Medicina

12 pages, 1467 KB

Open AccessReview

Effectiveness of Non-Pharmacological Interventions in Patients with Facial Paralysis: An Umbrella and Mapping Review

by Mónica Grande-Alonso, Alba Ayllón-Poza, Álvaro Saavedra-Böss, Nayra Daniela Santa Cruz-Saavedra, Celia Vidal-Quevedo, Carlos Forner-Álvarez and Ferran Cuenca-Martínez

Medicina 2025, 61(8), 1502; https://doi.org/10.3390/medicina61081502 - 21 Aug 2025

Viewed by 468

Abstract

Background and Objectives: Facial paralysis involves the complete or partial loss of facial movement due to damage to the facial nerve, leading to impaired voluntary muscle function and facial asymmetry. Given its significant physical and psychosocial impact, there is an urgent need [...] Read more.

Background and Objectives: Facial paralysis involves the complete or partial loss of facial movement due to damage to the facial nerve, leading to impaired voluntary muscle function and facial asymmetry. Given its significant physical and psychosocial impact, there is an urgent need to strengthen the evidence supporting non-pharmacological treatments. This umbrella review aims to compile the most reliable and current data to establish a consensus on the effectiveness of such interventions for patients with facial paralysis. Materials and Methods: This study is an umbrella review. A systematic search was conducted in PubMed, Embase, Scopus, and CINAHL (28 July 2024). The variables assessed included overall healing/recovery rate, facial disability, and facial function. Methodological quality was evaluated using the AMSTAR and ROBIS tools. Screening was performed independently by two reviewers, with a third reviewer resolving any discrepancies. Results: Five systematic reviews were included, all evaluating the impact of non-pharmacological interventions in facial paralysis. The findings suggest that acupuncture and electrical stimulation may improve recovery rates and facial function, although high heterogeneity and methodological limitations were noted in some studies. No definitive conclusions could be drawn regarding facial disability. Conclusions: The combination of electrotherapy with other complementary techniques, such as facial exercises or laser therapy, appears to be a safe and potentially effective approach for facial paralysis rehabilitation. Nonetheless, further research employing standardized protocols and higher methodological quality is necessary to establish more robust conclusions for physiotherapeutic practice. Full article

(This article belongs to the Special Issue Physiotherapy in Musculoskeletal Pain: Assessment and Management)

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14 pages, 3831 KB

Open AccessArticle

Decoding the Spitz Puzzle: Histological Patterns and Diagnostic Challenges in Everyday Pathology Practice—A Single-Center Study

by Iuliu Gabriel Cocuz, Georgian-Nicolae Radu, Maria Cătălina Popelea, Raluca Niculescu, Maria Elena Cocuz, Adrian-Horațiu Sabău, Andreea-Cătălina Tinca, Andreea Raluca Cozac-Szoke, Bogdan Pastor, Diana Maria Chiorean, Corina Eugenia Budin, Irina Bianca Kosovski and Ovidiu Simion Cotoi

Medicina 2025, 61(8), 1501; https://doi.org/10.3390/medicina61081501 - 21 Aug 2025

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Abstract

Background and Objectives: Spitz tumors represent a diagnostic challenge in dermatopathology due to their large spectrum of morphological characteristics and overlap with malignant lesions, especially in pathology departments where molecular pathology is not available. Even though most Spitz lesions are benign, the [...] Read more.

Background and Objectives: Spitz tumors represent a diagnostic challenge in dermatopathology due to their large spectrum of morphological characteristics and overlap with malignant lesions, especially in pathology departments where molecular pathology is not available. Even though most Spitz lesions are benign, the uncertainty around their biological behavior necessitates an integrated approach in daily practice. The objective of our study was to evaluate the epidemiological, macroscopic, and histopathological characteristics of Spitz lesions in accordance with WHO Classification of Skin Tumours. Materials and Methods: We performed a retrospective, descriptive, and hypothesis-generating study on Spitz tumors diagnosed between 2018 and 2024 in the Clinical Pathology Department of the Mures Clinical County Hospital, Romania. We included 10 cases and analyzed their macroscopic characteristics (localization, shape, dimension, and color), microscopic characteristics (cellular types, cytologic atypia, pagetoid migration, mitoses, and the type of lesion), and immunohistochemical profile. Results: The study population was composed of young patients with an average age of 20.2 years old, with a slight predominance of female gender. Most lesions were Spitz nevi, intradermic, or compound, with a fusiform, epithelioid, or rhomboid cell shape. Pagetoid migration and cytological atypia were seen in fewer cases. The Ki 67 proliferation index was under 5% in all cases. The main limitation of this study involved the low number of cases and the lack of molecular testing, which limited the molecular characterization of Spitz tumors. Complete excision was performed in all cases. Conclusions: In the absence of molecular testing, our study emphasizes the importance of clinical–morphological assessment using immunohistochemistry in establishing a correct diagnosis in Spitz lesions. Our results confirm that most of the Spitz lesions were benign and provide a basis for future research with a multidisciplinary approach, including molecular testing. Full article

(This article belongs to the Section Oncology)

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15 pages, 758 KB

Open AccessReview

A Critical Narrative Review of Coaxial Double-Pigtail Stenting Within the LAMS in the Management of Pancreatic Fluid Collections

by Giuseppe Infantino, Gabriele Rancatore, Dario Quintini, Lucio Carrozza, Dario Ligresti, Marco Giacchetto, Nicoletta Belluardo, Giuseppe Rizzo, Elio D’Amore, Giacomo Emanuele Maria Rizzo and Ilaria Tarantino

Medicina 2025, 61(8), 1500; https://doi.org/10.3390/medicina61081500 - 21 Aug 2025

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Abstract

Endoscopic ultrasound (EUS)-guided drainage using lumen-apposing metal stents (LAMSs) has become the standard for managing pancreatic fluid collections (PFCs), especially walled-off necrosis (WON). However, LAMS-specific adverse events (AEs), including bleeding, stent occlusion, and infection, remain a concern. To mitigate these complications, some experts [...] Read more.

Endoscopic ultrasound (EUS)-guided drainage using lumen-apposing metal stents (LAMSs) has become the standard for managing pancreatic fluid collections (PFCs), especially walled-off necrosis (WON). However, LAMS-specific adverse events (AEs), including bleeding, stent occlusion, and infection, remain a concern. To mitigate these complications, some experts advocate placing coaxial double-pigtail plastic stents (DPPSs) within LAMSs. This narrative review critically examines the evidence from retrospective and prospective studies, one RCT, and recent meta-analyses on this combined approach. While the routine use of coaxial double-pigtail plastic stents (DPPSs) within LAMSs is not universally supported, emerging data suggest benefits in select high-risk scenarios, such as large WON, debris-rich cavities, or disconnected pancreatic duct syndrome (DPDS), in which coaxial DPPS within LAMSs can reduce occlusion, infection, and recurrence. In addition, the type of LAMS appears to influence safety outcomes: the SPAXUS stent shows lower bleeding and migration rates than the Hot AXIOS. We propose a pragmatic algorithm for the patient-tailored use of coaxial DPPS and discuss technical innovations to improve outcomes. While evidence is still evolving, personalized strategies and future high-quality studies are needed to define the optimal role of coaxial DPPS within LAMSs in the EUS-guided drainage of PFCs. Full article

(This article belongs to the Special Issue Development and Application of Digestive Endoscopy)

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23 pages, 1080 KB

Open AccessReview

Human Papillomavirus Across the Reproductive Lifespan: An Integrative Review of Fertility, Pregnancy Outcomes, and Fertility-Sparing Management

by Matteo Terrinoni, Tullio Golia D’Augè, Giuseppe Mascellino, Federica Adinolfi, Michele Palisciano, Dario Rossetti, Gian Carlo Di Renzo and Andrea Giannini

Medicina 2025, 61(8), 1499; https://doi.org/10.3390/medicina61081499 - 21 Aug 2025

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Abstract

Background and Objectives: Human papillomavirus (HPV) is the most prevalent sexually transmitted infection worldwide and, beyond its oncogenic potential, may impair reproductive health in both sexes. This review examines HPV’s effects on male and female fertility, obstetric outcomes, vertical transmission, and fertility-sparing [...] Read more.

Background and Objectives: Human papillomavirus (HPV) is the most prevalent sexually transmitted infection worldwide and, beyond its oncogenic potential, may impair reproductive health in both sexes. This review examines HPV’s effects on male and female fertility, obstetric outcomes, vertical transmission, and fertility-sparing management in oncology. Materials and Methods: A systematic search of PubMed, Embase, and Scopus was conducted using terms related to HPV and reproduction. Additional search terms included those related to therapeutic vaccines, antivirals, and genotype prevalence. English-language human studies reporting clinical reproductive outcomes were included. Thirty-seven studies met the inclusion criteria. Two reviewers independently screened and assessed study quality using a simplified GRADE framework. Results: In men, seminal HPV infection correlates with reduced progressive motility (SMD ≈ −0.85), abnormal morphology, and increased DNA fragmentation. In women, high-risk HPV doubles the odds of infertility (OR ≈ 2.3) and is associated with endometrial involvement. High first-trimester viral load predicts vertical transmission (aOR 6.4), which is also increased by vaginal delivery (RR 1.8) and is linked to PROM (OR 1.8) and preterm birth (OR 1.8). Modeling suggests that nine-valent vaccination plus 5-year HPV-based screening could reduce CIN2+ by up to 80% and excisional treatments by >75%. Fertility-sparing surgery in early cervical cancer yields a <4% recurrence and up to 68% live birth rates. Conclusions: This review uniquely synthesizes reproductive and oncologic impacts of HPV and emphasizes risk stratification, multidisciplinary prevention, and fertility preservation. Integration of HPV DNA quantification, personalized care, and vaccine-based strategies offers a path toward optimized outcomes in both sexes. Full article

(This article belongs to the Special Issue Advances in Cervical Cancer Treatment and HPV Management: From Conventional Therapies to Emerging Strategies)

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16 pages, 982 KB

Open AccessArticle

Temporal Sequence of Metabolic Syndrome Components: Abdominal Obesity as the Primary Driver of Progression in a Korean Prospective Cohort Study

by Hoon Seok Kim and Jaeeun Yoo

Medicina 2025, 61(8), 1498; https://doi.org/10.3390/medicina61081498 - 21 Aug 2025

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Abstract

Background and Objectives: Metabolic syndrome (MetS) progresses gradually as individual components accumulate. However, there is limited understanding regarding whether the sequence of component appearance influences disease progression. This study sought to determine the most frequent initial MetS component and evaluate whether this [...] Read more.

Background and Objectives: Metabolic syndrome (MetS) progresses gradually as individual components accumulate. However, there is limited understanding regarding whether the sequence of component appearance influences disease progression. This study sought to determine the most frequent initial MetS component and evaluate whether this component influences the subsequent risk of developing full MetS. Materials and Methods: We examined data from 6137 participants in the Korean Genome and Epidemiology Study (KoGES), free of MetS at baseline (2001–2002), followed until 2011–2012. Participants were stratified by the first emerging MetS component: abdominal obesity, elevated blood pressure, high fasting glucose, high triglycerides, or low HDL cholesterol. The primary endpoint was progression to full MetS, defined as the development of three or more components. We also assessed transition probabilities between components and sex-specific sequence differences. Results: Abdominal obesity was the most frequent initial metabolic abnormality (31.0%), followed by elevated blood pressure (26.3%), low HDL cholesterol (15.3%), high triglycerides (13.7%), and high fasting glucose (4.9%). Over a median 8.2-year follow-up, participants with initial abdominal obesity exhibited the greatest progression rate to full MetS (44.4%), significantly higher than those with elevated blood pressure (24.8%), high triglycerides (23.0%), high fasting glucose (21.6%), or low HDL cholesterol (9.3%) (all p < 0.001). After controlling for age, sex, smoking status, and baseline BMI, initial abdominal obesity was associated with a 4.77-fold increased risk (95% CI: 3.68–6.18) of developing full MetS compared to initial low HDL cholesterol. Distinct transition patterns were observed: high triglycerides frequently transitioned to low HDL cholesterol (78.1%), while abdominal obesity most often led to elevated blood pressure (52.1%). Marked sex-related differences were also found: abdominal obesity was more common initially among women (41.7% vs. 25.2%), whereas elevated blood pressure was predominant among men (37.6% vs. 21.2%). Conclusions: The initial MetS component strongly predicts progression to full syndrome, with abdominal obesity conferring the highest risk. Early identification and targeted interventions addressing abdominal obesity may effectively prevent MetS and its subsequent complications. Full article

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

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15 pages, 622 KB

Open AccessReview

Artificial Intelligence in the Diagnosis and Imaging-Based Assessment of Pelvic Organ Prolapse: A Scoping Review

by Marian Botoncea, Călin Molnar, Vlad Olimpiu Butiurca, Cosmin Lucian Nicolescu and Claudiu Molnar-Varlam

Medicina 2025, 61(8), 1497; https://doi.org/10.3390/medicina61081497 - 21 Aug 2025

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Abstract

Background and Objectives: Pelvic organ prolapse (POP) is a complex condition affecting the pelvic floor, often requiring imaging for accurate diagnosis and treatment planning. Artificial intelligence (AI), particularly deep learning (DL), is emerging as a powerful tool in medical imaging. This scoping [...] Read more.

Background and Objectives: Pelvic organ prolapse (POP) is a complex condition affecting the pelvic floor, often requiring imaging for accurate diagnosis and treatment planning. Artificial intelligence (AI), particularly deep learning (DL), is emerging as a powerful tool in medical imaging. This scoping review aims to synthesize current evidence on the use of AI in the imaging-based diagnosis and anatomical evaluation of POP. Materials and Methods: Following the PRISMA-ScR guidelines, a comprehensive search was conducted in PubMed, Scopus, and Web of Science for studies published between January 2020 and April 2025. Studies were included if they applied AI methodologies, such as convolutional neural networks (CNNs), vision transformers (ViTs), or hybrid models, to diagnostic imaging modalities such as ultrasound and magnetic resonance imaging (MRI) to women with POP. Results: Eight studies met the inclusion criteria. In these studies, AI technologies were applied to 2D/3D ultrasound and static or stress MRI for segmentation, anatomical landmark localization, and prolapse classification. CNNs were the most commonly used models, often combined with transfer learning. Some studies used hybrid models of ViTs, demonstrating high diagnostic accuracy. However, all studies relied on internal datasets, with limited model interpretability and no external validation. Moreover, clinical deployment and outcome assessments remain underexplored. Conclusions: AI shows promise in enhancing POP diagnosis through improved image analysis, but current applications are largely exploratory. Future work should prioritize external validation, standardization, explainable AI, and real-world implementation to bridge the gap between experimental models and clinical utility. Full article

(This article belongs to the Section Obstetrics and Gynecology)

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Graphical abstract

23 pages, 1514 KB

Open AccessSystematic Review

Autologous Platelet Concentrates in the Management of Medication-Related Osteonecrosis of the Jaw: A Systematic Review

by Filipa Ferreira, Carlos Faria and Daniel Humberto Pozza

Medicina 2025, 61(8), 1496; https://doi.org/10.3390/medicina61081496 - 21 Aug 2025

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Abstract

Background and Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a challenging condition linked to antiresorptive and antiangiogenic medications. Their complex pathophysiology and resistance to standard treatments have led researchers to explore adjunctive therapies. This systematic review evaluated the effectiveness of autologous [...] Read more.

Background and Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a challenging condition linked to antiresorptive and antiangiogenic medications. Their complex pathophysiology and resistance to standard treatments have led researchers to explore adjunctive therapies. This systematic review evaluated the effectiveness of autologous platelet concentrates—namely platelet-rich plasma (PRP) and platelet-rich fibrin (PRF)—in promoting healing, bone regeneration, and symptom relief in MRONJ patients. Materials and Methods: A systematic literature search was conducted using PubMed, Scopus, and Web of Science for studies that assessed the use of PRP or PRF in MRONJ management. The risk of bias and study quality were evaluated using ROB-2 and ROBINS-I tools. Results: A total of 24 studies were included: seven on PRP and 17 on PRF. Reported complete mucosal healing rates ranged from 33% to 100% for PRP and from 36% to 100% for PRF. Although two randomized controlled trials and one prospective observational study found no statistically significant advantage of PRF over conventional surgical treatments, most studies indicated positive outcomes. Overall, the methodological quality varied, with several studies showing moderate-to-high risk of bias. Conclusions: Platelet concentrates can add benefits to traditional MRONJ treatments. The current evidence suggests that integrating these autologous therapies with conventional approaches clinically enhances healing outcomes, supports bone regeneration, and alleviates symptoms, ultimately leading to improved patient care. Full article

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

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11 pages, 864 KB

Open AccessArticle

Inflammatory Biomarkers and Carotid Atherosclerosis: The Predictive Role of the Neutrophil/Albumin Ratio

by Halis Yilmaz, Cemre Turgul, Yucel Yilmaz, Saban Kelesoglu and Aydin Tuncay

Medicina 2025, 61(8), 1495; https://doi.org/10.3390/medicina61081495 - 21 Aug 2025

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Abstract

Background and Objectives: Carotid artery stenosis is an inflammatory vascular disease closely linked to atherosclerosis and associated with inflammatory biomarkers. The neutrophil/albumin ratio (NAR) is a novel promising biomarker in assessing cardiovascular disease severity. This study aimed to evaluate the relationship between [...] Read more.

Background and Objectives: Carotid artery stenosis is an inflammatory vascular disease closely linked to atherosclerosis and associated with inflammatory biomarkers. The neutrophil/albumin ratio (NAR) is a novel promising biomarker in assessing cardiovascular disease severity. This study aimed to evaluate the relationship between NAR and lesion severity in patients with carotid artery stenosis. Materials and Methods: This retrospective, single-center, comparative study included 625 asymptomatic patients who underwent digital subtraction angiography (DSA) for suspected high-grade carotid artery stenosis between 2012 and 2022. Patients were classified into two groups based on stenosis severity: critical carotid artery stenosis (≥70% stenosis) and non-critical carotid artery stenosis (<70%). Only asymptomatic patients were included; patients with symptoms were excluded. NAR was calculated preoperatively as neutrophil count divided by serum albumin. Additional inflammatory markers, such as neutrophil–lymphocyte ratio (NLR) and C-reactive protein (CRP) to albumin ratio (CAR), were also analyzed. Results: Severe carotid artery stenosis was detected in 191 of the patients who underwent DSA. Individuals in the critical carotid artery stenosis group were older and had a higher prevalence of diabetes mellitus and hypertension (51 (45–57) vs. 60 (54–68), p < 0.001; 143 vs. 83, p = 0.025; 193 vs. 104, respectively, p = 0.021), as well as higher neutrophil counts (4.3 (3.2–6.2) vs. 8.1 (4.9–12.5), p < 0.001), NLR (2.2 (1.4–3.2) vs. 4.2 (2.3–8.9), p < 0.001), while CRP (3.8 (1.8–8) vs. 5.7 (3.6–7.6), p = 0.005) and CAR (0.9 (0.5–1.9) vs. 1.6 (0.8–2.1), p < 0.001) values were significantly higher. NAR was higher in patients of the critical carotid artery stenosis group than the non-critical (1.1 (0.8–1.6) vs. 2.1 (1.4–3.2), p < 0.001). Multivariate analysis identified NAR as an independent predictor of carotid artery stenosis (Odds Ratio [OR]: 3.432; 95% Confidence Interval [CI]: 2.116–5.566; p < 0.001). The best cut-off value of NAR for predicting critical carotid artery stenosis was 1.47, which provided 73.8% sensitivity and 70.5% specificity. Conclusions: NAR, which can be easily measured through a simple blood test, demonstrated moderate sensitivity and specificity in predicting critical carotid artery stenosis, suggesting its potential role as a supportive marker in clinical risk assessment. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Coronary Artery and Peripheral Artery Diseases)

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12 pages, 1626 KB

Open AccessArticle

Operative Treatment of Adolescent Diaphyseal Clavicle Fracture: Elastic Stable Intramedullary Nail Versus Plate Fixation

by Kunhyung Bae, Soorack Ryu, Sung Hoon Choi, Hyunjae Kwon and Yoon Hae Kwak

Medicina 2025, 61(8), 1494; https://doi.org/10.3390/medicina61081494 - 21 Aug 2025

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Abstract

Background and Objectives: Adolescent diaphyseal clavicle fracture surgery has increased in recent years. However, the optimal operative method remains debated, particularly between elastic stable intramedullary nailing (ESIN) and plate fixation. This study compared postoperative outcomes and complication rates between ESIN and plate [...] Read more.

Background and Objectives: Adolescent diaphyseal clavicle fracture surgery has increased in recent years. However, the optimal operative method remains debated, particularly between elastic stable intramedullary nailing (ESIN) and plate fixation. This study compared postoperative outcomes and complication rates between ESIN and plate fixation for treating diaphyseal clavicle fractures in adolescent patients. Materials and Methods: We conducted a retrospective review of 35 adolescents who underwent surgery for diaphyseal clavicle fractures between 2010 and 2024. Patients were assigned to either the ESIN group (n = 18) or the plate fixation group (n = 17). Postoperative outcomes assessed included the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, intraoperative time, time to complete fracture union, and clavicle shortening at 1 year postoperatively. Postoperative complications were also evaluated. Results: Fracture union occurred significantly faster with ESIN than with plate fixation, specifically 3 weeks earlier (11.0 weeks vs. 14.0 weeks; p < 0.001). No significant differences were observed between the groups in QuickDASH scores, intraoperative time, or clavicle shortening at 1 year. The overall postoperative complication rate was 25.7% (9/35), with no statistically significant difference between the ESIN (27.8%) and plate fixation groups (23.5%) (p = 0.774). Refractures occurred exclusively in the plate fixation group (n = 2), while one patient in the ESIN group required early nail removal due to insertion site irritation. Conclusions: ESIN provided functional and radiographic outcomes comparable to plate fixation in adolescents with diaphyseal clavicle fractures, with a 3-week shorter time to union and a less-invasive surgical approach. Full article

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

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13 pages, 1262 KB

Open AccessArticle

Selective Advantage of NACT in Advanced Ovarian Cancer: A Retrospective Single-Centre Analysis

by Adrienne Szilvia Berczi, Olivér Lampé, Zoárd Tibor Krasznai, Mónika Orosz, Lili Fábián and Rudolf Lampé

Medicina 2025, 61(8), 1493; https://doi.org/10.3390/medicina61081493 - 20 Aug 2025

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Abstract

Background and Objectives: Advanced-stage epithelial ovarian cancer (EOC) is associated with poor prognosis, with complete macroscopic cytoreduction representing the strongest modifiable predictor of survival. Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is an alternative to primary debulking surgery (PDS) in patients [...] Read more.

Background and Objectives: Advanced-stage epithelial ovarian cancer (EOC) is associated with poor prognosis, with complete macroscopic cytoreduction representing the strongest modifiable predictor of survival. Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is an alternative to primary debulking surgery (PDS) in patients with high tumor burden. However, its impact on surgical complexity remains debated. This study aimed to compare operative characteristics and survival outcomes between NACT + IDS and PDS using standardized scoring metrics in a real-world oncologic setting. Materials and Methods: We retrospectively analyzed 47 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC-IV high-grade serous EOC treated between January 2018 and August 2022 at a single tertiary center. Twenty-five patients received platinum–taxane-based NACT followed by IDS, and twenty-two underwent upfront PDS with adjuvant chemotherapy. Surgical effort was quantified using the Surgical Complexity Score (SCS), and intra-abdominal tumor burden was assessed via the Peritoneal Cancer Index (PCI). Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan–Meier analysis. Hazard ratios (HRs) with 95% confidence intervals were derived from Cox proportional hazards models. Results: Complete cytoreduction (R0) was achieved in 76% of the NACT + IDS group and 68% of the PDS group. Mean surgical complexity and operative time were significantly lower following NACT (SCS 5.0 vs. 6.2, p = 0.04; 140 vs. 197 min, p = 0.001), without significant differences in blood loss, complication rates, or length of hospital stay. Median PFS was 25 months in the NACT + IDS group versus 21 months in the PDS group, and the difference was not statistically significant. Among patients with R0 resection, survival outcomes were comparable between treatment arms. Conclusions: NACT + IDS was associated with shorter and less complex surgeries in selected patients, but survival outcomes appeared similar when R0 was achieved. Data suggest that selective use of NACT in patients with extensive disease burden or limited general health status may be suitable, while confirming that complete cytoreduction remains the most critical prognostic factor, although these survival comparisons are exploratory given the retrospective design and limited sample size. Full article

(This article belongs to the Special Issue Update on Surgical Treatment for Ovarian Cancer)

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11 pages, 678 KB

Open AccessArticle

Reliability of Body Fat Percentage Measurements and Their Impact on Airway Resistance: Does Leptin Play a Significant Role?

by Rodrigo Muñoz-Cofré, Edgardo Rojas-Mancilla, Pablo A. Lizana, Máximo Escobar-Cabello, Claudio García-Herrera, Daniel Conei, Fernando Valenzuela-Aedo, Francisco Javier Soto-Rodríguez and Mariano del Sol

Medicina 2025, 61(8), 1492; https://doi.org/10.3390/medicina61081492 - 20 Aug 2025

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Abstract

Background/Objectives: The measurement of body fat percentage (%BF) could alert us to potential respiratory problems; however, differences in %BF values have been reported depending on the method used. Therefore, the objectives of this study were to determine whether there are differences in %BF [...] Read more.

Background/Objectives: The measurement of body fat percentage (%BF) could alert us to potential respiratory problems; however, differences in %BF values have been reported depending on the method used. Therefore, the objectives of this study were to determine whether there are differences in %BF obtained through skinfold measurements (SF) and bioelectrical impedance analysis (BIA), and their correlation with airflow limitation (AFL), and secondly, to observe the relationship between leptin and AFL. Materials and Methods: A cross-sectional study was conducted with 80 participants (40 men and 40 women, aged 18–30 years). Assessments of %BF were made using SF and BIA. Spirometric parameters and pulmonary volumes were measured. Plasma leptin levels were determined using ELISA. Bivariate correlations and gender differences were analyzed. Results: When comparing %BF measured by SF and BIA, no significant differences were found between the two methods in either females or males. Furthermore, in both men and women, there was a direct and significant correlation between %BF obtained through BIA and SF (r = 0.936; r = 0.789, p < 0.001, respectively). Leptin showed a significant correlation with airway resistance (Raw) and specific airway resistance (sRaw) in men (r = 0.506; r = 0.553, p < 0.001, respectively) and women (r = 0.537, p = 0.001; r = 0.489, p = 0.003, respectively). Leptin also showed a significant correlation with %BF measured by both SF and BIA in men (r = 0.675; r = 0.687, p < 0.001, respectively) and women (r = 0.583; r = 0.682, p < 0.001, respectively). Conclusions: BIA and SF offer comparable results in estimating %BF. The significant correlation between leptin, %BF, and FEV1/FVC suggests a possible pathophysiological mechanism mediated by adiposity that could affect pulmonary function even in young and clinically healthy individuals. Full article

(This article belongs to the Section Pulmonology)

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15 pages, 936 KB

Open AccessArticle

The Resurgence of Syphilis: A 20-Year Evaluation of Epidemiological Trends and Serological Test Performance Using Rapid Plasma Reagin and Indirect Hemagglutination Assays

by Melda Payaslıoğlu, İmran Sağlık and Esra Kazak

Medicina 2025, 61(8), 1491; https://doi.org/10.3390/medicina61081491 - 20 Aug 2025

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Abstract

Background and Objectives: This retrospective single-center study aimed to evaluate the epidemiological, clinical, and laboratory characteristics of syphilis cases diagnosed at our hospital between 2005 and 2024, with a focus on the performance of serological tests used for diagnosis. The study also [...] Read more.

Background and Objectives: This retrospective single-center study aimed to evaluate the epidemiological, clinical, and laboratory characteristics of syphilis cases diagnosed at our hospital between 2005 and 2024, with a focus on the performance of serological tests used for diagnosis. The study also sought to characterize changing epidemiological trends of syphilis over this 20-year period. Materials and Methods: Data from 671 patients with confirmed syphilis diagnoses were retrospectively analyzed. Demographic information, transmission routes, co-infection status, and serological test results—including Rapid Plasma Reagin (RPR) and Indirect Hemagglutination Assay (IHA)—were evaluated. Statistical analyses were performed using chi-square and Fisher-based tests, with Bonferroni correction applied for multiple comparisons Results: Of the 671 cases, 74.6% were male and 25.4% female, with the highest incidence in the 22–41 age group. The number of diagnosed cases increased approximately 6-fold after 2016 compared to the preceding years. Unprotected sexual contact was the most common transmission route. HIV co-infection was present in 32.6% of cases, predominantly in males. Significant differences in RPR and IHA titers were observed across clinical stages of syphilis, with notably higher titers in late latent and neurosyphilis cases. Conclusions: The 6-fold increase in syphilis diagnoses since 2016, alongside a high rate of HIV co-infection, underscores the need for targeted prevention and screening programs for high-risk populations. Serological testing remains essential for diagnosis and disease monitoring. Full article

(This article belongs to the Section Infectious Disease)

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17 pages, 989 KB

Open AccessArticle

The Use of Serum Scoring Systems in Predicting Liver Fibrosis Caused by Chronic Hepatitis B: A Retrospective Case-Control Study

by Müge Özgüler, Samet Durak, Özgen Arslan Solmaz, Gülden Eser Karlıdağ, Ömür Gündağ, Yasemin Kırık, Büşra Tanır and Sümeyye Selim Kara

Medicina 2025, 61(8), 1490; https://doi.org/10.3390/medicina61081490 - 20 Aug 2025

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Abstract

Background and Objectives: Early diagnosis and monitoring of liver fibrosis in chronic hepatitis B are crucial for effective disease management and prognosis. Traditionally, percutaneous liver biopsy has been regarded as the gold standard for assessing the degree of fibrosis histopathologically. However, this [...] Read more.

Background and Objectives: Early diagnosis and monitoring of liver fibrosis in chronic hepatitis B are crucial for effective disease management and prognosis. Traditionally, percutaneous liver biopsy has been regarded as the gold standard for assessing the degree of fibrosis histopathologically. However, this method has several drawbacks. Consequently, non-invasive serum scoring systems are becoming increasingly preferred. These serum scoring systems have emerged as valuable non-invasive tools for predicting liver fibrosis in patients with chronic hepatitis B. Multiple serum-based scoring systems have been developed and validated for this purpose. The aim of this study is to determine the role of serum scoring systems in chronic hepatitis B, evaluate their performance, and analyze their correlation with liver biopsy results. Materials and Methods: Patients diagnosed with Chronic Hepatitis B who underwent liver biopsy and were found to have liver fibrosis associated with chronic hepatitis B between August 2018 and July 2024 were included in this retrospective comparative case-control study and liver function tests, INR, alpha-fetoprotein levels, hemogram parameters, kidney function tests, and cholesterol levels at the time of biopsy were recorded. Results: The present study included a total of 249 patients, comprising 138 men (55.5%; mean age 42.1 years) and 111 women (44.5%; mean age 45.8 ± 13.5 years). The results of sixteen commonly used scoring systems in the current literature were evaluated for predicting fibrosis. According to ROC analysis, the most notable score identified was the KING score (0.775). The subsequent scores, in order, were AGAP (0.768), GUCI (0.748), FIB-4 (0.735), APRI (0.729), and S-INDEX (0.701). Conclusions: Non-invasive methods offer potential advantages over liver biopsy. While these scoring systems demonstrate good accuracy in identifying advanced fibrosis and cirrhosis, their performance in detecting mild to moderate fibrosis is generally less reliable. They can function as preliminary screening tests to identify patients who may require further evaluation or to prioritize individuals for more advanced imaging studies or liver biopsy. Full article

(This article belongs to the Section Infectious Disease)

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16 pages, 818 KB

Open AccessReview

Psychoneurobiological Aspects of Burning Mouth Syndrome and Oral Lichen Planus: A Narrative Review

by Dora Martić, Ana Glavina, Liborija Lugović-Mihić and Maja Vilibić

Medicina 2025, 61(8), 1489; https://doi.org/10.3390/medicina61081489 - 20 Aug 2025

Viewed by 463

Abstract

Burning mouth syndrome (BMS) and oral lichen planus (OLP) are two chronic oral diseases/disorders that continue to pose a challenge for conventional diagnosis and treatment. Both diseases do not occur in isolation but rather appear to reflect a broader interplay of psychological, neurological, [...] Read more.

Burning mouth syndrome (BMS) and oral lichen planus (OLP) are two chronic oral diseases/disorders that continue to pose a challenge for conventional diagnosis and treatment. Both diseases do not occur in isolation but rather appear to reflect a broader interplay of psychological, neurological, endocrine, and immunological factors, i.e., complex disorders in interconnected biological and psychological systems. In BMS, patients often suffer from persistent burning sensations without visible lesions, which may be related to altered pain processing, emotional stress, and dysregulation in the brain regions responsible for interoception and perception. Although OLP is primarily characterised by immune-mediated mucosal damage, it often has significant psychological comorbidity, particularly in the erosive form. Common features such as cortisol imbalance, disturbed cytokine patterns, and high levels of anxiety and depression suggest that these conditions may be due to overlapping systemic disorders. It is no longer sufficient to focus only on the visible lesions or symptom relief. Understanding these diseases/disorders through a more comprehensive psychoneuroendocrine immune system (PNEI) opens up new opportunities for early intervention, improved diagnostics, and more personalised therapeutic strategies that go beyond treating symptoms. Ultimately, these diseases/disorders require a more integrated and patient-centred approach, where understanding the whole system is as important as treating its individual parts. Full article

(This article belongs to the Topic Oral Health Management and Disease Treatment)

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24 pages, 3018 KB

Open AccessSystematic Review

The Effects of Hyaluronic Acid on Gait Parameters in Patients with Knee Osteoarthritis: A Systematic Literature Review

by Cosimo Costantino, Sara Ronzoni, Annalisa Ingletto, Roberto Sabato, Antonello Salerno, Stefano Palermi, Ruben Foresti, Chiara Martini and Andrea Demeco

Medicina 2025, 61(8), 1488; https://doi.org/10.3390/medicina61081488 - 20 Aug 2025

Viewed by 514

Abstract

Background and Objectives: Knee Osteoarthritis affects about 10% of people over 50, causing pain and functional limitation. Hyaluronic acid (HA) is crucial in regulating the osteocartilaginous matrix. Patients are usually assessed using clinical scores to examine symptoms and quality of life, and [...] Read more.

Background and Objectives: Knee Osteoarthritis affects about 10% of people over 50, causing pain and functional limitation. Hyaluronic acid (HA) is crucial in regulating the osteocartilaginous matrix. Patients are usually assessed using clinical scores to examine symptoms and quality of life, and in this context, gait analysis could provide an objective assessment of walking patterns to identify any deficits. This systematic review investigates the short and long-term effects of intra-articular HA injections on gait kinematics, pain and activities of daily living (ADL), investigating the correlation between outcomes. Materials and Methods: The review followed PRISMA guidelines. The PICO model included patients with radiographic knee osteoarthritis who received intra-articular HA injections, comparing them to healthy controls or those receiving corticosteroids or placebo. Outcomes included gait kinetics and functional scales at baseline and during follow-ups. Results: From 342 identified articles, 13 were included, comprising a total of 321 patients. The gait analysis utilized optoelectronic systems, inertial sensors, and electromyographic sensors pre- and post-HA treatment. Clinical parameters were assessed using the Visual Analogue Scale, WOMAC OA, Knee Society Score, Lequesne Score, and SF-36. The data showed significant improvement in speed (p = 0.001) and step cadence (p < 0.005) 30 days post-treatment and improvements in knee adduction moment (p < 0.001) and sagittal ground reaction force vectors (p < 0.01) up to six months post-treatment. Pain reduction and improvements in VAS (p < 0.001) and Lequesne score (p < 0.001) were observed in short-term follow-ups. Conclusions: Our study suggests an improvement in pain and knee function after hyaluronic acid injection. Moreover, gait analysis is an important tool for objectively assessing deficits and developing personalized rehabilitation programs. Furthermore, combining infiltrative treatment with rehabilitation could extend the effects of hyaluronic acid and improve results. Full article

(This article belongs to the Section Orthopedics)

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13 pages, 1087 KB

Open AccessArticle

Optimal Maintenance Strategy for Patients with Improved Left Ventricular Function Following Sacubitril/Valsartan Therapy

by Yoonjee Park, Minjung Bak, Heayoung Shin, David Hong, Jeong Hoon Yang, Darae Kim, Eun-Seok Jeon and Jin-Oh Choi

Medicina 2025, 61(8), 1487; https://doi.org/10.3390/medicina61081487 - 19 Aug 2025

Viewed by 598

Abstract

Background and Objectives: Optimal pharmacological treatment following left ventricular ejection fraction (LVEF) improvement remains largely unknown. This study compared the clinical outcomes of patients with heart failure (HF) with improved EF (HFimpEF) based on the maintenance of sacubitril/valsartan (S/V) or transition to [...] Read more.

Background and Objectives: Optimal pharmacological treatment following left ventricular ejection fraction (LVEF) improvement remains largely unknown. This study compared the clinical outcomes of patients with heart failure (HF) with improved EF (HFimpEF) based on the maintenance of sacubitril/valsartan (S/V) or transition to a renin–angiotensin system blocker (RASB). Material and Method: A total of 354 patients with recovered LVEF of at least 40% after S/V treatment from a single center were retrospectively analyzed. Patients were categorized into three groups: those who continued S/V (n = 294), those who switched to RASB (n = 47), and those who discontinued both S/V and RASB (n = 13). The primary endpoint was HF relapse, defined as a two-fold increase in baseline serum N-terminal-pro hormone B-type natriuretic peptide (NT-proBNP) concentration exceeding 400 pg/dL. Secondary endpoints included the ratio and difference between baseline and peak NT-proBNP levels. Result: Baseline clinical characteristics were well balanced among groups. Over a median follow-up of 399 (252–589) days, HF relapse occurred more frequently in patients who discontinued both S/V and RASB compared to those who maintained either treatment (53.8% vs. 16.3% vs. 10.6%; p = 0.001). NT-proBNP levels also showed a more pronounced increase in this group. However, there were no significant differences in primary or secondary outcomes between the S/V and RASB groups. Conclusions: Our findings suggest that replacing S/V with another RASB does not worsen outcomes in patients with HFimpEF after S/V treatment, whereas discontinuation of both therapies is associated with a significantly higher risk of HF relapse. A prospective trial is warranted to confirm the safety and effectiveness of this approach in maintaining remission. Full article

(This article belongs to the Section Cardiology)

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15 pages, 1412 KB

Open AccessArticle

A Single Bout of Foam Rolling After Nordic Hamstring Exercise Improves Flexibility but Has No Effect on Muscle Stiffness or Functional Muscle Parameters

by Coşkun Rodoplu, Christian Burger, Josef Fischer, Josefina Manieu Seguel, Ramiz Arabacı and Andreas Konrad

Medicina 2025, 61(8), 1486; https://doi.org/10.3390/medicina61081486 - 19 Aug 2025

Viewed by 527

Abstract

Background and Objectives: The Nordic hamstring exercise (NHE) effectively strengthens the hamstrings, reduces the risk of hamstring strain, and induces fatigue in the muscles; thus, post-NHE recovery strategies should be optimized. Foam rolling (FR) is a widely used method, with the belief [...] Read more.

Background and Objectives: The Nordic hamstring exercise (NHE) effectively strengthens the hamstrings, reduces the risk of hamstring strain, and induces fatigue in the muscles; thus, post-NHE recovery strategies should be optimized. Foam rolling (FR) is a widely used method, with the belief that it can speed up recovery. Thus, this study investigated the acute and 48-h effects of FR following the NHE on muscle stiffness, pain pressure threshold (PPT), flexibility, countermovement jump (CmJ) height, and maximal voluntary isometric contraction (MVIC). Materials and Methods: Thirty-two active males were randomly assigned to either an FR group (n = 16) or a passive recovery (PR, n = 16) group. Measurements were taken at three time points: pre-test, post-test_0h, and post-test_48h. Participants performed the NHE (3 sets × 10 reps) before the recovery interventions. Variables assessed included muscle stiffness (MyotonPro), flexibility (sit and reach), PPT (algometer), jump performance (force platform), and MVIC peak torque (dynamometer). Results: FR significantly improved acute flexibility (12.7%, p < 0.001) following the NHE and prevented flexibility loss at 48 h, compared to the PR group. However, FR showed no significant advantages over PR in terms of muscle stiffness, PPT, CmJ, or MVIC, both acutely and at 48 h (p > 0.05). Conclusions: FR is an effective acute recovery strategy for improving flexibility after the NHE but offers limited effects for muscle stiffness, PPT, and other functional muscle parameters, both acutely and at 48 h. Further research should explore the long-term effects and efficacy of FR across diverse populations and recovery scenarios. Full article

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9 pages, 261 KB

Open AccessArticle

Evaluating Maternal Healthcare Quality Through the Lens of Maternal near Miss: A Retrospective Analysis from a High-Volume Tertiary Center

by İbrahim Polat and Tuğçe Arslanoğlu

Medicina 2025, 61(8), 1485; https://doi.org/10.3390/medicina61081485 - 19 Aug 2025

Viewed by 375

Abstract

Background and Objectives: As maternal mortality has become increasingly rare in developed countries, it is no longer a reliable metric for evaluating obstetric care quality. To address this limitation, the World Health Organization (WHO) introduced the concept of maternal near miss (MNM)—a term [...] Read more.

Background and Objectives: As maternal mortality has become increasingly rare in developed countries, it is no longer a reliable metric for evaluating obstetric care quality. To address this limitation, the World Health Organization (WHO) introduced the concept of maternal near miss (MNM)—a term adapted from aviation—to standardize the identification and analysis of severe maternal complications. In addition to MNM, various indices are used to assess both access to and the quality of healthcare services. Materials and Methods: This retrospective study evaluated all pregnant women who presented at Başakşehir Çam and Sakura City Hospital, including postpartum referrals, between May 2020 and May 2023. Given the ongoing COVID-19 pandemic during the study period, data from COVID-19-positive patients were reported separately. All definitions and classifications were based on the standardized WHO MNM criteria. Results: A total of 45,458 births occurred at our institution during the study period. Among the COVID-19-excluded cohort, we identified 223 life-threatening conditions (LTCs), 206 MNM cases, and 17 maternal deaths. The resulting mortality index was 7.62%. The most frequent primary diagnoses included placental invasion anomalies, severe preeclampsia, and uterine atony. The most common interventions among LTC cases were ICU admission, prolonged hospitalization, hysterectomy, and massive transfusion. Conclusions: Although the rates of LTCs, MNM, and maternal mortality (MM) are gradually declining, they remain essential metrics for assessing healthcare quality. This study reveals that, while tertiary centers may report higher-than-global-average indices, there remains a significant gap between current outcomes and ideal targets. Enhancing diagnostic training, optimizing intervention strategies, and implementing robust clinical algorithms are critical steps toward reducing severe maternal morbidity and mortality. Full article

(This article belongs to the Special Issue Advances in Obstetrics and Maternal-Fetal Medicine)

12 pages, 299 KB

Open AccessArticle

Low-Density Lipoprotein Cholesterol Target Attainment in Lithuania: A Nationwide Analysis of Real-World Health Data

by Gediminas Urbonas, Tomas Lapinskas, Indrė Čeponienė, Olga Vasiliauskienė, Jelena Umbrasienė, Ingrida Grabauskytė and Jurgita Plisienė

Medicina 2025, 61(8), 1484; https://doi.org/10.3390/medicina61081484 - 19 Aug 2025

Viewed by 515

Abstract

Background and Objectives: Low-density lipoprotein cholesterol (LDL-C) reduction is critical for cardiovascular disease (CVD) prevention. This study aimed to assess the proportion of patients achieving the LDL-C target in Lithuania and to identify factors associated with target achievement. Materials and Methods: [...] Read more.

Background and Objectives: Low-density lipoprotein cholesterol (LDL-C) reduction is critical for cardiovascular disease (CVD) prevention. This study aimed to assess the proportion of patients achieving the LDL-C target in Lithuania and to identify factors associated with target achievement. Materials and Methods: This retrospective study used anonymized health data from the Electronic Health Services and Cooperation Infrastructure Information System (ESPBI IS) in Lithuania. Adults aged ≥40 years with at least one LDL-C measurement in 2023 and no documented cancer diagnosis were included. The primary outcome was the proportion of patients achieving LDL-C < 1.8 mmol/L, the target recommended by the European Society of Cardiology guidelines for high-risk individuals. Univariate logistic regression analysis was conducted to identify factors associated with achieving the LDL-C target. Results: The study included 396,835 patients (mean age, 66.9 years). The mean LDL-C concentration was 3.32 mmol/L, and only 8.1% of patients achieved LDL-C < 1.8 mmol/L. Target achievement was higher among patients in the secondary CVD prevention group compared to primary prevention (20.6% vs. 7.3%). Over half of patients (56.4%) received no lipid-lowering therapy (LLT). Statin monotherapy was the most prescribed LLT (31.3%), while only 2.7% of patients received statin and ezetimibe combination. In logistic regression analysis, secondary prevention status, more frequent cardiologist consultations, and higher LLT prescription frequency were associated with LDL-C target achievement. Compared to patients not receiving LLT, the odds of achieving LDL-C < 1.8 mmol/L were significantly higher in those receiving statin monotherapy (odds ratio [OR]: 3.153, 95% confidence interval [CI]: 3.069–3.240), statin and ezetimibe (OR: 7.631, 95% CI: 7.267–8.013), or statin and antihypertensive (OR: 3.945, 95% CI: 3.803–4.092). Conclusions: LDL-C target attainment remains low in Lithuania, with the underuse of LLT. Broader implementation of guideline-recommended lipid-lowering strategies is needed to improve LDL-C control. Full article

(This article belongs to the Special Issue Primary Care in the Post-Pandemic Era)

16 pages, 1531 KB

Open AccessReview

Desquamative Gingivitis Revisited: A Narrative Review on Pathophysiology, Diagnostic Challenges, and Treatment

by Doina Iulia Rotaru, Ioana Chifor Porumb, Lorentz Jäntschi and Radu Marcel Chisnoiu

Medicina 2025, 61(8), 1483; https://doi.org/10.3390/medicina61081483 - 19 Aug 2025

Viewed by 544

Abstract

Background and objectives: Desquamative gingivitis (DG) is a clinical term used to describe gingival conditions marked by erythema (unrelated to dental plaque), epithelial desquamation, and various intraoral lesions, with occasional extraoral involvement. It is typically linked to a range of underlying diseases. [...] Read more.

Background and objectives: Desquamative gingivitis (DG) is a clinical term used to describe gingival conditions marked by erythema (unrelated to dental plaque), epithelial desquamation, and various intraoral lesions, with occasional extraoral involvement. It is typically linked to a range of underlying diseases. Materials and methods: A narrative literature review was conducted using PubMed, Scopus, Google Scholar, and the Cochrane Library, searching with keywords like “oral dysplasia”, “oral mucosa lesions”, or “desquamative gingivitis”. In addition to the literature review, a case report of a patient with DG is included to illustrate the diagnostic challenges and treatment considerations in a clinical setting, and to design and test simplified diagnosis and treatment-planning algorithms. Results: Diagnosis can be supported by a standard punch biopsy to obtain tissue samples for histopathological evaluation. The complex clinical case presented illustrates the clinical features of DG and highlights the challenges associated with its diagnosis and management. The mainstay of treatment, as resulted from 96 studies included in our review, involves topical and systemic corticosteroids, with topical calcineurin inhibitors serving as adjunctive therapy. Conclusions: A universally accepted treatment protocol is still lacking for DG, so this report outlines an effective, experience-based therapeutic approach. Additionally, it offers a simplified framework for diagnosis, treatment planning, and therapeutic management, contributing to the growing knowledge base needed for a decision-support algorithm development. Full article

(This article belongs to the Special Issue Current and Future Trends in Dentistry and Oral Health)

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13 pages, 1308 KB

Open AccessArticle

Toward Standardized Assessment of Dynamic Subjective Visual Vertical: Effects of Visual Stimulus Intensity in Health and Multiple Sclerosis

by Tautvydas Klėgėris, Diego Kaski, Renata Balnytė, Virgilijus Uloza, Alina Kuzminienė and Ingrida Ulozienė

Medicina 2025, 61(8), 1482; https://doi.org/10.3390/medicina61081482 - 18 Aug 2025

Viewed by 381

Abstract

Background and Objectives: Decreased balance function in multiple sclerosis (MS) patients is influenced by impaired gravity perception, which can be measured by the subjective visual vertical (SVV) test. The value of this test can be increased by executing it in a moving [...] Read more.

Background and Objectives: Decreased balance function in multiple sclerosis (MS) patients is influenced by impaired gravity perception, which can be measured by the subjective visual vertical (SVV) test. The value of this test can be increased by executing it in a moving visual background (i.e., dynamic SVV). However, clinicians and researchers use varying dynamic stimulus properties due to the lack of consensus on optimal parameters for reliably distinguishing between health and disease. Materials and Methods: To evaluate how dynamic visual stimulus intensity affects the perception of verticality in patients with MS and healthy individuals. Materials and Methods: We assessed static and dynamic SVV in 31 MS patients with dizziness and 32 age- and sex-matched controls using the virtual reality application VIRVEST. We evaluated the effects of modifying two parameters in dynamic SVV testing: rotation velocity (10°/s, 30°/s, and 60°/s) and visual field coverage (small vs. large). Results: The median of static SVV deviations was significantly greater in the MS group (1.8° vs. 0.9°). The mildest dynamic stimulus intensity of 10°/s, with a small visual field coverage, yielded the greatest discriminatory capacity to differentiate between the groups (AUC = 0.897; p < 0.001). This stimulus elicited a median SVV deviation of 4.3° in the MS group and 2.1° in the control group (p < 0.001) while also inducing significantly lower test-induced dizziness compared with stronger stimuli. Median visual dependence values measured at 10°/s with a small visual field coverage were 4.2 in the MS group and 2.02 in the control group (p < 0.001), also yielding the greatest AUC values compared to stronger stimuli (AUC = 0.828; p < 0.001). Conclusions: Our results support the use of relatively mild dynamic stimulus intensity. Future studies are encouraged to evaluate different dynamic stimulus parameters and patient populations. Full article

(This article belongs to the Special Issue Multiple Sclerosis and Related Disorders: Theory, Methods and Applications)

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9 pages, 644 KB

Open AccessArticle

Optimizing Endoscopic Transpyloric Feeding Tube Placement in Low Birth Weight Infants: Practical Insights from Clinical Experience

by Yeoun Joo Lee, Hansol Kim, Shin Yun Byun, Narae Lee, Mun Hui Jung and Seung Hee Jeong

Medicina 2025, 61(8), 1481; https://doi.org/10.3390/medicina61081481 - 18 Aug 2025

Viewed by 398

Abstract

Background and Objectives: Transpyloric (TP) feeding tube placement is a viable nutritional strategy in low birth weight infants (LBWIs) with severe gastroesophageal reflux or feeding intolerance. However, technical challenges are encountered in patients of this age group due to their small body [...] Read more.

Background and Objectives: Transpyloric (TP) feeding tube placement is a viable nutritional strategy in low birth weight infants (LBWIs) with severe gastroesophageal reflux or feeding intolerance. However, technical challenges are encountered in patients of this age group due to their small body size and the limited availability of appropriately sized equipment. Materials and Methods: We retrospectively reviewed 15 endoscopic TP tube placements performed in 12 LBWIs weighing less than 2.5 kg between May 2017 and March 2025. Emphasis was placed on procedural techniques, equipment selection, and troubleshooting strategies for successful bedside execution. Results: All procedures were performed without the use of additional accessories, by advancing a feeding tube preloaded with a guidewire under direct visualization provided by a 5.5 mm outer diameter endoscope. All procedures were technically successful, including 14 performed at the bedside using a portable endoscope. A 6 or 8 Fr feeding tube loaded with a soft-tipped guidewire was advanced through the pylorus under direct endoscopic visualization. The average body weight at the time of the procedure was 1950 ± 296 g. No complications such as mucosal injury, perforation, or tube dislodgement occurred during the procedure. The average enteral feeding volume increased from 33.4 ± 52.8 cc/kg to 92.0 ± 44.4 cc/kg within 7 days. Full enteral nutrition was achieved in all surviving patients within three weeks. The feeding tube remained in place for a mean duration of 26.1 ± 19.2 days. Conclusions: Endoscopic TP tube placement in LBWIs can be safely and reliably performed at the bedside with appropriate technical modifications. It facilitates earlier advancement to full enteral nutrition and may serve as a viable option for LBWIs unresponsive to standard feeding methods. Full article

(This article belongs to the Section Pediatrics)

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3 pages, 199 KB

Open AccessEditorial

Editorial for the Special Issue “Hot Topics and Innovations in Reconstructive and Cosmetic Surgery/Aesthetic Medicine”

by Luigi Losco

Medicina 2025, 61(8), 1480; https://doi.org/10.3390/medicina61081480 - 18 Aug 2025

Viewed by 316

Abstract

Innovations and emerging trends in Plastic Reconstructive and Aesthetic Surgery—as well as in Aesthetic Medicine—are continuously expanding the frontiers of modern clinical practice [...] Full article

(This article belongs to the Special Issue Hot Topics and Innovations in Reconstructive and Cosmetic Surgery/Aesthetic Medicine)

13 pages, 278 KB

Open AccessArticle

Association of Apolipoprotein C-III Gene Polymorphisms (rs2854116 and rs2854117) with Susceptibility to Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in a Turkish Population

by Damla Karaagac, Suat Morkuzu, Naci Senkal, Ersel Bilgin, Yasemin Oyacı, Tufan Tükek, Sacide Pehlivan and Alpay Medetalibeyoglu

Medicina 2025, 61(8), 1479; https://doi.org/10.3390/medicina61081479 - 18 Aug 2025

Viewed by 401

Abstract

Background and Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is characterized by the accumulation of fat in the liver, progressing from simple steatosis to various complications, with increasing prevalence in the modern world. Our study aimed to investigate the relationship between MASLD [...] Read more.

Background and Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is characterized by the accumulation of fat in the liver, progressing from simple steatosis to various complications, with increasing prevalence in the modern world. Our study aimed to investigate the relationship between MASLD pathogenesis and the presence of apolipoprotein C-III (ApoC-III) gene variants rs2854116 and rs2854117 by comparing allele and genotype frequencies between MASLD patients and healthy individuals, as well as analyzing their association with biochemical parameters in Turkish populations. Materials and Methods: The study included 202 MASLD patients and 100 healthy controls who presented to our outpatient clinic. MASLD presence was determined by ultrasonography (USG). The demographic, laboratory, and clinical data of the participants were recorded. ApoC-III gene variants rs2854116 and rs2854117 were genotyped using the Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) method from genomic DNA samples obtained from blood. Results: The genotype and allele frequencies of ApoC-III gene variants rs2854116 and rs2854117 did not show significant differences between patient and healthy groups (p > 0.05). When biochemical parameters were evaluated, the LDH value of rs2854116 variant CT/CC genotype carriers was found to be significantly higher than TT genotype carriers (p = 0.016). Conclusions: We observed a high prevalence of MASLD in our Turkish cohort. However, the specific genetic variants we investigated were not associated with MASLD status. This suggests that these variants may not be significant contributing factors to MASLD in this population. Full article

(This article belongs to the Section Gastroenterology & Hepatology)

14 pages, 843 KB

Open AccessArticle

Epidemiology of Tennis-Related Injuries Among Competitive Youth Players in Tunisia: Frequency, Characteristics, and Management Patterns

by Saoussen Layouni, Ismail Dergaa, Hela Ghali, Halil İbrahim Ceylan, Valentina Stefanica, Marwa Neguez, Ines Loubiri, Wissem Dhahbi, Chaima Rjiba, Sarra Ksibi, Sahbi Elmtaoua, Sonia Jemni and Helmi Ben Saad

Medicina 2025, 61(8), 1478; https://doi.org/10.3390/medicina61081478 - 18 Aug 2025

Viewed by 645

Abstract

Background and Objectives: Tennis involves repetitive high-velocity movements, rapid directional changes, and challenging environmental conditions, exposing players to injury risk. However, injury surveillance data for North African youth players are lacking. This study aimed to determine the frequency, characteristics, and management of [...] Read more.

Background and Objectives: Tennis involves repetitive high-velocity movements, rapid directional changes, and challenging environmental conditions, exposing players to injury risk. However, injury surveillance data for North African youth players are lacking. This study aimed to determine the frequency, characteristics, and management of tennis-related injuries among competitive Tunisian youth players. Materials and Methods: A cross-sectional study was conducted among players aged 5–18 years from tennis clubs (October 2023–November 2024). Data were collected using researcher-administered questionnaires, incorporating the Oslo Sports Trauma Research Center Overuse Injury Questionnaire and a sport-specialization assessment, following International Olympic Committee guidelines. Results: Among 256 players, 53.5% (n = 137) reported 366 injuries. Lower limbs were most affected (58.5%), followed by upper limbs (32.8%); knees (23.2%), ankles (17.5%), and wrists (10.1%). Muscle/tendon (36.9%), superficial tissue (28.1%), and ligament/joint capsule injuries (27.6%) predominated. Most injuries occurred during practice (74.9%) and hot weather (93.4%). Severe injuries represented 24%, while 29.5% were minor without time loss. Subsequent injuries occurred in 54.6% of injured players, with significantly higher rates in those with incomplete rehabilitation (p < 0.001). Conclusions: The high frequency of recurrent injuries and limited rehabilitation highlight critical gaps in injury management, emphasizing the need for targeted neuromuscular training, accessible rehabilitation, and standardized return-to-play protocols. Full article

(This article belongs to the Section Sports Medicine and Sports Traumatology)

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11 pages, 519 KB

Open AccessArticle

Free vs. Local Tissue Transfer and Reconstruction in Pediatric Head and Neck Cancer Patients: A Comparable Complication Outcome Review

by Valeria Mejia, Asli Pekcan, Melanie Bakovic, Raina Kushal Patel, Marvee Turk, Idean Roohani, Pasha Shakoori, Mark Urata and Jeffrey A. Hammoudeh

Medicina 2025, 61(8), 1477; https://doi.org/10.3390/medicina61081477 - 18 Aug 2025

Viewed by 454

Abstract

Background and Objectives: Reconstructive outcomes following head and neck (H&N) cancer resection in pediatric patients remain understudied, particularly regarding the comparative efficacy of free versus local tissue transfer. Materials and Methods: A retrospective review was conducted on pediatric patients undergoing malignant [...] Read more.

Background and Objectives: Reconstructive outcomes following head and neck (H&N) cancer resection in pediatric patients remain understudied, particularly regarding the comparative efficacy of free versus local tissue transfer. Materials and Methods: A retrospective review was conducted on pediatric patients undergoing malignant H&N tumor resection at a tertiary center from 2007 to 2024. Patients were stratified by reconstruction type (free vs. local flap), and outcomes assessed included flap failure, wound complications, revision rates, operative time, hospital stay, and 30-day readmission. Results: A total of 41 patients (mean age: 10.6 years) met inclusion criteria; 18 underwent free flaps and 23 received local flaps. Common diagnoses included osteosarcoma (21.9%) and rhabdomyosarcoma (12.2%). Anterolateral thigh (44.4%) and fibula (33.3%) were the most common free flaps; temporalis (21.7%) and pectoralis (13.0%) were common local flaps. Flap survival was high in both groups (94.4% vs. 100%). However, local flaps had significantly higher rates of hardware exposure (34.7% vs. 5.5%, p = 0.025) and wound dehiscence (39.1% vs. 5.5%, p = 0.045). Free flaps were associated with longer operative times (10.3 vs. 6.5 h, p = 0.011) and hospital stays (29.1 vs. 13.9 days, p = 0.036). Conclusions: While both approaches achieved high flap survival, free flaps may offer more durable reconstruction and reduce wound-related complications in complex pediatric H&N oncologic cases. Full article

(This article belongs to the Section Pediatrics)

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21 pages, 2014 KB

Open AccessSystematic Review

Interventional Procedures in Deep Venous Thrombosis Treatment: A Review of Techniques, Outcomes, and Patient Selection

by Arkadiusz Kacała, Mateusz Dorochowicz, Jędrzej Fischer, Adrian Korbecki, Aleksander Truszyński, Anna Madura, Krzysztof Dyś, Andrzej Szuba and Maciej Guziński

Medicina 2025, 61(8), 1476; https://doi.org/10.3390/medicina61081476 - 18 Aug 2025

Viewed by 953

Abstract

Background and Objectives: Deep venous thrombosis (DVT) is associated with pulmonary embolism and long-term complications such as post-thrombotic syndrome (PTS). Anticoagulation prevents thrombus extension but does not actively remove clot. Interventional techniques, including catheter-directed thrombolysis, mechanical and pharmacomechanical thrombectomy, and venous stenting, have [...] Read more.

Background and Objectives: Deep venous thrombosis (DVT) is associated with pulmonary embolism and long-term complications such as post-thrombotic syndrome (PTS). Anticoagulation prevents thrombus extension but does not actively remove clot. Interventional techniques, including catheter-directed thrombolysis, mechanical and pharmacomechanical thrombectomy, and venous stenting, have been introduced to restore venous patency and reduce complications. This systematic review summarizes current evidence on outcomes, safety, and patient selection for these procedures. Materials and Methods: A systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science was conducted for studies published between January 2000 and February 2024. Eligible studies included randomized controlled trials, systematic reviews, meta-analyses, and observational studies with ≥20 patients. Extracted outcomes were technical success, thrombus clearance, venous patency, PTS, quality of life, and complications. Risk of bias was assessed using the Cochrane Risk of Bias Tool, Newcastle–Ottawa Scale, and AMSTAR-2. Results: Of 456 records screened, 35 studies were included. Randomized trials (CaVenT, ATTRACT, CAVA) showed that catheter-directed and pharmacomechanical approaches improved venous patency and reduced moderate-to-severe PTS in selected patients with iliofemoral DVT, though overall benefit was variable. Mechanical thrombectomy devices (e.g., AngioJet, ClotTriever, FlowTriever) achieved high thrombus clearance and shorter procedural times, with device-specific complication profiles. Observational data demonstrated venous stenting patency rates of 74–89% at 12 months. Study heterogeneity limited direct comparisons. Conclusions: Interventional procedures can reduce PTS and improve outcomes in carefully selected patients, particularly those with acute iliofemoral DVT. Modern mechanical and pharmacomechanical techniques enhance efficiency and safety, while venous stenting addresses underlying obstructions. Further high-quality trials with long-term follow-up are needed to define optimal patient selection and comparative effectiveness. Full article

(This article belongs to the Special Issue Progress in Venous Thromboembolism Research)

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9 pages, 357 KB

Open AccessArticle

by Zornitsa Mitkova, Elena Dimitrova, Hristiana Tomova, Nikolay Gerasimov, Diyan Gospodinov, Konstantin Mitov, Stamen Pishev, Boryana Parashkevova and Guenka Petrova

Medicina 2025, 61(8), 1475; https://doi.org/10.3390/medicina61081475 - 17 Aug 2025

Viewed by 487

Abstract

Background and Objectives: The goal of this study is to assess health-related quality of life (HRQoL) using the EuroQoL (EQ-5D-5L) and identify factors that might contribute to it. Materials and Methods: This is a real-life, observational study involving 234 hypertensive patients [...] Read more.

Background and Objectives: The goal of this study is to assess health-related quality of life (HRQoL) using the EuroQoL (EQ-5D-5L) and identify factors that might contribute to it. Materials and Methods: This is a real-life, observational study involving 234 hypertensive patients from Sofia and Burgas, conducted between January 2024 and July 2024. Patients were interviewed during their regular outpatient examinations and completed the questionnaire independently. Results: In total, 141 out of 234 respondents reported a visual analog scale (VAS) score of 70, and 152 reported a utility score of 0.7. The average VAS scores for males and females were 77.5 and 77.0, respectively, and the utility scores were 0.848 and 0.768, respectively. With advancing age, patients’ quality of life (QoL) decreased from 0.879 to 0.652 utility. Respondents with higher levels of education had higher utility scores (0.848 for bachelor’s/master’s degrees vs. 0.542 for primary education). With an increase in the number of concomitant diseases and prescribed medications, the QoL decreased (0.848 vs. 0.623 and 0.848 vs. 0.736, respectively). Conclusions: This first study of HRQoL using EQ-5D-5L among Bulgarian hypertensive patients revealed relatively high average VAS and utility scores. These results suggest that the disease is under control and that patients are being successfully treated and monitored. Factors such as comorbidity, residence, education, disability, and disease duration significantly affected and worsened patients’ HRQoL. Full article

(This article belongs to the Section Cardiology)

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13 pages, 612 KB

Open AccessArticle

Glycated Hemoglobin as a Predictor of Postoperative Delirium in Diabetic Patients Undergoing Noncardiac Surgery: A Retrospective Study

by Mahir Bahceci, Ersel Gulec, Mediha Turktan, Zehra Hatipoglu and Dilek Ozcengiz

Medicina 2025, 61(8), 1474; https://doi.org/10.3390/medicina61081474 - 16 Aug 2025

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Abstract

Background and Objectives: Diabetes is a known risk factor for postoperative delirium (POD); however, the relationship between the markers of glycemic control and the occurrence of POD in noncardiac surgery is not established. We initiated this pilot study to determine any possible [...] Read more.

Background and Objectives: Diabetes is a known risk factor for postoperative delirium (POD); however, the relationship between the markers of glycemic control and the occurrence of POD in noncardiac surgery is not established. We initiated this pilot study to determine any possible associations between preoperative HbA1c levels and POD development; this will allow for larger, definitive studies to be designed and preliminary effect sizes to be established for future research. Materials and Methods: This retrospective pilot study included 78 patients with diabetes who underwent elective noncardiac surgery under general anesthesia between July 2020 and January 2021. We obtained the patients’ demographic data, medical history, surgical parameters, and preoperative HbA1c levels to determine the occurrence of POD (using CAM-ICU). Univariate and multivariate regression analyses were applied to check the leading associations for the development of POD. Results: POD was observed in seven patients (9.0%). The results of the preliminary multivariate analysis suggested that HbA1c may be associated with POD (OR, 2.96; 95% CI [1.34–6.52], p = 0.007); fasting blood glucose (OR, 1.04; 95% CI [1.01–1.07], p = 0.013); and duration of anesthesia (OR, 1.02; 95% CI [1.00–1.04], p = 0.019). The ROC analysis of HbA1c showed an optimal threshold of 7.4%, with a sensitivity of 91.5%, and a specificity of 85.7% in terms of predicting POD (AUC = 0.91, p < 0.001). Conclusions: Through this pilot study, we have provided evidence that leads to the assumption that preoperative HbA1c at, or above, 7.4% can result in an increased risk of delirium in diabetic patients who undergo noncardiac surgery. The findings of this study allow for the implementation of the proposed methodology and the collection of critical data necessary for the design of appropriately powered definitive trials. Full article

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

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18 pages, 828 KB

Open AccessArticle

Relative Grip Strength as a Screening Indicator for Metabolic Syndrome in Korean Adults: A Cross-Sectional Study Using Data from KNHANES

by Jongsuk Park and Sangho Kim

Medicina 2025, 61(8), 1473; https://doi.org/10.3390/medicina61081473 - 16 Aug 2025

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Abstract

Background and Objectives: This study aimed to assess the association between relative grip strength (RGS) and metabolic syndrome (MetS) in Korean adults and to explore sex- and age-specific cutoff values for screening purposes. Materials and Methods: This cross-sectional study analyzed data [...] Read more.

Background and Objectives: This study aimed to assess the association between relative grip strength (RGS) and metabolic syndrome (MetS) in Korean adults and to explore sex- and age-specific cutoff values for screening purposes. Materials and Methods: This cross-sectional study analyzed data from 12,072 Korean adults (aged 19–64 years) who participated in the 2017–2019 Korea National Health and Nutrition Examination Survey. Receiver operating characteristic (ROC) curve analysis was performed stratified by sex and age group, and participants were categorized into adequate (ARG) and low (LRG) RGS groups. Multivariable logistic regression was used to examine the association between RGS (as both categorical and continuous variables) and MetS, adjusting for lifestyle and behavioral covariates. Results: The RGS demonstrated moderate discriminatory power for MetS, with area under the curve (AUC) values ranging from 0.601 to 0.742. Age- and sex-specific cutoff values for RGS progressively decreased with age. Individuals in the LRG group had significantly higher odds of MetS across all age and sex groups. The LRG group had significantly greater odds of MetS in nearly all subgroups (e.g., women aged 20–39 years: odds ratio [OR] = 6.846; men: OR = 3.502). As a continuous variable, each 0.1-unit increase in RGS was associated with a 22.1–33.4% reduction in the odds of MetS (p < 0.001). Conclusions: RGS is inversely associated with MetS, particularly in women and younger adults. Although its discriminatory ability is moderate, the RGS may serve as a simple and accessible screening indicator to help identify individuals with an increased metabolic risk. Full article

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

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Medicina, Volume 61, Issue 8 (August 2025) – 189 articles

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