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Medicina, Volume 60, Issue 7 (July 2024) – 160 articles

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10 pages, 422 KiB  
Article
The Influence of Dental Status and Blood Parameters Characterizing Endogenous Intoxication on the Timing of Childbirth
by Maria Hakobyan, Gayane Manrikyan, Marina Markaryan, Izabella Vardanyan and Mikayel Manrikyan
Medicina 2024, 60(7), 1176; https://doi.org/10.3390/medicina60071176 (registering DOI) - 19 Jul 2024
Abstract
Background and Objectives: Epidemiological and microbiological–immunological studies have led to the conclusion that periodontal disease may be a risk factor for preterm birth. The aim of this study was to investigate and identify the relationship of some hematological cellular biomarkers characterizing the [...] Read more.
Background and Objectives: Epidemiological and microbiological–immunological studies have led to the conclusion that periodontal disease may be a risk factor for preterm birth. The aim of this study was to investigate and identify the relationship of some hematological cellular biomarkers characterizing the chronic oral focus of infection with pregnancy outcomes and their impact on those outcomes. Materials and Methods: Clinical and laboratory tests were conducted on 100 pregnant women, grouped by full-term or preterm births, with the assessment of the following markers: DMF, CPI and PIRI, PHP, microbiological examination of periodontal pockets and amniotic fluid, WBS count, WBCSI, LGI, and NMR. A statistical analysis was carried out with SPSS Statistics version 19.0. Results: Women with preterm labor had higher-grade caries (CSL > 0.3), while women with full-term childbirth had moderate caries (CSL < 0.3). A satisfactory level of oral hygiene efficiency was found in 50% (group 1) and 38.1% (group 2) of the expectant mothers. The periodontal status by the PIRI showed tissue lesions in 20.7% (group 1) and 92.9% (group 2) of the women. The WBCSI was 2.27 ± 0.82 and 2.15 ± 0.68, the NMR was 9.29 ± 5.119 and 11.62 ± 7.78, and the LGI was 3.54 ± 1.1 and 3.73 ± 0.81 in groups 1 and 2, respectively. Comparative analysis of bacterial contamination of the amniotic fluid revealed the predominance of Fusobacterium nucleatum (64.3%), Tannerella forsythia (57.1%), Prevotella intermedia (50%), Porphyromonas gingivalis (57.1%), Staphylococcus aureus (45.2%), and Candida albicans (50%) in women with premature birth. Conclusions: In women with preterm birth, the values of the indices characterizing a chronic oral focus of infection evoke more significant correlations with the timing of delivery, which indicates the significant role of an oral focus of infection. The presence of microbial invasion of amniotic fluid may indicate the role of periodontopathogenic bacteria in pregnant women diagnosed with a risk of preterm birth. Full article
(This article belongs to the Special Issue Biomarkers in Clinical Medicine and Dentistry)
11 pages, 2522 KiB  
Article
Unveiling Bladder Cancer Prognostic Insights by Integrating Patient-Matched Sample and CpG Methylation Analysis
by Chanbyeol Kim, Sangwon Oh, Hamin Im and Jungsoo Gim
Medicina 2024, 60(7), 1175; https://doi.org/10.3390/medicina60071175 (registering DOI) - 19 Jul 2024
Viewed by 90
Abstract
Bladder cancer prognosis remains a pressing clinical challenge, necessitating the identification of novel biomarkers for precise survival prediction and improved quality of life outcomes. This study proposes a comprehensive strategy to uncover key prognostic biomarkers in bladder cancer using DNA methylation analysis and [...] Read more.
Bladder cancer prognosis remains a pressing clinical challenge, necessitating the identification of novel biomarkers for precise survival prediction and improved quality of life outcomes. This study proposes a comprehensive strategy to uncover key prognostic biomarkers in bladder cancer using DNA methylation analysis and extreme survival pattern observations in matched pairs of cancer and adjacent normal cells. Unlike traditional approaches that overlook cancer heterogeneity by analyzing entire samples, our methodology leverages patient-matched samples to account for this variability. Specifically, DNA methylation profiles from adjacent normal bladder tissue and bladder cancer tissue collected from the same individuals were analyzed to pinpoint critical methylation changes specific to cancer cells while mitigating confounding effects from individual genetic differences. Utilizing differential threshold settings for methylation levels within cancer-associated pathways enabled the identification of biomarkers that significantly impact patient survival. Our analysis identified distinct survival patterns associated with specific CpG sites, underscoring these sites’ pivotal roles in bladder cancer outcomes. By hypothesizing and testing the influence of methylation levels on survival, we pinpointed CpG biomarkers that profoundly affect the prognosis. Notably, CpG markers, such as cg16269144 (PRKCZ), cg16624272 (PTK2), cg11304234, and cg26534425 (IL18), exhibited critical methylation thresholds that correlate with patient mortality. This study emphasizes the importance of tailored approaches to enhancing prognostic accuracy and refining therapeutic strategies for bladder cancer patients. The identified biomarkers pave the way for personalized prognostication and targeted interventions, promising advancements in bladder cancer management and patient care. Full article
(This article belongs to the Section Oncology)
16 pages, 1568 KiB  
Article
The Role of Programmed Cell Death 1/Programmed Death Ligand 1 (PD-1/PD-L1) Axis in Sepsis-Induced Apoptosis
by Oana Coman, Bianca-Liana Grigorescu, Adina Huțanu, Anca Bacârea, Anca Meda Văsieșiu, Raluca Ștefania Fodor, Florin Stoica and Leonard Azamfirei
Medicina 2024, 60(7), 1174; https://doi.org/10.3390/medicina60071174 (registering DOI) - 19 Jul 2024
Viewed by 93
Abstract
Background and Objectives: Sepsis involves a dysregulated host response, characterized by simultaneous immunosuppression and hyperinflammation. Initially, there is the release of pro-inflammatory factors and immune system dysfunction, followed by persistent immune paralysis leading to apoptosis. This study investigates sepsis-induced apoptosis and its [...] Read more.
Background and Objectives: Sepsis involves a dysregulated host response, characterized by simultaneous immunosuppression and hyperinflammation. Initially, there is the release of pro-inflammatory factors and immune system dysfunction, followed by persistent immune paralysis leading to apoptosis. This study investigates sepsis-induced apoptosis and its pathways, by assessing changes in PD-1 and PD-L1 serum levels, CD4+ and CD8+ T cells, and Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE II) severity scores. Materials and Methods: This prospective, observational, single-centre study enrolled 87 sepsis patients admitted to the intensive care unit at the County Emergency Clinical Hospital in Târgu Mureș, Romania. We monitored the parameters on day 1 (the day sepsis or septic shock was diagnosed as per the Sepsis-3 Consensus) and day 5. Results: Our study found a statistically significant variation in the SOFA score for the entirety of the patients between the studied days (p = 0.001), as well as for the studied patient groups: sepsis, septic shock, survivors, and non-survivors (p = 0.001, p = 0.003, p = 0.01, p = 0.03). On day 1, we found statistically significant correlations between CD8+ cells and PD-1 (p = 0.02) and PD-L1 (p = 0.04), CD4+ and CD8+ cells (p < 0.0001), SOFA and APACHE II scores (p < 0.0001), and SOFA and APACHE II scores and PD-L1 (p = 0.001 and p = 0.01). On day 5, we found statistically significant correlations between CD4+ and CD8+ cells and PD-L1 (p = 0.03 and p = 0.0099), CD4+ and CD8+ cells (p < 0.0001), and SOFA and APACHE II scores (p < 0.0001). Conclusions: The reduction in Th CD4+ and Tc CD8+ lymphocyte subpopulations were evident from day 1, indicating that apoptosis is a crucial factor in the progression of sepsis and septic shock. The increased expression of the PD-1/PD-L1 axis impairs costimulatory signalling, leading to diminished T cell responses and lymphopenia, thereby increasing the susceptibility to nosocomial infections. Full article
(This article belongs to the Special Issue Management of Septic Shock in ICU)
18 pages, 808 KiB  
Systematic Review
The Complex Role of Mast Cells in Head and Neck Squamous Cell Carcinoma: A Systematic Review
by Sofia-Eleni Tzorakoleftheraki and Triantafyllia Koletsa
Medicina 2024, 60(7), 1173; https://doi.org/10.3390/medicina60071173 (registering DOI) - 19 Jul 2024
Viewed by 129
Abstract
Background and Objectives: Head and neck squamous cell carcinoma (HNSCC) is a heterogeneous malignancy influenced by various genetic and environmental factors. Mast cells (MCs), typically associated with allergic responses, have recently emerged as key regulators of the HNSCC tumor microenvironment (TME). This [...] Read more.
Background and Objectives: Head and neck squamous cell carcinoma (HNSCC) is a heterogeneous malignancy influenced by various genetic and environmental factors. Mast cells (MCs), typically associated with allergic responses, have recently emerged as key regulators of the HNSCC tumor microenvironment (TME). This systematic review explores the role of MCs in HNSCC pathogenesis and their potential as prognostic markers and therapeutic targets. Materials and Methods: A systematic search was conducted in the PubMed, Scopus and ClinicalTrials.gov databases until 31 December 2023, using “Mast cells” AND “Head and neck squamous cell carcinoma” as search terms. Studies in English which reported on MCs and HNSCC were included. Screening, data extraction and analysis followed PRISMA guidelines. No new experiments were conducted. Results: Out of 201 articles, 52 studies met the inclusion criteria, 43 of which were published between 2020 and 2023. A total of 28821 HNSCC and 9570 non-cancerous tissue samples had been examined. MC density and activation varied among normal tissues and HNSCC. Genetic alterations associated with MCs were identified, with specific gene expressions correlating with prognosis. Prognostic gene signatures associated with MC density were established. Conclusions: MCs have arisen as multifaceted TME modulators, impacting various aspects of HNSCC development and progression. Possible site-specific or HPV-related differences in MC density and activation should be further elucidated. Despite conflicting findings on their prognostic role, MCs represent promising targets for novel therapeutic strategies, necessitating further research and clinical validation for personalized HNSCC treatment. Full article
(This article belongs to the Section Oncology)
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10 pages, 2469 KiB  
Case Report
Mimicry of Rhabdomyosarcoma by Tonsillar Actinomycosis: Case Report
by John Fernando Montenegro Palacios, Shirley Vanessa Correa Forero, Gaby Alejandra Ordoñez Andrade, Jasbleidy Posu Barco, Luis Alvaro Melo Burbano and Yamil Liscano
Medicina 2024, 60(7), 1172; https://doi.org/10.3390/medicina60071172 (registering DOI) - 19 Jul 2024
Viewed by 138
Abstract
Actinomycosis is a rare infectious disease characterized by slowly progressive, chronic suppurative lesions, often mistaken for malignancies due to its ability to mimic them. It is caused by Actinomyces bacteria, which are part of the normal flora of the human oropharynx, gastrointestinal, and [...] Read more.
Actinomycosis is a rare infectious disease characterized by slowly progressive, chronic suppurative lesions, often mistaken for malignancies due to its ability to mimic them. It is caused by Actinomyces bacteria, which are part of the normal flora of the human oropharynx, gastrointestinal, and urogenital tracts. This case report describes a 51-year-old male with a history of mandibular rhabdomyosarcoma presenting with severe shoulder and hip pain, dysphagia, and headaches, initially suspected to be a cancer recurrence. However, after further investigation, including a PET-CT and tonsillectomy, the diagnosis of actinomycosis was confirmed through histopathological examination. The case highlights the diagnostic challenges of actinomycosis, especially in patients with complex clinical histories, emphasizing the importance of considering it as a differential diagnosis in similar presentations. The patient was treated with long-term antibiotic therapy, predominantly beta-lactams, demonstrating the necessity of a comprehensive diagnostic approach and the implications of a delayed diagnosis. This case underscores the critical need for high clinical suspicion and awareness among healthcare professionals regarding the potential for actinomycosis to mimic more common diseases, ensuring timely and accurate treatment. Full article
(This article belongs to the Section Infectious Disease)
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14 pages, 1924 KiB  
Review
Antimalarial Drugs at the Intersection of SARS-CoV-2 and Rheumatic Diseases: What Are the Potential Opportunities?
by Saule Abisheva, Kristina Rutskaya-Moroshan, Gulnaz Nuranova, Tansholpan Batyrkhan and Anilim Abisheva
Medicina 2024, 60(7), 1171; https://doi.org/10.3390/medicina60071171 (registering DOI) - 19 Jul 2024
Viewed by 133
Abstract
Background and Objectives: The coronavirus disease of 2019 (COVID-19) pandemic has posed a serious threat to humanity and is considered a global health emergency. Antimalarial drugs (ADs) have been used in the treatment of immuno-inflammatory arthritis (IIA) and coronavirus infection (COVID-19). The [...] Read more.
Background and Objectives: The coronavirus disease of 2019 (COVID-19) pandemic has posed a serious threat to humanity and is considered a global health emergency. Antimalarial drugs (ADs) have been used in the treatment of immuno-inflammatory arthritis (IIA) and coronavirus infection (COVID-19). The aim of this review is to analyze the current knowledge about the immunomodulatory and antiviral mechanisms of action, characteristics of use, and side effects of antimalarial drugs. Material and Methods: A literature search was carried out using PubMed, MEDLINE, SCOPUS, and Google Scholar databases. The inclusion criteria were the results of randomized and cohort studies, meta-analyses, systematic reviews, and original full-text manuscripts in the English language containing statistically confirmed conclusions. The exclusion criteria were summary reports, newspaper articles, and personal messages. Qualitative methods were used for theoretical knowledge on antimalarial drug usage in AIRDs and SARS-CoV-2 such as a summarization of the literature and a comparison of the treatment methods. Results: The ADs were considered a “candidate” for the therapy of a new coronavirus infection due to mechanisms of antiviral activity, such as interactions with endocytic pathways, the prevention of glycosylation of the ACE2 receptors, blocking sialic acid receptors, and reducing the manifestations of cytokine storms. The majority of clinical trials suggest no role of antimalarial drugs in COVID-19 treatment or prevention. These circumstances do not allow for their use in the treatment and prevention of COVID-19. Conclusions: The mechanisms of hydroxychloroquine are related to potential cardiotoxic manifestations and demonstrate potential adverse effects when used for COVID-19. Furthermore, the need for high doses in the treatment of viral infections increases the likelihood of gastrointestinal side effects, the prolongation of QT, and retinopathy. Large randomized clinical trials (RCTs) have refuted the fact that there is a positive effect on the course and results of COVID-19. Full article
(This article belongs to the Section Infectious Disease)
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10 pages, 1867 KiB  
Article
Short-Term Comparison of Switching to Brolucizumab or Faricimab from Aflibercept in Neovascular AMD Patients
by Akiko Kin, Takahiro Mizukami, Satoru Ueno, Soichiro Mishima and Yoshikazu Shimomura
Medicina 2024, 60(7), 1170; https://doi.org/10.3390/medicina60071170 (registering DOI) - 19 Jul 2024
Viewed by 124
Abstract
Background and Objectives: In this study, our objective was to assess and compare the changes in visual and structural outcomes among patients with neovascular age-related macular degeneration (nAMD) who were switched from intravitreal aflibercept (IVA) to either intravitreal brolucizumab (IVBr) or intravitreal [...] Read more.
Background and Objectives: In this study, our objective was to assess and compare the changes in visual and structural outcomes among patients with neovascular age-related macular degeneration (nAMD) who were switched from intravitreal aflibercept (IVA) to either intravitreal brolucizumab (IVBr) or intravitreal faricimab (IVF) injections in a clinical setting. Materials and Methods: This observational clinical study included 20 eyes of 20 patients switched to brolucizumab and 15 eyes of 14 patients switched to faricimab from aflibercept in eyes with nAMD. We measured the structural outcome (central macular thickness (CMT)) and the visual outcome (best-corrected visual acuity (BCVA); logMAR) as follows: just before the most recent IVA injection (B0), one month after the most recent IVA injection (B1), just before the first IVBr or IVF injection (A0), one month after (A1) and three months after (A3) the first IVBr or IVF injection. Results: BCVA showed significant improvement at A1 (0.25 ± 0.34) and at A3 (0.19 ± 0.24) compared to A0 (0.38 ± 0.35) in the IVBr group (p = 0.0156, p = 0.0166, respectively). CMT (μm) was significantly thinner at A1 (IVBr: 240.55 ± 51.82, IVF: 234.91 ± 47.29) and at A3 (IVBr: 243.21 ± 76.15, IVF: 250.50 ± 72.61) compared to at A0 (IVBr: 303.55 ± 79.18, IVF: 270.33 ± 77.62) in the IVBr group (A1: p = 0.0093, A3: p = 0.0026) and in the IVF group (A1: p = 0.0161, A3: p = 0.0093). There was no significant difference in BCVA and CMT improvement observed between two groups at any time point (p > 0.05 for all). Conclusions: Switching from aflibercept to either brolucizumab or faricimab has a significant anatomical effect in eyes with nAMD and both treatments appear to be effective short-term treatment options. There is a trend towards greater visual improvements and reductions in CMT with brolucizumab. Full article
(This article belongs to the Section Ophthalmology)
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18 pages, 736 KiB  
Systematic Review
Post-Mastectomy Breast Reconstruction Disparities: A Systematic Review of Sociodemographic and Economic Barriers
by Kella L. Vangsness, Jonathan Juste, Andre-Phillippe Sam, Naikhoba Munabi, Michael Chu, Mouchammed Agko, Jeff Chang and Antoine L. Carre
Medicina 2024, 60(7), 1169; https://doi.org/10.3390/medicina60071169 (registering DOI) - 19 Jul 2024
Viewed by 148
Abstract
Background: Breast reconstruction (BR) following mastectomy is a well-established beneficial medical intervention for patient physical and psychological well-being. Previous studies have emphasized BR as the gold standard of care for breast cancer patients requiring surgery. Multiple policies have improved BR access, but [...] Read more.
Background: Breast reconstruction (BR) following mastectomy is a well-established beneficial medical intervention for patient physical and psychological well-being. Previous studies have emphasized BR as the gold standard of care for breast cancer patients requiring surgery. Multiple policies have improved BR access, but there remain social, economic, and geographical barriers to receiving reconstruction. Threats to equitable healthcare for all breast cancer patients in America persist despite growing awareness and efforts to negate these disparities. While race/ethnicity has been correlated with differences in BR rates and outcomes, ongoing research outlines a multitude of issues underlying this variance. Understanding the current and continuous barriers will help to address and overcome gaps in access. Methods: A systematic review assessing three reference databases (PubMed, Web of Science, and Ovid Medline) was carried out in accordance with PRISMA 2020 guidelines. A keyword search was conducted on 3 February 2024, specifying results between 2004 and 2024. Studies were included based on content, peer-reviewed status, and publication type. Two independent reviewers screened results based on title/abstract appropriateness and relevance. Data were extracted, cached in an online reference collection, and input into a cloud-based database for analysis. Results: In total, 1756 references were populated from all databases (PubMed = 829, Ovid Medline = 594, and Web of Science = 333), and 461 duplicate records were removed, along with 1147 results deemed ineligible by study criteria. Then, 45 international or non-English results were excluded. The screening sample consisted of 103 publications. After screening, the systematic review produced 70 studies with satisfactory relevance to our study focus. Conclusions: Federal mandates have improved access to women undergoing postmastectomy BR, particularly for younger, White, privately insured, urban-located patients. Recently published studies had a stronger focus on disparities, particularly among races, and show continued disadvantages for minorities, lower-income, rural-community, and public insurance payers. The research remains limited beyond commonly reported metrics of disparity and lacks examination of additional contributing factors. Future investigations should elucidate the effect of these factors and propose measures to eliminate barriers to access to BR for all patients. Full article
(This article belongs to the Special Issue Updates on Post-mastectomy Breast Reconstruction)
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9 pages, 1384 KiB  
Article
Annual Trends of High Tibial Osteotomy: Analysis of an Official Registry in Italy
by Umile Giuseppe Longo, Alessandro Mazzola, Stefano Campi, Giuseppe Salvatore, Vincenzo Candela, Carlo Casciaro, Diana Giannarelli, Margaux D’Hooghe and Rocco Papalia
Medicina 2024, 60(7), 1168; https://doi.org/10.3390/medicina60071168 (registering DOI) - 19 Jul 2024
Viewed by 133
Abstract
Background and Objectives: Knee osteoarthritis is a serious burden for modern countries. Timing of surgery and treatment choice are still a matter of controversy in the orthopedic literature. The purpose of this study was to ascertain the incidence and hospitalization trends of high [...] Read more.
Background and Objectives: Knee osteoarthritis is a serious burden for modern countries. Timing of surgery and treatment choice are still a matter of controversy in the orthopedic literature. The purpose of this study was to ascertain the incidence and hospitalization trends of high tibial osteotomy in Italy from 2001 to 2016. Materials and Methods: Data are sourced from the National Hospital Discharge Reports (SDO) of the Italian Ministry of Health between 2001 and 2016. Results: A total of 34,402 high tibial osteotomies were performed over the study period in Italy. The cumulative incidence was 3.6 cases per 100,000 residents. The age classes 50–54, 55–59 showed the higher number of procedures. In pediatric patients (0–19 years), high tibial osteotomies are also largely performed. The majority of patients having surgery were men with a M/F ratio of 1.5. The mean age of patients was 44.2 ± 19.2 years. Males were significantly younger than females (43.3 ± 20.7 vs. 45.6 ± 17.7). The average length of hospitalization was 6.1 ± 7.3 days. Over the course of the analysis, a declining trend in hospital stay length was seen. The main primary diagnosis codes were “Varus knee” (736.42 ICD-9-CM code, 33.9%), “Osteoarthrosis, localized, primary, leg region” (715.16 ICD-9-CM code, 9.5%). Conclusions: Over the study period, high tibial osteotomies in Italy almost halved. Varus deformity and knee osteoarthritis are the leading causes requiring high tibial osteotomy. Except for the pediatric setting, results showed that from the 20–24 age class to the 50–54 age class, there was an increasing request for knee osteotomy, whereas in those aged >60 years, the incidence progressively decreased. The evident decline in HTO performed over the years in Italy seems to reflect a minor role for knee osteotomy in the management of knee OA, as it seems to be primarily reserved for younger male patients. Full article
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8 pages, 274 KiB  
Article
Factors Associated with Postpartum Depression among Women in Eastern Sudan: A Cross-Sectional Study
by Khalid Nasralla, Saeed Omar, Ghusun Alharbi, Fai Aljarallah, Nadiah AlHabardi and Ishag Adam
Medicina 2024, 60(7), 1167; https://doi.org/10.3390/medicina60071167 (registering DOI) - 19 Jul 2024
Viewed by 195
Abstract
Background and Objectives: Postpartum depression is one of the most common complications of childbirth. While the epidemiology of postpartum depression has been extensively studied in African countries, there is little published data on the topic in Sudan. In addition, no studies have [...] Read more.
Background and Objectives: Postpartum depression is one of the most common complications of childbirth. While the epidemiology of postpartum depression has been extensively studied in African countries, there is little published data on the topic in Sudan. In addition, no studies have been conducted in Eastern Sudan. This study aims to evaluate the factors associated with postpartum depression among Sudanese women in Gadarif in Eastern Sudan. Materials and Methods: A cross-sectional study (using the systematic random sampling technique) of women presenting to Gadarif Maternity Hospital for postnatal follow-up within six weeks of childbirth was conducted. A questionnaire was used to collect sociodemographic information, and the Edinburgh Postnatal Depression Scale was used to assess postpartum depression. Results: Three hundred women were enrolled in the study. The median (interquartile) age and parity were 30.0 (25.0–34.0) years and 2 (1–4). Thirty-one (10.3%) of the women had postpartum depression. A univariate analysis showed that a past history of depression was the only factor associated with postpartum depression (OR = 3.04, 95% CI = 1.03–8.97). Other investigated factors (age, parity, educational level, occupation, history of previous miscarriage or intrauterine fetal death, a family history of depression, financial support, medical insurance, whether the pregnancy was planned or not, and if the gender of the newborn was known before delivery) were not associated with postpartum depression. Conclusions: The current study showed that 1 out of 10 women had postpartum depression that was associated with a past history of depression. Factors that have been reported to be associated with postpartum depression in African countries (age, parity, education, and occupation) were not found to be associated in this study. Mental health assessment needs to be employed for women in their antenatal and postpartum periods. Full article
(This article belongs to the Section Obstetrics and Gynecology)
9 pages, 988 KiB  
Article
Barriers against Implementation of European Society of Gastrointestinal Endoscopy Performance Measures for Colonoscopy in Clinical Practice
by Giulia Gibiino, Leonardo Frazzoni, Andrea Anderloni, Lorenzo Fuccio, Alessandro Lacchini, Cristiano Spada and Carlo Fabbri
Medicina 2024, 60(7), 1166; https://doi.org/10.3390/medicina60071166 (registering DOI) - 19 Jul 2024
Viewed by 168
Abstract
Background and Objectives: The implementation and monitoring of the European Society of Gastrointestinal Endoscopy (ESGE) performance measures for colonoscopy are suboptimal in clinical practice. Electronic reporting systems may play an important role in data retrieval. We aimed to define the possibility of systematically [...] Read more.
Background and Objectives: The implementation and monitoring of the European Society of Gastrointestinal Endoscopy (ESGE) performance measures for colonoscopy are suboptimal in clinical practice. Electronic reporting systems may play an important role in data retrieval. We aimed to define the possibility of systematically assessing and monitoring ESGE performance measures for colonoscopy through reporting systems. Materials and Methods: We conducted a survey during a nationwide event on the quality of colonoscopy held in Rome, Italy, in March 2023 by a self-administered questionnaire. Analyses were conducted overall and by workplace setting. Results: The attendance was 93% (M/F 67/26), with equal distribution of age groups, regions and public or private practices. Only about one-third (34%) and 21.5% of participants stated that their reporting system allows them to retrieve all the ESGE performance measures, overall and as automatic retrieval, respectively. Only 66.7% and 10.7% of respondents can systematically report the cecal intubation and the adenoma detection rate, respectively. The analysis according to hospital setting revealed no significant difference for all the items. Conclusions: We found a generalized lack of systematic tracking of performance measures for colonoscopy due to underperforming reporting systems. Our results underline the need to update reporting systems to monitor the quality of endoscopy practice in Italy. Full article
(This article belongs to the Section Gastroenterology & Hepatology)
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10 pages, 637 KiB  
Article
Progranulin and Vaspin as Potential Novel Markers in the Etiology of Type 1 Diabetes in Children
by Katarzyna Jakubek-Kipa, Sabina Galiniak and Artur Mazur
Medicina 2024, 60(7), 1165; https://doi.org/10.3390/medicina60071165 (registering DOI) - 19 Jul 2024
Viewed by 184
Abstract
Background and Objectives: Diabetes is a significant health problem, prompting the search for new therapeutic strategies. Recently, researchers have focused on identifying novel markers for the progression of this condition. It is well established that adipokines, such as progranulin and vaspin, play crucial [...] Read more.
Background and Objectives: Diabetes is a significant health problem, prompting the search for new therapeutic strategies. Recently, researchers have focused on identifying novel markers for the progression of this condition. It is well established that adipokines, such as progranulin and vaspin, play crucial roles in regulating lipid and carbohydrate metabolism. Materials and Methods: This single-center cross-sectional study aimed to assess serum progranulin and vaspin levels in 80 children diagnosed with type 1 diabetes (T1D) and to examine their correlation with body mass index (BMI), glycated hemoglobin, and lipid profile. The cohort included 40 children newly diagnosed with diabetes, 40 children with long-term diabetes (20 well-controlled and 20 poorly controlled), and 14 non-diabetic children as a control group. Progranulin and vaspin levels were determined using a sandwich enzyme-linked immunosorbent assay. Results: There were no significant differences in the progranulin and vaspin concentrations in the studied groups (p = 0.246 and p = 0.095, respectively). No statistically significant differences were noted in the levels of both adipokines among boys and girls within the T1D, well-controlled T1D, and poorly controlled T1D groups. We did not find any differences in the progranulin and vaspin levels among all children with T1D and healthy controls when divided based on BMI percentiles. A negative correlation was observed between progranulin concentration and the age of children in the T1D, well-controlled T1D, and healthy groups. Furthermore, progranulin correlated negatively with BMI among children with T1D. In contrast, vaspin concentration correlated positively with age among healthy children. Conclusions: Our study provides novel insights into the status of progranulin and vaspin among pediatric participants with varying levels of type 1 diabetes control. However, further research involving larger patient cohorts and different stages of sexual maturation is warranted. Full article
(This article belongs to the Section Endocrinology)
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8 pages, 2502 KiB  
Brief Report
Handheld 6-Lead ECG for Early Detection of Acute Inferior Wall ST-T Segment Elevation Myocardial Infarction: HINT-MI Study Design and Rationale
by Sodam Jung, In-Sook Kang, Sanghoon Shin, Choongki Kim and Junbeom Park
Medicina 2024, 60(7), 1164; https://doi.org/10.3390/medicina60071164 - 18 Jul 2024
Viewed by 226
Abstract
Background: ST-T segment elevation myocardial infarction (STEMI) is a critical condition that requires rapid diagnosis and treatment. Recently, various ECG recording devices have been developed. In this study, we aim to determine the utility of a 6-lead handheld ECG recording device to [...] Read more.
Background: ST-T segment elevation myocardial infarction (STEMI) is a critical condition that requires rapid diagnosis and treatment. Recently, various ECG recording devices have been developed. In this study, we aim to determine the utility of a 6-lead handheld ECG recording device to shorten the time taken for the diagnosis of inferior wall STEMI. Methods and Design: HINT-MI is an investigator-derived, observational, prospective study that will evaluate the ability of a handheld 6-lead ECG device to diagnose acute inferior wall STEMI. Patients who have undergone coronary angiography for STEMI or for other reasons will be enrolled in the study. This study aims to evaluate sensitivity and specificity of a handheld 6-lead ECG device by the level of agreement with a standard 12-lead ECG for diagnosing inferior wall STEMI. Further, we will determine whether the use of the handheld device can reduce the time needed for reperfusion treatment through faster diagnosis. Conclusions: This study aims to investigate the feasibility of a handheld 6-lead ECG device for diagnosing inferior wall STEMI to reduce the time required to diagnose inferior wall STEMI and to allow timely treatment. Full article
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3 pages, 188 KiB  
Editorial
Atypical Autism: Causes, Diagnosis and Support
by Rekha Jagadapillai
Medicina 2024, 60(7), 1163; https://doi.org/10.3390/medicina60071163 - 18 Jul 2024
Viewed by 172
Abstract
Autism spectrum disorder (ASD) is a group of neurobehavioral disorders defined by persistent deficits in social communication and social interactions with repetitive behaviors, and it is typically diagnosed within the first three years of life [...] Full article
(This article belongs to the Special Issue Atypical Autism: Causes, Diagnosis, and Support)
14 pages, 994 KiB  
Review
Diagnostic Value of Cardiovascular Magnetic Resonance T1 and T2 Mapping in Acute Myocarditis: A Systematic Literature Review
by Karolina Gaizauskiene, Kamile Leketaite, Sigita Glaveckaite and Nomeda Valeviciene
Medicina 2024, 60(7), 1162; https://doi.org/10.3390/medicina60071162 - 18 Jul 2024
Viewed by 210
Abstract
Background and Objectives: Over the past decade, there has been increasing attention paid to advanced and innovative cardiovascular magnetic resonance (CMR) modalities, such as T1 and T2 mapping, which play a major role in diagnosing diffuse myocardial disease. There is little data [...] Read more.
Background and Objectives: Over the past decade, there has been increasing attention paid to advanced and innovative cardiovascular magnetic resonance (CMR) modalities, such as T1 and T2 mapping, which play a major role in diagnosing diffuse myocardial disease. There is little data summarizing the current evidence regarding the diagnostic accuracy of T1 and T2 mapping, and extracellular volume (ECV) in acute myocarditis. The aim of our study was to select, analyze, and systematically review the recent scientific literature on the diagnostic value of CMR T1 and T2 parametric mapping in clinically suspected acute myocarditis. Materials and Methods: The literature search was performed in the PubMed database. Articles published in the years 2014–2024 were included in the analysis. At the initial stage, 458 articles were reviewed, and 13 exploratory research studies were further analyzed and presented in this systematic literature review. Results: The analysis included 686 patients with clinically suspected myocarditis and 372 subjects in the control group. The average age of patients with suspected myocarditis was 40.25 years; 26% of them were women. Prolonged native myocardial T1 relaxation time provides diagnostic accuracy in the setting of suspected acute myocarditis ranging from 69 to 99%, with sensitivity from 64 to 98% and specificity from 87 to 100%. Diagnostic accuracy of prolonged T2 relaxation time ranges from 47 to 87%, with sensitivity being from 48% to 94% and specificity from 60% to 92%. ECV alone showed moderate diagnostic performance, with diagnostic accuracy ranging from 62% to 76%, sensitivity from 47% to 73%, and specificity from 76% to 90%. T1 and T2 mapping and ECV, combined with the late gadolinium enhancement (LGE) technique, increases the probability of detecting myocardial inflammatory changes at various stages of the disease, improving the diagnostic accuracy to 96%. Conclusions: New quantitative CMR techniques, i.e., T1 and T2 mapping, have an advantage over conventional CMR sequences in detecting inflammatory myocardial structural changes and play an important role in diagnosing acute myocarditis. Incorporating these sequences in daily clinical practice increases the diagnostic value of CMR in acute myocarditis and becomes an alternative to endomyocardial biopsy, which has been considered the gold standard until now. Full article
(This article belongs to the Section Cardiology)
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12 pages, 1227 KiB  
Systematic Review
The Application of Robotics in Cardiac Rehabilitation: A Systematic Review
by Aseel Aburub, Mohammad Z. Darabseh, Rahaf Badran, Ala’a M. Shurrab, Anwaar Amro and Hans Degens
Medicina 2024, 60(7), 1161; https://doi.org/10.3390/medicina60071161 - 18 Jul 2024
Viewed by 282
Abstract
Background and Objectives: Robotics is commonly used in the rehabilitation of neuro-musculoskeletal injuries and diseases. While in these conditions, robotics has clear benefits, it is unknown whether robotics will also enhance the outcome of cardiac rehabilitation. This systematic review evaluates the use [...] Read more.
Background and Objectives: Robotics is commonly used in the rehabilitation of neuro-musculoskeletal injuries and diseases. While in these conditions, robotics has clear benefits, it is unknown whether robotics will also enhance the outcome of cardiac rehabilitation. This systematic review evaluates the use of robotics in cardiac rehabilitation. Methods: A systematic literature search was conducted using PubMed (MEDLINE), CINAHL, AMED, SPORTDiscus, and the Physiotherapy Evidence Database. Longitudinal interventional studies were included if they met specified criteria. Two reviewers independently conducted title, abstract, and full-text screening and data extraction. The quality assessment and risk of bias were conducted according to the PEDRO scale and Cochrane Risk of Bias tool 2, respectively. Results: Four trials were included in this review out of 60 screened studies. The quality of the included studies was good with a low risk of bias. The trials used different robotic systems: Lokomat® system, Motomed Letto/Thera Trainer tigo, BEAR, and Myosuit. It was found that interventions that included the use of robotic assistance technologies improved the exercise capacity, VO2 max/peak, left ventricular ejection fraction, QOL, and physical functioning in people with cardiac diseases. Conclusions: Robotic assistance technologies can be used in cardiac rehabilitation programs. Further studies are needed to confirm the results and determine whether the use of robotics enhances intervention outcomes above standard interventions. Full article
(This article belongs to the Section Cardiology)
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19 pages, 8176 KiB  
Article
Fatty Acid Synthase Promotes Hepatocellular Carcinoma Growth via S-Phase Kinase-Associated Protein 2/p27KIP1 Regulation
by Antonio Cigliano, Maria M. Simile, Gianpaolo Vidili, Giovanni M. Pes, Maria P. Dore, Francesco Urigo, Eleonora Cossu, Li Che, Claudio Feo, Sara M. Steinmann, Silvia Ribback, Rosa M. Pascale, Matthias Evert, Xin Chen and Diego F. Calvisi
Medicina 2024, 60(7), 1160; https://doi.org/10.3390/medicina60071160 - 18 Jul 2024
Viewed by 271
Abstract
Background and Objectives: Aberrant upregulation of fatty acid synthase (FASN), catalyzing de novo synthesis of fatty acids, occurs in various tumor types, including human hepatocellular carcinoma (HCC). Although FASN oncogenic activity seems to reside in its pro-lipogenic function, cumulating evidence suggests that FASN’s [...] Read more.
Background and Objectives: Aberrant upregulation of fatty acid synthase (FASN), catalyzing de novo synthesis of fatty acids, occurs in various tumor types, including human hepatocellular carcinoma (HCC). Although FASN oncogenic activity seems to reside in its pro-lipogenic function, cumulating evidence suggests that FASN’s tumor-supporting role might also be metabolic-independent. Materials and Methods: In the present study, we show that FASN inactivation by specific small interfering RNA (siRNA) promoted the downregulation of the S-phase kinase associated-protein kinase 2 (SKP2) and the consequent induction of p27KIP1 in HCC cell lines. Results: Expression levels of FASN and SKP2 directly correlated in human HCC specimens and predicted a dismal outcome. In addition, forced overexpression of SKP2 rendered HCC cells resistant to the treatment with the FASN inhibitor C75. Furthermore, FASN deletion was paralleled by SKP2 downregulation and p27KIP1 induction in the AKT-driven HCC preclinical mouse model. Moreover, forced overexpression of an SKP2 dominant negative form or a p27KIP1 non-phosphorylatable (p27KIP1-T187A) construct completely abolished AKT-dependent hepatocarcinogenesis in vitro and in vivo. Conclusions: In conclusion, the present data indicate that SKP2 is a critical downstream effector of FASN and AKT-dependent hepatocarcinogenesis in liver cancer, envisaging the possibility of effectively targeting FASN-positive liver tumors with SKP2 inhibitors or p27KIP1 activators. Full article
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12 pages, 283 KiB  
Article
Post-Partum Clinical and Patient-Reported Outcome Changes in Mothers with Multiple Sclerosis: Findings from the NAPPREMS Study
by Dejan Jakimovski, Katelyn S. Kavak, Kara Patrick, Omid Mirmosayyeb, Svetlana P. Eckert, David Hojnacki and Bianca Weinstock-Guttman
Medicina 2024, 60(7), 1159; https://doi.org/10.3390/medicina60071159 - 18 Jul 2024
Viewed by 239
Abstract
Background and Objective: Pregnancy in mothers with multiple sclerosis (MS) commonly results in significant changes in disease activity and changes in clinical care, including the discontinuation of disease modifying therapy (DMT). This study aimed at understanding the clinical and patient-reported outcomes (PROs) [...] Read more.
Background and Objective: Pregnancy in mothers with multiple sclerosis (MS) commonly results in significant changes in disease activity and changes in clinical care, including the discontinuation of disease modifying therapy (DMT). This study aimed at understanding the clinical and patient-reported outcomes (PROs) before, during and 1-year after delivery. Materials and Methods: A total of 30 pregnant mothers with MS were recruited as part of the study. Clinical (relapse activity and disability changes), PRO information and MRI outcomes were collected on four separate visits: one baseline visit—0–30 days post-delivery; and 3 follow-up visits at week 24, week 36 and week 52 from the baseline. PRO was assessed using a validated questionnaire called the Fatigue Scale for Motor and Cognitive Function (FSMC). The MRI scans were analyzed, and the count of new T2 lesions and/or contrast-enhancing lesions was determined. Results: The average time between delivery and the start of DMT was 142.5 days. Relapse activity before the pregnancy was numerically linked with the activity during the pregnancy, where up to 57.1% of the activity during pregnancy occurred in pwMS with previously active disease before conception (statistically trending with p = 0.073). The relapse activity after the pregnancy occurred twice as often in pwMS whose MS was clinically active before conception. All five pwMS who experienced a relapse prior to the pregnancy experienced worsening in their physical PRO domain. Conclusions: Pre-pregnancy activity is crucial in the screening of mothers with MS at risk for post-partum relapses, worsening of clinical disability and/or PRO measures. A post-partum MS period may benefit from the routine PRO utilization and screening for its worsening. The inflammatory activity during pregnancy was not associated with short-term disease progression. Full article
(This article belongs to the Section Neurology)
2 pages, 198 KiB  
Reply
Reply to Saleh, C. Comment on “Bažadona et al. The Interconnection between Carotid Intima–Media Thickness and Obesity: Anthropometric, Clinical and Biochemical Correlations. Medicina 2023, 59, 1512”
by Danira Bažadona, Martina Matovinović, Magdalena Krbot Skorić, Hrvoje Grbavac, Andrej Belančić and Branko Malojčić
Medicina 2024, 60(7), 1158; https://doi.org/10.3390/medicina60071158 - 18 Jul 2024
Viewed by 101
Abstract
We would like to begin by expressing our gratitude for the interest shown in our research [...] Full article
12 pages, 2920 KiB  
Article
The Impact of Orthodontic Extrusion on Keratinized Gingiva
by Ivan Arsić, Nemanja Marinković, Tina Pajević, Jovan Marković, Miroslav Dragović, Zorana Stamenković, Neda Stefanović and Nenad Nedeljković
Medicina 2024, 60(7), 1157; https://doi.org/10.3390/medicina60071157 - 17 Jul 2024
Viewed by 269
Abstract
Background and Objectives: The key factor that enables osteoblastic activity and the formation of new bone, as well as gingiva, during orthodontic tooth extrusion (OE) is the periodontal ligament. The reaction of periodontal tissues associated with changes in the gingiva is a [...] Read more.
Background and Objectives: The key factor that enables osteoblastic activity and the formation of new bone, as well as gingiva, during orthodontic tooth extrusion (OE) is the periodontal ligament. The reaction of periodontal tissues associated with changes in the gingiva is a part of orthodontic tooth displacement. The aim of this study was to examine the effect of OE on the width of the zone of the keratinized and attached gingiva, the position of the mucogingival junction, and the height of the interdental papillae in the region where the OE was performed as well as in the adjacent region. Materials and Methods: This research included 28 adult patients (both orthodontically treated and untreated). The treated group included 15 patients, in whom orthodontic extrusion of the upper or lower frontal teeth was indicated and performed. The untreated group included 13 patients, with no previous or undergoing orthodontic treatment. Patients with periodontal disease and periodontal pockets in the frontal region and patients allergic to iodine were excluded from the study. Gingivomorphometric measurements were performed on two occasions in three groups of teeth (24 extruded and 30 agonist teeth in the treated patients; 66 teeth in the untreated patients). Statistical analysis of the obtained data was performed using the software package SPSS version 26.0. Results: Orthodontic extrusion induced changes in the position of the mucogingival line and an increase in the width of the keratinized gingiva. There were no statistically significant effects on the depth of the gingival sulcus, the attached gingiva width, or the height of the interdental papillae. Conclusions: Orthodontic tooth extrusion has an effect on the periodontium in the observed region. Vertical orthodontic force, directed towards the coronal plane, affects the surrounding soft oral tissues. Full article
(This article belongs to the Special Issue Advances in Clinical Periodontology)
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16 pages, 2558 KiB  
Systematic Review
Anti-TNF Alpha and Risk of Lymphoma in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis
by Ahmad A. Imam
Medicina 2024, 60(7), 1156; https://doi.org/10.3390/medicina60071156 (registering DOI) - 17 Jul 2024
Viewed by 245
Abstract
Background and Objectives: Anti-tumor necrosis factor-alpha (TNF-α) agents are effective in treating rheumatoid arthritis (RA) but may entail a risk of lymphoma due to TNF-α’s role in immune surveillance. This systematic review and meta-analysis assesses the risk of lymphoma in patients with RA [...] Read more.
Background and Objectives: Anti-tumor necrosis factor-alpha (TNF-α) agents are effective in treating rheumatoid arthritis (RA) but may entail a risk of lymphoma due to TNF-α’s role in immune surveillance. This systematic review and meta-analysis assesses the risk of lymphoma in patients with RA treated with anti-TNF agents versus patients treated with methotrexate and/or a placebo. Materials and Methods: The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Embase, PubMed, and Google Scholar were systematically searched for relevant literature. Data were extracted and analyzed to determine risk ratios (RRs) and 95% confidence intervals (CIs), with heterogeneity assessed using I2 statistics. Methodological quality and risk of bias were assessed using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and the Newcastle–Ottawa Scale for observational studies. Results: The search yielded 932 articles, 13 of which were retained for qualitative review and 12 for quantitative synthesis. Overall, the studies reviewed included 181,735 participants: 3772 from six RCTs and 177,963 from seven observational studies. The meta-analysis of RCTs revealed no significant difference in the risk of lymphoma between patients receiving anti-TNF-α therapy and patients on conventional treatments, with an overall RR of 1.43 (95% CI: 0.32–5.16) and I2 of 0%. Conversely, observational studies showed some variability, with an overall RR of 1.43 (95% CI: 0.59–3.47) and significant heterogeneity (I2 = 95%), whereas others indicated a potentially elevated risk of lymphoma in specific subgroups but had inconsistent results. Conclusions: The systematic and meta-analysis revealed no significant difference in the risk of lymphoma for patients with RA treated with anti-TNF-α agents versus conventional therapies. However, given the limitations of the studies included, additional research is needed to validate the results and explore potential risk factors contributing to the development of lymphoma in patients with RA. Full article
(This article belongs to the Section Oncology)
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16 pages, 912 KiB  
Article
Biomechanical Behavior of Injected Cement Spacers versus Traditional Cages in Low-Density Lumbar Spine under Compression Loading
by Tibor Csakany, Peter Varga, Boyko Gueorguiev, Eva Lakatos and Marta Kurutz
Medicina 2024, 60(7), 1155; https://doi.org/10.3390/medicina60071155 - 17 Jul 2024
Viewed by 239
Abstract
Background and Objectives: Osteoporosis renders the use of traditional interbody cages potentially dangerous given the high risk of damage in the bone–implant interface. Instead, injected cement spacers can be applied as interbody devices; however, this technique has been mainly used in cervical [...] Read more.
Background and Objectives: Osteoporosis renders the use of traditional interbody cages potentially dangerous given the high risk of damage in the bone–implant interface. Instead, injected cement spacers can be applied as interbody devices; however, this technique has been mainly used in cervical spine surgery. This study aimed at investigating the biomechanical behavior of cement spacers versus traditional cages in lumbar spine surgery. Materials and Methods: Destructive monotonic axial compression testing was performed on 20 human cadaveric low-density lumbar segments from elderly donors (14 f/6 m, 70.3 ± 12.0 y) treated with either injected cement spacers (n = 10) or traditional cages (n = 10) without posterior instrumentation. Stiffness, failure load and displacement were compared. The effects of bone density, vertebral geometry and spacer contact area were evaluated. Results: Cement spacers demonstrated higher stiffness, significantly smaller displacement (p < 0.001) and a similar failure load compared to traditional cages. In the cage group, stiffness and failure load depended strongly on bone density and vertebral height, whereas failure displacement depended on vertebral anterior height. No such correlations were identified with cement spacers. Conclusions: Cement spacers used in lumbar interbody stabilization provided similar compression strength, significantly smaller failure displacement and a stiffer construct than traditional cages that provided benefits mainly for large and strong vertebrae. Cement stabilization was less sensitive to density and could be more beneficial also for segments with smaller and less dense vertebrae. In contrast to the injection of cement spacers, the optimal insertion of cages into the irregular intervertebral space is challenging and risks damaging bone. Further studies are required to corroborate these findings and the treatment selection thresholds. Full article
(This article belongs to the Section Orthopedics)
9 pages, 3310 KiB  
Article
Long-Term Outcomes and a Radiological Assessment of Hydroxyapatite–Tricalcium Phosphate-Coated Total Hip Arthroplasty (Trilogy/Zimmer): A Long-Term Follow-Up Study
by Shinya Ibuchi, Norio Imai, Yoji Horigome, Yuki Hirano, Keishi Kimura and Hiroyuki Kawashima
Medicina 2024, 60(7), 1154; https://doi.org/10.3390/medicina60071154 - 17 Jul 2024
Viewed by 278
Abstract
Background and Objectives: Favorable short- and mid-term results for hydroxyapatite (HA)–tricalcium phosphate (TCP)-coated total hip arthroplasty (THA) (Trilogy/Zimmer) have been reported in the literature; however, the long-term results beyond 15 years have not been documented. Therefore, this study evaluated the long-term postoperative results, [...] Read more.
Background and Objectives: Favorable short- and mid-term results for hydroxyapatite (HA)–tricalcium phosphate (TCP)-coated total hip arthroplasty (THA) (Trilogy/Zimmer) have been reported in the literature; however, the long-term results beyond 15 years have not been documented. Therefore, this study evaluated the long-term postoperative results, radiological bone changes, and implant fixation of the acetabular component of HA-TCP-coated THA. Materials and Methods: This is a retrospective cohort study of 212 patients who underwent primary HA-TCP-coated THA (Trilogy/Zimmer) at our institution between 1 October 2002, and 31 March 2008; 166 who were available for follow-up at least 15 years postoperatively were included (capture rate: 78.3%). All implants were Trilogy/Zimmer. We investigated the survival rate, with aseptic loosening as the endpoint. Clinical evaluations included the presence of dislocation and a modified Harris Hip Score (mHHS) preoperatively and at the final observation. Results: The mean age at surgery and at the follow-up period were 57.7 ± 9.6 and 17.1 ± 1.5 years, respectively. The survival rate was 99.4% (165/166), with aseptic loosening as the endpoint. Dislocation was observed in 4/166 (2.4%) patients. The mHHS improved significantly from 46.1 points preoperatively to 82.2 points during the last survey (p < 0.05). The results revealed that fixation was favorable in all cases except for one case of aseptic loosening. The Trilogy implant coated with HA-TCP was highly effective in bone induction, and bone ingrowth was considered to have occurred without failure, further indicating its usefulness. The long-term results of cementless THA using an HA-TCP coating (Trilogy/Zimmer), with a mean follow-up period of 17.1 years, revealed a commendable survival rate of 99.4%, considering aseptic loosening as the endpoint. Conclusions: HA-TCP-coated THA (Trilogy/Zimmer) had good long-term results. However, further long-term observation is required in patients who have undergone this surgery, and the stem side should be evaluated and investigated, including comorbidities. Full article
(This article belongs to the Section Orthopedics)
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11 pages, 318 KiB  
Article
Retrospective Evaluation of Survival and Prognostic Factors in Immune Thrombocytopenia: A Single-Center and Cross-Sectional Study
by Gökhan Pektaş, İbrahim Asaf Uncu, Yelda Dere, Şeyma Öncü, Merve Becit Kızılkaya, Gökhan Sadi and Mehmet Bilgehan Pektaş
Medicina 2024, 60(7), 1153; https://doi.org/10.3390/medicina60071153 - 17 Jul 2024
Viewed by 253
Abstract
Background and Objectives: Immune thrombocytopenia (ITP) is an autoimmune disease characterized by the autoantibody-mediated destruction of platelets. The treatment of ITP aims to maintain a sufficient platelet count to prevent bleeding. First-line treatment options include corticosteroids and intravenous immunoglobulin (IVIg), while second-line treatments [...] Read more.
Background and Objectives: Immune thrombocytopenia (ITP) is an autoimmune disease characterized by the autoantibody-mediated destruction of platelets. The treatment of ITP aims to maintain a sufficient platelet count to prevent bleeding. First-line treatment options include corticosteroids and intravenous immunoglobulin (IVIg), while second-line treatments include splenectomy, rituximab and other immunosuppressive agents, and thrombopoietin (TPO) receptor agonists. This study aims to discuss the treatment methods and results from 100 patients with ITP at the Muğla Training and Research Hospital through a pharmacological approach. Materials and Methods: Demographic characteristics, clinical findings, bone marrow aspiration and biopsy results, and treatments and treatment responses at the time of diagnosis of the 100 patients with ITP who were treated and followed up in the period 2015–2023 were evaluated retrospectively. Results: In the third month after treatment, the overall response percentage was 100% in patients who received steroids only and 88% in patients who received IVIg treatment alone or in combination with steroids (p > 0.05). The most preferred second-line treatments were splenectomy (41%), eltrombopag (26%), and rituximab (10%). Bone marrow biopsy was performed in 54% of patients, where 35.1% showed increased megakaryocytes, 44.4% adequate megakaryocytes, and 14.8% decreased megakaryocytes. It is noted that eltrombopag and rituximab, in particular, yield higher complete remission rates than immunosuppressive drugs. Conclusions: Considering the side effects of immunosuppressive medications, IVIg, splenectomy, and steroid therapy, the use of new agents such as eltrombopag, which are easily tolerated and have a lower risk of side effects, is expected to increase. Full article
(This article belongs to the Section Hematology and Immunology)
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15 pages, 840 KiB  
Review
The Efficiency of Rehabilitation Therapy in Patients Diagnosed with Neurogenic Bladder: A Systematic Review
by Adina Ionelia Manaila, Nadinne Alexandra Roman, Ionut Cristian Cozmin Baseanu, Diana Minzatanu, Vlad Ionut Tuchel, Elena Bianca Basalic and Roxana Steliana Miclaus
Medicina 2024, 60(7), 1152; https://doi.org/10.3390/medicina60071152 - 17 Jul 2024
Viewed by 285
Abstract
Considerable research efforts have been directed towards investigating neurogenic bladder dysfunction over the preceding decade. This condition stands as the most prevalent and incapacitating pelvic floor disorder amidst patients afflicted with specific upper motor neuron syndromes, including multiple sclerosis, stroke, and spinal cord [...] Read more.
Considerable research efforts have been directed towards investigating neurogenic bladder dysfunction over the preceding decade. This condition stands as the most prevalent and incapacitating pelvic floor disorder amidst patients afflicted with specific upper motor neuron syndromes, including multiple sclerosis, stroke, and spinal cord injury. The current study aims to bring up-to-date findings on rehabilitation methods for treating neurogenic bladder. The Web of Science database (MEDLINE, PsychINFO, EMBASE, CENTRAL, ISRCTN, and ICTRP) was screened for randomized controlled studies and clinical studies using combinations of keywords including “neurogenic bladder”, “stroke”, “multiple sclerosis”, and “spinal cord injury”. The PEDro scale was used to assess the quality of the articles included in this study. After a thorough examination, eleven articles met the criteria for inclusion in our research. The outcome measures showed a variety of forms of electrostimulation that can be combined with or without PFMT. These interventions significantly enhance health-related quality of life, as evidenced by various assessment methods. The physical approach constitutes an effective therapeutic method that can reduce the severity of urinary incontinence. Full article
(This article belongs to the Section Urology & Nephrology)
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13 pages, 7493 KiB  
Article
Comparative Study of 1444 nm Laser Monotherapy versus Integrated Liposuction in the Treatment of Axillary Osmidrosis
by Jae Hoon Jeong and Chongsoo Park
Medicina 2024, 60(7), 1151; https://doi.org/10.3390/medicina60071151 - 17 Jul 2024
Viewed by 201
Abstract
Background and Objectives: The 1444 nm wavelength Neodymium:Yttrium–Aluminum–Garnet (Nd:YAG) laser treatment is an efficient method for treating axillary osmidrosis (AO); however, it has a relatively low treatment persistence. To address this issue, we performed integrated liposuction surgery with a laser to treat AO [...] Read more.
Background and Objectives: The 1444 nm wavelength Neodymium:Yttrium–Aluminum–Garnet (Nd:YAG) laser treatment is an efficient method for treating axillary osmidrosis (AO); however, it has a relatively low treatment persistence. To address this issue, we performed integrated liposuction surgery with a laser to treat AO and compared the results with those of a group treated only with a laser. Materials and Methods: This study compared the outcomes of AO treatment between the two groups up to six months postoperatively. The first group of 18 patients underwent laser treatment alone, and the second group of 12 patients underwent integrated liposuction surgery in addition to laser treatment. Outcomes were assessed using the following variables: degree of malodor (DOM), sweating area, patient satisfaction, pain levels, and complications, such as burns, swelling, and contractures. Results: Compared to the laser-only group, the integrated liposuction group demonstrated significantly superior outcomes in terms of DOM (p = 0.002) and patient satisfaction (p = 0.006), as well as a reduction in the sweating area (p = 0.012). The pain rating was higher in the liposuction group, but the difference was not statistically significant (p = 0.054). Compared with the patients in the integrated liposuction treatment group, those in the laser treatment group exhibited a significantly higher number of burns under the axillae (p = 0.025). However, no significant differences were observed in the swelling or contracture between the groups. Conclusions: Integrated liposuction with laser therapy significantly improved treatment outcomes, including malodor, patient satisfaction, sweat test results, and decreased complication rates. Full article
(This article belongs to the Section Surgery)
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15 pages, 3117 KiB  
Article
Relationship of Metabolic Dysfunction-Associated Steatohepatitis-Related Hepatocellular Carcinoma with Oral and Intestinal Microbiota: A Cross-Sectional Pilot Study
by Takaaki Matsui, Toshiya Morozumi, Yuko Yamamoto, Takashi Kobayashi, Ryo Takuma, Masato Yoneda, Asako Nogami, Takaomi Kessoku, Muneaki Tamura, Yoshiaki Nomura, Toru Takahashi, Yohei Kamata, Shuntaro Sugihara, Kyoko Arai, Masato Minabe, Norio Aoyama, Kenji Mitsudo, Atsushi Nakajima and Motohiro Komaki
Medicina 2024, 60(7), 1150; https://doi.org/10.3390/medicina60071150 - 17 Jul 2024
Viewed by 228
Abstract
Background and Objectives: The incidence of metabolic dysfunction-associated steatohepatitis (MASH)-related hepatocellular carcinoma (HCC) is increasing worldwide, alongside the epidemic of obesity and metabolic syndrome. Based on preliminary reports regarding the potential association of HCC and periodontitis, this study aimed to analyze the [...] Read more.
Background and Objectives: The incidence of metabolic dysfunction-associated steatohepatitis (MASH)-related hepatocellular carcinoma (HCC) is increasing worldwide, alongside the epidemic of obesity and metabolic syndrome. Based on preliminary reports regarding the potential association of HCC and periodontitis, this study aimed to analyze the involvement of periodontal bacteria as well as the oral and intestinal bacterial flora in MASH-related HCC (MASH-HCC). Materials and Methods: Forty-one patients with MASH and nineteen with MASH-HCC participated in the study, completing survey questionnaires, undergoing periodontal examinations, and providing samples of saliva, mouth-rinsed water, feces, and peripheral blood. The oral and fecal microbiome profiles were analyzed by 16S ribosomal RNA sequencing. Bayesian network analysis was used to analyze the causation between various factors, including MASH-HCC, examinations, and bacteria. Results: The genus Fusobacterium had a significantly higher occupancy rate (p = 0.002) in the intestinal microflora of the MASH-HCC group compared to the MASH group. However, Butyricicoccus (p = 0.022) and Roseburia (p < 0.05) had significantly lower occupancy rates. The Bayesian network analysis revealed the absence of periodontal pathogenic bacteria and enteric bacteria affecting HCC. However, HCC directly affected the periodontal bacterial species Porphyromonas gingivalis, Tannerella forsythia, Fusobacterium nucleatum, and Prevotella intermedia in the saliva, as well as the genera Lactobacillus, Roseburia, Fusobacterium, Prevotella, Clostridium, Ruminococcus, Trabulsiella, and SMB53 in the intestine. Furthermore, P. gingivalis in the oral cavity directly affected the genera Lactobacillus and Streptococcus in the intestine. Conclusions: MASH-HCC directly affects periodontal pathogenic and intestinal bacteria, and P. gingivalis may affect the intestinal bacteria associated with gastrointestinal cancer. Full article
(This article belongs to the Special Issue Boundaries between Oral and General Health)
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15 pages, 1042 KiB  
Article
Assessment of Motivations, Treatment Risks, and Oral Health in Adults with Fixed Orthodontic Care: A Cross-Sectional Study
by Antonija Tadin, Marija Badrov, Branimira Mikelic Vitasovic and Lidia Gavic
Medicina 2024, 60(7), 1149; https://doi.org/10.3390/medicina60071149 - 17 Jul 2024
Viewed by 208
Abstract
Aim: This cross-sectional study aims to investigate the reasons why adults seek orthodontic treatment, their perceived treatment risks, oral hygiene habits, and awareness of oral health. Materials and Methods: This study, which involved 246 adults, used a self-report questionnaire to collect sociodemographic data [...] Read more.
Aim: This cross-sectional study aims to investigate the reasons why adults seek orthodontic treatment, their perceived treatment risks, oral hygiene habits, and awareness of oral health. Materials and Methods: This study, which involved 246 adults, used a self-report questionnaire to collect sociodemographic data and examine the participants’ understanding of oral health, self-assessment of oral health status, adherence to oral hygiene routines, and use of oral hygiene products. In addition, the reasons for opting for orthodontic treatment, negative associations, and expected outcomes were examined. The collected data were subjected to statistical analysis, including descriptive and regression methods. Results: The results showed that factors such as previous oral health education and regular use of specialized toothbrushes, including rotary toothbrushes, were significantly associated with higher knowledge levels (p < 0.05). However, daily oral hygiene practices were suboptimal, with the low utilization of aids: only 58.9% reported using interdental brushes, and 36.6% used dental floss regularly. Commonly reported dental problems included food debris between teeth (46.3%), tartar (35.4%), and tooth sensitivity to cold (26.4%). The primary motivations for orthodontic treatment were aesthetic improvement (63.8%), enhancements in oral function (49.6%), and addressing psychosocial concerns (42.7%). In contrast, the most frequently mentioned negative aspects associated with fixed orthodontic treatment were aesthetic concerns (30.9%), treatment duration (27.6%), and mouth ulcers (24.0%). Conclusions: Based on the research findings, regular oral hygiene education is recommended for adult patients considering fixed orthodontic therapy, including the use of additional tools such as interdental brushes and floss to improve oral health and reduce the risk of complications during treatment. The importance of chemical compounds in dentifrices and mouthwashes cannot be overstated, as they play a crucial role in addressing various dental issues. In addition, it is crucial to carefully weigh the pros and cons of therapy and to visit a dentist regularly to maintain oral health and monitor progress during treatment. Full article
(This article belongs to the Section Dentistry and Oral Health)
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9 pages, 1149 KiB  
Article
Effects of Bosentan on Hypoxia, Inflammation and Oxidative Stress in Experimental Blunt Thoracic Trauma Model
by Nedim Uzun, Sinem Durmus, Gonca Gercel, Burhan Aksu, Naile Fevziye Misirlioglu and Hafize Uzun
Medicina 2024, 60(7), 1148; https://doi.org/10.3390/medicina60071148 - 17 Jul 2024
Viewed by 230
Abstract
Background and Objectives: In this study, we aimed to investigate the effects of bosentan, an endothelin receptor antagonist, on endothelin-1 (ET-1), hypoxia-inducible factor-1 (HIF-1), nuclear factor-kappa B (NF-κB), and tumor necrosis factor (TNF)-α as inflammation markers, pro-oxidant antioxidant balance (PAB), and total antioxidant [...] Read more.
Background and Objectives: In this study, we aimed to investigate the effects of bosentan, an endothelin receptor antagonist, on endothelin-1 (ET-1), hypoxia-inducible factor-1 (HIF-1), nuclear factor-kappa B (NF-κB), and tumor necrosis factor (TNF)-α as inflammation markers, pro-oxidant antioxidant balance (PAB), and total antioxidant capacity (TAC) levels as oxidative stress parameters in lung tissues of rats in an experimental model of pulmonary contusion (PC) induced by blunt thoracic trauma. Materials and Methods: Thirty-seven male Sprague-Dawley rats were divided into five groups. C: The control group (n = 6) consisted of unprocessed and untreated rats. PC3 (n = 8) underwent 3 days of PC. PC-B3 (n = 8) received 100 mg/kg bosentan and was given orally once a day for 3 days. The PC7 group (n = 7) underwent 7 days of PC, and PC-B7 (n = 8) received 100 mg/kg bosentan and was given orally once a day for 7 days. Results: ET-1, NF-κB, TNF-α, HIF-1α, and PAB levels were higher, while TAC activity was lower in all groups compared with the control (p < 0.05). There was no significant difference in ET-1 and TNF-α levels between the PC-B3 and PC-B7 groups and the control group (p < 0.05), while NF-κB, HIF-1α, and PAB levels were still higher in both the PC-B3 and PC-B7 groups than in the control group. Bosentan decreased ET-1, NF-κB, TNF-α, HIF-1α, and PAB and increased TAC levels in comparison to the nontreated groups (p < 0.05). Conclusions: Bosentan decreased the severity of oxidative stress in the lungs and reduced the inflammatory reaction in rats with PC induced by blunt thoracic trauma. This suggests that bosentan may have protective effects on lung injury mechanisms by reducing hypoxia, inflammation, and oxidative stress. If supported by similar studies, bosentan can be used in both pulmonary and emergency clinics to reduce ischemic complications, inflammation, and oxidative stress in some diseases that may be accompanied by ischemia. Full article
(This article belongs to the Section Emergency Medicine)
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9 pages, 2059 KiB  
Case Report
Extremely Rare Case of Successful Treatment of Foot Ulcer Associated with Evans’ Syndrome and Buerger’s Disease
by Ha-Jong Nam, Se-Young Kim, Je-Yeon Byeon and Hwan-Jun Choi
Medicina 2024, 60(7), 1147; https://doi.org/10.3390/medicina60071147 - 16 Jul 2024
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Abstract
Evans Syndrome (ES) is a rare autoimmune disorder characterized by the simultaneous occurrence of immune thrombocytopenia (ITP) and autoimmune hemolytic anemia (AIHA). Thrombotic complications in ES patients are uncommon, particularly involving Buerger’s Disease (BD). We report a case of a 49-year-old male with [...] Read more.
Evans Syndrome (ES) is a rare autoimmune disorder characterized by the simultaneous occurrence of immune thrombocytopenia (ITP) and autoimmune hemolytic anemia (AIHA). Thrombotic complications in ES patients are uncommon, particularly involving Buerger’s Disease (BD). We report a case of a 49-year-old male with ES and a history of diabetes and heavy smoking, presenting with a necrotic wound on his right great toe. Diagnostic evaluations revealed severe stenosis and thrombosis in the lower limb arteries, diagnosed as BD. The patient underwent successful popliteal–tibioperoneal artery bypass surgery and the subsequent disarticulation and revision of the distal phalanx, followed by the application of an acellular dermal matrix (ADM) to promote healing. Post-surgery, the patient showed significant improvement in blood flow and complete epithelialization without complications. This case highlights the importance of a multidisciplinary approach to managing complex wounds in ES patients, suggesting potential treatment pathways for future cases involving BD. Full article
(This article belongs to the Section Surgery)
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