Medicina, Volume 61, Issue 8 (August 2025) – 162 articles

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

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

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

Background and Objectives: Cardiovascular diseases (CVDs) remain the leading cause of mortality in Poland, with heart failure (HF) presenting a significant public health issue. Materials and Methods: This study aimed to analyze trends in HF incidence, hospitalization rates, patient demographics, and mortality over two decades A comparative analysis was performed using data from two national reports: (1) the 2013 report “Heart Failure—Analysis of Economic and Social Costs, “ assessing HF patients from 2004 to 2012, and (2) the 2023 report “Heart Failure in Poland 2014–2021,” based on data from the Polish Ministry of Health, National Health Fund, and HTA Consulting. This study examined the prevalence of HF (ICD-10 codes: I50, J81), hospitalization rates, comorbidities, mortality trends, and access to rehabilitation. Results: Between 2014 and 2019, the number of HF patients grew by 34%, reaching 1.02 million in 2019. Only 9% of HF patients were younger than 60 years. Multimorbidity was common, with arterial hypertension, atherosclerotic cardiovascular disease, and arrhythmias, often preceding HF diagnosis. HF-related mortality increased, with 149,963 in 2021, compared to 16,606 in 2012. In 2019, hospitalizations related to HF increased by 41% compared to 2014. The economic burden of HF care increased by 117% between 2014 and 2020, with hospitalizations accounting for 94% of total costs, up from 65% in 2012. Access to cardiac rehabilitation remained limited. Conclusions: HF prevalence, hospitalization rates, and mortality have increased in Poland, alongside a rising burden of multimorbidity. These findings provide a foundation for future healthcare planning to reduce the impact of HF in Poland. Full article

Background and Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) and eosinophilic otitis media (EOM) are frequently co-existing eosinophilic disorders related to type 2 inflammation, which significantly impair the quality of life of patients. Dupilumab, a monoclonal antibody targeting the IL-4 receptor alpha and anti-IL-13, has demonstrated a promising profile of efficacy and safety in the treatment of CRSwNP; however, evidence on its role in concomitant EOM and CRSwNP remains limited in the literature. This study aims to evaluate the clinical efficacy of dupilumab in patients with concomitant CRSwNP and EOM over a six-month observational period. Materials and Methods: A retrospective observational cohort study was conducted on twenty-two patients (aged 18–75 years) over six months with severe uncontrolled CRSwNP and confirmed refractory EOM who were treated with dupilumab (300 mg every two weeks). Demographic data are collected, and outcome measures included Nasal Polyp Score (NPS), Sino-Nasal Outcome Test (SNOT-22), Visual Analog Scale for nasal congestion (VAS), tympanogram classification, and Chronic Otitis Media Outcome Test (COMOT-15), evaluated at baseline and 6 months. Results: Over the six-month treatment period, patients with coexisting CRSwNP and eosinophilic otitis media experienced significant improvements across the multiple validated clinical and patient-reported outcome measures. The Nasal Polyp Score (NPS) significantly decreased from a median of 5.7 (IQR: 1.2) at baseline to 1.5 (IQR: 1.3) at six months (p < 0.0001). The SNOT-22 showed a substantial decline from a median of 77.6 (IQR: 19.0) to 21.5 (IQR: 13.4), p < 0.0001. Visual Analog Scale (VAS) scores for nasal congestion improved significantly from 8.4 (IQR: 1.1) to 1.7 (IQR: 1.2), p < 0.0001. Tympanogram scores improved from Tympanogram type “B” to Tympanogram type “A” (p = 0.018). COMOT-15 scale decreased from a median of 51.3 (IQR: 8.4) to 19.2 (IQR: 5.0) (p < 0.0001). Peripheral eosinophil counts remained unchanged or increased (baseline 0.80 vs. 0.84 cells/μL at six months, (p = 0.834)). Conclusions: Dupilumab treatment in patients with CRSwNP and EOM led to significant clinical improvements in sinonasal symptoms, middle ear function, and quality of life over six months, with no significant change in peripheral eosinophilia. Full article

Drug-coated balloons (DCBs) have transformed percutaneous coronary intervention (PCI) by delivering antiproliferative drugs directly to the arterial wall, offering a stent-less approach that mitigates the risks associated with permanent metallic implants. Initially developed for in-stent restenosis (ISR), DCBs have demonstrated robust efficacy in reducing neointimal hyperplasia and target lesion revascularization (TLR) rates across diverse coronary lesions, including small vessel disease (SVD), de novo lesions, and complex anatomies such as bifurcation lesions. Paclitaxel-coated balloons have long been the cornerstone of DCB therapy due to their established clinical outcomes, but sirolimus-coated balloons are emerging as a promising alternative with potentially superior safety profiles and sustained drug release. The pharmacological mechanism of DCBs relies on rapid drug transfer during brief balloon inflation, achieving high local concentrations without residual foreign material. Landmark trials, such as BASKET-SMALL 2, RESTORE SVD, and AGENT IDE, have demonstrated comparable or non-inferior outcomes of DCBs versus drug-eluting stents (DESs) in specific settings, with lower rates of stent thrombosis and shorter dual antiplatelet therapy (DAPT) requirements. Despite these advances, challenges persist, including optimizing drug formulations, ensuring uniform delivery, and addressing calcified lesions. Ongoing research into novel coatings, dual–drug systems, and artificial intelligence (AI)-guided interventions is poised to redefine PCI strategies. This review provides a comprehensive analysis of drug-coated balloon (DCB) angioplasty, not limited to specific clinical scenarios such as in-stent restenosis, small vessel disease, or bifurcation lesions, highlighting their transformative role in coronary artery disease (CAD) management. Instead, it addresses the full spectrum of pharmacological principles, mechanisms of action, clinical indications, comparative efficacy across various coronary artery disease contexts, and future directions of DCBs. Full article

Objective: The association between right ventricular myocardial fiber deformation and nutrition in weightlifters has not been fully characterized. This study analyzed nutritional factors and right ventricle speckle tracking echocardiography parameters in weightlifters before and after bench press exercises. Methods: This interventional study examined the effects of bench press exercises on myocardial function. Nutritional parameters were assessed prior to exercise. Echocardiography with speckle tracking using vector velocity analysis was performed before and immediately after the bench press exercise. This study included a group of non-elite athlete weightlifters and a non-athlete control group to compare right myocardial function. In the athlete group, transthoracic echocardiograms (TTEs) were conducted before and after the exercise to assess changes in systolic and diastolic right heart function. A cohort of 30 weightlifters from 2014 who continued regular training was re-evaluated in 2024, and nutritional data were collected. Data analyses included ANOVA and Student’s T-tests, and correlation coefficients were calculated to explore associations with speckle tracking results. Results: This study involved 211 male weightlifters and a control group of 60 non-athletes. Measured values for the control group and athletes before and after bench press exercise were as follows: right longitudinal global strain (−27.31 ± 1.47, −23.55 ± 2.37, −30.98 ± 2.12); right global longitudinal strain rate (−1.79 ± 0.078, −1.48 ± 0.33, −2.88 ± 0.259 1/s), all p < 0.001; and isovolumic acceleration (2.38 ± 0.22, 3.52 ± 0.15, 6.66 ± 0.88 m/s², p < 0.001). Following exercise, right intraventricular synchrony increased, and longitudinal strain delay decreased (144.88 ± 22.52, 168.92 ± 29.35, 98.27 ± 12.11 ms, p < 0.001). The follow-up group demonstrated a similar response to exercise as the other weightlifters. Right ventricular longitudinal strain showed correlations with protein, vitamin E, and zinc levels (R² = 0.399, p = 0.021; R² = 0.378, p = 0.03; R² = 0.566, p < 0.01), and right ventricular radial velocities correlated with group B vitamins. Conclusions: Weightlifters show less right ventricular deformity before exercise compared to controls, but their strain increases significantly post-exercise. Speckle tracking values might correlate with nutrition. Full article

Background and Objectives: AIDS-related mortality has significantly decreased due to antiretroviral therapy (ART), leading to a substantial increase in average lifespan. Consequently, cardiovascular diseases have become a growing concern among people living with HIV (PLWH). This study aimed to assess the cardiovascular risk profile of people living with HIV receiving ART and to explore the association between traditional and HIV-related factors with increased cardiovascular risk. Materials and Methods: We conducted a case study involving 112 PLWH receiving ART at a specialized clinic in southeastern Romania to estimate cardiovascular risk (CVR) using the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D^®) score. For participants aged 40 and above, the SCORE2 algorithm was additionally applied. Results: Most participants were male and under 40 years of age, including 34 individuals from Romania’s distinct pediatric HIV cohort. We observed a substantial cardiovascular risk burden: abdominal obesity was present in 24.1% of participants, active smoking was reported by 55.4%, and over 70% had low physical activity levels. Among participants aged 40 and above, the D:A:D^® and SCORE2 scores were strongly correlated, with an average cardiovascular age exceeding chronological age by a mean of 7.5 years. Although CVR remained similarly low among subgroups of PLWH under 40, the prevalence of metabolic syndrome was higher in patients from the pediatric cohort compared to those diagnosed later. Traditional risk factors—such as age, obesity, hypertension, dyslipidemia, smoking, and alcohol use—as well as elevated C-reactive protein levels, were significantly associated with increased CVR. Conclusions: Residual inflammation in PLWH, despite complete viral suppression in combination with metabolic syndrome, is associated with increased cardiovascular risk even in younger and clinically stable populations. Routine integration of metabolic and cardiovascular risk screening into HIV care may support timely prevention and personalized management strategies starting at an early age. Full article

Background and Objectives: Non-small-cell lung cancer (NSCLC) often has epidermal growth factor receptor (EGFR) mutations, which are key targets for therapy. EGFR mutation subtypes, especially exon 19 deletions and exon 21 L858R mutations, influence responses to EGFR tyrosine kinase inhibitors (TKIs) and patient survival. Despite progress in TKI treatments, resistance and different responses remain challenges. This study explores the relationship between EGFR mutation subtypes, PD-L1 expression, and patient outcomes after anti-EGFR therapy. Materials and Methods: We studied 176 cases of EGFR mutation-positive NSCLC. Next-generation sequencing was used to analyze EGFR and other mutations, while PD-L1 expression was evaluated through immunohistochemistry. We analyzed EGFR mutation subtypes, PD-L1 status, treatments, and survival outcomes. Results: Among 176 cases, 88.6% were adenocarcinomas. Within the EGFR mutation spectrum, exon 19 deletions were the most common subtype, accounting for 40.9% of cases, followed by the point mutation in exon 21, which occurred in 35.8% of cases. Less frequent alterations, making up 23.3% of all detected mutations, included mutations in exon 18, insertions, and point mutations such as S768I and T790M in exon 20, as well as changes in exon 2, exon 7, and other less frequently affected regions. Exon 19 mutations were associated with older age, female sex, adenocarcinoma, and bone metastasis (p < 0.05). TP53 was the most common concurrent mutation (44.3%). PD-L1 positivity (TPS ≥ 1%) was observed in 48.3%, with high expression (TPS ≥ 50%) in 25.9%. Exon 21 mutations were significantly linked to PD-L1 negativity (p = 0.008). The median overall survival was longest with TKI therapy (51 months), and this was also observed in PD-L1-positive patients, although the difference was not statistically significant. The median progression-free survival for patients treated with TKIs and those with EGFR mutations was 14 months. PD-L1-positive patients receiving TKIs had significantly longer survival than those who did not (51 vs. 17 months, p = 0.003). Conclusions: EGFR mutation subtypes and PD-L1 expression seem to affect treatment outcomes and survival in NSCLC. The observed links emphasize the potential value of combining molecular and immunological markers to guide therapy choices. Full article

Background and Objectives: Early repolarization (ER), previously considered benign for many years, is now recognized as a substantial risk factor for malignant arrhythmia, coronary artery disease, and mortality. The ER pattern, previously regarded as a benign electrocardiographic characteristic, has lately been demonstrated to have a strong association with malignant arrhythmias, coronary artery disease, and elevated death rates. This study seeks to illustrate the prognostic significance of QT interval (QTc) prolongation on electrocardiograms for acute coronary syndrome and death in emergency cases. Prolongation of QTc duration on electrocardiography in emergency room cases may serve as a possible predictor for acute coronary syndrome and mortality. Materials and Methods: A retrospective study was conducted on 924 patients diagnosed with ER in the emergency department from 2020 to 2023. The QTc durations, serum glucose levels, troponin I levels, and additional auxiliary data of the patients were assessed. The alteration in the aVR derivation, often overlooked and deemed insignificant, was compared with clinical severity in ER cases. Results: The average age of the 924 patients in the study was 48.43 (9.65) years, with 30.7% being female. In the non-cardiac group, the mean age was 51.67 (7.98) years, with 738 females (31.9%). The QTc interval in the patient group was 409.54 (33.46) ms, while in the control group it was 411.57 (27.91) ms (p < 0.001). The one-year death rate was 49 (5.3%) for the ER group and nine (0.9%) for the follow-up group. The most common comorbid condition in both groups was tobacco and/or tobacco product intake. Univariate and multivariate regression analyses conducted for both ER types and mortality indicated that QTc prolongation may serve as a predictive factor (p < 0.001). The sensitivity and specificity of prolonged QTc in predicting acute coronary syndrome and mortality were determined to be 76% at the lowest and 98% at the highest levels in ER cases (p < 0.001). The Kaplan–Meier survival analysis for ER types revealed 321 days for the horizontal type and 363 days for the ascending type. Conclusions: Prolonged QTc duration in early repolarization cases may serve as an independent predictor of acute coronary syndrome and mortality. Full article

Background and Objectives: Borderline personality disorder (BPD) is a complex psychiatric condition characterized by emotional instability, impulsivity, a fluctuating self-image, and persistent difficulties in maintaining close interpersonal relationships. Among university students, these traits may be associated with social adjustment and academic functioning difficulties. The present study aimed to examine the prevalence of borderline traits within a Romanian student population and to investigate the associations between these traits and interpersonal difficulties encountered in family life, romantic relationships, and academic environments. Materials and Methods: This cross-sectional study included a total of 151 undergraduate students enrolled in higher education institutions across Romania. Data were gathered through an online questionnaire available between March and May 2025. The instrument comprised items addressing socio-demographic characteristics, diagnostic criteria for borderline personality traits according to the DSM, as well as self-reported social behaviour patterns. Statistical analysis was performed using GraphPad Prism 9, version 9.3.1 for Windows, employing Fisher’s exact test and the odds ratio (OR), with a significance threshold set at p < 0.05. Results: Most participants reported experiencing affective instability (71.5%) and distorted self-image (58.9%). Fear of abandonment was present in 29.4% of the respondents, while impulsivity was identified in 37.7%. Borderline personality traits were significantly associated with a range of social difficulties, including relational anxiety, outbursts of anger, peer conflicts, social withdrawal, and dissociative symptoms. Individuals who exhibited impulsivity, self-injurious behaviours, or dissociative episodes demonstrated a markedly increased risk of social dysfunction, with odds ratios ranging from 3 to 10 (p < 0.0001). Conclusions: The findings reveal a high prevalence of borderline traits within the analysed sample, along with statistically significant associations with social and emotional difficulties. These results underscore the importance of implementing psychological screening programs in universities, as well as early intervention strategies focused on the mental well-being of young adults. Establishing a supportive academic environment and fostering collaboration between faculty members and mental health professionals may play a key role in preventing symptom escalation and in promoting healthy personal and relational development. Full article

Background and Objectives: The effect of AR expression on prognosis in hormone receptor-positive her2-negative breast cancer is controversial. There are studies showing that AR is a treatment target, a mechanism of resistance to endocrine treatments, and a prognostic indicator in these patients whose standard treatment is a CDK 4/6 inhibitor added to endocrine treatment. We aimed to investigate the effect of AR, the AR/ER ratio, and the AR/PR ratio on CDK4/6 inhibitor treatment response in breast cancer, as well as their effects on PFS, and to validate the hypothesis that AR is a target for research. Materials and Methods: Patients who were diagnosed with metastatic hormone receptor-positive her2-negative breast cancer and received cdk4/6 inhibitor + aromatase inhibitor in first-line therapy were included in this study conducted at Balıkesir Atatürk City Hospital. The tru-cut biopsy samples of the patients were evaluated immunohistochemically for AR, ER, and PR. Kaplan–Meier analysis was used to calculate the estimated median survival in PFS analyses, and the variables were compared with the Log-Rank test. Receiver Operating Characteristic (ROC) analysis was applied to determine the ideal cut-off. Cox regression analysis was used in univariate survival models, and the multivariate model was established with the “Forward: Likelihood Ratio (LR)” method. Hazard ratios (HRs) were also calculated as 95% confidence intervals (95% CIs). A p value below 0.05 was accepted for statistical significance. Results: In total, 41 patients were included in the study, and 73% (n = 30) of the patients were AR-positive. Increased AR (HR 1.014; 95% CI: 1.002–1.026; p = 0.023) was an unfavorable prognostic indicator. In our study, being ≥55 years old, being postmenopausal, not having visceral metastasis, having a non-IDC histology, having a low AR level (<50%), having an AR/ER ratio < 0.74, and having an AR/PR ratio < 1.00 were found to be associated with longer PFS. All factors were evaluated with univariate Cox regression analysis. Increasing AR (HR 1.014; 95% CI: 1.002–1.026; p = 0.023) was an unfavorable prognostic marker. Having an AR/ER ratio ≥ 0.74 (HR: 2.522; 95% CI: 1.004–6.336; p = 0.049) and having AR/PR ≥ 1 (HR: 2.659; 95% CI: 1.029–6.869; p = 0.043) were negative prognostic indicators. Conclusions: Our results were consistent with the literature and demonstrated the value of the androgen receptor as a therapeutic target, a mechanism explaining resistance to endocrine therapy, and an adverse prognostic indicator for creating resistance to endocrine therapy in breast cancer. Full article

Background and Objectives: High-grade gliomas (HGGs) are aggressive primary brain tumors with a poor prognosis despite multimodal treatment. The anesthetic technique used during surgery may influence tumor progression and survival, but its role in HGGs remains unclear. This meta-analysis evaluated the effect of total intravenous anesthesia (TIVA) versus inhalational anesthesia (INHA) on overall survival (OS) and progression-free survival (PFS) in HGG patients. Materials and Methods: A systematic search was conducted in PubMed, Scopus, and Cochrane databases for studies assessing the impact of TIVA versus INHA on OS and PFS in HGG patients. Statistical analysis was performed using R version 4.3.1. Heterogeneity across studies was quantified using the Cochrane Q test alongside the I² statistic. A random-effects model was employed to derive the pooled hazard ratios (HRs). Results: A total of five studies involving 827 participants (mean age 58 years, mean females 38%) were included, of whom 406 (49%) received TIVA. No statistically significant differences were observed in OS (HR 0.77; 95% CI [0.58–1.02]; p = 0.07; I² = 67%) or PFS (HR 0.88; 95% CI [0.70–1.10]; p = 0.27; I² = 51%) between the groups. A subgroup analysis revealed that TIVA was associated with improved OS in patients with grade IV tumors (HR 0.70; 95% CI [0.51–0.96]; p = 0.03), while no significant effect was observed in the mixed grade III–IV subgroup. However, the test for subgroup differences was not statistically significant (p = 0.0669), and this finding should be interpreted with caution. No significant differences were observed in median OS or PFS, or in single-arm meta-analyses. Conclusions: This meta-analysis found no statistically significant differences in overall or progression-free survival between TIVA and INHA in patients undergoing surgery for HGGs. Although a subgroup analysis suggested a possible survival advantage of TIVA in grade IV tumors, the lack of a statistically significant subgroup difference test limits the strength of this finding. Further investigation is needed to determine whether anesthetic technique influences outcomes in this subgroup. Full article

Background and Objectives: Over the past few years, there has been a significant shift in focus from developing better diagnostic tools to detecting Alzheimer’s disease (AD) earlier and initiating treatment interventions. This review will explore four main objectives: (a) the role of biomarkers in enhancing the diagnostic accuracy of AD, highlighting the major strides that have been made in recent years; (b) the role of neuropsychological testing in identifying biomarkers of AD, including the relationship between cognitive performance and neuroimaging biomarkers; (c) the amyloid hypothesis and possible molecular mechanisms of AD; and (d) the innovative AD therapeutics and the challenges and limitations of AD research. Materials and Methods: We have searched PubMed and Scopus databases for peer-reviewed research articles published in English (preclinical and clinical studies as well as relevant reviews and meta-analyses) investigating the molecular mechanisms, biomarkers, and treatments of AD. Results: Genome-wide association studies (GWASs) discovered 37 loci associated with AD risk. Core 1 biomarkers (α-amyloid Aβ42, phosphorylated tau, and amyloid PET) detect early AD phases, identifying both symptomatic and asymptomatic individuals, while core 2 biomarkers inform the short-term progression risk in individuals without symptoms. The recurrent failures of Aβ-targeted clinical studies undermine the amyloid cascade hypothesis and the objectives of AD medication development. The molecular mechanisms of AD include the accumulation of amyloid plaques and tau protein, vascular dysfunction, neuroinflammation, oxidative stress, and lipid metabolism dysregulation. Significant advancements in drug delivery technologies, such as focused Low-Ultrasound Stem, T cells, exosomes, nanoparticles, transferin, nicotinic and acetylcholine receptors, and glutathione transporters, are aimed at overcoming the BBB to enhance treatment efficacy for AD. Aducanumab and Lecanemab are IgG1 monoclonal antibodies that retard the progression of AD. BACE inhibitors have been explored as a therapeutic strategy for AD. Gene therapies targeting APOE using the CRISPR/Cas9 genome-editing system are another therapeutic avenue. Conclusions: Classic neurodegenerative biomarkers have emerged as powerful tools for enhancing the diagnostic accuracy of AD. Despite the supporting evidence, the amyloid hypothesis has several unresolved issues. Novel monoclonal antibodies may halt the AD course. Advances in delivery systems across the BBB are promising for the efficacy of AD treatments. Full article

Background and Objectives: Osteoarthritis (OA) is a degenerative joint disease involving inflammation, oxidative stress, and extracellular matrix (ECM) degradation, leading to cartilage damage and joint dysfunction. This study aimed to evaluate the chondroprotective effects of intra-articular hydrolyzed collagen in a rat model of knee OA using a dual-compartment biochemical and histological approach. Materials and Methods: Twenty male Sprague-Dawley rats underwent ACL transection to induce osteoarthritis and were randomly assigned to receive intra-articular hydrolyzed collagen or saline once weekly for three weeks. At six weeks, knee joints were evaluated histologically using the Mankin score. Synovial fluid and cartilage homogenates were analyzed via enzyme-linked immunosorbent assay (ELISA) for cytokines, cartilage degradation markers, and oxidative stress indicators. Results: The collagen-treated group demonstrated significantly lower Mankin scores. Levels of pro-inflammatory cytokines, interleukin-1 beta (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α), as well as cartilage degradation markers, matrix metalloproteinase-13 (MMP-13), C-terminal crosslinked telopeptide of type II collagen (CTX-II), and cartilage oligomeric matrix protein (COMP), were significantly reduced (p < 0.05). Additionally, oxidative stress indicators including inducible nitric oxide synthase (iNOS), total oxidant status (TOS), and oxidative stress index (OSI) were decreased, while total antioxidant status (TAS) was increased in both synovial fluid and cartilage homogenates (p < 0.05). Conclusions: Intra-articular hydrolyzed collagen reduced inflammation, oxidative stress, and extracellular matrix (ECM) degradation, indicating potential chondroprotective effects across both synovial and cartilage compartments. Full article

Background and Objectives: The use of Artificial Intelligence (AI) in the medical field is rapidly expanding. This review aims to explore and summarize all published research on the development and validation of deep learning (DL) models in gynecologic laparoscopic surgeries. Materials and Methods: MEDLINE, IEEE Xplore, and Google scholar were searched for eligible studies published between January 2000 and May 2025. Selected studies developed a DL model using datasets derived from gynecologic laparoscopic procedures. The exclusion criteria included non-gynecologic datasets, non-laparoscopic datasets, non-Convolutional Neural Network (CNN) models, and non-English publications. Results: A total of 16 out of 621 studies met our inclusion criteria. The findings were categorized into four main application areas: (i) anatomy classification (n = 6), (ii) anatomy segmentation (n = 5), (iii) surgical instrument classification and segmentation (n = 5), and (iv) surgical action recognition (n = 5). Conclusions: This review emphasizes the growing role of AI in gynecologic laparoscopy, improving anatomy recognition, instrument tracking, and surgical action analysis. As datasets grow and computational capabilities advance, these technologies are poised to improve intraoperative guidance and standardize surgical training. Full article

Major surgical operations of the gastrointestinal tract, such as colorectal resections, lead to significant burden on the human body, which is expressed during the first postoperative hours with an intense inflammatory reaction and consumption of a large amount of energy, increasing patients’ nutritional requirements. Therefore, specific protocols have been implemented for the early initiation of oral feeding. However, not every patient could meet them due to old age and associated pathophysiological changes, the use of opioid drugs for the management of postoperative pain (which is associated with postoperative ileus or nausea), as well as open resections which might lead to gastrointestinal impairment during the first postoperative days. Therefore, a tailored nutritional approach after colorectal resections seems necessary under specific conditions. Parenteral nutrition could be part of this personalized treatment, as it might counterbalance the energy deficit occurring during the early postoperative period, which appears to be associated with adverse clinical outcomes. Nevertheless, the conventional way of administration through central venous lines is associated with significant complications. On the other hand, the alternative administration of parenteral nutrition through a peripheral venous catheter could avoid morbidity, maintaining patients’ energy balance even during the first postoperative hours. However, the efficacy of peripheral parenteral nutrition on the postoperative outcomes of patients undergoing colorectal resections needs to be investigated in prospective randomized trials. The aim of the present review is to present the current trends regarding administration of peripheral parenteral nutrition (PPN) after colorectal resections and highlight any potential correlations between PPN and postoperative inflammatory reaction, as well as short-term nutritional status. Full article

Background and Objectives: Hemoglobinopathies are genetic disorders of hemoglobin and are among the most common inherited diseases. The prevalence rates of sickle cell disease and thalassemia in Saudi Arabia are higher than those in other countries in the Middle East. Saudi Arabia has launched many prevention programs such as a premarital screening program, genetic counseling programs, and neonatal screening in order to reduce the incidence of genetic diseases. The former program includes the most common genetic diseases: sickle cell disease and thalassemia. Many studies conducted since the premarital program started have reported a decrease in the prevalence of sickle cell disease and thalassemia. However, all studies focus on large cities, including their subdivisions, but there is a lack of studies on subdivisions specifically. Materials and Methods: The aim of this study was to assess the prevalence, 5-year time trend, and distribution of β-thalassemia and sickle cell traits in Al-Kharj province using the data of the PMSGC program during the period from January 2017 to February 2021. Results: A total of 21,150 individuals were screened, and 508 were diagnosed with sickle cell disease and thalassemia. Also, we showed that thalassemia was more prevalent than sickle cell disease (66% and 34%, respectively), and there was an increase in β-thalassemia and α-thalassemia. Conclusions: Riyadh city’s prevalence rate of β-thalassemia was reported as 7 per 1000, while the current study found a prevalence rate of 5.6 per 1000 in Al-Kharj, which suggests a possible increase as a result of population growth in Al-Kharj province as part of Riyadh city. This study recommends further improvement in preventive measures in high-risk regions, as well as enhanced community awareness, to provide the highest rate of reduction for disorders. Full article

Background and Objectives: Monteggia fracture-dislocations are rare but critical injuries in children. Accurate early diagnosis is essential to avoid long-term complications; however, such injuries are frequently missed. Therefore, this study aimed to assess the diagnostic accuracy of Monteggia fractures among physicians of varying specialties and experience levels and to identify factors influencing diagnostic performance. Materials and Methods: This retrospective study analyzed the radiographic interpretations of pediatric elbow and forearm injuries by six physician groups: orthopedic residents, general orthopedic surgeons, pediatric orthopedic surgeons, general radiologists, and subspecialized musculoskeletal radiologists. The final diagnosis established by pediatric radiology experts served as the reference standard. Influential variables, such as image quality, splint application, and age-related ossification, were evaluated. Results: In total, 120 patients were included, 40 (33.3%) of whom were diagnosed with Monteggia fractures and 80 (66.7%) with other fracture types. The diagnostic accuracy of Monteggia fractures varied significantly according to the physician’s experience. First-year residents and non-subspecialty radiologists had the highest rate of missed diagnoses. While other fracture types were occasionally influenced by technical factors, most missed Monteggia fracture cases stemmed from recognition failure. Subtle imaging features, plastic deformation of the ulna, and the omission of dedicated elbow views contributed to the misdiagnosis. Awareness and training improved performance, and a high index of suspicion was identified as crucial. Early follow-ups and standardized imaging protocols were identified as effective safeguards. Conclusions: Experience level, awareness, and imaging protocol quality were identified as being central to the accurate diagnosis of pediatric Monteggia fractures. Implementing educational strategies, promoting systematic imaging reviews, and reinforcing team-based approaches may reduce the rate of missed diagnoses. Full article

Background and Objectives: Feces-induced peritonitis (FIP), a clinically relevant model of polymicrobial sepsis, induces systemic inflammation and acute lung injury (ALI). Methylene blue (MB), a phenothiazine-based compound, exhibits vasoregulatory, antioxidant, and anti-inflammatory properties in the context of sepsis. This study aimed to evaluate the protective effects of MB on pulmonary injury in a rat model of FIP-induced sepsis. Materials and Methods: Forty male Wistar rats were randomly assigned to four groups: control, FIP, FIP + Saline, and FIP + MB. MB was administered intraperitoneally at a dose of 20 mg/kg, 1 h after FIP induction. At 24 h post-induction, plasma levels of inflammatory markers [interleukin-6 (IL-6), interleukin-1 beta (IL-1β), tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP)], oxidative stress marker [malondialdehyde (MDA)], metabolic indicator [lactic acid], and vascular signaling marker [cyclic guanosine monophosphate (cGMP)] were measured. Lung injury was evaluated through histopathological analysis and thoracic computed tomography (CT)-based Hounsfield unit (HU) quantification, while pulmonary function was assessed via arterial blood gas analysis, including arterial oxygen pressure (PaO₂) and carbon dioxide pressure (PaCO₂). Results: FIP induction led to significant increases in plasma levels of IL-6, IL-1β, TNF-α, CRP, MDA, cGMP, and lactic acid, accompanied by elevated CT attenuation (HU) values and a marked reduction in arterial PaO₂ and PaCO₂. MB treatment significantly decreased the levels of IL-6, IL-1β, TNF-α, CRP, MDA, lactic acid, and cGMP, improved PaO₂, and attenuated both histopathological lung injury and CT-assessed parenchymal density. No significant differences were observed in PaCO₂ among the groups. Conclusions: MB mitigates inflammation, oxidative damage, and pulmonary dysfunction in FIP-induced sepsis. Further studies are warranted to optimize dosing and timing and to evaluate long-term outcomes. Full article

Background and Objectives: Complicated left-sided colonic diverticulitis is one of the important causes of hospital admissions and emergency surgery in industrialized societies and requires serious clinical decision-making processes for patient management. This study aims to evaluate the predictive role of albumin-based nutritional indices in deciding on surgical strategy (primary anastomosis vs. Hartmann procedure) in patients treated operatively for complicated left-sided colonic diverticulitis. Materials and Methods: This retrospective single-center study included 57 patients who were operatively treated for Hinchey stage III–IV diverticulitis between 2021 and 2024. Patients were divided into two groups according to surgical method: Hartmann procedure (n = 40) and primary anastomosis (n = 17). Prognostic Nutritional Index (PNI), Hemoglobin–Albumin–Lymphocyte–Platelet Score (HALP), CRP–Albumin–Lymphocyte (CALLY) Index, and Modified Glasgow Prognostic Score (mGPS) were evaluated as albumin-based nutritional indices in the preoperative period. Predictive parameters were determined using ROC analysis and multivariate logistic regression. Results: Albumin level, PNI, HALP, and CALLY scores were found to be significantly lower in the Hartmann procedure group. Additionally, the proportion of patients with mGPS score 2 was significantly higher in the Hartmann procedure group (57.5% vs. 5.9%; p < 0.001). In the ROC analysis, the cut-off value for the CALLY index was determined as 0.45 (AUC: 0.826). In multivariate analysis, albumin < 38.5 g/L (OR: 16.53), CALLY index < 0.45 (OR: 6.40), and systemic inflammatory response syndrome (SIRS) detection (OR: 12.98) were determined as independent factors predicting the Hartmann procedure. Conclusions: A low CALLY index was found to be independent predictors for the Hartmann procedure. The CALLY index, which reflects the inflammatory response, immune capacity and nutritional status, can assist surgeons in making objective, and individualized decisions by holistically evaluating the patient’s physiological status. Multicenter prospective studies are required to confirm the clinical validity of the findings. Full article

Background and Objectives: Gait is a fundamental human behavior essential for individual autonomy and well-being; it reflects a complex inter-joint coordination that can change with aging. Materials and Methods: This study applied a network-based fingerprinting approach to evaluate the stability and individuality of gait coordination in adults (mean age: 41.6) and older adults (mean age: 73.5). Each participant completed two gait recordings, from which we constructed kinematic networks (i.e., kinectome) representing joint–velocity correlations. Then, borrowing from network fingerprinting techniques, we computed measures of intra-subject similarity (Iself), inter-subject similarity within the same group (Iothers), cross-group similarity (Iextra), and individual discriminability (Differentiation rate, DR). Results: While Iself was comparable across groups, older adults showed higher Iothers and lower DR, indicating more homogeneous and less distinctive coordination patterns. Furthermore, Iothers was significantly higher than Iextra in the older group only, suggesting age-specific convergence in motor behavior. Conclusions: These findings support the hypothesis that aging reduces the individuality of gait coordination, possibly due to adaptive or degenerative changes in motor control. Kinectome-based fingerprinting thus offers a promising tool for capturing subtle shifts in neuromotor organizations linked to aging. Full article

The 2021 WHO classification of brain tumours revolutionised the oncological field by emphasising the role of molecular, genetic and pathogenetic advances in classifying brain tumours. In this context, incidental gliomas have been increasingly identified due to the widespread performance of standard and advanced MRI sequences and represent a diagnostic and therapeutic challenge. The impactful decision to perform a surgical procedure deeply relies on the non-invasive identification of features or parameters that may correlate with brain tumour genetic profile and grading. Therefore, it is paramount to reach an early and proper diagnosis through neuroradiological techniques, such as MRI. Standard MRI sequences are the cornerstone of diagnosis, while consolidated and emerging roles have been awarded to advanced sequences such as Diffusion-Weighted Imaging/Apparent Diffusion Coefficient (DWI/ADC), Perfusion-Weighted Imaging (PWI), Magnetic Resonance Spectroscopy (MRS), Diffusion Tensor Imaging (DTI) and functional MRI (fMRI). The current novelty relies on the application of AI in brain neuro-oncology, mainly based on radiomics and radiogenomics models, which enhance standard and advanced MRI sequences in predicting glioma genetic status by identifying the mutation of multiple key biomarkers deeply impacting patients’ diagnosis, prognosis and treatment, such as IDH, EGFR, TERT, MGMT promoter, p53, H3-K27M, ATRX, Ki67 and 1p19. AI-driven models demonstrated high accuracy in glioma detection, grading, prognostication, and pre-surgical planning and appear to be a promising frontier in the neuroradiological field. On the other hand, standardisation challenges in image acquisition, segmentation and feature extraction variability, data scarcity and single-omics analysis, model reproducibility and generalizability, the black box nature and interpretability concerns, as well as ethical and privacy challenges remain key issues to address. Future directions, rooted in enhanced standardisation and multi-institutional validation, advancements in multi-omics integration, and explainable AI and federated learning, may effectively overcome these challenges and promote efficient AI-based models in glioma management. The aims of our multidisciplinary review are to: (1) extensively present the role of standard and advanced MRI sequences in the differential diagnosis of iLGGs as compared to HGGs (High-Grade Gliomas); (2) give an overview of the current and main applications of AI tools in the differential diagnosis of iLGGs as compared to HGGs (High-Grade Gliomas); (3) show the role of MRI, radiomics and radiogenomics in unravelling glioma genetic profiles. Standard and advanced MRI, radiomics and radiogenomics are key to unveiling the grading and genetic profile of gliomas and supporting the pre-operative planning, with significant impact on patients’ differential diagnosis, prognosis prediction and treatment strategies. Today, neuroradiologists are called to efficiently use AI tools for the in vivo, non-invasive, and comprehensive assessment of gliomas in the path towards patients’ personalised medicine. Full article

Background and Objectives: Ghrelin plays key roles in appetite regulation, involving both homeostatic and hedonic pathways. In obesity, its metabolism is affected by alterations in neural and hormonal responses. Liver-Enriched Antimicrobial Peptide 2 (LEAP2), recently identified as an endogenous ghrelin receptor antagonist, has emerged as a potential regulator of appetite and energy balance, and bariatric surgery is known to induce changes in this system. In this review, we aimed to evaluate the roles of acyl ghrelin, des-acyl ghrelin, and LEAP2 in food intake regulation and summarize findings on the alterations in their levels after bariatric surgery. Materials and Methods: We conducted a narrative review of human and animal studies published in the literature investigating the roles of acyl ghrelin, des-acyl ghrelin, and LEAP2 in food intake regulation, as well as changes in their levels in obesity and following bariatric surgery. Results: Alterations in the ghrelin system, i.e., the acyl ghrelin and des-acyl ghrelin isoforms and LEAP2, in obesity have been reported. Experimental studies have shown that LEAP2 administration reduces food intake and body weight by suppressing ghrelin-induced food intake. Most studies have found marked reductions in fasting acyl ghrelin after sleeve gastrectomy, more so than after Roux-en-Y gastric bypass. Conclusions: In obesity, altered neural and hormonal responses to food also affect ghrelin metabolism, with significant deviations in acyl ghrelin levels and impaired appetite regulation mechanisms. Unlike ghrelin, LEAP2 levels tend to be elevated in obesity. While changes in acyl ghrelin and des-acyl ghrelin isoforms, particularly after sleeve gastrectomy, are well documented, data on LEAP2 remain limited. Further research is needed to better define the role of LEAP2 in ghrelin-mediated food intake and its potential as a therapeutic target in obesity. Full article

Background/Objectives: Heart failure (HF) with reduced ejection fraction (EF) has, in more than 50% of cases, an ischemic etiology and continues to be associated with increased mortality and morbidity despite all the progress registered in the field of medical therapy and interventional revascularization. Myocardial revascularization is extensively used in clinical practice based on the traditional concept that it can improve myocardial function and outcome in ischemic HF. This review is aimed at presenting current knowledge regarding revascularization in patients with chronic ischemic HF and reduced EF. Methods: The impact of revascularization on symptomatology, left ventricle reverse remodeling, major adverse cardiac events (MACEs), and the role of complete revascularization and of percutaneous interventional revascularization in chronic total occlusion (PCI-CTO) were analyzed. The best therapeutic strategies, revascularization and/or optimal medical therapy (OMT), are debated in different categories of patients, in order to identify who will benefit more from revascularization strategies. Results: Based on the long-term results of the STICH trial incorporated in the guidelines with a class I-b recommendation, coronary artery bypass graft (CABG) remains the main modality of revascularization for prognostic improvement in ischemic HF with multivessel disease. But real-life patients are usually old with multiple comorbidities and high surgical risk. In this category, the Heart Team opinion is required to evaluate the probability of complete revascularization and to choose between percutaneous coronary intervention (PCI) and CABG according to clinical status and coronary anatomy. Conclusions: However, until further studies are available, the results of the REVIVED-BCIS2 trial encourage OMT over PCI in patients with ischemic cardiomyopathy. The available randomized controlled trials (RCTs) showed improved angina and quality of life in PCI-CTO versus OMT, but the effect on MACEs was not demonstrated. Full article

Background and Objectives: Currently, infertility is one of the major problems affecting up to 12% of couples worldwide, with more than a quarter of cases being male-related. It is assumed that Leukocyte-poor platelet-rich plasma (LP-PRP) can improve the function of germ cells and serve as a regenerative substrate as a source of biologically active substances that play an important role in the process of spermatogenesis in infertile men. We aimed to evaluate the proliferation, apoptosis, and growth factors of germ cells after the administration of LP-PRP in patients with non-obstructive azoospermia. Materials and Methods: The study used archival material (paraffin blocks of testicular biopsies) of patients with non-obstructive azoospermia aged 21–34 years (n = 41; associated diagnosis: varicocele). We confirm that no interventions or biopsies were performed as part of the study itself. They were injected bilaterally into the spermatic cord and in the region of the lower pole of the testis under ultrasound control were injected with PRP once a week for 6 weeks. Biopsies were immunohistochemical reactions with antibodies to Ki-67, Bcl-2, caspase 3 and p53, IGF-1, TGF-β, and VEGF-A. Results: Immunohistochemical study of testicular biopsies after LP-PRP injection revealed an increase in the number of cells stained for proliferation proteins (Ki-67) and anti-apoptosis (Bcl-2), IGF-1, TGF-β, VEGF-A; decrease caspase-3- and p53-positive cells. Conclusions: In LP-PRP, platelet α-granule growth factors, which are key regulators of the cell cycle of germ cells, demonstrate restoration of the proliferative-apoptotic balance, confirmed by the expression levels of Ki-67, Bcl-2, caspase 3, and p53 in patients with non-obstructive azoospermia. In human testicular biopsies, the administration of LP-PRP led to an exponential release of numerous growth factors from platelet α-granules, which, based on their regenerative properties, improved the morphological and immunohistochemical picture of the germinal epithelium in non-obstructive azoospermia. Full article

Background and Objectives: Total neoadjuvant therapy (TNT) for locally advanced rectal cancer (LARC) offers significant advantages in terms of pathologic response and long-term survival; however, it is still unclear which patients will benefit the most from this treatment. This study aims to investigate the role of metabolic parameters on pretreatment positron emission tomography–computed tomography (PET/CT) images in predicting treatment response after TNT. Materials and Methods: The research was conducted using a single-center, retrospective design. Patients treated with total neoadjuvant therapy are included if they have locally advanced rectal cancer (cT3/T4-N0 or cTany-N1/N2). The patient group was categorized into two groups: CR and non-CR. Clinicopathologic features, PET/CT parameters, CA19-9, and CEA values were compared between these two groups. Results: In total, 52 patients were included. The CR group had 21 patients, and the non-CR group had 31 patients. The analysis demonstrated that the CR group had significantly lower metabolic tumor volume (MTV) and total lesion glycolysis (TLG) than the non-CR group (p = 0.022 vs. p = 0.003, p < 0.05). Also, CA19-9 values were lower than the non-CR group, and this difference was statistically remarkable (p = 0.40, p < 0.05). Conclusions: MTV and TLG parameters in PET/CT for pretreatment staging and pretreatment blood CA 19-9 levels are prognostic factors for predicting treatment response, and they may play a crucial role in choosing treatment. Comprehensive research is warranted on this subject with a larger patient population. Full article

Background and Objectives: The aim of this study was to investigate IL-40 levels in preoperative blood and intraoperative pericardial fluid samples obtained from healthy individuals and patients with diagnosed heart disease who were scheduled for open heart surgery to determine whether it is a biomarker for cardiovascular diseases. Material and Methods: A total of 90 individuals were included in the study and divided into three groups. Group 1 (Healthy Group, n = 45): Blood was collected from a total of 45 healthy men and women over 18 years of age without any diagnosis of cardiovascular disease. Group 2 (Patient Group 1, n = 45): In this group, blood samples from a total of 45 male and female patients over 18 years of age with a diagnosis of heart disease and scheduled for open heart surgery were studied. Group 3 (Patient Group 2, n = 45): Pericardial fluids were obtained from patients in Group 3 immediately after pericardial incision during surgery. IL-40, TAS, TOS and OSI levels in blood plasma and pericardial fluid were determined by the ELISA kit method. Results: In the statistical analysis between the groups, IL-40, TOS and OSI levels were found to be higher in the patient group and in the pericardial fluid (p < 0.001), while TAS was higher in the control group. It was considered statistically significant (p < 0.001). Conclusions: IL-40, TOS and OSI levels were elevated in patient serum and pericardial fluid. Therefore, we suggest that IL-40 may be a new biomarker for the detection of cardiovascular diseases. Full article

Background and Objectives: Gestational diabetes mellitus (GDM), which is becoming increasingly common in contemporary society, is recognized for its considerable psychosocial impact on pregnant women throughout the perinatal phase. The purpose of this research was to explore the possible links between mental health status and dietary habits among pregnant women diagnosed with GDM, alongside examining how these factors correlate with clinical indicators like HbA1c measurements and the necessity for insulin therapy. Materials and Methods: The study included 82 pregnant participants, 37 with gestational diabetes mellitus and 45 without. Blood samples were collected from all participants for biochemical analysis, including fasting blood glucose, postprandial blood glucose, and HbA1c levels, which can be clinical indicators for the presence of gestational diabetes mellitus, and the need for insulin treatment was recorded. Then, participants completed a questionnaire collecting sociodemographic and clinical data as well as the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Salzburg Emotional Eating Scale (SEES), and REZZY Eating Disorders Scale (REZZY). Data were statistically analyzed. Results: A previous diagnosis of gestational diabetes was more frequent in the case group (18.9%) than in the control group (2.2%) (p = 0.020). OGTT positivity was detected in 56.8% of the case group, whereas all control participants had negative results (p < 0.001). There were no statistically significant differences between the two groups in psychological symptom scores or eating behavior assessments (p > 0.05). Conclusions: Pregnant women with gestational diabetes mellitus were observed to score higher on measures of anxiety, depression, and emotional eating, particularly in response to negative emotions. These findings may indicate a potential association between gestational diabetes and psychological or behavioral factors related to metabolic regulation during pregnancy. Full article

Background and Objectives: Over 30% of people who suffer from cancers are at risk of developing brain metastases. The typical recommended surgical therapy for metastases within the brain is gross total resection (GTR). Nevertheless, GTR solely may not always be adequate for disease management since remaining tumors can show local advancements and invasion. The focus of this research is to summarize the current data and to compare the outcomes of GTR and supramarginal resection. Materials and Methods: A search on the PubMed, Scopus, Cochrane Central Library, and Web of Science (WOS) databases was performed using specific keywords for single or multiple brain metastasis of any origin in patients who underwent either supramarginal resection or gross total resection. Results: The average age of the patients involved in the study spanned between 51 ± 6 years and 60.5 ± 10.1 years. Males represented 48.7% of the total population. The incidence of 1-year survival among the GTR group was 37.1%, whereas the supramarginal resection group showed an incidence of 91.3%, under the random effect model (0.551, 95% CI [0.18, 0.921]). The incidence of 2-year survival among the GTR group was 21.26%, whereas the supramarginal resection group showed an incidence of 72.46%, under the random effect model (0.380, 95% CI [0.113, 0.648]). The incidence of local recurrence among the GTR group was 57.69%, whereas the supramarginal resection group showed an incidence of 18.4%, under the random effect model (0.266, 95% CI [0.106, 0.426]). Conclusions: Supramarginal resection is a promising approach for the management of brain metastases. Full article