Medicina

17 pages, 9133 KiB

Open AccessArticle

FICTION Technique—A Candidate for the Assessment of HER2 Status in Breast Invasive Carcinomas

by Bogdan Fetica, Mihaiela Luminita Blaga, Adrian Pavel Trifa, Cosmina Maria Bocean, Ovidiu Balacescu, Annamaria Fulop and Bogdan Pop

Medicina 2025, 61(6), 1069; https://doi.org/10.3390/medicina61061069 (registering DOI) - 11 Jun 2025

Abstract

Background and Objectives: The assessment of HER2 status in invasive breast carcinomas (IBCs) is critical for determining treatment strategies. The aim of this study was to evaluate the FICTION technique as a potential method for assessing HER2 status and to compare it [...] Read more.

Background and Objectives: The assessment of HER2 status in invasive breast carcinomas (IBCs) is critical for determining treatment strategies. The aim of this study was to evaluate the FICTION technique as a potential method for assessing HER2 status and to compare it with the standard sequential immunohistochemistry (IHC)–in situ hybridization (ISH) assays. Materials and Methods: This study included 49 patients diagnosed with invasive breast carcinomas. HER2 status was assessed using both IHC+FISH and FICTION techniques, and the results were compared. Results: Comparative analysis demonstrated an 83.67% categorical agreement between IHC and IF using the ASCO/CAP system. The percentage of cells showing any degree of HER2 protein expression was higher with IF (73.77%) than with IHC (60.71%) (p = 0.00026). The in situ hybridization assays showed an excellent agreement, with a 90% or higher concordance. The concordance of the ASCO/CAP group classification of cases using both ISH assays (FICTION and standard FISH) was high (85, 7%). Agreement was 100% for the final classification of cases (Her2 positive/negative). Conclusions: We compared standard tests for Her2 protein expression and the gene copy number with a modified FICTION protocol. The study showed moderate agreement between IHC and IF for Her2 protein and excellent agreement between FISH and FICTION ISH for the gene copy number. Final Her2 status was unaffected by low IF IHC concordance. Optimizing the FICTION protocol could improve results. Combining protein and gene assays may enhance IBC patient stratification. Full article

(This article belongs to the Special Issue Advances in Cancer Therapy from Research to Clinical Practice—Surgical, Molecular or Systemic Management of Cancer: 2nd Edition)

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21 pages, 2969 KiB

Open AccessSystematic Review

Value of Probiotics on Outcome in Patients Following Liver Surgery: A Systematic Review and Meta-Analysis

by Robert Karitnig, Andreas Bogner, Nora Jahn, Christos Vlachos, Andri Lederer, Antonia Geisler, Robert Sucher and Hans Michael Hau

Medicina 2025, 61(6), 1068; https://doi.org/10.3390/medicina61061068 (registering DOI) - 10 Jun 2025

Abstract

Background and Objectives: The gut–liver axis plays a crucial role in the development of post-surgical infections. Surgery-induced dysbiosis can lead to increased bacterial translocation, impairing the liver’s detoxification capacity and negatively affecting surgical outcomes. Following liver surgery, approximately a third of the patients [...] Read more.

Background and Objectives: The gut–liver axis plays a crucial role in the development of post-surgical infections. Surgery-induced dysbiosis can lead to increased bacterial translocation, impairing the liver’s detoxification capacity and negatively affecting surgical outcomes. Following liver surgery, approximately a third of the patients develop bacterial infections, with a high risk of bacteremia or even sepsis-related liver failure and death. The potential advantages of administering pro- or synbiotics before/after surgery remain a topic of discussion. Therefore, a systematic review of randomized clinical trials comparing patients with and without supplementation and their outcomes and effects after liver resection (LR) or liver transplantation (LT) was conducted. Materials and Methods: A computer-based search of electronic databases was conducted to gather randomized controlled trials (RCTs) that focused on probiotic/synbiotic use during the perioperative period for liver surgery patients. Two researchers independently screened the studies, extracted the data, evaluated the risk of bias, and performed a meta-analysis using RevMan Web. Results: Our research revealed 19 relevant randomized controlled studies that included a total of 1698 patients on the perioperative use of pro-/symbiotic administration in liver surgery. Eight studies were performed on liver transplantation (LT), and 11 studies were performed for liver resection (LR). The results of the meta-analysis demonstrated that the probiotic group exhibited lower rates of postoperative infectious complications (OR = 0.34; 95%CI 0.25 to 0.45; p < 0.0001), hospital stay duration (SMD = −0.13; 95%CI −0.25 to −0.00; p = 0.05), lower serum endotoxin levels (SMD = −0.39%CI −0.59 to −19; p < 0.0001), and white blood cell counts (SMD = −SMD = −0.35; 95%CI −0.56 to −0.13; p = 0.002) compared to the control group. Further, with regard to liver function, we observed significant postoperative differences in alanine aminotransferase (ALT)-levels (SMD = −0.46; 95%CI −0.63 to −0.29; p < 0.0001), aspartate aminotransferase (AST) levels (SMD = −0.53; 95%CI −0.71 to −0.34; p < 0.0001), bilirubin levels (SMD = −0.35; 95%CI −0.50 to −0.19; p < 0.0001), and international ratio (INR) levels (SMD = −0.1; 95%CI −0.12 to −0.08; p ≤ 0.0001), favoring the symbiotic group compared to the control group. Conclusions: The use of pro-/synbiotics during the perioperative period reduces the risk of postoperative infections, support postoperative liver function, and recovery and shortens hospital stays for liver surgery patients. However, they do not appear to particularly aid in inflammation reduction. Full article

(This article belongs to the Special Issue Advances in Pathogenesis and Treatment of Chronic Liver Disease)

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13 pages, 1460 KiB

Open AccessSystematic Review

Dyslipidemia in Myasthenia Gravis: A Systematic Review and Meta-Analysis

by Vasileios Giannopapas, Vassiliki Smyrni, Georgia Papagiannopoulou, Stavroula Salakou, Dimitrios K. Kitsos, Ilianna Bethani, Christina Zompola, John S. Tzartos, Georgios Tsivgoulis, Sotirios Giannopoulos and Maria Kosmidou

Medicina 2025, 61(6), 1067; https://doi.org/10.3390/medicina61061067 - 10 Jun 2025

Abstract

Background and Objectives: Myasthenia Gravis (MG) comprises an autoimmune disorder marked by muscle weakness and fatigue. MG has been associated with comorbid conditions, including dyslipidemia (DL), which may exacerbate the clinical burden of MG and impact the overall quality of life. Materials and [...] Read more.

Background and Objectives: Myasthenia Gravis (MG) comprises an autoimmune disorder marked by muscle weakness and fatigue. MG has been associated with comorbid conditions, including dyslipidemia (DL), which may exacerbate the clinical burden of MG and impact the overall quality of life. Materials and Methods: This systematic review and meta-analysis aimed to assess the prevalence of DL in patients with MG. Following PRISMA guidelines, a comprehensive search was conducted in the MEDLINE, Scopus, and Google Scholar databases. Primary outcomes included the pooled prevalence of DL in MG patients, and the relative risk of DL compared to healthy controls. Results: Nineteen studies involving 98,947 MG patients were analyzed. The pooled prevalence of DL was 23.64% (95% CI: 17.01–30.98). The relative risk of DL in MG patients versus controls was 1.13 (95% CI: 0.53–2.41), indicating no significant increase. Meta-regression revealed a positive correlation between DL prevalence and MG onset age (β = 0.02, p < 0.001), with a 2% rise in DL prevalence per 1-year increase in onset age. Regional subgroup analysis showed a statistical trend of higher DL prevalence in the USA (33.02%) compared to Asia (19.89%) and Europe (17.5%). Conclusions: This study found that approximately one in four MG patients has comorbid DL, with MG onset age significantly influencing DL prevalence. These findings highlight the need for personalized management strategies and evaluations (e.g., statins, LP(a) levels). Further research is warranted to elucidate the pathophysiological links between MG and DL. Full article

(This article belongs to the Section Neurology)

30 pages, 1869 KiB

Open AccessReview

Clinical Applications of Artificial Intelligence in Periodontology: A Scoping Review

by Georgios S. Chatzopoulos, Vasiliki P. Koidou, Lazaros Tsalikis and Eleftherios G. Kaklamanos

Medicina 2025, 61(6), 1066; https://doi.org/10.3390/medicina61061066 - 10 Jun 2025

Abstract

Background and Objectives: This scoping review aimed to identify and synthesize current evidence on the clinical applications of artificial intelligence (AI) in periodontology, focusing on its potential to improve diagnosis, treatment planning, and patient care. Materials and Methods: A comprehensive literature [...] Read more.

Background and Objectives: This scoping review aimed to identify and synthesize current evidence on the clinical applications of artificial intelligence (AI) in periodontology, focusing on its potential to improve diagnosis, treatment planning, and patient care. Materials and Methods: A comprehensive literature search was conducted using electronic databases including PubMed-MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Web of Science™ Core Collection. Studies were included if they met predefined PICO criteria relating to AI applications in periodontology. Due to the heterogeneity of study designs, imaging modalities, and outcome measures, a scoping review approach was employed rather than a systematic review. Results: A total of 6394 articles were initially identified and screened. The review revealed a significant interest in utilizing AI, particularly convolutional neural networks (CNNs), for various periodontal applications. Studies demonstrated the potential of AI models to accurately detect and classify alveolar bone loss, intrabony defects, furcation involvements, gingivitis, dental biofilm, and calculus from dental radiographs and intraoral images. AI systems often achieved diagnostic accuracy, sensitivity, and specificity comparable to or exceeding that of dental professionals. Various CNN architectures and methodologies, including ensemble models and task-specific designs, showed promise in enhancing periodontal disease assessment and management. Conclusions: AI, especially deep learning techniques, holds considerable potential to revolutionize periodontology by improving the accuracy and efficiency of diagnostic and treatment planning processes. While challenges remain, including the need for further research with larger and more diverse datasets, the reviewed evidence supports the integration of AI technologies into dental practice to aid clinicians and ultimately improve patient outcomes. Full article

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

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15 pages, 626 KiB

Open AccessArticle

Prevalence and Fall Risk of Sarcopenia Based on the 2023 Korean Working Group on Sarcopenia Criteria

by Minjung Kim, Seongmin Choi, Dong Hwan Yun, Yunsoo Soh and Chang Won Won

Medicina 2025, 61(6), 1065; https://doi.org/10.3390/medicina61061065 - 10 Jun 2025

Abstract

Background and Objectives: Sarcopenia is a major risk factor for falls in older adults. The 2023 Korean Working Group on Sarcopenia (KWGS) introduced revised definitions, including functional sarcopenia, which considers low strength and performance despite normal muscle mass. This study investigated the [...] Read more.

Background and Objectives: Sarcopenia is a major risk factor for falls in older adults. The 2023 Korean Working Group on Sarcopenia (KWGS) introduced revised definitions, including functional sarcopenia, which considers low strength and performance despite normal muscle mass. This study investigated the prevalence of sarcopenia, severe sarcopenia, and functional sarcopenia using the KWGS criteria and their association with fall risk by sex and fall frequency. Materials and Methods: A cross-sectional analysis was conducted using data from 2061 community-dwelling Korean adults aged 70–84 years who participated in the Korean Frailty and Aging cohort study. Sarcopenia was classified based on muscle mass, grip strength, and four physical performance tests. Fall experiences in the past year were categorized as ≥1, ≥2, and ≥4 falls. Logistic regression analyses were performed separately according to sex to evaluate the association between sarcopenia definition and fall risk. Results: The prevalence of sarcopenia and severe sarcopenia was 32.9% and 10.1% in men and 21.5% and 5.0% in women, respectively. Functional sarcopenia was more prevalent in women (10.5%) than in men (5.1%). In men, sarcopenia (defined using gait speed) was associated with fall risk across all thresholds (odds ratio [OR] = 2.28 for ≥1 fall; OR = 5.64 for ≥4 falls). In women, sarcopenia (defined using gait speed) was associated with ≥1 fall (OR = 1.72), while functional sarcopenia (defined using gait speed and timed up-and-go test) was associated with frequent falls (OR = 3.79–3.87). Conclusions: The 2023 KWGS guidelines revealed sex-specific differences in the prevalence of sarcopenia and highlighted gait speed as a key predictor of fall risk in men, whereas functional sarcopenia was more prevalent in women. Limitations include the cross-sectional design and use of self-reported fall data, which may be subject to recall bias. Full article

(This article belongs to the Section Neurology)

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12 pages, 924 KiB

Open AccessArticle

Association Between Cardiometabolic Index and Mortality Among Patients with Atherosclerotic Cardiovascular Disease: Evidence from NHANES 1999–2018

by Duo Yang, Wei Li, Wei Luo, Yunxiao Yang, Jiayi Yi, Chen Li, Hai Gao and Xuedong Zhao

Medicina 2025, 61(6), 1064; https://doi.org/10.3390/medicina61061064 - 10 Jun 2025

Abstract

Background and Objectives: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of global morbidity and mortality. The cardiometabolic index (CMI) has been shown to be associated with metabolic disorders and mortality in general populations, but its role in ASCVD-specific mortality risk remains unexplored. [...] Read more.

Background and Objectives: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of global morbidity and mortality. The cardiometabolic index (CMI) has been shown to be associated with metabolic disorders and mortality in general populations, but its role in ASCVD-specific mortality risk remains unexplored. Materials and Methods: This cohort study was based on the National Health and Nutrition Examination Survey (NHANES). Weighted Cox proportional hazards models were fitted to estimate the associations between CMI and mortality. Restricted cubic splines were used to explore nonlinear relationships. Subgroup analyses were used to investigate potential differences among specific ASCVD patients. Results: A total of 2157 patients with ASCVD were included. Over a median 83-month follow-up, 887 all-cause and 300 cardiovascular deaths occurred. Each unit increase in CMI was associated with an 11.3% increased risk of all-cause mortality (HR = 1.113, 95% CI: 1.112–1.115) and a 6.4% increased risk of cardiovascular mortality (HR = 1.064, 95% CI: 1.062–1.065). There was a nonlinear J-shaped relationship between CMI and all-cause mortality, while the risk of cardiovascular mortality increased linearly with increasing CMI. Conclusions: These findings underscore the importance of monitoring and managing CMI in patients with ASCVD in clinical practice and suggest that optimizing CMI levels may help reduce the risk of death and improve the long-term prognosis of patients. Full article

(This article belongs to the Section Cardiology)

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11 pages, 559 KiB

Open AccessReview

Evolving Treatment Strategies for Neuropathic Pain: A Narrative Review

by Alan D. Kaye, Grace Armistead, Lane S. Amedio, Mills E. Manthei, Shahab Ahmadzadeh, Brian Bernhardt and Sahar Shekoohi

Medicina 2025, 61(6), 1063; https://doi.org/10.3390/medicina61061063 - 10 Jun 2025

Abstract

Neuropathic pain resulting from injury to the somatosensory nervous system affects approximately 6.9–10% of the general population and significantly impacts quality of life. Common presentations include burning, stabbing, tingling, or electrical sensations, occurring spontaneously or through hyperalgesia or allodynia. Treatment approaches follow a [...] Read more.

Neuropathic pain resulting from injury to the somatosensory nervous system affects approximately 6.9–10% of the general population and significantly impacts quality of life. Common presentations include burning, stabbing, tingling, or electrical sensations, occurring spontaneously or through hyperalgesia or allodynia. Treatment approaches follow a tiered system. First-line therapies include gabapentinoids (e.g., gabapentin, pregabalin), which target voltage-gated calcium channels; tricyclic antidepressants (e.g., amitriptyline, nortriptyline); and serotonin-norepinephrine reuptake inhibitors such as duloxetine. Second-line options encompass topical agents (e.g., 5% lidocaine, 8% capsaicin), opioid-like medications (e.g., tramadol, tapentadol), and adjunctive therapies including psychological therapies and lifestyle interventions. For refractory cases, third-line treatments include NMDA receptor antagonists (e.g., ketamine, dextromethorphan), cannabinoids, and botulinum toxin type A, though these have more limited clinical evidence. Procedural interventions such as spinal cord stimulation and transcutaneous electrical nerve stimulation provide alternatives when pharmacological approaches fail. Despite advances in treatment options, many patients remain undertreated, highlighting the need for individualized, multimodal approaches and continued research into the complex pathophysiology of neuropathic pain conditions. Full article

(This article belongs to the Section Neurology)

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15 pages, 1602 KiB

Open AccessArticle

A Nomogram to Predict Cancer-Specific Survival of Transitional Cell Carcinoma of Ureter After Surgery

by Der-Shin Ke and Chao-Yu Hsu

Medicina 2025, 61(6), 1062; https://doi.org/10.3390/medicina61061062 - 9 Jun 2025

Abstract

Background and Objectives: Due to the rare focus on ureteral cancer survival analyses, this study investigates post-surgery cancer-specific survival (CSS) rates, along with prognostic factors affecting these outcomes. It aims to enhance understanding of disease progression and determinants of patient survival and [...] Read more.

Background and Objectives: Due to the rare focus on ureteral cancer survival analyses, this study investigates post-surgery cancer-specific survival (CSS) rates, along with prognostic factors affecting these outcomes. It aims to enhance understanding of disease progression and determinants of patient survival and develop a nomogram for reference. Materials and Methods: This research undertook a retrospective analysis of ureteral cancer patients who received surgical intervention from 2010 to 2017, utilizing data from the Surveillance, Epidemiology, and End Results database. The primary endpoint was survival, with 1-, 3-, and 5-year CSS rates calculated using the Kaplan–Meier method. Initial univariate Cox proportional hazards analyses identified factors impacting survival, with those yielding a p-value under 0.05 progressing to multivariate Cox regression analysis to ascertain significant prognostic indicators. Results: The investigation encompassed 2277 patients diagnosed with ureteral cancer. CSS rates at 1, 3, and 5 years post-surgery were observed at 88.2%, 68.1%, and 60.3%, respectively. Multivariate analyses identified age, staging of tumor, node and metastasis, and the application of radiotherapy as significant prognostic indicators for CSS. Based on these factors, a post-surgical nomogram for CSS was developed. Conclusions: The survival outcomes for ureteral cancer are not yet satisfactory. Age and stage emerge as pivotal prognostic elements, significantly impacting CSS following surgery. Recognizing these factors is essential for clinicians, as they offer critical insights that inform treatment strategies and patient management. Full article

(This article belongs to the Section Urology & Nephrology)

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17 pages, 786 KiB

Open AccessArticle

Obesity in Italy: An Empirical Analysis of Healthcare Consumption, Quality of Life and Comorbidities

by Elenka Brenna and Claudio Jommi

Medicina 2025, 61(6), 1061; https://doi.org/10.3390/medicina61061061 - 9 Jun 2025

Abstract

Background and Objectives: Obesity is a health condition that significantly augments the risk of several chronic diseases and is a major public health concern. In Italy, this phenomenon has highly increased in the last few decades, raising alarm about both NHS sustainability [...] Read more.

Background and Objectives: Obesity is a health condition that significantly augments the risk of several chronic diseases and is a major public health concern. In Italy, this phenomenon has highly increased in the last few decades, raising alarm about both NHS sustainability and population health. We investigate whether and to what extent obesity impacts three different categories of outcomes, namely healthcare consumption, quality of life and the presence of relevant comorbidities. Materials and Methods: We use data from the European Health Interview Survey, 2019, a micro dataset that displays more than 45,000 observations, providing detailed information on the health status and healthcare access, demographics and socioeconomic characteristics among Italian individuals aged 15 and over. We first provide a descriptive analysis of the socioeconomic gradient of obesity, and then we implement propensity score matching to detect the effects of this condition on healthcare use, quality of life and comorbidities. To the best of our knowledge, this is the first empirical paper to jointly consider the healthcare consumption, declared comorbidities and quality of life of Italian obese individuals. Results: The findings show that obese individuals consume more health services, have a lower quality of life and present a higher rate of comorbidities compared to non-obese individuals with the same observable characteristics. We also find that obesity is rooted in socioeconomic drivers, with richer and more educated individuals being less likely to present with this condition. Conclusions: The findings call for policy measures aimed at monitoring and contrasting the rising phenomenon of obesity in Italy, with a tailored approach across socioeconomic groups. Full article

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

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15 pages, 568 KiB

Open AccessArticle

Resistance Rates of Mycobacterium tuberculosis Complex Strains: A Retrospective Study in Türkiye

by Melda Payaslıoğlu, İmran Sağlık and Cüneyt Özakın

Medicina 2025, 61(6), 1060; https://doi.org/10.3390/medicina61061060 - 9 Jun 2025

Abstract

Background and Objectives: Tuberculosis (TB) is one of the most common infectious diseases in developing countries. The resistance of the causative agent, Mycobacterium tuberculosis, to two or more first-line anti-TB drugs results in multidrug-resistant (MDR) TB, posing a serious challenge to [...] Read more.

Background and Objectives: Tuberculosis (TB) is one of the most common infectious diseases in developing countries. The resistance of the causative agent, Mycobacterium tuberculosis, to two or more first-line anti-TB drugs results in multidrug-resistant (MDR) TB, posing a serious challenge to the control of TB worldwide. This study was designed to determine the changes in drug resistance over time in TB strains isolated from patients in all departments of Uludağ University Hospital in western Türkiye. Materials and Methods: We retrospectively analyzed 104,598 clinical samples sent to our laboratory for the investigation of the presence of TB between 1996 and 2023. BACTEC 460 TB, BACTEC MGIT 960 culture systems and Löwenstein–Jensen medium were used for the culture of these samples. The susceptibility of M. tuberculosis complex strains grown in culture to isoniazid (INH) (0.1 μg/mL), rifampicin (RIF) (1.0 μg/mL), ethambutol (ETB) (5.0 μg/mL) and streptomycin (SM) (1.0 μg/mL) antibiotics was studied according to the manufacturer’s recommendation. Results: Out of 104,598 patient samples, 2752 (2.6%) were culture-positive, and the susceptibility test results of 1869 of these were analyzed. Of the isolates, 358 (19.2%) were found to be resistant to at least one first-line drug, i.e., INH, RIF, ETB, or SM. In addition, 2.9% were resistant to two or more first-line drugs. Conclusions: Drug susceptibility testing is essential to ensure the optimal treatment and control of drug-resistant TB strains. This study highlights the value of ongoing efforts to control tuberculosis drug resistance in the fight against this disease. Full article

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

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28 pages, 1597 KiB

Open AccessReview

Bio-Adrenomedullin and Dipeptidyl Peptidase 3 as Novel Sepsis Biomarkers in the Emergency Department and the Intensive Care Unit: A Narrative Review

by Ioannis Ventoulis, Christos Verras, Dionysis Matsiras, Vasiliki Bistola, Sofia Bezati, John Parissis and Effie Polyzogopoulou

Medicina 2025, 61(6), 1059; https://doi.org/10.3390/medicina61061059 - 9 Jun 2025

Abstract

Early recognition and timely treatment of sepsis and septic shock is vital. Despite appropriate management, mortality and morbidity rates remain high. In recent years, many of the research efforts have been directed towards finding novel biomarkers that would rapidly identify, classify and risk-stratify [...] Read more.

Early recognition and timely treatment of sepsis and septic shock is vital. Despite appropriate management, mortality and morbidity rates remain high. In recent years, many of the research efforts have been directed towards finding novel biomarkers that would rapidly identify, classify and risk-stratify the severity of sepsis in order to achieve prompt and targeted treatment of patients with sepsis and septic shock. Among these biomarkers, adrenomedullin (ADM) in the form of the biologically active fragment (bio-ADM) and dipeptidyl peptidase 3 (DPP3) have recently been in the spotlight. The aim of this narrative review is to summarize current evidence on these two novel biomarkers regarding their clinical utility in diagnosis, prognosis, treatment monitoring and therapy guidance of sepsis and septic shock in the emergency department (ED) and in the intensive care unit (ICU) setting. Bio-ADM seems to be a promising biomarker with respect to the overall management of sepsis (diagnosis, severity prediction, prognosis and treatment monitoring and guidance). On the other hand, DPP3 appears to be useful mainly for sepsis prognosis and for predicting sepsis-induced acute kidney injury. Given their potential clinical utility in sepsis management, the use of these two novel biomarkers, in conjunction with established biomarkers and clinical scores, could lead to the application of refined integrated protocols in the ED and the ICU, which could promptly and effectively inform clinical decision-making in patients presenting with sepsis or septic shock. Full article

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

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13 pages, 605 KiB

Open AccessArticle

Predictors of Methotrexate Success and Fertility Outcomes in Tubal Ectopic Pregnancy: A Retrospective Cohort Study

by Elisa Scarpelli, Vito Andrea Capozzi, Licia Roberto, Asya Gallinelli, Alessandra Pezzani, Michela Monica and Roberto Berretta

Medicina 2025, 61(6), 1058; https://doi.org/10.3390/medicina61061058 - 9 Jun 2025

Abstract

Background and Objectives: Ectopic pregnancy (EP) is a potentially life-threatening condition and the leading cause of maternal mortality in the first trimester. Although both surgical and medical approaches are effective, selection criteria for Methotrexate (MTX) treatment remain inconsistent across international guidelines. Additionally, [...] Read more.

Background and Objectives: Ectopic pregnancy (EP) is a potentially life-threatening condition and the leading cause of maternal mortality in the first trimester. Although both surgical and medical approaches are effective, selection criteria for Methotrexate (MTX) treatment remain inconsistent across international guidelines. Additionally, limited data on long-term reproductive outcomes are available. Materials and Methods: We conducted a single-center retrospective cohort study of 107 patients diagnosed with tubal EP and treated at the Obstetrics and Gynecology Unit of the University Hospital of Parma between 2019 and 2023. MTX (50 mg/m²) was offered to patients with β-hCG < 5000 mIU/mL, sac diameter < 40 mm, and no embryonic cardiac activity or hemoperitoneum; others underwent salpingectomy. Treatment outcomes, predictors of MTX success, and fertility outcomes were analyzed. Results: Medical treatment was offered to 36 patients (33.6%), with an overall success rate of 72%: in total, 20 resolved after a single dose and 6 after a second dose. Surgical conversion was necessary in 10 patients. The remaining 71 patients (66.4%) underwent primary salpingectomy. Initial β-hCG levels and gestational age did not significantly predict MTX failure (p 0.14 and 0.73, respectively), whereas gestational sac diameter was identified as a reliable predictor of treatment success (p = 0.01). In particular, a gestational sac maximum diameter of <2 cm emerged as a positive factor for MTX success (OR 1.13, 95% CI: 1.1–1.3, p = 0.04). Among the 50 patients with follow-up data, 68% achieved a term live birth, with no significant difference between the MTX (52.9%) and surgical (75.8%) groups (p 0.12). Most of the pregnancies (90%) occurred spontaneously, while only 10% required assisted reproductive technologies. Conclusions: MTX is a safe and effective treatment for tubal EP when patients are appropriately selected. Gestational sac diameter appears to be a reliable predictor of success. Both medical and surgical treatments yielded comparable reproductive outcomes, supporting individualized care models that prioritize fertility preservation. Full article

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

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3 pages, 220 KiB

Open AccessEditorial

Editorial for Special Issue “Diagnosis and Treatment of Cervical Cancer”

by Giorgia Perniola and Tullio Golia D’Augè

Medicina 2025, 61(6), 1057; https://doi.org/10.3390/medicina61061057 - 9 Jun 2025

Abstract

Cervical cancer remains one of the most significant gynecologic malignancies worldwide, particularly impacting women in their reproductive years [...] Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Cervical Cancer)

14 pages, 2937 KiB

Open AccessReview

Use of JAK Inhibitors in Lichen Planus: An Update

by Dario Didona, Raffaele Dante Caposiena Caro, Laura Calabrese, Martina D’Onghia, Giulia Galluccio, Matteo Riccardo Di Nicola, Alessandra Rallo and Giovanni Paolino

Medicina 2025, 61(6), 1056; https://doi.org/10.3390/medicina61061056 - 8 Jun 2025

Viewed by 130

Abstract

Lichen planus (LP) is a chronic inflammatory disorder affecting approximately 1% of the population. It presents with a wide range of clinical manifestations, mainly involving the skin, mucosal surfaces, and skin appendages, and is often characterized by a relapsing course and variable response [...] Read more.

Lichen planus (LP) is a chronic inflammatory disorder affecting approximately 1% of the population. It presents with a wide range of clinical manifestations, mainly involving the skin, mucosal surfaces, and skin appendages, and is often characterized by a relapsing course and variable response to treatment. Although several therapeutic strategies are available, many are off-label and show limited efficacy in resistant forms. Increasing evidence points to the central role of the JAK/STAT signaling pathway in the immunopathogenesis of LP, with cytokines such as interferon-gamma and interleukin-21 playing key roles in sustaining chronic inflammation. Based on this rationale, Janus kinase (JAK) inhibitors have recently been proposed as potential therapeutic agents in LP. This review explores the biological basis for their use and systematically summarizes the existing clinical evidence on the use of JAK inhibitors in cutaneous, mucosal, appendageal, and nail variants of LP. The preliminary data suggests favorable outcomes in many patients with difficult-to-treat disease, with an acceptable safety profile. Further prospective trials are needed to establish their definitive role in the management of LP. Full article

(This article belongs to the Special Issue Chronic Inflammatory Skin Diseases: Where We Are and Where We Are Going: 2nd Edition)

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23 pages, 496 KiB

Open AccessSystematic Review

The Psychological and Physical Benefits of Progressive Muscle Relaxation in Chronic Respiratory Diseases: A Systematic Review

by Adelina Maritescu, Alexandru Florian Crisan, Camelia Corina Pescaru, Cristian Oancea and Daniela Iacob

Medicina 2025, 61(6), 1055; https://doi.org/10.3390/medicina61061055 - 7 Jun 2025

Viewed by 158

Abstract

Background and Objectives: Chronic respiratory diseases, such as COPD, cystic fibrosis, and post-COVID-19, are frequently accompanied by psychological distress and physical impairment. As a non-pharmacological intervention, progressive muscle relaxation (PMR) may benefit these patients psychologically and physiologically. This systematic review aimed to evaluate [...] Read more.

Background and Objectives: Chronic respiratory diseases, such as COPD, cystic fibrosis, and post-COVID-19, are frequently accompanied by psychological distress and physical impairment. As a non-pharmacological intervention, progressive muscle relaxation (PMR) may benefit these patients psychologically and physiologically. This systematic review aimed to evaluate the effects of PMR on anxiety, depression, fatigue, sleep quality, dyspnea, and pulmonary function in patients with COPD, CF, and COVID-19. Materials and Methods: Following PRISMA guidelines, a comprehensive search was conducted across PubMed, Scopus, Web of Science, MEDLINE, Cochrane, SpringerLink, and ClinicalTrials.gov. Eligible studies assessed PMR in adult patients with COPD, CF, or COVID-19. Psychological and physical outcomes were extracted, and methodological quality and risk of bias were evaluated using standardized tools. Results: A total of 32 studies were included in the analysis. PMR was consistently associated with reductions in anxiety, depression, fatigue, and sleep-related distress, particularly in patients with COPD and COVID-19. Some also reported improvements in dyspnea and mild pulmonary function tests, but these were more variable. Only one study evaluated PMR in patients with cystic fibrosis, providing the first clinical data for this group. Interventions were predominantly short-term, with significant variation in design, duration, and methodology, and the risk of bias was often moderate or high. Conclusions: PMR is a helpful strategy in treating chronic respiratory diseases, particularly for reducing psychological distress and improving sleep. However, the evidence is limited by methodological variations and lack of long-term follow-up. Rigorous research is needed to support clinical application, particularly in cystic fibrosis. Full article

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28 pages, 2140 KiB

Open AccessReview

Mammalian PI-Phospholipase C Isozymes: Structural and Functional Insights and Roles in Health and Disease

by May Hamdi, Mohammed Al-Matwi, Nour Elghoul, Hissa Al-Kuwari, Tahseen S. Sayed, Emna Riguene and Michail Nomikos

Medicina 2025, 61(6), 1054; https://doi.org/10.3390/medicina61061054 - 7 Jun 2025

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Abstract

The Phosphoinositide Specific-Phospholipase C (PI-PLC) family of enzymes plays a crucial role in various cellular processes by catalyzing the hydrolysis of phosphatidylinositol 4,5-bisphosphate [PI(4,5)P₂] into inositol 1,4,5-trisphosphate (IP₃) and diacylglycerol (DAG), which are essential messengers mediating critical intracellular signaling [...] Read more.

The Phosphoinositide Specific-Phospholipase C (PI-PLC) family of enzymes plays a crucial role in various cellular processes by catalyzing the hydrolysis of phosphatidylinositol 4,5-bisphosphate [PI(4,5)P₂] into inositol 1,4,5-trisphosphate (IP₃) and diacylglycerol (DAG), which are essential messengers mediating critical intracellular signaling pathways. Herein, we carry out a comprehensive analysis of the structure, function, regulation, and implications of the PI-PLC family enzymes in both physiological and pathological contexts. More specifically, we discuss the structural features of PI-PLCs, elucidating their conserved domains and catalytic mechanisms. Furthermore, we explore the multifaceted roles of PI-PLCs in signal transduction, cellular homeostasis, and membrane dynamics, whilst highlighting the intricate regulatory mechanisms governing their activity such as protein–protein interactions, post-translational modifications, and lipid modulation. Lastly, we assess the involvement of PI-PLCs in various diseases, such as cancer, neurological disorders, immune dysregulation, and male infertility, emphasizing their potential as therapeutic targets. Full article

(This article belongs to the Section Genetics and Molecular Medicine)

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10 pages, 300 KiB

Open AccessReview

Contemporary Practices in Refractory Out-of-Hospital Cardiac Arrest: A Narrative Review

by Jan Jezeršek and Matej Strnad

Medicina 2025, 61(6), 1053; https://doi.org/10.3390/medicina61061053 - 7 Jun 2025

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Abstract

Out-of-hospital cardiac arrest remains a major cause of adult mortality worldwide, with survival to hospital discharge rates around 10%. Despite advances in prehospital care, rapid recognition and high-quality chest compressions are the primary interventions, while early defibrillation is one of the few measures [...] Read more.

Out-of-hospital cardiac arrest remains a major cause of adult mortality worldwide, with survival to hospital discharge rates around 10%. Despite advances in prehospital care, rapid recognition and high-quality chest compressions are the primary interventions, while early defibrillation is one of the few measures shown to improve survival. This literature review examines novel interventions for patients with refractory ventricular fibrillation and pulseless ventricular tachycardia, focusing on double sequential defibrillation, beta-adrenergic receptor antagonists, and extracorporeal cardiopulmonary resuscitation. Evidence suggests that double sequential defibrillation may improve survival to discharge in refractory ventricular fibrillation, but consensus and large-scale validation are lacking. Beta-blockers show promise for increasing the rates of return of spontaneous circulation and favourable neurological outcomes, yet robust evidence is still needed. Extracorporeal cardiopulmonary resuscitation, particularly when initiated rapidly in selected patients, can enhance survival and neurological outcomes, though studies show mixed results and highlight the importance of patient selection and system readiness. Overall, while these interventions offer potential, their widespread adoption requires further high-quality research to determine efficacy, optimal protocols, and resource implications in both prehospital and emergency department settings. Full article

(This article belongs to the Section Cardiology)

12 pages, 596 KiB

Open AccessSystematic Review

Scrotal Flaps for Penile Skin Reconstruction: A Systematic Review

by Sorin V. Parasca, Andrei Dumitrescu, Florin R. Stanescu and Ruxandra D. Sinescu

Medicina 2025, 61(6), 1052; https://doi.org/10.3390/medicina61061052 - 6 Jun 2025

Viewed by 151

Abstract

Background and Objectives: Infection, trauma, skin cancer, foreign substance injections and lymphedema are among the most frequent causes of penile skin defects. Scrotal flaps are a promising reconstructive option for penile resurfacing, offering improved functional and aesthetic outcomes; however, there is no [...] Read more.

Background and Objectives: Infection, trauma, skin cancer, foreign substance injections and lymphedema are among the most frequent causes of penile skin defects. Scrotal flaps are a promising reconstructive option for penile resurfacing, offering improved functional and aesthetic outcomes; however, there is no clear consensus on their superiority. Materials and Methods: A review of the literature was performed in PubMed Central and Scopus, and multiple keywords were employed. The initial search retrieved 9181 articles; 32 articles were finally selected, of which 13 were case reports and 19 were case series. Results: A total of 368 patients were included, the majority (71%) consulting for sclerosing lipogranuloma. Seven types of scrotal flaps were used: unilateral scrotal flap (n = 1), bilateral anterior scrotal flaps (n = 149), two-stage scrotal flap (n = 57), bipedicled bilateral anterior scrotal flaps (n = 140), apron-style scrotal flap (n = 1), scrotal pull-up (n = 13), and island dartos musculocutaneous flap (n = 7). Patient satisfaction was high in all studies. Outcome evaluation was typically conducted using subjective questionnaires with 2 or 5 items or visual analog scales. Few studies employed validated sexual function questionnaires, as the IIEF-5 or the EHS. Conclusions: Scrotal flaps provide good quality tissue for penile resurfacing, having the closest resemblance to normal penis skin. For a better understanding of the outcomes of different scrotal flaps, a thorough evaluation of postoperative complications should be made. The LOS and revision surgery rates may serve as surrogates for the financial burden of the procedure. Erectile function should be thoroughly evaluated with a 10-item Likert scale, IIEF-5, EHS, and POSAS. Full article

(This article belongs to the Special Issue Recent Research and Trends in Plastic, Aesthetic and Regenerative Surgery)

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16 pages, 3192 KiB

Open AccessReview

Tissue Doppler Imaging in Acute and Critical Care: Enhancing Diagnostic Precision

by Ugo Giulio Sisto, Daniele Orso, Davide Maione, Francesco Venturelli and Antonio De Luca

Medicina 2025, 61(6), 1051; https://doi.org/10.3390/medicina61061051 - 6 Jun 2025

Viewed by 154

Abstract

Background and Objectives: The advent of portable ultrasound devices revolutionized clinical practice in emergency medicine. Point-of-care ultrasound (POCUS) has become a cornerstone diagnostic and procedural tool, enhancing diagnostic accuracy and patient safety. Beyond traditional clinical evaluation, POCUS allows for rapid patient assessment, exclusion [...] Read more.

Background and Objectives: The advent of portable ultrasound devices revolutionized clinical practice in emergency medicine. Point-of-care ultrasound (POCUS) has become a cornerstone diagnostic and procedural tool, enhancing diagnostic accuracy and patient safety. Beyond traditional clinical evaluation, POCUS allows for rapid patient assessment, exclusion of life-threatening conditions, and prognostication in various critical situations. Tissue Doppler imaging (TDI), as an advanced echocardiographic technique, offers additional quantitative data by measuring myocardial velocities, thereby improving the evaluation of systolic and diastolic ventricular function. This review aims to highlight the potential role of TDI in multiple acute and critical conditions. Materials and Methods: We performed a narrative review across the main application topics of TDI. Results: TDI provides crucial diagnostic and prognostic value in acute coronary syndromes, in the assessment of systolic or diastolic dysfunction, and in the etiological diagnosis of acute heart failure. It aids in differentiating cardiogenic pulmonary edema from acute respiratory distress syndrome and identifies right ventricular systolic dysfunction in acute pulmonary embolism. TDI also facilitates distinguishing hypertensive emergencies from urgencies and contributes to the stratification of atrial fibrillation recurrence risk. Additionally, it supports the differential diagnosis of constrictive pericarditis versus other restrictive cardiomyopathy patterns. In intensive care settings, TDI is particularly valuable during mechanical ventilation weaning, where elevated E/E’ values serve as a predictor of weaning failure. Its accessibility, rapid execution, and high reproducibility make it suitable for longitudinal monitoring. Conclusions: TDI enhances diagnostic precision, guides therapeutic strategies, and provides critical prognostic insights across a wide range of time-sensitive clinical scenarios, solidifying its role as an indispensable tool in modern emergency and critical care practice. Full article

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

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13 pages, 440 KiB

Open AccessArticle

Demographic Characteristics and Inflammatory Biomarker Profile in Psoriatic Arthritis Patients with Comorbid Fibromyalgia: A Cross-Sectional Study

by Marino Paroli, Chiara Gioia, Daniele Accapezzato and Rosalba Caccavale

Medicina 2025, 61(6), 1050; https://doi.org/10.3390/medicina61061050 - 6 Jun 2025

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Abstract

Background and Objectives: Psoriatic arthritis (PsA) is a chronic rheumatic disease that is frequently associated with fibromyalgia (FM). The coexistence of FM complicates the evaluation of PsA disease activity and the planning of treatment strategies, as the two conditions share many overlapping clinical [...] Read more.

Background and Objectives: Psoriatic arthritis (PsA) is a chronic rheumatic disease that is frequently associated with fibromyalgia (FM). The coexistence of FM complicates the evaluation of PsA disease activity and the planning of treatment strategies, as the two conditions share many overlapping clinical symptoms. To investigate the contribution of demographic factors and available serum biomarkers of inflammation and autoimmunity in characterizing the heterogeneity among patients meeting the classification criteria for both PsA and FM. Materials and Methods: This cross-sectional, single-center study involved 1547 adult patients evaluated between January 2017 and December 2024 who met the CASPAR criteria for PsA. A patient subgroup also met the 2016 ACR criteria for FM. Demographic data, serum inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and autoimmunity markers including antinuclear antibodies (ANA), rheumatoid factor (RF), and anti-citrullinated protein antibodies (ACPA) were evaluated. Statistical analyses included chi-square tests, t-tests, Mann–Whitney U tests, and multivariate logistic regression to identify independent predictors associated with the coexistence of PsA and FM. Results: A total of 254 patients (16.42%) were diagnosed with concomitant FM. Compared to patients with PsA alone, those with concurrent PsA and FM showed significantly lower C-reactive protein (CRP) levels (0.39 ± 0.74 vs. 2.88 ± 12.31 mg/dL; p < 0.001) and a higher frequency of antinuclear antibody (ANA) positivity (13.57% vs. 5.78%; p < 0.001). No significant differences were observed in rheumatoid factor (RF) or anti-citrullinated protein antibody (ACPA) positivity between the groups. Multivariate logistic regression identified female sex, ANA positivity, CRP levels ≤ 0.5 mg/dL, and elevated body mass index (BMI) as independent predictors of the presence of concomitant FM. Conclusions: Patients with concomitant PsA and FM have a distinct demographic and serological profile, suggesting the existence of a clinically significant subgroup within the PsA population. Recognition of these differences may improve diagnostic accuracy and support the development of personalized, non-immunosuppressive therapeutic strategies for this subgroup of patients. Full article

(This article belongs to the Section Hematology and Immunology)

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12 pages, 393 KiB

Open AccessArticle

Helicobacter pylori Seroprevalence and Its Associations with Sociodemographic Characteristics, Environmental Factors, and Gastrointestinal Complaints: A Cross-Sectional Study in the Adult Population of Kaunas City, Lithuania

by Paulius Jonaitis, Janina Petkeviciene, Violeta Salteniene, Egle Ciupkeviciene, Laimas Jonaitis, Mantas Kriukas, Dalia Luksiene, Vaiva Lesauskaite, Juozas Kupcinskas and Limas Kupcinskas

Medicina 2025, 61(6), 1049; https://doi.org/10.3390/medicina61061049 - 6 Jun 2025

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Abstract

Background and Objectives: Helicobacter pylori, classified as a Group I carcinogen, is the main risk factor for gastric cancer, one of the leading causes of cancer mortality globally. Lithuania reports one of the highest gastric cancer rates in Europe, yet recent [...] Read more.

Background and Objectives: Helicobacter pylori, classified as a Group I carcinogen, is the main risk factor for gastric cancer, one of the leading causes of cancer mortality globally. Lithuania reports one of the highest gastric cancer rates in Europe, yet recent large-scale epidemiological data on H. pylori prevalence are lacking. This study aimed to assess the current seroprevalence of H. pylori in Lithuanian adults and its associations with sociodemographic, environmental factors, and dyspeptic symptoms. Materials and Methods: A cross-sectional study was conducted between 2020 and 2023 at the Lithuanian University of Health Sciences in Kaunas city. Randomly selected adults aged 25–69 years underwent venous blood sampling for H. pylori IgG antibody testing (Serion ELISA) and completed a questionnaire on demographic–environmental factors and dyspeptic symptoms in the past 30 days. Subjects previously treated for H. pylori were excluded from seroprevalence analysis. Seroprevalence was compared across age groups using χ² and Z-tests with Bonferroni correction. Multivariable logistic regression identified factors associated with H. pylori seropositivity. The selected level of statistical significance was p < 0.05. Results: A total of 1046 adults (mean age 47.2 years, SD = 11.5; 50% males) participated in the study. The overall age-standardized H. pylori seroprevalence was 63.1% (95% CI 60.4–66.7). Seropositivity increased with age, peaking at 80.3% in males aged 55–69. Higher seroprevalence was observed among those with basic education and those lacking access to municipal or heated water during childhood. Regression analysis revealed that male sex, aging, and lower education were significantly associated with H. pylori seropositivity. No significant link was found between H. pylori seroprevalence and gastrointestinal complaints. Conclusions: H. pylori seroprevalence remains high in Lithuanian adults, highlighting the need for ongoing surveillance and consideration of screening strategies. H. pylori infection was linked to sociodemographic and environmental factors but not dyspeptic complaints. Full article

(This article belongs to the Section Gastroenterology & Hepatology)

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20 pages, 2657 KiB

Open AccessArticle

Terpinen-4-ol Targets HIF-1α/TGF-β1/TNF-α Axis to Attenuate Ethanol-Induced Hepatotoxicity: Network Pharmacology and In Vitro Validation

by Tariq G. Alsahli, Maryam Khalid, Muhammad Nasir Hayat Malik and Saud O. Alshammari

Medicina 2025, 61(6), 1048; https://doi.org/10.3390/medicina61061048 - 6 Jun 2025

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Abstract

Background and Objective: Alcoholic liver disease (ALD) is a major health burden caused by chronic alcohol consumption, leading to oxidative stress, inflammation, and fibrosis. Current treatments are limited, highlighting the need for novel therapeutic agents. This study investigated the hepatoprotective effects of ‘Terpinen-4-ol [...] Read more.

Background and Objective: Alcoholic liver disease (ALD) is a major health burden caused by chronic alcohol consumption, leading to oxidative stress, inflammation, and fibrosis. Current treatments are limited, highlighting the need for novel therapeutic agents. This study investigated the hepatoprotective effects of ‘Terpinen-4-ol (T4OL)’, a natural monoterpene from tea tree oil, against ethanol-induced liver injury, focusing on its molecular and cellular mechanisms. Materials and Methods: Network pharmacology and molecular docking were employed to predict T4OL’s interaction with ALD-associated targets. Human HepG2 cells were used to validate the in silico findings. Cells were exposed to ethanol (8%) prior to treatment with T4OL or silymarin (SIL), and cytotoxicity was assessed through MTT, crystal violet, and trypan blue assays. Moreover, ELISA and qPCR were conducted to evaluate antioxidant, inflammatory, and fibrotic markers. Results: Network pharmacology analysis suggested that T4OL exerts its hepatoprotective effects by suppressing inflammatory and fibrotic mediators (HIF-1α, TGF-β1, and TNF-α). Docking studies also exhibited a strong binding affinity of T4OL to key ALD targets, with docking scores comparable to SIL. In addition, T4OL (13–1300 µM) dose-dependently protected HepG2 cells from ethanol-induced damage, restoring viability by up to 80% at 650 µM. It significantly elevated antioxidant levels (GSH by 2.5-fold, SOD by 1.8-fold) and suppressed pro-inflammatory and fibrotic markers (IL-6, COL1A1, TIMP-1) by 40–60%. At higher concentrations (650–1300 µM), T4OL outperformed SIL in cytoprotection and anti-fibrotic effects. Conclusions: T4OL mitigates ethanol-induced liver injury by targeting oxidative stress, inflammation, and fibrosis pathways, demonstrating superior efficacy to SIL at optimal doses. Its multi-target action supports its potential as a therapeutic candidate for ALD. Full article

(This article belongs to the Special Issue Molecular and Cellular Advances on Drug Discovery, Pharmacology and Toxicology, 2nd Edition)

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9 pages, 828 KiB

Open AccessArticle

Underlying Diagnosis of Food Bolus Obstruction Acute Admissions to Otorhinolaryngology: A Shift to Provide the Best Care as per the Current Guidelines

by Rasads Misirovs, Anna Kamusella, Michael Miller and Samit Majumdar

Medicina 2025, 61(6), 1047; https://doi.org/10.3390/medicina61061047 - 6 Jun 2025

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Abstract

Background and Objectives: In the United Kingdom, some patients with food bolus obstruction (FBO) are admitted under the care of ear, nose, and throat (ENT) doctors. In the literature, eosinophilic oesophagitis (EoE) is the most common cause of FBO. We analysed ENT FBO [...] Read more.

Background and Objectives: In the United Kingdom, some patients with food bolus obstruction (FBO) are admitted under the care of ear, nose, and throat (ENT) doctors. In the literature, eosinophilic oesophagitis (EoE) is the most common cause of FBO. We analysed ENT FBO admissions and interventions used in our hospital to investigate for EoE. Materials and Methods: This paper details a retrospective study of adult FBO admissions to an ENT ward from January 2016 to December 2019 at a single centre. Results: In total, 120 patients were admitted. Half of the patients required instrumentation to resolve the obstruction—31% underwent rigid oesophagoscopy (RO) and 69% oesophagogastroduodenoscopy (OGD). Biopsies were taken during 48% of inpatient OGDs and 5% of ROs. 48% had a histopathological diagnosis of EoE. There was no mention of a specific number of eosinophils per high-power field in 53% of EoE pathology reports. Potentially, some patients were EoE-negative due to an inadequate number of biopsies taken—71% of patients had an insufficient number of biopsies to exclude EoE. A total of 56% of all patients with FBO did not undergo inpatient or outpatient OGDs with biopsies. Conclusions: Biopsies were not taken in all FBO patients undergoing oesophagoscopy, leaving EoE underdiagnosed. Follow-up arrangements were often suboptimal to exclude EoE. Full article

(This article belongs to the Special Issue Update on Otorhinolaryngologic Diseases (2nd Edition))

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16 pages, 601 KiB

Open AccessReview

Impact of Dual Antibiotic Prophylaxis on 90-Day Surgical Site Infection Rates Following Posterior Spinal Fusion for Juvenile Scoliosis: A Single-Center Study of 296 Cases

by Paolo Brigato, Davide Palombi, Leonardo Oggiano, Sergio De Salvatore, Alessandro Rogani, Sergio Sessa and Pier Francesco Costici

Medicina 2025, 61(6), 1046; https://doi.org/10.3390/medicina61061046 - 6 Jun 2025

Viewed by 180

Abstract

Background and Objectives: Surgical site infections (SSIs) significantly impact pediatric spinal deformity surgery. Considering the increased risk of Gram-negative infections in neuromuscular scoliosis (NMS), broader antibiotic coverage could be advantageous. Some studies suggest extending this approach to all scoliosis etiologies to reduce SSI [...] Read more.

Background and Objectives: Surgical site infections (SSIs) significantly impact pediatric spinal deformity surgery. Considering the increased risk of Gram-negative infections in neuromuscular scoliosis (NMS), broader antibiotic coverage could be advantageous. Some studies suggest extending this approach to all scoliosis etiologies to reduce SSI rates. This study evaluates whether a dual antibiotic prophylaxis with cephalosporin and aminoglycoside reduces SSI incidence within 90 days postsurgery in adolescent idiopathic scoliosis (AIS), NMS, and syndromic scoliosis (SS) patients. Materials and Methods: This study included pediatric patients with AIS, NMS, or SS curves, treated with posterior spinal fusion between January 2019 and December 2022, with a minimum two-year follow-up. The primary outcome was early SSI incidence and its correlation with dual antibiotic prophylaxis in pediatric scoliosis surgery. Secondary outcomes included operative data, blood loss, hemoglobin levels, hospital stay, complications, pelvic fixation, and radiographic correction and how these factors could be identified as potential risk factors for SSIs. Descriptive and inferential statistics were used to analyze antibiotic regimen, SSI risk, and perioperative variables using chi-square, Mann–Whitney U, ANOVA, and Cox regression. Significance was set at p < 0.05. Results: The study included 296 patients: 222 with AIS, 46 with NMS, and 28 with SS. Ninety days postsurgery, SSI rates were 1.2% in AIS (0.8% deep, 0.4% superficial), 6.5% in NMS (all superficial), and 3.5% in SS (all superficial). Deep SSIs in AIS were associated with methicillin-resistant Staphylococcus aureus (MRSA). None of the cases required implant removal. Univariate Cox regression did not reveal any statistically significant predictors for SSIs. However, older age at surgery showed a protective trend, while higher preoperative ASA scores seemed to be a negative prognostic factor (respectively p = 0.051 and p = 0.08). Conclusions: Dual antibiotic prophylaxis with cefazolin and amikacin was associated with a lower SSI rate after posterior spinal fusion for scoliosis, with no adverse events. Further studies are needed to refine dosage, timing, and duration. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Adolescent Idiopathic Scoliosis)

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26 pages, 2107 KiB

Open AccessReview

Kidney and Bladder Transplantation: Advances, Barriers, and Emerging Solutions

by Gani Kuttymuratov, Timur Saliev, Ardak Ainakulov, Askar Ayaganov, Kuat Oshakbayev, Daulet Zharassov, Abdurakhman Tuleuzhan and Nurlybek Uderbayev

Medicina 2025, 61(6), 1045; https://doi.org/10.3390/medicina61061045 - 5 Jun 2025

Viewed by 397

Abstract

Urogenital transplantation has emerged as a ground-breaking field with the potential to revolutionize the treatment of end-stage organ failure and congenital or acquired defects of the kidney and urinary bladder. This review provides a comprehensive analysis of the current state, clinical experiences, and [...] Read more.

Urogenital transplantation has emerged as a ground-breaking field with the potential to revolutionize the treatment of end-stage organ failure and congenital or acquired defects of the kidney and urinary bladder. This review provides a comprehensive analysis of the current state, clinical experiences, and experimental progress in kidney and bladder transplantation, with a particular focus on immunological, surgical, and ethical challenges. While kidney transplantation is now a well-established procedure offering improved survival and quality of life for patients with chronic renal failure, bladder transplantation remains in the experimental phase, facing hurdles in vascularization, tissue integration, and functional restoration. Recent advancements in tissue engineering, regenerative medicine, and immunosuppressive strategies are critically discussed, highlighting their role in shaping the future of urogenital grafts. This review also explores xenotransplantation and bio-artificial organ development as promising frontiers. Continued interdisciplinary research is essential to overcome the current limitations and enable routine clinical application of bladder transplantation while optimizing outcomes in kidney grafts. Full article

(This article belongs to the Special Issue Kidney Transplantation Complications: Updates and Challenges)

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29 pages, 1729 KiB

Open AccessArticle

Morphofunctional Assessment of Malnutrition and Sarcopenia Using Nutritional Ultrasonography in Patients Undergoing Maintenance Hemodialysis

by José C. De La Flor, Estefanya García-Menéndez, Gregorio Romero-González, Celia Rodríguez Tudero, Elena Jiménez Mayor, Enrique Florit Mengual, Esperanza Moral Berrio, Beatriz Soria Morales, Michael Cieza Terrones, Secundino Cigarrán Guldris and Jesús Hernández Vaquero

Medicina 2025, 61(6), 1044; https://doi.org/10.3390/medicina61061044 - 5 Jun 2025

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Abstract

Background and Objectives: Malnutrition and sarcopenia are highly prevalent and clinically impactful conditions in patients undergoing maintenance hemodialysis (MHD), yet their early detection remains challenging. This study aimed to assess the diagnostic performance of nutritional ultrasonography (NUS) in the morphofunctional evaluation of malnutrition [...] Read more.

Background and Objectives: Malnutrition and sarcopenia are highly prevalent and clinically impactful conditions in patients undergoing maintenance hemodialysis (MHD), yet their early detection remains challenging. This study aimed to assess the diagnostic performance of nutritional ultrasonography (NUS) in the morphofunctional evaluation of malnutrition and sarcopenia, and to compare its utility with established tools such as bioimpedance analysis (BIA), biochemical markers, handgrip strength (HGS), and functional performance tests. Materials and Methods: A cross-sectional study was conducted in 74 stable MHD patients. Clinical, analytical, anthropometric, BIA, NUS, and functional parameters were collected, along with validated nutritional and frailty scales. NUS was used to assess the quadriceps rectus femoris (QRF) and preperitoneal visceral fat (PPVF), measuring Y-axis, Y-axis/height, cross-sectional muscle area rectus femoris (CS-MARF), muscle area rectus femoris index adjusted to height (MARFI_h), and supramuscular fat (SMF). Sarcopenia was defined according to the 2019 European Working Group on Sarcopenia in Older People (EWGSOP) criteria. Results: The prevalence of risk, confirmed, and severe sarcopenia was 24.3%, 40.5%, and 20.3%, respectively. Severe-to-moderate protein-energy wasting (PEW) affected 44.6% of patients. Compared to non-sarcopenic individuals, sarcopenic patients had lower values of HGS, prealbumin, lean body mass, and phase angle. NUS-derived cut-off values for sarcopenia were Y-axis ≤ 8 mm, Y-axis/height ≤ 2.9 mm/m², CS-MARF ≤ 2.4 cm², and MARFIh ≤ 0.9 cm²/m². The most discriminative NUS parameters were Y-axis and SMF (AUC 0.67), followed by Y-axis/height (AUC 0.65) and MARFI_h (AUC 0.63). NUS measurements correlated significantly with ASMI, phase angle, HGS, and SPPB scores. Conclusions: Nutritional ultrasonography is a feasible, reproducible, and clinically valuable tool for assessing muscle mass and quality in MHD patients. Its incorporation into routine practice may enhance early detection of malnutrition and sarcopenia, thereby facilitating timely, individualized nutritional interventions. Full article

(This article belongs to the Section Urology & Nephrology)

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11 pages, 1035 KiB

Open AccessReview

A Narrative Review of the Odyssey of Thyroid Cancer Diagnosis: Can 99mTc-SESTAMIBI Molecular Imaging Replace Fine Needle Aspiration Biopsy?

by Ioannis Iakovou, Nikitas Papadopoulos, Paraskevi Exadaktylou, Christos Melidis, Georgia Koutsouki, Ilias Katsadouros, Savvas Frangos, Ioannis Koutelidakis, Kalliopi Kotsa and Evanthia Giannoula

Medicina 2025, 61(6), 1043; https://doi.org/10.3390/medicina61061043 - 5 Jun 2025

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Abstract

Background and Objectives: Many diagnostic methods exist for identifying thyroid malignancy, but most of them resemble an odyssey, as the journey from palpating a nodule to receiving a definitive diagnose is often long and costly. The aim of the present study is to [...] Read more.

Background and Objectives: Many diagnostic methods exist for identifying thyroid malignancy, but most of them resemble an odyssey, as the journey from palpating a nodule to receiving a definitive diagnose is often long and costly. The aim of the present study is to investigate the role of Sestamibi scintigraphy in the characterization of cytological indeterminate thyroid nodules. Materials and Methods: A focused literature review was conducted, emphasizing the comparison between Fine Needle Aspiration Biopsy (FNAB), the main diagnostic method for thyroid cancer, and Sestamibi. Results: It is widely accepted that Sestamibi is the primary alternative for patients with non-diagnostic FNAB. As shown in the literature, Sestamibi has a high negative predictive value in excluding thyroid malignancy. Conclusions: Much like Odysseus’ adventurous 10-year journey returning to Ithaca, the path to diagnosing thyroid cancer is not straightforward. Molecular imaging with 99mTc-Sestamibi may serve as a valuable adjunct in evaluating thyroid nodules with inconclusive cytological findings. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Thyroid Cancer in the Precision Medicine Era)

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18 pages, 4464 KiB

Open AccessArticle

Protective Effect of Mesenchymal Stem Cell-Derived Extracellular Vesicles on Inner Ear Sensorineural Cells Affected by Cisplatin

by Maria Perde-Schrepler, Ioana Brie, Mihai Cenariu, Sergiu Chira, Lajos Raduly, Liviuta Budisan, Ioana Berindan-Neagoe, Rares Stiufiuc, Maximilian Dindelegan, Cristina Blebea, Emoke Pall and Alma Aurelia Maniu

Medicina 2025, 61(6), 1042; https://doi.org/10.3390/medicina61061042 - 5 Jun 2025

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Abstract

Background and Objectives: Extracellular vesicles (EVs) derived from mesenchymal stem cells have gained much attention as potential therapeutic agents in many diseases, including hearing disorders such as sensorineural hearing loss (SNHL). EVs inherit similar therapeutic effects, including the stimulation of tissue regeneration [...] Read more.

Background and Objectives: Extracellular vesicles (EVs) derived from mesenchymal stem cells have gained much attention as potential therapeutic agents in many diseases, including hearing disorders such as sensorineural hearing loss (SNHL). EVs inherit similar therapeutic effects, including the stimulation of tissue regeneration from the parental cells. The aim of our study was to isolate EVs produced by MSCs and use them to treat inner ear cells in culture to evaluate their protective potential against the damaging effect of an ototoxic drug. Materials and Methods: We isolated MSC-derived EVs by precipitation and characterized them by number, size, and morphology using nanoparticle tracking analysis and TEM, evaluated the protein concentration by BCA assay and the presence of EV markers CD9, CD63, and CD81 by the Dot Blot immunoblotting method. HEI-OC1 inner ear cell line was treated with EVs either alone or followed by Cisplatin. We assessed the uptake of EVs in HEI-OC1 cells by fluorescence microscopy after PKH26 labeling, ROS production by the DCFDA (dichlorfluorescein diacetate) assay, cellular viability by Alamar Blue assay, and apoptosis with the Annexin V/Propidium Iodide method. Results: The isolated EVs had mean dimensions of 184.4 nms and the concentration of the EV suspension was 180 × 10⁶ particles/mL. TEM analysis showed intact vesicular structures with lipid-bilayer membranes having similar sizes with those measured by NTA. The PKH26-labeled EVs were observed in the HEI-OC1 cells after 24 h incubation, the amount increasing with the concentration. EVs reduced ROS production and increased the number of viable cells both alone and as pretreatment before Cisplatin, dose-dependently. Cells in early apoptosis were inhibited by EVs, while those in late apoptosis were enhanced, both with and without Cisplatin. Conclusions: EVs secreted by MSC protected HEI-OC1 cells against Cisplatin toxicity, reduced ROS production, and stimulated cell viability and the elimination of damaged cells by apoptosis, protecting the HEI-OC1 cells against Cisplatin-induced damage. Full article

(This article belongs to the Section Pharmacology)

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13 pages, 1322 KiB

Open AccessArticle

Effects of Different Patient and Prosthetic Variables on Marginal Bone Behavior in Dental Implants: A Clinical Retrospective Study

by Sergio Alexandre Gehrke, Antonio Scarano, Felice Lorusso, Thalles Yurgen Balduino and Marco Aurélio Bianchini

Medicina 2025, 61(6), 1041; https://doi.org/10.3390/medicina61061041 - 5 Jun 2025

Viewed by 407

Abstract

Background and Objectives: This study aimed to evaluate marginal bone level (MBL) changes in implant-supported rehabilitation based on patient demographics, implant location, transmucosal abutment height, and crown emergence profile. Materials and Methods: A total of 50 patients (28 females and 22 males), [...] Read more.

Background and Objectives: This study aimed to evaluate marginal bone level (MBL) changes in implant-supported rehabilitation based on patient demographics, implant location, transmucosal abutment height, and crown emergence profile. Materials and Methods: A total of 50 patients (28 females and 22 males), with 111 implant–abutment (IA) sets, were analyzed. The mean age was 65.2 ± 10.9 years (range: 33–81). Implants were placed in the maxilla (68.5%) and mandible (31.5%), with an average evaluation period of 12.7 ± 4.1 months. MBL changes at mesial (MBLm) and distal (MBLd) sites were recorded and analyzed based on sex, age, implant location, abutment transmucosal height, and crown emergence profile. Statistical comparisons were performed using Bonferroni’s multiple comparison test and one-way ANOVA with Tukey’s post hoc test. Results: MBL changes did not show significant differences based on sex (p > 0.05) or age group (p > 0.05). However, maxillary implants exhibited greater bone loss than mandibular implants, though this difference was not statistically significant. Transmucosal abutment height (TMh) significantly influenced MBL, with taller abutments (TMh3: −1.07 ± 0.93 mm) showing less bone loss than shorter abutments (TMh1: −2.11 ± 1.82 mm) (p < 0.05). Crown emergence profile also affected MBL, particularly in the distal emergence profile, where design 1 exhibited the least bone loss compared to designs 2 and 3 (p = 0.0176). Conclusions: The study findings suggest that transmucosal abutment height and crown emergence profile significantly influence peri-implant bone stability. Transmucosal abutment height (> 2.5 mm) was associated with reduced bone loss. Further research is recommended to evaluate the long-term effects on peri-implant bone maintenance. Full article

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

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Open AccessArticle

Integrated Diagnostic Approach Using Basophil Activation Test and IgE Assays for Shrimp and Prawn Allergy

by Nhu N. Q. Nguyen, Thao H. Nguyen, Minh K. Le, Tram B. Duong, Duy L. Pham, Tai T. Tran and Tu H. K. Trinh

Medicina 2025, 61(6), 1040; https://doi.org/10.3390/medicina61061040 - 5 Jun 2025

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Abstract

Background and Objectives: Shellfish allergies are common in Vietnam. The basophil activation test (BAT) is a powerful tool in the diagnosis of food allergies. We aimed to evaluate the application of BAT to distinguish shrimp allergy in comparison with skin prick test [...] Read more.

Background and Objectives: Shellfish allergies are common in Vietnam. The basophil activation test (BAT) is a powerful tool in the diagnosis of food allergies. We aimed to evaluate the application of BAT to distinguish shrimp allergy in comparison with skin prick test and specific IgE measurement. Materials and Methods: We recruited adult shrimp- or prawn-allergic subjects from the University Medical Center (Vietnam). BAT was performed using the in-house crude extracts for two allergens: black tiger shrimp Penaeus monodon (shrimp) and giant freshwater prawn Macrobrachium rosenbergii (prawn). The percentages of CD63 in response to shrimp and prawn were recorded. The results of skin prick tests (SPT) and the specific IgE (sIgE) levels in response to commercial shrimp/prawn were noted. Receiver operating characteristic (ROC) analysis and area under the curve (AUC) were calculated. Results: Of 43 recruited subjects, 9 (26.5%) subjects had a specific allergy to shrimp, 2 (5.9%) subjects had a specific allergy to prawn, and 23 (67.6%) subjects had both shrimp and prawn allergy. Basophil CD63% was significantly increased in subjects with allergy to shrimp and prawn (p < 0.05% for all). Compared with SPT and sIgE, CD63 expression-based BAT was better in discriminating subjects with allergies to these species from their non-allergic counterparts (AUC/sensitivity/specificity = 0.88/77%/89% for shrimp, and 0.74/88%/77% for prawn, p < 0.05 for all). The addition of SPT and BAT improved the diagnostic power. A positive BAT could help identify shrimp/prawn allergy among cases with negative SPT/sIgE to shrimp/prawn. BAT facilitated the diagnosis of shrimp allergy among prawn-allergic subjects (100% accurate). Conclusions: The BAT test can help predict clinical reactions to shrimp and prawn in allergic patients, and enhance diagnostic accuracy in cases where SPT or specific IgE tests yield negative results. Full article

(This article belongs to the Special Issue Research on Allergy, Asthma, and Clinical Immunology)

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Medicina, Volume 61, Issue 6 (June 2025) – 126 articles

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