Medicina

22 pages, 678 KiB

Open AccessReview

Pharmacologic Disruption: How Emerging Weight Loss Therapies Are Challenging Bariatric Surgery Guidelines

by Safi G. Alqatari, Abrar J. Alwaheed, Manal A. Hasan, Reem J. Al Argan, Marj M. Alabdullah and Mohammed D. Al Shubbar

Medicina 2025, 61(7), 1292; https://doi.org/10.3390/medicina61071292 (registering DOI) - 18 Jul 2025

Abstract

Obesity is a chronic, relapsing disease with multifactorial origins and significant global health implications. Historically, bariatric surgery has been the most effective intervention for achieving sustained weight loss and metabolic improvement, especially in individuals with moderate to severe obesity. However, the therapeutic landscape [...] Read more.

Obesity is a chronic, relapsing disease with multifactorial origins and significant global health implications. Historically, bariatric surgery has been the most effective intervention for achieving sustained weight loss and metabolic improvement, especially in individuals with moderate to severe obesity. However, the therapeutic landscape is rapidly evolving. Recent advances in pharmacotherapy—including GLP-1 receptor agonists, dual and triple incretin agonists, and amylin-based combination therapies—have demonstrated unprecedented efficacy, with some agents inducing 15–25% weight loss, approaching outcomes once exclusive to surgical intervention. These developments challenge the continued applicability of existing bariatric surgery criteria, which were established in an era of limited medical alternatives. In this narrative review, we examine the evolution of surgical eligibility thresholds and critically assess the potential role of novel pharmacotherapies in redefining treatment algorithms. By comparing the efficacy, safety, metabolic benefits, and cost-effectiveness of surgery versus next-generation drugs, we explore whether a more stepwise, pharmacotherapy-first approach may now be justified, particularly in patients with BMI 30–40 kg/m². We also discuss future directions in obesity management, including personalized treatment strategies, perioperative drug use, and the integration of pharmacologic agents into long-term care pathways. As the field advances, a paradigm shift toward individualized, minimally invasive interventions appears inevitable—necessitating a timely re-evaluation of current bariatric surgery guidelines to reflect the expanding potential of medical therapy. Full article

(This article belongs to the Section Pharmacology)

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13 pages, 1843 KiB

Open AccessArticle

The Positional Relationship Between the Mandibular Canal and the Lower Third Molar Determined on Cone-Beam Computed Tomography

by Horatiu Urechescu, Ancuta Banu, Marius Pricop, Felicia Streian, Alisia Pricop and Cristiana Cuzic

Medicina 2025, 61(7), 1291; https://doi.org/10.3390/medicina61071291 (registering DOI) - 17 Jul 2025

Abstract

Background and Objectives: The extraction of mandibular third molars poses challenges due to their proximity to the mandibular canal and risk of inferior alveolar nerve (IAN) injury. Accurate preoperative evaluation is essential to minimize complications. This study assessed the three-dimensional positional relationship [...] Read more.

Background and Objectives: The extraction of mandibular third molars poses challenges due to their proximity to the mandibular canal and risk of inferior alveolar nerve (IAN) injury. Accurate preoperative evaluation is essential to minimize complications. This study assessed the three-dimensional positional relationship between the mandibular canal and lower third molars using cone-beam computed tomography (CBCT), aiming to identify anatomical positions associated with increased surgical risk. Materials and Methods: This retrospective study analyzed 253 CBCT scans of fully developed lower third molars. The mandibular canal position was classified as apical (Class I), buccal (Class II), lingual (Class III), or interradicular (Class IV). Contact was categorized as no contact, contact with a complete or defective white line, or canal penetration. In no-contact cases, the apex–canal distance was measured. Statistical analysis included descriptive and contingency analyses using the Chi-Square Likelihood Ratio test. Results: Class I was most common (70.8%) and presented the lowest risk, while Classes III and IV showed significantly higher frequencies of canal contact or penetration. Class II exhibited shorter distances even in no-contact cases, suggesting residual risk. Statistically significant associations were found between canal position and both contact type (p < 0.001) and apex–canal distance (p = 0.046). Conclusions: CBCT offers valuable insight into the anatomical relationship between third molars and the mandibular canal. High-risk positions—particularly lingual and interradicular—require careful assessment. Even in the absence of contact, close proximity may pose a risk and should inform surgical planning. Full article

(This article belongs to the Special Issue Research on Oral and Maxillofacial Surgery)

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21 pages, 511 KiB

Open AccessSystematic Review

Trimester-Specific Serum Lipid Profiles in Gestational Diabetes Mellitus: A Systematic Review, Meta-Analysis, and Meta-Regression

by Milos Milincic, Andja Cirkovic, Katarina Ivanovic, Stefan Dugalic and Miroslava Gojnic Dugalic

Medicina 2025, 61(7), 1290; https://doi.org/10.3390/medicina61071290 - 17 Jul 2025

Abstract

Background and Objectives: Gestational diabetes mellitus (GDM) is a major public health concern associated with adverse maternal and neonatal outcomes. It was found that even physiological pregnancy is followed by a significant shift in serum lipid profile, and even more pronounced in [...] Read more.

Background and Objectives: Gestational diabetes mellitus (GDM) is a major public health concern associated with adverse maternal and neonatal outcomes. It was found that even physiological pregnancy is followed by a significant shift in serum lipid profile, and even more pronounced in GDM pregnancies. We aimed to comprehensively assess lipid parameters among pregnant women with and without GDM. Materials and Methods: A systematic review, covering PubMed, WoS, and SCOPUS until 23 July 2024, with meta-analysis and meta-regression, was conducted, comprising studies measuring TG, TC, LDL-C, HDL-C, VLDL-C, and TG/HDL ratio in pregnant women diagnosed with GDM, and those with normal glucose tolerance. The overall effect size measure was the SMD. NOS and JADAD scales were used for quality assessment, I² statistics for heterogeneity evaluation, and funnel plots for publication bias inspection. Results: A total of 457 studies were included in the qualitative analysis, and 74, 277, and 122 studies were included in the quantitative analysis for the 1st 2nd, and 3rd trimester, respectively. TG and TG/HDL levels were significantly elevated in all three trimesters (TG: SMD = 0.61, 0.57, and 0.48, p < 0.001 for all, and TG/HDL: SMD = 0.44, 0.66, and 0.49; p < 0.001 for all), while TC and LDL-C levels showed significant increases in the 1st and 2nd trimesters (TC: SMD = 0.38, 0.27, p < 0.001 for both, LDL-C: SMD = 0.33, 0.20, p < 0.001 for both), in pregnant women with GDM compared to those without the condition. Conclusions: GDM is associated with significant lipid abnormalities, particularly elevated TG and decreased HDL-C levels. These lipid changes are most pronounced in the first and second trimesters, highlighting the importance of early detection and management. Full article

(This article belongs to the Section Obstetrics and Gynecology)

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19 pages, 4325 KiB

Open AccessArticle

The Impact of Nanoparticle Coatings on the Color of Teeth Restored Using Dental Adhesives Augmented with Magnetic Nanoparticles

by Carina Sonia Neagu, Andreea Codruta Novac, Cristian Zaharia, Meda-Lavinia Negrutiu, Izabell Craciunescu, Vlad Mircea Socoliuc, Catalin Nicolae Marin, Ionela-Amalia Bradu, Luminita Maria Nica, Marius Stef, Virgil-Florin Duma, Mihai Romînu and Cosmin Sinescu

Medicina 2025, 61(7), 1289; https://doi.org/10.3390/medicina61071289 - 17 Jul 2025

Abstract

Background and Objectives: Dental adhesives augmented with magnetic nanoparticles (MNPs) have been proposed to prevent microleakages. MNPs dispersed in a dental adhesive reduce the thickness of the adhesive layer applied in a magnetic field and enhance the bond strength by favoring the [...] Read more.

Background and Objectives: Dental adhesives augmented with magnetic nanoparticles (MNPs) have been proposed to prevent microleakages. MNPs dispersed in a dental adhesive reduce the thickness of the adhesive layer applied in a magnetic field and enhance the bond strength by favoring the penetration of the adhesive into dentinal tubules. However, the restoration’s color has been found to be affected by the MNPs. This study tests the hypothesis that MNP coating can alleviate the esthetic impact of magnetic dental adhesives. Materials and Methods: We synthesized Fe₃O₄ MNPs with silica coating (MNPs-SiO₂), calcium-based coating (MNPs-Ca), and no coating. Their morphology was studied using transmission electron microscopy (TEM) and scanning electron microscopy (SEM). Their chemical composition was assessed by energy-dispersive X-ray spectroscopy (EDX), and magnetic properties were measured using a vibrating sample magnetometer. FTIR spectroscopy was used to evaluate the polymerization of the MNP-laden adhesive. We prepared cavities in molar phantoms divided in four groups (n = 15 each) restored using the same adhesive with different MNP contents: Group 0 (G0)—no MNPs, G1—MNPs-SiO₂, G2—MNPs-Ca, and G3—uncoated MNPs. The restoration’s color was quantified in the CIELAB color space using a dental spectrophotometer. Results: MNPs-SiO₂ were globular, whereas MNPs-Ca had a cubic morphology. The SiO₂ layer was 73.1 nm ± 9.9 nm thick; the Ca(OH)₂ layer was 19.97 nm ± 2.27 nm thick. The saturation magnetization was 18.6 emu/g for MNPs-SiO₂, 1.0 emu/g for MNPs-Ca, and 65.7 emu/g for uncoated MNPs. MNPs had a marginal effect on the adhesive’s photopolymerization. The mean color difference between G0 and G2 was close to the 50:50% acceptability threshold, whereas the other groups were far apart from G0. The mean whiteness index of G2 did not differ significantly from that of G0; G1 deviated marginally from G0, whereas G3 differed significantly from G0. Conclusions: These results suggest that MNP coating can mitigate the influence of MNP-laden dental adhesives on the color of restorations. Full article

(This article belongs to the Collection New Concepts for Dental Treatments and Evaluations)

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18 pages, 386 KiB

Open AccessReview

Role of Non-Invasive Ventilation in Elderly Patients: Therapeutic Opportunity or Medical Futility? An Updated Narrative Review

by Francesca Sangiovanni, Giulia Sartori, Nadia Castaldo, Alberto Fantin and Ernesto Crisafulli

Medicina 2025, 61(7), 1288; https://doi.org/10.3390/medicina61071288 - 17 Jul 2025

Abstract

Background and Objectives: Acute respiratory failure (ARF) represents an increasingly relevant clinical challenge in older subjects due to population aging and the high prevalence of cardiopulmonary comorbidities. Non-invasive ventilation (NIV), developed as continuous positive airway pressure (CPAP) or bilevel positive airway pressure [...] Read more.

Background and Objectives: Acute respiratory failure (ARF) represents an increasingly relevant clinical challenge in older subjects due to population aging and the high prevalence of cardiopulmonary comorbidities. Non-invasive ventilation (NIV), developed as continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP), has become a first-line treatment in various forms of ARF, including acute cardiogenic pulmonary oedema (ACPE) and acute exacerbations of COPD (AECOPD), offering several clinical advantages. In this context, the limited evidence on the efficacy of NIV in older patients leaves considerable uncertainty as to whether it constitutes a valid therapeutic option or represents medical futility in these patients. Materials and Methods: This narrative review explores the use of NIV and its outcomes in four key clinical scenarios in the elderly: ARF due to ACPE, AECOPD, community-acquired pneumonia (CAP), and palliative/end-of-life care. Results: Strong evidence supports NIV use with improved outcomes in ACPE and AECOPD, even in older populations. Conversely, data on its use in pneumonia are inconclusive, with potential harm if applied inappropriately. In palliative care, NIV can help relieve symptoms, but if not used appropriately, it may extend suffering. Conclusions: Age alone does not appear to be a sufficient factor to determine whether or not to use NIV; it becomes relevant only when considered in conjunction with the purpose of its use and the patient’s clinical history and condition. Data remain limited and often conflicting, particularly when investigating the elderly population and patients with a “do not intubate” (DNI) order. There is a need for additional research on these patients, focusing on long-term outcomes and quality of life. Full article

(This article belongs to the Section Pulmonology)

24 pages, 1808 KiB

Open AccessSystematic Review

Effectiveness and Safety of Acupuncture for Nausea and Vomiting in Cancer Patients: A Systematic Review and Meta-Analysis

by Sung-A Kim, Sujung Yeo and Sabina Lim

Medicina 2025, 61(7), 1287; https://doi.org/10.3390/medicina61071287 - 17 Jul 2025

Abstract

Background and Objectives: Nausea and vomiting (NV) are common and distressing adverse effects among cancer patients undergoing treatment. Despite the widespread use of pharmacological antiemetics, these medications are often insufficient for controlling nausea and may cause medication interactions and side effects. Acupuncture [...] Read more.

Background and Objectives: Nausea and vomiting (NV) are common and distressing adverse effects among cancer patients undergoing treatment. Despite the widespread use of pharmacological antiemetics, these medications are often insufficient for controlling nausea and may cause medication interactions and side effects. Acupuncture has been proposed as a complementary therapy; however, the comprehensive analysis of its effects on NV across all emetogenic cancer treatments remains limited. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of acupuncture in managing NV in cancer patients undergoing chemotherapy, radiotherapy, or surgery. Materials and Methods: We conducted a comprehensive search across three electronic databases and two clinical registry platforms from inception to December 2024. Randomized controlled trials (RCTs) evaluating acupuncture for NV in cancer patients were included. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Safety outcomes were assessed based on the Common Terminology Criteria for Adverse Events (CTCAE). Results: Seventeen RCTs met the inclusion criteria, with twelve studies included in the meta-analysis. Acupuncture did not demonstrate significant effects on acute nausea (RR: 0.98; 95% CI: 0.84–1.15; p = 0.80) or acute vomiting (RR: 0.93; 95% CI: 0.65–1.32; p = 0.67). However, it significantly reduced delayed vomiting (RR: 0.76; 95% CI: 0.61–0.95; p = 0.02). Subgroup analysis demonstrated significant effects when acupuncture was administered for at least five days (RR: 0.56; 95% CI: 0.39–0.81; p = 0.002). The most frequently used acupoints were PC6, ST36, CV12, LI4, LR3, and ST25. No serious adverse events related to acupuncture treatments were reported, with only minor AEs such as localized bleeding and mild bruising observed. Conclusions: Acupuncture represents a safe and effective complementary therapy for managing delayed vomiting in cancer patients receiving emetogenic treatments. Clinicians can anticipate optimal benefits from at least five days of treatment, particularly using acupoints PC6, ST36, CV12, LI4, LR3, and ST25. Further high-quality studies are needed to establish standardized treatment regimens and explore its comprehensive effects on NV. Full article

(This article belongs to the Section Oncology)

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16 pages, 602 KiB

Open AccessReview

Clinical Applications and Efficacy of Cyanoacrylates in Oral Surgery and Periodontology: A Scoping Review

by Davide Gerardi, Pierangelo Burdo, Ilser Turkyilmaz, Francesca Diomede, Gustavo Duarte Mendes, Maurizio Piattelli and Giuseppe Varvara

Medicina 2025, 61(7), 1286; https://doi.org/10.3390/medicina61071286 - 17 Jul 2025

Abstract

Background and Objectives: Cyanoacrylate (CA) tissue adhesives have gained increasing attention as alternatives to sutures in oral surgery and periodontology. The objective of this scoping review is to assess their clinical applications and effectiveness in wound closure and postoperative management. Materials and [...] Read more.

Background and Objectives: Cyanoacrylate (CA) tissue adhesives have gained increasing attention as alternatives to sutures in oral surgery and periodontology. The objective of this scoping review is to assess their clinical applications and effectiveness in wound closure and postoperative management. Materials and Methods: The review was conducted following the JBI methodology and PRISMA-ScR guidelines. A comprehensive search was performed in PubMed, Scopus, and Web of Science to identify randomized controlled trials published between 2015 and 2025 evaluating the use of CAs in oral surgery and periodontal procedures. Results: A total of 19 studies were included. Cyanoacrylate adhesives demonstrated comparable or superior outcomes to other wound healing strategies in terms of operative time, postoperative pain reduction, and early wound healing. Their use was particularly beneficial in free gingival grafts and palatal donor site management. However, the findings across studies were not always consistent, and some trials did not report statistically significant differences. The use of long-chain CA formulations is associated with minimal toxicological risk, though these adhesives demonstrate intrinsic hemostatic and antimicrobial effects. Conclusions: Cyanoacrylate tissue adhesives represent a valid alternative to sutures in several dental surgical contexts, especially in procedures involving mucogingival grafts. Further high-quality clinical studies are needed to clarify their long-term outcomes and broaden their indications in dentistry. Full article

(This article belongs to the Special Issue Research on Oral and Maxillofacial Surgery)

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12 pages, 2258 KiB

Open AccessArticle

In Vitro Efficacy of Water-Soluble Mercaptopyridine-Substituted Oxotitanium (IV) Phthalocyanine Compounds in Photodynamic Therapy of Oral Squamous Cell Carcinoma

by Merve Çiftçi, Mansur Doğan, Didem Duman, Özge Göktuğ Temiz, Mahmut Durmuş and Efkan Bağda

Medicina 2025, 61(7), 1285; https://doi.org/10.3390/medicina61071285 - 17 Jul 2025

Abstract

Background and Objectives: The efficacy of newly synthesized water-soluble octa-mercaptopyridine-substituted oxotitanium (IV) phthalocyanine (oxo-TiPc) and copper (II) phthalocyanine (CuPc) compounds in photodynamic therapy (PDT) was investigated using human tongue squamous cell cancer cell line (SCC-9, ATCC) cultures. Materials and Methods: A [...] Read more.

Background and Objectives: The efficacy of newly synthesized water-soluble octa-mercaptopyridine-substituted oxotitanium (IV) phthalocyanine (oxo-TiPc) and copper (II) phthalocyanine (CuPc) compounds in photodynamic therapy (PDT) was investigated using human tongue squamous cell cancer cell line (SCC-9, ATCC) cultures. Materials and Methods: A laser light source with a wavelength of 635 nm was used for this study. The cytotoxic values of the cancerous (SCC-9) and healthy (L-929) cell samples to which different Pc concentrations were applied under laser light were evaluated spectroscopically with the XTT method. Results: The oxo-TiPc compound exhibited a significantly lower IC50 value (46.8 µM) for SCC-9 cells compared to the CuPc compound (286.2 µM), indicating higher anticancer activity. This cytotoxicity may be due to decreased aggregation and enhanced reactive oxygen species (ROS) formation. Double-staining tests confirmed that oxo-TiPc-induced cell death included both apoptosis and necrosis. Conclusions: The findings show that the oxo-TiPc compound, unlike the CuPc compound, exhibited more selective toxicity to the SCC-9 cell line and has a higher phototoxic effect. Full article

(This article belongs to the Section Pharmacology)

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17 pages, 444 KiB

Open AccessArticle

The Effect of Extended Dissection of Lymph Nodes (D2plus) with Gastrectomy on the Clinical and Oncological Outcomes in Gastric Cancer Patients, Compared to a Standard Dissection (D2)

by Sahar Lazari, Muhammad Masalha, Forat Swaid, Walid Shalata, Gideon Sroka, Weam Waked and Abed Agbarya

Medicina 2025, 61(7), 1284; https://doi.org/10.3390/medicina61071284 - 16 Jul 2025

Abstract

Background and Objectives: Gastric cancer treatment of partial or complete gastrectomy includes lymph nodes dissection (D2) to remove microscopic lymph node metastases adjacent to the tumor. A more extensive approach, an extended dissection (D2plus) has recently been employed, which includes resection of [...] Read more.

Background and Objectives: Gastric cancer treatment of partial or complete gastrectomy includes lymph nodes dissection (D2) to remove microscopic lymph node metastases adjacent to the tumor. A more extensive approach, an extended dissection (D2plus) has recently been employed, which includes resection of the lymph nodes in the pancreatic and periportal areas. However, despite its potential benefits of longer survival for patients diagnosed with advanced cancer, there are increased risks due to surgical complications. The current study aims to examine the balance between clinical benefit and higher risks of the extended dissection approach versus standard dissection. Materials and Methods: This retrospective analysis of gastric cancer patients treated in Bnai-Zion medical center examined the survival rates, oncological outcomes, and complication rates according to medical records data files. Results: The D2plus group experienced increased postoperative complications rate (56% vs. 20.6% D2 group p = 0.005) with mean survival time, shorter than the D2 standard approach (2.07 years vs. 3.44 years p = 0.01). A higher number of lymph nodes was removed on average in the D2plus group (29.4 ± 11.2), but without statistical significance in comparison to the D2 group (22.6 ± 8.9, p = 0.013). D2plus patients had reduced disease recurrence rates (20% vs. 32.4% in D2 group p = 0.29). Weight loss of D2plus patients was noted for higher rates than the D2 group (40% vs. 17.6% p = 0.056. Conclusions: Our study provides preliminary insights into the comparison between D2 and D2plus dissection in a single-center Western cohort. However, significant baseline differences between groups, particularly age, gender, and histopathological characteristics, limit definitive conclusions. The findings should be interpreted as hypothesis-generating rather than practice-changing. Larger, prospective, multicenter studies with propensity score matching or randomized design are needed to definitively establish the optimal surgical approach for different patient subgroups. Full article

(This article belongs to the Section Gastroenterology & Hepatology)

32 pages, 25018 KiB

Open AccessArticle

VPS26A as a Prognostic Biomarker and Therapeutic Target in Liver Hepatocellular Carcinoma: Insights from Comprehensive Bioinformatics Analysis

by Hye-Ran Kim and Jongwan Kim

Medicina 2025, 61(7), 1283; https://doi.org/10.3390/medicina61071283 - 16 Jul 2025

Abstract

Background and Objectives: VPS26A, a core component of the retromer complex, is pivotal to endosomal trafficking and membrane protein recycling. However, its expression profile, prognostic significance, and clinical relevance in liver hepatocellular carcinoma (LIHC) remain unexplored. This study investigates the prognostic potential of [...] Read more.

Background and Objectives: VPS26A, a core component of the retromer complex, is pivotal to endosomal trafficking and membrane protein recycling. However, its expression profile, prognostic significance, and clinical relevance in liver hepatocellular carcinoma (LIHC) remain unexplored. This study investigates the prognostic potential of VPS26A by extensively analyzing publicly available LIHC-related databases. Materials and Methods: Multiple databases, including TIMER, UALCAN, HPA, GSCA, KM Plotter, OSlihc, MethSurv, miRNet, OncomiR, LinkedOmics, GeneMANIA, and STRING, were used to evaluate VPS26A expression patterns, prognostic implications, correlations with tumor-infiltrating immune cells (TIICs), epigenetic modifications, drug sensitivity, co-expression networks, and protein–protein interactions in LIHC. Results: VPS26A was significantly overexpressed at both the mRNA and protein levels in LIHC tissues compared to that in normal tissues. This upregulation was strongly associated with a poor prognosis. Furthermore, VPS26A expression was both positively and negatively correlated with various TIICs. Epigenetic analysis indicated that VPS26A is regulated by promoter and regional DNA methylation. Additionally, VPS26A influences the sensitivity of LIHC cells to a broad range of anticancer agents. Functional enrichment and co-expression analyses revealed that VPS26A serves as a central regulator of the LIHC transcriptomic landscape, with positively correlated gene sets linked to poor prognosis. Additionally, VPS26A contributes to the molecular architecture governing vesicular trafficking, with potential relevance to diseases involving defects in endosomal transport and autophagy. Notably, miRNAs targeting VPS26A-associated gene networks have emerged as potential prognostic biomarkers for LIHC. VPS26A was found to be integrated into a highly interconnected signaling network comprising proteins in cancer progression, immune regulation, and cellular metabolism. Conclusions: Overall, VPS26A may serve as a potential prognostic biomarker and therapeutic target in LIHC. This study provides novel insights into the molecular mechanisms underlying LIHC progression, and highlights the multifaceted role of VPS26A in tumor biology. Full article

(This article belongs to the Section Oncology)

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13 pages, 309 KiB

Open AccessArticle

The Need for Pediatric Palliative Care in Romania: A Retrospective Study (2022–2023) Based on Quantitative Research and Analysis of Secondary Statistical Data

by Mihaela Hizanu Dumitrache, Mădălina Duceac Covrig, Dana Elena Mîndru, Alina Plesea Condratovici, Geta Mitrea, Eva Maria Elkan, Antoanela Curici, Bogdan Gafton and Letiția Doina Duceac

Medicina 2025, 61(7), 1282; https://doi.org/10.3390/medicina61071282 - 16 Jul 2025

Abstract

Background and Objectives: Estimating the need for palliative care for children is a crucial step in addressing the needs of children facing life-threatening conditions, while providing a powerful argument to combat unacceptably wide disparities in access to care. The need for palliative [...] Read more.

Background and Objectives: Estimating the need for palliative care for children is a crucial step in addressing the needs of children facing life-threatening conditions, while providing a powerful argument to combat unacceptably wide disparities in access to care. The need for palliative care for children in Romania remains insufficiently quantified. More accurate estimates are indispensable to assess the true extent of need and to support adequate policy responses. Materials and Methods: This retrospective cross-sectional study aimed to estimate the need for pediatric palliative care in Romania for 2022–2023. We analyzed secondary data obtained from the General Directorates of Social Assistance and Child Protection (DGASPC) in 41 counties and the six sectors of Bucharest. The analysis focused on life-limiting conditions as defined by the WHO Annex 3, Order no. 253/2018. Results: The study identified 14,499 pediatric cases with palliative care needs, showing a highly uneven national distribution, especially across diagnostic groups and age categories. We observed a higher number of cases in rural areas (7553) compared with urban areas (6946). Our own data do not include resource estimates; however, prior reports indicate only 50 palliative care beds for children in Romania. Conclusions: This study reveals a substantial and unevenly distributed need for pediatric palliative care in Romania, with notable disparities across age groups, diagnostic categories, and urban-rural areas. The identification of 14,499 eligible cases underscores the urgency of developing targeted policies and allocating adequate resources to ensure equitable access to specialized palliative services for all children in need. Full article

(This article belongs to the Section Pediatrics)

14 pages, 8916 KiB

Open AccessReview

Dens Invaginatus: A Comprehensive Review of Classification and Clinical Approaches

by Abayomi O. Baruwa, Craig Anderson, Adam Monroe, Flávia Cracel Nogueira, Luís Corte-Real and Jorge N. R. Martins

Medicina 2025, 61(7), 1281; https://doi.org/10.3390/medicina61071281 - 16 Jul 2025

Abstract

Dens invaginatus is a developmental dental anomaly characterized by the infolding of the enamel organ into the dental papilla during early odontogenesis. This process leads to a broad spectrum of anatomical variations, ranging from minor enamel-lined pits confined to the crown to deep [...] Read more.

Dens invaginatus is a developmental dental anomaly characterized by the infolding of the enamel organ into the dental papilla during early odontogenesis. This process leads to a broad spectrum of anatomical variations, ranging from minor enamel-lined pits confined to the crown to deep invaginations extending through the root, occasionally communicating with periodontal or periapical tissues. The internal complexity of affected teeth presents diagnostic and therapeutic challenges, particularly in severe forms that mimic root canal systems or are associated with pulpal or periapical pathology. Maxillary lateral incisors are most frequently affected, likely due to their unique developmental timeline and morphological susceptibility. Although various classification systems have been proposed, Oehlers’ classification remains the most clinically relevant due to its simplicity and correlation with treatment complexity. Recent advances in diagnostic imaging, especially cone beam computed tomography (CBCT), have revolutionized the identification and classification of these anomalies. CBCT-based adaptations of Oehlers’ classification allow for the precise assessment of invagination extent and pulpal involvement, facilitating improved treatment planning. Contemporary therapeutic strategies now include calcium-silicate-based cement sealing materials, endodontic microsurgery for inaccessible anatomy, and regenerative endodontic procedures for immature teeth with necrotic pulps. Emerging developments in artificial intelligence, genetic research, and tissue engineering promise to further refine diagnostic capabilities and treatment options. Early detection remains critical to prevent complications such as pulpal necrosis or apical disease. A multidisciplinary, image-guided, and patient-centered approach is essential for optimizing clinical outcomes in cases of dens invaginatus. Full article

(This article belongs to the Special Issue Medicine and Dentistry: New Methods and Clinical Approaches—2nd Edition)

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16 pages, 1767 KiB

Open AccessReview

Current Endocrine Therapy in Hormone-Receptor-Positive Breast Cancer: From Tumor Biology to the Rationale for Therapeutic Tunning

by Oana Maria Burciu, Adrian-Grigore Merce, Simona Cerbu, Aida Iancu, Tudor-Alexandru Popoiu, Ionut Marcel Cobec, Ioan Sas and Gabriel Mihail Dimofte

Medicina 2025, 61(7), 1280; https://doi.org/10.3390/medicina61071280 - 16 Jul 2025

Abstract

Background and Objectives: The objective of this review is to evaluate the current evidence regarding hormone treatments for both premenopausal and postmenopausal women with early-stage hormone receptor (HR) positive breast cancer. Materials and Methods: An in-depth exploration of the existing literature was [...] Read more.

Background and Objectives: The objective of this review is to evaluate the current evidence regarding hormone treatments for both premenopausal and postmenopausal women with early-stage hormone receptor (HR) positive breast cancer. Materials and Methods: An in-depth exploration of the existing literature was conducted, with landmark clinical trials such as TEXT, SOFT, ATLAS, and aTTom serving as primary references. Results: Through an extensive review of the literature, our findings indicate that for premenopausal women with HR-positive, HER2-negative BC with a low risk of recurrence, standard 5-year monotherapy with tamoxifen represents the optimal therapeutic management, given its favorable clinical outcomes and lower associated toxicity. In contrast, for premenopausal women with an intermediate to high risk of recurrence with the same tumor characteristics, the most effective approach stated in the literature is a combination of ovarian suppression therapy (chemical/surgical) and an aromatase inhibitor/selective estrogen receptor modulator (tamoxifen), with a possible extension of the standard therapeutic period. In postmenopausal patients with HR-positive, HER2-negative breast cancer with a low recurrence risk, the first line of treatment is usually a standard 5-year period of treatment with aromatase inhibitors (AIs)(letrozole, anastrozole, or exemestane). On the other hand, in postmenopausal women with an intermediate to high risk, combination therapy might be needed, as well as an extension of the standard therapeutic time. Conclusions: Treatment consensus depends on pre- vs. postmenopausal status and recurrence risk. Full article

(This article belongs to the Special Issue New Developments in Diagnosis and Management of Breast Cancer)

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15 pages, 1973 KiB

Open AccessArticle

Factors Affecting the Survival of Metastatic Breast Cancer Patients Treated with CDK 4/6 Inhibitors

by Zehra Sucuoğlu İşleyen, Harun Muğlu, Zeynep Alaca Topçu, Mehmet Beşiroğlu, Ayşe İrem Yasin, Atakan Topçu, Melih Şimşek, Mesut Şeker and Hacı Mehmet Türk

Medicina 2025, 61(7), 1279; https://doi.org/10.3390/medicina61071279 - 16 Jul 2025

Abstract

Background and Objective: We aim to determine the efficacy and the factors associated with the effectiveness of first-line CDK4/6i (ribociclib or palbociclib) treatment in HR-positive, HER2-negative MBC patients. Materials and Methods: This is a retrospective, cross-sectional, and descriptive study. Ninety patients with metastatic [...] Read more.

Background and Objective: We aim to determine the efficacy and the factors associated with the effectiveness of first-line CDK4/6i (ribociclib or palbociclib) treatment in HR-positive, HER2-negative MBC patients. Materials and Methods: This is a retrospective, cross-sectional, and descriptive study. Ninety patients with metastatic breast cancer receiving CDK 4/6i treatment from three different oncology clinics were included in this study. Results: Of the patients, 56 (62.2%) received ribociclib, and 34 (37.8%) were administered palbociclib. There was no significant difference between the groups regarding age, gender, comorbidities, ECOG performance status, or menopausal status (p > 0.05). The cut-off values for ER, PR, and Ki-67 levels were determined via ROC curve analysis. These values were found to be 80% for ER levels, 50% for PR levels, and 30% for Ki-67 levels. PFS was significantly longer for patients with ER levels greater than 80% and Ki-67 expression levels less than 30% according to multivariate analysis. Among the patients included in our study, the median PFS was 22.41 months for the patients with Ki-67 levels of 30% and above, while the median PFS was 17.24 months for the patients with ER levels of 80% and below. Among the patients with a combined ER of 80% or less and a Ki-67 of 30% or more, the median PFS was 12.42 months (p < 0.001). Conclusions: This study demonstrates that CDK4/6i therapies led to longer PFS among patients with ER levels greater than 80% and Ki-67 expression levels less than 30%. It is essential to determine which patient group benefits more from first-line CDK4/6is therapy. Full article

(This article belongs to the Collection Frontiers in Breast Cancer Diagnosis and Treatment)

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10 pages, 290 KiB

Open AccessArticle

Evaluation of Quality of Life in Adult Celiac Patients Living in Lithuania and Their Compliance with a Gluten-Free Diet: A Pilot Study

by Yeliz Serin, Jurgita Andruškienė, Anil K. Verma, Monika Śmiełowska, Nerijus Dzingelevičius, Albinas Vilčiauskis, Rita Vaičekauskaitė, Vijolė Bradauskienė, Bogusław Buszewski and Reda Dzingelevičienė

Medicina 2025, 61(7), 1278; https://doi.org/10.3390/medicina61071278 - 16 Jul 2025

Abstract

Background and Objectives: Celiac disease (CD) is a common gluten-related disorder associated with significantly worsened quality of life. The aim of this pilot study was to evaluate the quality of life of adult celiac patients living in Lithuania and their compliance with [...] Read more.

Background and Objectives: Celiac disease (CD) is a common gluten-related disorder associated with significantly worsened quality of life. The aim of this pilot study was to evaluate the quality of life of adult celiac patients living in Lithuania and their compliance with a gluten-free diet. Materials and Methods: This cross-sectional study was conducted on individuals aged 18 to 75 years diagnosed with CD and residing within the borders of Lithuania. This pilot study involved 73 participants, comprising 68 females and 5 males. The CD Specific Quality of Life Scale (CD-QOL) consisted of 20 items across four sub-dimensions. Responses to scale items were graded with a score ranging from 1 (not at all) to 5 (very much). The total score obtained from the scale can range up to 100, with a score < 40 classified as poor, 40–50 as moderate, and > 50 as good quality of life. Additionally, ten questions related to gluten-free diet-related quality of life were used. Results: The mean age of diagnosis for females (32.6 ± 11.7) was higher than that for males (22.0 ± 12.1), p < 0.05. The mean self-reported BMI for males (25.8 ± 4.5) was higher than that for females (22.3 ± 5.2), p < 0.05. The mean quality-of-life score (66.4 ± 12.5) was significantly higher in the good quality-of-life group compared to the poor group (33.7 ± 3.9), p < 0.001. Half of the respondents (50.7%) reported that gluten-free products are expensive, and 45.2% confirmed difficulties in dining out on a gluten-free diet. Conclusions: The results of this pilot study indicate that CD is associated with a worsened quality of life and that compliance with a gluten-free diet is primarily influenced by economic factors, such as the high cost of the diet. Full article

(This article belongs to the Section Gastroenterology & Hepatology)

24 pages, 1802 KiB

Open AccessSystematic Review

Non-Invasive Telemonitoring in Heart Failure: A Systematic Review

by Patrick A. Kwaah, Emmanuel Olumuyide, Kassem Farhat, Barbara Malaga-Espinoza, Ahmed Abdullah, Michael H. Beasley, Novi Y. Sari, Lily K. Stern, Julio A. Lamprea-Montealegre, Adrian daSilva-deAbreu and Jiun-Ruey Hu

Medicina 2025, 61(7), 1277; https://doi.org/10.3390/medicina61071277 - 15 Jul 2025

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Abstract

Background and Objectives: Heart failure (HF) represents a major public health challenge worldwide, with rising prevalence, high morbidity and mortality rates, and substantial healthcare costs. Non-invasive telemonitoring has emerged as a promising adjunct in HF management, yet its clinical effectiveness remains unclear. Materials [...] Read more.

Background and Objectives: Heart failure (HF) represents a major public health challenge worldwide, with rising prevalence, high morbidity and mortality rates, and substantial healthcare costs. Non-invasive telemonitoring has emerged as a promising adjunct in HF management, yet its clinical effectiveness remains unclear. Materials and Methods: In this systematic review, we summarize randomized controlled trials (RCTs) between 2004 and 2024 examining the efficacy of non-invasive telemonitoring on mortality, readmission, and quality of life (QoL) in HF. In addition, we characterize the heterogeneity of features of different telemonitoring interventions. Results: In total, 32 RCTs were included, comprising 13,294 participants. While some individual studies reported benefits, non-invasive telemonitoring demonstrated mixed effects on mortality, readmission rates, and QoL. The most common modality for interfacing with patients was by mobile application (53%), followed by web portals (22%), and stand-alone devices (19%). Periodic feedback (63%) was more common than continuous feedback (31%) or on-demand feedback (6%). Clinician reviews of patient telemonitoring data was event-triggered (44%) more commonly than based on a prespecified timeline (38%). In most designs (90%), patients played a passive role in telemonitoring. Conclusions: Non-invasive telemonitoring interventions for HF exhibited considerable variation in duration and system design and had a low rate of patient engagement. Future work should focus on identifying telemonitoring-responsive subgroups and refining telemonitoring strategies to complement traditional HF care. Full article

(This article belongs to the Section Cardiology)

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12 pages, 541 KiB

Open AccessReview

The Evolving Role of Extracorporeal In Situ Perfusion Technology in Organ Donor Recovery with Donation After Circulatory Determination of Death Organ Donors

by Victoria R. Hammond, Marisa E. Franklin and Glen A. Franklin

Medicina 2025, 61(7), 1276; https://doi.org/10.3390/medicina61071276 - 15 Jul 2025

Viewed by 63

Abstract

The need for organs suitable for transplantation has continued to rise as need outweighs availability. Increased demand has driven innovation in the field. Over the past ten years, donation after circulatory death (DCD) donors have become a greater portion of the donor pool. [...] Read more.

The need for organs suitable for transplantation has continued to rise as need outweighs availability. Increased demand has driven innovation in the field. Over the past ten years, donation after circulatory death (DCD) donors have become a greater portion of the donor pool. This method of donation includes a period of warm ischemia time to the organs. Thus, its use is dependent on recovery methods. Historically, extracorporeal membrane oxygenation (ECMO) was one of the first pumping technologies to enhance organ preservation in the potential donor. Subsequently, the adoption of normothermic regional perfusion (NRP) technology has also shown promise in organ transplantation. These technologies have increased utilization of organs and enhanced the pool of donor organs. This review seeks to summarize the literature supporting in situ technologies (ECMO and NRP) utilized in procurement of solid organs from DCD donors. The benefit of in situ perfusion in DCD organ recovery is that these technologies increase the number of organs available for transplantation by reducing ischemic injury. The disadvantages include the added technical aspect, added operating room time, and the increased ethical concerns surrounding these technologies compared to conventional methods of organ recovery. Full article

(This article belongs to the Section Pulmonology)

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12 pages, 300 KiB

Open AccessArticle

Prevalence, Appropriateness, and Outcomes of Colistin Use in Multidrug-Resistant Pseudomonas aeruginosa Infections: Insights from Hospital Data

by Rana K. Abu-Farha, Savana Sobh, Khawla Abu Hammour, Feras Darwish El-Hajji, Sireen A. Shilbayeh and Rania Itani

Medicina 2025, 61(7), 1275; https://doi.org/10.3390/medicina61071275 - 15 Jul 2025

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Abstract

Background and Objectives: This study aimed to assess the prevalence of colistin prescriptions among patients with multidrug-resistant (MDR) Pseudomonas aeruginosa (P. aeruginosa) infections admitted to a tertiary teaching hospital in Jordan. Additionally, the study evaluated the appropriateness of colistin prescriptions and [...] Read more.

Background and Objectives: This study aimed to assess the prevalence of colistin prescriptions among patients with multidrug-resistant (MDR) Pseudomonas aeruginosa (P. aeruginosa) infections admitted to a tertiary teaching hospital in Jordan. Additionally, the study evaluated the appropriateness of colistin prescriptions and assessed resistance levels of this strain. Materials and Methods: In this retrospective study, adult patients who were infected with MDR P. aeruginosa and were admitted to Jordan University Hospital between January 2018 and March 2024 were included. Data on demographics, clinical characteristics, sources of infection, antibiotic therapy, and clinical outcomes were collected. Results: Out of the 85 patients who met the inclusion criteria for having MDR P. aeruginosa, colistin was administered to 16 patients (18.8%). Notably, approximately two-thirds (68.7%) of the isolates from patients who received colistin were classified as extensively drug-resistant (XDR). Among the isolates, 15 out of 16 (93.8%) were resistant to both ciprofloxacin and imipenem. Among the patients requiring colistin, five (31.3%) discontinued therapy, while two (12.5%) remained on colistin despite the availability of safer alternatives. No significant difference was observed in 30-day all-cause mortality between patients treated with colistin (0%) and those who were not (4.3%, p = 1.00). Similarly, the incidence of acute kidney injury did not differ significantly between the colistin group (0%) and the non-colistin group (p = 1.00). No significant difference was found in the hospital stay between colistin-treated patients (median 10.5 days, IQR [5.0–14.0]) and those not treated with colistin (median 13.0 days, IQR [7.0–21.0]), (p = 0.22). Conclusions: This study demonstrated that colistin was selectively initiated in high-risk patients, particularly those with XDR P. aeruginosa. However, its inappropriate continuation despite safer alternatives, as well as its discontinuation when no other options existed, raise concerns about antibiotic de-escalation practices. Interestingly, no significant differences in mortality or acute kidney injury were observed between patients who were treated with colistin and those who were not. These findings emphasize the need for antimicrobial stewardship programs and highlight the importance of large-scale trials to evaluate colistin’s efficacy and safety in MDR infections. Full article

(This article belongs to the Section Infectious Disease)

14 pages, 1872 KiB

Open AccessArticle

Proposing an Optimal Occlusal Angle for Minimizing Masticatory and Cervical Muscle Activity in the Supine Position: A Resting EMG and Mixed-Effects Modeling Study

by Kyung-Hee Kim, Chang-Hyung Lee, Sungchul Huh, Byong-Sop Song, Hye-Min Ju, Sung-Hee Jeong, Yong-Woo Ahn and Soo-Min Ok

Medicina 2025, 61(7), 1274; https://doi.org/10.3390/medicina61071274 - 15 Jul 2025

Viewed by 71

Abstract

Background: The occlusal angle (OA), influenced by pillow height, may affect muscle tension in the head and neck. However, its optimal range for minimizing muscle activation has not been clearly defined. Objective: This study aimed to investigate the effects of OA on the [...] Read more.

Background: The occlusal angle (OA), influenced by pillow height, may affect muscle tension in the head and neck. However, its optimal range for minimizing muscle activation has not been clearly defined. Objective: This study aimed to investigate the effects of OA on the resting muscle activity of masticatory and cervical muscles and to identify an optimal OA range using cluster analysis and linear mixed-effects modeling. Methods: The resting muscle activities of the masseter (MAS), temporalis (TEM), sternocleidomastoid (SCM), and posterior vertebral muscles (PVM) were measured at OA conditions modulated by pillow heights of 0, 5, and 10 cm at 0, 1, and 5 min in the supine position. Intraclass correlation coefficients (ICCs) assessed measurement reliability. Statistical analyses included ANOVA, ROC curve analysis, k-means clustering, and linear mixed-effects models. Results: MAS and TEM resting muscle activity ratio (RMR) significantly increased with larger OA values (p < 0.001), while SCM showed decreased activation (p = 0.001). An OA range of 105°–111° was identified as the center of a low-activity cluster, and an upper cut-off of 138° was associated with potential muscular overload. ICC values for MAS and SCM ranged from 0.82 to 0.89, indicating excellent test–retest reliability. Conclusions: OA modulated by pillow height is a modifiable factor that influences muscle activity. An OA of 105°–111° may serve as a practical comfort zone, especially for individuals at risk of TMDs. Full article

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

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14 pages, 1713 KiB

Open AccessArticle

Clinical Application of a Customized Gene Panel for Identifying Autism Spectrum Disorder-Associated Variants

by Vittoria Greco, Donatella Greco, Simone Treccarichi, Maria Bottitta, Pinella Failla, Antonino Musumeci, Carla Papa, Valeria Chiavetta, Francesco Calì and Mirella Vinci

Medicina 2025, 61(7), 1273; https://doi.org/10.3390/medicina61071273 - 14 Jul 2025

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Abstract

Background and Objectives: Autism spectrum disorder (ASD) is a neurodevelopmental disorder that belong to genetic and epigenetic mechanism. Despite the recent advantages in next-generation sequencing (NGS) technology, ASD etiology is still unclear. Materials and Methods: In this study, we tested a [...] Read more.

Background and Objectives: Autism spectrum disorder (ASD) is a neurodevelopmental disorder that belong to genetic and epigenetic mechanism. Despite the recent advantages in next-generation sequencing (NGS) technology, ASD etiology is still unclear. Materials and Methods: In this study, we tested a customized target genetic panel consisting of 74 genes in a cohort of 53 ASD individuals. The tested panel was designed from the SFARI database. Results: Among 53 patients analyzed using a targeted genetic panel, 102 rare variants were identified, with nine individuals carrying likely pathogenic or pathogenic variants considered genetically “positive.” We identified six de novo variants across five genes (POGZ 2 variants, NCOR1, CHD2, ADNP, and GRIN2B), including two variants of uncertain significance in POGZ p.Thr451Met and NCOR1 p.Glu1137Lys, one likely pathogenic variant in GRIN2B p.Leu714Gln, and three pathogenic variants in POGZ p.Leu775Valfs32, CHD2 p.Thr1108Metfs8, and ADNP p.Pro5Argfs*2. Conclusions: This study presents a comprehensive characterization of the targeted gene panel used for genetic analysis, while critically evaluating its diagnostic limitations within the context of contemporary genomic approaches. A pivotal accomplishment of this study was the ClinVar submission of novel de novo variants which expands the documented mutational spectrum of ASD-associated genes and enhances future diagnostic interpretation. Full article

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

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17 pages, 362 KiB

Open AccessReview

Innovations in Stress Urinary Incontinence: A Narrative Review

by Tamas Szabo, Melinda-Ildiko Mitranovici, Liviu Moraru, Dan Costachescu, Laura Georgiana Caravia, Elena Bernad, Viviana Ivan, Adrian Apostol, Mihai Munteanu and Lucian Puscasiu

Medicina 2025, 61(7), 1272; https://doi.org/10.3390/medicina61071272 - 14 Jul 2025

Viewed by 69

Abstract

Urinary incontinence is characterized by the involuntary leakage of urine. The primary cause of stress urinary incontinence in women is the weakening of the pelvic floor muscles. Stress urinary incontinence (SUI) is a significant global health problem that impacts mainly middle-aged women, with [...] Read more.

Urinary incontinence is characterized by the involuntary leakage of urine. The primary cause of stress urinary incontinence in women is the weakening of the pelvic floor muscles. Stress urinary incontinence (SUI) is a significant global health problem that impacts mainly middle-aged women, with a severe impact on their quality of life. Traditional diagnostic methods and treatments often fail, although technological innovations have improved diagnostic accuracy, such as specific questionnaires or transperineal ultrasound. While medical therapies and surgical procedures are continuously being developed, controversies about the correct choices regarding diagnostic and treatment methods continue to exist. The aim of our review was to identify the innovative diagnostic tools and effective treatment procedures for SUI. A narrative review was conducted due to the heterogeneity of the studies. New methods for diagnosis and treatment have gained ground, and we have covered them in our review; however, the field continues to expand. A personalized approach to diagnosis is also a requirement because of the limitations of conventional urodynamic studies, and we emphasize the importance of such personalization in enhancing clinical decision making. Future medical strategies that combine both preventive and therapeutic care are desirable. Newer technologies were brought to light in this review, including stem cell therapy and laser therapy. Full article

(This article belongs to the Special Issue New Insights into Gynecological Disease)

21 pages, 5279 KiB

Open AccessArticle

The Influence of Zn and Ca Addition on the Microstructure, Mechanical Properties, Cytocompatibility, and Electrochemical Behavior of WE43 Alloy Intended for Orthopedic Applications

by Mircea Cătălin Ivănescu, Corneliu Munteanu, Ramona Cimpoeșu, Maria Daniela Vlad, Bogdan Istrate, Fabian Cezar Lupu, Eusebiu Viorel Șindilar, Alexandru Vlasa, Cristinel Ionel Stan, Maria Larisa Ivănescu and Georgeta Zegan

Medicina 2025, 61(7), 1271; https://doi.org/10.3390/medicina61071271 - 14 Jul 2025

Viewed by 109

Abstract

Background and Objectives: Magnesium (Mg)-based materials, such as the WE43 alloy, show potential in biomedical applications owing to their advantageous mechanical properties and biodegradability; however, their quick corrosion rate and hydrogen release restrict their general clinical utilization. This study aimed to develop [...] Read more.

Background and Objectives: Magnesium (Mg)-based materials, such as the WE43 alloy, show potential in biomedical applications owing to their advantageous mechanical properties and biodegradability; however, their quick corrosion rate and hydrogen release restrict their general clinical utilization. This study aimed to develop a novel Mg-Zn-Ca alloy system based on WE43 alloy, evaluating the influence of Zn and Ca additions on microstructure, mechanical properties, cytocompatibility, and electrochemical behavior for potential use in biodegradable orthopedic applications. Materials and Methods: The WE43-Zn-Ca alloy system was developed by alloying standard WE43 (Mg–Y–Zr–RE) with 1.5% Zn and Ca concentrations of 0.2% (WE43_0.2Ca alloy) and 0.3% (WE43_0.3Ca alloy). Microstructural analysis was performed utilizing scanning electron microscopy (SEM) in conjunction with energy-dispersive X-ray spectroscopy (EDS), while the chemical composition was validated through optical emission spectroscopy and X-ray diffraction (XRD). Mechanical properties were assessed through tribological tests. Electrochemical corrosion behavior was evaluated using potentiodynamic polarization in a 3.5% NaCl solution. Cytocompatibility was assessed in vitro on MG63 cells using cell viability assays (MTT). Results: Alloys WE43_0.2Ca and WE43_0.3Ca exhibited refined, homogeneous microstructures with grain sizes between 70 and 100 µm, without significant structural defects. Mechanical testing indicated reduced stiffness and an elastic modulus similar to human bone (19.2–20.3 GPa), lowering the risk of stress shielding. Cytocompatibility tests confirmed non-cytotoxic behavior for alloys WE43_0.2Ca and WE43_0.3Ca, with increased cell viability and unaffected cellular morphology. Conclusions: The study validates the potential of Mg-Zn-Ca alloys (especially WE43_0.3Ca) as biodegradable biomaterials for orthopedic implants due to their favorable combination of mechanical properties, corrosion resistance, and cytocompatibility. The optimization of these alloys contributed to obtaining an improved microstructure with a reduced degradation rate and a non-cytotoxic in vitro outcome, which supports efficient bone tissue regeneration and its integration into the body for complex biomedical applications. Full article

(This article belongs to the Special Issue Oral Physiology: Protective Mechanisms, Immune Responses and Pathways of Inflammation in Periodontal Conditions)

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15 pages, 987 KiB

Open AccessArticle

Type 2 Diabetes Mellitus in Patients with Different Types of Thyroid Nodular Lesions Among Western Romanian Patients: A Comprehensive Clinical, Biochemical, and Hormonal Analysis

by Mervat Matei, Sergiu-Ciprian Matei, Flavia-Medana Petrașcu, Ioana Golu, Melania Balaş, Daniela Amzăr, Ana-Maria Ungureanu, Bianca Roxana Natarâş and Mihaela Maria Vlad

Medicina 2025, 61(7), 1270; https://doi.org/10.3390/medicina61071270 - 14 Jul 2025

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Abstract

Background and Objectives: The prevalence of thyroid nodules and type 2 diabetes mellitus (T2D) has increased. This study firstly aims to assess the prevalence of T2DM among thyroid nodules patients who underwent total thyroidectomy in the Western Romanian population. By focusing on [...] Read more.

Background and Objectives: The prevalence of thyroid nodules and type 2 diabetes mellitus (T2D) has increased. This study firstly aims to assess the prevalence of T2DM among thyroid nodules patients who underwent total thyroidectomy in the Western Romanian population. By focusing on the biochemical and hormonal parameters, it also aims to provide insights into possible connections between T2D and different types (benignant or malignant) of thyroid nodules. Materials and Methods: A total of 926 patients who underwent total thyroidectomy were analysed, comprising 99 (10.7%) T2D patients and 827 (89.3%) non-diabetic patients (non-T2D). Results: This study’s results revealed an increased prevalence of T2D among thyroid nodules patients. Among these patients, higher values of FT4 and inflammatory markers and a higher prevalence of malignant nodules (55%, p = 0.001) were noted. Conclusions: Our study revealed an increased prevalence of T2D among thyroid nodules patients. The biochemical profile of thyroid nodules in T2D patients presents aspects, like elevated FT4 and inflammatory markers, which should be considered in their clinical management. Furthermore, a T2D patient seems to be more likely to develop thyroid malignancies. Thyroid screening strategies in diabetic patients should be considered. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Type 2 Diabetes Mellitus)

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19 pages, 1293 KiB

Open AccessReview

Customized 3D-Printed Scaffolds for Alveolar Ridge Augmentation: A Scoping Review of Workflows, Technology, and Materials

by Saeed A. Elrefaei, Lucrezia Parma-Benfenati, Rana Dabaja, Paolo Nava, Hom-Lay Wang and Muhammad H. A. Saleh

Medicina 2025, 61(7), 1269; https://doi.org/10.3390/medicina61071269 - 14 Jul 2025

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Abstract

Background and Objectives: Bone regeneration (BR) is a cornerstone technique in reconstructive dental surgery, traditionally using either barrier membranes, titanium meshes, or perforated non-resorbable membranes to facilitate bone regeneration. Recent advancements in 3D technology, including CAD/CAM and additive manufacturing, have enabled the development [...] Read more.

Background and Objectives: Bone regeneration (BR) is a cornerstone technique in reconstructive dental surgery, traditionally using either barrier membranes, titanium meshes, or perforated non-resorbable membranes to facilitate bone regeneration. Recent advancements in 3D technology, including CAD/CAM and additive manufacturing, have enabled the development of customized scaffolds tailored to patient needs, potentially overcoming the limitations of conventional methods. Materials and Methods: A scoping review was conducted according to the PRISMA guidelines. Electronic searches were performed in MEDLINE (PubMed), the Cochrane Library, Scopus, and Web of Science up to January 2025 to identify studies on digital technologies applied to bone augmentation. Eligible studies encompassed randomized controlled trials, cohort studies, case series, and case reports, all published in English. Data regarding digital workflows, software, materials, printing techniques, and sterilization methods were extracted from 23 studies published between 2015 and 2024. Results: The review highlights a diverse range of digital workflows, beginning with CBCT-based DICOM to STL conversion using software such as Mimics and Btk-3D^®. Customized titanium meshes and other meshes like Poly Ether-Ether Ketone (PEEK) meshes were produced via techniques including direct metal laser sintering (DMLS), selective laser melting (SLM), and five-axis milling. Although titanium remained the predominant material, studies reported variations in mesh design, thickness, and sterilization protocols. The findings underscore that digital customization enhances surgical precision and efficiency in BR, with several studies demonstrating improved bone gain and reduced operative time compared to conventional approaches. Conclusions: This scoping review confirms that 3D techniques represent a promising advancement in BR. Customized digital workflows provide superior accuracy and support for BR procedures, yet variability in protocols and limited high-quality trials underscore the need for further clinical research to standardize techniques and validate long-term outcomes. Full article

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

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17 pages, 1657 KiB

Open AccessArticle

The Possibilities of Multiparametric Magnetic Resonance Imaging to Reflect Functional and Structural Graft Changes 1 Year After Kidney Transplantation

by Andrejus Bura, Gintare Stonciute-Balniene, Laura Velickiene, Inga Arune Bumblyte, Ruta Vaiciuniene and Antanas Jankauskas

Medicina 2025, 61(7), 1268; https://doi.org/10.3390/medicina61071268 - 13 Jul 2025

Viewed by 126

Abstract

Background and Objectives: Non-invasive imaging biomarkers for the early detection of chronic kidney allograft injury are needed to improve long-term transplant outcomes. T1 mapping by magnetic resonance imaging (MRI) has emerged as a promising method to assess renal structure and function. This [...] Read more.

Background and Objectives: Non-invasive imaging biomarkers for the early detection of chronic kidney allograft injury are needed to improve long-term transplant outcomes. T1 mapping by magnetic resonance imaging (MRI) has emerged as a promising method to assess renal structure and function. This study aimed to determine the potential of MRI as a diagnostic tool for evaluating graft function and structural changes in kidney grafts 1 year after transplantation. Materials and Methods: Thirty-four kidney transplant recipients were prospectively recruited, with 27 completing the follow-up at one year. Renal MRI at 3T was performed to acquire T1, T2, and apparent diffusion coefficient (ADC) maps. Clinical parameters, including estimated glomerular filtration rate (eGFR), albumin-to-creatinine ratio (ACR), protein-to-creatinine ratio (PCR), and histological IF/TA scores, were collected. MRI parameters were compared across the groups stratified by clinical and histological markers. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) analysis. Results: At 1 year, T1 corticomedullary differentiation (CMD) values were significantly higher in patients with elevated ACR (≥3 mg/mmol), PCR (≥15 mg/mmol), and mild to moderate or severe IF/TA, reflecting a reduction in the corticomedullary gradient. T1 CMD demonstrated moderate-to-good diagnostic performance in detecting ACR (AUC 0.791), PCR (AUC 0.730), and IF/TA (AUC 0.839). No significant differences were observed in T2 or ADC values across these groups. T1 CMD also showed a significant positive correlation with ACR but not with eGFR, suggesting a closer association with structural rather than functional deterioration. Conclusions: T1 mapping, particularly T1 CMD, shows promise as a non-invasive imaging biomarker for detecting chronic allograft injury and monitoring renal function 1 year after kidney transplantation. Full article

(This article belongs to the Special Issue End-Stage Kidney Disease (ESKD))

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14 pages, 284 KiB

Open AccessReview

Targeting Arthrogenic Muscle Inhibition in Chronic Ankle Instability: A Narrative Review of Neural and Functional Rehabilitation Strategies

by Roberto Tedeschi, Federica Giorgi and Danilo Donati

Medicina 2025, 61(7), 1267; https://doi.org/10.3390/medicina61071267 - 13 Jul 2025

Viewed by 162

Abstract

Background and Objectives: Arthrogenic muscle inhibition (AMI) is a key neurophysiological barrier to effective rehabilitation in individuals with chronic ankle instability (CAI). The primary objective of this narrative review is to explore the role of arthrogenic muscle inhibition (AMI) in chronic ankle [...] Read more.

Background and Objectives: Arthrogenic muscle inhibition (AMI) is a key neurophysiological barrier to effective rehabilitation in individuals with chronic ankle instability (CAI). The primary objective of this narrative review is to explore the role of arthrogenic muscle inhibition (AMI) in chronic ankle instability (CAI) and to critically appraise neurophysiological and rehabilitative strategies targeting its resolution. Although peripheral strengthening remains a cornerstone of treatment, the roles of spinal and cortical modulation are increasingly recognised. Materials and Methods: A narrative review was conducted to examine recent clinical trials targeting AMI in CAI populations. A structured search of MEDLINE, Web of Science, Scopus, Cochrane Central, and PEDro was performed. Five studies were included, encompassing peripheral, spinal, and cortical interventions. The outcomes were grouped and analysed according to neurophysiological and functional domains. Results: Manual therapy combined with exercise improved pain, strength, and functional mobility. Fibular reposition taping transiently enhanced spinal reflex excitability, while transcranial direct current stimulation (tDCS) over the primary motor cortex significantly modulated corticospinal excitability and voluntary muscle activation. Improvements in subjective stability, dynamic balance, and neuromuscular responsiveness were observed in the majority of the five included studies, although methodological heterogeneity and short-term follow-ups limit generalisability. Conclusions: Multimodal interventions targeting different levels of the neuromotor system appear to be more effective than isolated approaches. Integrating manual therapy, sensorimotor training, and neuromodulation may optimise outcomes in CAI rehabilitation. Future trials should focus on standardised outcome measures and long-term efficacy. Full article

(This article belongs to the Special Issue Physical Therapy: A New Perspective)

12 pages, 781 KiB

Open AccessArticle

Effects of Adjuvant Respiratory Therapy on Secretion Expectoration and Treatment Adherence in Patients with Head and Neck Cancer Receiving Concurrent Chemo-Radiotherapy

by Hsiu-Ying Cho, Lan-Ti Chou, Chien-Yu Lin, Hsiu-Feng Hsiao, Chun Yu Lin and Horng-Chyuan Lin

Medicina 2025, 61(7), 1266; https://doi.org/10.3390/medicina61071266 - 13 Jul 2025

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Abstract

Background and Objectives: The common complaints of head and neck cancer patients receiving concurrent chemo-radiotherapy (CCRT) are dry mouth, dysphagia, trismus, hoarseness, sore throat, and oral mucosal damage, which result in retained secretions and difficult expectoration. We aimed to investigate the effect of [...] Read more.

Background and Objectives: The common complaints of head and neck cancer patients receiving concurrent chemo-radiotherapy (CCRT) are dry mouth, dysphagia, trismus, hoarseness, sore throat, and oral mucosal damage, which result in retained secretions and difficult expectoration. We aimed to investigate the effect of adjuvant respiratory therapy on secretion expectoration and treatment completion in patients with head and neck cancer receiving CCRT. Materials and Methods: From November 2016 to May 2018, 56 head and neck cancer patients were recruited retrospectively, and according to their respiratory therapy in the medical record, were divided into the control group (CG, n = 27) or the research group (RG, n = 29). In the CG, the patients were treated via the teaching of routine breathing exercises and expel techniques, while patients in the RG were treated with the inhalation of a ß-agonist bronchodilator agent five times each week, in addition to the standard treatment administered in the CG. Results: The total completion rate of treatment was significantly higher in the RG (21 patients) compared with the CG (12 patients) (72.4% vs. 44.4%, p < 0.05). After therapy, the rates of clinical symptoms were significantly increased in the RG compared with the CG, including smooth expectoration (76.2% vs. 75.0%), decreased secretions (61.9% vs. 58.3%), reduced viscosity of secretions (66.7% vs. 58.3%), lower cough frequency (71.4% vs. 50.0%), improved sore throat (52.4% vs. 41.7%), and swallowing function (52.4% vs. 50.0%). The continuation of chemo-radiotherapy without disruption was higher in the RG than it was in the CG (66.7% vs. 50.0%). There was no significant difference in adverse effects between the two groups. Conclusions: Adjuvant respiratory therapy not only improves secretion expectoration, but also reduces side effects, thus promoting the completion of the CCRT schedule in patients with head and neck cancer. Full article

(This article belongs to the Section Oncology)

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13 pages, 664 KiB

Open AccessArticle

Application of Interrupter Resistance and Spirometry Techniques in Pediatric Pulmonary Medicine: Feasibility and Concordance in Healthy Children Under 8 Years

by Rim Kammoun, Farah Gargouri, Asma Haddar, Halil İbrahim Ceylan, Valentina Stefanica, Walid Feki, Hatem Ghouili, Ismail Dergaa and Kaouthar Masmoudi

Medicina 2025, 61(7), 1265; https://doi.org/10.3390/medicina61071265 - 13 Jul 2025

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Abstract

Background and Objectives: Pediatric pulmonary medicine relies heavily on accurate lung function assessment, yet conventional spirometry presents challenges in children due to cooperation requirements. In this context, the interrupter resistance technique (Rint), a method used in pediatric pulmonology, offers a potentially more [...] Read more.

Background and Objectives: Pediatric pulmonary medicine relies heavily on accurate lung function assessment, yet conventional spirometry presents challenges in children due to cooperation requirements. In this context, the interrupter resistance technique (Rint), a method used in pediatric pulmonology, offers a potentially more feasible alternative for evaluating airway resistance in younger populations. This study aimed to assess the feasibility and clinical concordance between expiratory interrupter resistance (Rint(e)) and standard spirometry in healthy children under 8 years, thus contributing to the development of age-appropriate pulmonary function testing in pediatric medicine. Materials and Methods: A cross-sectional study was conducted on 200 healthy children (aged 2–8 years) in Tunisia. Pulmonary measurements were taken using a handheld device for both Rint(e) and spirometry. Feasibility rates were calculated, and correlations between the techniques were statistically analyzed. Results: Rint(e) showed significantly higher feasibility than spirometry (82.5% vs. 34.5%, p < 0.05). While older children had higher success rates with both techniques, feasibility was independent of sex, BMI, and passive smoking exposure. Moderate negative correlations were found between log Rint(e) and FEV1/FVC indices. Conclusions: In pediatric pulmonary assessment, Rint(e) demonstrated higher feasibility than spirometry among young children, making it a practical complementary method in clinical settings. However, due to only moderate correlation with spirometric indices, Rint(e) cannot yet replace spirometry in diagnostic use. Its integration into pediatric medicine may help address the gap in functional respiratory evaluation for children under the age of 8. Full article

(This article belongs to the Section Pediatrics)

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17 pages, 364 KiB

Open AccessReview

The Role of Plant-Based Diets and Personalized Nutrition in Endometriosis Management: A Review

by Marijana Matek Sarić, Tamara Sorić, Ana Sarić, Emili Marušić, Miran Čoklo, Mladen Mavar, Marija Ljubičić and Nataša Lisica Šikić

Medicina 2025, 61(7), 1264; https://doi.org/10.3390/medicina61071264 - 13 Jul 2025

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Abstract

Endometriosis is a chronic, estrogen-dependent inflammatory condition that affects multiple organ systems and significantly impairs the quality of life in women of reproductive age. While conventional hormonal therapies may alleviate symptoms of endometriosis, they are also frequently associated with intolerable side effects. As [...] Read more.

Endometriosis is a chronic, estrogen-dependent inflammatory condition that affects multiple organ systems and significantly impairs the quality of life in women of reproductive age. While conventional hormonal therapies may alleviate symptoms of endometriosis, they are also frequently associated with intolerable side effects. As a result, there is growing interest in complementary, non-invasive strategies to support long-term disease management. This review explores the potential of plant-based diets and personalized nutrition as adjunctive approaches in endometriosis care. Plant-based dietary patterns, which are rich in antioxidants, phytochemicals, dietary fiber, and essential micronutrients, have been shown to reduce systemic inflammation, modulate estrogen activity, and alleviate pelvic pain. Additionally, the use of medicinal plants, such as curcumin and ginger, has demonstrated anti-inflammatory and anti-proliferative effects in preclinical studies. Moreover, identifying and addressing individual food sensitivities, particularly to gluten, dairy, or fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, may improve gastrointestinal and inflammatory symptoms in susceptible individuals. Future research should focus on high-quality clinical trials and integrative care models to evaluate the long-term efficacy, safety, and sustainability of these individualized nutritional interventions in the holistic management of endometriosis. Full article

(This article belongs to the Section Obstetrics and Gynecology)

19 pages, 1773 KiB

Open AccessSystematic Review

Immunomodulatory Effects of Anesthetic Techniques in Lung Cancer Surgery: A Systematic Review and Meta-Analysis

by Georgios Konstantis, Ilias Katsadouros, Georgia Tsaousi, Vasileios Grosomanidis and Chryssa Pourzitaki

Medicina 2025, 61(7), 1263; https://doi.org/10.3390/medicina61071263 - 12 Jul 2025

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Abstract

Background and Objectives: Lung cancer represents one of the principal causes of cancer-associated mortality worldwide. Despite the numerous novel therapeutic agents, surgical resection remains, in many cases, the mainstay treatment. A growing body of evidence indicates that the anesthetic technique of choice [...] Read more.

Background and Objectives: Lung cancer represents one of the principal causes of cancer-associated mortality worldwide. Despite the numerous novel therapeutic agents, surgical resection remains, in many cases, the mainstay treatment. A growing body of evidence indicates that the anesthetic technique of choice contributes to perioperative immunosuppression, thus having an impact on cancer recurrence and prognosis. The aim of this systematic review is to provide a thorough summary of the current literature regarding the modulation of the immune response induced by the various anesthetic techniques that are used in lung cancer surgery, with a particular emphasis on cellular immunity. Materials and Methods: PubMed, Scopus, and the Cochrane databases were systematically searched from November 2023 up to March 2024 to identify randomized controlled trials (RCTs) that met the eligibility criteria. Results: A total of seven RCTs were included. Four of the RCTs compared the administration of general anesthesia alone versus general anesthesia combined with epidural anesthesia. The subsequent meta-analysis showed that the combination of general and epidural anesthesia exerted a positive impact on the cell counts of the CD3+ cells (SMD −0.42, 95% Cl −0.70 to −0.13 24 h postoperatively and SMD −0.86 95% Cl −1.48 to −0.23 72 h postoperatively), the CD4+ cells (SMD −0.41 95% Cl −0.69 to −0.12 at the end of surgery and SMD −0.56 95% Cl −0.85 to −0.27 72 h later), and the CD4+/CD8+ ratio (SMD −0.31 95% Cl −0.59 to −0.02 immediately after surgery, SMD −0.50 95% Cl −0.86 to −0.14 24 h postoperatively, and SMD −0.60 95% Cl −0.89 to −0.31 72 h later). The pooled results regarding CD8+ and NK cell counts were inconclusive. The remaining three studies compared volatile-based anesthesia with total intravenous anesthesia (TIVA). Due to disparities between these studies, qualitative analysis was inconclusive, whereas quantitative analysis was not feasible. Conclusions: The supplementation of general anesthesia with epidural anesthesia favorably impacts CD3+ and CD4+ cell counts, as well as the CD4+/CD8+ ratio. The present results and the effects of anesthetic technique on other immune cells must be consolidated with further high-quality studies. Full article

(This article belongs to the Section Pharmacology)

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Medicina, Volume 61, Issue 7 (July 2025) – 177 articles

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