Medicina

21 pages, 3679 KB

Open AccessArticle

Academic Point-of-Care Manufacturing in Oral and Maxillofacial Surgery: A Retrospective Review at Gregorio Marañón University Hospital

by Manuel Tousidonis, Gonzalo Ruiz-de-Leon, Carlos Navarro-Cuellar, Santiago Ochandiano, Jose-Ignacio Salmeron, Rocio Franco Herrera, Jose Antonio Calvo-Haro and Ruben Perez-Mañanes

Medicina 2026, 62(1), 234; https://doi.org/10.3390/medicina62010234 - 22 Jan 2026

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Abstract

Background and Objectives: Academic point-of-care (POC) manufacturing enables the in-hospital design and production of patient-specific medical devices within certified environments, integrating clinical practice, engineering, and translational research. This model represents a new academic ecosystem that accelerates innovation while maintaining compliance with medical device [...] Read more.

Background and Objectives: Academic point-of-care (POC) manufacturing enables the in-hospital design and production of patient-specific medical devices within certified environments, integrating clinical practice, engineering, and translational research. This model represents a new academic ecosystem that accelerates innovation while maintaining compliance with medical device regulations. Gregorio Marañón University Hospital has established one of the first ISO 13485-certified academic manufacturing facilities in Spain, providing on-site production of anatomical models, surgical guides, and custom implants for oral and maxillofacial surgery. This study presents a retrospective review of all devices produced between April 2017 and September 2025, analyzing their typology, materials, production parameters, and clinical applications. Materials and Methods: A descriptive, retrospective study was conducted on 442 3D-printed medical devices fabricated for oral and maxillofacial surgical cases. Recorded variables included device classification, indication, printing technology, material type, sterilization method, working and printing times, and clinical utility. Image segmentation and design were performed using 3D Slicer and Meshmixer. Manufacturing used fused deposition modeling (FDM) and stereolithography (SLA) technologies with PLA and biocompatible resin (Biomed Clear V1). Data were analyzed descriptively. Results: During the eight-year period, 442 devices were manufactured. Biomodels constituted the majority (approximately 68%), followed by surgical guides (20%) and patient-specific implants (7%). Trauma and oncology were the leading clinical indications, representing 45% and 33% of all devices, respectively. The orbital region was the most frequent anatomical site. FDM accounted for 63% of the printing technologies used, and PLA was the predominant material. The mean working time per device was 3.4 h and mean printing time 12.6 h. Most devices were applied to preoperative planning (59%) or intraoperative use (35%). Conclusions: Academic POC manufacturing offers a sustainable, clinically integrated model for translating digital workflows and additive manufacturing into daily surgical practice. The eight-year experience of Gregorio Marañón University Hospital demonstrates how academic production units can enhance surgical precision, accelerate innovation, and ensure regulatory compliance while promoting education and translational research in healthcare. Full article

(This article belongs to the Special Issue New Trends and Advances in Oral and Maxillofacial Surgery)

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11 pages, 393 KB

Open AccessArticle

Short-Term Effects of Swimming Goggle Use on Anterior Segment Parameters in Patients with Keratoconus

by Nurullah Berk Açar, Atılım Armağan Demirtaş, Tuncay Küsbeci and Mehmet Gencay Çetin

Medicina 2026, 62(1), 233; https://doi.org/10.3390/medicina62010233 - 22 Jan 2026

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Abstract

Background and Objectives: Keratoconus is a bilateral but often asymmetric ectatic corneal disease characterized by progressive thinning, increased curvature, and conical shape of the cornea. Previous studies have reported that the use of swimming goggles in patients with keratoconus can lead to increased [...] Read more.

Background and Objectives: Keratoconus is a bilateral but often asymmetric ectatic corneal disease characterized by progressive thinning, increased curvature, and conical shape of the cornea. Previous studies have reported that the use of swimming goggles in patients with keratoconus can lead to increased intraocular pressure (IOP) and a transient reduction in anterior chamber volume (ACV), potentially affecting anterior segment morphology. This study aimed to evaluate the short-term effects of periorbital pressure induced by swimming goggles on corneal parameters in keratoconic eyes. Materials and Methods: A total of 44 eyes of 44 patients (mean age: 26.1 ± 5.1 years) diagnosed with keratoconus Stage 1–4 according to the Amsler–Krumeich classification were included. Measurements were taken using a Pentacam^® Scheimpflug camera before swimming goggle application and immediately after 20 min of wear. The parameters assessed included keratometry values (K1, K2, Km, Kmax), central and thinnest corneal thickness, corneal volume within the 10 mm zone (CV10), ACV, anterior chamber depth (ACD), iridocorneal angle (ICA), and pupil diameter (PD). Results: No statistically significant changes were observed in keratometric values, central and thinnest corneal thickness, ACV, ACD, ICA, PD, or IOP (all p > 0.05). CV10 showed a small reduction following goggle wear (Δ = −0.18 mm³, corresponding to a 0.3% decrease), which was statistically significant in the unadjusted analysis (p = 0.008) but did not remain significant after correction for multiple comparisons (p for false discovery rate [FDR] = 0.10). Conclusions: Short-term swimming goggle use may induce subtle reductions in CV10 in keratoconic eyes, suggesting a potential biomechanical sensitivity to transient periocular pressure. Although the observed change in CV10 did not retain statistical significance after multiple-comparison correction, it may reflect an early physiological response in structurally compromised corneas. CV measurements could serve as exploratory indicators of mechanical responsiveness in keratoconus, warranting further investigation in larger controlled studies. Full article

(This article belongs to the Section Ophthalmology)

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11 pages, 506 KB

Open AccessArticle

Early Mother–Newborn Skin-to-Skin Contact at Term Birth and Early Neonatal Thermoregulation Under Routine Clinical Practice

by Chia-Hui Liu, Sheng-You Su, Yuen-En Chang and Chia-Lung Shih

Medicina 2026, 62(1), 232; https://doi.org/10.3390/medicina62010232 - 22 Jan 2026

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Abstract

Background and Objectives: Early mother–newborn skin-to-skin contact (SSC) after birth is widely recommended to support neonatal physiological stabilization, including thermoregulation. Under routine clinical practice, however, SSC may be brief or interrupted, and its effectiveness in maintaining neonatal body temperature under such conditions [...] Read more.

Background and Objectives: Early mother–newborn skin-to-skin contact (SSC) after birth is widely recommended to support neonatal physiological stabilization, including thermoregulation. Under routine clinical practice, however, SSC may be brief or interrupted, and its effectiveness in maintaining neonatal body temperature under such conditions is less well described. This study aimed to evaluate early neonatal temperature changes under routine post-birth care practices that included brief SSC followed by separation for incubation care. Materials and Methods: This retrospective cohort study included 620 term mother–infant dyads delivered at a single regional teaching hospital. Newborns were managed according to routine clinical practice and were allocated to either a brief early SSC group or a control group without SSC. SSC duration differed by mode of delivery (approximately 10 min after cesarean section and 20 min after vaginal birth). Infant body temperature was recorded at predefined time points from birth through early incubation care. Associations between temperature changes and clinical factors, including mode of delivery, gestational age, parity, and birth weight, were analyzed. Results: No significant difference was observed between the SSC and control groups in overall changes in infant body temperature from birth to the beginning of incubation care (p = 0.245). After one hour of incubation, mean body temperature was comparable between groups (p = 0.357). Within the SSC group, infant body temperature decreased significantly during the SSC period (change from birth: −0.68 °C ± 0.35 °C; p < 0.001). At the start of incubation care, a significantly lower proportion of infants in the SSC group (22%) had body temperatures below 36.5 °C compared to the control group (32%) (p = 0.018). Multivariable analysis identified mode of delivery, reflecting differences in post-birth care routines and SSC duration, as the only factor independently associated with temperature changes during SSC. Conclusions: Under routine clinical conditions, brief and interrupted SSC was associated with transient reductions in neonatal body temperature; however, brief SSC was associated with a lower proportion of hypothermia compared with immediate incubation care, suggesting that even short periods of SSC may support early neonatal thermoregulation. Full article

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

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12 pages, 1569 KB

Open AccessArticle

Frequency and Age-Related Changes in Corneal Astigmatism in Cataract Surgery Candidates at a Training Hospital in Turkey

by Alper Can Yilmaz, Bagim Aycin Cakir Ince, Onder Ayyildiz and Fatih Mehmet Mutlu

Medicina 2026, 62(1), 231; https://doi.org/10.3390/medicina62010231 - 22 Jan 2026

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Abstract

Background and Objectives: To evaluate the magnitude, axis and age-related changes in corneal astigmatism in patients before cataract surgery. Materials and Methods: In this retrospective, cross-sectional, and observational study, data from 2152 eyes that underwent phacoemulsification were evaluated. Keratometric values were [...] Read more.

Background and Objectives: To evaluate the magnitude, axis and age-related changes in corneal astigmatism in patients before cataract surgery. Materials and Methods: In this retrospective, cross-sectional, and observational study, data from 2152 eyes that underwent phacoemulsification were evaluated. Keratometric values were obtained using the IOL Master 500 device. The frequency, magnitude and axis of corneal astigmatism were determined. The astigmatism axis was categorized as with the rule (WTR), against the rule (ATR), and oblique astigmatism. Quantitative analysis was performed using the power vector method (J0 and J45). The distribution and characteristics of corneal astigmatism data according to age were analyzed. Results: The mean age of the patients was 70.56 ± 8.88 years (range 40–94 years) and 1010 (46.9%) were males. Mean corneal astigmatism, J0 and J45 values were 0.96 ± 0.72, 0.05 ± 0.51, 0.01 ± 0.30 diopters (D), respectively. The most common range of magnitudes was 0.50–0.99 D with 38.8%, followed by <0.50 D (25.3%), 1.00–1.49 D (20.3%), and 1.50–1.99 D (8.7%). The cubic regression curve showed a U-shaped nonlinear relationship between age and corneal astigmatism (p < 0.001). The most common type of astigmatism was WTR with 43.4%, followed by ATR with 37.5% and oblique astigmatism with 19.1%. With the increase in age, the astigmatism axis gradually changed from WTR to ATR. There was a linear trend in the rate of these types of astigmatism across age groups (p < 0.05). Additionally, in patients under 65 years of age, WTR astigmatism was negatively correlated with age, while in patients 65 years of age and older, ATR astigmatism was positively correlated with age (r = −0.217, p < 0.001; r = 0.153, p < 0.001, respectively). Linear regression analyses revealed that the J0 value decreased significantly with age, whereas J45 showed no significant relationship. Specifically, J0 decreased by 0.014 D per year of age (95% confidence interval [CI], 0.011–0.016; p < 0.001). Conclusions: The results obtained in this study may provide information to guide surgeons in the management of astigmatism and the choice of toric intraocular lens in cataract surgery. Full article

(This article belongs to the Section Ophthalmology)

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12 pages, 770 KB

Open AccessArticle

The Prevalence, Mechanisms, and Clinical Significance of Inferior Vena Cava Compression in Autosomal Dominant Polycystic Kidney Disease: A Multicenter Retrospective Cohort Study Based on TriNetX

by Ahmad Matarneh, Bayan Matarneh, Abdelrauof Akkari, Sundus Sardar, Omar Salameh, Navin Verma and Nasrollah Ghahramani

Medicina 2026, 62(1), 230; https://doi.org/10.3390/medicina62010230 - 22 Jan 2026

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Abstract

Background and Objectives: Autosomal dominant polycystic kidney disease (ADPKD) is a leading cause of end-stage renal disease (ESRD). Progressive renal cyst growth in ADPKD can exert mass effects, including compression of the inferior vena cava (IVC), a rare but clinically significant complication with [...] Read more.

Background and Objectives: Autosomal dominant polycystic kidney disease (ADPKD) is a leading cause of end-stage renal disease (ESRD). Progressive renal cyst growth in ADPKD can exert mass effects, including compression of the inferior vena cava (IVC), a rare but clinically significant complication with implications for hemodynamic stability and renal outcomes. This study evaluated the prevalence of IVC compression in ADPKD and its impact on progression to ESRD, mortality, and overall survival. We aimed to provide quantitative measures to elucidate its prognostic significance. Materials and Methods: Using the TriNetX database, we conducted a retrospective cohort study of 658 ADPKD patients with IVC compression, comparing them to unmatched controls without compression. Outcomes included ESRD incidence, mortality, and survival. Kaplan–Meier curves and hazard ratios (HRs) with 95% confidence intervals (CIs) were used for analysis. Results: ESRD Risk: IVC compression was associated with a higher risk of ESRD (77.4% vs. 29.7%, RR: 2.61, 95% CI: 2.49–2.73, p < 0.001). Survival Probability: 5-year Survival was significantly reduced in patients with IVC compression (42.6%) compared to controls (61.7%) (HR: 4.00, 95% CI: 3.45–4.63, p = 0.002). Mortality: Mortality was higher in the compression group (29.2% vs. 9.1%). Combined Impact: ESRD patients with IVC compression had a lower survival rate (11.9%) than ESRD patients without compression (28.5%) (HR: 5.60, 95% CI: 5.12–6.13, p < 0.001). Conclusions: IVC compression in ADPKD is associated with significantly worse outcomes, including increased ESRD risk, higher mortality, and reduced survival. These findings underscore the importance of early diagnosis and targeted management strategies. Full article

(This article belongs to the Section Urology & Nephrology)

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14 pages, 304 KB

Open AccessArticle

Comparison of the Efficacy of Pirfenidone and Nintedanib in the Treatment of Patients with Idiopathic Pulmonary Fibrosis—A Single-Center Experience

by Nikola Trboljevac, Sanja Dimic-Janjic, Milica Kontic, Maja Omcikus, Branislav Ilic, Filip Markovic, Anka Postic, Lidija Isovic, Mihailo Stjepanovic and Dragana Nenezic

Medicina 2026, 62(1), 229; https://doi.org/10.3390/medicina62010229 - 22 Jan 2026

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Abstract

Background and Objectives: Idiopathic pulmonary fibrosis (IPF) is a progressive, unpredictable, fatal interstitial lung disease. Antifibrotic therapy with pirfenidone or nintedanib slows functional decline, yet comparative real-world evidence remains limited. Materials and Methods: This retrospective, single-center, comparative cohort study included 76 IPF patients [...] Read more.

Background and Objectives: Idiopathic pulmonary fibrosis (IPF) is a progressive, unpredictable, fatal interstitial lung disease. Antifibrotic therapy with pirfenidone or nintedanib slows functional decline, yet comparative real-world evidence remains limited. Materials and Methods: This retrospective, single-center, comparative cohort study included 76 IPF patients treated at the Clinic for Pulmonology at the University Clinical Center of Serbia (February 2019–February 2025). Diagnosis of IPF was made according to the guidelines of the American Thoracic Society and the European Respiratory Society. Demographic features, comorbidities, forced vital capacity (FVC), diffusion capacity for carbon monoxide (DLCO), high-resolution computerized tomography (HRCT) patterns, 6-min walk test distance (6MWTD), echocardiography, and survival outcomes were analyzed. Disease progression was defined as a ≥10% decline in FVC and/or DLCO after 12 months. Results: Of the 76 patients, 31 received nintedanib and 45 pirfenidone. Baseline characteristics, comorbidities, and HRCT patterns were comparable between groups. Mean annual decline in FVC was −1.74% with pirfenidone and −2.38% with nintedanib, without a statistical difference. DLCO declined by −4.25% and −6.29%, respectively, with similar downward trends over time in both groups. Progression was recorded in 35 (46.1%) patients, of whom 18 (58.06%) were in the nintedanib group and 17 (37.77%) in the pirfenidone group, with no difference between therapies (p = 0.81). Definite and probable usual interstitial pneumonia (UIP) were evenly represented on HRCT, although progression correlated significantly with the probable UIP pattern (p = 0.006). 6MWTD decreased in both groups over 12 months, again without treatment-related differences (p = 0.566). During up to 6 years of follow-up, overall survival was 4.18 years, with no significant difference between the nintedanib (4.55 years) and pirfenidone (3.81 years) groups (p = 0.159). No association was found between disease stage (FVC or DLCO) and progression. Conclusions: This study demonstrates that pirfenidone and nintedanib are equally effective in the management of IPF in real-world settings. The absence of significant differences in functional decline, progression rates, and survival indicates that treatment choices should be guided by individual clinical profiles rather than efficacy alone, reinforcing antifibrotic therapy as the primary approach to alter the course of IPF. Importantly, disease progression was strongly associated with a probable UIP pattern on HRCT, supporting current guidelines suggesting that probable UIP has a natural history and prognosis similar to those of definite UIP. Full article

(This article belongs to the Section Pulmonology)

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20 pages, 1962 KB

Open AccessArticle

Machine Learning-Based Prediction and Feature Attribution Analysis of Contrast-Associated Acute Kidney Injury in Patients with Acute Myocardial Infarction

by Neriman Sıla Koç, Can Ozan Ulusoy, Berrak Itır Aylı, Yusuf Bozkurt Şahin, Veysel Ozan Tanık, Arzu Akgül and Ekrem Kara

Medicina 2026, 62(1), 228; https://doi.org/10.3390/medicina62010228 - 22 Jan 2026

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Abstract

Background and Objectives: Contrast-associated acute kidney injury (CA-AKI) is a frequent and clinically significant complication in patients with acute myocardial infarction (AMI) undergoing coronary angiography. Early and accurate risk stratification remains challenging with conventional models that rely on linear assumptions and limited [...] Read more.

Background and Objectives: Contrast-associated acute kidney injury (CA-AKI) is a frequent and clinically significant complication in patients with acute myocardial infarction (AMI) undergoing coronary angiography. Early and accurate risk stratification remains challenging with conventional models that rely on linear assumptions and limited variable integration. This study aimed to evaluate and compare the predictive performance of multiple machine learning (ML) algorithms with traditional logistic regression and the Mehran risk score for CA-AKI prediction and to explore key determinants of risk using explainable artificial intelligence methods. Materials and Methods: This retrospective, single-center study included 1741 patients with AMI who underwent coronary angiography. CA-AKI was defined according to KDIGO criteria. Multiple ML models, including gradient boosting machine (GBM), random forest (RF), XGBoost, support vector machine, elastic net, and standard logistic regression were developed using routinely available clinical and laboratory variables. A weighted ensemble model combining the best-performing algorithms was constructed. Model discrimination was assessed using area under the receiver operating characteristic curve (AUC), along with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Model interpretability was evaluated using feature importance and SHapley Additive exPlanations (SHAP). Results: CA-AKI occurred in 356 patients (20.4%). In multivariable logistic regression, lower left ventricular ejection fraction, higher contrast volume, lower sodium, lower hemoglobin, and higher neutrophil-to-lymphocyte ratio (NLR) were independently associated with CA-AKI. Among ML approaches, the weighted ensemble model demonstrated the highest discriminative performance (AUC 0.721), outperforming logistic regression and the Mehran risk score (AUC 0.608). Importantly, the ensemble model achieved a consistently high NPV (0.942), enabling reliable identification of low-risk patients. Explainability analyses revealed that inflammatory markers, particularly NLR, along with sodium, uric acid, baseline renal indices, and contrast burden, were the most influential predictors across models. Conclusions: In patients with AMI undergoing coronary angiography, interpretable ML models, especially ensemble and gradient boosting-based approaches, provide superior risk stratification for CA-AKI compared with conventional methods. The high negative predictive value highlights their clinical utility in safely identifying low-risk patients and supporting individualized, risk-adapted preventive strategies. Full article

(This article belongs to the Section Urology & Nephrology)

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20 pages, 822 KB

Open AccessArticle

Dermatology “AI Babylon”: Cross-Language Evaluation of AI-Crafted Dermatology Descriptions

by Emmanouil Karampinis, Christina-Marina Zoumpourli, Christina Kontogianni, Theofanis Arkoumanis, Dimitra Koumaki, Dimitrios Mantzaris, Konstantinos Filippakis, Maria-Myrto Papadopoulou, Melpomeni Theofili, Nkechi Anne Enechukwu, Nomtondo Amina Ouédraogo, Alexandros Katoulis, Efterpi Zafiriou and Dimitrios Sgouros

Medicina 2026, 62(1), 227; https://doi.org/10.3390/medicina62010227 - 22 Jan 2026

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Abstract

Background and Objectives: Dermatology relies on a complex terminology encompassing lesion types, distribution patterns, colors, and specialized sites such as hair and nails, while dermoscopy adds an additional descriptive framework, making interpretation subjective and challenging. Our study aims to evaluate the ability [...] Read more.

Background and Objectives: Dermatology relies on a complex terminology encompassing lesion types, distribution patterns, colors, and specialized sites such as hair and nails, while dermoscopy adds an additional descriptive framework, making interpretation subjective and challenging. Our study aims to evaluate the ability of a chatbot (Gemini 2) to generate dermatology descriptions across multiple languages and image types, and to assess the influence of prompt language on readability, completeness, and terminology consistency. Our research is based on the concept that non-English prompts are not mere translations of the English prompts but are independently generated texts that reflect medical and dermatological knowledge learned from non-English material used in the chatbot’s training. Materials and Methods: Five macroscopic and five dermoscopic images of common skin lesions were used. Images were uploaded to Gemini 2 with language-specific prompts requesting short paragraphs describing visible features and possible diagnoses. A total of 2400 outputs were analyzed for readability using LIX score and CLEAR (comprehensiveness, accuracy, evidence-based content, appropriateness, and relevance) assessment, while terminology consistency was evaluated via SNOMED CT mapping across English, French, German, and Greek outputs. Results: English and French descriptions were found to be harder to read and more sophisticated, while SNOMED CT mapping revealed the largest terminology mismatch in German and the smallest in French. English texts and macroscopic images achieved the highest accuracy, completeness, and readability based on CLEAR assessment, whereas dermoscopic images and non-English texts presented greater challenges. Conclusions: Overall, partial terminology inconsistencies and cross-lingual variations highlighted that the language of the prompt plays a critical role in shaping AI-generated dermatology descriptions. Full article

(This article belongs to the Special Issue Dermato-Engineering and AI Assessment in Dermatology Practice)

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12 pages, 804 KB

Open AccessArticle

Total Neoadjuvant Therapy Versus Conventional Chemoradiotherapy in Rectal Cancer: Impact on Tumor Regression Grade and the Predictive Value of CEA

by Aikaterini Sarafi, Aikaterini Leventi, Klaountia Athitaki, Konstantinos Stamou, Ioannis Papaconstantinou and Dimitrios Korkolis

Medicina 2026, 62(1), 226; https://doi.org/10.3390/medicina62010226 - 22 Jan 2026

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Abstract

Background and Objectives: The introduction of total neoadjuvant therapy (TNT) in the preoperative stage has been associated with improved oncological outcomes. However, TNT may lead to tissue fibrosis and be accompanied by increased difficulty during surgery. Additionally, predicting tumor response to neoadjuvant [...] Read more.

Background and Objectives: The introduction of total neoadjuvant therapy (TNT) in the preoperative stage has been associated with improved oncological outcomes. However, TNT may lead to tissue fibrosis and be accompanied by increased difficulty during surgery. Additionally, predicting tumor response to neoadjuvant therapy is crucial for identifying patients who may achieve a complete pathological response (pCR) or qualify for organ-preserving strategies. The aim of this study is to evaluate the effect of TNT versus conventional chemoradiotherapy (CRT) on tumor regression grade (TRG) and the association between preoperative carcinoembryonic antigen (CEA) levels and good tumor response. A secondary endpoint is to investigate the effect of TNT on surgical difficulty, using indirect indicators like the quality of total mesorectal excision (TME), circumferential resection margin (CRM), and achievement of R0 resection. Materials and Methods: This is a retrospective, single-center study including 93 patients with locally advanced rectal cancer who received either TNT (n = 43) or CRT (n = 50). Results: The TNT group, compared to the CRT group, demonstrated a significantly higher rate of pCR (TRG0) (37.2% vs. 18%, p = 0.038) and good tumor regression (TRG 0–1) (53.5% vs. 28%, p = 0.019). Furthermore, patients with CEA < 5 ng/mL showed significantly higher rates of good tumor response (TRG 0–1) compared to those with CEA ≥ 5 ng/mL (45.3% vs. 16.7%, p = 0.032). When further categorized by treatment type, CEA levels did not demonstrate statistically significant differences Lastly, increased surgical difficulty could not be established, as no significant differences were observed in terms of positive CRM rates, R0 resection, and TME quality between groups. Conclusions: TNT was associated with improved TRG scores compared to CRT without increasing surgical difficulty. Lower pre-treatment CEAs were linked to better tumor response, irrespective of the type of treatment. These findings support the oncological benefit of TNT and suggest that CEA may have some predictive value for treatment response. Full article

(This article belongs to the Special Issue Novel Insights in Laparoscopic Surgery of Colorectal Carcinoma)

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12 pages, 285 KB

Open AccessArticle

The Effect of Comprehensive and Integrative Medical Services on Patients with Degenerative Lumbar Spinal Stenosis: A Randomized Controlled Study

by Sang Bong Ko, Sang Gyu Kwak and Hee Chan Kim

Medicina 2026, 62(1), 225; https://doi.org/10.3390/medicina62010225 - 21 Jan 2026

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Abstract

Background and Objectives: Degenerative lumbar spinal stenosis (DLSS) frequently manifests as lower leg radiating pain (LLRP), requiring selective nerve root block (SNRB). Comprehensive and Integrative Medical Services (CIMS)—a multimodal program consisting of acupuncture, cupping, and manual therapy—have been increasingly incorporated into clinical [...] Read more.

Background and Objectives: Degenerative lumbar spinal stenosis (DLSS) frequently manifests as lower leg radiating pain (LLRP), requiring selective nerve root block (SNRB). Comprehensive and Integrative Medical Services (CIMS)—a multimodal program consisting of acupuncture, cupping, and manual therapy—have been increasingly incorporated into clinical practice in Korea. However, randomized evidence remains limited. This study evaluated the efficacy and safety of adjunctive CIMS in patients with DLSS presenting neuropathic LLRP requiring SNRB. Materials and Methods: In a single-center, parallel-group, assessor-blinded randomized controlled trial (CRIS KCT0006036), adults with DLSS (LANSS > 7; VAS > 5) were randomized 1:1 to experimental or control groups (n = 77; experimental 38, control 39). All participants received SNRB plus pharmacotherapy (limaprost, pregabalin). The experimental group additionally received CIMS, delivered eight times over 4 weeks. The primary outcome was pain intensity (VAS) at baseline and weeks 4, 8, and 12. Secondary outcomes included SF-36, ODI, and RMDQ at baseline and weeks 4, 8, and 12. Repeated-measures two-factor ANOVA assessed the main effects and time × group interaction. Results: Mean VAS (experimental vs. control) was 4.73 ± 1.67 vs. 4.70 ± 1.95 at baseline; 3.74 ± 1.68 vs. 4.66 ± 1.60 at week 4; 3.93 ± 2.03 vs. 4.79 ± 1.55 at week 8; and 3.98 ± 1.98 vs. 4.98 ± 1.68 at week 12. The significant time × group interaction was identified (p = 0.040), indicating a greater pain reduction with CIMS. No significant time × group interactions were observed across SF-36 domains. Adherence to CIMS modalities was high, and no unexpected adverse events occurred. Conclusions: In DLSS patients receiving SNRB and pharmacotherapy, adjunctive CIMS resulted in greater pain reduction over 12 weeks compared with standard care alone, without introducing new safety concerns. These findings support the clinical utility of CIMS as an effective adjunctive treatment option for DLSS. Full article

(This article belongs to the Section Orthopedics)

18 pages, 1092 KB

Open AccessSystematic Review

Oral Microbiome and Metabolome Changes During Orthodontic Treatments: A Systematic Review of Limited Clinical Evidence

by Michela Boccuzzi, Riccardo Aiuto, Leonardo Lombardo, Matteo Piasente, Andrea Edoardo Bianchi and Alberto Clivio

Medicina 2026, 62(1), 224; https://doi.org/10.3390/medicina62010224 - 21 Jan 2026

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Abstract

Background and Objectives: Recent advances in dentistry include microbiological and metabolomic analyses, which have the potential to improve the understanding of oral microbiome–host imbalances during orthodontic treatment. Fixed appliances, functional devices and, more recently, clear aligners have been associated with several oral [...] Read more.

Background and Objectives: Recent advances in dentistry include microbiological and metabolomic analyses, which have the potential to improve the understanding of oral microbiome–host imbalances during orthodontic treatment. Fixed appliances, functional devices and, more recently, clear aligners have been associated with several oral health conditions, including enamel demineralization, dental caries, gingivitis, periodontitis and root and bone resorption. In this context, metabolomic approaches may enable the identification of metabolites in biological samples that could potentially serve as biomarkers and reflect functional biological changes within the oral ecosystem. Investigating orthodontic appliances and associated metabolomic alterations may therefore contribute to advancing current knowledge in orthodontics. This systematic review aimed to describe the available evidence on oral metabolomic changes during orthodontic treatment. Materials and Methods: A systematic literature search was conducted in PubMed, Web of Science, Scopus and the Cochrane Library. A total of 1632 records were identified. After duplicate removal and screening, 18 full-text articles were assessed for eligibility. Of these, 15 studies were excluded, and three studies met the inclusion criteria. Risk of bias was assessed using the ROBINS-I and RoB 2 tools, and the GRADE approach was applied to evaluate the certainty of evidence. The review protocol was registered in PROSPERO (CRD420251141544). Results: Three studies met the inclusion criteria. Overall, the available evidence was limited and heterogeneous. The included studies suggested potential differences in oral microbiome composition and metabolomic profiles between patients treated with fixed appliances and those treated with clear aligners. Reported metabolomic findings were exploratory and involved amino acid-related, immune-associated, and acidic metabolic pathways. Limitations: Only three studies were included, all conducted in a single country. The small sample size and methodological heterogeneity limit the generalizability of the findings. In addition, potential confounding variables highlight the need for further standardized longitudinal studies. Full article

(This article belongs to the Special Issue Recent Breakthroughs in Orthodontic Treatment)

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20 pages, 1684 KB

Open AccessArticle

Why Our Youth Vape?—A Trend Analysis Based on Cross-Sectional Annual Surveys of Middle and High School Students in the U.S.

by Tianyuan Guan, Zhaochong Yu, Preethi Bhosle, Chen Li, Kai Sun and Marepalli B. Rao

Medicina 2026, 62(1), 223; https://doi.org/10.3390/medicina62010223 - 21 Jan 2026

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Abstract

Background and Objectives: E-cigarette use among middle and high school students steadily increased in the last decade, raising significant public health concerns. It is argued that e-cigarettes contain a lower level of toxicants than combustible tobacco cigarettes. This perception has contributed to [...] Read more.

Background and Objectives: E-cigarette use among middle and high school students steadily increased in the last decade, raising significant public health concerns. It is argued that e-cigarettes contain a lower level of toxicants than combustible tobacco cigarettes. This perception has contributed to the growing popularity of e-cigarettes among youth. However, lower level of toxicants does not mean addiction is less likely. In this study, we examine trends in the usage of electronic cigarettes among middle and high school students in the U.S. from 2018 to 2023, compare these patterns with traditional cigarette use over the same period and population, and explore the underlying reasons driving e-cigarette use within this demographic. Understanding patterns and motivations are essential for developing effective prevention and intervention strategies. Materials and Methods: Data were derived from the National Youth Tobacco Survey (NYTS), administered by the Centers for Disease Control and Prevention (CDC). Population-level estimates and standard errors were calculated to facilitate comparisons across subgroups and time points. Results: A declining trend in e-cigarette use was observed over the study period. The proportion of students who reported exclusive e-cigarette use was significantly higher than that of those who used combustible cigarettes exclusively. Among reported motivations, anxiety consistently ranked among the top three reasons for vaping for current users. Conclusions: The downward trend in youth e-cigarette experimentation is encouraging. However, the period from 2020 to 2023, which includes the COVID-19 pandemic (2020 and 2021) era, may have impacted usage patterns. Alarmingly, the number of students who vape exclusively is approximately five times greater than that of those who smoke only cigarettes. This finding contradicts claims by e-cigarette manufacturers that their products facilitate smoking cessation. Further rising e-cigarette smoking exclusively is of public health concern, which warrants targeted intervention. Full article

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

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20 pages, 664 KB

Open AccessSystematic Review

Clinical Characteristics, Microbiological Spectrum, Biomarkers, and Imaging Insights in Acute Pyelonephritis and Its Complicated Forms—A Systematic Review

by Marius-Costin Chițu, Teodor Salmen, Paula-Roxana Răducanu, Carmen-Marina Pălimariu, Bianca-Margareta Salmen, Anca Pantea Stoian, Viorel Jinga and Dan Liviu Dorel Mischianu

Medicina 2026, 62(1), 222; https://doi.org/10.3390/medicina62010222 - 21 Jan 2026

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Abstract

Background and Objectives: Acute and obstructive pyelonephritis (AOP) management, despite advancements in diagnostic imaging and antimicrobial therapy, is characterized by delayed recognition and increasing antimicrobial resistance. This review aimed to summarize current evidence regarding the clinical characteristics, microbiological spectrum, biomarkers, and imaging findings [...] Read more.

Background and Objectives: Acute and obstructive pyelonephritis (AOP) management, despite advancements in diagnostic imaging and antimicrobial therapy, is characterized by delayed recognition and increasing antimicrobial resistance. This review aimed to summarize current evidence regarding the clinical characteristics, microbiological spectrum, biomarkers, and imaging findings associated with AOP. Materials and Methods: A systematic review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420251162736). Literature searches were performed across the PubMed, Scopus, and Web of Science databases for articles published between January 2014 and 31 March 2025 using the term “acute obstructive pyelonephritis”. Inclusion criteria comprised original full-text English-language studies, published in the last 10 years and conducted in adults, reporting clinical, laboratory, microbiological, and imaging characteristics. Exclusion criteria are letters to the editor, expert opinions, case reports, conference or meeting abstracts, reviews, and redundant publications; having unclear or incomplete data; and being performed on cell cultures or on mammals. The quality of included studies was assessed using the Newcastle–Ottawa Scale. Results: Twenty-three studies met the inclusion criteria. AOP predominantly affected elderly patients with comorbidities, especially diabetes mellitus and urinary tract obstruction. Predictors of septic shock included thrombocytopenia, hypoalbuminemia, elevated procalcitonin (>1.12 µg/L), presepsin, and a neutrophil-to-lymphocyte ratio ≥ 8.7. Escherichia coli remained the leading pathogen (60–95%) with extended-spectrum β-lactamase (ESBL) rates between 20 and 70%, followed by Klebsiella pneumoniae. CT demonstrated 71–100% sensitivity for detecting obstructive complications, confirming its superiority over ultrasound, while MRI provided comparable diagnostic accuracy in selected cases. Source control through double-J stenting or percutaneous drainage significantly improved survival. Conclusions: AOP requires prompt recognition and early decompression to prevent sepsis-related mortality. Biomarkers such as procalcitonin, presepsin, and neutrophil to lymphocyte ratio enhance risk stratification, while CT remains the gold-standard imaging modality. The increasing prevalence of ESBL-producing pathogens underscores the need for antimicrobial stewardship and individualized therapeutic strategies guided by local resistance data. Full article

(This article belongs to the Section Urology & Nephrology)

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10 pages, 703 KB

Open AccessArticle

Intralesional Platelet-Rich Plasma for Treating Chronic Peyronie’s Disease: A Single-Center Retrospective Cohort Study

by Luigi Pucci, Celeste Manfredi, Catello Sansone, Simone Tammaro, Giorgio Stanziola, Nunzio Langella, Giuseppe Dachille, Davide Arcaniolo, Marco De Sio and Maurizio Carrino

Medicina 2026, 62(1), 221; https://doi.org/10.3390/medicina62010221 - 21 Jan 2026

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Abstract

Background and Objectives: Peyronie’s disease (PD) is a chronic fibrotic disorder of the tunica albuginea causing penile deformity and sexual dysfunction. Platelet-rich plasma (PRP) has been proposed as a regenerative therapy with potential disease-modifying properties, but evidence of its use in chronic [...] Read more.

Background and Objectives: Peyronie’s disease (PD) is a chronic fibrotic disorder of the tunica albuginea causing penile deformity and sexual dysfunction. Platelet-rich plasma (PRP) has been proposed as a regenerative therapy with potential disease-modifying properties, but evidence of its use in chronic PD is scarce. This study evaluated the efficacy and safety of intralesional PRP injections in men with stable PD. Materials and Methods: A single-center retrospective cohort study was conducted including men with chronic PD treated with three weekly intralesional PRP injections (April 2022–April 2025). Inclusion required curvature stability for ≥6 months and absence of prior PD therapy. The primary outcome was a change in penile curvature at 4 weeks post-treatment. Secondary outcomes included plaque thickness (ultrasound), erectile function (IIEF-5), and safety (Clavien–Dindo grading). Results: Thirty-six men (mean age 61.2 ± 10.4 years) completed the treatment. Mean penile curvature decreased from 30.5 ± 7.3° to 24.2 ± 8.3° (Δ = −6.3°, 95% CI −7.7 to −5.3; p < 0.001); 25% achieved a ≥10° reduction. Mean plaque thickness declined from 3.25 ± 0.69 mm to 2.91 ± 0.76 mm (Δ = −0.34 mm; p < 0.001). IIEF-5 increased modestly (+1.1; p = 0.142). Only mild, transient adverse events occurred (pain 5.6%, hematoma 2.8%). Conclusions: Intralesional PRP was safe and yielded statistically significant but modest reductions in penile curvature and plaque thickness in chronic PD. Clinically meaningful improvement occurred in a minority of patients. These findings support keeping PRP investigational pending well-designed randomized controlled trials with standardized protocols and longer follow-up. Full article

(This article belongs to the Special Issue New Advances in Urology and Nephrology Disease: From Diagnosis to Treatment—2nd Edition)

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14 pages, 525 KB

Open AccessFeature PaperArticle

A Comprehensive Patient-Centric Analysis of Disease Burden, Treatment Challenges, and Unmet Needs in Behçet’s Disease: Insights from a Large Cohort Study

by Samar Tharwat, Ibrahim Moustafa I. A. Abdalla, Marwa A. F. Elhefnawi, Ahmed M. M. Abutaleb, Dana M. Zein, Alia A. I. Abdelmaksoud, Rawan S. Elmetwalli, Hana M. Elkilany, Rolan M. M. Abdelaziz and Mohammed Kamal Nassar

Medicina 2026, 62(1), 220; https://doi.org/10.3390/medicina62010220 - 21 Jan 2026

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Abstract

Background and Objectives: Behçet’s disease (BD) is a multisystem inflammatory disorder with significant physical, psychological, and social burdens. However, patient-reported outcomes and subjective symptom experiences remain under-recognized in clinical practice. This study aimed to provide a patient-centric analysis of the disease burden, [...] Read more.

Background and Objectives: Behçet’s disease (BD) is a multisystem inflammatory disorder with significant physical, psychological, and social burdens. However, patient-reported outcomes and subjective symptom experiences remain under-recognized in clinical practice. This study aimed to provide a patient-centric analysis of the disease burden, treatment challenges, and unmet needs in BD. Materials and Methods: A multinational cross-sectional study was conducted using a structured questionnaire among 528 BD patients recruited from online support groups and a specialized clinic. The questionnaire gathered information about participants’ backgrounds, medical histories, how symptoms affected them, psychological and social factors, side effects of treatments, and their suggestions for better care. Data were analyzed descriptively. Results: The mean age of the participants was 41.4 years, and 69.3% were male. The most common symptoms that significantly affected daily life were severe fatigue (82.8%), joint pain and swelling (79.0%), and neurological issues (74.1%). Nearly half of patients perceived that fatigue (49.1%) and neurological symptoms (45.1%) were underestimated by healthcare providers. Psychological distress was prevalent, with 74.1% of participants reporting either depression or anxiety. Side effects related to treatment were frequently encountered (56.3%), resulting in treatment discontinuation for 53.4% of the individuals. The main unmet needs identified were fatigue reduction (59.1%), pain management (43.0%), and the minimization of side effects (59.1%). Furthermore, patients expressed a desire for enhanced communication (62.9%), validation of their unobserved symptoms (74.1%), and comprehensive disease education (67.6%). Conclusions: BD imposes a profound multidimensional burden, with a significant disconnect between patient experiences and their perception of clinical recognition. Fatigue, pain, psychological distress, and treatment-related challenges contribute substantially to unmet needs. A patient-centered approach emphasizing communication, symptom validation, and holistic support is essential to improving care and quality of life in BD. Full article

(This article belongs to the Section Hematology and Immunology)

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12 pages, 2584 KB

Open AccessArticle

Protective Effects of Chitosan and Rosuvastatin on Renal Structure and Lipid Metabolism in Rabbits Fed a High-Fat Diet

by Carlos Alberto Araujo Chagas, Lucas Alves Sarmento Pires, Beatriz Correa Rodriguez, Bruna Fernanda De Souza Ribeiro, Albino Fonseca Junior and Marcio Antonio Babinski

Medicina 2026, 62(1), 219; https://doi.org/10.3390/medicina62010219 - 21 Jan 2026

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Abstract

Background and Objectives: This study compared the effects of rosuvastatin and chitosan on the kidneys of rabbits fed a high-fat diet. Materials and Methods: In total, 28 New Zealand White rabbits (Oryctolagus cuniculus) were randomly divided into four groups of 7 [...] Read more.

Background and Objectives: This study compared the effects of rosuvastatin and chitosan on the kidneys of rabbits fed a high-fat diet. Materials and Methods: In total, 28 New Zealand White rabbits (Oryctolagus cuniculus) were randomly divided into four groups of 7 rabbits: a control group (CG) fed a regular diet; a hyperlipidic group (HG) fed the regular diet and 20 mL of egg yolk daily; and the third (RG) and fourth (ChiG) groups fed the HG diet plus rosuvastatin and chitosan, respectively. Cholesterol, triglyceride, glucose, creatinine, and urea levels were analyzed. After kidney excision, glomerular height and length were analyzed and stereological analysis was conducted. The Kruskal–Wallis and Dunn multiple comparison tests were used for statistical analysis, and a p value of <0.05 was considered significant. Results: The chicken egg yolk diet was successful in inducing a hypercholesterolemic state. Total cholesterol levels showed a significant reduction in rabbits treated with rosuvastatin, and chitosan and rosuvastatin significantly reduced triglyceride, VLDL, creatinine, and glucose levels. The size of the glomerulus was increased significantly in the HG rabbits. Stereological analysis showed a mean glomerular volumetric density of 8.27 ± 3.27, 4.14 ± 2.87, 10.03 ± 3.22, and 6.18 ± 3.50 vV% for CG, HG, RG, and ChiG, respectively. Conclusions: Chitosan reduced triglyceride, VLDL, creatinine, and glucose levels but was less effective than rosuvastatin. Kidney morphology was slightly altered in the animals fed a high-fat diet, and these changes were ameliorated by treatment with chitosan or rosuvastatin. Full article

(This article belongs to the Section Urology & Nephrology)

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13 pages, 1949 KB

Open AccessArticle

Untargeted LC-HRMS-Based Metabolomic and Antibacterial Potential of Sargassum duplicatum Against Multidrug-Resistant Bacteria

by Feri Susanto, Riyanti, Hamdan Syakuri, Muhammad Nursid, Till F. Schäberle, Ute Mettal, Jae-Suk Choi and Maria Dyah Nur Meinita

Medicina 2026, 62(1), 218; https://doi.org/10.3390/medicina62010218 - 20 Jan 2026

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Abstract

Background/Objectives: The rise in antimicrobial resistance is one of the major challenges to global health systems, which necessitates the development of new antibacterial compounds. The bioactive compounds of brown seaweed Sargassum duplicatum have demonstrated potential antibacterial activity. This study applied metabolomic profiling and [...] Read more.

Background/Objectives: The rise in antimicrobial resistance is one of the major challenges to global health systems, which necessitates the development of new antibacterial compounds. The bioactive compounds of brown seaweed Sargassum duplicatum have demonstrated potential antibacterial activity. This study applied metabolomic profiling and molecular networking in combination with antibacterial screening assays to assess the antimicrobial properties of S. duplicatum extracts against multidrug-resistant bacteria. Methods: Two extraction methods, i.e., maceration and microwave extraction, were used. Therewith, untargeted metabolomic profiling was performed using Liquid Chromatography–High Resolution Mass Spectrometry (LC-HRMS). Molecular networks (MNs) were established and compound dereplication was conducted using the spectral database of the Global Natural Products Social Molecular Networking platform (GNPS). Additionally, antimicrobial assays were conducted against Gram-positive and Gram-negative bacterial strains, including multidrug-resistant bacteria, i.e., methicillin-resistant Staphyloccocus aureus ATCC 33592 (MRSA) and β-lactamase, producing Escherichia coli ATCC 35218 (TEM-1 positive strain). Result: Dereplication resulted in the prediction of six compounds with reported antimicrobial properties, i.e., 13-docosenamide, 9-octadecenamide, pheophorbide A, ouabain, sarmentoside B and AC1L1X1Z. Antibacterial screening of the extracts revealed that the ethyl acetate maceration extracts exhibited the strongest inhibitory activity, with inhibition values between 85 and 98% against S. aureus ATCC 33592. Conclusions: This metabolomics study requires further research to isolate, purify, confirm, and validate the dereplicated compounds that may have potential antibacterial activity. Full article

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13 pages, 562 KB

Open AccessArticle

Exploring the Role of the Head Rotation Sit-Up Test in Identifying Epley-Responsive, Non-Classical Presentations of BPPV

by Ryo Yoneima, Kenji Nishio, Hiromasa Kawashima, Sota Sakamoto, Tomohiro Nakamura, Akihiro Sawa, Ayaka Kakiwaki, Hiroyuki Taguchi, Satoshi Senzaki, Nobushiro Nishimura, Hidetoshi Matsuoka, Shiro Ono, Masaki Matsubara, Noritaka Yada and Kiyomi Yoshimoto

Medicina 2026, 62(1), 217; https://doi.org/10.3390/medicina62010217 - 20 Jan 2026

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Abstract

Background and Objectives: The Dix–Hallpike test (DHT) is the standard diagnostic maneuver for posterior semicircular canal benign paroxysmal positional vertigo (BPPV). However, some patients present with positional symptoms compatible with BPPV yet show no observable nystagmus on the DHT. We introduced the [...] Read more.

Background and Objectives: The Dix–Hallpike test (DHT) is the standard diagnostic maneuver for posterior semicircular canal benign paroxysmal positional vertigo (BPPV). However, some patients present with positional symptoms compatible with BPPV yet show no observable nystagmus on the DHT. We introduced the Head Rotation Sit-up Test (HRST) as a symptom-based maneuver and hypothesized that it would identify DHT-negative patients who nonetheless benefit from canalith repositioning. This study aimed to explore the potential role of the HRST. It was introduced as a complementary, symptom-based maneuver for evaluating non-classical vertigo presentations. Materials and Methods: We retrospectively reviewed patients clinically suspected of having BPPV by the attending physicians at Nara Medical University Hospital (August 2018–July 2022). All underwent both the DHT and HRST; those positive on either test received the Epley maneuver and were included. Patients were categorized as Group 1: DHT(−)/HRST(+), and Group 2: DHT(+), irrespective of the HRST, for the purpose of comparing patients who were positive on the HRST with those positive on the DHT. Post-treatment symptom severity was assessed on a 0–10 scale, with the patient’s most severe pre-treatment symptom defined as 10, and responder rates (post-Epley score < 5) were compared. Results: Among 179 patients with suspected BPPV, 80 were test-positive and were treated with the Epley maneuver. Group 1 comprised 31 patients, who more commonly reported non-rotational symptoms such as floating or unsteadiness, whereas rotational vertigo predominated in Group 2 (n = 49). Median post-Epley scores were significantly lower after treatment in both groups (Group 1: 2 [IQR 0–3]; Group 2: 3 [IQR 0–5]). Group 1 demonstrated a higher responder rate than Group 2 (90.3% vs. 65.3%, p = 0.016). Within Group 2, outcomes did not differ significantly between DHT(+)/HRST(+) and DHT(+)/HRST(−) subgroups. Conclusions: The HRST identified a clinically relevant subgroup of DHT-negative patients who nevertheless responded favorably to the Epley maneuver. Incorporating the HRST alongside the DHT may expand the diagnostic reach for BPPV, particularly among patients with non-classical symptoms or without observable nystagmus. These findings support the HRST as a useful complementary maneuver for detecting Epley responsive, symptom based positional vertigo. Full article

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

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17 pages, 673 KB

Open AccessArticle

Misophonia in Individuals with Obsessive–Compulsive Disorder: Its Relationship with Anxiety Sensitivity and Mindfulness

by Mahmut Onur Karaytuğ, Lut Tamam, Mehmet Emin Demirkol, Zeynep Namlı, Caner Yeşiloğlu, Sinem Çetin Demirtaş, Ali Meriç Kurt, Hale Nur Çakar, Efsun Damla Altın and Mahmut Gürbüz

Medicina 2026, 62(1), 216; https://doi.org/10.3390/medicina62010216 - 20 Jan 2026

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Abstract

Background and Objectives: This study aimed to examine the severity of misophonia symptoms in individuals diagnosed with obsessive–compulsive disorder (OCD) and to evaluate the pattern of the relationship between misophonia and OCD symptom severity in relation to anxiety sensitivity and mindfulness. Materials [...] Read more.

Background and Objectives: This study aimed to examine the severity of misophonia symptoms in individuals diagnosed with obsessive–compulsive disorder (OCD) and to evaluate the pattern of the relationship between misophonia and OCD symptom severity in relation to anxiety sensitivity and mindfulness. Materials and Methods: This comparative and cross-sectional study included 108 patients diagnosed with OCD according to DSM-5 criteria and 81 healthy control subjects without any psychiatric diagnosis. Participants completed the Misophonia Symptom List (MSL), Anxiety Sensitivity Index-3 (ASI-3), Mindful Attention Awareness Scale (MAAS), Yale–Brown Obsessive Compulsive Scale (Y-BOCS), and Beck Anxiety Inventory (BAI). Statistical analyses included group comparisons, Pearson correlations, multiple linear regression, and mediation analyses using the PROCESS macro. Results: MSL scores were significantly higher in the OCD group compared to the control group (104.10 ± 33.00 vs. 87.56 ± 20.07, p < 0.001). ASI-3 (33.53 ± 18.72 vs. 18.12 ± 11.55, p < 0.001) and BAI scores (20.74 ± 13.14 vs. 11.04 ± 8.47, p < 0.001) were higher; MAAS scores were lower (53.23 ± 14.92 vs. 60.72 ± 12.70, p < 0.001). In the OCD group, MSL scores were positively correlated with anxiety sensitivity (r = 0.626, p < 0.001) and Beck anxiety (r = 0.515, p < 0.001) and negatively correlated with MAAS (r = −0.357, p < 0.001). In multiple regression analysis, anxiety sensitivity was identified as the only variable significantly predicting misophonia severity (β = 0.523, p < 0.001). Mediation analyses showed that anxiety sensitivity emerged as the dominant indirect pathway between OCD symptom severity and misophonia, whereas the contribution of mindfulness was not independent of anxiety sensitivity in the serial mediation model. Conclusions: The findings indicate that misophonia symptoms are significantly elevated in individuals diagnosed with OCD and that these symptoms are particularly associated with cognitive-emotional variables such as anxiety sensitivity and mindfulness. Given the cross-sectional design, the mediation findings should be interpreted as indirect associations rather than evidence of causal pathways. Considering these variables may be useful in assessing misophonia symptoms accompanying OCD and planning clinical approaches. Full article

(This article belongs to the Section Psychiatry)

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23 pages, 1145 KB

Open AccessReview

Reconsidering Rehabilitation and Lifestyle Approaches to Improve Quality of Life in People with Multiple Sclerosis: A Scoping Review

by Elena Bianca Basalic, Nadinne Alexandra Roman, Diana Minzatanu, Adina Ionelia Manaila, Ionut Cristian Cozmin Baseanu and Roxana Steliana Miclaus

Medicina 2026, 62(1), 215; https://doi.org/10.3390/medicina62010215 - 20 Jan 2026

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Abstract

Background: Multiple sclerosis (MS) involves complex physical, cognitive and behavioral challenges that collectively affect quality of life. Integrating lifestyle components such as sleep optimization, dietary behaviors, stress management, and self-management strategies into rehabilitation may enhance outcomes beyond traditional approaches. This scoping review [...] Read more.

Background: Multiple sclerosis (MS) involves complex physical, cognitive and behavioral challenges that collectively affect quality of life. Integrating lifestyle components such as sleep optimization, dietary behaviors, stress management, and self-management strategies into rehabilitation may enhance outcomes beyond traditional approaches. This scoping review aimed to map rehabilitation interventions that combine psychomotor, cognitive, lifestyle-focused, or multimodal elements and assess quality of life in adults with MS. Methods: This scoping review was conducted in accordance with the PRISMA-ScR guidelines, which guided the identification, screening, and selection of studies. Screening and data extraction were conducted independently by two reviewers. From 135 records, nine primary studies and four secondary evidence sources were included. Results: Most studies involved adults with mild-to-moderate disability and predominantly relapsing–remitting multiple sclerosis. Physical or motor rehabilitation interventions were examined in five studies, while two studies evaluated multimodal rehabilitation programs, one study focused on cognitive rehabilitation, and one study investigated lifestyle-oriented or self-management-integrated approaches. Quality of life was assessed in all included studies, with improvements reported across multiple domains. Fatigue-related outcomes were reported in four studies, sleep-related outcomes in three studies, and digitally delivered or hybrid rehabilitation interventions were implemented in three studies, indicating an emerging trend toward technology-supported rehabilitation approaches. Conclusions: Contemporary MS rehabilitation is moving toward multidimensional, holistic models that integrate lifestyle components. Standardized outcomes, inclusion of more diverse MS phenotypes, and rigorous evaluation of integrated frameworks are required to strengthen the evidence base and inform clinical practice. Full article

(This article belongs to the Special Issue Clinical Recent Research in Rehabilitation and Preventive Medicine)

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12 pages, 822 KB

Open AccessArticle

The Impact of Concurrent Proton Pump Inhibitors on Nivolumab Response in Metastatic Non-Small Cell Lung Cancer: A Multicenter Real-Life Study

by Engin Hendem, Mehmet Zahid Koçak, Ayşegül Merç Çetinkaya, Gülhan Dinç, Melek Çağlayan, Muzaffer Uğraklı, Dilek Çağlayan, Murat Araz, Melek Karakurt Eryılmaz, Abdullah Sakin, Orhan Önder Eren, Ali Murat Tatlı, Çağlayan Geredeli and Mehmet Artaç

Medicina 2026, 62(1), 214; https://doi.org/10.3390/medicina62010214 - 20 Jan 2026

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Abstract

Background and Objectives: Clinically meaningful drug–drug interactions may be overlooked in oncology. Proton pump inhibitors (PPIs) may modulate outcomes with immune checkpoint inhibitors (ICIs) by altering the gut microbiome, altering the immune milieu, and affecting transporter interactions. We evaluated whether concomitant PPI [...] Read more.

Background and Objectives: Clinically meaningful drug–drug interactions may be overlooked in oncology. Proton pump inhibitors (PPIs) may modulate outcomes with immune checkpoint inhibitors (ICIs) by altering the gut microbiome, altering the immune milieu, and affecting transporter interactions. We evaluated whether concomitant PPI use affects survival among patients with metastatic non-small cell lung cancer (NSCLC) treated with nivolumab. Materials and Methods: We retrospectively included patients with metastatic NSCLC who received second-line nivolumab across five oncology centers (January 2020–June 2023). Patients were grouped as concomitant PPI users vs. non-users. Overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan–Meier method and compared with the log-rank test; multivariable Cox models assessed independent associations. Results: A total of 194 patients were screened, of whom 30 were excluded according to predefined criteria. The final analysis included 164 patients—85 PPI users and 79 non-users. Median OS was 26.1 months (95% CI 15.5–36.7) in PPI users and 29.3 months (22.2–36.4) in non-users; this difference was not statistically significant (p = 0.54). Median PFS was 6.2 months (3.7–8.6) in PPI users vs. 10.2 months (7.1–13.2) in non-users (p = 0.04). In multivariable analysis, absence of concomitant PPI use (No vs. Yes) was independently associated with longer PFS (HR = 0.52, 95% CI 0.24–0.89, p = 0.03), whereas PPI use was not associated with OS (HR = 0.96, 95% CI 0.67–1.61, p = 0.83). Conclusions: Concomitant PPI use during nivolumab therapy was associated with significantly shorter PFS and a numerical reduction in OS in real-world metastatic NSCLC. Where clinically feasible, the need for PPIs should be re-evaluated before and during ICI therapy. Full article

(This article belongs to the Section Oncology)

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12 pages, 615 KB

Open AccessArticle

Factors Affecting Axillary Lymph Node Involvement Based on Permanent Section Evaluation of the Excised Sentinel Lymph Nodes in Early-Stage Breast Cancer Patients: A Single-Center Retrospective Study

by Hakan Baysal, Tunc Eren, Kubra Kargici, Ozge Kapar, Begumhan Baysal and Orhan Alimoglu

Medicina 2026, 62(1), 213; https://doi.org/10.3390/medicina62010213 - 20 Jan 2026

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Abstract

Background and Objectives: Sentinel lymph node (LN) biopsy (SLNB) remains to be the standard approach for surgical axillary staging of breast cancer (BC) patients. The aim of this study was to investigate the factors that affect axillary LN involvement in early BC patients. [...] Read more.

Background and Objectives: Sentinel lymph node (LN) biopsy (SLNB) remains to be the standard approach for surgical axillary staging of breast cancer (BC) patients. The aim of this study was to investigate the factors that affect axillary LN involvement in early BC patients. Materials and Methods: Clinically node negative early stage (cT1-2N0) BC patients having undergone breast conserving surgery (BCS) between February 2021 and January 2024 were included. During axillary exploration of all cases, sentinel LNs were excised and reserved for permanent section pathological examination (PS) only. Historical records of patients including clinicopathological features, surgical outcomes as well as pathological results were recorded and analyzed retrospectively. p < 0.05 indicated statistically significant results. Results: The study group consisted of 150 women with cT1-2N0 BC having undergone BCS with a median age of 59 (range: 25–81) years. According to the PS results of the sentinel LNs, the need for reoperation to complete axillary lymph node dissection was present in three (2%) patients. Tumors of the Luminal B subtype were significantly associated with increased sentinel LN positivity (p = 0.014). The risk of sentinel LN metastasis was found to be 5.2 times greater in patients with a Ki-67 ≥ %14 [OR: 5.224 (%95 CI:1.73–15.82, p = 0.003)] and the Ki-67 proliferation index was determined as an independent risk factor. Conclusions: In early-stage BC patients, PS of the excised sentinel LN offers sufficient axillary LN staging. On the other hand, a more careful clinical assessment is necessary for early BC patients harboring tumors with an elevated Ki-67 index and/or tumors of the Luminal B subtype. Full article

(This article belongs to the Section Surgery)

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10 pages, 996 KB

Open AccessArticle

Combined Clavicular Hook Plate and Coracoid Screw Fixation for Coracoid Process Fractures Associated with Acromioclavicular Joint Dislocation

by Bong Gun Lee, Young Seok Lee, Chang-Hun Lee, Wan-Sun Choi, Chang-Woo Woo and Young-Hoon Jo

Medicina 2026, 62(1), 212; https://doi.org/10.3390/medicina62010212 - 20 Jan 2026

Viewed by 217

Abstract

Background and Objectives: Coracoid process (CP) fractures combined with acromioclavicular (AC) joint dislocation are extremely rare, and evidence guiding optimal surgical management remains limited. This retrospective, single-center case series study evaluated clinical and radiologic outcomes after simultaneous fixation of both lesions using a [...] Read more.

Background and Objectives: Coracoid process (CP) fractures combined with acromioclavicular (AC) joint dislocation are extremely rare, and evidence guiding optimal surgical management remains limited. This retrospective, single-center case series study evaluated clinical and radiologic outcomes after simultaneous fixation of both lesions using a clavicular hook plate and a coracoid screw. Materials and Methods: We retrospectively reviewed 15 consecutive patients with Ogawa type I CP fractures combined with AC joint dislocation who underwent clavicular hook plate and coracoid screw fixation between March 2019 and May 2024. Clinical outcomes at final follow-up included shoulder range of motion (ROM), visual analog scale (VAS) for pain, and the Constant score. Radiologic outcomes included CP union confirmed by computed tomography (CT) and residual AC joint subluxation. Results: The cohort comprised 13 men and 2 women with a mean age of 55.2 years, and the mean final follow-up was 40.2 months. At final follow-up, mean ROM was 168° for forward elevation, 161° for abduction, and 69° for external rotation at the side, with internal rotation to L1. The mean VAS score was 0.4 and the mean Constant score was 97. CT-confirmed union of the CP fracture was achieved in all patients, and no residual AC joint subluxation was observed. All patients returned to sports and activities of daily living. Conclusions: In this series, simultaneous fixation using a clavicular hook plate and a coracoid screw provided reliable stabilization for CP fractures with AC joint dislocation, achieving consistent CP union, restoration of AC joint alignment, and favorable clinical outcomes. However, given the retrospective, non-comparative study design, these findings should be interpreted with caution, and further comparative studies are warranted. Full article

(This article belongs to the Special Issue Orthopedic Trauma: Surgical Treatment and Rehabilitation)

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24 pages, 707 KB

Open AccessReview

Obesity and Its Clinical Implications in End-Stage Kidney Disease

by Kristina Petruliene, Alanta Zilinskiene, Ruta Vaiciuniene, Kestutis Vaiciunas, Inga Arune Bumblyte and Egle Dalinkeviciene

Medicina 2026, 62(1), 211; https://doi.org/10.3390/medicina62010211 - 20 Jan 2026

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Abstract

Both obesity and chronic kidney disease (CKD) are increasingly recognized as global epidemics. Their escalating incidence and far-reaching health implications highlight the urgent need for comprehensive prevention and management strategies. This review aims to clarify how obesity interacts with end-stage kidney disease (ESKD) [...] Read more.

Both obesity and chronic kidney disease (CKD) are increasingly recognized as global epidemics. Their escalating incidence and far-reaching health implications highlight the urgent need for comprehensive prevention and management strategies. This review aims to clarify how obesity interacts with end-stage kidney disease (ESKD) and how to improve the management of obese patients receiving kidney replacement therapy. It also explores underlying mechanisms, current treatments, future directions, and ongoing controversies. By highlighting this intricate relationship, the review seeks to enhance clinical practice and promote further research toward more personalized care for this vulnerable population. Obesity is frequent in dialysis patients and creates challenges related to body composition, metabolism, and treatment. While higher body mass index (BMI) may appear to improve survival, this paradox does not offset the cardiovascular and functional risks of visceral and sarcopenic obesity. Obesity also increases post-transplant complications and can limit access to transplantation. Lifestyle changes rarely achieve lasting weight loss, whereas bariatric surgery—especially sleeve gastrectomy—can improve transplant eligibility with fewer complications. Weight-loss medications may be used before transplantation but remain insufficiently studied in ESKD. After transplantation, weight-reduction efforts should continue, with pharmacotherapy preferred over bariatric surgery. Comprehensive assessment strategies and individualized management approaches in ESKD patients are essential to optimize outcomes in this growing patient population. Full article

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

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17 pages, 1073 KB

Open AccessArticle

From Exhaustion to Empowerment: A Pilot Study on Motor Control-Based Exercise for Fatigue and Quality of Life in Long COVID-19 Patients

by Carmen Jiménez-Antona, Ricardo Moreta-Fuentes, David Varillas-Delgado, César Moreta-Fuentes and Sofía Laguarta-Val

Medicina 2026, 62(1), 210; https://doi.org/10.3390/medicina62010210 - 20 Jan 2026

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Abstract

Background and Objectives: Long COVID-19 (LC) is a multifaceted condition characterized by persistent fatigue and impaired health-related quality of life (HRQoL). Exercise intolerance and post-exertional symptom exacerbation (PESE) pose challenges for rehabilitation. This study aimed to evaluate the effects of a 12-week [...] Read more.

Background and Objectives: Long COVID-19 (LC) is a multifaceted condition characterized by persistent fatigue and impaired health-related quality of life (HRQoL). Exercise intolerance and post-exertional symptom exacerbation (PESE) pose challenges for rehabilitation. This study aimed to evaluate the effects of a 12-week core-focused plank exercise program on fatigue and HRQoL in women with LC, using validated patient-reported measures. Materials and Methods: A pilot quasi-experimental design was implemented, with non-randomized group allocation. Thirty-nine women with LC were recruited from the Madrid Long COVID Association. Participants were assigned to either an intervention group (n = 20), which completed a supervised plank-based motor control program, or a control group (n = 19), which maintained usual activity. Fatigue was assessed using the Modified Fatigue Impact Scale (MFIS), and HRQoL was measured using the EQ-5D-5L and EQ Visual Analog Scale (EQ-VAS). Body composition was evaluated via bioelectrical impedance analysis. Results: The intervention group showed significant reductions after intervention in the MFIS total scores compared to the control group, particularly in the physical (21.26 ± 6.76 vs. 25.21 ± 6.06; p < 0.001) and psychosocial domains (4.51 ± 0.41 vs. 5.21 ± 0.38; p < 0.001), without triggering PESE. EQ-VAS scores improved significantly (63.94 ± 15.33 vs. 46.31 ± 14.74; p = 0.034). No significant changes were found in body composition parameters, suggesting that benefits were driven by neuromuscular adaptations rather than morphological changes. Conclusions: A core-focused, non-aerobic exercise program effectively reduced fatigue and improved perceived health status in women with LC. These findings support the use of motor control-based interventions as a safe and feasible strategy for LC rehabilitation, particularly in populations vulnerable to PESE, suggesting clinical applicability for the rehabilitation of women with LC. Further randomized trials are warranted to confirm these results and explore long-term outcomes. Full article

(This article belongs to the Special Issue Exercise Rehabilitation Strategies for Long-Term Conditions in the Post-Pandemic Era)

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13 pages, 752 KB

Open AccessArticle

Changes in Bioelectrical Impedance Analysis and Lipid Profile in Children Diagnosed with Short Stature Who Undergo Growth Hormone Therapy: One Single-Center Experience

by Ioana Maria Vlasa, Raluca Monica Pop, Ionut Maxim Vlasa and Ionela Maria Pașcanu

Medicina 2026, 62(1), 209; https://doi.org/10.3390/medicina62010209 - 20 Jan 2026

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Abstract

Background and Objectives: The effect of growth hormone (GH) on body composition is well recognized, and recombinant human GH (rGH) therapy may improve lean mass and related parameters. The aim of this study was to analyze changes in body composition parameters and [...] Read more.

Background and Objectives: The effect of growth hormone (GH) on body composition is well recognized, and recombinant human GH (rGH) therapy may improve lean mass and related parameters. The aim of this study was to analyze changes in body composition parameters and lipid profile under rGH treatment in children diagnosed with short stature and to explore potential influencing factors. Materials and Methods: A secondary data analysis was conducted in the Endocrinology Department of the Mures County Hospital, Romania, approved by the local Ethics Committee. All children diagnosed with short stature and receiving rGH treatment were eligible for inclusion if they had four body composition analyses at least 6 months apart. Analyzed variables included age, gender, environment, mean rGH dose, height and body mass index (BMI) SDS, body composition parameters assessed by bioimpedance, and family-related variables. Statistical analysis was performed using SPSS v.25 with a level of significance α = 0.05. Results: There was no statistically significant trend in body composition parameters taken during serial measurements, except for the sarcopenic index and height (p < 0.001). Environment, pubertal development, and family-related variables other than maternal BMI had no significant influence on body composition or lipid profile. Gender differences in body composition revealed that the change in muscle mass (p = 0.009) and skeletal muscle mass (p = 0.013) was statistically significantly higher for boys, and body fat (p = 0.013) for girls. In linear regression analysis, mother’s BMI emerged as a significant predictor for changes in high-density lipoprotein cholesterol (HDL-C) levels (p = 0.032, β = −0.691) during rGH therapy. Body composition changes did not differ by treatment indication. Conclusions: Gender may be associated with treatment-related changes in body composition during pediatric rGH therapy, while maternal BMI may predict HDL-C variation. rGH treatment appears to improve the sarcopenic index and has minimal and variable effects on the lipid profile. Full article

(This article belongs to the Section Endocrinology)

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12 pages, 813 KB

Open AccessArticle

The Role of DLNO in the Functional Assessment of Patients with Idiopathic Pulmonary Fibrosis

by Pasquale Tondo, Josuel Ora, Matteo Pio Natale, Giulia Scioscia, Bartolomeo Zerillo, Matteo Salvatore Di Maggio, Paola Rogliani and Donato Lacedonia

Medicina 2026, 62(1), 208; https://doi.org/10.3390/medicina62010208 - 19 Jan 2026

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Abstract

Background and Objectives: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive interstitial lung disease characterized by alveolar-capillary membrane remodeling and impaired gas diffusion. The diffusing capacity of the lung for nitric oxide (DLNO) has been proposed as a physiological parameter reflecting membrane diffusing [...] Read more.

Background and Objectives: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive interstitial lung disease characterized by alveolar-capillary membrane remodeling and impaired gas diffusion. The diffusing capacity of the lung for nitric oxide (DLNO) has been proposed as a physiological parameter reflecting membrane diffusing capacity and pulmonary vascular involvement, potentially providing complementary information to diffusing capacity of the lung for carbon monoxide (DLCO). This study aimed to evaluate the role of DLNO in the functional assessment of patients with IPF and its correlation with clinical and echocardiographic outcomes. Materials and Methods: This observational, retrospective study included 35 consecutive IPF patients receiving antifibrotic therapy between February and December 2023. All participants underwent plethysmography, combined single-breath DLNO and DLCO testing, six-minute walk test (6MWT), mMRC dyspnea scale assessment, and echocardiography for the estimation of a higher probability of pulmonary hypertension (PH). Results: DLNO was significantly lower in males compared to females (49.3 ± 16.7% vs. 74.6 ± 16.1%, p < 0.001), with a reduced DLNO/DLCO ratio in men. DLNO correlated with oxygen therapy requirement (p = 0.010) and lower oxygen saturation during the 6MWT (p = 0.021). Patients with higher echocardiographic probability of PH showed markedly reduced DLNO values (17.6 ± 7.6%, p = 0.016) and higher FVC/DLNO ratios (2.31 ± 0.85 vs. 1.65 ± 0.64, p = 0.023), together with lower DLCO levels (p = 0.037). Conclusions: DLNO may complement DLCO in the evaluation of gas exchange and alveolar-capillary dysfunction in IPF. Although preliminary, these findings support the potential clinical utility of DLNO as an adjunct parameter in the functional characterization of IPF. Further multicenter studies are warranted to confirm these results. Full article

(This article belongs to the Special Issue Immunological Mechanisms and Diagnostic Advances in Interstitial Lung Diseases and Systemic Inflammatory Disorders)

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14 pages, 482 KB

Open AccessArticle

Prognostic Value of the National Early Warning Score Combined with Nutritional and Endothelial Stress Indices for Mortality Prediction in Critically Ill Patients with Pneumonia

by Ferhan Demirer Aydemir, Murat Daş, Özge Kurtkulağı, Ece Ünal Çetin, Feyza Mutlay and Yavuz Beyazıt

Medicina 2026, 62(1), 207; https://doi.org/10.3390/medicina62010207 - 19 Jan 2026

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Abstract

Background and Objectives: Pneumonia is a leading cause of intensive care unit (ICU) admission and is associated with high mortality, particularly among patients with multiple comorbidities. Accurate early risk stratification is essential for guiding clinical decision-making in critically ill patients. However, the [...] Read more.

Background and Objectives: Pneumonia is a leading cause of intensive care unit (ICU) admission and is associated with high mortality, particularly among patients with multiple comorbidities. Accurate early risk stratification is essential for guiding clinical decision-making in critically ill patients. However, the prognostic benefit of combining clinical scoring systems with nutritional and endothelial stress indices in ICU patients with pneumonia remains unclear. Materials and Methods: This retrospective, single-center cohort study included adult patients admitted to the ICU with a diagnosis of pneumonia between 1 January 2023 and 1 July 2025. Demographic characteristics, comorbidities, clinical variables, laboratory parameters, and prognostic scores were obtained from electronic medical records. The National Early Warning Score (NEWS), Prognostic Nutritional Index (PNI), and Endothelial Activation and Stress Index (EASIX) were calculated at ICU admission. The primary outcome was in-hospital mortality. Univariate and multivariate logistic regression analyses were performed to examine variables associated with in-hospital mortality. The discriminative performance of individual and combined prognostic models was evaluated using receiver operating characteristic (ROC) curve analysis. Results: A total of 221 patients were included; 79 (35.7%) survived and 142 (64.3%) died during hospitalization. Non-survivors had significantly higher NEWS and EASIX values and lower PNI values compared with survivors (all p < 0.05). In multivariate analysis, endotracheal intubation (OR: 12.46; p < 0.001), inotropic use (OR: 5.14; p = 0.001), and serum lactate levels (OR: 1.75; p = 0.003) were identified as being independently associated with in-hospital mortality. Models combining NEWS with PNI or EASIX demonstrated improved discriminatory performance. Conclusions: In critically ill patients with pneumonia, integrating NEWS with nutritional and endothelial stress indices provides numerically improved discrimination compared with NEWS alone, although the incremental gain did not reach statistical significance. Full article

(This article belongs to the Special Issue Multidisciplinary Approaches and Recent Advances in Anesthesiology and Critical Care)

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14 pages, 884 KB

Open AccessArticle

Predictors of Progressive Fibrosing Interstitial Lung Diseases and Survival in Fibrosing Interstitial Lung Disease-Related Usual Interstitial Pneumonia

by Hongyan Fu, Xiao Li, Hongyang Shi, Jie Zhang and Ming Zhang

Medicina 2026, 62(1), 206; https://doi.org/10.3390/medicina62010206 - 19 Jan 2026

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Abstract

Background and Objectives: Usual interstitial pneumonia (UIP) is associated with progressive fibrosing interstitial lung diseases (PF-ILD) and poor survival in patients with fibrosing interstitial lung disease (FILD). We aimed to investigate the predictors of PF-ILD and survival in patients with FILD-UIP. Materials and [...] Read more.

Background and Objectives: Usual interstitial pneumonia (UIP) is associated with progressive fibrosing interstitial lung diseases (PF-ILD) and poor survival in patients with fibrosing interstitial lung disease (FILD). We aimed to investigate the predictors of PF-ILD and survival in patients with FILD-UIP. Materials and Methods: This retrospective study was conducted at a single, tertiary hospital in China. Patients underwent routine follow-up visits every 3 to 6 months according to standard operating procedures (SOPs). Patients with FILD-UIP were further stratified using the proposed PF-ILD criteria. Results: This retrospective study enrolled 150 patients with FILD-UIP between October 2020 and June 2025, with 117 patients completing follow-up for more than 12 months. FILD-UIP was categorized as idiopathic pulmonary fibrosis (IPF) (n = 67) and non-IPF-UIP (n = 50), which included connective tissue disease-associated UIP (n = 29), hypersensitivity pneumonitis-associated UIP (n = 7), and interstitial pneumonia with autoimmune features-associated UIP (n = 14). During the follow-up period, 32 (47.8%) patients with IPF and 19 (38.0%) non-IPF-UIP experienced PF-ILD. Pulmonary hypertension (PH) and predicted percentage of forced vital capacity (FVC%pred) were dependent risk factors for PF-ILD in patients with FILD-UIP, non-IPF-UIP, and IPF. King’s Brief Interstitial Lung Disease (KBILD) is a dependent risk factor for PF-ILD in patients with FILD-UIP and IPF. PF-ILD is similarly associated with poor survival in patients with FILD-UIP, non-IPF-UIP, and IPF. Conclusions: Baseline disease severity is closely associated with the incidence of PF-ILD, with all forms of FILD-UIP at risk of PF-ILD and showing similar outcomes to IPF-UIP/PF-ILD. Full article

(This article belongs to the Special Issue Advances in Interstitial Lung Diseases: From Diagnosis to Treatment)

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13 pages, 985 KB

Open AccessArticle

Early SGLT2 Inhibitor Therapy in Acute Coronary Syndrome: Mitigating Adverse Remodeling in High-Risk Phenotypes—A Real-World Study

by Teodora Mateoc, Ioana-Maria Suciu, Dan Gaiță, Andor Minodora, Roxana Popescu, Tania Vlad, Corina Flangea, Călin Muntean and Daliborca-Cristina Vlad

Medicina 2026, 62(1), 205; https://doi.org/10.3390/medicina62010205 - 19 Jan 2026

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Abstract

Background and Objectives: SGLT2 inhibitors are foundational in heart failure therapy, yet their impact on left ventricular (LV) remodeling immediately following acute coronary syndrome (ACS) remains less defined. This study evaluated the association between early SGLT2 inhibitor initiation and structural recovery in a [...] Read more.

Background and Objectives: SGLT2 inhibitors are foundational in heart failure therapy, yet their impact on left ventricular (LV) remodeling immediately following acute coronary syndrome (ACS) remains less defined. This study evaluated the association between early SGLT2 inhibitor initiation and structural recovery in a real-world post-ACS cohort. Materials and Methods: We conducted a retrospective observational study including 238 revascularized ACS patients, stratified into an SGLT2 inhibitor group (n = 71) and a control group (n = 167). Changes in LV ejection fraction (LVEF) and indexed LV mass (LVMi) were assessed by echocardiography at baseline and follow-up (mean 286 days). Multivariable regression models were adjusted for baseline imbalances and tested for interactions with diabetes status. Results: A significant “confounding by indication” was observed; the SGLT2 group presented a high-risk phenotype with higher diabetes prevalence (56.3% vs. 25.7%, p < 0.001), lower baseline LVEF (38.3% vs. 43.3%), and greater hypertrophy. After adjustment, statistical independence was attenuated by baseline severity, yet the SGLT2 group achieved follow-up structural outcomes comparable to lower-risk controls. Interaction analysis indicated these trends were consistent regardless of diabetes status (p > 0.05). Conclusions: In this high-risk ACS population, early SGLT2 inhibitor therapy was associated with stabilization of cardiac structure. Despite a profound baseline disadvantage, the recovery trajectory effectively aligned with that of a lower-risk population, highlighting a clinically relevant pattern of structural stabilization consistent across metabolic subgroups. Full article

(This article belongs to the Special Issue Diabetes, Hypertension, and Cardiovascular Diseases: New Insights, Risk Factors, and Drug Therapies)

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Medicina, Volume 62, Issue 1 (January 2026) – 234 articles

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