Next Issue
Volume 60, December
Previous Issue
Volume 60, October
 
 

Medicina, Volume 60, Issue 11 (November 2024) – 183 articles

  • Issues are regarded as officially published after their release is announced to the table of contents alert mailing list.
  • You may sign up for e-mail alerts to receive table of contents of newly released issues.
  • PDF is the official format for papers published in both, html and pdf forms. To view the papers in pdf format, click on the "PDF Full-text" link, and use the free Adobe Reader to open them.
Cover Story (view full-size image):
Order results
Result details
Section
Select all
Export citation of selected articles as:
15 pages, 2630 KiB  
Article
Dental Decision-Making in Pediatric Dentistry: A Cross-Sectional Case-Based Questionnaire Among Dentists in Germany
by Bakr A. Rashid, Ahmad Al Masri, Christian H. Splieth, Mustafa Abdalla and Julian Schmoeckel
Medicina 2024, 60(11), 1907; https://doi.org/10.3390/medicina60111907 - 20 Nov 2024
Viewed by 845
Abstract
Background and Objectives: The most recent guidelines and recommendations regarding treatments of dental caries in children are shifting towards evidence-based minimal or non-invasive approaches aiming to preserve the vitality of teeth and potentially reduce the need for dental general anesthesia. This study [...] Read more.
Background and Objectives: The most recent guidelines and recommendations regarding treatments of dental caries in children are shifting towards evidence-based minimal or non-invasive approaches aiming to preserve the vitality of teeth and potentially reduce the need for dental general anesthesia. This study investigated the treatment recommendations of dentists actively practicing pediatric dentistry in Germany regarding different patient cases with caries in primary teeth. Materials and Methods: The questionnaire was distributed on paper or online to pediatric dentists and general dentists practicing pediatric dentistry. Five cases of children with dental treatment needs representing a variety of clinical situations were selected for the questionnaire. Considering four different scenarios regarding pain symptoms (yes/no) and cooperation level (good/low) for each case resulted in 20 questions, where the preferred treatment option could be chosen out of 21 options ranging from observation only to extraction with/without different sedation techniques. The answers were categorized into three categories for each case and scenario according to guidelines, recent scientific evidence, and recommendations (recommended, acceptable, or not recommended/contraindicated). Results: In total, 222 participants responded to the survey (161 female; 72.5%). In 55.2% of the total 4440 answers, the participants chose a “recommended” treatment option, in 16.4% “acceptable”, but in 28.4%, a “not recommended” treatment, which ranged for the five cases between 18.7 and 36.1%. While pain and low cooperation levels led to more invasive and justified treatment choices (only 26.3% “not recommended”), less severe scenarios resulted more often in “not recommended” options (pain with good cooperation: 31.0%; or low cooperation without pain: 32.6%). The dentist’s age, experience, and educational background did not significantly correlate to choosing “not recommended” treatment options. Conclusions: A child’s pain and cooperation level greatly impact the treatment decisions made by dentists, with a risk of too invasive treatment options in low-severity cases. Substantial disparities in treatment recommendations for caries in primary teeth persist among dental practitioners regardless of their age, experience, and educational background. Full article
(This article belongs to the Special Issue Updates on Caries Management in the Primary and Permanent Dentition)
Show Figures

Figure 1

13 pages, 3267 KiB  
Article
Clinical Challenges in Diagnosing Primordial Dwarfism: Insights from a MOPD II Case Study
by Alexandru Daniel Jurca, Codruța Diana Petchesi, Sânziana Jurca, Emilia Severin, Aurora Alexandra Jurca and Claudia Maria Jurca
Medicina 2024, 60(11), 1906; https://doi.org/10.3390/medicina60111906 - 20 Nov 2024
Viewed by 358
Abstract
Background and Objectives. Primordial dwarfism (PD) is a rare group of genetic conditions where individuals experience severe growth restriction, both in the womb and after birth. From as early as the fetal stage, those affected are significantly smaller than their peers. What [...] Read more.
Background and Objectives. Primordial dwarfism (PD) is a rare group of genetic conditions where individuals experience severe growth restriction, both in the womb and after birth. From as early as the fetal stage, those affected are significantly smaller than their peers. What makes PD distinct is its slow but steady growth pattern, resulting in proportionate dwarfism, where all parts of the body are equally shortened. Diagnosing and managing PD presents significant challenges due to its rarity and the wide range of clinical and genetic variability. The main conditions in this group include Seckel syndrome, Microcephalic Osteodysplastic Primordial Dwarfism (MOPD) types I/III, MOPD type II, Meier–Gorlin syndrome, and Silver–Russell syndrome (SRS). The first four—Seckel syndrome, MOPD types I/III, MOPD type II, and Meier–Gorlin syndrome—are associated with microcephaly, and together they are known as microcephalic PD. Given how uncommon PD is, establishing its exact incidence is difficult. It is estimated that about 4 million infants die within the first month of life, with 99% of these deaths occurring in the neonatal period. Materials and Methods. Accurately diagnosing PD requires meticulous evaluation, as it can be easily confused with other genetic disorders that also cause dwarfism. In this article, we present the case of a 10-year-old patient diagnosed with MOPD II, the most common and well-documented form of microcephalic PD. Results. Genetic analysis revealed a pathogenic variant in the PCNT (pericentrin) gene ((c.1550dup, p.Gln518Alafs*7), alongside a deletion of exons 37–41. Conclusions. This case sheds light on the clinical and genetic complexities of primordial dwarfism, underscoring the importance of timely and accurate diagnosis for effective patient care. Full article
(This article belongs to the Section Genetics and Molecular Medicine)
Show Figures

Figure 1

10 pages, 1203 KiB  
Article
Outcomes of Ixazomib Treatment in Relapsed and Refractory Multiple Myeloma: Insights from Croatian Cooperative Group for Hematologic Diseases (KROHEM)
by Josip Batinić, Barbara Dreta, Goran Rinčić, Antonia Mrdeža, Karla Mišura Jakobac, Delfa Radić Krišto, Milan Vujčić, Mario Piršić, Željko Jonjić, Vlatka Periša, Jasminka Sinčić Petričević, Božena Coha, Hrvoje Holik, Toni Valković, Marija Stanić, Ivan Krečak, Ante Stojanović, Domagoj Sajfert and Sandra Bašić-Kinda
Medicina 2024, 60(11), 1905; https://doi.org/10.3390/medicina60111905 - 20 Nov 2024
Viewed by 463
Abstract
Background and Objectives: Ixazomib, used in combination with lenalidomide and dexamethasone (IRd), has shown efficacy in clinical trials for relapsed/refractory multiple myeloma (RRMM). Materials and Methods: This study evaluates the real-world effectiveness and safety of IRd in Croatian RRMM patients. A [...] Read more.
Background and Objectives: Ixazomib, used in combination with lenalidomide and dexamethasone (IRd), has shown efficacy in clinical trials for relapsed/refractory multiple myeloma (RRMM). Materials and Methods: This study evaluates the real-world effectiveness and safety of IRd in Croatian RRMM patients. A retrospective analysis was conducted on 164 RRMM patients treated with ixazomib at nine Croatian haematology centres from November 2016 to February 2023. Data on patient demographics, treatment regimens, and outcomes were collected and analysed using Kaplan–Meier survival curves and Cox proportional hazards models in R. The median age at ixazomib initiation was 66 years (range 40–91). Results: The overall response rate (ORR) was 65.8%, with 42% of patients achieving a very good partial response (VGPR) or better. The median progression-free survival (PFS) was 15.4 months, while median overall survival (OS) was 28.2 months. Hematologic toxicities included anaemia (53%), neutropenia (50%), and thrombocytopenia (45%). Infective complications, primarily COVID-19 and pneumonia, were reported in 38% of patients. The safety profile was consistent with previous studies, indicating manageable adverse events. Ixazomib-based therapy is effective and well tolerated in a real-world Croatian RRMM population. Conclusions: The findings align with clinical trial results, demonstrating the applicability of ixazomib in routine clinical practice. Further studies are needed to optimise treatment sequencing and improve patient outcomes. Full article
(This article belongs to the Special Issue Cutting-Edge Research in Relapsed and Refractory Multiple Myeloma)
Show Figures

Figure 1

22 pages, 334 KiB  
Review
Use of Epinephrine in Cardiac Arrest: Advances and Future Challenges
by Caitlin A. Williams, Hannah E. Fairley, Quincy K. Tran and Ali Pourmand
Medicina 2024, 60(11), 1904; https://doi.org/10.3390/medicina60111904 - 20 Nov 2024
Viewed by 561
Abstract
Epinephrine is the most common medication used in cardiac arrest. Although the medication has been a mainstay of treatment over the last century, the utility and efficacy of epinephrine has been re-evaluated in recent years. This study aims to evaluate the literature describing [...] Read more.
Epinephrine is the most common medication used in cardiac arrest. Although the medication has been a mainstay of treatment over the last century, the utility and efficacy of epinephrine has been re-evaluated in recent years. This study aims to evaluate the literature describing the efficacy, timing, and dosing of epinephrine use in cardiac arrest. We utilized an extensive PubMed and SCOPUS search that included randomized control trials, prospective observational studies, and secondary analysis of observational data. These articles evaluated the administration of epinephrine in cardiac arrest and reported patient outcomes, including survival rates, neurological function, and return of spontaneous circulation. Dosing of epinephrine has been standardized at 1 mg per administration in adults and studies show that higher doses may not have better outcomes and can potentially be harmful. Research on the optimal timing of epinephrine has shown that earlier administration of epinephrine in cardiac arrest is more likely to have improved outcomes compared to later administration and longer intervals, although there are still conflicting results on the improvement of neurological outcomes. Intravenous is the preferred route of administration for epinephrine, but new research suggests intramuscular administration may be beneficial. While epinephrine has been shown to improve the rates of return of spontaneous circulation and even survival to hospital discharge in several studies, epinephrine use may not provide patients who survive cardiac arrest with a meaningful neurological recovery. Full article
(This article belongs to the Special Issue Cardiopulmonary Resuscitation: Recent Advances and Future Challenges)
14 pages, 2568 KiB  
Article
Comparative Analysis of Surgical Methods for Distal, Mid-, and Proximal Shaft Hypospadias in Young Males: A Prospective Study on Postoperative Outcomes
by Almira Zharkimbayeva, Maratbek Aubakirov, Vasily Lozovoy, Madina Madiyeva, Samatbek Abdrakhmanov and Azat Dyussembayev
Medicina 2024, 60(11), 1903; https://doi.org/10.3390/medicina60111903 - 20 Nov 2024
Viewed by 357
Abstract
Background and Objectives: The purpose of this study is to report on the results of hypospadias surgery in boys using newly developed methods compared with traditional methods of urethroplasty. Materials and Methods: A total of 136 patients were divided into two groups. Fifty [...] Read more.
Background and Objectives: The purpose of this study is to report on the results of hypospadias surgery in boys using newly developed methods compared with traditional methods of urethroplasty. Materials and Methods: A total of 136 patients were divided into two groups. Fifty patients with coronal, subcoronal, and distal penile types of hypospadias were allocated to Group I. These patients were treated with a new method of SMU I and urethroplasty according to the Snodgrass procedure and MAGPI. Group II consisted of 86 patients with mid- and proximal shaft penile types of hypospadias who underwent urethroplasty using the new SMU II method and urethroplasty according to the Snodgraft and Bracka procedures. The outcomes were assessed according to the level of postoperative wound healing and the presence of complications. Results: The mean age of the patients was 41 to 60 months. After urethroplasty using the SMU I and SMU II methods, recovery was noted in 92.9% of the patients, and repeated surgery was performed in 7.1%. In the patients undergoing operations utilizing the SMU I and SMU II methods, neomeatus dystopia was not detected and postoperative fistulas were observed in 16.7% of incidence. With the standard urethroplasty method, the rate of complications was higher (p < 0.05). Even though the duration of surgery in the group undergoing a procedure using the standard urethroplasty method was lower (p < 0.001), the frequency of primary wound healing was higher in the SMU I and SMU II groups (p < 0.001). Conclusions: The proposed new methods of distal and shaft hypospadias surgery, in comparison with traditional surgical techniques, have the following advantages: good cosmetic appearance of the penis, complete straightening of the shaft, and right outflow of urine through the slit-like neomeatus at the apex of the glans penis. Full article
(This article belongs to the Section Urology & Nephrology)
Show Figures

Figure 1

11 pages, 851 KiB  
Article
DNMT1 rs2228611, rs2228612 and DNMT3A rs2276598, rs752208 Polymorphisms and Their Association with Breast Cancer Phenotype and Prognosis
by Meda Marija Kaušylaitė, Justina Jurevičė, Erika Korobeinikova, Jurgita Gudaitienė, Elona Juozaitytė and Rasa Ugenskienė
Medicina 2024, 60(11), 1902; https://doi.org/10.3390/medicina60111902 - 20 Nov 2024
Viewed by 457
Abstract
Background and Objectives: Breast cancer is a leading cause of cancer-related deaths globally. This study investigates the impact of genetic polymorphisms in DNA methyltransferases (DNMT1 and DNMT3A) on breast cancer pathomorphology and patient prognosis. Specifically, we focused on DNMT1 polymorphisms [...] Read more.
Background and Objectives: Breast cancer is a leading cause of cancer-related deaths globally. This study investigates the impact of genetic polymorphisms in DNA methyltransferases (DNMT1 and DNMT3A) on breast cancer pathomorphology and patient prognosis. Specifically, we focused on DNMT1 polymorphisms rs2228611 and rs2228612 and DNMT3A polymorphisms rs2276598 and rs752208. Materials and Methods: Conducted at the Institute of Oncology of the Lithuanian University of Health Sciences, this study included 201 Lithuanian women with early-stage breast cancer. DNA was extracted from peripheral blood samples, and genotyping for the specified polymorphisms was performed using the PCR-RFLP assay. Statistical analyses were applied to evaluate associations between polymorphisms and clinicopathological characteristics. Results: The non-carriers of the DNMT1 rs2228611 G allele were less likely to be diagnosed at an older age, while the DNMT3A rs752208 T allele was linked to lower-grade tumors. Survival analysis indicated a potential relationship between DNMT3A rs752208 and overall survival, although no significant findings were observed in progression-free or metastasis-free survival. Conclusions: This study suggests that the DNMT1 and DNMT3A polymorphisms may influence breast cancer pathomorphology and prognosis. The DNMT1 rs2228611 G allele may be associated with earlier onset, and the DNMT3A rs752208 T allele might correlate with less aggressive tumors. These findings underscore the potential of DNMT gene polymorphisms as prognostic biomarkers in breast cancer, warranting further investigation with larger sample sizes. Full article
(This article belongs to the Section Genetics and Molecular Medicine)
Show Figures

Figure 1

10 pages, 893 KiB  
Hypothesis
Differences in Gender and Overall Survival for Temperature-Sensitive TP53 Mutations in Gastroesophageal Cancer
by Danial H. Shaikh, Margaret Park, Jiandong Chen, Jeffrey Huang, Mark S. Friedman, Aamir N. Dam, Anjuli K. Luthra, Saraswathi Cappelle, Luis R. Pena, Jennifer B. Permuth and Shaffer R. S. Mok
Medicina 2024, 60(11), 1901; https://doi.org/10.3390/medicina60111901 - 20 Nov 2024
Viewed by 438
Abstract
Background and Objectives: Temperature-sensitive (TS) mutants of TP53 are thermally unstable, unfolded, and inactive at body temperature but can be refolded and reactivated at sub-physiological temperatures. TS TP53 may be amenable for functional rescue by hypothermia or structure-stabilizing drugs, and may retain [...] Read more.
Background and Objectives: Temperature-sensitive (TS) mutants of TP53 are thermally unstable, unfolded, and inactive at body temperature but can be refolded and reactivated at sub-physiological temperatures. TS TP53 may be amenable for functional rescue by hypothermia or structure-stabilizing drugs, and may retain low-level transcriptional activity at 37 °C. TP53 mutations are observed in 47% of all esophageal cancers (ECs) and 25% to 40% of gastric cancers (GCs). We aimed to investigate the trends and outcomes of EC and GC with TS TP53 mutations using cBioportal. We hypothesize that TS TP53 mutants in EC and GC present a unique prognostic profile distinct from non-TS TP53 mutants, potentially affecting overall survival and cancer progression. Materials and Methods: We identified 1924 patients from cBioportal with GC or EC, harboring any TP53 mutation. Patients were then stratified based on the TP53 temperature sensitivity according to a recently reported functional analysis of its activity. Patients were also stratified based on a history of Barrett’s esophagus (BE), cancer stage, sex, and race. We then compared populations (TS vs. non-TS TP53) to assess differences and evaluated survival outcomes. Results: Males represented 77% of the cohort, and 51.6% of the samples were from patients with stage IV cancer. No association was found between TS vs. non-TS mutational status and BE, cancer stage, or race. Interestingly, a significantly higher proportion of females (22.9%) than males (14.5%) displayed a TS TP53 mutation (p = 0.012). No significant difference was seen in overall survival between the TS and non-TS mutations capable of ≥50% growth suppression at 32 °C (median = 33 vs. 28 months, p = 0.36). This trend was also observed when the patients were filtered based on cancer location. The median survival for EC was 32.5 months compared to 33 months (p = 0.67). In cases of GC, median survival times could not be determined due to the insufficient number of events. Conclusions: Although no statistical significance was observed, a decrease in overall survival for patients with TS TP53 mutations was noted. The result is counterintuitive given that TS mutants have less severe structural destabilization and suggests TS TP53 mutations may have a unique prognostic value that warrants further investigation. Full article
(This article belongs to the Section Oncology)
Show Figures

Figure 1

7 pages, 2064 KiB  
Case Report
Methotrexate-Induced Toxicity After Ultrasound-Guided Intragestational Injection in a Patient with Caesarean Scar Pregnancy—A Case Report
by Sofoklis Stavros, Anastasios Potiris, Angeliki Gerede, Athanasios Zikopoulos, Maria Giourga, Christina Karasmani, Athanasios Karpouzos, Theodoros Karampitsakos, Spyridon Topis, Ismini Anagnostaki, Konstantinos Louis, Ioannis Tsakiridis, Themistoklis Dagklis, Peter Drakakis and Ekaterini Domali
Medicina 2024, 60(11), 1900; https://doi.org/10.3390/medicina60111900 - 20 Nov 2024
Viewed by 467
Abstract
Background and Objectives: Caesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy in which the early pregnancy implants at the site of the uterine scar. Methotrexate (MTX) in lower doses can be used to treat CSPs. However, MTX administration is [...] Read more.
Background and Objectives: Caesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy in which the early pregnancy implants at the site of the uterine scar. Methotrexate (MTX) in lower doses can be used to treat CSPs. However, MTX administration is associated with a spectrum of side effects that include hematological toxicities. This case report presents a CSP treated with an intragestational injection of MTX and subsequently developed pancytopenia. Materials and Methods: A 23-year-old woman at six weeks and six days of pregnancy was referred as a potential case of CSP. After establishing the diagnosis, she was treated with a transvaginal ultrasound-guided intragestational administration of 80 mg MTX (adjusted to 50 mg/m2 body surface area) under sedation. Results: On day four after the MTX injection, she developed oral ulcers, fever, and pruritic phlyctenular maculopapular rash. Subsequently, the patient developed febrile neutropenia and was admitted to the Intensive Care Unit. On day six, a subsequent exacerbation of the rash was observed with the formation of blisters and purplish spots with concurrent odynophagia and sialorrhea. Ultimately, the patient developed pancytopenia due to bone marrow suppression. Fifteen days after MTX administration, the patient recovered and was discharged from the hospital hemodynamically stable, afebrile, with dropping β-hcg levels, and in good clinical condition. Conclusions: Although methotrexate administration is the preferred option for the treatment of cesarean scar pregnancies, clinicians should be aware of the fact that its use entails potential risks, even when it is used locally. To our knowledge, this case is the first description of pancytopenia due to bone marrow suppression following a single low dose of intragestational methotrexate injection. Full article
Show Figures

Figure 1

10 pages, 601 KiB  
Systematic Review
A Review of Fecal Microbiota Transplantation in Children—Exploring Its Role in the Treatment of Inflammatory Bowel Diseases
by Yanna Ko, Sara Alaedin, Dewni Fernando, Jerry Zhou and Vincent Ho
Medicina 2024, 60(11), 1899; https://doi.org/10.3390/medicina60111899 - 20 Nov 2024
Viewed by 455
Abstract
Background and Objectives: There is an increasing use of fecal matter transplantation (FMT) worldwide as research into the impact of the gut microbiome in various disease states is growing. FMT is the transfer of stool from a healthy human donor to a [...] Read more.
Background and Objectives: There is an increasing use of fecal matter transplantation (FMT) worldwide as research into the impact of the gut microbiome in various disease states is growing. FMT is the transfer of stool from a healthy human donor to a patient for the purpose of restoring intestinal dysbiosis. This review will assess the efficacy and safety of FMT in the treatment of pediatric inflammatory bowel diseases (IBDs) and explore the future directions of the use of FMT in children. Materials and Methods: A systematic review was performed where a literature search of publications published prior to 15 September 2023 was performed. Efficacy outcomes and safety data as well as microbiome analysis were reviewed from the studies where applicable. Results: Nine studies on UC and two studies on CD satisfied eligibility criteria and individually analysed. Most of the studies provided microbiome analyses. Conclusions: FMT is a safe treatment for paediatric IBD, and is shown to be effective in inducing clinical response by some studies. However the lack of randomized controlled trials limited the results of our study. Full article
Show Figures

Figure 1

11 pages, 551 KiB  
Article
Genomic Analysis of Advanced Phyllodes Tumors Using Next-Generation Sequencing and Their Chemotherapy Response: A Retrospective Study Using the C-CAT Database
by Shuhei Suzuki and Yosuke Saito
Medicina 2024, 60(11), 1898; https://doi.org/10.3390/medicina60111898 - 19 Nov 2024
Viewed by 674
Abstract
Background and Objectives: Phyllodes tumors are rare breast neoplasms with limited therapeutic options and poorly understood molecular characteristics. This study aimed to analyze genomic alterations and treatment outcomes in advanced phyllodes tumors using Japan’s national clinical genomic testing registry (C-CAT database) to [...] Read more.
Background and Objectives: Phyllodes tumors are rare breast neoplasms with limited therapeutic options and poorly understood molecular characteristics. This study aimed to analyze genomic alterations and treatment outcomes in advanced phyllodes tumors using Japan’s national clinical genomic testing registry (C-CAT database) to identify potential therapeutic targets and predictive markers. Materials and Methods: We conducted a retrospective analysis of 60 phyllodes tumor cases from 80,329 patients registered in the C-CAT database between June 2019 and August 2024. Comprehensive genomic profiling was performed using multiple platforms including FoundationOne CDx, NCC OncoPanel, and other approved tests. Treatment responses were evaluated according to RECIST criteria, and pathogenic variants were assessed using established databases including ClinVar and OncoKB. Results: The cohort’s median age was 54 years (range: 13–79), with TERT promoter variants (70%), MED12 (52%), and TP53 (50%) mutations being the most frequent alterations. Forty patients received first-line chemotherapy, predominantly anthracycline-based regimens (n = 29). Although not reaching statistical significance, cases with CDKN2A and TERT alterations showed trends toward treatment resistance (OR > 3.0). One patient with a high tumor mutational burden (37/Mb) responded to pembrolizumab. Potential germline variants were identified in two cases (3.3%), involving MSH6 and TP53 alterations. Notably, no cases with CDKN2B alterations demonstrated treatment response (p = 0.09). Conclusions: Our findings suggest distinct molecular patterns in phyllodes tumors compared to other soft tissue sarcomas, with potential implications for treatment selection. The identification of specific genetic alterations associated with treatment resistance may guide therapeutic decision-making, while the presence of actionable mutations in select cases indicates potential opportunities for targeted therapy approaches. Full article
(This article belongs to the Collection Frontiers in Breast Cancer Diagnosis and Treatment)
Show Figures

Figure 1

11 pages, 647 KiB  
Article
Assessing the Effectiveness of A-PRF+ for Treating Periodontal Defects: A Prospective Interventional Pilot Study Involving Smokers
by Ada Stefanescu, Dorin Ioan Cocoș, Gabi Topor, Fabian Cezar Lupu, Doriana Forna-Agop and Kamel Earar
Medicina 2024, 60(11), 1897; https://doi.org/10.3390/medicina60111897 - 19 Nov 2024
Viewed by 460
Abstract
Background and Objectives: This study aimed to evaluate the effects of advanced platelet-rich fibrin (A-PRF+) tissue regeneration therapy on clinical periodontal parameters in non-smokers and smoker patients. The anticipated biological mechanisms of A-PRF+ include stimulating angiogenesis, thereby promoting the formation of new blood [...] Read more.
Background and Objectives: This study aimed to evaluate the effects of advanced platelet-rich fibrin (A-PRF+) tissue regeneration therapy on clinical periodontal parameters in non-smokers and smoker patients. The anticipated biological mechanisms of A-PRF+ include stimulating angiogenesis, thereby promoting the formation of new blood vessels, which is essential for tissue healing. Additionally, A-PRF+ harnesses the regenerative properties of platelet-rich fibrin, contributing to the repair and regeneration of periodontal tissues. Materials and Methods: The study was conducted on 55 patients, divided into two groups: non-smoker patients (n = 29) and smoker patients (n = 26). A single operator conducted the surgical procedure. Following the administration of local anesthesia with articaine 4% with adrenaline 1:100,000 precise intracrevicular incisions were made, extending towards the adjacent teeth, until the interproximal spaces, with meticulous attention to conserving the interdental gingival tissue to the greatest extent possible. Extended, full-thickness vestibular and oral flaps were carefully lifted, and all granulation tissue was meticulously removed from the defect without altering the bone contour. After debridement of the defects, A-PRF+ was applied. BOP (bleeding on probing), PI (plaque index), CAL (clinical attachment loss), and probing depth (PD) were determined at baseline and six months post-surgery. Results: Significant reductions were observed in PD and CAL after six months. In the non-smokers group, PD decreased from 7.0 ± 1.0 mm to 3.1 ± 0.1 mm (p < 0.001), while in the smokers group, PD decreased from 6.9 ± 1.1 mm to 3.9 ± 0.3 mm (p < 0.001). CAL decreased in the non-smokers group from 5.8 ± 0.7 mm to 2.6 ± 0.2 mm and from 5.7 ± 0.9 mm to 3.2 ± 0.2 mm (p < 0.001) in smokers. Notably, the reductions in CAL and PD were statistically more significant in the non-smokers group. Conclusions: Even though the clinical periodontal improvements were considerable in smoker patients, they did not reach the level observed in non-smoker patients. Full article
Show Figures

Figure 1

24 pages, 1588 KiB  
Review
Alloimmune Causes of Recurrent Pregnancy Loss: Cellular Mechanisms and Overview of Therapeutic Approaches
by Cristina Uța, Alexandru Tîrziu, Elena-Larisa Zimbru, Răzvan-Ionuț Zimbru, Marius Georgescu, Laura Haidar and Carmen Panaitescu
Medicina 2024, 60(11), 1896; https://doi.org/10.3390/medicina60111896 - 19 Nov 2024
Viewed by 704
Abstract
Recurrent pregnancy loss (RPL) is a complex early pregnancy complication affecting 1–2% of couples and is often linked to immune dysfunction. Aberrations in T and B cell subpopulations, as well as natural killer (NK) cell activity, are particularly influential, with studies showing that [...] Read more.
Recurrent pregnancy loss (RPL) is a complex early pregnancy complication affecting 1–2% of couples and is often linked to immune dysfunction. Aberrations in T and B cell subpopulations, as well as natural killer (NK) cell activity, are particularly influential, with studies showing that abnormal NK cell activation and imbalances in T and B cell subtypes contribute to immune-mediated miscarriage risk. Successful pregnancy requires a tightly regulated balance between pro-inflammatory and anti-inflammatory immune responses. In the early stages, inflammation supports processes such as trophoblast invasion and spiral artery remodeling, but this must be tempered to prevent immune rejection of the fetus. In this review, we explore the underlying immune mechanisms of RPL, focusing on how dysregulated T, B, and NK cell function disrupts maternal tolerance. Specifically, we discuss the essential role of uterine NK cells in the early stages of vascular remodeling in the decidua and regulate the depth of invasion by extravillous trophoblasts. Furthermore, we focus on the delicate Treg dynamics that enable the maintenance of optimal immune homeostasis, where the balance, and not only the quantity of Tregs, is crucial for fostering maternal–fetal tolerance. Other T cell subpopulations, such as Th1, Th2, and Th17 cells, also contribute to immune imbalance, with Th1 and Th17 cells promoting inflammation and potentially harming fetal tolerance, while Th2 cells support immune tolerance. Finally, we show how changes in B cell subpopulations and their functions have been associated with adverse pregnancy outcomes. We further discuss current therapeutic strategies aimed at correcting these immune imbalances, including intravenous immunoglobulin (IVIg), glucocorticoids, and TNF-α inhibitors, examining their efficacy, challenges, and potential side effects. By highlighting both the therapeutic benefits and limitations of these interventions, we aim to offer a balanced perspective on clinical applications for women facing immune-related causes of RPL. Full article
Show Figures

Figure 1

9 pages, 743 KiB  
Review
The Role of the Gut Microbiota in Individuals with Irritable Bowel Syndrome: A Scoping Review
by Takahiko Nagamine
Medicina 2024, 60(11), 1895; https://doi.org/10.3390/medicina60111895 - 19 Nov 2024
Viewed by 646
Abstract
Irritable bowel syndrome (IBS) represents the most prevalent disorder of brain–gut interaction, affecting approximately 10% of the global population. The objective of this study was to examine the mechanisms by which the gut microbiota contributes to the development of IBS. To this end, [...] Read more.
Irritable bowel syndrome (IBS) represents the most prevalent disorder of brain–gut interaction, affecting approximately 10% of the global population. The objective of this study was to examine the mechanisms by which the gut microbiota contributes to the development of IBS. To this end, a review of articles that examined the gut microbiota of IBS patients was conducted. A search was conducted using PubMed and J-STAGE for articles published over the past five years that relate to the gut microbiota in patients with IBS. Individuals diagnosed with IBS display a reduction in alpha diversity and a decline in butyrate-producing bacteria, which collectively indicate a state of dysbiosis within their gut microbiota. Butyrate plays a dual role in the body, acting as a source of nutrition for the intestinal epithelium while also regulating the expression of dopamine transporters and D2 receptors in the central nervous system through epigenetic mechanisms. These characteristics may be linked to dysfunction of the central dopamine D2 pathway and play a role in the formation of various symptoms in IBS. Full article
(This article belongs to the Section Gastroenterology & Hepatology)
Show Figures

Figure 1

11 pages, 870 KiB  
Review
Sjögren’s Disease and Gastroesophageal Reflux Disease: What Is Their Evidence-Based Link?
by Diana Mieliauskaitė and Vilius Kontenis
Medicina 2024, 60(11), 1894; https://doi.org/10.3390/medicina60111894 - 18 Nov 2024
Viewed by 670
Abstract
Sjögren’s disease (SjD), or primary Sjögren’s syndrome (pSS), is a heterogeneous chronic autoimmune disorder with multiple clinical manifestations that can develop into non-Hodgkin’s lymphoma in mucosa-associated lymphoid tissue. SjD is one of the autoimmune diseases with the maximum delayed diagnosis due to its [...] Read more.
Sjögren’s disease (SjD), or primary Sjögren’s syndrome (pSS), is a heterogeneous chronic autoimmune disorder with multiple clinical manifestations that can develop into non-Hodgkin’s lymphoma in mucosa-associated lymphoid tissue. SjD is one of the autoimmune diseases with the maximum delayed diagnosis due to its insidious onset, heterogeneous clinical features and varied course. It is increasingly recognized that extraglandular manifestations represent a clinical challenge for patients with SjD. The European League Against Rheumatism (EULAR) Sjögren’s Syndrome (SS) Disease Activity Index (ESSDAI) is a systemic disease activity index designed to measure disease activity in patients with primary Sjogren’s syndrome. It consists of 12 domains: cutaneous, pulmonary, renal, articular, muscular, peripheral nervous system, central nervous system, hematological, glandular, constitutional, lymphadenopathy and lymphoma, biological. More than a quarter of patients with pSS may have systemic features that are not included in the ESSDAI classification, i.e., various cardiovascular, ophthalmic, ENT, and other systemic or organ involvement that increase the magnitude of the systemic phenotype in the disease. The ESSDAI also excludes the gastrointestinal (GI) tract, and unfortunately, GI manifestations are not routinely assessed. Gastroesophageal reflux disease (GERD) is one of the most prevalent gastrointestinal disorders, impairing quality of life and consuming a large volume of medical resources. Recently carried out the Mendelian randomized trial confirmed the causal link between SjD and gastroesophageal reflux disease (GERD) and showed that GERD is a risk factor for SjD. This review aims to provide an overview of the research describing evidenced based links between Sjögren’s disease and gastroesophageal reflux disease, with the intention of ensuring that any systemic pathology in Sjögren’s disease is properly assessed and that management of the disease is directed towards the patient. A comprehensive literature search was carried out on PubMed, Web of Science, Scopus and the Cochrane Library databases. Two researchers searched for published studies indexed from inception to 1 September 2024 using the keywords ‘Sjögren’s syndrome’ OR ‘Sjögren’s disease’ AND ‘gastroesophageal reflux disease’ AND ‘microbiota’ OR microbiota dysbiosis’. We limited our search for scientific articles to human studies, and only included articles in English. Overall, there is a lack of evidence-based studies assessing the association between GERD and Sjögren’s disease and the changes in the microbiota associated with GERD in a multidisciplinary setting. Such studies are needed for the future, as this will improve the early diagnosis of Sjögren’s disease and the personalized management of the disease. Full article
(This article belongs to the Special Issue Recent Advances in Autoimmune Rheumatic Diseases: 2nd Edition)
Show Figures

Figure 1

16 pages, 934 KiB  
Article
Impact of a Physical Exercise and Health Education Program on Metabolic Syndrome and Quality of Life in Postmenopausal Breast Cancer Women Undergoing Adjuvant Treatment with Aromatase Inhibitors
by Pedro Cespedes, Francisco M. Martínez-Arnau, María Dolores Torregrosa, Omar Cauli and Cristina Buigues
Medicina 2024, 60(11), 1893; https://doi.org/10.3390/medicina60111893 - 18 Nov 2024
Viewed by 774
Abstract
Background and Objectives: Adjuvant treatment with aromatase inhibitors (AIs) in breast cancer (BC) survivors can cause adverse effects such as metabolic syndrome (MS) (insulin resistance, central obesity, atherogenic dyslipidemia, and hypertension) associated with morbidity and premature mortality. We evaluate the effect of [...] Read more.
Background and Objectives: Adjuvant treatment with aromatase inhibitors (AIs) in breast cancer (BC) survivors can cause adverse effects such as metabolic syndrome (MS) (insulin resistance, central obesity, atherogenic dyslipidemia, and hypertension) associated with morbidity and premature mortality. We evaluate the effect of a multimodal program based on physical exercise and health education on MS and health-related quality of life (QoL) in postmenopausal women with BC under AIs. Methods: A total of 56 postmenopausal women, diagnosed with BC, aged 60 years or older (mean age 67.2 years) and on hormonal treatment with AIs, were included in the multimodal physical exercise and health education program, and evaluated before and after their participation. The assessment of the five criteria of the MS included the following: waist circumference, high blood pressure, fasting glucose, triglycerides, and high-density lipoprotein cholesterol. Two main instruments were used to evaluate the impact of the intervention on QoL: the EORTC QLQ C30 (questionnaire for cancers in general) and the EORTC QLQ BR23 (specifically for breast cancer patients). The EuroQol 5D (EQ-5D) was also used to compare these results. Results: The percentage of women meeting the MS criteria was 37.7% at baseline and fell to 15.1% at 3 months after the intervention (p = 0.02). The intervention significantly reduced hypertension (p < 0.001), central obesity (p < 0.001), and the concentration of triglycerides (p = 0.016). No significant changes were observed in fasting glucose and HDL concentration. A statistically significant improvement was found in QoL (on both the QLQ30 and BR23 scales). A multivariate regression model analysis identified marital status (being married) (95% CI: 1.728–131.615, p = 0.014), and percentage of attendance at health education sessions (95% CI: 1.010–1.211, p = 0.029) as positive predictive variables of improvement in MS. Conclusions: The implementation of multimodal, community-based programs of physical exercise and health education improve the prevalence of MS and specific criteria of MS and QoL in postmenopausal women with breast cancer receiving AI treatment. Full article
(This article belongs to the Section Obstetrics and Gynecology)
Show Figures

Figure 1

7 pages, 12416 KiB  
Case Report
Heart Failure Associated with Giant Uterine Leiomyoma: A Case Report
by Hai-Ning Hsu, Fang-Chin Hsu, Yuan Hung, Po-Chao Hsu and Kuo-Min Su
Medicina 2024, 60(11), 1892; https://doi.org/10.3390/medicina60111892 - 18 Nov 2024
Viewed by 583
Abstract
Heart failure impairs the heart’s pumping ability and triggers catecholamine production as an adaptive mechanism. Uterine leiomyomas are common tumors of the female reproductive tract. Their growth is promoted by dysregulated angiogenesis and gonadal steroid hormones. Although uterine leiomyomas share risk factors with [...] Read more.
Heart failure impairs the heart’s pumping ability and triggers catecholamine production as an adaptive mechanism. Uterine leiomyomas are common tumors of the female reproductive tract. Their growth is promoted by dysregulated angiogenesis and gonadal steroid hormones. Although uterine leiomyomas share risk factors with most cardiovascular diseases, their relationship with heart failure has not been well described. Herein, we present the case of a 45-year-old woman with heart failure who visited the emergency department, where we incidentally discovered a giant uterine leiomyoma. The patient was admitted with progressive dyspnea and abdominal distension. Echocardiography revealed an enlarged right ventricle and a decreased systolic function. Computed tomography revealed cardiomegaly with bilateral pleural effusions and a tumor measuring 18.0 × 12.0 cm in the abdominal cavity with massive ascites. A diagnosis of heart failure in conjunction with a uterine leiomyoma was established, which prompted the prescription and adjustment of heart failure medications according to the patient’s clinical presentation. Three weeks later, given the persistent symptoms of bilateral lower extremities pitting edema and abdominal distension, a total hysterectomy was performed. Postoperatively, echocardiography revealed marked improvement in her heart failure. The patient was discharged in a stable clinical and hemodynamic conditions, and reported good physical condition at the 4-month follow-up. Growth factors and the compression effect of uterine leiomyomas may predispose patients to heart failure and exacerbate its deterioration. Although reports of fibroid-related heart failure are rare, uterine leiomyomas should be considered a potential cause of refractory heart failure. Nevertheless, a direct association requires a longer follow-up period. Full article
(This article belongs to the Section Cardiology)
Show Figures

Figure 1

17 pages, 4732 KiB  
Article
Substrate-Induced Structural Dynamics and Evolutionary Linkage of Siderophore-Iron ABC Transporters of Mycobacterium tuberculosis
by Aisha Farhana, Abdullah Alsrhani, Hasan Ejaz, Muharib Alruwaili, Ayman A. M. Alameen, Emad Manni, Zafar Rasheed and Yusuf Saleem Khan
Medicina 2024, 60(11), 1891; https://doi.org/10.3390/medicina60111891 - 18 Nov 2024
Viewed by 600
Abstract
Background and Objective: ATP-binding cassette (ABC) transporters are prominent drug targets due to their highly efficient trafficking capabilities and their significant physiological and clinical roles. Gaining insight into their biophysical and biomechanistic properties is crucial to maximize their pharmacological potential. Materials and [...] Read more.
Background and Objective: ATP-binding cassette (ABC) transporters are prominent drug targets due to their highly efficient trafficking capabilities and their significant physiological and clinical roles. Gaining insight into their biophysical and biomechanistic properties is crucial to maximize their pharmacological potential. Materials and Methods: In this study, we present the biochemical and biophysical characterization, and phylogenetic analysis of the domains of Mycobacterium tuberculosis (M. tuberculosis) ABC transporters: the exporter Rv1348 (IrtA) and the importer system Rv1349-Rv2895c (IrtB-Rv2895c), both involved in siderophore-mediated iron uptake. Results: Our findings reveal that the substrate-binding domain (SBD) of IrtA functions as an active monomer, while Rv2895c, which facilitates the uptake of siderophore-bound iron, exists in a dynamic equilibrium between dimeric and monomeric forms. Furthermore, ATP binding induces the dimerization of the ATPase domains in both IrtA (ATPase I) and IrtB (ATPaseII), but only the ATPase domain of IrtA (ATPase I) is active independently. We also analyzed the stability of substrate binding to the domains of the two transporters across varying temperature and pH ranges, revealing significant shifts in their activity under different conditions. Our study highlights the conformational changes that accompany substrate interaction with the transporter domains, providing insights into the fundamental mechanism required for the translocation of siderophore to the extracytoplasmic milieu by IrtB and, subsequently, import of their ferrated forms by the IrtB-Rv2895c complex. Phylogenetic analyses based on ATPase domains reveal that IrtA shares features with both archaeal and eukaryotic transporters, while IrtB is unique to mycobacterial species. Conclusions: Together, these findings provide valuable insights, which could accelerate the development of intervention strategies for this critical pathway pivotal in the progression of M. tuberculosis infection. Full article
(This article belongs to the Section Infectious Disease)
Show Figures

Figure 1

12 pages, 1694 KiB  
Article
Immediate and Long-Term Effects of Breathing Exercises on Reaction Time
by Burçin Akçay, Ozan Bahadır Türkmen, Ebru Kaya Mutlu, Canan Demir, Ahmet Kurtoğlu, Kopzhassar Bayetov, Madawi H. Alotaibi and Safaa M. Elkholi
Medicina 2024, 60(11), 1890; https://doi.org/10.3390/medicina60111890 - 18 Nov 2024
Viewed by 510
Abstract
Background and Objectives: The aim of this study was to investigate the immediate and long-term effects of breathing exercises on simple and choice reaction time. Materials and Methods: A total of 31 participants were included in the study. The participants were [...] Read more.
Background and Objectives: The aim of this study was to investigate the immediate and long-term effects of breathing exercises on simple and choice reaction time. Materials and Methods: A total of 31 participants were included in the study. The participants were randomly divided into two groups. The intervention group (IG; n:16) received 12 sessions of breathing exercises for four weeks (three days a week), while the control group (CG; n:15) received no intervention. Both groups underwent the same assessments at the same times: at baseline, after the first exercise session, and after four weeks/after 12 exercise sessions. Reaction time was assessed using three conditions: choice reaction time (CRT) of the upper limb, auditory reaction time (ART), and visual reaction time (VRT) tests. The first assessment was applied at baseline. The second assessment measured the short-term effect of the breathing exercises after the study group received their first breathing exercise session. The third assessment, to determine the long-term effect, was repeated four weeks after the baseline (A4W) assessment after completing 12 breathing exercises. Results: There was no significant difference between the groups at baseline, immediately, and A4W (p < 0.05) for the VRT, ART, and CRT results with the dominant hand (DH), whereas a group-by-time interaction was found only for the visual reaction time results with the non-dominant hand (nDH) (p > 0.05). Conclusions: The results of this study, which included the evaluation of the immediate and long-term effects of breathing exercises on reaction time, showed an improvement in visual reaction time between the groups over time. In further studies, it is recommended to evaluate the changes and responses in the central nervous system with objective methods to reveal the effect of breathing exercises on reaction time more clearly. Full article
(This article belongs to the Section Sports Medicine and Sports Traumatology)
Show Figures

Figure 1

15 pages, 911 KiB  
Systematic Review
Application of Additive Manufacturing in Assisted Reproductive Techniques: What Is the Evidence? A Clinical and Technical Systematic Review of the Literature
by Adamantia Kontogeorgi, Ioannis Boutas, Gkalia Tsangkalova, Pantelis Messaropoulos, Nektarios I. Koufopoulos, Roxana Schwab, Antonis Makrigiannakis, Magda Zanelli, Andrea Palicelli, Maurizio Zizzo, Giuseppe Broggi, Rosario Caltabiano and Sophia N. Kalantaridou
Medicina 2024, 60(11), 1889; https://doi.org/10.3390/medicina60111889 - 18 Nov 2024
Viewed by 666
Abstract
Background and Objectives: This article investigates the transformative impact of 3D and bio 3D printing technologies in assisted reproductive technology (ART), offering a comprehensive review of their applications in improving reproductive outcomes. Materials and Methods: Following PRISMA guidelines, we conducted a thorough literature [...] Read more.
Background and Objectives: This article investigates the transformative impact of 3D and bio 3D printing technologies in assisted reproductive technology (ART), offering a comprehensive review of their applications in improving reproductive outcomes. Materials and Methods: Following PRISMA guidelines, we conducted a thorough literature search focusing on the intersection of ART and additive manufacturing, resulting in the inclusion of 48 research papers. Results: The study highlights bio 3D printing’s potential in revolutionizing female infertility treatments, especially in follicle complex culture and ovary printing. We explore the use of decellularized extracellular matrix (dECM) as bioink, demonstrating its efficacy in replicating the ovarian microenvironment for in vitro maturation of primordial oocytes. Furthermore, advancements in endometrial cavity interventions are discussed, including the application of sustained-release systems for growth factors and stem cell integration for endometrial regeneration, showing promise in addressing conditions like Asherman’s syndrome and thin endometrium. We also examine the role of conventional 3D printing in reproductive medicine, including its use in educational simulators, personalized IVF instruments, and microfluidic platforms, enhancing training and precision in reproductive procedures. Conclusions: Our review underscores both 3D printing technologies’ contribution to the dynamic landscape of reproductive medicine. They offer innovative solutions for individualized patient care, augmenting success rates in fertility treatments. This research not only presents current achievements but also anticipates future advancements in these domains, promising to expand the horizons for individuals and families seeking assistance in their reproductive journeys. Full article
(This article belongs to the Section Obstetrics and Gynecology)
Show Figures

Figure 1

16 pages, 436 KiB  
Review
Mitochondrial Dysfunction: Effects and Therapeutic Implications in Cerebral Gliomas
by Gerardo Caruso, Roberta Laera, Rosamaria Ferrarotto, Cristofer Gonzalo Garcia Moreira, Rajiv Kumar, Tamara Ius, Giuseppe Lombardi and Maria Caffo
Medicina 2024, 60(11), 1888; https://doi.org/10.3390/medicina60111888 - 18 Nov 2024
Viewed by 542
Abstract
Gliomas are the most common primary brain tumors, representing approximately 28% of all central nervous system tumors. These tumors are characterized by rapid progression and show a median survival of approximately 18 months. The therapeutic options consist of surgical resection followed by radiotherapy [...] Read more.
Gliomas are the most common primary brain tumors, representing approximately 28% of all central nervous system tumors. These tumors are characterized by rapid progression and show a median survival of approximately 18 months. The therapeutic options consist of surgical resection followed by radiotherapy and chemotherapy. Despite the multidisciplinary approach and the biomolecular role of targeted therapies, the median progression-free survival is approximately 6–8 months. The incomplete tumor compliance with treatment is due to several factors such as the presence of the blood–brain barrier, the numerous pathways involved in tumor transformation, and the presence of intra-tumoral mutations. Among these, the interaction between the mutations of genes involved in tumor bio-energetic metabolism and the functional response of the tumor has become the protagonist of numerous studies. In this scenario, the main role is played by mitochondria, cellular organelles delimited by a double membrane and containing their own DNA (mtDNA), which participates in numerous cellular processes such as the regulation of cellular metabolism, cellular proliferation, and apoptosis and is also the main source of cellular energy production. Therefore, it is understood that the mitochondrion, specifically its functional alteration, is a leading figure in tumor transformation, including brain tumors. The acquisition of mutations in the mitochondrial DNA of tumor cells and the subsequent identification of the so-called mitochondria-related genes (MRGs), both functional (mutation of Complex I) and structural (mutations of Complex III/IV), have been seen to play an important role in metabolic reprogramming with increased proliferation, resistance to apoptosis, and the progression of tumorigenesis. This demonstrates that these mitochondrial alterations could have a role not only in the intrinsic tumor biology but also in the extrinsic one associated with the therapeutic response. We aim to summarize the main mitochondrial dysfunction interactions present in gliomas and how they might impact prognosis. Full article
(This article belongs to the Section Neurology)
Show Figures

Figure 1

18 pages, 1591 KiB  
Article
Pain After Lower Limb Amputations: Insights from the Heidelberg Amputation Registry
by Timo Albert Nees, Cornelia Matt, Julian Deisenhofer, Julia Block, Sebastian I. Wolf, Tobias Renkawitz, Burkhard Lehner and Merkur Alimusaj
Medicina 2024, 60(11), 1887; https://doi.org/10.3390/medicina60111887 - 18 Nov 2024
Viewed by 469
Abstract
Background and Objectives: The experience of unpleasant sensory phenomena after lower limb amputations (LLAs), including phantom limb pain (PLP), phantom limb sensation (PLS), and residual limb pain (RLP), impacts global healthcare and adversely affects outcomes post-amputation. This study aimed to describe the [...] Read more.
Background and Objectives: The experience of unpleasant sensory phenomena after lower limb amputations (LLAs), including phantom limb pain (PLP), phantom limb sensation (PLS), and residual limb pain (RLP), impacts global healthcare and adversely affects outcomes post-amputation. This study aimed to describe the distribution of PLP, PLS, and RLP among patients with LLAs registered in the Heidelberg Amputation Registry. The primary objective was to determine the prevalence of sensory abnormalities across different amputation levels and causes. Materials and Methods: In this single-center, cross-sectional study, data from 459 patients registered in the Heidelberg Amputation Registry were analyzed for the occurrence of PLP, PLS and RLP. Subsequently, logistic regression models were used to identify the independent risk factors associated with sensory disturbances following LLAs. The mean age of the LLA patients (31% female, 69% male) was 58 years (SD ± 18). Results: The patients were, on average, 44 years old (SD ± 22) at the time of amputation, with a mean duration since amputation of 15 years (SD ± 17). Transtibial amputations were the most common (43%), followed by transfemoral (39%) and partial foot amputations (10%). Hip and knee disarticulations were observed in 3.7% and 3.5% of the cohort, respectively, with hemipelvectomies accounting for 1%. Traumatic injuries (32%) and neoplastic disorders (22%) were the leading causes of LLAs, while peripheral artery disease and diabetes were responsible for 12% and 6% of cases, respectively. Importantly, a significant proportion of participants (85%) reported experiencing abnormal sensations. The prevalence rates for phantom limb pain (PLP), phantom limb sensation (PLS), and residual limb pain (RLP) were 58%, 66%, and 46%, respectively. The occurrence of sensory disturbances, with the exception of RLP, was significantly affected by the level of amputation. Notably, the age at amputation emerged as an independent risk factor for developing abnormal sensations, including PLS. Conclusions: In conclusion, this study provides a comprehensive overview of sensory abnormalities in a diverse cohort of LLA patients, highlighting the age at amputation as an important factor. The findings emphasize the role of comprehensive registries in enhancing care for individuals with amputations and guiding targeted pain management strategies. Full article
(This article belongs to the Special Issue Innovations in Amputation Care)
Show Figures

Figure 1

12 pages, 584 KiB  
Article
Evaluation of the Hypothalamic–Pituitary–Adrenal Axis in Patients with Primary Sjögren’s Disease
by Ana Glavina, Petar Zurak, Dinko Martinović, Majda Gotovac, Daniela Šupe-Domić and Liborija Lugović-Mihić
Medicina 2024, 60(11), 1886; https://doi.org/10.3390/medicina60111886 - 17 Nov 2024
Viewed by 507
Abstract
Background and Objectives: Patients with primary Sjögren’s disease (pSjD) show contradictory results regarding the activity of the hypothalamic–pituitary–adrenal (HPA) axis. The aim of this study was to determine the salivary cortisol concentration to evaluate the function of the HPA axis (hypoactive/hyperactive) between patients [...] Read more.
Background and Objectives: Patients with primary Sjögren’s disease (pSjD) show contradictory results regarding the activity of the hypothalamic–pituitary–adrenal (HPA) axis. The aim of this study was to determine the salivary cortisol concentration to evaluate the function of the HPA axis (hypoactive/hyperactive) between patients with pSjD and control subjects. Materials and Methods: A total of 34 subjects participated in the cross-sectional study: 17 patients with pSjD and 17 control subjects. Stimulated whole saliva (SWS) was used to determine salivary cortisol concentration using an enzyme-linked immunosorbent assay (ELISA). Results: The salivary cortisol concentration showed a statistically significant difference between patients with pSjD and control subjects (4.69 ± 2.88 vs. 0.49 ± 0.37; p < 0.001; Student t-test). The area under the curve (AUC) was 100.0% in patients with pSjD (p < 0.001). The cut-off point was set to >1.454. The patients with pSjD had four times higher scores for depression and stress and six times higher scores for anxiety compared to the control subjects (p = 0.048, p < 0.001, p = 0.038; Mann–Whitney U test). The patients with pSjD had a statistically significantly higher total Oral Health Impact Profile (OHIP) score compared to the control subjects (p < 0.001, Mann–Whitney U test). Conclusions: The patients with pSjD showed short-term hyperactivity of the HPA axis compared to the control subjects. Full article
Show Figures

Figure 1

9 pages, 1228 KiB  
Article
Transient Elevation of Liver Function Tests and Bilirubin Levels After Laparoscopic Cholecystectomy
by Alexandros Giakoustidis, Menelaos Papakonstantinou, Christos Gkoutzios, Paraskevi Chatzikomnitsa, Areti Danai Gkaitatzi, Athanasia Myriskou, Petros Bangeas, Panagiotis Dimitrios Loufopoulos, Vasileios N. Papadopoulos and Dimitrios Giakoustidis
Medicina 2024, 60(11), 1885; https://doi.org/10.3390/medicina60111885 - 17 Nov 2024
Viewed by 572
Abstract
Background and Objectives: Laparoscopic cholecystectomy constitutes the current “gold standard” treatment of symptomatic gallstone disease. In order to avoid intraoperative vasculobiliary injuries, it is mandatory to establish the “critical view of safety”. In cases of poor identification of the cystic duct and [...] Read more.
Background and Objectives: Laparoscopic cholecystectomy constitutes the current “gold standard” treatment of symptomatic gallstone disease. In order to avoid intraoperative vasculobiliary injuries, it is mandatory to establish the “critical view of safety”. In cases of poor identification of the cystic duct and artery leading to a missed intraoperative injury, patients present with elevated liver function tests (LFTs) or increased bilirubin postoperatively. The aim of this study is to present a series of patients of our institute with elevated liver enzymes and bilirubin after laparoscopic cholecystectomy in the absence of intraoperative injury or any other obvious etiology and to provide a possible explanation of this finding. Materials and Methods: From 2019 to 2023, 200 patients underwent elective laparoscopic cholecystectomy at the Papageorgiou General Hospital and at the European Interbalkan Medical Center of Thessaloniki utilizing the “critical view of safety” method. We retrospectively collected the intraoperative reports, and the pre- and postoperative imaging and laboratory studies of the patients included in this series. Postoperative LFTs and bilirubin levels were extracted and the reason for their transient elevation was examined. Results: From 200 cases of laparoscopic cholecystectomy, elevated LFTs and bilirubin were found in six patients on the first postoperative day, which is suggestive of a missed intraoperative injury. All patients were asymptomatic. During the investigatory workup, a triple-phase CT of the liver and/or an MRCP were ordered, but no pathological findings, such as biliary injury, hepatic artery injury or choledocholithiasis, were found. On postoperative day 3, LFTs and bilirubin levels decreased or normalized without any intervention. No postoperative complications were reported. Conclusions: In select cases, a transient increase in LFTs and/or bilirubin may be observed in the early postoperative period after elective laparoscopic cholecystectomy in the absence of an obvious etiology. A possible interpretation of these findings could involve the pneumoperitoneum or the anesthesia regimens used intra- or perioperatively. The specific cause, however, remains undetermined and yet to be examined by future studies. Full article
Show Figures

Figure 1

12 pages, 810 KiB  
Review
PiCCO or Cardiac Ultrasound? Which Is Better for Hemodynamic Monitoring in ICU?
by Maria Andrei, Nicoleta Alice Dragoescu, Andreea Stanculescu, Luminita Chiutu, Octavian Dragoescu and Octavian Istratoaie
Medicina 2024, 60(11), 1884; https://doi.org/10.3390/medicina60111884 - 17 Nov 2024
Viewed by 638
Abstract
Advanced hemodynamic monitoring is fundamental in the management of the critically ill. Blood pressure and cardiac function are key markers of cardiovascular system function;, thus, having accurate measurements of these parameters in critically ill patients is essential. Currently, there are various methods available [...] Read more.
Advanced hemodynamic monitoring is fundamental in the management of the critically ill. Blood pressure and cardiac function are key markers of cardiovascular system function;, thus, having accurate measurements of these parameters in critically ill patients is essential. Currently, there are various methods available to choose from, as well as a greater understanding of the methods and criteria to be able to compare devices and select the best option for our patients’ needs. Cardiac ultrasound and transpulmonary thermodilution help tailor the therapy for a patient’s individual needs by putting the results of a thorough hemodynamic assessment into context. Both these hemodynamic monitoring techniques have their advantages, drawbacks and limitations. Cardiac ultrasound is a safe, non-invasive, less expensive, efficient bedside tool for diagnosing, monitoring and guiding critically ill patients’ therapy management. It is recommended in the consensus guidelines as the first-choice method, especially when it comes to identifying different types of shock or the various factors involved. Pulse index contour continuous cardiac output (PiCCO) is a minimally invasive hemodynamic monitoring technique, integrating various static and hemodynamic parameters through a combination of trans-cardiopulmonary thermodilution and pulse contour analysis. The PiCCO method provides guidance to fluid and vasoactive therapy in critically ill patients and is also used for intraoperative and postoperative fluid management and monitoring in cardiac surgery. While invasive methods such as PiCCO are recommended for hemodynamic monitoring and can provide accurate information, they are not always necessary and are contraindicated in some cases. Full article
(This article belongs to the Special Issue Management of Septic Shock in ICU)
Show Figures

Figure 1

8 pages, 1629 KiB  
Article
Prevention of Air Embolism in Extracorporeal Membrane Oxygenation Systems: An In Vitro Study on Protection of Central Venous Catheter Lumen
by Danilo Franco, Nejc Krasna, Robert Novak, Giovanni Esposito, Raffaele Izzo, Jan Belohlavek, Marko Noc and Tomaz Goslar
Medicina 2024, 60(11), 1883; https://doi.org/10.3390/medicina60111883 - 17 Nov 2024
Viewed by 488
Abstract
Background and Objectives: This study aimed to investigate the risk and mechanisms of air entry into the extracorporeal membrane oxygenation (ECMO) circuit through the central venous catheter (CVC) in a veno-venous configuration. The primary goal was to assess the impact of different air [...] Read more.
Background and Objectives: This study aimed to investigate the risk and mechanisms of air entry into the extracorporeal membrane oxygenation (ECMO) circuit through the central venous catheter (CVC) in a veno-venous configuration. The primary goal was to assess the impact of different air volumes on ECMO circuit performance at varying pump speeds. Material and Methods: The study utilized a circuit model to simulate ECMO conditions and evaluate the potential entry points of air, specifically through the unprotected lumen of the CVC. Various interventions, such as the use of a closed three-way stopcock or clave, were implemented to assess their efficacy in preventing air entry. Results: The unprotected lumen of the central venous catheter posed a significant risk for air entry into the ECMO circuit. The introduction of a closed three-way stopcock or clave proved effective in preventing air ingress through the central venous catheter. Auditory cues, such as a distinct hissing sound, served as an early warning sign of air presence in the circuit. The study demonstrated that even small volumes of air, as minimal as 1 mL, could pass through the oxygenator at specific pump speeds, and larger volumes could lead to pump dysfunction. Conclusions: The study identified the unprotected lumen of the central venous catheter as a potential entry point for air into the ECMO circuit. The use of a closed three-way stopcock or one-way valve was found to be a reliable protective measure against air infiltration. Early detection through the observation of a hissing sound in the circuit provided a valuable warning sign. These findings contribute to enhancing the safety and performance of ECMO systems by minimizing the risk of air embolism. Full article
(This article belongs to the Special Issue Advancements in Cardiovascular Medicine and Interventional Radiology)
Show Figures

Figure 1

11 pages, 1206 KiB  
Article
Estimating Coronary Sinus Oxygen Saturation from Pulmonary Artery Oxygen Saturation
by Alexander Gall, Hosamadin S. Assadi, Rui Li, Zia Mehmood, Bahman Kasmai, Gareth Matthews and Pankaj Garg
Medicina 2024, 60(11), 1882; https://doi.org/10.3390/medicina60111882 - 16 Nov 2024
Viewed by 546
Abstract
Background and Objectives: Coronary sinus oxygen saturation is a useful indicator of health and disease states. However, it is not routinely used in clinical practice. Cardiovascular magnetic resonance imaging (CMR) oximetry can accurately estimate oxygen saturation in the pulmonary artery. This research [...] Read more.
Background and Objectives: Coronary sinus oxygen saturation is a useful indicator of health and disease states. However, it is not routinely used in clinical practice. Cardiovascular magnetic resonance imaging (CMR) oximetry can accurately estimate oxygen saturation in the pulmonary artery. This research aimed to provide a method for calculating coronary sinus oxygen saturation (ScsO2) from pulmonary artery oxygen saturation (SpaO2) that could be applied to CMR. Materials and Methods: A systematic literature review was conducted to identify prior work that included invasive measures of ScsO2 and either SpaO2 or right ventricular oxygen saturation. This revealed one study with appropriate data (ScsO2 and SpaO2 measurements, n = 18). We then carried out agreement and correlation analyses. Results: Regression analysis demonstrated a statistically significant, positive relationship between ScsO2 and SpaO2, giving a regression equation of ScsO2 = −31.198 + 1.062 × SpaO2 (r = 0.76, p < 0.001). A multivariable regression analysis of all reported variables, excluding SpaO2, independently identified superior vena cava oxygen saturation (SsvcO2) and arterial oxygen saturation (SaO2) as predictors of ScsO2 (r = 0.78, p < 0.001), deriving the equation ScsO2 = −452.8345 + 4.3579 × SaO2 + 0.8537 × SsvcO2. Conclusions: In this study, we demonstrated a correlation between coronary sinus oxygen saturation and pulmonary artery oxygen saturation, allowing the estimation of ScsO2 from SpaO2. This association enables the estimation of ScsO2 from purely CMR-derived data. We have also described a second model using arterial and superior vena cava saturation measurements, providing an alternative method. Future validation in larger, independent cohorts is needed. Full article
(This article belongs to the Section Cardiology)
Show Figures

Figure 1

17 pages, 974 KiB  
Article
Pre-Pregnancy Provegetarian Food Pattern and the Risk of Developing Gestational Diabetes Mellitus: The Seguimiento Universidad de Navarra (SUN) Cohort Study
by Vanessa Bullón-Vela, Ainara Martínez-Tabar, Maddi Etxezarreta-Uranga, Miguel Ángel Martínez-González, Francisco Javier Basterra-Gortari and Maira Bes-Rastrollo
Medicina 2024, 60(11), 1881; https://doi.org/10.3390/medicina60111881 - 16 Nov 2024
Viewed by 799
Abstract
Background and Objectives: Gestational diabetes mellitus (GDM) is one of the most common medical conditions in pregnancy, with adverse effects on maternal and neonatal outcomes. Evidence suggests a beneficial effect of plant-based dietary patterns, rich in foods derived from plant sources and low [...] Read more.
Background and Objectives: Gestational diabetes mellitus (GDM) is one of the most common medical conditions in pregnancy, with adverse effects on maternal and neonatal outcomes. Evidence suggests a beneficial effect of plant-based dietary patterns, rich in foods derived from plant sources and low in animal foods, on type 2 diabetes; however, their effects on GDM remain unclear. We aimed to investigate the association between pre-pregnancy provegetarian food patterns and the incidence of GDM in a Spanish cohort. Materials and Methods: This subsample of the Seguimiento Universidad de Navarra (SUN) cohort analyzed 3589 Spanish university graduate pregnant women with a mean (standard deviation) age of 28 (±4.3) who were initially free of pre-existing diabetes at baseline. Dietary food consumption was evaluated through a validated, 136-item semi-quantitative food frequency questionnaire. The pre-pregnancy provegetarian food pattern was obtained by assigning positive scores to plant-based food groups and reverse scores to animal food groups. Energy-adjusted quintiles were applied to allocate points to construct the provegetarian food pattern, ranging from 12 to 60 points. Logistic regression models were performed to estimate the odds ratios (OR) of GDM across quintiles of a pre-pregnancy provegetarian food pattern, using the lowest quintile as the reference category. Results: We identified 178 incidence cases of GDM. Women in the highest quintile (Q5) of provegetarian food pattern before pregnancy exhibited a 42% relative reduction in the odds of GDM [adjusted OR (95% CI) Q5 vs. Q1: 0.58 (0.35, 0.97); p-trend = 0.109]. Higher consumption of meat and dairy before pregnancy was associated with a significantly increased risk of GDM [adjusted OR (95% CI) Q5 vs. Q1: 1.94 (1.19, 3.16); p-trend = 0.005] and [adjusted OR (95% CI) Q5 vs. Q1: 1.77 (1.07, 2.94); p-trend = 0.082], respectively. Conclusions: Higher pre-pregnancy consumption of a provegetarian food pattern was associated with a lower risk of developing GDM in Spanish women. Further studies are needed to confirm these findings. Full article
(This article belongs to the Section Endocrinology)
Show Figures

Figure 1

18 pages, 7713 KiB  
Article
Neurometabolic Profile in Obese Patients: A Cerebral Multi-Voxel Magnetic Resonance Spectroscopy Study
by Miloš Vuković, Igor Nosek, Johannes Slotboom, Milica Medić Stojanoska and Duško Kozić
Medicina 2024, 60(11), 1880; https://doi.org/10.3390/medicina60111880 - 16 Nov 2024
Viewed by 705
Abstract
Background and Objectives: Obesity-related chronic inflammation may lead to neuroinflammation and neurodegeneration. This study aimed to evaluate the neurometabolic profile of obese patients using cerebral multivoxel magnetic resonance spectroscopy (mvMRS) and assess correlations between brain metabolites and obesity markers, including body mass index [...] Read more.
Background and Objectives: Obesity-related chronic inflammation may lead to neuroinflammation and neurodegeneration. This study aimed to evaluate the neurometabolic profile of obese patients using cerebral multivoxel magnetic resonance spectroscopy (mvMRS) and assess correlations between brain metabolites and obesity markers, including body mass index (BMI), waist circumference, waist-hip ratio, body fat percentage, and indicators of metabolic syndrome (e.g., triglycerides, HDL cholesterol, fasting blood glucose, insulin, and insulin resistance index (HOMA-IR)). Materials and Methods: This prospective study involved 100 participants, stratified into two groups: 50 obese individuals (BMI ≥ 30 kg/m2) and 50 controls (18.5 ≤ BMI < 25 kg/m2). Anthropometric measurements, body fat percentage, and biochemical markers were evaluated. All subjects underwent long- and short-echo mvMRS analysis of the frontal and parietal supracallosal subcortical and deep white matter, as well as the cingulate gyrus, analyzing NAA/Cr, Cho/Cr, and mI/Cr ratios, along with absolute concentrations of NAA and Cho. Results: Obese participants exhibited significantly decreased NAA/Cr and Cho/Cr ratios in the deep white matter of the right cerebral hemisphere (p < 0.001), while absolute concentrations of NAA and Cho did not differ significantly between groups (p > 0.05). NAA levels showed negative correlations with more reliable obesity parameters (waist circumference and waist-to-hip ratio) but not with BMI, particularly in the deep frontal white matter and dorsal anterior cingulate gyrus of the left cerebral hemisphere. Notably, insulin demonstrated a significant negative impact on NAA (ρ = −0.409 and ρ = −0.410; p < 0.01) and Cho levels (ρ = −0.403 and ρ = −0.392; p < 0.01) at these locations in obese individuals. Conclusions: Central obesity and hyperinsulinemia negatively affect specific brain regions associated with cognitive and emotional processing, while BMI is not a reliable parameter for assessing brain metabolism. Full article
(This article belongs to the Special Issue Advances in Clinical Diabetes, Obesity, and Metabolic Diseases)
Show Figures

Figure 1

12 pages, 845 KiB  
Article
Low Serum Beta-2 Microglobulin Level: A Possible Biomarker for Sarcopenia in the Elderly Population
by Ceren Kanat Sahin, Burak Mete, Hakan Demirhindi, Gülşah Yaşa Öztürk, Esra Ateş Bulut, Erkan Kozanoğlu, Gülçin Dağlıoğlu, Bülent Kaya and Ertuğrul Bayram
Medicina 2024, 60(11), 1879; https://doi.org/10.3390/medicina60111879 - 16 Nov 2024
Viewed by 469
Abstract
Background and Objectives: One of the most critical problems regarding sarcopenia is the difficulty of the diagnosis process. This study aimed to determine the prevalence and investigate the role of serum beta-2 microglobulin level as a biomarker for diagnosing sarcopenia. Materials and [...] Read more.
Background and Objectives: One of the most critical problems regarding sarcopenia is the difficulty of the diagnosis process. This study aimed to determine the prevalence and investigate the role of serum beta-2 microglobulin level as a biomarker for diagnosing sarcopenia. Materials and Methods: This nested case–control study was conducted between 2023 and 2024 on 251 older adults. Muscle strength was measured using a hand dynamometer, and muscle mass was assessed using the bioelectrical impedance method. Individuals with low muscle strength and low muscle mass were accepted as having definitive sarcopenia. Results: The mean age of the 251 older adults included in the study was 72.19 ± 6.11 years. The prevalence of sarcopenia in individuals aged 65 years and over was found to be 5.2%. Serum beta-2 microglobulin levels were statistically significantly lower in sarcopenic participants compared to the control group (p = 0.002). The optimal cut-off value for serum beta-2 microglobulin level was 2.26 mcg/mL, and values lower than this point were found to be diagnostic for sarcopenia. Regarding the cut-off value, the sensitivity was 92.31% and the specificity was 80.77%, the positive predictive value was 70.59%, the negative predictive value was 95.45%, the Youden index was 0.731, and the area under the curve value was 0.901. Individuals who had beta-2 microglobulin levels below 2.26 mcg/mL were found to have a 10.75 times higher risk of sarcopenia. Conclusions: A low serum beta-2 microglobulin level has the potential to be an important candidate biomarker for the diagnosis of sarcopenia. Full article
Show Figures

Figure 1

12 pages, 654 KiB  
Article
Exploring the Relationship Between Lipoprotein (a) Level and Myocardial Infarction Risk: An Observational Study
by Ionut Cezar Buciu, Eugen Nicolae Tieranu, Andreea Stefania Pircalabu, Octavian Istratoaie, Ovidiu Mircea Zlatian, Ramona Cioboata, Ionut Donoiu, Constantin Militaru, Sebastian Militaru and Cristian Militaru
Medicina 2024, 60(11), 1878; https://doi.org/10.3390/medicina60111878 - 16 Nov 2024
Viewed by 566
Abstract
Background and Objectives: This observational study investigates the relationship between Lipoprotein (a) (Lp(a)) levels and the risk of acute myocardial infarction (AMI). This study aims to highlight the association of elevated Lipoprotein (a) levels with an increased atherogenic profile and the potential [...] Read more.
Background and Objectives: This observational study investigates the relationship between Lipoprotein (a) (Lp(a)) levels and the risk of acute myocardial infarction (AMI). This study aims to highlight the association of elevated Lipoprotein (a) levels with an increased atherogenic profile and the potential risk of AMI. Materials and Methods: We conducted a case–control study involving 106 individuals, including 64 AMI patients (both STEMI and NSTEMI) and 42 healthy controls. Comprehensive clinical and biochemical assessments, including Lp(a) measurements, were conducted. Results: Patients with Lp(a) levels ≥ 30 mg/dL had a threefold increased risk of AMI compared to those with lower levels, independent of traditional risk factors such as cholesterol, smoking, and body weight. Elevated Lp(a) was observed in 50% of AMI patients compared to 28.57% in controls (p = 0.028). Notably, a multivariate analysis identified high Lp(a) levels, low HDL-C levels, and obesity as significant independent predictors of AMI, indicating these factors may contribute to AMI risk more prominently than other conventional risk factors in patients with elevated Lp(a). Moreover, the association between Lp(a) and AMI risk was consistent across various patient subgroups, with low HDL-C further compounding the risk. Conclusions: Lp(a) is a significant independent risk factor for acute myocardial infarction; therefore, screening for Lp(a) levels can help identify high-risk individuals beyond traditional markers. Therapeutic approaches targeting Lp(a) may reduce AMI incidence. Future research should explore how Lp(a) promotes atherosclerosis and assess Lp(a)-lowering therapies to improve patient outcomes. Full article
(This article belongs to the Special Issue Advances in Acute Myocardial Infarction)
Show Figures

Figure 1

Previous Issue
Next Issue
Back to TopTop