural and vascular changes in the retina become more pronounced as myopia progresses from moderate to high. The strong correlation between DVD, RT, and myopia severity highlights their potential as reliable biomarkers for monitoring myopia progression through OCTA imaging. These findings provide new insights into the vascular and structural changes underlying myopia and their diagnostic significance. Full article

(This article belongs to the Section Ophthalmology)

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15 pages, 8625 KiB

Open AccessArticle

Morphometric Measurement of Mean Cortical Curvature: Analysis of Alterations in Cognitive Impairment

by Renāte Rūta Apse, Nauris Zdanovskis, Kristīne Šneidere, Guntis Karelis, Ardis Platkājis and Ainārs Stepens

Medicina 2025, 61(3), 531; https://doi.org/10.3390/medicina61030531 - 18 Mar 2025

Viewed by 325

Abstract

Background and Objectives: Cognitive impairment, including mild cognitive impairment (MCI) and Alzheimer’s disease (AD), is a growing public health concern. Early detection and an understanding of structural changes are crucial for accurate diagnosis and timely intervention. Cortical curvature, a morphometric measure derived [...] Read more.

Background and Objectives: Cognitive impairment, including mild cognitive impairment (MCI) and Alzheimer’s disease (AD), is a growing public health concern. Early detection and an understanding of structural changes are crucial for accurate diagnosis and timely intervention. Cortical curvature, a morphometric measure derived from structural magnetic resonance imaging (MRI), has emerged as a potential biomarker for neurodegenerative processes. This study investigates the relationship between mean cortical curvature and cognitive impairment. Materials and Methods: A cross-sectional study was conducted with 58 participants, categorized into, first, cognitively impaired (CI) and non-cognitively impaired (NC) groups and, second, a normal cognitive group (NC), a mild cognitive performance group (MPG), and a low cognitive performance group (LPG) based on the Montreal Cognitive Assessment (MoCA) score. MRI data were acquired using a 3.0 Tesla scanner, and cortical reconstruction was performed using FreeSurfer 7.2.0. Mean cortical curvature values were extracted for 34 brain regions per hemisphere. Results: Significant differences in mean cortical curvature were found between the CI and NC groups. In the right hemisphere, statistically significant changes in mean curvature were observed in the isthmus cingulate (U = 188.5, p = 0.006), lingual (U = 202.5, p = 0.013), pars orbitalis (U = 221.5, p = 0.031), and posterior cingulate regions (U = 224.5, p = 0.035). In the left hemisphere, significant differences were detected in the cuneus (U = 226.5, p = 0.038) and posterior cingulate (U = 231.5, p = 0.046) regions. Analysis across three cognitive performance groups (NC, MPG, and LPG) showed significant curvature differences in the right isthmus cingulate (H(2) = 7.492, p = 0.024) and lingual regions (H(2) = 6.250, p = 0.044). Conclusions: Decreased mean cortical curvature in brain regions associated with cognitive function could be indicative of cognitive impairment and may reflect early neurodegenerative changes. These results highlight cortical curvature as a potential structural sign for cognitive impairment, showing the need for further investigation in longitudinal studies. Full article

(This article belongs to the Special Issue Magnetic Resonance in Various Diseases and Biomedical Applications)

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18 pages, 2154 KiB

Open AccessReview

Bone Health for Gynaecologists

by Angel Yordanov, Mariela Vasileva-Slaveva, Eva Tsoneva, Stoyan Kostov and Vesselina Yanachkova

Medicina 2025, 61(3), 530; https://doi.org/10.3390/medicina61030530 - 18 Mar 2025

Viewed by 510

Abstract

Osteoporosis, the most common bone disorder, profoundly impacts women’s health, especially during postmenopausal phases. Characterised by diminished bone mineral density (BMD), it increases the risk of fractures, affecting mobility, quality of life, and potentially mortality. The present review analyses the intricate interactions among [...] Read more.

Osteoporosis, the most common bone disorder, profoundly impacts women’s health, especially during postmenopausal phases. Characterised by diminished bone mineral density (BMD), it increases the risk of fractures, affecting mobility, quality of life, and potentially mortality. The present review analyses the intricate interactions among physiological alterations, diseases, and medications that lead to bone mineral density reduction in women. It underscores the importance of gynaecologists in the prevention, diagnosis, and management of osteoporosis via early risk assessment, suitable hormone treatment, and lifestyle modifications. Essential considerations encompass the categorisation of osteoporosis into primary (age-related) and secondary (attributable to diseases or pharmacological treatments) types, with particular emphasis on predisposing conditions such as premature menopause, hormone deficits, and cancer therapies. The significance of diagnostic instruments such as DXA and novel methodologies like trabecular bone score and quantitative ultrasonography is emphasised for precise evaluation and surveillance. The review also addresses nutritional methods, physical exercise, and pharmaceutical interventions, including hormone replacement therapy (HRT), selective oestrogen receptor modulators (SERMs), and other anti-resorptive drugs, to preserve bone health. This review highlights the important role of gynaecologists in maintaining women’s bone health, promoting a proactive strategy to avert osteoporosis-related complications and enhance long-term results. Full article

(This article belongs to the Special Issue Bone Regeneration, Osteoporosis and Osteoarthritis)

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14 pages, 1941 KiB

Open AccessSystematic Review

Effect of Autologous Skin Cell Suspensions Versus Standard Treatment on Re-Epithelialization in Burn Injuries: A Meta-Analysis of RCTs

by Faisal M. Obeid

Medicina 2025, 61(3), 529; https://doi.org/10.3390/medicina61030529 - 18 Mar 2025

Viewed by 334

Abstract

Background and Objectives: Burn injuries, particularly partial-thickness burns, often require advanced therapies to improve re-epithelialization and scar quality. This study aims to evaluate the efficacy of autologous skin cell suspensions, such as Recell, compared to standard treatments in promoting faster and better-quality [...] Read more.

Background and Objectives: Burn injuries, particularly partial-thickness burns, often require advanced therapies to improve re-epithelialization and scar quality. This study aims to evaluate the efficacy of autologous skin cell suspensions, such as Recell, compared to standard treatments in promoting faster and better-quality skin healing. Our goal is to provide evidence-based conclusions on the effectiveness of these regenerative approaches in burn treatment. Materials and Methods: During our comprehensive investigation, we systematically examined several databases for the period to November 2024, including PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials. Our primary objective was to assess the efficacy of autologous cell suspension in treatment for burn injuries. We employed the ROB2 method to assess the quality of evidence to ensure the validity of the conclusions derived from these studies. The gathered data were systematically organized in a standardized online format and analyzed with RevMan 5.4. Results: Our systematic literature search identified nine studies (n = 358 patients) evaluating the efficacy of autologous skin cell suspensions in promoting re-epithelialization in burn injuries. The meta-analysis revealed a statistically significant reduction in time to re-epithelialization in the autologous skin cell suspension group compared to the control group (MD = −1.71 days, 95% CI [−2.73, −0.70], p = 0.001), with moderate heterogeneity among the studies (I² = 58%). However, no significant differences were found in secondary outcomes, including postoperative pain (SMD = −0.71, 95% CI [−2.42, 1.00], p = 0.42), POSAS scores (MD = −0.35, 95% CI [−2.12, 1.42], p = 0.69), Vancouver Scar Scale (MD = −0.76, 95% CI [−2.86, 1.33], p = 0.48), or the incidence of complete healing by the 4th week (RR = 0.98, 95% CI [0.94, 1.02], p = 0.24). Similarly, no significant differences were found in postoperative infection rates (RR = 0.85, 95% CI [0.28, 2.60], p = 0.78) or the need for further interventions (RR = 0.15, 95% CI [0.02, 1.16], p = 0.07). Conclusions: autologous skin cell suspension significantly reduces the time to re-epithelialization in burn injuries compared to standard treatments. However, no significant differences were found in secondary outcomes, such as postoperative pain, scar quality (POSAS, Vancouver Scar Scale), complete healing rates, infection rates, or the need for additional interventions. While autologous skin cell suspension shows promise in accelerating re-epithelialization, it does not provide significant advantages over conventional methods in other clinical aspects. The results underscore the need for further research with larger, more robust studies to assess the long-term benefits of autologous skin cell suspension in burns carefully. Full article

(This article belongs to the Special Issue Recent Advances in Plastic and Reconstructive Surgery)

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15 pages, 6489 KiB

Open AccessArticle

Enhancing Endothelial Differentiation of Mesenchymal Stem Cells Derived from Human Turbinates Using Lab-on-a-Chip Technology

by Do Hyun Kim, Sang Hi Park, Mi-yeon Kwon, Chae-Yoon Lim, Sun Hwa Park, David W. Jang, Se Hwan Hwang and Sung Won Kim

Medicina 2025, 61(3), 528; https://doi.org/10.3390/medicina61030528 - 18 Mar 2025

Viewed by 303

Abstract

Background and Objectives: Endothelial cells are essential to various therapeutic strategies for cardiovascular diseases. Developing efficient methods to generate large quantities of well-defined endothelial cells could improve cardiovascular treatment. This study explored the impact of lab-on-a-chip technology on the endothelial differentiation potential [...] Read more.

Background and Objectives: Endothelial cells are essential to various therapeutic strategies for cardiovascular diseases. Developing efficient methods to generate large quantities of well-defined endothelial cells could improve cardiovascular treatment. This study explored the impact of lab-on-a-chip technology on the endothelial differentiation potential of mesenchymal stem cells derived from the human inferior nasal turbinate (hNTSCs). Materials and Methods: hNTSCs were isolated from five patients and divided into two groups: an experimental group subjected to lab-on-a-chip technology and a control group following two-dimensional differentiation protocols. The endothelial differentiation capacity of hNTSCs was assessed through histological examination and gene expression analysis. Results: Comparative evaluation of traditional differentiation methods and lab-on-a-chip technology indicated that hNTSCs expressed endothelial cell-specific markers, including CD34, KDR, CDH5, and CD31. Notably, CD31, CD34, and CDH5 exhibited significantly elevated expression levels in the lab-on-a-chip system. Additionally, cytokine analysis showed marked increases in IL-1a and IL-8 expression under lab-on-a-chip conditions compared to standard differentiation techniques. Conclusions: Lab-on-a-chip technology may enhance the differentiation of hNTSCs into endothelial cells with angiogenic potential, highlighting its promise for future cardiovascular regenerative applications. Full article

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18 pages, 2684 KiB

Open AccessArticle

Evaluating Heart Rate Variability as a Biomarker for Autonomic Function in Parkinson’s Disease Rehabilitation: A Clustering-Based Analysis of Exercise-Induced Changes

by Ahmed M. Basri and Ahmad F. Turki

Medicina 2025, 61(3), 527; https://doi.org/10.3390/medicina61030527 - 17 Mar 2025

Viewed by 530

Abstract

Background: Heart rate variability (HRV) is a key biomarker reflecting autonomic nervous system (ANS) function and neurocardiac regulation. Reduced HRV has been associated with cardiovascular risk, neurodegenerative disorders, and autonomic dysfunction. In Parkinson’s disease (PD), HRV impairments indicate altered autonomic balance, which [...] Read more.

Background: Heart rate variability (HRV) is a key biomarker reflecting autonomic nervous system (ANS) function and neurocardiac regulation. Reduced HRV has been associated with cardiovascular risk, neurodegenerative disorders, and autonomic dysfunction. In Parkinson’s disease (PD), HRV impairments indicate altered autonomic balance, which may be modifiable through structured exercise interventions. This study investigates the effects of aerobic exercise on HRV in patients with PD and evaluates autonomic adaptations to rehabilitation. Methods: A total of 110 patients with PD (55 male, 55 female) participated in a supervised three-month aerobic exercise program. HRV was assessed pre- and post-intervention using electrocardiogram (ECG) recordings. Time-domain and frequency-domain HRV metrics, including standard deviation of RR intervals (SDRR), very-low-frequency (VLF), low-frequency (LF), high-frequency (HF) power, and LF/HF ratio, were analyzed. Principal Component Analysis (PCA) and clustering techniques were applied to identify subgroups of HRV responders based on autonomic adaptation. Results: Significant improvements in HRV were observed post-intervention, with a reduction in LF/HF ratio (p < 0.05), indicating improved autonomic balance. Cluster analysis identified four distinct HRV response subgroups: Strong Responders, Moderate Responders, Mixed/Irregular Responders, and Low Responders. These findings highlight individual variability in autonomic adaptations to exercise. PCA revealed that key HRV parameters contribute differently to autonomic regulation, emphasizing the complexity of HRV changes in PD rehabilitation. Conclusions: This study demonstrates that aerobic exercise induces beneficial autonomic adaptations in PD patients, as reflected by HRV changes. The identification of response subgroups suggests the need for personalized rehabilitation strategies to optimize autonomic function. Further research is warranted to explore the long-term impact of HRV-guided rehabilitation interventions in PD management. Full article

(This article belongs to the Section Neurology)

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15 pages, 2429 KiB

Open AccessArticle

The Effects of Individual Components of E-Cigarettes on Ion Transport and Airway Surface Liquid Height in Human Bronchial Epithelial Cells

by Ozge Beyazcicek, Robert Tarran, Recep Ozmerdivenli and Ersin Beyazcicek

Medicina 2025, 61(3), 526; https://doi.org/10.3390/medicina61030526 - 17 Mar 2025

Viewed by 458

Abstract

Background and Objectives: The rising popularity of new-generation electronic cigarettes (e-cig) like JUUL necessitates a better understanding of their impact on respiratory and other body systems, as the effects of JUUL’s components remain unclear. This study aimed to investigate the effects of JUUL [...] Read more.

Background and Objectives: The rising popularity of new-generation electronic cigarettes (e-cig) like JUUL necessitates a better understanding of their impact on respiratory and other body systems, as the effects of JUUL’s components remain unclear. This study aimed to investigate the effects of JUUL components on ion channels and airway surface liquid (ASL) height in human bronchial epithelial cells (HBECs). Furthermore, the cytotoxic effects of these components were investigated in human embryonic kidney 293T (HEK293T) cells. Materials and Methods: The components tested included nicotine salt (NicSalt), benzoic acid (BA), sodium hydrogen tartrate (NaTar), propylene glycol/vegetable glycerin (PG/VG), freebase nicotine (FBNic) and nicotine salt+benzoic acid (NicSalt+BA). Each component was prepared at 100 µM, and HBECs were exposed for 24 h to measure ASL height, short-circuit current (I_sc), and transepithelial electrical resistance (TEER). Results: Initial exposure (0 h) to these substances did not significantly alter ASL height. However, after 2 h, FBNic-treated HBECs exhibited a significant reduction in ASL height compared to NicSalt and other tested substances, with the most pronounced decrease observed at the 6th hour. This effect persisted over prolonged exposure, suggesting a cumulative impact on airway hydration and epithelial function. Additionally, adenosine administration did not induce a significant increase in ASL height. NicSalt, BA, and FBNic were found to disrupt ion balance in HBECs, affecting ion channels and ASL homeostasis while significantly decreasing TEER. In terms of cytotoxicity, NicSalt, and benzoic acid demonstrated minimal cytotoxicity at low concentrations, whereas FBNic showed significantly higher cytotoxicity at moderate levels. Conclusions: In conclusion, this study highlights that e-cigarette components can disrupt airway surface liquid homeostasis by affecting ion channel activity, compromise epithelial barrier integrity by reducing transepithelial electrical resistance, and emphasize the importance of their cytotoxic effects. Full article

(This article belongs to the Section Epidemiology & Public Health)

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13 pages, 1234 KiB

Open AccessArticle

Measurement of Limbic System Anatomical Volumes in Patients Diagnosed with Schizophrenia Using Vol2brain and Comparison with Healthy Individuals

by Mert Ocak and Buket Oguz

Medicina 2025, 61(3), 525; https://doi.org/10.3390/medicina61030525 - 17 Mar 2025

Viewed by 400

Abstract

Background and Objectives: Schizophrenia is a chronic psychiatric disorder affecting approximately 24 million people worldwide, characterized by structural and functional brain abnormalities. Despite its prevalence, automated segmentation tools like Vol2Brain have been underutilized in large-sample studies examining limbic system anatomical volumes in [...] Read more.

Background and Objectives: Schizophrenia is a chronic psychiatric disorder affecting approximately 24 million people worldwide, characterized by structural and functional brain abnormalities. Despite its prevalence, automated segmentation tools like Vol2Brain have been underutilized in large-sample studies examining limbic system anatomical volumes in patients with schizophrenia. This study aimed to assess volume differences in all major limbic system structures between schizophrenia patients and healthy controls using Vol2Brain. Method: This retrospective study included 68 schizophrenia patients and 68 healthy controls, with MRI scans obtained from OpenNeuro. Limbic system volumetric and cortical thickness measurements were conducted using Vol2Brain, an automated segmentation platform. Results: Schizophrenia patients exhibited significantly reduced volumes in the amygdala, hippocampus, anterior cingulate gyrus, posterior cingulate gyrus, and middle cingulate gyrus compared to controls. However, the left amygdala volume was larger in schizophrenia patients. A cortical thickness analysis revealed that schizophrenia patients had thinner limbic cortices, particularly in the anterior and posterior cingulate gyri and the right parahippocampal gyrus. In contrast, the right anterior cingulate gyrus was thicker in schizophrenia patients. The differences in total and left parahippocampal gyrus volumes and cortical thickness did not reach statistical significance. Conclusions: These findings reinforce previous evidence of limbic system abnormalities in patients with schizophrenia, which may contribute to cognitive and emotional dysregulation. The study also highlights Vol2Brain’s potential as a rapid, cost-free, and reliable alternative for brain volume analysis, facilitating more standardized and reproducible neuroimaging assessments in psychiatric research. Full article

(This article belongs to the Section Neurology)

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18 pages, 1822 KiB

Open AccessSystematic Review

Impact of Virtual Reality Alone and in Combination with Conventional Therapy on Balance in Parkinson’s Disease: A Systematic Review with a Meta-Analysis of Randomized Controlled Trials

by Giorgio De Natale, Erda Qorri, Jasemin Todri and Orges Lena

Medicina 2025, 61(3), 524; https://doi.org/10.3390/medicina61030524 - 17 Mar 2025

Cited by 1 | Viewed by 854

Abstract

Background and Objectives: Virtual reality (VR)-based interventions provide immersive and interactive environments that can enhance motor learning and deliver real-time feedback, offering potential advantages over conventional therapies. This systematic review evaluated the impact of non-immersive and immersive VR exergaming interventions versus conventional [...] Read more.

Background and Objectives: Virtual reality (VR)-based interventions provide immersive and interactive environments that can enhance motor learning and deliver real-time feedback, offering potential advantages over conventional therapies. This systematic review evaluated the impact of non-immersive and immersive VR exergaming interventions versus conventional therapy on balance in Parkinson’s disease (PD) through a detailed analysis of randomized controlled trials (RCTs). Materials and Methods: A comprehensive search was conducted across the PubMed, Lilacs, IBECS, CENTRAL, Web of Science (WOS), EBSCOHost, and SciELO databases. Article selection and duplicate removal were managed using Rayyan QCRI. The quality of the evidence was assessed using the GRADE system. Results: From an initial screening of 100 studies, 58 underwent title and abstract screening. After full-text evaluation, 11 RCTs met the inclusion criteria, involving 518 participants with PD (average age: 67.3 years; 67.95% men). The balance outcomes were primarily measured using the Berg balance scale (BBS), employed in most studies (n = 9). The pooled analysis demonstrated a significant improvement in the balance scores for the experimental groups compared to the controls, with a standardized mean difference (SMD) of 0.58 [95% CI: 0.07, 1.09, p = 0.03]. However, the heterogeneity was substantial (I² = 77%). The analysis of the six-minute walking test (6 MWT), as another outcome of four articles, revealed a mean difference of 32.99 m [95% CI: −8.02, 74.00], but the effect was not statistically significant (p = 0.11). The heterogeneity for this outcome was moderate (I² = 41%), indicating some variability across studies. Alternative tools, such as the Tinetti Performance-Oriented Mobility Assessment (POMA) scale, the UPDRS III, and the sensory organization test (SOT), were also evaluated where possible. Conclusions: VR-based interventions offer promise for improving balance in Parkinson’s disease, enhancing rehabilitation engagement. Their integration into clinical practice could complement conventional therapy. However, further research is needed to optimize protocols, standardize parameters, and maximize their impact on mobility, independence, and quality of life. Full article

(This article belongs to the Section Neurology)

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9 pages, 836 KiB

Open AccessArticle

Effect of Remimazolam and Propofol on Blood Glucose and Serum Inflammatory Markers in Patients with Type 2 Diabetes: A Clinical Trial with Prospective Randomized Control

by Sang Hun Kim, Sang Min Yoon, Ji Hye Ahn and Yoon Ji Choi

Medicina 2025, 61(3), 523; https://doi.org/10.3390/medicina61030523 - 17 Mar 2025

Viewed by 315

Abstract

Background and Objectives: Patients with type 2 diabetes are at a higher risk of postoperative complications, such as infections, delayed wound healing, and increased mortality compared to non-diabetic patients. Materials and Methods: This prospective randomized study aims to compare the effects of two anesthetics, [...] Read more.

Background and Objectives: Patients with type 2 diabetes are at a higher risk of postoperative complications, such as infections, delayed wound healing, and increased mortality compared to non-diabetic patients. Materials and Methods: This prospective randomized study aims to compare the effects of two anesthetics, remimazolam and propofol, on blood glucose levels and immune function in diabetic patients undergoing surgery. Seventy-four diabetic patients undergoing general anesthesia were randomly assigned to receive either remimazolam or propofol. Plasma blood glucose levels, anti-inflammatory markers, and insulin levels were measured during the perioperative period. Results: No statistically significant differences were observed between the remimazolam and propofol groups in terms of neutrophil-to-lymphocyte ratio, anti-inflammatory markers, or glucose levels during the perioperative period (p value > 0.05). Conclusions: These results suggest that there is no difference between propofol and remimazolam in immune function deterioration that occurs due to surgical stress. This study is limited by its small sample size, and in future, larger trials could be conducted to find differences in the effects of blood sugar levels and serum inflammatory markers between the two groups. Full article

(This article belongs to the Special Issue Anesthesia and Analgesia in Surgical Practice)

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11 pages, 1571 KiB

Open AccessArticle

Metformin Increases Serum Isthmin-1 Levels and Lowers Low-Density Lipoprotein: Potential Implications for Lipid Metabolism in T2DM

by Merve Yilmaz Bozoglan, Tuncay Kuloglu, Nevzat Gozel, Faruk Kılınc, Erkan Cakmak, Ramazan Fazıl Akkoç and Betül Dağoğlu Hark

Medicina 2025, 61(3), 522; https://doi.org/10.3390/medicina61030522 - 17 Mar 2025

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Abstract

Background and Objectives: Type 2 Diabetes Mellitus (T2DM) is a metabolic disease caused by the failure of the skeletal muscle, liver and adipose tissue to respond to insulin. Metformin is the first choice for the treatment of T2DM. Isthmin 1 (Ism1) is a [...] Read more.

Background and Objectives: Type 2 Diabetes Mellitus (T2DM) is a metabolic disease caused by the failure of the skeletal muscle, liver and adipose tissue to respond to insulin. Metformin is the first choice for the treatment of T2DM. Isthmin 1 (Ism1) is a newly discovered adipokine that affects all carbohydrate, lipid and protein metabolism. This study examines the changes in serum and salivary levels of Ism1 in patients using metformin, considering its potential as a follow-up marker for T2DM if present in the salivary glands. Materials and Methods: The study included 30 newly diagnosed T2DM patients and 30 non-diabetic controls. Ism1 was measured by ELISA in serum and saliva after 3 months and compared with routine biochemical parameters. Immunostaining of Ism1 was performed in salivary glands. Results: Ism1 was immunohistochemically detected in salivary glands for the first time. Serum Ism1 levels increased significantly after 3 months of metformin treatment (p = 0.028). The increase in salivary Ism1 levels did not reach statistical significance. Fasting plasma glucose (FPG) (p < 0.001), HbA1c (p < 0.001) and LDL (p = 0.015) levels decreased with metformin. There was a significant negative correlation between the increase in Ism1 levels and the decrease in LDL levels (rho = −0.362, p = 0.05). Conclusions: Despite its first detection in salivary glands, the hypothesis that Ism1 may be a surveillance marker in T2DM could not be confirmed. The negative correlation of Ism1 with LDL levels suggests that Ism1 may contribute to the ameliorative effect of metformin on serum lipids. Further studies are needed to support this conclusion. Full article

(This article belongs to the Section Endocrinology)

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11 pages, 5658 KiB

Open AccessCase Report

A Novel Hybrid Approach to Manage Mycotic Pseudoaneurysm Post-Renal Transplantation: Successful Graft Preservation

by Ho Li, Yi-Chang Lin, Chien-Chang Kao, Pei-Jhang Chiang, Meng-Han Chou, Hui-Kung Ting, Yu-Cing Jhuo, Ming-Hsin Yang, Chih-Wei Tsao, En Meng, Guang-Huan Sun, Dah-Shyong Yu, Sun-Yran Chang, Chin-Li Chen and Sheng-Tang Wu

Medicina 2025, 61(3), 521; https://doi.org/10.3390/medicina61030521 - 17 Mar 2025

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Abstract

Background and Objectives: Post-transplant anastomotic pseudoaneurysms are a rare but serious complication of renal transplantation, typically requiring graft sacrifice. This case report demonstrates a novel hybrid approach for managing a mycotic pseudoaneurysm while preserving graft function. Case report: A 56-year-old male developed [...] Read more.

Background and Objectives: Post-transplant anastomotic pseudoaneurysms are a rare but serious complication of renal transplantation, typically requiring graft sacrifice. This case report demonstrates a novel hybrid approach for managing a mycotic pseudoaneurysm while preserving graft function. Case report: A 56-year-old male developed a pseudoaneurysm at the anastomotic site after cadaveric kidney transplantation, presenting with recurrent infections and declining renal function. Imaging confirmed the pseudoaneurysm. A hybrid strategy combining femoral–femoral bypass with a polytetrafluoroethylene graft, percutaneous transluminal angioplasty with stenting, and coil embolization was performed. Results: The intervention successfully isolated the pseudoaneurysm and preserved graft function. Post-procedure, serum creatinine levels improved, stabilizing at 2.3 mg/dL during follow-up. Imaging confirmed no residual flow in the aneurysm, and vascular complications were absent. Conclusions: This report highlights a successful combined surgical and endovascular approach for treating mycotic pseudoaneurysms, preserving graft function and restoring limb blood flow. This strategy offers a promising alternative for managing complex post-transplant complications, though long-term outcomes require further evaluation. Full article

(This article belongs to the Section Urology & Nephrology)

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Medicina, Volume 61, Issue 3 (March 2025) – 187 articles

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