Medicina

21 pages, 559 KiB

Open AccessArticle

Development and Validation of Predictive Models for Non-Adherence to Antihypertensive Medication

by Cristian Daniel Marineci, Andrei Valeanu, Cornel Chiriță, Simona Negreș, Claudiu Stoicescu and Valentin Chioncel

Medicina 2025, 61(7), 1313; https://doi.org/10.3390/medicina61071313 - 21 Jul 2025

Abstract

Background and Objectives: Investigating the adherence to antihypertensive medication and identifying patients with low adherence allows targeted interventions to improve therapeutic outcomes. Artificial intelligence (AI) offers advanced tools for analyzing medication adherence data. This study aimed to develop and validate several predictive [...] Read more.

Background and Objectives: Investigating the adherence to antihypertensive medication and identifying patients with low adherence allows targeted interventions to improve therapeutic outcomes. Artificial intelligence (AI) offers advanced tools for analyzing medication adherence data. This study aimed to develop and validate several predictive models for non-adherence, using patient-reported data collected via a structured questionnaire. Materials and Methods: A cross-sectional, multi-center study was conducted on 3095 hypertensive patients from community pharmacies. A structured questionnaire was administered, collecting data on sociodemographic factors, medical history, self-monitoring behaviors, and informational exposure, alongside medication adherence measured using the Romanian-translated and validated ARMS (Adherence to Refills and Medications Scale). Five machine learning models were developed to predict non-adherence, defined by ARMS quartile-based thresholds. The models included Logistic Regression, Random Forest, and boosting algorithms (CatBoost, LightGBM, and XGBoost). Models were evaluated based on their ability to stratify patients according to adherence risk. Results: A total of 79.13% of respondents had an ARMS Score ≥ 15, indicating a high prevalence of suboptimal adherence. Better adherence was statistically associated (adjusted for age and sex) with more frequent blood pressure self-monitoring, a reduced salt intake, fewer daily supplements, more frequent reading of medication leaflets, and the receipt of specific information from pharmacists. Among the ML models, CatBoost achieved the highest ROC AUC Scores across the non-adherence classifications, although none exceeded 0.75. Conclusions: Several machine learning models were developed and validated to estimate levels of medication non-adherence. While the performance was moderate, the results demonstrate the potential of AI in identifying and stratifying patients by adherence profiles. Notably, to our knowledge, this study represents the first application of permutation and SHapley Additive exPlanations feature importance in combination with probability-based adherence stratification, offering a novel framework for predictive adherence modelling. Full article

(This article belongs to the Section Cardiology)

► Show Figures

Figure 1

46 pages, 9773 KiB

Open AccessReview

Visceral Arterial Pseudoaneurysms—A Clinical Review

by Ashita Ashish Sule, Shreya Sah, Justin Kwan, Sundeep Punamiya and Vishal G. Shelat

Medicina 2025, 61(7), 1312; https://doi.org/10.3390/medicina61071312 - 21 Jul 2025

Viewed by 44

Abstract

Background and Objectives: Visceral arterial pseudoaneurysms (VAPAs) are rare vascular lesions characterized by the disruption of partial disruption of the arterial wall, most commonly involving the intima and media. They have an estimated incidence of 0.1–0.2%, with the splenic artery most commonly [...] Read more.

Background and Objectives: Visceral arterial pseudoaneurysms (VAPAs) are rare vascular lesions characterized by the disruption of partial disruption of the arterial wall, most commonly involving the intima and media. They have an estimated incidence of 0.1–0.2%, with the splenic artery most commonly affected. Their management poses unique challenges due to the high risk of rupture. Timely recognition is crucial, as unmanaged pseudoaneurysms have a mortality rate of 90%. This narrative review aims to synthesize current knowledge regarding the epidemiology, etiology, clinical presentation, diagnostic methods, and management strategies for VAPAs. Materials and Methods: A literature search was performed across Pubmed for articles reporting on VAPAs, including case reports, review articles, and cohort studies, with inclusion of manuscripts that were up to (date). VAPAs are grouped by embryological origin—foregut, midgut, and hindgut. Results: Chronic pancreatitis is a primary cause of VAPAs, with the splenic artery being involved in 60–65% of cases. Other causes include acute pancreatitis, as well as iatrogenic trauma from surgeries, trauma, infections, drug use, and vascular diseases. VAPAs often present as abdominal pain upon rupture, with symptoms like nausea, vomiting, and gastrointestinal hemorrhage. Unruptured pseudoaneurysms may manifest as pulsatile masses or bruits but are frequently asymptomatic and discovered incidentally. Diagnosis relies on both non-invasive imaging techniques, such as CT angiography and Doppler ultrasound, and invasive methods like digital subtraction angiography, which remains the gold standard for detailed evaluation and treatment. A range of management options exists that are tailored to individual cases based on the aneurysm’s characteristics and patient-specific factors. This encompasses both surgical and endovascular approaches, with a growing preference for minimally invasive techniques due to lower associated morbidity. Conclusions: VAPAs are a critical condition requiring prompt early recognition and intervention. This review highlights the need for ongoing research to improve diagnostic accuracy and refine treatment protocols, enhancing patient outcomes in this challenging domain of vascular surgery. Full article

(This article belongs to the Section Surgery)

► Show Figures

Figure 1

28 pages, 1805 KiB

Open AccessArticle

Development and Validation of the CHDSI Questionnaire: A New Tool for Measuring Disease-Specific Quality of Life in Children and Adolescents with Congenital Heart Defects

by Paul C. Helm, Ulrike M. M. Bauer, Peter Ewert and Julia Remmele

Medicina 2025, 61(7), 1311; https://doi.org/10.3390/medicina61071311 - 21 Jul 2025

Viewed by 40

Abstract

Background and Objectives: Congenital heart defects (CHD) affect around 1% of the population, making them the most common congenital disease worldwide. Thanks to advances in treatment, over 90% of affected children are able to reach adulthood, shifting focus to long-term outcomes such [...] Read more.

Background and Objectives: Congenital heart defects (CHD) affect around 1% of the population, making them the most common congenital disease worldwide. Thanks to advances in treatment, over 90% of affected children are able to reach adulthood, shifting focus to long-term outcomes such as disease-specific quality of life (DsQoL). To date, there has been no validated, standardized instrument for assessing DsQoL in young German CHD patients. This study introduces the Congenital Heart Disease Specific Inventory (CHDSI), the first freely available German-language instrument for measuring DsQoL in children and adolescents with CHD. Materials and Methods: The CHDSI was developed at the German Heart Center Munich in collaboration with affected children and adolescents and validated nationwide via the National Register for Congenital Heart Defects (NRCHD) with 1201 participants (46 kindergarten children, 530 children, 625 adolescents). Two age-specific versions (36/37 items) and a 31-item preschool version were created, alongside a 6-item short form (CHDSI-SF) for rapid screening. Reliability was assessed using Cronbach’s alpha and split-half methods; construct validity via confirmatory factor analysis (CFA) using DWLS; and score interpretation through standardized stanine scales. The small sample size of kindergarten children precluded a model test for this group. The standard values given for this subsample should therefore be interpreted with caution. Results: The CHDSI showed excellent internal consistency (Cronbach’s α = 0.856 to 0.900) and high split-half reliability (>0.95). CFA confirmed a robust six-factor structure with excellent model fit (CFI and TLI ≥ 0.991, RMSEA ≤ 0.05). Subscales showed strong discriminant validity, and significant differences were found by CHD severity and sex. Conclusions: The CHDSI is a psychometrically valid, age-appropriate, and freely available instrument for assessing DsQoL in children and adolescents with CHD. It provides valuable support for clinical decision-making and research. Further studies should explore international validation and cultural adaptation. Full article

(This article belongs to the Section Cardiology)

► Show Figures

Figure 1

14 pages, 330 KiB

Open AccessReview

Integrating Radiomics and Deep-Learning for Prognostic Evaluation in Nasopharyngeal Carcinoma

by Irina Maria Pușcaș, Anda Gâta, Alexandra Roman, Silviu Albu, Vlad Alexandru Gâta and Alexandru Irimie

Medicina 2025, 61(7), 1310; https://doi.org/10.3390/medicina61071310 - 21 Jul 2025

Viewed by 41

Abstract

Nasopharyngeal carcinoma (NPC) represents a prevalent malignant tumor within the head and neck region, and enhancing the precision of prognostic assessments is a critical objective. Recent advancements in the integration of artificial intelligence (AI) and medical imaging have spurred a surge in research [...] Read more.

Nasopharyngeal carcinoma (NPC) represents a prevalent malignant tumor within the head and neck region, and enhancing the precision of prognostic assessments is a critical objective. Recent advancements in the integration of artificial intelligence (AI) and medical imaging have spurred a surge in research focusing on NPC image analysis through AI applications, particularly employing radiomics and artificial neural network approaches. This review provides a detailed examination of the prognostic advancement in NPC, utilizing imaging studies based on radiomics and deep learning techniques. The findings from these studies offer a promising outlook for achieving exceptionally precise prognoses regarding survival and treatment responses in NPC. The limitations of existing research and the potential for further application of radiomics and deep learning in NPC imaging are explored. It is recommended that future research efforts should aim to develop a comprehensive, labeled dataset of NPC images and prioritize studies that leverage AI for NPC screening. Full article

(This article belongs to the Section Oncology)

21 pages, 756 KiB

Open AccessSystematic Review

Challenges in Identifying Biomarkers of Frailty Syndrome: A Systematic Review

by Indira Omarova, Ainur Yeshmanova, Gulzhan Gabdulina, Aigul Tazhiyeva, Shynar Ryspekova, Akmaral Abdykulova, Ainur Nuftieva, Tamara Abdirova, Dame Sailanova, Zhanar Mombiyeva and Indira Karibayeva

Medicina 2025, 61(7), 1309; https://doi.org/10.3390/medicina61071309 - 21 Jul 2025

Viewed by 39

Abstract

Background and Objectives: The aim of this study is to categorize and combine (according to the source of biomaterial) biomarkers of frailty syndrome and identify challenges in research on these biomarkers by reviewing the current literature from the past five years. Methods [...] Read more.

Background and Objectives: The aim of this study is to categorize and combine (according to the source of biomaterial) biomarkers of frailty syndrome and identify challenges in research on these biomarkers by reviewing the current literature from the past five years. Methods: We systematically searching five electronic databases—PubMed, Scopus, Web of Science, CINAHL, and the Cochrane Library—for citations from 1 January 2019 to 1 July 2024. We conducted a qualitative data synthesis and categorized the limitations by topics and subtopics. PROSPERO—CRD: 42024491369. Results: A total of 61 papers met the criteria for inclusion in this study. These studies included a total of 56,758 participants, and 1479 unique biomarkers. We categorized biomarkers such as blood, genetic, urinary, and salivary biomarkers. Our analysis identified three major categories of challenges: challenges related to study design, unclear pathophysiological mechanisms, and biomarker-specific challenges. Conclusions: This review underscores the extensive research into biomarkers associated with frailty syndrome, such as blood, genetic, urinary, and salivary biomarkers. However, significant challenges persist, including methodological inconsistencies, biomarker measurement variability, and a limited understanding of underlying mechanisms. Full article

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

► Show Figures

Figure 1

12 pages, 953 KiB

Open AccessSystematic Review

Diagnostic Accuracy of Non-Radiologist-Performed Ultrasound for Diagnosing Acute Appendicitis in Pediatric Patients: A Systematic Review and Meta-Analysis

by Se Kwang Oh

Medicina 2025, 61(7), 1308; https://doi.org/10.3390/medicina61071308 - 21 Jul 2025

Viewed by 65

Abstract

Background and Objectives: Acute appendicitis is a common cause of abdominal pain requiring surgery in pediatric patients. Given concerns regarding radiation exposure from computed tomography (CT), ultrasound (US) has become the first-line diagnostic modality. In many emergency and resource-limited settings, non-radiologist physicians often [...] Read more.

Background and Objectives: Acute appendicitis is a common cause of abdominal pain requiring surgery in pediatric patients. Given concerns regarding radiation exposure from computed tomography (CT), ultrasound (US) has become the first-line diagnostic modality. In many emergency and resource-limited settings, non-radiologist physicians often perform these examinations. This study aimed to evaluate the diagnostic accuracy of a non-radiologist-performed ultrasound in detecting acute appendicitis in children. Materials and Methods: We conducted a systematic review and meta-analysis according to the PRISMA guidelines. The literature was searched across PubMed, Ovid MEDLINE, EMBASE, the Cochrane Library, and Google Scholar through June 2024. Studies reporting on the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of non-radiologist-performed ultrasounds in pediatric appendicitis were included. Study quality was assessed using the QUADAS-2 tool, and a bivariate random-effects model was used for statistical analysis. Results: Eight studies, with a total of 1006 pediatric patients, were included. The pooled sensitivity and specificity were 0.87 (95% CI, 0.83–0.90) and 0.93 (95% CI, 0.91–0.95), respectively. The area under the SROC curve was 0.783 (95% CI, 0.708–0.853), suggesting moderate-to-good diagnostic accuracy. Substantial heterogeneity was observed across studies, possibly due to differences in operator training and ultrasound techniques. Conclusions: Non-radiologist-performed ultrasound demonstrates moderate-to-good diagnostic accuracy in identifying pediatric appendicitis. These findings support its implementation in emergency or resource-constrained settings and suggest that incorporating structured ultrasound training for non-radiologists may improve timely diagnosis and optimize clinical decision-making in pediatric emergency care. Full article

(This article belongs to the Section Surgery)

► Show Figures

Figure 1

20 pages, 552 KiB

Open AccessReview

Sarcopenia in Urothelial Bladder Carcinoma: A Narrative Review

by Constantin Radu Vrabie, Andreea Ioana Parosanu and Cornelia Nitipir

Medicina 2025, 61(7), 1307; https://doi.org/10.3390/medicina61071307 - 20 Jul 2025

Viewed by 130

Abstract

Background and Objectives: Urothelial bladder carcinoma includes a spectrum of malignant lesions with heterogeneous molecular, biological, and clinical features and a variable risk of progression from non-muscle-invasive bladder cancer (NMIBC) to muscle-invasive disease (MIBC) and ultimately to metastatic urothelial carcinoma (mUC). Sarcopenia, [...] Read more.

Background and Objectives: Urothelial bladder carcinoma includes a spectrum of malignant lesions with heterogeneous molecular, biological, and clinical features and a variable risk of progression from non-muscle-invasive bladder cancer (NMIBC) to muscle-invasive disease (MIBC) and ultimately to metastatic urothelial carcinoma (mUC). Sarcopenia, a condition secondary to a catabolic state, is characterized by progressive loss of skeletal muscle mass and function and is highly prevalent across all stages of bladder cancer. This review aims to synthesize current evidence regarding the clinical impact of sarcopenia and its dynamic changes throughout the disease course. Materials and Methods: A narrative literature review was conducted using PubMed, Scopus, and Cochrane databases, incorporating the most relevant published sources. Search terms included “bladder carcinoma”, “sarcopenia”, “body composition”, “NMIBC”, and “MIBC”. Case reports and congress abstracts were excluded. Results: In NMIBC treated with intravesical Bacillus Calmette–Guérin (BCG), sarcopenia has been shown to have a negative predictive value in some studies. Among patients receiving neoadjuvant chemotherapy (NAC) for MIBC, sarcopenia has been associated with increased toxicity, dose reductions, and treatment delays. In the context of radical surgery, sarcopenia correlates with increased postoperative mortality and a higher rate of severe complications. In mUC, low muscle mass is a negative prognostic factor regardless of treatment type and is associated with chemotherapy-related hematologic toxicity, although it does not appear to predict immune-related adverse events (irAEs). Conclusions: Sarcopenia is a highly prevalent and clinically relevant phenotype of urothelial bladder cancer patients, impacting prognosis, treatment response, and chemotherapy toxicity. Incorporating sarcopenia with other relevant components of body composition (BC) and systemic inflammatory markers may facilitate the development of more robust risk scores. Current evidence is primarily limited by the retrospective design of most studies. Future prospective research is needed to clarify the prognostic role of sarcopenia and support its integration into routine clinical decision-making. Full article

(This article belongs to the Section Oncology)

► Show Figures

Figure 1

16 pages, 296 KiB

Open AccessArticle

The Impact of Synbiotics on the Bacterial Flora During the Course of Chronic Sinusitis

by Karolina Goroszkiewicz, Grażyna Lisowska, Grażyna Stryjewska-Makuch, Olga Karłowska-Bijak and Maciej Misiołek

Medicina 2025, 61(7), 1306; https://doi.org/10.3390/medicina61071306 - 20 Jul 2025

Viewed by 125

Abstract

Background and objectives: Chronic rhinosinusitis (CRS) is a multifactorial inflammatory condition often associated with microbiome imbalance (dysbiosis). Recent studies highlight the potential role of synbiotics—combinations of probiotics and prebiotics—in modulating the microbiota and supporting immune responses. The authors of this study aimed [...] Read more.

Background and objectives: Chronic rhinosinusitis (CRS) is a multifactorial inflammatory condition often associated with microbiome imbalance (dysbiosis). Recent studies highlight the potential role of synbiotics—combinations of probiotics and prebiotics—in modulating the microbiota and supporting immune responses. The authors of this study aimed to evaluate the impact of oral synbiotic supplementation on the sinus microbiota in patients undergoing endoscopic sinus surgery (ESS) for CRS. Materials and Methods: A total of 425 adult patients with CRS were enrolled in a multicenter retrospective study. According to EPOS 2020 guidelines, participants qualified for ESS. The intervention group (n = 194) received a synbiotic preparation for 6–8 weeks before and after surgery; the control group (n = 231) received no supplementation. Intraoperative and follow-up bacteriological samples were collected and analyzed. Statistical analysis included chi-square, t-tests, Wilcoxon tests, and ANOVA models. Results: Patients receiving synbiotics showed a significant reduction in pathogenic bacterial colonies postoperatively compared to the control group. In the synbiotic group coagulase-negative staphylococci appeared more frequently. Patients in the synbiotic group required significantly less postoperative antibiotic therapy (p < 0.05). Both groups exhibited an increase in Gram-positive and physiological flora and a decrease in Gram-negative bacteria following ESS. Conclusions: Synbiotic supplementation may beneficially influence the composition of the sinus microbiota and reduce pathogenic bacterial colonization following ESS. The findings suggest that synbiotics could serve as a supportive strategy in CRS treatment, potentially decreasing the need for postoperative antibiotics. Full article

(This article belongs to the Section Translational Medicine)

11 pages, 1461 KiB

Open AccessArticle

Volumetric Bone Mineral Density Assessed by Dual-Energy CT Predicts Bone Strength Suitability for Cementless Total Knee Arthroplasty

by Dong Hwan Lee, Dai-Soon Kwak, Sheen-Woo Lee, Yong Deok Kim, Nicole Cho and In Jun Koh

Medicina 2025, 61(7), 1305; https://doi.org/10.3390/medicina61071305 - 20 Jul 2025

Viewed by 128

Abstract

Background and Objectives: Adequate bone quality is essential for promoting initial bone ingrowth and preventing early migration during cementless total knee arthroplasty (TKA). However, gold-standard criteria for identifying suitable bone strength have yet to be established. Dual-energy computed tomography (DECT)-based volumetric bone [...] Read more.

Background and Objectives: Adequate bone quality is essential for promoting initial bone ingrowth and preventing early migration during cementless total knee arthroplasty (TKA). However, gold-standard criteria for identifying suitable bone strength have yet to be established. Dual-energy computed tomography (DECT)-based volumetric bone mineral density (vBMD) is an emerging tool for assessing bone quality. This study aimed to determine whether DECT-derived vBMD can accurately predict suitable bone strength for cementless TKA. Materials and Methods: A total of 190 patients undergoing primary TKA with a standardized posterior-stabilized implant were prospectively enrolled. Prior to TKA, DECT-derived vBMD was measured in the femoral box region. Actual bone strength was evaluated using an indentation test on resected femoral box specimens. Correlation and linear regression analyses were performed to assess the relationship between DECT vBMD and actual bone strength. Receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) calculations were used to determine the optimal cut-off value and diagnostic accuracy of DECT vBMD in identifying candidates suitable for cementless TKA. Results: DECT-derived vBMD exhibited a strong correlation with actual bone strength (correlation coefficient = 0.719, p < 0.01), while linear regression analysis revealed a moderate association (R² = 0.51, p < 0.01). In addition, it demonstrated excellent diagnostic performance in predicting adequate bone quality for cementless TKA, yielding an AUC of 0.984, with a sensitivity of 91.9% and a specificity of 92.0%. Conclusions: DECT-derived vBMD is a reliable and accurate tool for assessing bone strength around the knee and predicting the suitable bone quality for cementless TKA. Full article

(This article belongs to the Special Issue Clinical Research in Orthopaedics and Trauma Surgery)

► Show Figures

Figure 1

14 pages, 4344 KiB

Open AccessArticle

Ultrasound-Based Morphological and Functional Assessment in Male CrossFit Athletes with Unilateral Subacromial Shoulder Pain: An Observational Study

by Fabien Guerineau, Ann Cools, Jaime Almazán-Polo, María Dolores Sosa-Reina, Vanesa Abuín-Porras, Cristian Baroa-Fernández, Pablo García-Ginés, Ana Román-Franganillo and Ángel González-de-la-Flor

Medicina 2025, 61(7), 1304; https://doi.org/10.3390/medicina61071304 - 19 Jul 2025

Viewed by 111

Abstract

Background and Objectives: CrossFit is a discipline involving a wide range of overhead movements performed at high intensity and under accumulated fatigue that predispose to a high risk of shoulder complex injuries. This study aimed to compare ultrasonographic findings between symptomatic and [...] Read more.

Background and Objectives: CrossFit is a discipline involving a wide range of overhead movements performed at high intensity and under accumulated fatigue that predispose to a high risk of shoulder complex injuries. This study aimed to compare ultrasonographic findings between symptomatic and asymptomatic shoulders in CrossFit athletes. Materials and Methods: A cross-sectional study was conducted to compare ultrasound parameters between the painful and non-painful shoulders in CrossFit athletes with unilateral subacromial shoulder pain. Assessed variables included subacromial subdeltoid bursa thickness, supraspinatus tendon thickness, the acromiohumeral distance, the coracoacromial ligament distance, the bicipital groove angle, cross-sectional area of the biceps brachii longus head tendon, as well as the serratus anterior and lower trapezius muscle thickness. Results: Twenty male CrossFit athletes (forty shoulders) with an average age of 25.70 ± 4.03 years participated in the study. A statistically significant increase was observed (p < 0.05) in the subacromial subdeltoid bursa thickness in the painful shoulder compared to the asymptomatic side. All other ultrasound parameters did not show statistically significant differences. Conclusions: Only subacromial subdeltoid bursa thickness differed significantly between sides. This isolated finding may not fully explain shoulder pain, which cannot be solely attributed to morphological changes. Further research is needed to determine the relationship between shoulder pain and ultrasound features in CrossFit athletes, as well as the role of ultrasound in predicting structural changes in pain conditions. Full article

(This article belongs to the Special Issue Recent Trends in Physical Therapy for Musculoskeletal Disorders)

► Show Figures

Figure 1

13 pages, 2403 KiB

Open AccessArticle

Redefining the Diagnostic Approach to Adrenal Insufficiency: Re-Assessment of Baseline and Cortisol Increment Cut-Offs with the 1 µg Synacthen Test

by Taieb Ach, Rim Dhaffar, Asma Ammar, Aycha Ghachem, Imen Halloul, Wiem Saafi, Hamza El Fekih, Ghada Saad, Yosra Hasni and Monia Zaouali

Medicina 2025, 61(7), 1303; https://doi.org/10.3390/medicina61071303 - 19 Jul 2025

Viewed by 94

Abstract

Background and Objectives: Adrenal insufficiency (AI) is an endocrine disorder characterized by inadequate cortisol production, leading to non-specific symptoms that delay diagnosis. The Low Dose Synacthen Test (LDST) is commonly used to evaluate adrenal function, but traditional cortisol cut-offs may not accurately reflect [...] Read more.

Background and Objectives: Adrenal insufficiency (AI) is an endocrine disorder characterized by inadequate cortisol production, leading to non-specific symptoms that delay diagnosis. The Low Dose Synacthen Test (LDST) is commonly used to evaluate adrenal function, but traditional cortisol cut-offs may not accurately reflect adrenal function in all patients. This study aims to identify baseline cortisol cut-offs to accurately rule in and out AI, reassess the value of cortisol increment during LDST, and evaluate the accuracy of 30 and 60 min cortisol measurements in diagnosing AI. Materials and Methods: We conducted a cross-sectional analysis of patients who underwent LDST at Farhat Hached University Hospital. Diagnostic accuracy of baseline cortisol levels and cortisol increment was assessed using ROC curve analysis to determine optimal cut-offs for predicting LDST outcomes. Results: Among 163 patients (mean age 42.9 years, 63% female), baseline cortisol ≤ 5.35 μg/dL had 100% specificity but 41.5% sensitivity for LDST failure. Conversely, baseline cortisol ≥ 12.4 μg/dL had 100% sensitivity with 45.9% specificity. Single measurements at 30 and 60 min correctly classified 92.64% and 93.87% of cases, respectively. ROC analysis of 30 and 60 min cortisol increments showed high diagnostic accuracy (AUC 0.923 and 0.914, respectively). The optimal cortisol increment cut-off was 6.35 μg/dL for ruling in AI (99% specificity). Conclusions: We propose a novel AI diagnostic algorithm based on a single 30 min cortisol measurement, complemented by revised baseline cortisol cut-offs and cortisol increment as additional criteria. This approach may enhance diagnostic accuracy and minimize unnecessary testing, warranting further clinical validation. Full article

(This article belongs to the Section Endocrinology)

► Show Figures

Figure 1

21 pages, 733 KiB

Open AccessReview

Feminine Intimate Hygiene: A Review of Healthy and Unhealthy Habits in Women

by Elizabeta Lohova-Matisa, Dace Rezeberga and Anna Miskova

Medicina 2025, 61(7), 1302; https://doi.org/10.3390/medicina61071302 - 19 Jul 2025

Viewed by 202

Abstract

Background and Objectives: Intimate hygiene is essential in every woman’s cleaning routine and is strongly associated with women’s health. Unfortunately, there is minimal data available on correct intimate hygiene. Materials and Methods: This systematic review was conducted as per the Preferred Reporting [...] Read more.

Background and Objectives: Intimate hygiene is essential in every woman’s cleaning routine and is strongly associated with women’s health. Unfortunately, there is minimal data available on correct intimate hygiene. Materials and Methods: This systematic review was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Multiple electronic databases (PubMed, Embase, Web of Science) were searched. Results: We included 33 studies published between 2000 and 2022 that investigated washing habits, various products, underwear preferences, and pubic hair grooming habits among women. A total number of 21 (64%) articles discussed topics associated with washing habits, including douching, washing product usage, and the choice between bathing and showering. Out of 33 articles, 7 (21%) discuss underwear, clothing, and panty liner usage as a feminine, everyday intimate hygiene routine. A total number of 11 (33%) studies included pubic hair removal methods, reasons, and associated complications in their article. Conclusions: The majority of women have basic knowledge about correct intimate hygiene, including showering at least once a day and regularly changing their underwear. Douching remains one of the most popular intimate hygiene habits among women. Pubic hair shaving became the primary preferred grooming method. Full article

(This article belongs to the Section Obstetrics and Gynecology)

► Show Figures

Figure 1

11 pages, 285 KiB

Open AccessArticle

by Jung Yoon Park, Hyoung Moo Park, Youn-Jee Chung, Mee-Ran Kim, Kyung Jin Hwang and Jae-Yen Song

Medicina 2025, 61(7), 1301; https://doi.org/10.3390/medicina61071301 - 19 Jul 2025

Viewed by 135

Abstract

Background and Objectives: Body composition changes with aging and menopause, often leading to increased adiposity and a shift in fat distribution. While BMI is commonly used in clinical practice, it does not accurately reflect fat mass or distribution. This study aims to evaluate [...] Read more.

Background and Objectives: Body composition changes with aging and menopause, often leading to increased adiposity and a shift in fat distribution. While BMI is commonly used in clinical practice, it does not accurately reflect fat mass or distribution. This study aims to evaluate age-related changes in both total and regional adiposity using DXA-derived indices in Korean women aged ≥ 40 years and to assess the limitations of BMI-based obesity classification. Materials and Methods: This retrospective multicenter study analyzed the DXA scans and clinical records of 914 Korean women aged 40–80 years who attended menopause clinics across multiple institutions between 2018 and 2021. We analyzed five adiposity indices: body mass index (BMI), total body fat percentage (TB%F), fat mass index (FMI), visceral adipose tissue (VAT) area, and android-to-gynoid (A/G) fat ratio. Excess adiposity was defined as BMI ≥ 23 kg/m², TB%F ≥ 40%, FMI ≥ 9 kg/m², VAT > 100 cm², or A/G ratio > 1.0. Age group comparisons were made using ANOVA, and misclassification was assessed by comparing BMI with other indices. Results: Mean BMI increased with age, peaking in the 60s before declining in the 70s. TB%F and FMI peaked in the 50s, while VAT and A/G ratio increased continuously with age. Excess adiposity was found in 41.9% of women by TB%F, 40.5% by FMI, and 59.4% by VAT in the 70s. Notably, 22% of women with normal BMI (<23 kg/m²) had VAT > 100 cm², and 35.7% had A/G > 1.0, indicating central obesity. Conclusions: DXA-based indices provide a more accurate assessment of adiposity and associated cardiometabolic risks in aging women than BMI alone. Clinical screening strategies should consider incorporating regional fat distribution markers, particularly in midlife and postmenopausal populations, to better identify individuals at risk. Full article

(This article belongs to the Special Issue Advances in Public Health and Healthcare Management for Chronic Care)

16 pages, 544 KiB

Open AccessArticle

Cardiovascular Events and Preoperative Beta-Blocker Use in Non-Cardiac Surgery: A Prospective Holter-Based Analysis

by Alexandru Cosmin Palcău, Liviu Ionuț Șerbanoiu, Livia Florentina Păduraru, Alexandra Bolocan, Florentina Mușat, Daniel Ion, Dan Nicolae Păduraru, Bogdan Socea and Adriana Mihaela Ilieșiu

Medicina 2025, 61(7), 1300; https://doi.org/10.3390/medicina61071300 - 18 Jul 2025

Viewed by 168

Abstract

Background and Objectives: The perioperative use of beta-blockers remains controversial due to conflicting evidence of their risks and benefits. The aim of this study was to evaluate the association between chronic beta-blocker (bb) therapy and perioperative cardiac events in non-cardiac surgeries using [...] Read more.

Background and Objectives: The perioperative use of beta-blockers remains controversial due to conflicting evidence of their risks and benefits. The aim of this study was to evaluate the association between chronic beta-blocker (bb) therapy and perioperative cardiac events in non-cardiac surgeries using 24 h continuous Holter monitoring. Materials and Methods: A prospective observational study was conducted on patients undergoing elective or emergency non-cardiac surgery at a Romanian tertiary care hospital. The patients were divided into two groups: G1 (not receiving Bb) and G2 (on chronic Bb). The incidences of perioperative cardiac events, such as severe bradycardia (<40 b/min), new-onset atrial fibrillation (AF), extrasystolic arrhythmia (Ex), and sustained ventricular tachycardia (sVT) and arterial hypotension, were compared between the two groups using clinical, electrocardiography (ECG), and Holter ECG data. Beta-blocker indications, complications, and outcomes were analyzed using chi-squared tests and logistic regression. Results: A total of 100 consecutive patients (63% men, mean age of 53.7 years) were enrolled in the study. G2 included 30% (n = 30) of patients on chronic beta-blocker therapy. The indications included atrial fibrillation (46.7%, n = 14), arterial hypertension (36.7%, n = 11), extrasystolic arrhythmias (10%, n = 3), and chronic coronary syndrome (6.6%, n = 2). Beta-blocker use was significantly associated with severe bradycardia (n = 6; p < 0.001) in G2, whereas one patient in G1 had bradycardia, and 15 and 1 patients had hypotension (p < 0.001) in G1 and G2, respectively. The bradycardia and arterial hypotension cases were promptly treated and did not influence the patients’ prognoses. The 14 patients with AF in G2 had a 15-fold higher odds of requiring beta-blockers (p < 0.001, odds ratio (OR) = 15.145). No significant associations were found between beta-blocker use and the surgery duration (p = 0.155) or sustained ventricular tachycardia (p = 0.857). Ten patients developed paroxysmal postoperative atrial fibrillation (AF), which was related to longer surgery durations (165 (150–180) vs. 120 (90–150) minutes; p = 0.002) and postoperative anemia [hemoglobin (Hg): 10.4 (9.37–12.6) vs. 12.1 (11–13.2) g/dL; p = 0.041]. Conclusions: Patients under chronic beta-blocker therapy undergoing non-cardiac surgery have a higher risk of perioperative bradycardia and hypotension. Continuous Holter monitoring proved effective in detecting transient arrhythmic events, emphasizing the need for careful perioperative surveillance of these patients, especially the elderly, in order to prevent cardiovascular complications These findings emphasize the necessity of tailored perioperative beta-blocker strategies and support further large-scale investigations to optimize risk stratification and management protocols. Full article

(This article belongs to the Special Issue Early Diagnosis and Treatment of Cardiovascular Disease)

► Show Figures

Figure 1

18 pages, 665 KiB

Open AccessArticle

The Effects of 8-Week Hydrogen-Rich Water Consumption on Appetite, Body Composition, Sleep Quality, and Circulating Glucagon-like Peptide-1 in Obese Men and Women (HYDRAPPET): A Randomized Controlled Trial

by Nikola Todorovic, Sonja Baltic, David Nedeljkovic, Jovan Kuzmanovic, Darinka Korovljev, Dejan Javorac, Katarina Bijelic, Nebojsa Kladar, Alex Tarnava and Sergej M. Ostojic

Medicina 2025, 61(7), 1299; https://doi.org/10.3390/medicina61071299 - 18 Jul 2025

Viewed by 192

Abstract

Background and Objectives: Preliminary studies indicate that dihydrogen (H₂) may affect molecular pathways involved in appetite regulation; however, its role in influencing patient-reported appetite outcomes in individuals with obesity remains uncertain. This randomized, placebo-controlled, double-blind trial aimed to evaluate the effects [...] Read more.

Background and Objectives: Preliminary studies indicate that dihydrogen (H₂) may affect molecular pathways involved in appetite regulation; however, its role in influencing patient-reported appetite outcomes in individuals with obesity remains uncertain. This randomized, placebo-controlled, double-blind trial aimed to evaluate the effects of H₂ supplementation on appetite, body composition, sleep quality, obesity-specific quality of life, and related biomarkers in obese men and women. Materials and Methods: The study included 36 participants (24 females; age 42.1 ± 13.2 years; BMI 30.8 ± 4.2 kg/m²) randomized to receive either 1.0 L of hydrogen-rich water (15 mg of H₂) or 1.0 L of control water (0 mg of H₂) daily for eight weeks. Results: The results demonstrated that hydrogen-rich water significantly mitigated cravings (p = 0.05), improved subjective sleep quality (p = 0.05), reduced total cholesterol (p = 0.02) and LDL cholesterol (p = 0.04), and increased plasma glucagon-like peptide-1 levels (p = 0.05) compared to the control. No severe adverse effects were reported throughout the trial. Conclusions: These findings suggest that hydrogen-rich water may serve as a safe and effective dietary strategy to address appetite regulation and related metabolic indices in individuals with obesity. The study is registered at ClinicalTrials.gov (NCT06722326). Full article

(This article belongs to the Special Issue Breakthroughs in Clinical Diabetes, Obesity and Metabolic Diseases)

► Show Figures

Figure 1

15 pages, 3987 KiB

Open AccessArticle

Cardioprotective Effects of Bosentan in Rats Subjected to Lung Ischemia–Reperfusion Injury

by Şevki Mustafa Demiröz, Ayşegül Küçük, Esra Tekin, Sibel Söylemez, Hanife Yılmaz, Şaban Cem Sezen, Muharrem Atlı, Hüseyin Demirtaş, Abdullah Özer, Yusuf Ünal and Mustafa Arslan

Medicina 2025, 61(7), 1298; https://doi.org/10.3390/medicina61071298 - 18 Jul 2025

Viewed by 173

Abstract

Objective: This study aimed to investigate the cardioprotective effects of bosentan, an endothelin receptor antagonist, in a rat model of lung ischemia–reperfusion (I/R) injury, with a focus on myocardial tissue involvement. Methods: Twenty-four male Wistar rats were randomly assigned to four [...] Read more.

Objective: This study aimed to investigate the cardioprotective effects of bosentan, an endothelin receptor antagonist, in a rat model of lung ischemia–reperfusion (I/R) injury, with a focus on myocardial tissue involvement. Methods: Twenty-four male Wistar rats were randomly assigned to four groups: sham, bosentan, I/R, and I/R + bosentan. Lung I/R injury was induced by hilar clamping for 45 min, followed by 60 min of reperfusion. Bosentan (30 mg/kg) was administered intraperitoneally 30 min prior to the procedure. Myocardial tissue was evaluated histopathologically for structural disorganization, inflammation, fibrosis, and edema. TGF-β1 protein levels in myocardial tissue were compared across the groups using β-actin as the loading control. ELISA was used to quantify ET-1, NF-κB, and p53 levels, while spectrophotometric analysis was employed to assess MDA levels and the activities of SOD and CAT enzymes in heart tissue. Results: The I/R group exhibited significant myocardial disorganization, inflammation, and interstitial edema compared to the sham and bosentan groups. Bosentan treatment markedly ameliorated these histopathological alterations. Additionally, the I/R group showed elevated levels of ET-1, NF-κB, p53, and MDA, along with reduced SOD and CAT activities; these changes were significantly attenuated by bosentan administration. Bosentan treatment significantly reduced myocardial ET-1 levels (from 136.88 ± 5.02 to 120.18 ± 2.67 nmol/g, p = 0.003), NF-κB levels (from 0.87 ± 0.04 to 0.51 ± 0.03 ng/mg, p = 0.002), and TGF-β1 expression (from 1.72 ± 0.10 to 0.91 ± 0.08 relative units, p = 0.001). Moreover, bosentan increased antioxidant enzyme activities, elevating SOD levels from 21.45 ± 1.23 to 32.67 ± 1.45 U/mg protein (p = 0.001) and CAT levels from 15.22 ± 0.98 to 25.36 ± 1.12 U/mg protein (p = 0.002). Conclusions: Bosentan exerts cardioprotective effects in rats subjected to lung I/R injury by reducing myocardial damage, inflammation, and oxidative stress. These findings suggest that bosentan may serve as a potential therapeutic agent for preventing remote organ injury associated with pulmonary I/R. Full article

(This article belongs to the Section Cardiology)

► Show Figures

Figure 1

14 pages, 1899 KiB

Open AccessArticle

The Impact of Yes-Associated Protein 1 (YAP1) Expression Patterns in Locally Advanced Breast Cancer: Associations with Pathological Response and Tumor Features

by Osman Erinc, Sabin Goktas Aydin, Taskin Erkinuresin, Ozgur Yilmaz, Ahmet Aydin, Sevinc Dagistanli and Murat Akarsu

Medicina 2025, 61(7), 1297; https://doi.org/10.3390/medicina61071297 - 18 Jul 2025

Viewed by 147

Abstract

Background and Objectives: The Hippo pathway, via Yes-associated protein 1 (YAP1), regulates cell proliferation, apoptosis, and tissue regeneration. Aberrant YAP1 activation is linked to tumor progression and immune evasion in various cancers, including breast carcinoma, despite conflicting evidence on its prognostic value. [...] Read more.

Background and Objectives: The Hippo pathway, via Yes-associated protein 1 (YAP1), regulates cell proliferation, apoptosis, and tissue regeneration. Aberrant YAP1 activation is linked to tumor progression and immune evasion in various cancers, including breast carcinoma, despite conflicting evidence on its prognostic value. Preclinical studies have explored drugs targeting YAP1–TEAD interactions, but therapeutic application is limited. Materials and Methods: This study included 50 patients with locally advanced breast cancer, who were assessed by a multidisciplinary tumor board and underwent neoadjuvant treatment per tumor subtype and clinical guidelines. Eligibility required both pre-treatment core biopsy and post-treatment surgical resection samples. Due to the absence of residual tumor in some patients achieving complete pathological response, post-treatment tissue was available and analyzable in 30 patients. YAP1 expression was evaluated immunohistochemically for nuclear and cytoplasmic staining patterns. ROC analysis identified a cutoff for YAP1 expression, defining tumors with ≥70% nuclear and ≥80% cytoplasmic staining. Results: YAP1 expression had a significant relationship with tumor subtype (p = 0.001), being most frequent in HER-2-positive tumors (55.6%) and least frequent in luminal tumors (11.1%). YAP1 positivity significantly predicted axillary pathological complete response (pCR) (p = 0.01). In YAP1-positive patients, 77.8% achieved axillary pCR compared to 31.7% in YAP1-negative patients, though the YAP1 status and breast pCR association were insignificant (p = 0.07). The Mann–Whitney U test indicated that higher Ki-67 values were significantly associated with positive YAP1 expression (p = 0.028). In contrast, there was no association between ER, PR status, age, and tumor size. Following treatment, there was a statistically significant change in YAP1 expression, with nuclear staining decreasing (p = 0.004) while cytoplasmic staining increased (p = 0.002). YAP1 was significantly linked to axillary pCR, HER-2 status, and Ki-67. Conclusions: Post treatment, nuclear YAP1 decreased, whereas cytoplasmic expression increased, showing a localization shift. These results suggest that YAP1 may predict treatment response and become a future therapeutic target. Full article

(This article belongs to the Section Oncology)

► Show Figures

Figure 1

20 pages, 1125 KiB

Open AccessReview

Dietary Principles, Interventions and Oxidative Stress in Psoriasis Management: Current and Future Perspectives

by Oana-Georgiana Vaduva, Aristodemos-Theodoros Periferakis, Roxana Elena Doncu, Vlad Mihai Voiculescu and Calin Giurcaneanu

Medicina 2025, 61(7), 1296; https://doi.org/10.3390/medicina61071296 - 18 Jul 2025

Viewed by 310

Abstract

Psoriasis is a chronic inflammatory autoimmune disease that causes significant deterioration of the quality of life, and due to its multifactorial causes, it is often difficult to manage. Apart from genetic and environmental components, an important part of its pathophysiology comprises an oxidative [...] Read more.

Psoriasis is a chronic inflammatory autoimmune disease that causes significant deterioration of the quality of life, and due to its multifactorial causes, it is often difficult to manage. Apart from genetic and environmental components, an important part of its pathophysiology comprises an oxidative stress induction that the standard antioxidative mechanisms of the human body cannot compensate for. Moreover, in many psoriatic patients, there is a documented imbalance between antioxidant and pro-oxidative factors. Usually, psoriasis is evaluated using the Psoriasis Area and Severity Index (PASI) score. It has been demonstrated that dietary choices can lead to significant modification of PASI scores. Hypocaloric diets that are rich in antioxidants are highly effective in this regard, especially when focusing on vegetables and restricting consumption of animal-derived protein. Specific dietary regimens, namely the Mediterranean diet and potentially the ketogenic diet, are very beneficial, in the former case owing in large part to the omega-three fatty acids it provides and its ability to alter gut microbiome, a factor which seems to play a notable role in the pathogenesis of the disease. Another option is the topical application of vitamin D and its analogues, combined with corticosteroids, which can ameliorate the manifestations of psoriasis at the level of the skin. Finally, oral vitamin D supplementation has a positive impact on psoriatic arthritis and can mitigate the risk of associated comorbidities. Full article

(This article belongs to the Special Issue Recent Advances in Autoimmune Rheumatic Diseases: 2nd Edition)

► Show Figures

Figure 1

16 pages, 330 KiB

Open AccessArticle

The Role of Age in Shaping Cognitive, Physical, and Psychosocial Outcomes in Hemodialysis Patients: A Cross-Sectional Study

by Leszek Sułkowski, Andrzej Matyja and Maciej Matyja

Medicina 2025, 61(7), 1295; https://doi.org/10.3390/medicina61071295 - 18 Jul 2025

Viewed by 156

Abstract

Background and Objectives: Chronic kidney disease frequently progresses to end-stage renal disease, requiring dialysis, which imposes significant physical, psychological, and social burdens. Age is a key factor influencing symptom experience and quality of life in dialysis patients, yet findings on its impact remain [...] Read more.

Background and Objectives: Chronic kidney disease frequently progresses to end-stage renal disease, requiring dialysis, which imposes significant physical, psychological, and social burdens. Age is a key factor influencing symptom experience and quality of life in dialysis patients, yet findings on its impact remain mixed. This study aimed to examine how age relates to a broad range of health domains—including fatigue, pain, cognition, mental health, sexual satisfaction, bowel control, visual impairment, social support, and quality of life—among hemodialysis patients. Materials and Methods: A cross-sectional study was conducted at a single dialysis center in Poland, involving 79 adult patients undergoing maintenance hemodialysis. Standardized, validated psychometric instruments were used, including the Modified Fatigue Impact Scale (MFIS), Perceived Deficits Questionnaire (PDQ), Pain Effects Scale (PES), Mental Health Inventory (MHI), Modified Social Support Survey (MSSS), Sexual Satisfaction Scale (SSS), Bowel Control Scale (BWCS), Impact of Visual Impairment Scale (IVIS), and WHOQOL-BREF for quality of life. Spearman’s or Pearson’s correlation coefficients were used to evaluate relationships between age and scale scores. Full and abbreviated versions of scales were also compared. Results: Age showed moderate positive correlations with fatigue (ρ = 0.44–0.53), cognitive deficits (ρ = 0.37–0.45), pain (r = 0.41), bowel control issues (ρ = 0.32), and visual impairment (ρ = 0.37), all statistically significant (p < 0.01). No significant associations were observed between age and mental health (MHI), perceived social support (MSSS), or quality of life (WHOQOL-BREF). Abbreviated versions of the scales showed strong correlations with their full versions (ρ > 0.9). Conclusions: While age is linked to increased symptom burden in select domains such as cognition, fatigue, and pain, it does not significantly affect mental health, perceived social support, or overall quality of life in hemodialysis patients. These findings support the use of age-sensitive, multidimensional assessments to inform individualized care strategies. Full article

(This article belongs to the Section Urology & Nephrology)

15 pages, 1045 KiB

Open AccessArticle

Metabolomic Profiling of Erector Spinae Plane Block for Breast Cancer Surgery

by Ekin Guran, Ozan Kaplan, Serpil Savlı, Cigdem Sonmez, Lutfi Dogan and Suheyla Unver

Medicina 2025, 61(7), 1294; https://doi.org/10.3390/medicina61071294 - 18 Jul 2025

Viewed by 161

Abstract

Background and Objectives: Regional and systemic analgesic techniques, such as erector spinae plane (ESP) block and opioid administration, implemented during cancer surgery, have been shown to influence immune responses and potentially affect cancer outcomes. Surgical stress and analgesic techniques used in cancer surgery—such [...] Read more.

Background and Objectives: Regional and systemic analgesic techniques, such as erector spinae plane (ESP) block and opioid administration, implemented during cancer surgery, have been shown to influence immune responses and potentially affect cancer outcomes. Surgical stress and analgesic techniques used in cancer surgery—such as regional nerve blocks or systemic opioids—not only affect pain control but also influence immune and inflammatory pathways that may impact cancer progression. To understand the biological consequences of these interventions, metabolomic profiling has emerged as a powerful approach for capturing systemic metabolic and immunological changes, which are particularly relevant in the oncologic perioperative setting. In this study, we examined the impact of the ESP on the metabolomic profile, as well as levels of VEGF, cortisol, and CRP, in addition to its analgesic effects in breast cancer surgery. Materials and Methods: Ninety patients were placed into three different analgesia groups (morphine, ESP, and control groups). Demographic data, ASA classification, comorbidities, surgery types, and pain scores were documented. Blood samples were taken at preoperative hour 0, postoperative hour 1, and postoperative hour 24 (T0, T1, and T24). VEGF, cortisol, and CRP levels were measured, and metabolomic analysis was performed. Results: Study groups were comparable regarding demographic findings, comorbidities, and surgery types (p > 0.05). NRS scores of group ESP were lowest in the first 12 h period (p < 0.01) and ESP block reduced opioid consumption (p < 0.01). VEGF and cortisol levels of group morphine were similar to ESP at T24 (p > 0.05). Group ESP had lower VEGF and cortisol levels than the control at T24 (p = 0.025, p = 0.041, respectively.). The CRP level of group morphine was higher than both ESP and control at T24 (p = 0.022). Metabolites involved in primary bile acid, steroid hormone biosynthesis, amino acid, and glutathione metabolism were changed in group ESP. Conclusions: Metabolites in bile acid biosynthesis and steroid hormone pathways, which play a key role in immune responses, were notably lower in the ESP group. Accordingly, VEGF and cortisol peaks were more moderate in group ESP. In conclusion, we think that ESP block, which provides adequate analgesia, is an acceptable approach in terms of modulating immune responses in breast cancer surgery. Full article

(This article belongs to the Special Issue Insights and Advances in Cancer Biomarkers)

► Show Figures

Figure 1

15 pages, 1484 KiB

Open AccessArticle

High-Risk PNPLA3 rs738409 Genotype Is Associated with Higher Concentrations of CCL2 in Liver Transplant Candidates with Alcoholic End-Stage Liver Disease

by Ivan Budimir Bekan, Dino Šisl, Alan Šućur, Ana Bainrauch, Valerija Bralić Lang, Pavao Planinić, Nataša Kovačić, Danka Grčević, Anna Mrzljak and Tomislav Kelava

Medicina 2025, 61(7), 1293; https://doi.org/10.3390/medicina61071293 - 18 Jul 2025

Viewed by 124

Abstract

Background and Objectives: Patients with GG rs738409 patatin-like phospholipase domain-containing protein 3 (PNPLA3) genotype (148M variant) have greater risk to develop end-stage liver disease and its associated clinical complications, including hepatocellular carcinoma (HCC). We aimed to analyze the association between the PNPLA3 [...] Read more.

Background and Objectives: Patients with GG rs738409 patatin-like phospholipase domain-containing protein 3 (PNPLA3) genotype (148M variant) have greater risk to develop end-stage liver disease and its associated clinical complications, including hepatocellular carcinoma (HCC). We aimed to analyze the association between the PNPLA3 genotype and augmented inflammatory response in transplant candidates with end-stage alcoholic liver disease (ALD). Materials and Methods: Concentrations of 13 cytokines were measured in 106 end-stage ALD patients without HCC (40 with CC, 40 with CG, and 26 with GG genotype), 35 end-stage ALD patients with HCC, and 19 control patients by cytometric bead array. Results: We found significantly higher concentrations of IL-1, IFN-α, IFN-γ, TNF-α, IL-6, CXCL8, IL-10, IL-12, IL-32, and IL-33 in patients with ALD compared to controls, while the concentration of CCL2 was significantly lower. No differences were observed in the concentration of IL-17 and IL-18. ALD patients with and without HCC had similar cytokine concentrations (p > 0.05 for all comparisons). End-stage ALD patients without HCC of the GG genotype had significantly higher CCL2 concentrations (212.6 [135.9–264.9] pg/mL) compared to end-stage ALD patients without HCC carrying the CC/CG genotypes (141.3 [104.1–201.6] pg/mL, p = 0.002, Mann–Whitney). No significant differences across the genotypes were found for the remaining measured cytokines (p > 0.05). GG carriers also had significantly higher levels of AST and ALT, and lower platelet counts. Conclusions: End-stage ALD patients without HCC who carry the PNPLA3 GG genotype have relatively higher CCL2 levels compared to those with the CC or CG genotypes. Relatively elevated CCL2 concentrations in GG patients might contribute to their increased risk of developing clinical complications compared to CC/CG patients. Full article

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

► Show Figures

Figure 1

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 - 18 Jul 2025

Viewed by 267

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)

► Show Figures

Figure 1

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 - 17 Jul 2025

Viewed by 161

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)

► Show Figures

Figure 1

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

Viewed by 183

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)

► Show Figures

Figure 1

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

Viewed by 217

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)

► Show Figures

Figure 1

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

Viewed by 216

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

Viewed by 187

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)

► Show Figures

Figure 1

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

Viewed by 169

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)

► Show Figures

Figure 1

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

Viewed by 133

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)

► Show Figures

Figure 1

17 pages, 513 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

Viewed by 223

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)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Medicina, Volume 61, Issue 7 (July 2025) – 198 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI