Medicina

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

Viewed by 764

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, 4913 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

Viewed by 649

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

Viewed by 509

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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13 pages, 915 KiB

Open AccessArticle

Prevalence and Risk Factors of Osteoporosis: A Cross-Sectional Study in a Tertiary Center

by Samican Özmen, Sefa Kurt, Hikmet Tunç Timur, Onur Yavuz, Hakan Kula, Ayşegül Yılmaz Demir and Ali Balcı

Medicina 2024, 60(12), 2109; https://doi.org/10.3390/medicina60122109 - 23 Dec 2024

Viewed by 703

Abstract

Background and Objectives: Osteoporosis is a common disease of the skeletal system that increases the risk of fracture. The prevalence of osteoporosis has been increasing as the aging population increases, affecting more than 200 million people worldwide. This study aimed to shed light [...] Read more.

Background and Objectives: Osteoporosis is a common disease of the skeletal system that increases the risk of fracture. The prevalence of osteoporosis has been increasing as the aging population increases, affecting more than 200 million people worldwide. This study aimed to shed light on the clinical impact of osteoporosis on women’s health and quality of life by evaluating the prevalence and risk factors for this disease among postmenopausal women, using a 10-year dataset from a tertiary center. Materials and Methods: This retrospective cohort study was conducted at Dokuz Eylül University, Department of Obstetrics and Gynecology, between 2010 and 2022. A total of 3289 postmenopausal women aged 50–60 years who were undergoing routine gynecological checkups were included in the study. Patients with a prior diagnosis, a history of medical conditions, or who were taking medications affecting bone mineral density (BMD) were excluded. Data on demographics, smoking status, diabetes status, body mass index (BMI), parity, and fracture history were collected. BMD scores were classified as normal, osteopenia, or osteoporosis. Results: The prevalence of osteoporosis was 10.4%. The median age of the patients was 56.0 years. Smoking, diabetes, and a history of bone fractures were found to significantly increase the risk of osteoporosis. BMI was found to have a protective effect against osteoporosis. According to multivariate analysis, the risk of osteoporosis increased by 2.46 times in patients who smoke, 3.78 times in patients with diabetes, and 6.23 times in patients with a history of fractures. Conclusions: Awareness of modifiable risk factors such as smoking is crucial for preventing osteoporosis-related complications. Diabetes, even when it is not complicated, increases the risk of osteoporosis. Physical exercise, calcium, and vitamin D intake are important, especially during young adulthood, as they are the primary contributors to peak bone mass. Because neck fractures are more common in patients with osteopenia, early diagnosis and routine screening can mitigate future complications. Full article

(This article belongs to the Section Obstetrics and Gynecology)

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15 pages, 2127 KiB

Open AccessArticle

Impact of Vascular Endothelial Growth Factor on the Shape, Survival, and Osteogenic Transformation of Gingiva-Derived Stem Cell Spheroids

by Ji-Eun Lee, Somyeong Hwa, Hee-Ra Lee, Ju-Hwan Kim, Hyun-Jin Lee and Jun-Beom Park

Medicina 2024, 60(12), 2108; https://doi.org/10.3390/medicina60122108 - 23 Dec 2024

Viewed by 533

Abstract

Background and Objectives: Vascular endothelial growth factor (VEGF) is a protein which stimulates the formation of new blood vessels, playing a crucial role in processes such as wound healing and tumor growth. Methods: This study investigated the effects of VEGF on [...] Read more.

Background and Objectives: Vascular endothelial growth factor (VEGF) is a protein which stimulates the formation of new blood vessels, playing a crucial role in processes such as wound healing and tumor growth. Methods: This study investigated the effects of VEGF on cell viability and osteogenic differentiation in mesenchymal stem cell (MSC) spheroids. Stem cell spheroids were fabricated using concave microwells and cultured with VEGF at concentrations of 0, 0.01, 0.1, 1, and 10 ng/mL. Morphological assessments were conducted on days 1, 3, 5, and 7, while cell viability was evaluated using the LIVE/DEAD assay and Cell Counting Kit-8. Alkaline phosphatase activity (ALP) and calcium deposition were measured to assess osteogenic differentiation, and qPCR was used to analyze osteogenic marker expression. Results: The spheroids maintained their shape across all VEGF concentrations, with the largest diameter being at 0.01 ng/mL on day 1, which decreased over time. Cell viability was highest at 0.01 ng/mL VEGF, while calcium deposition peaked at 0.1 ng/mL. Osteogenic markers, including RUNX2, osteocalcin, and COL1A1, showed significant upregulation at 1 ng/mL VEGF. Conclusions: These results suggest that VEGF enhances early osteogenic differentiation in MSC spheroids, indicating its potential for bone repair and tissue regeneration. VEGF could be applied in clinical settings for bone healing, fracture repair, and regenerative dentistry treatments. Full article

(This article belongs to the Section Dentistry and Oral Health)

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14 pages, 320 KiB

Open AccessArticle

The Impact of Diet on Hidradenitis Suppurativa Severity: A Cross-Sectional Case–Control Study

by Ferhan Kesik, Sibel Dogan-Gunaydin and Mehmet Fisunoglu

Medicina 2024, 60(12), 2107; https://doi.org/10.3390/medicina60122107 - 23 Dec 2024

Viewed by 1746

Abstract

Background and Objectives: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease primarily affecting hair follicles, characterized by painful nodules, abscesses, and sinus tract formation. Recent evidence suggests that weight management and nutritional factors may influence HS symptoms. This cross-sectional case–control study aimed [...] Read more.

Background and Objectives: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease primarily affecting hair follicles, characterized by painful nodules, abscesses, and sinus tract formation. Recent evidence suggests that weight management and nutritional factors may influence HS symptoms. This cross-sectional case–control study aimed to assess the impact of body composition and nutritional factors on HS severity. Materials and Methods: We included 50 patients with HS and 50 matched controls comparable in body mass index (BMI), sex, and age. The data collected included 3-day food records, a food frequency questionnaire, 24 h physical activity records, Mediterranean Diet Adherence Screener (MEDAS) scores, body composition, and anthropometric measurements. The macronutrient and micronutrient intake, as well as dietary glycemic index (GI), were analyzed. HS severity was assessed using the Hurley staging system and the International Hidradenitis Suppurativa Severity Score System (IHS4). Results: HS patients exhibited significantly lower adherence to the Mediterranean diet and a higher dietary GI compared to controls. Their micronutrient intake was also reduced, while the consumption of junk food, dairy products, and nightshade vegetables was more frequent. The MEDAS scores and physical activity levels were negatively correlated with the IHS4 scores, while higher anthropometric measurements, dietary energy, protein, total fat, and GI showed positive correlations. The Hurley stage was negatively correlated with the MEDAS scores and positively correlated with the GI and visceral fat. In multiple regression analysis, the MEDAS score emerged as the primary variable associated with disease severity. Conclusions: These findings suggest that an increased adherence to the Mediterranean diet, intake of food with a lower GI, and maintaining an ideal body weight may positively affect HS management. Long-term studies are warranted to corroborate our findings. Full article

(This article belongs to the Section Dermatology)

18 pages, 613 KiB

Open AccessReview

Craniocervical Posture and Malocclusion: A Comprehensive Literature Review of Interdisciplinary Insights and Implications

by Andreea Kui, Alexandru Bereanu, Ana-Maria Condor, Dalia Pop, Smaranda Buduru, Anca Labunet, Sebastian Șoicu, Rareș Buduru and Andrea Chisnoiu

Medicina 2024, 60(12), 2106; https://doi.org/10.3390/medicina60122106 - 22 Dec 2024

Viewed by 634

Abstract

Background and Objectives: The impact of craniocervical posture on malocclusion has long intrigued researchers in dentistry, orthodontics, and physical therapy. This research aims to elucidate the relationship between craniocervical posture and both dental and skeletal malocclusions and to explore the potential for [...] Read more.

Background and Objectives: The impact of craniocervical posture on malocclusion has long intrigued researchers in dentistry, orthodontics, and physical therapy. This research aims to elucidate the relationship between craniocervical posture and both dental and skeletal malocclusions and to explore the potential for integrated multidisciplinary therapeutic approaches. Materials and Methods: We analyzed peer-reviewed articles published between 2013 and 2023 from PubMed/Medline, Web of Science, EMBASE, and Scopus. The search strategy included terms related to craniocervical posture and malocclusion, focusing on studies that evaluated the relationship between these conditions before and after various orthodontic or surgical treatments. Results: A total of 20 studies met the inclusion criteria, providing nuanced insights into the interplay between malocclusion types and craniocervical alignment. Findings suggest that altered craniocervical posture is more prevalent in individuals with skeletal malocclusions. In particular, orthodontic treatment and orthognathic surgery appear to influence craniocervical posture, suggesting a bidirectional relationship between craniofacial structure and neck alignment. Conclusions: Our literature review confirms a significant association between craniocervical posture and malocclusion, emphasizing the need for an integrative approach to the diagnosis and treatment of craniofacial anomalies. Future research should aim to quantify these relationships further through longitudinal studies, thereby increasing the understanding necessary to develop comprehensive treatment protocols. Full article

(This article belongs to the Special Issue Advancements in Dental Medicine, Oral Anesthesiology and Surgery)

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13 pages, 575 KiB

Open AccessArticle

Epidemiology of Rounding Error

by Jimmy T. Efird

Medicina 2024, 60(12), 2105; https://doi.org/10.3390/medicina60122105 - 22 Dec 2024

Viewed by 507

Abstract

This work represents a significant contribution to understanding the importance of appropriately rounding numbers with minimal error. That is, to reduce inexact rounding and data truncation error and simultaneously eliminate unintentional misleading findings in epidemiological studies. The rounding of numbers represents a compromise [...] Read more.

This work represents a significant contribution to understanding the importance of appropriately rounding numbers with minimal error. That is, to reduce inexact rounding and data truncation error and simultaneously eliminate unintentional misleading findings in epidemiological studies. The rounding of numbers represents a compromise solution that attempts to find a balance between the loss of information from reporting too few significant digits versus retaining more digits than necessary. Substituting a rounded number for its original value may be acceptable and practical in many applied situations if an adequate degree of accuracy is retained. On the other hand, numeric error may result from improper rounding or data truncation which, in effect, compromises the credibility of study findings and may lead to a false sense of discovery. Performing complex computations on such values, especially when sequential or composite operations are involved, can lead to error propagation and inaccurate results. Having an overall awareness of the nature and impact of rounding error, including preventive actions, can contribute greatly to the integrity of research, yielding more reliable and accurate conclusions. Heuristic examples are provided to illustrate the consequences of rounding and data truncation error in epidemiology studies, specifically those pertaining to relative effect estimation. Full article

(This article belongs to the Special Issue Advances in Epidemiological and Statistical Methods for Medical Research)

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15 pages, 545 KiB

Open AccessArticle

Transition Readiness in Pediatric Chronic Digestive Diseases: A Regional Perspective from North-Eastern Romania

by Silvia Cristina Poamaneagra, Felicia Galos, Elena Tataranu, Catalina Mihai, Carmen Anton, Cristiana-Mihaela Andronic, Georgiana-Emmanuela Gilca-Blanariu, Gheorghe G. Balan, Oana Timofte, Liliana Anchidin-Norocel, Oana Maria Rosu and Smaranda Diaconescu

Medicina 2024, 60(12), 2104; https://doi.org/10.3390/medicina60122104 - 22 Dec 2024

Viewed by 677

Abstract

Background: The transition from the pediatric to the adult healthcare system is a challenging process involving adolescents, parents, and pediatric and adult specialists. For a successful approach for an organized transition program, we must assess the level of training of adolescents facing [...] Read more.

Background: The transition from the pediatric to the adult healthcare system is a challenging process involving adolescents, parents, and pediatric and adult specialists. For a successful approach for an organized transition program, we must assess the level of training of adolescents facing transition. Methods: We applied a clinic-based questionnaire measuring perceived self-management skills, adherence to health-related tasks, medication knowledge, and social adjustment to pediatric patients with chronic digestive diseases from North-East Romanian medical units, including a tertiary center and private practice offices. Results: There were 124 participants; 73.38% from rural areas, 26.62% from urban areas; 59.67% were females, and 40.33% were males; 91.93% attended school and 73.4% declared wanting to pursue university classes after turning 18. Adolescents from urban areas showed better medication managerial (p < 0.01) and tracking healthcare change skills. Significant correlations were found between medication and appointment making, tracking health dynamics, and communication skills. Other correlations were found between communication skills and medication knowledge, appointments management, and tracking healthcare dynamics. All the investigated domains were positively correlated with the overall scores, highlighting the potential impact of active targeted interventions during transition. Conclusions: We identified significant areas to address and potentially influence during an organized transition program such as communication skills and knowledge regarding the chronic disease and the followed medication. Full article

(This article belongs to the Section Pediatrics)

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10 pages, 805 KiB

Open AccessArticle

Association Between Baseline and Changes in Early Neutrophil-to-Lymphocyte Ratio on Survival in Patients with Metastatic Bladder Carcinoma Treated with Immunotherapy

by Ezgi Değerli, Çağatay Arslan, Fatih Selçukbiricik, Ömer Fatih Ölmez, Dilek Erdem, Jamshid Hamdard, Mesut Yılmaz, Rumeysa Çolak, Caner Kapar, Mustafa Erman, Fatih Kuş and Deniz Tural

Medicina 2024, 60(12), 2103; https://doi.org/10.3390/medicina60122103 - 22 Dec 2024

Viewed by 549

Abstract

Background and Objectives: A high baseline neutrophil-to-lymphocyte ratio (NLR) is a poor prognostic factor in various cancers. However, its predictive role in metastatic bladder cancer (mBC) treated with immunotherapy is unclear. In this study, we aimed to investigate the relationship between the [...] Read more.

Background and Objectives: A high baseline neutrophil-to-lymphocyte ratio (NLR) is a poor prognostic factor in various cancers. However, its predictive role in metastatic bladder cancer (mBC) treated with immunotherapy is unclear. In this study, we aimed to investigate the relationship between the baseline and change in NLR and overall survival in mBC patients treated with immunotherapy, with the potential to significantly impact patient care. Materials and Methods: A retrospective analysis was conducted on 56 mBC patients who received second-line immunotherapy after progressing on platinum-based chemotherapy. Patients were classified into high and low NLR groups using a cutoff value of 3.3. A further division was made based on NLR changes after two cycles of immunotherapy: whether NLR increased (≥10%) or decreased (≥10%). The endpoint was to estimate the association between clinicopathological features and survival outcomes. Results: The study included 56 patients, with a median age of 66.6 years and a male-to-female ratio of 2.3:1. A low baseline NLR was associated with better OS than a high baseline NLR (p = 0.005). After two immunotherapy cycles, patients with a decreased NLR (≥10%) had significantly longer OS than those with an increased NLR (≥10%), regardless of the baseline NLR (p = 0.003). The overall median survival was 15 months, with 10 months for the NLR-increased group and not reached for the NLR-decreased group. Conclusions: Our study highlights the potential of baseline NLR and early changes in NLR as valuable prognostic markers for mBC patients receiving immunotherapy. Elevated neutrophils and lymphopenia negatively impact prognosis and treatment effectiveness, and NLR shows promise as a prognostic marker, inspiring further research and potential improvements in patient care. Full article

(This article belongs to the Section Oncology)

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11 pages, 328 KiB

Open AccessArticle

Association Between Chlamydia trachomatis and Helicobacter pylori with Inflammation in Polycystic Ovary Syndrome: A Cross-Sectional Study

by Yeşim Alpay Çağlar and Mine Islimye Taşkin

Medicina 2024, 60(12), 2102; https://doi.org/10.3390/medicina60122102 - 22 Dec 2024

Viewed by 527

Abstract

Objective: Chronic low-grade inflammation occurs in polycystic ovary syndrome (PCOS), and there are many contributing factors. In this study, we aimed to investigate Helicobacter pylori and Chlamydia trachomatis infections in patients with PCOS and to evaluate the association between these microorganisms and [...] Read more.

Objective: Chronic low-grade inflammation occurs in polycystic ovary syndrome (PCOS), and there are many contributing factors. In this study, we aimed to investigate Helicobacter pylori and Chlamydia trachomatis infections in patients with PCOS and to evaluate the association between these microorganisms and the inflammatory process in the etiology of the disease. Materials and Methods: This comparative cross-sectional clinical study was conducted at Balıkesir University Hospital and included 40 female patients diagnosed with PCOS in the gynecology outpatients clinic and 40 healthy female controls. Demographic data were recorded. Blood hormone profiles and biochemical parameters were analyzed. An enzyme-linked immunosorbent assay test kit was used to measure H. pylori IgG and C. trachomatis IgG. Results: According to the analysis of the study data, there was no significant association between the PCOS and non-PCOS groups with regard to the presence of Helicobacter pylori IgG (p = 0.1) and Chlamydia trachomatis IgG (p = 0.338). CRP levels were significantly higher in the PCOS group (p = 0.001). In the subgroup analyses, the CRP levels were not significantly different between the H. pylori and C. trachomatis antibody-positive and -negative groups. Diabetes mellitus was significantly associated with PCOS (p = 0.005). The smoking rate was significantly higher in the control group than in the PCOS group (p = 0.036). Compared to the control group, the BMI, LH, HOMA-IR, TSH, and TG levels were significantly higher in participants with PCOS (p = 0.000; p = 0.004; p = 0.001; p = 0.001; p = 0.043; p = 0.000). FSH was lower in PCOS patients compared to controls (p = 001). In the subgroup analyses, no significant differences were found between the H. pylori and C. trachomatis antibody-positive and -negative groups. Conclusions: PCOS is characterized by chronic nonspecific low-grade inflammation. The etiopathogenesis of PCOS involves comorbidities that cause a chronic inflammatory process. However, the possible infective causes still seem to be open to investigation. In particular, studies on microbiota and periodontal diseases in PCOS may provide important contributions. Full article

(This article belongs to the Section Infectious Disease)

13 pages, 1350 KiB

Open AccessArticle

Prognostic Role of Neutrophil Percentage-to-Albumin Ratio in Patients with Non-ST-Elevation Myocardial Infarction

by Mehmet Karaca and Ayca Gumusdag

Medicina 2024, 60(12), 2101; https://doi.org/10.3390/medicina60122101 - 22 Dec 2024

Viewed by 751

Abstract

Background and Objectives: This study aimed to investigate whether neutrophil percentage-to-albumin ratio (NPAR) levels on admission have prognostic significance regarding one-year major adverse cardiovascular and cerebrovascular events (MACCEs) in non-ST-elevation myocardial infarction (NSTEMI) patients. Materials and Methods: A total of 464 [...] Read more.

Background and Objectives: This study aimed to investigate whether neutrophil percentage-to-albumin ratio (NPAR) levels on admission have prognostic significance regarding one-year major adverse cardiovascular and cerebrovascular events (MACCEs) in non-ST-elevation myocardial infarction (NSTEMI) patients. Materials and Methods: A total of 464 patients aged 59.2 ± 11.6 years constituted the cohort of this retrospectively designed study. Considering a 1-year follow-up period, the patients were divided into two groups: those with MACCEs and those without. The complete blood count, serum C-reactive protein and serum albumin levels were measured at admission. The NPAR, C-reactive protein/albumin ratio (CAR) and systemic immune-inflammation (SII) index were calculated for all patients, and the associations of these inflammatory-based biomarkers with 1-year MACCEs were evaluated. Results: During the 12-month follow-up period, MACCEs were observed in 75 (16.2%) patients, of which 35 (7.5%) patients died. The patients with MACCEs had higher CRP (p < 0.001), a higher percentage of neutrophils (p < 0.001), lower albumin levels (p < 0.001), a higher CAR (p < 0.001), a higher SII index (p = 0.008) and a higher NPAR (p < 0.001). A high anatomical SxSI score, a high low-density lipoprotein cholesterol level, hypoalbuminemia, high neutrophil counts, a high NPAR level and a high CAR level were independent predictors for one-year MACCEs (all p < 0.05). The NPAR (area under the curve [AUC] = 0.775, p < 0.001) and albumin level (AUC = 0.708, p < 0.001) had better and sufficient discriminatory power and predictive accuracy in determining one-year MACCEs, when compared to the neutrophil (AUC = 0.693, p < 0.001), CAR (AUC = 0.639, p < 0.001) and SII index (AUC = 0.660, p < 0.001), in terms of the receiver operating characteristic curve. The DeLong test revealed that the predictive performance of the NPAR was superior to that of the other inflammatory parameters. In particular, individuals with an NPAR value greater than 17.6 were at greater risk of developing MACCEs (p < 0.001). Conclusions: The NPAR can be used as a newly identified promising inflammatory biomarker to predict one-year MACCEs in NSTEMI patients undergoing revascularization therapy. Full article

(This article belongs to the Section Cardiology)

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8 pages, 1531 KiB

Open AccessCase Report

A Rare Case of Concurrent Intraventricular Meningioma and Choroid Plexus Papilloma: A Case Report

by Daniel Markov, Kristian Bechev, Usman Khalid, Vladimir Aleksiev, Galabin Markov and Elena Poryazova

Medicina 2024, 60(12), 2100; https://doi.org/10.3390/medicina60122100 - 22 Dec 2024

Viewed by 534

Abstract

This case presents an unusual combination between an intraventricular meningioma and a choroid plexus papilloma. Intraventricular meningiomas are rare intraventricular tumors presenting with symptoms of hydrocephalus, headache, and neurological deficits. The rarity of choroid plexus papillomas is highlighted in medical diagnostics, with the [...] Read more.

This case presents an unusual combination between an intraventricular meningioma and a choroid plexus papilloma. Intraventricular meningiomas are rare intraventricular tumors presenting with symptoms of hydrocephalus, headache, and neurological deficits. The rarity of choroid plexus papillomas is highlighted in medical diagnostics, with the majority of these findings being incidental within the setting of obstructive hydrocephalus. We present the case of a 66-year-old male patient who exhibited symptoms of headaches. Magnetic resonance imaging showed the presence of an intraventricular tumor in the region of the trigone of the right lateral ventricle, which was assessed for surgical removal. A postoperative hemorrhage necessitated a reoperation, after which the patient began to gradually recover. Hemianopsian disturbances persisted during and after his hospital stay. This report describes a rare case of concurrent choroid plexus papilloma and ventricular meningioma, manifesting as a single tumor mass. Full article

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35 pages, 936 KiB

Open AccessReview

Novel Molecular Classification of Breast Cancer with PET Imaging

by Ngô Minh Toàn

Medicina 2024, 60(12), 2099; https://doi.org/10.3390/medicina60122099 - 21 Dec 2024

Viewed by 983

Abstract

Breast cancer is a heterogeneous disease characterized by a wide range of biomarker expressions, resulting in varied progression, behavior, and prognosis. While traditional biopsy-based molecular classification is the gold standard, it is invasive and limited in capturing tumor heterogeneity, especially in deep or [...] Read more.

Breast cancer is a heterogeneous disease characterized by a wide range of biomarker expressions, resulting in varied progression, behavior, and prognosis. While traditional biopsy-based molecular classification is the gold standard, it is invasive and limited in capturing tumor heterogeneity, especially in deep or metastatic lesions. Molecular imaging, particularly positron emission tomography (PET) imaging, offering a non-invasive alternative, potentially plays a crucial role in the classification and management of breast cancer by providing detailed information about tumor location, heterogeneity, and progression. This narrative review, which focuses on both clinical patients and preclinical studies, explores the latest advancements in PET imaging for breast cancer, emphasizing the development of new tracers targeting hormone receptors such as the estrogen alpha receptor, progesterone receptor, androgen receptor, estrogen beta receptor, as well as the ErbB family of receptors, VEGF/VEGFR, PARP1, PD-L1, and markers for indirectly assessing Ki-67. These innovative radiopharmaceuticals have the potential to guide personalized treatment approaches based on the unique tumor profiles of individual patients. Additionally, they may improve the assessment of treatment efficacy, ultimately leading to better outcomes for those diagnosed with breast cancer. Full article

(This article belongs to the Section Oncology)

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15 pages, 817 KiB

Open AccessArticle

Management of Ventilator-Associated Pneumonia Caused by Pseudomonas and Acinetobacter Organisms in a Pediatric Center: A Randomized Controlled Study

by Mona Moheyeldin AbdelHalim, Seham Awad El Sherbini, El Shimaa Salah Ahmed, Heba Abdullah Abdalbaset Gharib, Marwa O. Elgendy, Ahmed R. N. Ibrahim and Heba Sherif Abdel Aziz

Medicina 2024, 60(12), 2098; https://doi.org/10.3390/medicina60122098 - 21 Dec 2024

Viewed by 668

Abstract

A dangerous infection contracted in hospitals, ventilator-associated pneumonia is frequently caused by bacteria that are resistant to several drugs. It is one of the main reasons why patients in intensive care units become ill or die. This research aimed to determine the most [...] Read more.

A dangerous infection contracted in hospitals, ventilator-associated pneumonia is frequently caused by bacteria that are resistant to several drugs. It is one of the main reasons why patients in intensive care units become ill or die. This research aimed to determine the most effective empirical therapy of antibiotics for better ventilator-associated pneumonia control and to improve patient outcomes by using the minimal inhibitory concentration method and the Ameri–Ziaei double antibiotic synergism test and by observing the clinical responses to both single and combination therapies. Patients between the ages of one month and twelve who had been diagnosed with ventilator-associated pneumonia and had been on mechanical ventilation for more than 48 h were included in the study, which was carried out in the Pediatric Intensive Care Unit at Cairo University’s Hospital. When ventilator-associated pneumonia is suspected, it is critical to start appropriate antibiotic therapy as soon as possible. This is especially important in cases where multidrug-resistant Gram-negative infections may develop. Although using Polymyxins alone or in combination is effective, it is important to closely monitor their administration to prevent resistance from increasing. The combination therapy that showed the greatest improvement was a mix of aminoglycosides, quinolones, and β-lactams. A combination of aminoglycosides and dual β-lactams came next. Although the optimal duration of antibiotic treatment for ventilator-associated pneumonia is still unknown, treatments longer than seven days are usually required to eradicate MDR P. aeruginosa or A. baumannii completely. Full article

(This article belongs to the Special Issue Antimicrobial Stewardship and Antimicrobial Resistance)

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13 pages, 35081 KiB

Open AccessArticle

Comparison of the Effects of Perineural and Intraperitoneal Ozone Therapy on Nerve Healing in an Experimental Sciatic Nerve Injury Model

by Burcu Ayık, Abdullah Ortadeveci, Fulya Bakılan, Dilek Burukoğlu Dönmez, Semih Öz, Cengiz Bal, Hilmi Özden and Onur Armağan

Medicina 2024, 60(12), 2097; https://doi.org/10.3390/medicina60122097 - 21 Dec 2024

Viewed by 599

Abstract

Background and Objectives: The aim was to evaluate nerve healing using immunohistochemical, histological, and functional techniques and to compare the effects of two different therapeutic ozone application methods by perineural and intraperitoneal ozone treatment in rats with a crush injury model of sciatic [...] Read more.

Background and Objectives: The aim was to evaluate nerve healing using immunohistochemical, histological, and functional techniques and to compare the effects of two different therapeutic ozone application methods by perineural and intraperitoneal ozone treatment in rats with a crush injury model of sciatic nerve. Materials and Methods: Forty male Sprague Dawley rats were divided into four subgroups of ten rats each: (1) Control group: The left sciatic nerve incised and closed without crush injury, no treatment; (2) Paralyzed group: Crush injury to the left sciatic nerve, no treatment; (3) Perineural ozone group: Crush injury to the left sciatic nerve, treated with perineural ozone therapy; (4) Intraperitoneal ozone group: Crush injury to the left sciatic nerve, treated with intraperitoneal ozone therapy. The treatments were administered for a 14-day period. Hematoxylin and eosin (H&E) and toluidine blue staining were used for histological examination; TUNEL staining was used for immunohistochemical examination. Pinch test and rotarod performance assessment were utilized for functional evaluation. Results: The pinch test scores showed significant improvement in perineural and intraperitoneal ozone treatment groups after treatment (p < 0.001 and p = 0.003, respectively). The scores of myelin degeneration, vascular congestion, vascular wall thickness, inflammation, and toluidine blue and TUNEL staining were significantly lower in both ozone treatment groups compared to the paralyzed group (p < 0.001). Vascular wall thickness scores were significantly higher in the perineural ozone group compared to the control and intraperitoneal ozone groups (p = 0.004 and p = 0.013, respectively). The Schwann cell proliferation scores were significantly higher in the perineural ozone group compared to the control group and intraperitoneal ozone groups (p < 0.001). Conclusions: Both applications of ozone therapy accelerated the healing of nerve regeneration, reduced inflammation and apoptosis based on histopathological results, and enhanced nerve function in rats with sciatic nerve injury. Perineural ozone therapy has been demonstrated to be an efficacious alternative to systemic ozone treatments in the management of sciatic nerve injury. Further studies are needed to determine optimal ozone dosage and administration protocols for the treatment of nerve injury. Full article

(This article belongs to the Special Issue New Insights into Neurodevelopmental Biology and Disorders)

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19 pages, 504 KiB

Open AccessArticle

Effects of Sodium-Glucose Cotransporter-2 Inhibitors on Body Composition and Fluid Status in Cardiovascular Rehabilitation Patients with Coronary Artery Disease and Heart Failure

by José C. De La Flor, Blanca Coto Morales, Elena Basabe, María Rey Hernandez, Rocío Zamora González-Mariño, Celia Rodríguez Tudero, Irwing Benites Flores, Carlos Espinoza, Michael Cieza Terrones, Secundino Cigarrán Guldris and Jesús Hernández Vaquero

Medicina 2024, 60(12), 2096; https://doi.org/10.3390/medicina60122096 - 21 Dec 2024

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Abstract

Background and Objectives: Sodium glucose cotransporter-2 (SGLT-2) inhibitors have emerged as integral therapeutic tools in the management of patients with cardiovascular–kidney–metabolic (CKM) syndrome. In addition to their well-documented effects on lowering glucose levels and cardiovascular- and reno-protective actions, SGLT-2 inhibitors, through a [...] Read more.

Background and Objectives: Sodium glucose cotransporter-2 (SGLT-2) inhibitors have emerged as integral therapeutic tools in the management of patients with cardiovascular–kidney–metabolic (CKM) syndrome. In addition to their well-documented effects on lowering glucose levels and cardiovascular- and reno-protective actions, SGLT-2 inhibitors, through a reduction in body weight (BW), generate changes in the body composition and volume status that have not been clearly studied. Materials and Methods: This retrospective, observational longitudinal cohort, single-center study analyzed and compared body composition and fluid status measured by bioelectrical impedance analysis (BIA) from weeks 0 to 12 after the initiation of the cardiac rehabilitation (CR) program for coronary artery disease and heart failure in 59 patients who started treatment with SGLT-2 inhibitors (SGLT-2iG) and 112 patients without SGLT-2 inhibitors (non-SGLT-2iG). Results: Changes between the baseline and week 12 in the SGLT-2iG and non-SGLT-2iG were −0.3 L (p = 0.003) and −0.03 L (p = 0.82) in extracellular water (ECW) (p = 0.05), −0.39 L (p < 0.001) and −0.14 L (p = 0.33) in intracellular water (ICW) (p = 0.12), −0.69 (p < 0.001) and −0.16 (p = 0.52) in total body water (TBW) (p = 0.08), and −0.01 (p = 0.37) and −0.001 (p = 0.25) in the ECW/TBW ratio, respectively. After 3 months of exercise therapy in the CR program, patients in the SGLT-2iG showed a greater decrease than the non-SGLT-2iG in weight (−1.34 kg, p < 0.001 vs. −0.99, p = 0.02), body mass index (BMI) (−0.45 kg/m², p < 0.001 vs. −0.38, p = 0.004), arm circumference (−0.57 cm, p = 0.008 vs. −0.12 cm, p = 0.21), waist circumference (−1.5 cm, p = 0.04 vs. −0.11 cm, p = 0.83), systolic blood pressure (SBP) (−8.9 mmHg, p = 0.049 vs. −4.19, p = 0.08), and diastolic blood pressure (DBP) (−5.15, p = 0.03 vs. −2.85, p = 0.01). The bioelectrical impedance analysis (BIA) revealed a significant decrease in body fat mass (BFM) and visceral fat area, without a loss of lean body mass (LBM) or skeletal muscle mass in the SGLT-2iG. Conclusions: SGLT-2 inhibitors exert beneficial effects on body compartments and volume status. Although they induce modest weight loss, this appears to be mainly directed at ECW, BFM, and visceral fat, without a loss of LBM nor skeletal muscle mass, which could contribute to the observed CKM benefits. Full article

(This article belongs to the Section Urology & Nephrology)

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10 pages, 281 KiB

Open AccessArticle

Interaction Effects Between COVID-19 Outbreak and Fever on Mortality Among OHCA Patients Visiting Emergency Departments

by Dahae Lee, Jung Ho Lee, Eujene Jung, Yong Soo Cho and Hyun Ho Ryu

Medicina 2024, 60(12), 2095; https://doi.org/10.3390/medicina60122095 - 21 Dec 2024

Viewed by 557

Abstract

Background and Objectives: Fever in patients who have suffered an out-of-hospital cardiac arrest (OHCA) has been linked to poor clinical outcomes, as a fever can exacerbate neurological damage, increase metabolic demands, and trigger inflammatory responses. This study evaluates the impact of the [...] Read more.

Background and Objectives: Fever in patients who have suffered an out-of-hospital cardiac arrest (OHCA) has been linked to poor clinical outcomes, as a fever can exacerbate neurological damage, increase metabolic demands, and trigger inflammatory responses. This study evaluates the impact of the COVID-19 outbreak and associated fevers on OHCA outcomes and examines how they can worsen patient prognosis. Materials and Methods: Our retrospective observational analysis used data from the National Emergency Department Information System (NEDIS), comprising adult OHCA patients at 402 EDs in Korea between 27 January and 31 December 2020 (COVID-19 pandemic period) and the corresponding period in 2019 (pre-COVID-19). The primary outcome was in-hospital mortality, with the COVID-19 outbreak as the main exposure variable and fever as an important interaction variable. We employed multilevel multivariate logistic regression with an interaction term (year of visit × fever) to examine the effects of COVID-19 and fever on mortality. Risk-adjusted mortality rates were calculated, and a difference-in-difference analysis evaluated the impact of COVID-19 on excess mortality by fever status. Results: During COVID-19, in-hospital mortality was higher among OHCA patients compared to the pre-pandemic period (adjusted OR 1.22, 95% CI 1.11–1.34), particularly among febrile patients (adjusted OR 1.40, 95% CI 1.24–1.59). Interaction analysis revealed that COVID-19 disproportionately increased mortality in febrile OHCA patients compared with non-febrile patients (difference-in-difference: 0.8%, 95% CI 0.2–1.5). Conclusions: Our study found that the COVID-19 pandemic significantly increased mortality among OHCA patients, with febrile patients experiencing disproportionately worse outcomes due to systemic delays and pandemic-related disruptions. Full article

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

8 pages, 855 KiB

Open AccessArticle

Comparison of Standard and Point-of-Care CD4+ T Lymphocyte Measurement Methods in HIV-1 Infected Turkish Patients

by Müge Toygar Deniz, Sıla Akhan, Murat Sayan and Sibel Balcı

Medicina 2024, 60(12), 2094; https://doi.org/10.3390/medicina60122094 - 21 Dec 2024

Viewed by 614

Abstract

Background and Objectives: CD4+ T lymphocytes are the primary targets of HIV infection. CD4+ T lymphocyte count is an indicator of immune competence. In this study, we aimed to compare standard flow cytometry and point-of-care (POC) CD4+ T lymphocyte in terms of [...] Read more.

Background and Objectives: CD4+ T lymphocytes are the primary targets of HIV infection. CD4+ T lymphocyte count is an indicator of immune competence. In this study, we aimed to compare standard flow cytometry and point-of-care (POC) CD4+ T lymphocyte in terms of cost, effectiveness, reliability, time, and the use of this method for disease. Materials and Methods: This study includes 113 patients. CD4+ T lymphocyte count and percentage were evaluated by flow cytometry and POC. Also, hemoglobin (Hb) level was studied. The data obtained by two methods are compared. Results: When the two methods were compared, intraclass coefficients demonstrated a good consistency for Hb (ICC = 0.849) and CD4+ T lymphocyte percentage (ICC = 0.803). For CD4+ T lymphocyte count, consistency was moderate, ICC = 0.651, but still statistically significant (p < 0.001). Conclusions: In resource-limited countries, virological monitoring with HIV RNA cannot be performed at any time because it is expensive. However, CD4+ T lymphocyte count and percentage monitoring is important in predicting treatment success. POC results are in good consistency with the standard method, and it is also a test that can be used due to being cheap, easy, and quick. Full article

(This article belongs to the Section Infectious Disease)

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28 pages, 2561 KiB

Open AccessArticle

Hepatitis C Virus Infection in Hemodialysis Patients in the Era of Direct-Acting Antiviral Treatment: Observational Study and Narrative Review

by Ioana Adela Ratiu, Adelina Mihaescu, Nicu Olariu, Cristian Adrian Ratiu, Bako Gabriel Cristian, Anamaria Ratiu, Mirela Indries, Simona Fratila, Danut Dejeu, Alin Teusdea, Mariana Ganea, Corina Moisa and Luciana Marc

Medicina 2024, 60(12), 2093; https://doi.org/10.3390/medicina60122093 - 21 Dec 2024

Viewed by 497

Abstract

Background and Objectives: Hepatitis C virus (HCV) infection is a major global public health concern, particularly in hemodialysis (HD) patients. This study aims to evaluate the demographic, clinical, and laboratory characteristics of HCV-positive patients undergoing HD and assess the long-term impact of direct-acting [...] Read more.

Background and Objectives: Hepatitis C virus (HCV) infection is a major global public health concern, particularly in hemodialysis (HD) patients. This study aims to evaluate the demographic, clinical, and laboratory characteristics of HCV-positive patients undergoing HD and assess the long-term impact of direct-acting antivirals (DAAs) on patient outcomes. Moreover, a narrative review aims to summarize the current knowledge regarding HCV treatment in HD patients. The search in the PubMed, Google Scholar, and Scopus databases identified 48 studies relevant to our topic, 18 regarding clinical history and 29 related to HCV treatment. Methods: A retrospective analysis was performed on 165 HD patients from Bihor County HD centers, Romania, between 2014 and 2024. The cohort was divided into two groups: 54 patients who tested positive for HCV and 111 controls who were HCV-negative. Data collected from GPs included demographic information, comorbidities, laboratory parameters, and psychological assessments. Outcomes were evaluated at over 5 years after DAA treatment. A literature review was conducted using PubMed and Google Scholar to identify relevant studies on HCV in HD patients from 1989 to 2024. Results: Laboratory results showed similar parameters across groups, except for lower serum cholesterol levels in the HCV-positive DAA-treated group vs. HCV-positive non-treated ones (155.607 mg% vs. 170.174 mg%, p = 0.040) and increased ALT levels when comparing the same groups (29.107 vs. 22.261, p = 0.027), whereas comorbidities did not differ significantly. The incidence of malignancies was significantly higher among HCV-positive compared to HCV-negative patients (20.3% vs. 8.1%, p = 0.023), mainly among those treated with DAAs, highlighted by the multivariate analysis. Cardiovascular disease remains the leading cause of mortality regardless of HCV status or the use of antiviral therapy. Psychological assessments revealed more severe depression in HCV-positive patients compared to their HCV-negative counterparts. Conclusions: HCV infection in the hemodialysis population typically follows a subclinical course. At over five years after DAA therapy, the results indicate a stabilization of the liver function and the absence of major complications. However, the incidence of malignancies remains high in HCV-positive patients. Full article

(This article belongs to the Section Infectious Disease)

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13 pages, 2315 KiB

Open AccessSystematic Review

Anti-Platelet Therapy with Cangrelor in Cardiogenic Shock Patients: A Systematic Review and Single-Arm Meta-Analysis

by Jacopo D’Andria Ursoleo, Luca Baldetti, Marina Pieri, Pasquale Nardelli, Savino Altizio, Silvia Ajello and Anna Mara Scandroglio

Medicina 2024, 60(12), 2092; https://doi.org/10.3390/medicina60122092 - 21 Dec 2024

Viewed by 622

Abstract

Background and Objectives: Percutaneous coronary intervention (PCI) is a proven therapy for acute myocardial infarction (AMI) cardiogenic shock (CS). Dual anti-platelet therapy (i.e., aspirin plus an oral P2Y12 inhibitor) is recommended in patients treated with PCI. However, CS patients present severe hemodynamic instability, [...] Read more.

Background and Objectives: Percutaneous coronary intervention (PCI) is a proven therapy for acute myocardial infarction (AMI) cardiogenic shock (CS). Dual anti-platelet therapy (i.e., aspirin plus an oral P2Y12 inhibitor) is recommended in patients treated with PCI. However, CS patients present severe hemodynamic instability, deranged hemostatic balance, and the need for invasive mechanical circulatory support (MCS) alongside invasive procedures, resulting in an increased risk of both bleeding and thrombotic complications, leaving uncertainty about the best anti-thrombotic treatment. Recently, the parenteral short-acting P2Y12 inhibitor has been increasingly used in the acute cardiac care setting, mainly in light of its favourable pharmacokinetic profile and organ-independent metabolism. Materials and Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a systematic review and single-arm meta-analysis of the safety and efficacy outcomes (i.e., rates of major bleeding, occurrence of stent/any thrombosis, and hospital survival) of all existing original studies reporting on the intravenous administration of cangrelor in AMI-CS patients. Results: Ten studies (678 patients with CS) published between 2017 and 2023 were included in the present review: nine were observational and one had a randomized design. Percutaneous revascularization was performed in >80% of patients across the studies. Moreover, 26% of patients were treated with temporary MCS, and in all studies, concomitant systemic anticoagulation was performed. Cangrelor was administered intravenously at the dosage of 4 mcg/kg/min in 57% of patients, 0.75 mcg/kg/min in 37% of patients, and <0.75 mcg/kg/min in 6%. The pooled rate of major bleeding was 17% (11–23%, confidence interval [CI]), and the pooled rate of stent thrombosis and any thrombosis were 1% (0.3–2.3% CI) and 3% (0.4–7% CI), respectively. Pooled hospital survival was 66% (59–73% CI). Conclusions: Cangrelor administration in AMI-CS patients was feasible and safe with a low rate of thromboembolic complications. Haemorrhagic complications were more frequent than thrombotic events. Nevertheless, to date, the optimal dosage of cangrelor in this clinical context still remains not universally recognized. Full article

(This article belongs to the Section Pulmonology)

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13 pages, 1094 KiB

Open AccessArticle

Metabolic Dysfunction-Associated Steatotic Liver Disease in Type 2 Diabetes Patients—The Relationship with Platelets Indicators

by Danusia Onișor, Andrada Larisa Roiban and Simona Cernea

Medicina 2024, 60(12), 2091; https://doi.org/10.3390/medicina60122091 - 21 Dec 2024

Viewed by 581

Abstract

Background and Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is an important chronic liver disease with major health risks, especially in the presence of T2DM, but the pathophysiology of this condition is not fully understood. This study aimed to investigate the platelet [...] Read more.

Background and Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is an important chronic liver disease with major health risks, especially in the presence of T2DM, but the pathophysiology of this condition is not fully understood. This study aimed to investigate the platelet hematometric indices in patients with T2DM and MASLD. Materials and Methods: Demographic and medical (including anthropometric) data were collected from 271 participants, from whom blood samples were also drawn in fasting conditions for complete blood count, liver and metabolic panel, ferritin, haptoglobin, creatinine, and fibrosis markers. The correlations of main platelet parameters with clinical and laboratory data were investigated by bivariate and multiple regression analyses. Results: The median platelets number was 235·10³/μL, and thus, the study population was divided into two subgroups: with higher and lower numbers (group 1 (mean): 286.38 ± 43.29·10³/μL and group 2 (mean): 188.12 ± 39.77·10³/μL). Despite similar BMIs, group 2 had higher fatty liver index (FLI) (84.44 ± 18.04 vs. 79.85 ± 17.98; p = 0.0088) and insulin resistance (HOMA-IR: 3.16 ± 1.50 vs. 2.63 ± 1.31; 0.0008), higher direct bilirubin, transaminases, uric acid, and ferritin concentrations. Higher percentages of males and subjects with HOMA-IR values >2.5 were accounted for in this group. In the multiple regression analyses, the platelet count and plateletcrit (PTC) correlated independently with sex, leucocyte count, HOMA-IR, and bilirubin concentrations (p < 0.0001). The platelet distribution width (PDW) was positively correlated with insulin resistance in two separate analyses (β = 0.060; p = 0.0004, and β = 0.052; p = 0.0025), and with GGT, while the mean platelet volume presented a weak but significant positive association with FLI. Patients with higher HOMA-IR had higher PDW and a lower platelet count and PTC. Conclusions: Male patients with T2DM and MASLD had lower platelet count and PTC and larger PDW. Higher insulin resistance was associated with lower platelet count and PTC and higher PDW. Full article

(This article belongs to the Section Gastroenterology & Hepatology)

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18 pages, 403 KiB

Open AccessReview

Graft Selection in Anterior Cruciate Ligament Reconstruction: A Comprehensive Review of Current Trends

by Marko Ostojic, Pier Francesco Indelli, Bruno Lovrekovic, Jerome Volcarenghi, Doria Juric, Hassan Tarek Hakam, Mikhail Salzmann, Nikolai Ramadanov, Aleksandra Królikowska, Roland Becker and Robert Prill

Medicina 2024, 60(12), 2090; https://doi.org/10.3390/medicina60122090 - 20 Dec 2024

Viewed by 850

Abstract

Anterior cruciate ligament (ACL) injuries are common in sports and often require surgical intervention, e.g., ACL reconstruction (ACLR), aimed at restoring knee stability and enabling a return to pre-injury activity levels. The choice of graft is crucial, impacting biomechanical properties, clinical outcomes, and [...] Read more.

Anterior cruciate ligament (ACL) injuries are common in sports and often require surgical intervention, e.g., ACL reconstruction (ACLR), aimed at restoring knee stability and enabling a return to pre-injury activity levels. The choice of graft is crucial, impacting biomechanical properties, clinical outcomes, and complication rates, and is especially important in revision surgeries after graft failure. Over the past 30 years, trends in graft selection have evolved towards more individualized approaches, considering factors such as patient activity level, prior injuries, and tissue availability. In Europe, autografts like hamstring tendon (HT), bone-patellar tendon-bone (BTB), and quadriceps tendon (QT) are preferred, with the increasing use of QT grafts. This review synthesizes the current literature on graft selection and its influence on ACLR outcomes. Full article

(This article belongs to the Special Issue Development and Application of Objective Measures in Physiotherapy for Musculoskeletal Disorders, Orthopedics, and Sports Medicine)

11 pages, 2624 KiB

Open AccessArticle

Teenage Patients with Class II Subdivision Treated with Aligners and Elastics: A Retrospective Study

by Vincenzo Quinzi, Andrea Conigliaro, Eda Fani, Lucia Memè, Fabiana Fiasca, Nicolò Carugo and Giuseppe Marzo

Medicina 2024, 60(12), 2089; https://doi.org/10.3390/medicina60122089 - 20 Dec 2024

Viewed by 641

Abstract

Background and Objectives: This study aimed to evaluate the outcomes of Class II subdivision teenage patients treated with Invisalign^® clear aligners (CAs) and elastics. Materials and Methods: A total of 23 individuals aged 14.3 ± 2.5 years were enrolled in [...] Read more.

Background and Objectives: This study aimed to evaluate the outcomes of Class II subdivision teenage patients treated with Invisalign^® clear aligners (CAs) and elastics. Materials and Methods: A total of 23 individuals aged 14.3 ± 2.5 years were enrolled in this study. The participants were divided into Group 1 (mandibular midline deviation) and Group 2 (maxillary midline deviation). The midline deviation from the facial midline; anteroposterior discrepancy; overjet (OJ), overbite (OB), and Peer Assessment Rating (PAR) scores; upper incisor and lower incisor (L1) positions; and angulation were measured at the beginning (T0) and end (T1) of the orthodontic treatment. Results: Group 1 showed significant higher variations in OJ (−2.3 ± 2.3 vs. −0.6 ± 0.8, p < 0.001), OB (−2.1 ± 2.3 vs. −1.1 ± 1.4, p < 0.001), PAR score (−32.0 ± 11.7 vs. −27.3 ± 13.1, p < 0.001), L1-to-mandibular-plane angle (−3.6 ± 7.0 vs. −1.3 ± 3.2, p < 0.001), and interincisal angle (10.07 ± 8.7 vs. 5.9 ± 5.3, p = 0.007). The midline deviation was the only measurement with higher variation in Group 2. The average distance between the mesiobuccal cusp of the maxillary first molar and the buccal groove of the mandibular first molar was 0.3 ± 0.5 mm. Conclusions: A total of 21 patients achieved bilateral Class I (91% success rate) and demonstrated great improvement (72–96%) in PAR scores. Regardless of the etiology of malocclusion, the orthodontic correction of the Class II subdivision with CAs showed high accuracy and predictable results. Full article

(This article belongs to the Special Issue Recent Advances in Pediatric Oral Health)

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12 pages, 823 KiB

Open AccessArticle

Risk Factors and Postoperative Complications of Lobectomy for Non-Small Cell Lung Cancer: An Exploratory Analysis of Premedication and Clinical Variables

by Markéta Kepičová, Lubomír Tulinský, Adéla Kondé, Paula Dzurňáková, Peter Ihnát, Dávid Adamica, Čestmír Neoral and Lubomír Martínek

Medicina 2024, 60(12), 2088; https://doi.org/10.3390/medicina60122088 - 20 Dec 2024

Viewed by 650

Abstract

Background and Objectives: Postoperative pneumonia and complications significantly impact outcomes in thoracic surgery, particularly for patients undergoing lobectomy for non-small cell lung cancer (NSCLC). This study evaluates whether preoperative premedication influences the risk of postoperative pneumonia and overall complications. Materials and Methods [...] Read more.

Background and Objectives: Postoperative pneumonia and complications significantly impact outcomes in thoracic surgery, particularly for patients undergoing lobectomy for non-small cell lung cancer (NSCLC). This study evaluates whether preoperative premedication influences the risk of postoperative pneumonia and overall complications. Materials and Methods: This retrospective study included 346 patients who underwent lobectomy for NSCLC at the University Hospital Ostrava between 2015 and 2021. Data on demographic variables, tumour staging, surgical approach, and premedication (anticholinergics, benzodiazepines, antihistamines, and analgesics) were analysed. Postoperative outcomes included pneumonia and complications classified by the modified Clavien–Dindo system. Results: Premedication was not significantly associated with postoperative pneumonia (10.7%) or overall complications (26.0%). Tumour size was the only factor significantly associated with complications, with larger tumours increasing the odds (OR: 1.16, p = 0.032). Other factors, including age, ASA classification, BMI, and surgical approach, did not demonstrate significant associations with postoperative outcomes. Conclusions: Premedication does not appear to significantly influence the risk of postoperative pneumonia or overall complications in patients undergoing lobectomy for NSCLC. Similarly, other clinical variables, such as age, ASA classification, BMI, and surgical approach, also did not show significant associations with these outcomes. These findings suggest that premedication can be individualised without increasing postoperative risks. However, tumour size emerged as a significant factor associated with complications, highlighting the need for careful preoperative assessment and planning, particularly in patients with larger tumours. Full article

(This article belongs to the Section Surgery)

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11 pages, 1589 KiB

Open AccessArticle

HALP Score in Predicting Response to Treatment in Patients with Early-Stage Gastric Cancer: A Multi-Centred Retrospective Cohort Study

by Tolga Köşeci, Mustafa Seyyar, Yasemin Aydınalp Camadan, Halil Çelik, Burak Mete, Hakan Demirhindi, Kadir Eser, Serdar Ata, Ali Alper Solmaz and Timuçin Çil

Medicina 2024, 60(12), 2087; https://doi.org/10.3390/medicina60122087 - 20 Dec 2024

Viewed by 527

Abstract

Background and Objectives: The HALP (Haemoglobin, Albumin, Lymphocyte and Platelet) score is used to predict the prognosis of different types of cancer. This study aimed to investigate the role of the HALP score in predicting pathological response in early-stage gastric cancer patients. [...] Read more.

Background and Objectives: The HALP (Haemoglobin, Albumin, Lymphocyte and Platelet) score is used to predict the prognosis of different types of cancer. This study aimed to investigate the role of the HALP score in predicting pathological response in early-stage gastric cancer patients. Materials and Methods: This retrospective cohort study was conducted on 118 patients diagnosed with early-stage gastric cancer and subjected to perioperative (FLOT) treatment between 2018 and 2023. The role of the HALP score in predicting the pathological response to perioperative treatment in patients was investigated. Results: The mean age of the 118 patients included in the study was 61.3 ± 11.1 (min = 23; max = 86). In the ROC analysis, the optimum cut-off value for the HALP score in pathological response classification was found to be 28.9 (AUC = 0.710, sensitivity = 56.7%, specificity = 80%, PPV = 86.79%, NPV = 46.15%). The pathological response rate was 69% in all patients, 87% in patients with a HALP score ≥ 28.9, and 52% in patients with a HALP score < 28.9 (p < 0.001). The probability of pathological response is 6.5 times higher in patients with a HALP score ≥ 28.9. In the Fagan nomogram, when the HALP score was ≥28.9, our pathological response probability estimate (post-test response probability) was found to increase to 64.8% (Positive Likelihood Ratio = 3, Negative Likelihood Ratio = 0.53). In patients with HALP scores ≥ 28.9 and <28.9, progression rates were 16.7% and 47.8%, respectively (p < 0.001), and median survival times were 45.4 and 30.6 months (p < 0.001). Conclusions: The HALP score is a useful and easily accessible score for determining pathological responses in patients with locally advanced gastric cancer. Full article

(This article belongs to the Section Oncology)

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11 pages, 3819 KiB

Open AccessCase Report

A Rare Diagnosis of Parotid Gland Follicular Lymphoma Arising in Warthin Tumor: Case Report and Literature Review

by Ido Vaknin, Irit Allon, Shirley Zafrir-Haver and Alex Abramson

Medicina 2024, 60(12), 2086; https://doi.org/10.3390/medicina60122086 - 19 Dec 2024

Viewed by 878

Abstract

Introduction: A Warthin tumor is a benign salivary gland neoplasm, mostly found in the parotid gland. The number of reported Warthin tumors has increased over the years due to better diagnostic modalities and health system modernization. Warthin tumor rarely transforms into a [...] Read more.

Introduction: A Warthin tumor is a benign salivary gland neoplasm, mostly found in the parotid gland. The number of reported Warthin tumors has increased over the years due to better diagnostic modalities and health system modernization. Warthin tumor rarely transforms into a malignant tumor; in this work, we present all cases reported in the English literature of different types of lymphomas within Warthin tumors. In this case, we present a low-grade follicular lymphoma arising within a Warthin tumor. Clinical report: A 64-year-old man presented to an oral and maxillofacial surgery clinic with a growing right facial mass. The medical history was significant for stable angina pectoris, hypertension, hypercholesterolemia, obesity, and a 20-pack-year smoking history. Fine needle aspiration suggested a diagnosis of Warthin tumor. A contrast CT scan of the parotid gland demonstrated a 2.9 × 2.7 × 4.1 cm diameter mass. The patient underwent right superficial parotidectomy. Histological examination of the mass revealed a low-grade follicular lymphoma arising in a pre-existing Warthin tumor. The postoperative PET CT showed no distant disease, and bone marrow biopsy during hematologic evaluation confirmed Stage 1 low-grade follicular lymphoma. The patient received 24 Gy of VMAT radiation therapy to the right parotid gland and continued hematologic follow-up. Conclusions: Based on a literature review, this is one of the few well-documented cases reported of low-grade follicular lymphoma within a Warthin tumor. This case highlights the importance of the thorough evaluation and diagnosis of parotid masses. Furthermore, this case reopens the debate on the “wait and see” approach regarding Warthin tumors. Fine needle aspiration-based diagnosis should not be considered final, as some malignant characteristics can be missed if declining surgery. Full article

(This article belongs to the Section Oncology)

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43 pages, 4170 KiB

Open AccessSystematic Review

Gamified Health Promotion in Schools: The Integration of Neuropsychological Aspects and CBT—A Systematic Review

by Evgenia Gkintoni, Fedra Vantaraki, Charitini Skoulidi, Panagiotis Anastassopoulos and Apostolos Vantarakis

Medicina 2024, 60(12), 2085; https://doi.org/10.3390/medicina60122085 - 19 Dec 2024

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Abstract

Background and Objectives: This systematic review examines the integration of gamified health promotion strategies in school settings, with a focus on their potential to positively influence health behaviors and promote well-being among adolescents. This study explores the incorporation of cognitive behavioral therapy (CBT), [...] Read more.

Background and Objectives: This systematic review examines the integration of gamified health promotion strategies in school settings, with a focus on their potential to positively influence health behaviors and promote well-being among adolescents. This study explores the incorporation of cognitive behavioral therapy (CBT), artificial intelligence, and neuropsychological principles in gamified interventions, aiming to enhance engagement and effectiveness. Materials and Methods: A narrative synthesis of 56 studies, following PRISMA guidelines, underscores the significant impact of these gamified interventions on mental health outcomes, emphasizing reductions in anxiety, depression, and burnout while improving coping skills and lifestyle habits. The focus of key areas in mental health outcomes, emotional regulation, cognitive flexibility, and adherence mechanisms is explored through quantitative and qualitative syntheses to underscore intervention effectiveness and design principles. Results: This review highlights the high-quality evidence supporting the use of gamification in educational settings and calls for further research to optimize design elements and address implementation barriers. The findings propose that well-designed gamified health interventions can effectively engage students, promote healthy behaviors, and improve mental well-being while acknowledging the need for further studies to explore underlying mechanisms and long-term effects. Conclusions: Gamified health interventions that embed CBT and neuropsychological principles are promising for promoting the mental well-being of schoolchildren. Although the evidence indicates that they are effective in improving psychological and behavioral outcomes, further research is needed to optimize design features and overcome implementation challenges to ensure wider and more sustainable application. Full article

(This article belongs to the Section Psychiatry)

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13 pages, 714 KiB

Open AccessArticle

Prognostic Value of Neutrophil, Monocyte, Lymphocyte, and Platelet/High-Density Lipoprotein Ratios in Ischemic Heart Disease: An NHANES Analysis

by Chia-Chen Wu, Chia-Hui Wu, Chien-Ho Lee, Tien-Yu Chen and Cheng-I Cheng

Medicina 2024, 60(12), 2084; https://doi.org/10.3390/medicina60122084 - 19 Dec 2024

Viewed by 523

Abstract

The prognostic value of easily accessible hematologic biomarkers, such as the neutrophil-to-HDL ratio, as well as the monocyte-to-HDL, lymphocyte-to-HDL, and platelet-to-HDL ratios, remains underexplored in patients with established ischemic heart disease (IHD). Community-dwelling adults aged ≥ 20 with established IHD from the National [...] Read more.

The prognostic value of easily accessible hematologic biomarkers, such as the neutrophil-to-HDL ratio, as well as the monocyte-to-HDL, lymphocyte-to-HDL, and platelet-to-HDL ratios, remains underexplored in patients with established ischemic heart disease (IHD). Community-dwelling adults aged ≥ 20 with established IHD from the National Health and Nutrition Examination Survey (NHANES) 1999–2018 were eligible. Mortality was tracked through linkage to the National Death Index (NDI) until the end of 2019. Cox regressions examined the associations between these hematologic ratios and all-cause mortality. Receiver operating characteristic (ROC) curve analysis assessed the predictive accuracy of these ratios for mortality. A total of 2265 patients were analyzed, with a median follow-up period of 80 months. After adjusting for demographic factors, lifestyle variables, and comorbidities, patients in the highest quartile of the neutrophil/HDL had a significantly increased all-cause mortality risk (aHR = 1.41, 95% CI: 1.13–1.77) compared to those in the lowest quartile. No significant associations were found between the other ratios and mortality. In conclusion, this study found that among the hematologic ratios analyzed, an elevated neutrophil-to-HDL ratio has the strongest potential for mortality risk stratification in community-dwelling patients with ischemic heart disease in the US, offering important guidance for both patients and clinicians. Full article

(This article belongs to the Section Cardiology)

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12 pages, 1608 KiB

Open AccessArticle

Temporal Trends and Identification of Suicide Mortality Risk Areas in Brazil (2000–2022): Are We Dealing with an Underestimated Epidemic?

by Danilo de Gois Souza, Lucas Almeida Andrade, José Augusto Passos Góes, Luís Ricardo Santos de Melo, Matheus Santos Melo, Caíque Jordan Nunes Ribeiro, José Marcos de Jesus Santos, Emerson Lucas Silva Camargo, Álvaro Francisco Lopes de Sousa, Liliane Moretti Carneiro, Regina Claudia da Silva Souza, Márcio Bezerra Santos, Shirley Veronica Melo Almeida Lima, Carla Aparecida Arena Ventura and Allan Dantas dos Santos

Medicina 2024, 60(12), 2083; https://doi.org/10.3390/medicina60122083 - 19 Dec 2024

Viewed by 472

Abstract

Background and Objectives: Suicide is a pressing public health issue globally, including in Brazil, where it ranks among the leading causes of mortality. This study aimed to analyze the spatial, temporal, and spatiotemporal distribution of suicide mortality in Brazil from 2000 to [...] Read more.

Background and Objectives: Suicide is a pressing public health issue globally, including in Brazil, where it ranks among the leading causes of mortality. This study aimed to analyze the spatial, temporal, and spatiotemporal distribution of suicide mortality in Brazil from 2000 to 2022. Materials and Methods: Using secondary data from the Mortality Information System of Brazil’s 5570 municipalities, an ecological study of time series was conducted. Segmented linear regression (Joinpoint 4.6 version) was used to calculate temporal trends, while Moran’s indices were employed to analyze spatial autocorrelations. Retrospective scanning was utilized to investigate spatiotemporal clusters, and choropleth maps were developed to visualize high-risk areas. Results: The analysis revealed the occurrence of 240,843 suicides in Brazil, with higher percentages in the southeast, south, and northeast regions. The south, central–west, and southeast regions exhibited the highest mortality rates, predominantly among white, single men, aged 20 to 59, with 1 to 11 years of schooling. Intentional self-harm by hanging, strangulation, and suffocation was the main cause. The general trend of mortality due to suicide in Brazil was increasing (AAPC: 2.9; CI 95%: 2.6 to 3.0), with emphasis on the age groups from 10 to 19 years (AAPC: 3.7; CI 95%: 2.9 to 4.5) and 20–39 years old (AAPC: 2.9; CI 95%: 2.3 to 3.5). The brutal and smoothed rates revealed areas of high mortality in the south, north, and central–west regions. Conclusions: The findings of this study highlight the need to direct resources and efforts to the south and midwest regions of Brazil, where suicide rates are the highest. Additionally, implementing targeted prevention programs for young men, who are the most affected, is essential to reduce suicide mortality in these areas. Full article

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Medicina, Volume 60, Issue 12 (December 2024) – 205 articles

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