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Med. Sci., Volume 13, Issue 2 (June 2025) – 21 articles

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10 pages, 752 KiB  
Review
Research Priorities for Diabetic Ketoacidosis: An Evidence and Gap Mapping Review
by Nicolas Sieben and Mahesh Ramanan
Med. Sci. 2025, 13(2), 53; https://doi.org/10.3390/medsci13020053 (registering DOI) - 1 May 2025
Abstract
Background/Objectives: Diabetic ketoacidosis (DKA) is a common acute complication of diabetes with treatment consisting of reversal of cause, insulin administration, fluid resuscitation and electrolyte repletion. Yet, many aspects of DKA management are currently based on low-quality evidence or physiological rationale. This evidence and [...] Read more.
Background/Objectives: Diabetic ketoacidosis (DKA) is a common acute complication of diabetes with treatment consisting of reversal of cause, insulin administration, fluid resuscitation and electrolyte repletion. Yet, many aspects of DKA management are currently based on low-quality evidence or physiological rationale. This evidence and gap map review presents an overview of the current body of literature and identifies evidence gaps in relation to therapeutic interventions for DKA. Methods: Interventions and outcomes relevant to DKA were identified and iteratively developed to produce a coding model for the proposed evidence and gap map. PubMed was searched with Me SH terms relevant to the identified interventions and outcomes. Studies identified were screened and assigned interventions and outcomes. Interventional research was uploaded to EPPI-Reviewer and EPPI-Mapper to produce the evidence and gap map. Results: The search identified 1131 studies, of which 18 were non-human and 345 were duplicates. A total of 768 unique studies were screened, and 118 were identified as interventions (52 pediatric and 66 adult studies). A total of 26 high-quality studies, 88 medium-quality studies and 4 low-quality studies were identified. These 118 studies were coded into the proposed DKA evidence and gap map. The intervention domains were fluid therapy, insulin therapy, electrolyte replacement, adjunct therapies and admission type. The outcome domains were DKA resolution, insulin duration, length of stay, morbidity and mortality, complications, and biochemical parameters. Conclusions: Fluid type and insulin infusion administration were prominent in the current literature. These studies frequently used DKA resolution and complications associated with DKA such as electrolyte disturbances and cerebral edema as the primary outcomes. Substantial gaps were identified with scant evidence to guide prophylactic electrolyte administration, enteral intake and adjunctive therapy (thiamine, bicarbonate). Even for well-investigated interventions such as fluids and insulin, substantial gaps existed, particularly for patient-centered and healthcare service outcomes. Full article
(This article belongs to the Section Critical Care Medicine)
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6 pages, 318 KiB  
Article
Sustained Long-Term Results with Minimal Reintervention Rates in Patients with Frozen Elephant Trunk and Acute Aortic Syndromes
by Filippos-Paschalis Rorris, Christos F. Pitros, Constantine N. Antonopoulos, Konstantinos Papakonstantinou, Lydia Kokotsaki, Pantelis Tsipas, Ilias Gissis and John Kokotsakis
Med. Sci. 2025, 13(2), 52; https://doi.org/10.3390/medsci13020052 (registering DOI) - 1 May 2025
Abstract
The Frozen Elephant Trunk (FET) technique is indicated in acute aortic syndromes with arch involvement and malperfusion of tissues. We sought to report on long-term outcomes of FET in emergent cases of acute aortic syndromes. Methods: Twenty-three adult patients were referred to our [...] Read more.
The Frozen Elephant Trunk (FET) technique is indicated in acute aortic syndromes with arch involvement and malperfusion of tissues. We sought to report on long-term outcomes of FET in emergent cases of acute aortic syndromes. Methods: Twenty-three adult patients were referred to our department for surgical management of acute aortic syndromes and underwent aortic arch replacement using the FET technique between November 2010 and January 2022. The primary outcome was long-term survival. Secondary outcomes were the 30-day mortality rate and the incidence of neurologic complications, i.e., stroke and spinal cord ischemia. Results: The mean patient age was 57.1 (±12.5) years, and the majority (20 patients, 87%) were male. The most common indication was Stanford type A acute aortic dissection (aTAAD) in 17 (74%) patients, followed by non-A non-B dissection in 2 (8.7%) patients, penetrating aortic ulcer (PAU) of the aortic arch in 2 (8.7%) patients, type A intramural hematoma (IMH) in 1 (4.3%) patient and blunt thoracic aortic injury of the aortic arch in 1 (4.3%) patient. Kaplan–Meier survival analysis revealed a 73% survival at 12 months, which persisted up to 11 years of follow-up. Conclusion: The FET technique provides a reliable solution for surgical management of patients with acute aortic syndromes. Excellent, sustained long-term results can be achieved. Full article
(This article belongs to the Section Cardiovascular Disease)
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12 pages, 1504 KiB  
Article
Effectiveness of Stress Shielding Prevention Using a Low Young’s Modulus Ti-33.6Nb-4Sn Stem: A 7-Year Follow-Up Study
by Kazuyoshi Baba, Yu Mori, Hidetatsu Tanaka, Ryuichi Kanabuchi, Yasuaki Kuriyama, Hiroaki Kurishima, Kentaro Ito, Masayuki Kamimura, Daisuke Chiba and Toshimi Aizawa
Med. Sci. 2025, 13(2), 51; https://doi.org/10.3390/medsci13020051 (registering DOI) - 1 May 2025
Abstract
Background: Stress shielding (SS) after total hip arthroplasty (THA) leads to proximal femoral bone loss and increases the risk of complications such as implant loosening and periprosthetic fracture. While various low-stiffness stems have been developed to prevent SS, they often compromise mechanical stability. [...] Read more.
Background: Stress shielding (SS) after total hip arthroplasty (THA) leads to proximal femoral bone loss and increases the risk of complications such as implant loosening and periprosthetic fracture. While various low-stiffness stems have been developed to prevent SS, they often compromise mechanical stability. A novel femoral stem composed of Ti-33.6Nb-4Sn (TNS) alloy offers a gradually decreasing Young’s modulus from proximal to distal regions, potentially improving load distribution and reducing SS. This study aimed to evaluate the mid-term clinical and radiographic outcomes of the TNS stem, with a particular focus on its effectiveness in suppressing SS. Methods: A prospective clinical study was conducted involving 35 patients who underwent THA using the TNS stem, with a minimum follow-up of 7 years. Twenty-one patients with Ti6Al4V metaphyseal-filling stems served as controls. Clinical outcomes were assessed using Japanese Orthopaedic Association (JOA) scores, and radiographic SS was graded using Engh’s classification and analyzed in Gruen zones. Inter-examiner reliability and statistical comparisons between groups were performed using appropriate tests. Results: The TNS group showed significantly higher preoperative JOA scores than the control group, but no significant difference in final scores. Both groups demonstrated significant improvement postoperatively. Third-degree SS occurred in the TNS group, although the overall SS grade distribution was significantly lower than in the control group (p = 0.03). SS frequency was significantly reduced in Gruen Zones 2, 3, and 6 in the TNS group. Conclusions: The TNS stem demonstrated a significant reduction in SS progression compared to conventional titanium stems over a 7-year period, with comparable clinical outcomes. However, the occurrence of third-degree SS indicates that material optimization alone may be insufficient, highlighting the need for further design improvements. Full article
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13 pages, 1138 KiB  
Article
Accuracy of Accuhaler, Ellipta, and Turbuhaler Testers in Patients with Chronic Obstructive Pulmonary Disease
by Narongkorn Saiphoklang, Thiravit Siriyothipun and Sarawut Panichaporn
Med. Sci. 2025, 13(2), 50; https://doi.org/10.3390/medsci13020050 - 29 Apr 2025
Viewed by 136
Abstract
Background: Peak inspiratory flow rate (PIFR) measurement is an essential tool for assessing the effectiveness of inhaler therapy in chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the accuracy of three different inhaler testers compared to the In-Check DIAL® [...] Read more.
Background: Peak inspiratory flow rate (PIFR) measurement is an essential tool for assessing the effectiveness of inhaler therapy in chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the accuracy of three different inhaler testers compared to the In-Check DIAL® device. Methods: A cross-sectional study was conducted in clinically stable COPD patients. Participants performed PIFR measurements using the In-Check DIAL® device and three inhaler testers (Accuhaler, Ellipta, and Turbuhaler). Optimal PIFR was defined as ≥60 L/min. Minimum PIFR was defined as ≥30 L/min. Results: A total of 82 COPD patients (93.9% male) were included, with a mean age of 73.3 ± 8.8 years. Post-bronchodilator forced expiratory volume in one second was 69.2 ± 21.0%. The prevalence of optimal PIFR was 78%, 74%, and 52% for the Accuhaler, Ellipta, and Turbuhaler testers, respectively. For detecting optimal PIFR, the Accuhaler tester demonstrated an accuracy of 80.5%, sensitivity of 100%, and specificity of 11.1%. The Ellipta tester showed an accuracy of 78.1%, sensitivity of 100%, and specificity of 14.3%, while the Turbuhaler tester achieved an accuracy of 56.1%, sensitivity of 100%, and specificity of 7.7%. All devices showed excellent accuracy (>95%), sensitivity (>98%), and specificity (100% except for the Turbuhaler tester) in detecting minimum PIFR. Conclusions: The majority of COPD patients achieved optimal PIFR across the three different devices, with the highest prevalence observed for the Accuhaler tester. All three inhaler testers demonstrated excellent accuracy in assessing PIFR in COPD patients, suggesting their potential as reliable alternatives to the In-Check DIAL® device in clinical practice. Full article
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14 pages, 495 KiB  
Article
Effects of Oral Doxofylline and Procaterol on Chronic Obstructive Pulmonary Disease: A Randomized Crossover Study
by Narongkorn Saiphoklang, Sarawut Panichaporn, Thiravit Siriyothipun and Pitchayapa Ruchiwit
Med. Sci. 2025, 13(2), 49; https://doi.org/10.3390/medsci13020049 - 29 Apr 2025
Viewed by 118
Abstract
Background: Oral bronchodilators may serve as an adjunctive therapy in patients with chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the effects of oral doxofylline and oral procaterol on lung function and clinical symptoms in COPD patients. Methods: A [...] Read more.
Background: Oral bronchodilators may serve as an adjunctive therapy in patients with chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the effects of oral doxofylline and oral procaterol on lung function and clinical symptoms in COPD patients. Methods: A crossover randomized controlled trial was conducted in patients with clinically stable COPD. Participants first received either doxofylline or procaterol for 4 weeks, followed by a 1-week washout period. Assessments included the modified Medical Research Council (mMRC) dyspnea scale, COPD assessment test (CAT) scores, and 6-minute walking distance (6MWD). Pulmonary function was evaluated using spirometry with bronchodilator (BD) testing and all adverse events were recorded. Results: Twenty patients were randomly assigned to begin treatment with either doxofylline or procaterol. Their mean age was 71.7 ± 9.4 years. After four weeks of treatment, the doxofylline group showed significantly greater improvement in pulmonary function parameters (post-BD peak expiratory flow and post-BD forced expiratory flow 25–75) compared to the procaterol group. However, there were no significant differences in mMRC scores, CAT scores, or 6MWD between the two groups. More neurological adverse events were observed in the doxofylline group compared to the procaterol group (35% vs. 5%, p = 0.044). Conclusions: Doxofylline improved pulmonary function in COPD patients but did not provide superior functional performance compared to procaterol. Neurological adverse events were more frequently associated with doxofylline. Doxofylline may serve as an adjunctive therapy to enhance pulmonary function in COPD patients, but caution is advised due to its potential side effects. Full article
(This article belongs to the Section Pneumology and Respiratory Diseases)
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23 pages, 1033 KiB  
Review
Memory T Cells in Respiratory Virus Infections: Protective Potential and Persistent Vulnerabilities
by Henry Sutanto, Febrian Ramadhan Pradana, Galih Januar Adytia, Bagus Aditya Ansharullah, Alief Waitupu, Bramantono Bramantono and Deasy Fetarayani
Med. Sci. 2025, 13(2), 48; https://doi.org/10.3390/medsci13020048 - 29 Apr 2025
Viewed by 214
Abstract
Respiratory virus infections, such as those caused by influenza viruses, respiratory syncytial virus (RSV), and coronaviruses, pose a significant global health burden. While the immune system’s adaptive components, including memory T cells, are critical for recognizing and combating these pathogens, recurrent infections and [...] Read more.
Respiratory virus infections, such as those caused by influenza viruses, respiratory syncytial virus (RSV), and coronaviruses, pose a significant global health burden. While the immune system’s adaptive components, including memory T cells, are critical for recognizing and combating these pathogens, recurrent infections and variable disease outcomes persist. Memory T cells are a key element of long-term immunity, capable of responding swiftly upon re-exposure to pathogens. They play diverse roles, including cross-reactivity to conserved viral epitopes and modulation of inflammatory responses. However, the protective efficacy of these cells is influenced by several factors, including viral evolution, host age, and immune system dynamics. This review explores the dichotomy of memory T cells in respiratory virus infections: their potential to confer robust protection and the limitations that allow for breakthrough infections. Understanding the underlying mechanisms governing the formation, maintenance, and functional deployment of memory T cells in respiratory mucosa is critical for improving immunological interventions. We highlight recent advances in vaccine strategies aimed at bolstering T cell-mediated immunity and discuss the challenges posed by viral immune evasion. Addressing these gaps in knowledge is pivotal for designing effective therapeutics and vaccines to mitigate the global burden of respiratory viruses. Full article
(This article belongs to the Section Immunology and Infectious Diseases)
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21 pages, 1169 KiB  
Review
Dichloroacetate and Salinomycin as Therapeutic Agents in Cancer
by Sunny Hunt, Anita Thyagarajan and Ravi P. Sahu
Med. Sci. 2025, 13(2), 47; https://doi.org/10.3390/medsci13020047 - 23 Apr 2025
Viewed by 265
Abstract
Cancer is the second leading cause of mortality worldwide. Despite the available treatment options, a majority of cancer patients develop drug resistance, indicating the need for alternative approaches. Repurposed drugs, such as antiglycolytic and anti-microbial agents, have gained substantial attention as potential alternative [...] Read more.
Cancer is the second leading cause of mortality worldwide. Despite the available treatment options, a majority of cancer patients develop drug resistance, indicating the need for alternative approaches. Repurposed drugs, such as antiglycolytic and anti-microbial agents, have gained substantial attention as potential alternative strategies against different disease pathophysiologies, including lung cancer. To that end, multiple studies have suggested that the antiglycolytic dichloroacetate (DCA) and the antibiotic salinomycin (SAL) possess promising anticarcinogenic activity, attributed to their abilities to target the key metabolic enzymes, ion transport, and oncogenic signaling pathways involved in regulating cancer cell behavior, including cell survival and proliferation. We used the following searches and selection criteria. (1) Biosis and PubMed were used with the search terms dichloroacetate; salinomycin; dichloroacetate as an anticancer agent; salinomycin as an anticancer agent; dichloroacetate side effects; salinomycin side effects; salinomycin combination therapy; dichloroacetate combination therapy; and dichloroacetate or salinomycin in combination with other agents, including chemotherapy and tyrosine kinase inhibitors. (2) The exclusion criteria included not being related to the mechanisms of DCA and SAL or not focusing on their anticancer properties. (3) All the literature was sourced from peer-reviewed journals within a timeframe of 1989 to 2024. Importantly, experimental studies have demonstrated that both DCA and SAL exert promising anticarcinogenic properties, as well as having synergistic effects in combination with other therapeutic agents, against multiple cancer models. The goal of this review is to highlight the mechanistic workings and efficacy of DCA and SAL as monotherapies, and their combination with other therapeutic agents in various cancer models, with a major emphasis on non-small-cell lung cancer (NSCLC) treatment. Full article
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11 pages, 3026 KiB  
Article
Trends in Heart Transplantation and Outcome Analysis: Nationwide Study Using the National Inpatient Sample and Readmission Database
by Vivek Joseph Varughese, Aditya Sunil Bhaskaran, Hadrian Hoang-Vu Tran, Nikita Wadhwani, Vignesh Krishnan Nagesh, Izage Kianifar Aguilar, Damien Islek, Simcha Weissman and Adam Atoot
Med. Sci. 2025, 13(2), 46; https://doi.org/10.3390/medsci13020046 - 22 Apr 2025
Viewed by 194
Abstract
Background: Heart transplantation (Htx) remains the definitive therapy for patients with end-stage heart failure. Despite advancements in mechanical circulatory support (MCS), immunosuppressive strategies, and organ allocation policies, donor availability remains a major limitation. This study analyzes the trends in Htx in the United [...] Read more.
Background: Heart transplantation (Htx) remains the definitive therapy for patients with end-stage heart failure. Despite advancements in mechanical circulatory support (MCS), immunosuppressive strategies, and organ allocation policies, donor availability remains a major limitation. This study analyzes the trends in Htx in the United States between 2016 and 2022, focusing on demographic shifts, mortality trends, and 30-day readmission patterns. Methods: We utilized the National Inpatient Sample (NIS) from 2016 to 2022 and the National Readmissions Database (NRD) for 2021 to identify Htx admissions using ICD-10 PCS code O2YA0Z0. Patient characteristics, mortality rates, and readmission patterns were analyzed using ANOVA and multivariate logistic regression, with statistical significance defined as p < 0.05. Results: The total number of Htx procedures increased from 641 in 2016 to 773 in 2022. The mean age of transplant recipients remained between 45 and 50 years, with no significant differences across years. Racial and socioeconomic disparities persisted, with approximately 60% of transplants occurring in White patients and 21–26% of recipients belonging to the lowest income quartile. All-cause in-hospital mortality remained stable at 4–7%. The 30-day readmission rate in 2021 was 57.7%, with heart failure, transplant rejection, and infections being the leading causes. Peripheral vascular disease (PVD) was the only comorbidity significantly associated with higher 30-day readmission risk (OR: 1.815, 95% CI: 1.477–2.230). Conclusions: Htx utilization has increased over time, driven by improvements in donor allocation and perioperative management. However, racial and socioeconomic disparities remain, and readmission rates continue to be high. Future efforts should focus on optimizing post-transplant care and addressing disparities to improve long-term outcomes. Full article
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11 pages, 1980 KiB  
Article
Readmission Events Following EGD for Upper Gastrointestinal Bleed: An Analysis Using the National Readmission Database
by Vignesh Krishnan Nagesh, Vivek Joseph Varughese, Jaber Musalli, Gomathy Aarthy Nageswaran, Erin Russell, Susan Anne Feldman, Simcha Weissman and Adam Atoot
Med. Sci. 2025, 13(2), 45; https://doi.org/10.3390/medsci13020045 - 20 Apr 2025
Viewed by 139
Abstract
Background: Upper Gastrointestinal Bleed (UGIB) is a common and potentially life-threatening condition with an annual incidence of 80–150 per 100,000 individuals and a mortality rate of 2–10%. Esophagogastroduodenoscopy (EGD) is the gold standard for both diagnosis and treatment, but post-discharge outcomes, including readmissions, [...] Read more.
Background: Upper Gastrointestinal Bleed (UGIB) is a common and potentially life-threatening condition with an annual incidence of 80–150 per 100,000 individuals and a mortality rate of 2–10%. Esophagogastroduodenoscopy (EGD) is the gold standard for both diagnosis and treatment, but post-discharge outcomes, including readmissions, remain underexplored. Methods: This study utilized the 2021 National Readmission Database (NRD) to analyze 30-day readmission rates following EGD for UGIB. Adult patients (≥18 years) admitted for UGIB and undergoing EGD were included; those who died during the index hospitalization were excluded. Demographic, clinical, and socioeconomic factors associated with readmission were examined using multivariate logistic regression. Results: Among 34,257 patients admitted for UGIB and undergoing EGD, 11,088 (32.4%) were readmitted within 30 days, with 5423 (49%) due to recurrent UGIB. Readmitted patients had a higher mean age (68.46 vs. 67.63 years) and greater prevalence of cirrhosis (16.71% vs. 13.84%). Hospital resource utilization was significantly higher among readmissions, with increased total hospital charges (USD 82,544.82 vs. USD 61,521.17) and longer hospital stays (5.38 vs. 4.97 days). Mortality was lower among readmitted patients (1.46% vs. 3.53%). Multivariate analysis identified cirrhosis (OR 7.20, 95% CI: 6.45–8.02), untreated H. pylori infection (OR 3.43, 95% CI: 2.15–4.30), atrial fibrillation (OR 1.52, 95% CI: 1.36–1.69), and chronic antithrombotic therapy (OR 1.63, 95% CI: 1.41–1.89) as significant predictors of recurrent UGIB readmission. Lower socioeconomic status was also associated with increased readmission risk (OR 1.15, 95% CI: 1.05–1.25). Conclusions: Readmission following EGD for UGIB is common and driven primarily by recurrent bleeding. Cirrhosis, untreated H. pylori infection, atrial fibrillation, and chronic anticoagulation therapy are key risk factors. These findings highlight the need for targeted interventions, including improved post-discharge management and optimization of anticoagulation strategies, to reduce readmission rates and improve patient outcomes. Full article
(This article belongs to the Section Hepatic and Gastroenterology Diseases)
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13 pages, 3897 KiB  
Review
Intelligent Care: A Scientometric Analysis of Artificial Intelligence in Precision Medicine
by Khalid M. Adam, Elshazali W. Ali, Mohamed E. Elangeeb, Hytham A. Abuagla, Bahaeldin K. Elamin, Elsadig M. Ahmed, Ali M. Edris, Abubakr A. Elamin Mohamed Ahmed and Elmoiz I. Eltieb
Med. Sci. 2025, 13(2), 44; https://doi.org/10.3390/medsci13020044 - 19 Apr 2025
Viewed by 288
Abstract
The integration of advanced computational methods into precision medicine represents a transformative advancement in healthcare, enabling highly personalized treatment strategies based on individual genetic, environmental, and lifestyle factors. These methodologies have significantly enhanced disease diagnostics, genomic analysis, and drug discovery. However, rapid expansion [...] Read more.
The integration of advanced computational methods into precision medicine represents a transformative advancement in healthcare, enabling highly personalized treatment strategies based on individual genetic, environmental, and lifestyle factors. These methodologies have significantly enhanced disease diagnostics, genomic analysis, and drug discovery. However, rapid expansion in this field has resulted in fragmented understandings of its evolution and persistent knowledge gaps. This study employs a scientometric approach to systematically map the research landscape, identify key contributors, and highlight emerging trends in precision medicine. Methods: A scientometric analysis was conducted using data retrieved from the Scopus database, covering publications from 2019 to 2024. Tools such as VOSviewer and R-bibliometrix package (version 4.3.0) were used to perform co-authorship analysis, co-citation mapping, and keyword evolution tracking. The study examined annual publication growth, citation impact, research productivity by country and institution, and thematic clustering to identify core research areas. Results: The analysis identified 4574 relevant publications, collectively amassing 70,474 citations. A rapid growth trajectory was observed, with a 34.3% increase in publications in 2024 alone. The United States, China, and Germany emerged as the top contributors, with Harvard Medical School, the Mayo Clinic, and Sichuan University leading in institutional productivity. Co-citation and keyword analysis revealed three primary research themes: diagnostics and medical imaging, genomic and multi-omics data integration, and personalized treatment strategies. Recent trends indicate a shift toward enhanced clinical decision support systems and precision drug discovery. Conclusions: Advanced computational methods are revolutionizing precision medicine, spurring increased global research collaboration and rapidly evolving methodologies. This study provides a comprehensive knowledge framework, highlighting key developments and future directions. The insights derived can inform policy decisions, funding allocations, and interdisciplinary collaborations, driving further advancements in healthcare solutions. Full article
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20 pages, 1073 KiB  
Systematic Review
A Scoping Review on the Prevalence of Hashimoto’s Thyroiditis and the Possible Associated Factors
by Hernando Vargas-Uricoechea, Alejandro Castellanos-Pinedo, Karen Urrego-Noguera, María V. Pinzón-Fernández, Ivonne A. Meza-Cabrera and Hernando Vargas-Sierra
Med. Sci. 2025, 13(2), 43; https://doi.org/10.3390/medsci13020043 - 10 Apr 2025
Viewed by 1062
Abstract
Background: Hashimoto’s thyroiditis (HT) is the most common autoimmune thyroid disease (AITD) and is characterized by the presence of thyroid autoantibodies against thyroid peroxidase and/or thyroglobulin. Several studies have found that the global prevalence of HT has increased in recent decades, while others [...] Read more.
Background: Hashimoto’s thyroiditis (HT) is the most common autoimmune thyroid disease (AITD) and is characterized by the presence of thyroid autoantibodies against thyroid peroxidase and/or thyroglobulin. Several studies have found that the global prevalence of HT has increased in recent decades, while others show the opposite. Methods and Results: The objective of this scoping review was to synthesize and analyze the different studies that have evaluated the prevalence of HT (in adults) and the possible associated factors. The following databases were consulted, as follows: MEDLINE, Web of Science, PubMed, and Scopus. The search terms “epidemiology”, “prevalence”, and “Hashimoto disease” and “Hashimoto thyroiditis” were used. The search was limited to articles published between January 1965 and October 2024, and only articles in English were considered. In order to reduce selection bias, each article was scrutinized using the JBI Critical Appraisal Checklist independently by two authors. Studies were included if the number of participants (study population and/or cases and controls, depending on the study design) was clearly described and duplicate studies were excluded. A total of 59 studies were identified, the vast majority of them used a cross-sectional design, using different methods of disease assessment. Conclusions: Globally, the prevalence of HT is estimated to be between 5–10%; some areas with prevalences > 20% and others < 0.5% were identified. Prevalence is also higher in women than in men. Multiple underlying factors (genetic, epigenetic, environmental, and lifestyle), together with socioeconomic, nutritional, overdiagnosis, inter alia, may explain (at least in part) the wide variability in the prevalence of HT. Full article
(This article belongs to the Section Endocrinology and Metabolic Diseases)
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24 pages, 1896 KiB  
Systematic Review
Diagnostic Accuracy of Sonazoid-Enhanced Ultrasonography for Detection of Liver Metastasis
by Anas Elgenidy, Khaled Saad, Reda Ibrahim, Aya Sherif, Taher Elmozugi, Moaz Y. Darwish, Mahmoud Abbas, Yousif A. Othman, Abdelrahman Elshimy, Alyaa M. Sheir, Dina H. Khattab, Abdallah A. Helal, Mario M. Tawadros, Osama Abuel-naga, Hazem I. Abdel-Rahman, Doaa Ali Gamal, Amira Elhoufey, Hamad Ghaleb Dailah, Rami A. Metwally, Noran ElBazzar and Hashem Abu Serhanadd Show full author list remove Hide full author list
Med. Sci. 2025, 13(2), 42; https://doi.org/10.3390/medsci13020042 - 9 Apr 2025
Viewed by 457
Abstract
Purpose: To evaluate the potential clinical role and reliability of Sonazoid-enhanced ultrasound (SEUS) as a diagnostic tool for liver metastatic lesions. Methods: An extensive literature search was conducted across five electronic databases, PubMed, Scopus, Embase, Cochrane Library, and Web of Science, from their [...] Read more.
Purpose: To evaluate the potential clinical role and reliability of Sonazoid-enhanced ultrasound (SEUS) as a diagnostic tool for liver metastatic lesions. Methods: An extensive literature search was conducted across five electronic databases, PubMed, Scopus, Embase, Cochrane Library, and Web of Science, from their inception up to January 2024 to identify all studies evaluating the use of Sonazoid-enhanced ultrasonography for detecting hepatic metastases. A meta-analysis was performed to assess diagnostic accuracy using the Meta-DiSc 2.0 software. Results: A total of 31 studies were included, 16 of which were eligible for meta-analysis and diagnostic test accuracy evaluation. A total of 13 studies in the meta-analysis evaluated the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) for 1347 metastatic and 1565 non-metastatic liver lesions. The pooled sensitivity and specificity for CEUS were 0.88 (95% CI: 0.82–0.92) and 0.92 (95% CI: 0.84–0.96), respectively. The combined positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 11.89 (95% CI: 5.42–26.09), 0.12 (95% CI:0.08–0.19), and 91.99 (95% CI: 32.15–263.17), respectively. Additionally, four studies of the meta-analysis assessed the diagnostic performance of contrast-enhanced intraoperative sonography (CE-IOUS) in detecting 664 metastatic and 246 non-metastatic liver lesions. The pooled sensitivity and specificity for CE-IOUS were 0.93 (95% CI: 0.82–0.97) and 0.84 (95% CI: 0.65–0.93), respectively. The aggregated positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated as 5.95 (95% CI: 2.32–15.25), 0.07 (95% CI: 0.02–0.24), and 77.68 (95% CI: 10.33–583.86), respectively. Conclusions: CE-IOUS and CEUS are reliable approaches for diagnosing liver metastatic lesions. CE-IOUS, in particular, exhibits higher accuracy in identifying liver metastatic lesions, indicating its potential effectiveness in clinical practice. Full article
(This article belongs to the Section Cancer and Cancer-Related Research)
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9 pages, 212 KiB  
Article
Visual–Motor Functions and Associated Cognitive Outcomes in Pediatric Cancer Survivors
by Alena Deviaterikova
Med. Sci. 2025, 13(2), 41; https://doi.org/10.3390/medsci13020041 - 5 Apr 2025
Viewed by 282
Abstract
Introduction: Pediatric cancer survivors are at high risk for visual–motor and cognitive deficits that persist throughout life. These domains are related to academic performance. The current study examined (i) whether both visuomotor and cognitive functions and (ii) whether visuomotor functions alone mediate the [...] Read more.
Introduction: Pediatric cancer survivors are at high risk for visual–motor and cognitive deficits that persist throughout life. These domains are related to academic performance. The current study examined (i) whether both visuomotor and cognitive functions and (ii) whether visuomotor functions alone mediate the relationship between age and cognitive functions. Methods: In total, there were 210 participants (7–17 years): 70 posterior fossa tumors (Mage = 12.1  ±  3.2 years, 44% female) and 70 acute lymphoblastic leukemia (Mage = 12.3  ±  3.4 years, 45% female) survivors and 70 (Mage = 12.2 ± 3.3 years, 41% female) healthy controls. Visual motor integration, motor coordination and visual perception were assessed using the Beery VMI test. Working memory, attention and planning were assessed using CANTAB. Results: Impaired motor function is significantly more pronounced than cognitive impairment in both groups of cancer survivors (effect size from 25 to 30% for visual–motor and from 5 to 7% for cognitive functions). A multiple regression model revealed that age and visual motor functions are significant predictors of attention (in the ALL group β = −0.490, t = −4.88, p = 0.000) and working memory (in the PFT group β = 0.264, t = 2.72, p = 0.008; in the ALL group β = 0.215, t = 2.24, p = 0.028). Conclusions: In children who have experienced acute lymphoblastic leukemia and tumors of the posterior cranial fossa, visual–motor dysfunction is more pronounced than cognitive impairment. In addition, there is an association between visual–motor function disorders and working memory. These findings can be used to develop more specific rehabilitation protocols. Full article
(This article belongs to the Section Cancer and Cancer-Related Research)
17 pages, 546 KiB  
Article
Role of IL-2, IL-6, and TNF-α as Potential Biomarkers in Ischemic Heart Disease: A Comparative Study of Patients with CAD and Non-CAD
by Ahmed E. Altyar, Shilpa Bhardwaj, Nehmat Ghaboura, Priya Kaushik, Sattam Khulaif Alenezi, Mohammed Jaffar Sadiq Mantargi and Muhammad Afzal
Med. Sci. 2025, 13(2), 40; https://doi.org/10.3390/medsci13020040 - 4 Apr 2025
Viewed by 274
Abstract
Background: Ischemic heart disease (CAD), a leading global health burden, arises primarily from atherosclerosis, an inflammatory condition characterized by lipid accumulation and metabolic dysregulation. The precise contribution of inflammatory cytokines (IL-2, IL-6, and TNF-α) to CAD pathogenesis remains an area of significant research. [...] Read more.
Background: Ischemic heart disease (CAD), a leading global health burden, arises primarily from atherosclerosis, an inflammatory condition characterized by lipid accumulation and metabolic dysregulation. The precise contribution of inflammatory cytokines (IL-2, IL-6, and TNF-α) to CAD pathogenesis remains an area of significant research. Aim: The primary aim of this study is to examine the IL-2, IL-6, and TNF-α in patients with coronary artery disease (CAD) and compare them with Non-CAD individuals to evaluate their potential as diagnostic biomarkers for CAD. Methodology: A prospective observational study was conducted over 3 years, involving 100 participants divided into CAD and non-CAD groups. Blood samples were isolated and analyzed for IL-2, IL-6, and TNF-α levels utilizing ELISA kits. Biochemical parameters, including lipid profiles, were also assessed. Results: This study observed significantly elevated IL-6 in patients with CAD compared with controls, while IL-2 and TNF-α levels did not reach statistical significance. The CAD group exhibited dyslipidemia characterized by elevated triglycerides and reduced HDL. Furthermore, the CAD group demonstrated alterations in biochemical parameters, including lower albumin and calcium levels, higher urea and uric acid levels, and an elevated erythrocyte sedimentation rate. These findings suggest a systemic inflammatory state and metabolic disturbances in patients with CAD. Conclusions: This study highlights IL-6 as a potential biomarker and key player in CAD pathogenesis. These findings warrant further investigation into the therapeutic potential of targeting inflammatory pathways for cardiovascular risk reduction. Full article
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11 pages, 808 KiB  
Review
Positioning of the Central Venous Catheter for Hemodialysis Using Wireless Intracavitary ECG: A Case Series and Narrative Review of the Literature
by Simone Gianazza, Cristina Valli, Stefano Mangano, Arline Vechiu, Monica Breda, Laura Composto, Clara Claudia Sardo, Camilla Ariti and Andrea Rizzi
Med. Sci. 2025, 13(2), 39; https://doi.org/10.3390/medsci13020039 - 2 Apr 2025
Viewed by 242
Abstract
This study aimed to evaluate the practicality and feasibility of using intracavitary electrocardiography to confirm the proper placement of a central venous catheter for hemodialysis. Central venous catheters are typically placed using an echo-guided technique based on anatomical landmarks, followed by X-ray confirmation. [...] Read more.
This study aimed to evaluate the practicality and feasibility of using intracavitary electrocardiography to confirm the proper placement of a central venous catheter for hemodialysis. Central venous catheters are typically placed using an echo-guided technique based on anatomical landmarks, followed by X-ray confirmation. Anesthesiology guidelines recommend evaluating the intracavitary electrocardiogram during the procedure to verify the correct CVC placement. This study involved 11 patients without rhythm disturbances, in whom a central venous catheter was placed in the right internal jugular vein at our institute in 2024. The patient’s electrocardiogram was analyzed using the MAGELLANO® (Italy) device to identify changes in the P wave or QRS complex, which confirmed the CVC’s correct placement at the right cavoatrial junction. Thoracic ultrasound was used to identify the right internal jugular vein and exclude iatrogenic pneumothorax. A subsequent chest X-ray was performed to further confirm the correct placement. In addition, a non-systematic review of the most recent literature on this topic was conducted using the Database PubMed—United States National Library of Medicine. Chest X-ray consistently verified the correct placements identified by ECG-IC, with no post-procedure complications. ECG-IC is a straightforward, viable, and cost-effective technique with high sensitivity when administered by properly trained professionals. This approach, combining ultrasound-guided CVC placement in the right internal jugular vein and intracavitary ECG monitoring, can omit X-ray control in more than 90% of cases. Full article
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10 pages, 196 KiB  
Article
Safety of and Adverse Reactions to the COVID-19 Vaccine Among Pregnant and Breastfeeding Women
by Nguyen Thi Minh Thanh, Le Thi Hang, Mai Trong Hung, Tran Hoa Phuong, Nguyen Thi Phuong Lan, Mac Dang Tuan, Nguyen Xuan Bach and Nguyen Duy Anh
Med. Sci. 2025, 13(2), 38; https://doi.org/10.3390/medsci13020038 - 1 Apr 2025
Viewed by 308
Abstract
Objectives: This study aimed to evaluate the incidence of adverse reactions to the COVID-19 vaccine among pregnant and breastfeeding women and identify associated demographic and clinical factors. Methods: A cross-sectional study was conducted at a hospital in Hanoi, Vietnam, from November 2021 to [...] Read more.
Objectives: This study aimed to evaluate the incidence of adverse reactions to the COVID-19 vaccine among pregnant and breastfeeding women and identify associated demographic and clinical factors. Methods: A cross-sectional study was conducted at a hospital in Hanoi, Vietnam, from November 2021 to March 2022. A total of 1204 participants, including 991 pregnant women beyond 13 weeks of gestation and 213 breastfeeding women, were recruited through convenience sampling. Data were collected using a self-administered questionnaire designed to capture demographic information and adverse reactions occurring within seven to 28 days post-vaccination. Statistical analyses, including chi-square tests, Fisher’s exact tests, and logistic regression, were performed using Stata 16.0, with the significance set at p < 0.05. Results: The most common adverse reactions were localized pain at the injection site (26.2%), dizziness and fatigue (19.2%), and fever below 39 °C (29.1%). Severe adverse reactions, such as a tight throat, coma, and premature birth, were rare. A multivariate analysis identified the significant factors associated with the adverse reactions, including age (aOR = 2.04 for participants aged 36–40 years), occupation (lower odds for farmers and business professionals), urban residency (aOR = 0.64), and a history of allergies (aOR = 1.59). Education level, number of children, and gestational age were not significantly associated with adverse events. Conclusions: The findings support the safety of the COVID-19 vaccine in pregnant and breastfeeding women, with most of the adverse reactions being mild and self-limiting. Full article
(This article belongs to the Section Immunology and Infectious Diseases)
11 pages, 580 KiB  
Review
Congenital Hyperinsulinism India Association: An Approach to Address the Challenges and Opportunities of a Rare Disease
by Jaikumar B. Contractor, Venkatesan Radha, Krati Shah, Praveen Singh, Sunil Tadepalli, Somashekhar Nimbalkar, Viswanathan Mohan and Pratik Shah
Med. Sci. 2025, 13(2), 37; https://doi.org/10.3390/medsci13020037 - 1 Apr 2025
Viewed by 330
Abstract
India’s population complexity presents varied challenges in genetic research, and while facilities have gained traction in tier-1 and -2 cities, reliance on international collaborations often delays such investigations. COVID-19 further exacerbated the issues with such sample sharing. Congenital Hyperinsulinism (CHI) is a rare [...] Read more.
India’s population complexity presents varied challenges in genetic research, and while facilities have gained traction in tier-1 and -2 cities, reliance on international collaborations often delays such investigations. COVID-19 further exacerbated the issues with such sample sharing. Congenital Hyperinsulinism (CHI) is a rare genetic disorder of pancreatic β-cells causing hypoglycaemia in children due to abnormal insulin secretion. Given India’s high birth rate and consanguineous populations, annual CHI cases are estimated to be around up to 10,000, with up to 50% having unexplained genetic causes. Diffuse or atypical lesions in such patients often necessitate near-total-pancreatectomy, risking pancreatic exocrine insufficiency and diabetes, requiring lifelong therapy. Also, novel genetic variations complicate accurate diagnosis, risk assessment, and counselling, emphasising the need for rapid genetic assessment to prevent neurological injuries and inform treatment decisions. Despite significant efforts at many institutes, there are no dedicated organisations for CHI in India. With the implementation of the National Policy for Rare Diseases 2021, we plan to form a non-profit organisation, “Congenital Hyperinsulinism India Association (CHIA)”, comprising paediatric endocrinologists, paediatricians, geneticists, and independent researchers. The aims of this association are to generate a national database registry of patients, formulate a parent support group and CHIA consortium, design patient information leaflets, as well as foster genomic collaborations and promote clinical trials. Such steps will help sensitise the health authorities and policy makers, urging them to improve the allocation of health budgets for rare diseases, as well as empower patients and their families, contributing towards a better quality of life. Full article
(This article belongs to the Section Endocrinology and Metabolic Diseases)
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11 pages, 214 KiB  
Article
Use of Electrical Household Appliances and Risk of All Types of Tumours: A Case-Control Study
by Shabana Noori, Abdul Aleem, Imrana Niaz Sultan, Afrasiab Khan Tareen, Hayat Ullah and Muhammad Waseem Khan
Med. Sci. 2025, 13(2), 36; https://doi.org/10.3390/medsci13020036 - 1 Apr 2025
Viewed by 281
Abstract
Introduction: The use of electrical appliances using extremely low frequency (ELF) electromagnetic fields (EMF) has increased in the past few years. These ELF MF are reported to be linked to several adverse health effects. However, only a couple of studies have been conducted [...] Read more.
Introduction: The use of electrical appliances using extremely low frequency (ELF) electromagnetic fields (EMF) has increased in the past few years. These ELF MF are reported to be linked to several adverse health effects. However, only a couple of studies have been conducted on the association between risk of tumours and use of electronic devices using low frequency (LF) EMF. Methods: We studied the use of common household electrical appliances and suspected risk of tumours in a multi-hospital-based case-control study. In total, 316 patients were included in the final analysis. Results: The study results showed a below unity risk for most of the devices. A slight increased risk of tumour was observed for computer screen use OR: 1.13 (95% CI: 0.43–3.02) and use of microwave oven OR: 1.21 (95% CI: 0.36–4.04). We also had chance to investigate ELF MFs exposure association with tumour. Where we observed elevated odd ratios in individuals living near electricity transformer stations, with a statistically significant risk OR: 2.16 (95% CI: 1.30–3.59). However, the risk was below unity (OR: 0.98) in individuals residing close to powerlines. Conclusion: The current study serves as a pilot study of primary data and will be helpful in future epidemiological research studies on the topic in the region. Full article
(This article belongs to the Section Cancer and Cancer-Related Research)
11 pages, 1783 KiB  
Article
Tumour-Derived, Extracellular Microvesicles in the Treatment of Acute Renal Failure: An Experimental Study
by Galina V. Seledtsova, Victor I. Seledtsov, Ayana B. Dorzhieva, Irina P. Ivanova, Tatiana S. Khabalova, Adas Darinskas and Alexei A. von Delwig
Med. Sci. 2025, 13(2), 35; https://doi.org/10.3390/medsci13020035 - 1 Apr 2025
Viewed by 798
Abstract
Background/Objectives: This investigation compared the therapeutic efficacy of extracellular microvesicles (MVs) derived from murine L929 sarcoma cells and murine mesenchymal stem cells (MSCs). Methods: A mouse model of acute kidney injury (AKI) was used. Results: Both MVs from L929 cells [...] Read more.
Background/Objectives: This investigation compared the therapeutic efficacy of extracellular microvesicles (MVs) derived from murine L929 sarcoma cells and murine mesenchymal stem cells (MSCs). Methods: A mouse model of acute kidney injury (AKI) was used. Results: Both MVs from L929 cells (L929-MVs) and MSCs (MSC-MVs), unlike those obtained from murine peripheral blood mononuclear cells (PBMCs), enhanced survival rates in AKI mice and significantly improved kidney function. This was indicated by decreased levels of urine albumin and serum creatinine. Furthermore, treatment with L929-MVs and MSC-MVs elevated the proportions of CD4+CD25+FOXP3+ regulatory T cells while reducing the presence of pro-inflammatory CD4+CD44+ T cells in the spleens of AKI mice. Conclusions: the results highlight the potential of tumour-derived MVs to facilitate organ repair and exert cytoprotective immunomodulatory effects. Full article
(This article belongs to the Section Nephrology and Urology)
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13 pages, 614 KiB  
Systematic Review
Polymyalgia Rheumatica (PMR) and Polymyalgia Rheumatica-like (PMR-like) Manifestations in Cancer Patients Following Treatment with Nivolumab and Pembrolizumab: Methodological Blurred Points Identified Through a Systematic Review of Published Case Reports
by Ciro Manzo, Marco Isetta, Alberto Castagna and Melek Kechida
Med. Sci. 2025, 13(2), 34; https://doi.org/10.3390/medsci13020034 - 1 Apr 2025
Viewed by 355
Abstract
Background: Among rheumatologic diseases following therapy with immune checkpoint inhibitors (ICIs), the cases of cancer patients diagnosed as having polymyalgia rheumatica (PMR), particularly with nivolumab and pembrolizumab, has been steadily rising in published reports. Objectives: We performed a systematic review of [...] Read more.
Background: Among rheumatologic diseases following therapy with immune checkpoint inhibitors (ICIs), the cases of cancer patients diagnosed as having polymyalgia rheumatica (PMR), particularly with nivolumab and pembrolizumab, has been steadily rising in published reports. Objectives: We performed a systematic review of published case reports with the aim of answering these questions: (1) Is PMR following therapy with nivolumab and pembrolizumab an adverse drug reaction (ADR)? (2) Is there a difference between cases of PMR following therapy with nivolumab and those following therapy with pembrolizumab? Methods: Based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a comprehensive literature search in three main bibliographic databases: MEDLINE (Ovid interface), EMBASE, and COCHRANE Library was carried out on 27 December 2024. This systematic review has no registration number. Results: Data were extracted from 12 patients. Namely, 5 cases followed treatment with nivolumab and 7 with pembrolizumab. Validated scales for ADR assessment—such as Naranjo’s scale—were not used in 10 out of the 12 patients. Additionally, validated diagnostic or classification criteria for PMR were used in the majority of case reports related to nivolumab. On the contrary, clinical judgment alone was the rule in almost all case reports on pembrolizumab. Finally, the time interval between PMR manifestations and nivolumab/pembrolizumab therapy ranged from one to 14 cycles (fully compatible with pharmacokinetics). Conclusions: Our literature review highlighted significant methodological blurred lines in the categorization of PMR following therapy with nivolumab or pembrolizumab. Full article
(This article belongs to the Section Cancer and Cancer-Related Research)
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10 pages, 979 KiB  
Article
Study of Expression of MST3 in Myeloid Leukaemia
by Boro Arthi, Krishnaswamy Sujatha, Sridhar Gopal, Balasubramanian Balamuralikrishnan, Meyyazhagan Arun, Pappuswamy Manikantan, Palanisamy Sampathkumar and Arumugam Vijaya Anand
Med. Sci. 2025, 13(2), 33; https://doi.org/10.3390/medsci13020033 - 1 Apr 2025
Viewed by 281
Abstract
Myeloid leukaemia (ML) is a cancer that occurs by the accumulation of abnormally multiplied myeloid cells in bone marrow, peripheral blood, and other related tissue. MST3 is a gene of the GCK family that has a role in apoptosis, along with other cellular [...] Read more.
Myeloid leukaemia (ML) is a cancer that occurs by the accumulation of abnormally multiplied myeloid cells in bone marrow, peripheral blood, and other related tissue. MST3 is a gene of the GCK family that has a role in apoptosis, along with other cellular functions like cellular differentiation, cell cycle, metabolism, and others. Objectives: The objectives of this study were to count RBCs and WBCs, study MST3 expression in ML and control samples, and perform an in silico correlation study on the KRAS and NRAS genes. Methods: The counting of RBCs and WBCs was carried out using a hemacytometer, the expression of MST3 was studied using RT-PCR, and a correlation study was carried out using GEPIA. Results: RBC and WBC levels in ML differed from the control levels, and the expression of MST3 was found to be upregulated in ML in comparison to controls, with a 2.90–8.65-fold change, with a significant p-value > 0.05. A positive correlation in expression was also found between MST3 and KRAS and NRAS genes, with a significant r value correlation. Conclusions: From this study, it could be deduced that MST3 might have a role in ML pathogenesis, but further research is needed to study its role in the progression of the disease. Full article
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