Medicina

14 pages, 3788 KiB

Open AccessArticle

The Potential of SHAP and Machine Learning for Personalized Explanations of Influencing Factors in Myopic Treatment for Children

by Jun-Wei Chen, Hsin-An Chen, Tzu-Chi Liu, Tzu-En Wu and Chi-Jie Lu

Medicina 2025, 61(1), 16; https://doi.org/10.3390/medicina61010016 (registering DOI) - 26 Dec 2024

Abstract

Background and Objectives: The rising prevalence of myopia is a significant global health concern. Atropine eye drops are commonly used to slow myopia progression in children, but their long-term use raises concern about intraocular pressure (IOP). This study uses SHapley Additive exPlanations (SHAP) [...] Read more.

Background and Objectives: The rising prevalence of myopia is a significant global health concern. Atropine eye drops are commonly used to slow myopia progression in children, but their long-term use raises concern about intraocular pressure (IOP). This study uses SHapley Additive exPlanations (SHAP) to improve the interpretability of machine learning (ML) model predicting end IOP, offering clinicians explainable insights for personalized patient management. Materials and Methods: This retrospective study analyzed data from 1191 individual eyes of 639 boys and 552 girls with myopia treated with atropine. The average age of the whole group was 10.6 ± 2.5 years old. The refractive error of spherical equivalent (SE) in myopia degree was base SE at 2.63D and end SE at 3.12D. Data were collected from clinical records, including demographic information, IOP measurements, and atropine treatment details. The patients were divided into two subgroups based on a baseline IOP of 14 mmHg. ML models, including Lasso, CART, XGB, and RF, were developed to predict the end IOP value. Then, the best-performing model was further interpreted using SHAP values. The SHAP module created a personalized and dynamic graphic to illustrate how various factors (e.g., age, sex, cumulative duration, and dosage of atropine treatment) affect the end IOP. Results: RF showed the best performance, with superior error metrics in both subgroups. The interpretation of RF with SHAP revealed that age and the recruitment duration of atropine consistently influenced IOP across subgroups, while other variables had varying effects. SHAP values also offer insights, helping clinicians understand how different factors contribute to predicted IOP value in individual children. Conclusions: SHAP provides an alternative approach to understand the factors affecting IOP in children with myopia treated with atropine. Its enhanced interpretability helps clinicians make informed decisions, improving the safety and efficacy of myopia management. This study demonstrates the potential of combining SHAP with ML models for personalized care in ophthalmology. Full article

(This article belongs to the Special Issue Ophthalmology: New Diagnostic and Treatment Approaches)

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12 pages, 782 KiB

Open AccessArticle

Role of Ultrasonography in Monitoring Chemotherapeutic Effects on Primary Thyroid Lymphoma: A Single-Center Retrospective Study

by Shirong Liu, Ying Fu, Ligang Cui, Shumin Wang and Shi Tan

Medicina 2025, 61(1), 15; https://doi.org/10.3390/medicina61010015 (registering DOI) - 26 Dec 2024

Abstract

Background and Objectives: In this study, we assessed the utility of ultrasonography in monitoring the chemotherapeutic effects on primary thyroid lymphoma (PTL). Materials and Methods: This retrospective analysis included 17 patients with PTL who received chemotherapy from 2012 to 2022. The sonographic features [...] Read more.

Background and Objectives: In this study, we assessed the utility of ultrasonography in monitoring the chemotherapeutic effects on primary thyroid lymphoma (PTL). Materials and Methods: This retrospective analysis included 17 patients with PTL who received chemotherapy from 2012 to 2022. The sonographic features were examined pre- and post-treatment using ultrasound (US) to monitor the treatment response at the first to second, third to fourth, and end cycles of chemotherapy and follow-up, and progression-free survival (PFS) and overall survival (OS) were analyzed. Results: The sonographic findings for all the patients indicated diffuse or nodular infiltration with markedly hypoechoic masses, and “stripe-shaped” high echoes and posterior acoustic enhancement were observed. Following one to two cycles of chemotherapy, a US examination revealed varying tumor reduction degrees and diminished blood flow signals. After three to four cycles of chemotherapy, the US demonstrated an evaluation efficacy comparable to that of PET-CT in cases in which the lesion had entirely disappeared postchemotherapy; however, its ability to differentiate between treatment response and residual lesions was less effective compared to that of PET-CT. After the end cycle of chemotherapy, the lesion sizes had significantly decreased compared to those at the baseline (p < 0.05). Postchemotherapy, Adler’s blood flow grades decreased significantly, with 80% graded as 0–1. Among the 10 patients with cervical lymph node enlargement, 70% showed reduced lesion sizes and blood flow signals. The cumulative 5-year PFS and OS rates were both 80% for the diffuse type and 82.5% and 78.8% for the nodular type, respectively (p > 0.05). Conclusions: US can be utilized to monitor the therapeutic response following chemotherapy for PTL, especially for early assessment and repeated dynamic monitoring, and can serve as a complementary follow-up method to PET-CT. Full article

(This article belongs to the Section Endocrinology)

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39 pages, 2158 KiB

Open AccessReview

Integrated Insights into Metabolic and Bariatric Surgery: Improving Life Quality and Reducing Mortality in Obesity

by Ruxandra-Cristina Marin, Andrei-Flavius Radu, Paul Andrei Negru, Ada Radu, Denisa Negru, Raluca Anca Corb Aron, Teodora Maria Bodog, Ruxandra Florina Bodog, Paula Bianca Maghiar and Roxana Brata

Medicina 2025, 61(1), 14; https://doi.org/10.3390/medicina61010014 (registering DOI) - 26 Dec 2024

Abstract

Metabolic and bariatric surgery (MBS) is an effective intervention for patients with severe obesity and metabolic comorbidities, particularly when non-surgical weight loss methods prove insufficient. MBS has shown significant potential for improving quality of life and metabolic health outcomes in individuals with obesity, [...] Read more.

Metabolic and bariatric surgery (MBS) is an effective intervention for patients with severe obesity and metabolic comorbidities, particularly when non-surgical weight loss methods prove insufficient. MBS has shown significant potential for improving quality of life and metabolic health outcomes in individuals with obesity, yet it carries inherent risks. Although these procedures offer a multifaceted approach to obesity treatment and its clinical advantages are well-documented, the limited understanding of its long-term outcomes and the role of multidisciplinary care pose challenges. With an emphasis on quality-of-life enhancements and the handling of postoperative difficulties, the present narrative review seeks to compile the most recent findings on MBS while emphasizing the value of an integrated approach to maximize patient outcomes. Effective MBS and patients’ management require a collaborative team approach, involving surgeons, dietitians, psychologists, pharmacists, and other healthcare providers to address not only physiological but also psychosocial patient needs. Comparative studies demonstrate the efficacy of various MBS methods, including Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy that may considerably decrease morbidity and mortality in individuals with obesity. Future studies should target long-term patient treatment, and decision making should be aided by knowledge of obesity, comorbidity recurrence rates, and permanence of benefits. Full article

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9 pages, 474 KiB

Open AccessArticle

Using the Cardiac–Electrophysiological Balance Index to Predict Arrhythmia Risk After Colonoscopy

by Seyit Ali Volkan Polatkan, Seyda Gunay-Polatkan, Ozgen Isik and Deniz Sigirli

Medicina 2025, 61(1), 13; https://doi.org/10.3390/medicina61010013 (registering DOI) - 26 Dec 2024

Abstract

Background and Objectives: Colorectal cancer is the second leading cause of cancer-related deaths in the U.S., and colonoscopy is a critical tool for colon cancer screening and diagnosis. Electrolyte disturbances and autonomic nervous system dysfunction that may occur due to bowel preparation and [...] Read more.

Background and Objectives: Colorectal cancer is the second leading cause of cancer-related deaths in the U.S., and colonoscopy is a critical tool for colon cancer screening and diagnosis. Electrolyte disturbances and autonomic nervous system dysfunction that may occur due to bowel preparation and the colonoscopy procedure itself may play a role in the development of cardiac arrhythmia. This study aimed to assess the index of cardiac–electrophysiological balance (iCEB) to predict ventricular arrhythmia risk related to colonoscopy. Materials and Methods: Patients undergoing elective colonoscopy with a normal sinus rhythm were included. Electrocardiography (ECG) recordings both before bowel preparation and after the colonoscopy procedure were obtained. Values of the index of cardiac–electrophysiological balance (iCEB) were compared. Results: Among 36 patients, it was determined that the heart rate values of the patients before bowel preparation were higher than the heart rate values after colonoscopy [74.5 (60–108) bpm vs. 68.5 (53–108) bpm, p = 0.021]. The duration of QT interval increased (370.9 ± 27.8 ms vs. 398.7 ± 29.4 ms, p < 0.001) and the iCEB increased from 4.1 ± 0.5 to 4.5 ± 0.6 (p < 0.001), indicating a significant post-procedural risk of ventricular arrhythmias. Conclusions: These findings suggest that routine iCEB assessment post-colonoscopy could identify high-risk patients requiring closer monitoring. Full article

(This article belongs to the Section Gastroenterology & Hepatology)

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12 pages, 1613 KiB

Open AccessArticle

Evolution of Liver Resection for Hepatocellular Carcinoma: Change Point Analysis of Textbook Outcome over Twenty Years

by Yeshong Park, Ho-Seong Han, Seung Yeon Lim, Hyelim Joo, Jinju Kim, MeeYoung Kang, Boram Lee, Hae Won Lee, Yoo-Seok Yoon and Jai Young Cho

Medicina 2025, 61(1), 12; https://doi.org/10.3390/medicina61010012 (registering DOI) - 26 Dec 2024

Abstract

Background and Objectives: The aim of this study was to comprehensively analyze the evolution in textbook outcome (TO) achievement after liver resection for hepatocellular carcinoma (HCC) over two decades at a single tertiary referral center. Materials and Methods: All consecutive liver [...] Read more.

Background and Objectives: The aim of this study was to comprehensively analyze the evolution in textbook outcome (TO) achievement after liver resection for hepatocellular carcinoma (HCC) over two decades at a single tertiary referral center. Materials and Methods: All consecutive liver resections for HCC at Seoul National University Bundang Hospital from 2003 to 2022 were analyzed. The included 1334 patients were divided into four groups by time intervals identified through change point analysis. TO was defined as no intraoperative transfusions, positive margins, major complications, 30-day readmission or mortality, and prolonged length of hospital stay (LOS). Results: Multiple change point analysis identified three change points (2006, 2012, 2017), and patients were divided into four groups. More recent time interval groups were associated with older age (59 vs. 59 vs. 61 vs. 63 years, p < 0.0001) and more comorbidities. Minimally invasive procedures were increasingly performed (open/laparoscopic/robotic 37.0%/63.0%/0%) vs. 43.8%/56.2%/0% vs. 17.1%/82.4%/0.5% vs. 22.9%/75.9%/1.2%, p < 0.0001). TO achievement improved over time (1.9% vs. 18.5% vs. 47.7% vs. 62.5%, p < 0.0001), and LOS was the greatest limiting factor. Conclusions: TO after liver resection improved with advances in minimally invasive techniques and parenchymal sparing procedures, even in older patients with more comorbidities and advanced tumors. Full article

(This article belongs to the Special Issue Advances in Liver Surgery)

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11 pages, 1134 KiB

Open AccessArticle

Effects of a Serratus Anterior Plane Block After Video-Assisted Lung Wedge Resection: A Single-Center, Prospective, and Randomized Controlled Trial

by Seokjin Lee, Tae-Yun Sung, Choon-Kyu Cho, Gyuwon Lee and Woojin Kwon

Medicina 2025, 61(1), 11; https://doi.org/10.3390/medicina61010011 - 26 Dec 2024

Abstract

Background and Objectives: Video-assisted thoracoscopic surgery (VATS) is associated with less postoperative pain than traditional open thoracotomy. However, trocar and chest tube placement may damage the intercostal nerves, causing significant discomfort. An ultrasound-guided serratus anterior plane block (SAPB) is a promising mode [...] Read more.

Background and Objectives: Video-assisted thoracoscopic surgery (VATS) is associated with less postoperative pain than traditional open thoracotomy. However, trocar and chest tube placement may damage the intercostal nerves, causing significant discomfort. An ultrasound-guided serratus anterior plane block (SAPB) is a promising mode of pain management; this reduces the need for opioids and the associated side-effects. This study evaluated whether SAPB, compared to intravenous analgesia alone, reduces opioid consumption after thoracoscopic lung wedge resection. Materials and Methods: In total, 22 patients undergoing VATS lung wedge resections were randomized into two groups (SAPB and control): both received intravenous patient-controlled analgesia (PCA), and one group received additional SAPB. The primary outcome was the cumulative intravenous fentanyl consumption at 8 h postoperatively. The visual analog scale (VAS) pain scores and the incidence of postoperative complications were assessed over 48 h post surgery. Results: Fentanyl consumption by 8 h post surgery was significantly lower in the SAPB group than in the control group (183 ± 107 μg vs. 347 ± 202 μg, p = 0.035). Although the VAS scores decreased with time in both groups, the differences were not statistically significant. The SAPB group required fewer opioids by 48 h. No significant between-group differences were observed in postoperative complications, including nausea and vomiting. Conclusions: SAPB effectively reduced opioid consumption after VATS lung wedge resection. SABP may serve as a valuable component of multimodal pain management. Full article

(This article belongs to the Special Issue Current Therapies for Trauma and Surgical Critical Care)

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11 pages, 427 KiB

Open AccessArticle

Predictive Factors Associated with Inappropriate Intravenous Proton Pump Inhibitors Use in Hospitalized Patients: A Case-Control Study

by Niveen Khoury, David Stepensky, Naim Abu Freha, Mahmud Mahamid, Tawfik Khoury and Amir Mari

Medicina 2025, 61(1), 10; https://doi.org/10.3390/medicina61010010 - 25 Dec 2024

Abstract

Background and Objectives: Proton Pump Inhibitors (PPIs) are the most effective agents for treating acid-related gastrointestinal disorders. The prescription of an intravenous (IV) formulation of PPIs has increased dramatically. The aims of this study were to assess the appropriateness of IV PPI [...] Read more.

Background and Objectives: Proton Pump Inhibitors (PPIs) are the most effective agents for treating acid-related gastrointestinal disorders. The prescription of an intravenous (IV) formulation of PPIs has increased dramatically. The aims of this study were to assess the appropriateness of IV PPI use and to define the risk factors and outcomes associated with its inappropriate use. Materials and Methods: A case-control retrospective study included all the hospitalized patients who received IV PPIs was conducted. Patient health records were reviewed, data were collected covering the period of the individual patients’ admission to the hospital until discharge or death, and over the 3-month post-discharge period. The appropriateness of the IV PPI use and the resulting clinical outcomes were analyzed. Results: Overall, 540 patients were analyzed. Among them, 130/540 (24%) had inappropriate PPI use in terms of indication, dosage, and duration of treatment vs. 410 patients who had appropriate indications. Two parameters were associated with inappropriate use: congestive heart failure (OR 1.77; p = 0.02) and prescription of IV PPIs by surgeons vs. internists (OR 1.53; p = 0.05). Conclusions: Inappropriate IV PPI use is still common in daily clinical practice. Significant predictors of inappropriate use were the presence of congestive heart failure, elderly age, current use of anticoagulants and antithromotics, and the cases managed by surgeons, naturally due to suspected upper gastrointestinal bleedings. Full article

(This article belongs to the Special Issue Management of Gastrointestinal Disorders Related to Infectious Diseases and Medications)

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12 pages, 1497 KiB

Open AccessArticle

Accessibility and Quality of Palliative Care—Experience in Primary Health Care

by Viljaras Reigas and Ingrida Šukienė

Medicina 2025, 61(1), 9; https://doi.org/10.3390/medicina61010009 - 25 Dec 2024

Abstract

Background and Objectives: Palliative care is a very important part of medicine, aimed at ensuring an improvement in quality of life and a reduction in distressing symptoms in patients with serious, incurable, progressive diseases. The issues of the accessibility and quality of these [...] Read more.

Background and Objectives: Palliative care is a very important part of medicine, aimed at ensuring an improvement in quality of life and a reduction in distressing symptoms in patients with serious, incurable, progressive diseases. The issues of the accessibility and quality of these services should be a focus for health policymakers and researchers, although it is acknowledged that a significant portion of the public has not heard about this service. For this reason, it is important to investigate the experience of the accessibility and quality of palliative care services in primary healthcare facilities. Materials and Methods: A quantitative study was conducted in institutions providing outpatient and inpatient palliative care services. A total of 784 patients and 219 family members participated in the study. Participants expressed their opinions through a questionnaire containing 24 statements, to which they responded by indicating their level of agreement on a Likert scale. The collected data were analyzed using statistical analysis software. Results: Palliative care services are widely available in large cities, but their accessibility is very limited in small towns and rural areas. Patients and their families are not familiar with the concept of palliative care, often equating it with the provision of treatment and nursing services, and they see the support of clergy as unnecessary. Although patients and their families rate the quality of the services received positively, they note shortcomings related to communication among staff. Conclusions: Palliative care services are provided within the primary healthcare system by specialists with qualifications regulated by legislation; however, patients do not see the need to receive assistance from clergy members. Based on the study results, it can be concluded that in Lithuania, the accessibility of palliative care is ensured in larger cities but is insufficient in smaller towns and rural areas. Patients tend to rate indicators reflecting the quality of palliative care services positively; however, they are not convinced that these services improve their quality of life. Full article

(This article belongs to the Section Oncology)

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7 pages, 486 KiB

Open AccessArticle

The Frequency of Mediastinal Lymph Node Calcification in Sarcoidosis Patients and the Influencing Factors

by Pelin Pınar Deniz, Pelin Duru Çetinkaya, Saida Mehdiyeva and İsmail Hanta

Medicina 2025, 61(1), 8; https://doi.org/10.3390/medicina61010008 - 25 Dec 2024

Abstract

Background and Objectives: This study investigates the prevalence of calcification in mediastinal lymph nodes among sarcoidosis patients and the influencing factors. Sarcoidosis is a multisystemic inflammatory disease characterized by non-caseating epithelioid granulomas. Bilateral hilar lymphadenopathy (LAP) is the most common radiographic finding, [...] Read more.

Background and Objectives: This study investigates the prevalence of calcification in mediastinal lymph nodes among sarcoidosis patients and the influencing factors. Sarcoidosis is a multisystemic inflammatory disease characterized by non-caseating epithelioid granulomas. Bilateral hilar lymphadenopathy (LAP) is the most common radiographic finding, with studies showing a correlation between the frequency of lymph node calcification and disease duration, with a frequency of 3% relating to a duration of 5 years and a frequency of 20% relating to one of 10 years. Materials and Methods: This study involved fifty-seven patients diagnosed with sarcoidosis at our chest disease outpatient clinic from January 2020 to September 2022. We examined patient records to determine demographics, radiological findings, and respiratory function parameters. Results: The mean age of patients was 55.07 ± 13.53 (21–90). We identified eighty percent of patients with stage 2 sarcoidosis. Hilar lymph node calcification was observed in 13 cases (22.8%). Among the 13 cases, punctate calcification was detected in 2 (15.4%), while diffuse calcification was observed in 11 (84.6%). The mean duration of sarcoidosis diagnosis in patients was 4.1 ± 3.2 years (range: 1–14 years). Within the first 5 years after diagnosis, calcification in lymph nodes was detected in 18.6% of cases, while of patients diagnosed more than 5 years ago, 35.71% showed lymph node calcification. Conclusions: Our findings suggest that mediastinal lymph node calcification is more common than previously reported, and integrating clinical evaluation and patient history in cases with bilateral hilar LAP can help to avoid unnecessary invasive and costly procedures. Full article

(This article belongs to the Section Pulmonology)

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7 pages, 8199 KiB

Open AccessCase Report

Central Serous Chorioretinopathy Associated with Corticosteroid Use in a Patient with Leber Hereditary Optic Neuropathy: A Case Report

by Lepsa Zoric, Aleksandra Petrovic and Vladimir Milutinovic

Medicina 2025, 61(1), 7; https://doi.org/10.3390/medicina61010007 - 25 Dec 2024

Abstract

Introduction. Leber hereditary optic neuropathy (LHON) is a condition characterized by bilateral acute or subacute vision loss in seemingly healthy individuals. Depending on the disease stage and initial presentation, it is often diagnosed as optic neuritis. Elevated levels of endogenous and exogenous [...] Read more.

Introduction. Leber hereditary optic neuropathy (LHON) is a condition characterized by bilateral acute or subacute vision loss in seemingly healthy individuals. Depending on the disease stage and initial presentation, it is often diagnosed as optic neuritis. Elevated levels of endogenous and exogenous glucocorticoids have been associated with the onset of central serous chorioretinopathy (CSCR). In our patient, CSCR developed after only three days of pulse corticosteroid therapy, prescribed due to initial presentation as bilateral optic neuritis (papillitis). Objective. Through our case report, we aimed to highlight that CSCR can develop after the initiation of pulse corticosteroid therapy in a patient with LHON and to propose choroidal thickness as a potential contributing factor for this complication. Case Presentation. A 27-year-old male patient presented with painless subacute vision loss in both eyes. The decline in vision developed gradually over 20 days, prior to the patient’s referral to the UKCS Eye Disease Clinic for further examination and treatment, and was not accompanied by pain during eye movements. Initial investigations upon admission to the clinic established the diagnosis of optic neuritis. Consequently, pulse corticosteroid therapy was administered. Three days after the initiation of intravenous methylprednisolone, the patient developed bilateral central serous chorioretinopathy. After cessation of therapy, there was a rapid resolution of choroidopathy, but no improvement in visual acuity, prompting genetic testing. Subsequent laboratory results revealed a positive test for the LHON mutation m.3460 G>A (MT-ND1). Conclusions. LHON is often misdiagnosed as optic neuritis, as upon initial presentation the optic nerve disk often does not exhibit the apparent characteristics of LHON. Numerous studies have documented the development of central serous chorioretinopathy following corticosteroid treatment, though none have reported the onset of CSCR after only three days of pulse corticosteroid therapy. Increased choroidal thickness is a characteristic of the acute phase of LHON and may be associated with the development of CSCR in our patient. Full article

(This article belongs to the Section Ophthalmology)

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15 pages, 2610 KiB

Open AccessArticle

Relationship Between the Use of Fitness Trackers and Smartwatches for Monitoring Physical Activity and the Sociodemographic Characteristics of Long-Term Care Residents During the COVID-19 Lockdown

by Ivana Crnković, Karmen Lončarek, Nada Tomasović Mrčela, Danica Železnik and Tomislav Vlahović

Medicina 2025, 61(1), 6; https://doi.org/10.3390/medicina61010006 - 25 Dec 2024

Abstract

Background and Objectives: The use of wearable fitness technology is a trend nowadays and has significant potential in promoting an active lifestyle among long-term care (LTC) residents. The objectives of this observational study were to examine the use of fitness trackers and [...] Read more.

Background and Objectives: The use of wearable fitness technology is a trend nowadays and has significant potential in promoting an active lifestyle among long-term care (LTC) residents. The objectives of this observational study were to examine the use of fitness trackers and smartwatches for monitoring physical activity and to analyze the relationship between the use of these technological solutions and the sociodemographic characteristics of LTC residents during the COVID-19 lockdown. Materials and Methods: Face-to-face interviews were conducted with 198 LTC residents stationed in eleven organizational units that provide long-term accommodation services for older adults in the city of Zagreb in Croatia. LTC residents aged 65 and older who receive the 1st level of accommodation services in the social care system according to their functional ability and health status were included in this study. Results: During the COVID-19 lockdown, 19.19% of LTC residents used wearable activity trackers. Gender (p = 0.0411) and education level (p = 0.0485) were recognized as significant sociodemographic predictors regarding the use of fitness trackers and smartwatches for monitoring physical activity. An odds ratio for gender of 0.454 (95% CI: 0.213–0.969) indicates that women have a 54.6% lower chance of using fitness trackers and smartwatches then men. The odds ratio for the education effects of 0.050 (95% CI: 0.003–0.980) demonstrates that there is a 95% lower chance of using fitness trackers and smartwatches for individuals with only elementary education as opposed to university graduates. Conclusions: The sociodemographic differences of LTC residents regarding the use of fitness trackers and smartwatches require further research, but they are also an incentive for the implementation of these technological solutions to protect the health of older adults. Full article

(This article belongs to the Special Issue Impact on Human Health, Lifestyle and Quality of Care after COVID-19)

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11 pages, 3943 KiB

Open AccessCase Report

Bouveret’s Syndrome as a Rare Life-Threatening Complication of Gallstone Disease—A Surgical Problem: Two Case Reports

by Nebojsa S. Ignjatovic, Ilija D. Golubovic, Miodrag N. Djordjevic, Marko M. Stojanovic, Daniela A. Benedeto Stojanov, Jelena S. Ignjatovic, Jelena D. Zivadinovic and Sonja Golubovic

Medicina 2025, 61(1), 5; https://doi.org/10.3390/medicina61010005 - 24 Dec 2024

Abstract

Introduction: Bouveret syndrome, a rare and often underdiagnosed variant of gallstone ileus, is characterized by the presence of a large gallstone impacted in the proximal duodenum, resulting in significant gastric outlet obstruction and aerobilia. Early identification of Bouveret syndrome is crucial for [...] Read more.

Introduction: Bouveret syndrome, a rare and often underdiagnosed variant of gallstone ileus, is characterized by the presence of a large gallstone impacted in the proximal duodenum, resulting in significant gastric outlet obstruction and aerobilia. Early identification of Bouveret syndrome is crucial for developing an appropriate surgical strategy. Case 1: A 76-year-old female underwent a contrast-enhanced abdominal CT scan, which revealed a cholecysto-duodenal fistula with a 3.9 cm × 4.0 cm × 4.0 cm gallstone located in the proximal duodenum, along with a distended, fluid-filled stomach and aerobilia. Intraoperatively, due to chronic inflammation and adhesion between the gallbladder and duodenum, a cholecystectomy and fistula repair were performed. Case 2: A 72-year-old female presented with a gastroduodenal passage obstruction confirmed by imaging, which identified a duodeno-biliary fistula. The radiological examination showed oval filling defects in the duodenal bulb consistent with Bouveret’s syndrome, with the largest stone measuring approximately 6 cm in diameter. An enterotomy was performed for stone extraction and was followed by cholecystectomy and duodenal repair with omentoplasty. Conclusions: Bouveret’s syndrome is a rare but clinically significant condition that should be considered in patients presenting with signs of upper gastrointestinal obstruction, particularly in those with a history of chronic cholelithiasis. Early recognition and prompt surgical intervention are essential for obtaining optimal patient outcomes. Full article

(This article belongs to the Special Issue Diagnosis and Management Challenges in Difficult Surgical Cases)

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25 pages, 15851 KiB

Open AccessArticle

Original Personalized Reconstruction Method for Certain Large Tumors of the Lower Lip (Not Including Oral Commissures)

by Ovidiu Dan Grigorescu, Marius Irimie, Nadinne Roman, Roxana Steliana Miclaus, Maria-Cristina Cîmpeanu, Bogdan-Radu Necula, Christian-Gabriel Strempel, Simona Grigorescu, Marius Alexandru Moga and Dana Gabriela Festila

Medicina 2025, 61(1), 4; https://doi.org/10.3390/medicina61010004 - 24 Dec 2024

Abstract

Background/Objective: Surgical treatment of extensive tumors of the lower lip generates important defects in its structure and functions. Over time, a multitude of reconstruction options for these defects have been imagined. Unfortunately, the majority involve the use of both local and regional [...] Read more.

Background/Objective: Surgical treatment of extensive tumors of the lower lip generates important defects in its structure and functions. Over time, a multitude of reconstruction options for these defects have been imagined. Unfortunately, the majority involve the use of both local and regional flaps, which either lack labial structure or disorganize the oral commissures as nodal oral function points. We set out to design a new reconstruction method that is not burdened by any of the above disadvantages, starting from the necessity to reconstruct large lower lip defects by exclusively using local and/or regional labial flaps belonging only to the healthy upper lip and the remaining structures of the lower lip after surgical tumor removal. In this way, the tissues involved in lower lip reconstruction will have a 100% labial structure and, supplementarily, the remaining oral commissures will not be damaged. Method: This new reconstruction method is based on the original association of WY-plasty to reduce the size of the large primary defect until it becomes congruent with the Abbe–Sabattini cross-lip flap. Results: Applied in a personalized manner, impressive results were obtained in several patients with lip tumors affecting about one-half of the lower lip length and in whom oncological surgical ablation produced defects in more than two-thirds of it. Conclusions: This new method is characterized by functional oral advantages, and can be applied in a personalized way to only certain categories of patients. Other disadvantages are characteristic and specific of Abbe–Sabattini cross-lip flap plasty. Full article

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15 pages, 2965 KiB

Open AccessArticle

The Association of Plasma Selenium and Selenoprotein P Levels with Depression Severity and Anxiety Symptoms Among Medical Students in Latvia

by Zanda Birģele, Paula Marija Vimba, Anastasija Ševčenko, Andrejs Šķesters, Gunta Ancāne and Laura Valaine

Medicina 2025, 61(1), 3; https://doi.org/10.3390/medicina61010003 - 24 Dec 2024

Abstract

Background and Objectives: Oxidative stress has been identified as a key process involved in different diseases, particularly depression. Selenium (Se) protects against oxidative stress, one of the pathogenic mechanisms involved in affective disorders. Selenium is incorporated into antioxidant selenoproteins, such as selenoprotein [...] Read more.

Background and Objectives: Oxidative stress has been identified as a key process involved in different diseases, particularly depression. Selenium (Se) protects against oxidative stress, one of the pathogenic mechanisms involved in affective disorders. Selenium is incorporated into antioxidant selenoproteins, such as selenoprotein P, which acts as the main selenium-transport protein in plasma and as an extracellular oxidant defense mechanism. This study aimed to determine whether lower selenium and selenoprotein P levels correlate with high levels of depression and anxiety symptoms. Materials and Methods: The research design was a quantitative cross-sectional study among employed fourth-year medical students at Riga Stradins University in Latvia. The respondents were selected using convenience samples. The symptoms of anxiety were assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale, and the symptoms of depression were assessed using the Patient Health Questionnaire-9 (PHQ-9) scale. Results: A total of 32 respondents participated; 90.6% (n = 29) were female. A significant association was found between selenoprotein P and symptoms of depression (p = 0.006), as well as between selenoprotein P and symptoms of anxiety (p = 0.012). The median selenium level was not significantly lower (p = 0.214) in the study group compared to the control group. Conclusions: There is a statistically significant correlation between selenoprotein P and symptoms of depression and anxiety, and there is a tendency for students with symptoms of depression and anxiety to have lower selenium levels. However, alternative unrecognized oxidative stress mechanisms involved in the development of symptoms of depression and anxiety, involving selenium and selenoprotein P pathways, may exist. Consequently, further research assessing possible alternative pathways and the effect size is required. Full article

(This article belongs to the Section Psychiatry)

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9 pages, 273 KiB

Open AccessArticle

Impairment of Microcirculation Parameters in Patients with a History of Diabetic Foot Ulcers

by Julien Vouillarmet, Audrey Josset-Lamaugarny, Myriam Moret, Christine Cugnet-Anceau, Paul Michon, Emmanuel Disse and Dominique Sigaudo-Roussel

Medicina 2025, 61(1), 2; https://doi.org/10.3390/medicina61010002 - 24 Dec 2024

Abstract

Background and Objectives: According to the International Working Group on Diabetic Foot (IWGDF) risk classification, the estimated risk of developing a diabetic foot ulcer (DFU) is much higher in patients with a history of DFUs (Grade 3) compared to those with a [...] Read more.

Background and Objectives: According to the International Working Group on Diabetic Foot (IWGDF) risk classification, the estimated risk of developing a diabetic foot ulcer (DFU) is much higher in patients with a history of DFUs (Grade 3) compared to those with a peripheral neuropathy but without a history of DFUs (Grades 1 and 2). It has been suggested that microcirculation impairment is involved in DFU genesis and could be taken into account to refine the existing risk classification. The aim of this study was to evaluate microcirculation parameters in patients with diabetes according to their estimated DFU risk. Materials and Methods: A total of 172 patients with type 2 diabetes associated with a peripheral neuropathy and/or a history of DFUs were included and classified into two groups (Grade 1–2 and Grade 3) according to the IWGDF classification. All patients underwent an evaluation of peripheral neuropathy, plantar sudomotor function, and skin microcirculation parameters. These different parameters were compared between both groups. Results: There was no significant difference between the two groups in terms of age, diabetes duration, transcutaneous oxygen pressure level, skin microcirculatory reactivity, neuropathy disability score, neuropathy symptom score, or thermal sensitivity. Patients in Grade 3 were more likely to present with retinopathy (OR 3.15, 95%CI [1.53; 6.49]) and severe sudomotor dysfunction (OR 2.73 95%CI [1.29; 5.80] but less likely to have abnormal VPT (OR 0.20 95%CI [0.05; 0.80]). Conclusions: The present study found more retinopathy and a more pronounced alteration to sudomotor function in Grade 3 patients, suggesting that these parameters could be considered to better identify patients at high risk of DFUs. Full article

(This article belongs to the Section Endocrinology)

12 pages, 736 KiB

Open AccessArticle

Association of Pregnancy Complications with Endometrial or Ovarian or Breast Cancer: A Case Control Study

by Lin Cheng Han, Henry W. C. Leung, Heng-Jun Lin, John Hang Leung and Agnes L. F. Chan

Medicina 2025, 61(1), 1; https://doi.org/10.3390/medicina61010001 - 24 Dec 2024

Abstract

Background and Objectives: The relationship between pregnancy complications and the risk of gynecological and breast cancer remains inconclusive, with limited research available. This study aimed to determine whether pregnancy complications, including preeclampsia, gestational diabetes mellitus (GDM), large for gestational age (LGA), or [...] Read more.

Background and Objectives: The relationship between pregnancy complications and the risk of gynecological and breast cancer remains inconclusive, with limited research available. This study aimed to determine whether pregnancy complications, including preeclampsia, gestational diabetes mellitus (GDM), large for gestational age (LGA), or intrauterine growth restriction (IUGR) are associated with the development of endometrial cancer (EC), ovarian cancer (OC), or breast cancer (BC). Materials and Methods: This was a population-based case–control study linked to the National Health Insurance Research Database from 2008 to 2020, using ICD codes to identify parous gynecological cases (n = 6714). The propensity score matching method was used to match control groups (n = 1,153,346). Multivariable logistic regression models were used to determine the association between EC, OC, BC risk and pregnancy complications. Results: In adjusted multivariable logistic regression models, women with a history of preeclampsia did not have a significantly increased risk of endometrial, ovarian, or breast cancer compared to controls. Although women with GDM complications had a significantly increased risk of breast cancer, the increased risk of EC or OC was not significant. The risk of BC in women with a history of IUGR or LGA was not significant, whereas risk statistics for EC or OC in women with a history of IUGR or LGA could not be shown because of the small sample size. Conclusions: GDM is associated with BC risk. Future studies should aim to determine whether there is a causal relationship. Therefore, cancer screening is warranted in women with GDM. Full article

(This article belongs to the Topic Public Health and Healthcare in the Context of Big Data)

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10 pages, 2152 KiB

Open AccessArticle

Does Robotic Spine Surgery Add Value to Surgical Practice over Navigation-Based Systems? A Study on Operating Room Efficiency

by Pirateb Paramasivam Meenakshi Sundaram, Daniel Yang Yao Peh, Jane Wenjin Poh, Guna Pratheep Kalanchiam, Wayne Ming Quan Yap, Arun-Kumar Kaliya-Perumal and Jacob Yoong-Leong Oh

Medicina 2024, 60(12), 2112; https://doi.org/10.3390/medicina60122112 - 23 Dec 2024

Abstract

Background and Objectives: Spine surgery has undergone significant advancements, particularly with regard to robotic systems that enhance surgical techniques and improve patient outcomes. As these technologies become increasingly integrated into surgical practice, it is essential to evaluate their added value and cost savings. [...] Read more.

Background and Objectives: Spine surgery has undergone significant advancements, particularly with regard to robotic systems that enhance surgical techniques and improve patient outcomes. As these technologies become increasingly integrated into surgical practice, it is essential to evaluate their added value and cost savings. Hence, this study compared robot-assisted and navigation-based spine surgery, focusing on surgical efficiency. Materials and Methods: We conducted a single-center, retrospective cohort study of patients undergoing single- and double-level transforaminal lumbar interbody fusion (TLIF) and oblique lumbar interbody fusion (OLIF) surgeries. Patients were divided into two groups: those who had robot-assisted and navigation-based surgeries, stratified by surgery type (TLIF or OLIF) and fusion levels (one or two). A comparative analysis of factors related to surgical efficiency, including operative duration, blood loss, and length of hospital stay, was conducted. Results: Our results showed a statistically significant reduction in operative duration for robot-assisted one- and two-level OLIF cases, with average time savings of 50 and 62 min, respectively, compared to navigation-based surgery. These time savings translated to an estimated cost reduction of SGD 1500 for the hospital for each patient for a two-level OLIF procedure and could be higher as the number of operated levels increase. Conclusions: These results indicated that robot-assisted spine surgery offers superior surgical efficiency and cost savings, particularly with increased numbers of surgical levels. As robotic technologies evolve, their integration into spine surgery is justified, promising improved patient outcomes and cost-effectiveness. Full article

(This article belongs to the Section Orthopedics)

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11 pages, 4951 KiB

Open AccessArticle

Stem Cells Within Three-Dimensional-Printed Scaffolds Facilitate Airway Mucosa and Bone Regeneration and Reconstruction of Maxillary Defects in Rabbits

by Mi Hyun Lim, Jung Ho Jeon, Sun Hwa Park, Byeong Gon Yun, Seok-Won Kim, Dong-Woo Cho, Jeong Hak Lee, Do Hyun Kim and Sung Won Kim

Medicina 2024, 60(12), 2111; https://doi.org/10.3390/medicina60122111 - 23 Dec 2024

Abstract

Background and Objectives: Current craniofacial reconstruction surgical methods have limitations because they involve facial deformation. The craniofacial region includes many areas where the mucosa, exposed to air, is closely adjacent to bone, with the maxilla being a prominent example of this structure. [...] Read more.

Background and Objectives: Current craniofacial reconstruction surgical methods have limitations because they involve facial deformation. The craniofacial region includes many areas where the mucosa, exposed to air, is closely adjacent to bone, with the maxilla being a prominent example of this structure. Therefore, this study explored whether human neural-crest-derived stem cells (hNTSCs) aid bone and airway mucosal regeneration during craniofacial reconstruction using a rabbit model. Materials and Methods: hNTSCs were induced to differentiate into either mucosal epithelial or osteogenic cells in vitro. hNTSCs were seeded into polycaprolactone scaffold (three-dimensionally printed) that were implanted into rabbits with maxillary defects. Four weeks later, tissue regeneration was analyzed via histological evaluation and immunofluorescence staining. Results: In vitro, hNTSCs differentiated into both mucosal epithelial and osteogenic cells. hNTSC differentiation into respiratory epithelial cells was confirmed by Alcian Blue staining, cilia in SEM, and increased expression levels of FOXJ1 and E-cadherin through quantitative RT-PCR. hNTSC differentiation into bone was confirmed by Alizarin Red staining, increased mRNA expression levels of BMP2 (6.1-fold) and RUNX2 (2.3-fold) in the hNTSC group compared to the control. Four weeks post-transplantation, the rabbit maxilla was harvested, and H&E, SEM, and immunohistofluorescence staining were performed. H&E staining and SEM showed that new tissue and cilia around the maxillary defect were more prominent in the hNTSC group. Also, the hNTSCs group showed positive immunohistofluorescence staining for acetylated α-tubulin and cytokerin-5 compared to the control group. Conclusions: hNTSCs combined with PCL scaffold enhanced the regeneration of mucosal tissue and bone in vitro and promoted mucosal tissue regeneration in the in vivo rabbit model. Full article

(This article belongs to the Special Issue New Insights into Plastic and Reconstructive Surgery)

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11 pages, 1775 KiB

Open AccessArticle

Effects of Pelargonium Sidoides Extract on Apoptosis and Oxidative Stress in Human Neuroblastoma Cells

by Ali Aslan and Mücahit Seçme

Medicina 2024, 60(12), 2110; https://doi.org/10.3390/medicina60122110 - 23 Dec 2024

Abstract

Background and Objectives: Neuroblastoma is the most common extracranial solid tumor in children, often presenting challenges in treatment due to its clinical and genetic heterogeneity. This study investigated the anticancer potential of Pelargonium sidoides root extract on the human neuroblastoma cell line (SH-SY5Y). Using [...] Read more.

Background and Objectives: Neuroblastoma is the most common extracranial solid tumor in children, often presenting challenges in treatment due to its clinical and genetic heterogeneity. This study investigated the anticancer potential of Pelargonium sidoides root extract on the human neuroblastoma cell line (SH-SY5Y). Using XTT assays, ELISA-based oxidative stress markers, and RT-PCR analysis of apoptotic genes, the study explored the extract’s effects on cell proliferation, oxidative stress, and apoptosis. Materials and Methods: For the cell culture, SH-SY5Y human neuroblastoma cells were thawed, cultured, and maintained under appropriate conditions for experiments. The dose- and time-dependent activity of Pelorgonium sidoides extract on SH-SY5Y neuroblastoma cells was investigated by XTT assay. The change in the oxidative stress marker 8-Hydroxy-2′-deoxyguanosine (8-OhDG) level was determined by ELISA for the doses applied to the control group root extract at a concentration of 25 μg/mL. Total antioxidant status (TAS) and total oxidant status (TOS) were measured from the cells in the study group with the help of a commercial kit. The oxidative stress index (OSI) was calculated by dividing the TAS by the TOS and multiplying by 100. In order to evaluate the expression levels of apoptosis-related Bax, Bcl-2, Caspase-3, Caspase-8, and Caspase-9 genes at the mRNA level in control and dose group cells, RNA isolation was performed from the SH-SY5Y control and dose group cells (IC50 value). Results: It is observed that the P. sidoides substance inhibits proliferation in cells at 24 h (p < 0.05). As the dose increases, cell proliferation decreases (p < 0.05). The IC50 value was calculated to be 113.83 μg/mL at 24 h. The concentration of 8-OhDG increased in neuroblastoma cells as a result of P. sidoides extract treatment (p < 0.05). TOS levels increased in neuroblastoma cells treated with P. sidoides extract (p < 0.01). OSI levels increased in cells treated with P. sidoides extract (p < 0.001). BAX and Caspase-8 expression increased are statistically significant in the P. sidoides dose group (p < 0.05). Conclusions: P. sidoides extract induces apoptosis in neuroblastoma cells through oxidative stress and mitochondrial- and death receptor-mediated pathways. This study highlights the potential of P. sidoides as a complementary therapeutic agent for neuroblastoma, warranting further in vivo and clinical investigations to assess its safety and efficacy. Full article

(This article belongs to the Section Oncology)

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