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Med. Sci., Volume 13, Issue 3 (September 2025) – 29 articles

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15 pages, 245 KiB  
Article
Exploring Single-Nucleotide Polymorphisms in Primary and Secondary Male Infertility
by Fatina W. Dahadhah, Mohanad Odeh, Heba A. Ali, Jihad A. M. Alzyoud and Manal Issam Abu Alarjah
Med. Sci. 2025, 13(3), 109; https://doi.org/10.3390/medsci13030109 (registering DOI) - 1 Aug 2025
Abstract
Background/Objectives: Infertility, defined as the failure to achieve pregnancy after one year of regular unprotected intercourse, represents a significant global health challenge, with male factors contributing to approximately 50% of cases. In this epidemiological context, both primary male infertility (the inability to conceive [...] Read more.
Background/Objectives: Infertility, defined as the failure to achieve pregnancy after one year of regular unprotected intercourse, represents a significant global health challenge, with male factors contributing to approximately 50% of cases. In this epidemiological context, both primary male infertility (the inability to conceive a first child) and secondary male infertility (which occurs when a man who has already fathered a child faces difficulty conceiving again) remain poorly understood at the genetic level. This study explored the role of single-nucleotide polymorphisms (SNPs) in mitochondrial genes (MT-ND3, MT-ND4L, and MT-ND4) in primary and secondary male infertility. Methods: This study analyzed the genotype distributions of SNPs in 68 infertile males (49 with primary infertility and 19 with secondary infertility) using Sanger sequencing. Results: Key findings revealed that studied SNPs were significantly associated with infertility type. Specifically, rs2857285 (T>C,G) in the ND4 gene showed a significant correlation (p = 0.023) with the TT genotype, which is prominent in primary infertility. Another SNP, rs28358279 (T>A,C) in the ND4L gene, also demonstrated a significant correlation (p = 0.046) with the TT genotype, being more common in primary infertility. In addition, rs869096886 (A>G) in the ND4 gene had a borderline correlation (p = 0.051), indicating a possible association between this SNP and reproductive duration. Conclusions: This study emphasizes the potential relevance of mitochondrial malfunction in male infertility, specifically the effects of studied SNPs on sperm survival and function over time. These findings suggest that certain mitochondrial SNPs might be potential biomarkers for infertility risk. Larger studies are needed to confirm these associations and examine the functional effects of these SNPs. Combining genetic analysis with environmental and lifestyle factors could enhance our understanding of male infertility and improve diagnostic and therapeutic strategies. Full article
19 pages, 1079 KiB  
Article
Are Calculated Immune Markers with or Without Comorbidities Good Predictors of Colorectal Cancer Survival? The Results of a Longitudinal Study
by Zoltan Herold, Magdolna Herold, Gyongyver Szentmartoni, Reka Szalasy, Julia Lohinszky, Aniko Somogyi, Attila Marcell Szasz and Magdolna Dank
Med. Sci. 2025, 13(3), 108; https://doi.org/10.3390/medsci13030108 (registering DOI) - 1 Aug 2025
Abstract
Background/Objectives: Although numerous prognostic biomarkers have been proposed for colorectal cancer (CRC), their longitudinal evaluation remains limited. The aim of this study was to investigate longitudinal changes in biomarkers calculated from routinely used laboratory markers and their relationships to common chronic diseases (comorbidities). [...] Read more.
Background/Objectives: Although numerous prognostic biomarkers have been proposed for colorectal cancer (CRC), their longitudinal evaluation remains limited. The aim of this study was to investigate longitudinal changes in biomarkers calculated from routinely used laboratory markers and their relationships to common chronic diseases (comorbidities). Methods: A retrospective longitudinal observational study was completed with the inclusion of 817 CRC patients and a total of 4542 measurement points. Pan-immune inflammation value (PIV), prognostic nutritional index (PNI), and systemic immune-inflammation index (SII) were calculated based on complete blood count and albumin measurement data. Results: Longitudinal data analyses confirmed the different values and slopes of the parameters tested at the different endpoints. Survivors had the lowest and most constant PIVs and SII values, and the highest and most slowly decreasing PNI values. Those patients with non-cancerous death had similar values to the previous cohort, but an increase/decrease occurred towards the death event. Patients with CRC-related death had significantly higher PIVs and SII values and significantly lower PNI values (p < 0.0001), and a significant increase/decrease was observed at the early observational periods. The presence of lymph node and/or distant metastases, adjuvant chemotherapy, and hypertension significantly affected PIVs and SII and/or PNI values. The changes in PIVs and SII and PNI values toward pathological values are poor prognostic signs (p < 0.0001). Conclusions: Each of the three calculated markers demonstrates suitability for longitudinal patient follow-up, and their pathological alterations over time serve as valuable prognostic indicators. They may also be useful to detect certain clinicopathological parameters early. Full article
(This article belongs to the Section Cancer and Cancer-Related Research)
23 pages, 4589 KiB  
Review
The Novel Achievements in Oncological Metabolic Radio-Therapy: Isotope Technologies, Targeted Theranostics, Translational Oncology Research
by Elena V. Uspenskaya, Ainaz Safdari, Denis V. Antonov, Iuliia A. Valko, Ilaha V. Kazimova, Aleksey A. Timofeev and Roman A. Zubarev
Med. Sci. 2025, 13(3), 107; https://doi.org/10.3390/medsci13030107 (registering DOI) - 1 Aug 2025
Abstract
Background/Objectives. This manuscript presents an overview of advances in oncological radiotherapy as an effective treatment method for cancerous tumors, focusing on mechanisms of action within metabolite–antimetabolite systems. The urgency of this topic is underscored by the fact that cancer remains one of the [...] Read more.
Background/Objectives. This manuscript presents an overview of advances in oncological radiotherapy as an effective treatment method for cancerous tumors, focusing on mechanisms of action within metabolite–antimetabolite systems. The urgency of this topic is underscored by the fact that cancer remains one of the leading causes of death worldwide: as of 2022, approximately 20 million new cases were diagnosed globally, accounting for about 0.25% of the total population. Given prognostic models predicting a steady increase in cancer incidence to 35 million cases by 2050, there is an urgent need for the latest developments in physics, chemistry, molecular biology, pharmacy, and strict adherence to oncological vigilance. The purpose of this work is to demonstrate the relationship between the nature and mechanisms of past diagnostic and therapeutic oncology approaches, their current improvements, and future prospects. Particular emphasis is placed on isotope technologies in the production of therapeutic nuclides, focusing on the mechanisms of formation of simple and complex theranostic compounds and their classification according to target specificity. Methods. The methodology involved searching, selecting, and analyzing information from PubMed, Scopus, and Web of Science databases, as well as from available official online sources over the past 20 years. The search was structured around the structure–mechanism–effect relationship of active pharmaceutical ingredients (APIs). The manuscript, including graphic materials, was prepared using a narrative synthesis method. Results. The results present a sequential analysis of materials related to isotope technology, particularly nucleus stability and instability. An explanation of theranostic principles enabled a detailed description of the action mechanisms of radiopharmaceuticals on various receptors within the metabolite–antimetabolite system using specific drug models. Attention is also given to radioactive nanotheranostics, exemplified by the mechanisms of action of radioactive nanoparticles such as Tc-99m, AuNPs, wwAgNPs, FeNPs, and others. Conclusions. Radiotheranostics, which combines the diagnostic properties of unstable nuclei with therapeutic effects, serves as an effective adjunctive and/or independent method for treating cancer patients. Despite the emergence of resistance to both chemotherapy and radiotherapy, existing nuclide resources provide protection against subsequent tumor metastasis. However, given the unfavorable cancer incidence prognosis over the next 25 years, the development of “preventive” drugs is recommended. Progress in this area will be facilitated by modern medical knowledge and a deeper understanding of ligand–receptor interactions to trigger apoptosis in rapidly proliferating cells. Full article
(This article belongs to the Special Issue Feature Papers in Section Cancer and Cancer-Related Diseases)
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29 pages, 1505 KiB  
Review
Biological Macromolecule-Based Dressings for Combat Wounds: From Collagen to Growth Factors—A Review
by Wojciech Kamysz and Patrycja Kleczkowska
Med. Sci. 2025, 13(3), 106; https://doi.org/10.3390/medsci13030106 (registering DOI) - 1 Aug 2025
Abstract
Wound care in military and combat environments poses distinct challenges that set it apart from conventional medical practice in civilian settings. The nature of injuries sustained on the battlefield—often complex, contaminated, and involving extensive tissue damage—combined with limited access to immediate medical intervention, [...] Read more.
Wound care in military and combat environments poses distinct challenges that set it apart from conventional medical practice in civilian settings. The nature of injuries sustained on the battlefield—often complex, contaminated, and involving extensive tissue damage—combined with limited access to immediate medical intervention, significantly increases the risk of infection, delayed healing, and adverse outcomes. Traditional wound dressings frequently prove inadequate under such extreme conditions, as they have not been designed to address the specific physiological and logistical constraints present during armed conflicts. This review provides a comprehensive overview of recent progress in the development of advanced wound dressings tailored for use in military scenarios. Special attention has been given to multifunctional dressings that go beyond basic wound coverage by incorporating biologically active macromolecules such as collagen, chitosan, thrombin, alginate, therapeutic peptides, and growth factors. These compounds contribute to properties including moisture balance control, exudate absorption, microbial entrapment, and protection against secondary infection. This review highlights the critical role of advanced wound dressings in improving medical outcomes for injured military personnel. The potential of these technologies to reduce complications, enhance healing rates, and ultimately save lives underscores their growing importance in modern battlefield medicine. Full article
(This article belongs to the Collection Advances in Skin Wound Healing)
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24 pages, 1154 KiB  
Article
Psychic and Cognitive Impacts of Cardiovascular Disease: Evidence from an Observational Study and Comparison by a Systematic Literature Review
by Irene Cappadona, Anna Anselmo, Davide Cardile, Giuseppe Micali, Fabio Mauro Giambò, Francesco Speciale, Daniela Costanzo, Piercataldo D'Aleo, Antonio Duca, Alessia Bramanti, Marina Garofano, Placido Bramanti, Francesco Corallo and Maria Pagano
Med. Sci. 2025, 13(3), 105; https://doi.org/10.3390/medsci13030105 (registering DOI) - 1 Aug 2025
Abstract
Background/Objectives: Cardiovascular diseases (CVDs) are frequently associated with psychiatric and cognitive comorbidities. These conditions have been shown to significantly impact quality of life and clinical outcomes. This study aims to evaluate the prevalence of anxiety, depression, and cognitive deficits in patients with [...] Read more.
Background/Objectives: Cardiovascular diseases (CVDs) are frequently associated with psychiatric and cognitive comorbidities. These conditions have been shown to significantly impact quality of life and clinical outcomes. This study aims to evaluate the prevalence of anxiety, depression, and cognitive deficits in patients with CVD and to compare the results with existing evidence in the literature. Methods: A total of 74 patients were assessed using the following standardized screening tools: Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory (BAI). A systematic review was then conducted to compare the findings with those reported in the literature. Results: Most previous studies using the MoCA reported an over 70% absence of cognitive impairment, whereas this study shows a balanced distribution between the absence of (32.4%) and mild (35%) or moderate (32%) impairment. Studies with the MMSE indicated high rates of absence of cognitive deficits (74–79%), but here, the rate of absence was lower (58%), with an increase in mild impairment (42%). Regarding depression, compared with studies showing only absence or moderate/severe forms, this study reveals a more balanced profile, with 57% without depression and with varying severity levels (22% mild, 19% moderate, and 3% severe). Finally, for anxiety, unlike previous asymmetric distributions, greater variability was observed, with 58% without anxiety and significant percentages of mild (26%), moderate (12%), and severe (4%) anxiety. Conclusions: The results highlight a significant and varied prevalence of anxiety, depression, and cognitive deficits, emphasizing the importance of a multidimensional assessment to improve clinical management and therapeutic outcomes. Full article
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16 pages, 3082 KiB  
Review
Pleomorphic Adenoma: Extracapsular Dissection vs. Superficial Parotidectomy—An Updated Systematic Review and Meta-Analysis
by Giovanni Salzano, Veronica Scocca, Stefania Troise, Vincenzo Abbate, Paola Bonavolontà, Luigi Angelo Vaira, Umberto Committeri, Jerome R. Lechien, Sara Tramontano, Vitanna Canterino and Giovanni Dell’Aversana Orabona
Med. Sci. 2025, 13(3), 104; https://doi.org/10.3390/medsci13030104 - 31 Jul 2025
Viewed by 26
Abstract
Background/Objectives: The aim of our study was to evaluate clinical outcomes in patients with small pleomorphic adenoma (PA) after extracapsular dissection (ED) versus superficial parotidectomy (SP). Methods: Following the PRISMA guidelines, a systematic review covering the years from 1950 to 2025 [...] Read more.
Background/Objectives: The aim of our study was to evaluate clinical outcomes in patients with small pleomorphic adenoma (PA) after extracapsular dissection (ED) versus superficial parotidectomy (SP). Methods: Following the PRISMA guidelines, a systematic review covering the years from 1950 to 2025 was conducted using the Pubmed/MEDLINE, Cochrane Library, Scopus, Ovid MEDLINE and Embase databases. A single-arm meta-analysis was performed to evaluate intraoperative capsular rupture, recurrence, transient and permanent facial nerve palsy, Frey’s syndrome, salivary fistula, seroma and hematoma of patients who underwent ED vs. those who underwent SP, and funnel plots were constructed to evaluate the robustness of the findings. Results: Of the 1793 identified papers, 21 articles met the inclusion criteria. The meta-analysis (2507 patients) reported the following: (1) the risk of recurrence is similar in patients treated with ED and SP; (2) the transient facial nerve palsy rate is lower after ED (p < 0.05), while the permanent facial nerve palsy rate is similar with ED and SP; (3) post-operative complications, especially Frey’s syndrome (p < 0.05), are more common after SP. Conclusions: Given the similar recurrence rate and the lower morbidity compared to SP, ED could be considered the treatment of choice for pleomorphic adenomas of the parotid gland that are up to 3 cm in size, mobile and located in the superficial lobe of the parotid gland. Full article
(This article belongs to the Section Cancer and Cancer-Related Research)
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10 pages, 216 KiB  
Article
An Investigation of the BRCA2 Met1915Thr Polymorphism in Azerbaijani Breast Cancer Patients
by Zumrud Safarzade, Bayram Bayramov, Nigar Mehdiyeva, Hagigat Valiyeva, Gunay Ahmadova, Rena Kerimova, Qamar Qurbanova, Orkhan Isayev and Adil Allahverdiyev
Med. Sci. 2025, 13(3), 103; https://doi.org/10.3390/medsci13030103 - 31 Jul 2025
Viewed by 46
Abstract
Background/Objectives: Genetic polymorphisms in the BRCA2 gene have been implicated in breast cancer susceptibility. While numerous studies have investigated this polymorphism, its precise role in breast cancer development remains unclear. Furthermore, to the best of our knowledge, no related studies have been conducted [...] Read more.
Background/Objectives: Genetic polymorphisms in the BRCA2 gene have been implicated in breast cancer susceptibility. While numerous studies have investigated this polymorphism, its precise role in breast cancer development remains unclear. Furthermore, to the best of our knowledge, no related studies have been conducted in Azerbaijan. The aim of this study was to determine the distribution of the BRCA2 Met1915Thr polymorphism (rs4987117) in the Azerbaijani population and to evaluate its potential association with breast cancer risk. Methods: A total of 144 breast cancer patients and 152 healthy controls were recruited from the Oncology Clinic of Azerbaijan Medical University between 2021 and 2024. The Met1915Thr polymorphism was genotyped using PCR-RFLP and visualized on a 2% agarose gel. Results: A statistically significant association with increased breast cancer susceptibility was observed for the heterozygous Met/Thr genotype (OR = 1.83, 95%CI = 1.08–3.11, p = 0.02), the Thr allele (OR = 1.57, 95%CI = 1.12–2.20, p = 0.008), and under the dominant inheritance model (OR = 1.83, 95%CI = 1.15–2.90, p = 0.01). Notably, this association was more evident among individuals aged over 58 years, in whom the Met/Thr genotype conferred a significantly elevated risk (OR = 2.35, 95%CI = 1.17–4.73, p = 0.02). Conclusions: The BRCA2 Met1915Thr polymorphism is associated with an increased risk of breast cancer in the Azerbaijani population. These findings suggest a potential role of this polymorphism in breast cancer susceptibility and highlight the need for further studies in larger cohorts to validate these associations. Full article
26 pages, 1474 KiB  
Review
Gene Therapy for Cardiac Arrhythmias: Mechanisms, Modalities and Therapeutic Applications
by Paschalis Karakasis, Panagiotis Theofilis, Panayotis K. Vlachakis, Nikias Milaras, Kallirhoe Kalinderi, Dimitrios Patoulias, Antonios P. Antoniadis and Nikolaos Fragakis
Med. Sci. 2025, 13(3), 102; https://doi.org/10.3390/medsci13030102 - 30 Jul 2025
Viewed by 283
Abstract
Cardiac arrhythmias remain a major source of morbidity and mortality, often stemming from molecular and structural abnormalities that are insufficiently addressed by current pharmacologic and interventional therapies. Gene therapy has emerged as a transformative approach, offering precise and durable interventions that directly target [...] Read more.
Cardiac arrhythmias remain a major source of morbidity and mortality, often stemming from molecular and structural abnormalities that are insufficiently addressed by current pharmacologic and interventional therapies. Gene therapy has emerged as a transformative approach, offering precise and durable interventions that directly target the arrhythmogenic substrate. Across the spectrum of inherited and acquired arrhythmias—including long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, atrial fibrillation, and post-infarction ventricular tachycardia—gene-based strategies such as allele-specific silencing, gene replacement, CRISPR-mediated editing, and suppression-and-replacement constructs are showing growing translational potential. Advances in delivery platforms, including cardiotropic viral vectors, lipid nanoparticle-encapsulated mRNA, and non-viral reprogramming tools, have further enhanced the specificity and safety of these approaches. Additionally, innovative applications such as biological pacemaker development and mutation-agnostic therapies underscore the versatility of genetic modulation. Nonetheless, significant challenges remain, including vector tropism, immune responses, payload limitations, and the translational gap between preclinical models and human electrophysiology. Integration of patient-derived cardiomyocytes, computational simulations, and large-animal studies is expected to accelerate clinical translation. This review provides a comprehensive synthesis of the mechanistic rationale, therapeutic strategies, delivery platforms, and translational frontiers of gene therapy for cardiac arrhythmias. Full article
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25 pages, 3545 KiB  
Article
Combined Effects of PFAS, Social, and Behavioral Factors on Liver Health
by Akua Marfo and Emmanuel Obeng-Gyasi
Med. Sci. 2025, 13(3), 99; https://doi.org/10.3390/medsci13030099 - 28 Jul 2025
Viewed by 215
Abstract
Background: Environmental exposures, such as per- and polyfluoroalkyl substances (PFAS), in conjunction with social and behavioral factors, can significantly impact liver health. This research investigates the combined effects of PFAS (perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS), alcohol consumption, smoking, income, and education [...] Read more.
Background: Environmental exposures, such as per- and polyfluoroalkyl substances (PFAS), in conjunction with social and behavioral factors, can significantly impact liver health. This research investigates the combined effects of PFAS (perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS), alcohol consumption, smoking, income, and education on liver function among the U.S. population, utilizing data from the 2017–2018 National Health and Nutrition Examination Survey (NHANES). Methods: PFAS concentrations in blood samples were analyzed using online solid-phase extraction combined with liquid chromatography–tandem mass spectrometry (LC-MS/MS), a highly sensitive and specific method for detecting levels of PFAS. Liver function was evaluated using biomarkers such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyltransferase (GGT), total bilirubin, and the fatty liver index (FLI). Descriptive statistics and multivariable linear regression analyses were employed to assess the associations between exposures and liver outcomes. Bayesian Kernel Machine Regression (BKMR) was utilized to explore the nonlinear and interactive effects of these exposures. To determine the relative influence of each factor on liver health, Posterior Inclusion Probabilities (PIPs) were calculated. Results: Linear regression analyses indicated that income and education were inversely associated with several liver injury biomarkers, while alcohol use and smoking demonstrated stronger and more consistent associations. Bayesian Kernel Machine Regression (BKMR) further highlighted alcohol and smoking as the most influential predictors, particularly for GGT and total bilirubin, with posterior inclusion probabilities (PIPs) close to 1.0. In contrast, PFAS showed weaker associations. Regression coefficients were small and largely non-significant, and PIPs were comparatively lower across most liver outcomes. Notably, education had a higher PIP for ALT and GGT than PFAS, suggesting a more protective role in liver health. People with higher education levels tend to live healthier lifestyles, have better access to healthcare, and are generally more aware of health risks. These factors can all help reduce the risk of liver problems. Overall mixture effects demonstrated nonlinear trends, including U-shaped relationships for ALT and GGT, and inverse associations for AST, FLI, and ALP. Conclusion: These findings underscore the importance of considering both environmental and social–behavioral determinants in liver health. While PFAS exposures remain a long-term concern, modifiable lifestyle and structural factors, particularly alcohol, smoking, income, and education, exert more immediate and pronounced effects on hepatic biomarkers in the general population. Full article
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11 pages, 220 KiB  
Review
Superficial Cervical Plexus Block for Postoperative Pain Management in Occipital Craniotomies: A Narrative Review
by Shahab Ahmadzadeh, Bennett M. Ford, Alex V. Hollander, Mary Kathleen Luetkemeier, Tomasina Q. Parker-Actlis and Sahar Shekoohi
Med. Sci. 2025, 13(3), 101; https://doi.org/10.3390/medsci13030101 - 28 Jul 2025
Viewed by 327
Abstract
Post-craniotomy pain is common yet often sub-optimally managed because systemic opioids can obscure postoperative neurologic examinations. The superficial cervical plexus block (SCPB) has, therefore, emerged as a targeted regional anesthesia option for occipital craniotomies. The SCPB targets the C2–C4 nerves to anesthetize the [...] Read more.
Post-craniotomy pain is common yet often sub-optimally managed because systemic opioids can obscure postoperative neurologic examinations. The superficial cervical plexus block (SCPB) has, therefore, emerged as a targeted regional anesthesia option for occipital craniotomies. The SCPB targets the C2–C4 nerves to anesthetize the occipital scalp region, covering the lesser occipital nerve territory that lies within typical posterior scalp incisions. Clinical evidence shows the block is effective in reducing acute postoperative pain after occipital craniotomy and diminishes opioid requirements. Studies have demonstrated successful and long-lasting analgesia, reductions in 24-h opioid consumption, and a lower incidence of severe pain. Moreover, the technique exhibits a low complication rate and is safer than a deep cervical plexus block because the injection remains superficial and avoids critical vascular and neural structures. When delivered under ultrasound guidance, major adverse events are exceedingly rare. By reducing opioid use, the SCPB can help reduce postoperative complications, allowing earlier neurological assessments and fewer opioid-related side effects. Incorporation of the SCPB into multimodal analgesia regimens can, therefore, accelerate postoperative recovery by providing regionally focused, opioid-sparing pain control without clinically significant sedation. Overall, current data support the SCPB as a dependable, well-tolerated, and clinically practical approach for managing post-craniotomy pain in patients undergoing occipital approaches. In this narrative review, we will discuss the mechanism of action and anatomy, the clinical application, safety and tolerability, patient outcomes, and emerging future directions of the superficial cervical plexus block and how it mitigates post-occipital craniotomy pain. Full article
33 pages, 1137 KiB  
Review
Immunosenescence and the Geriatric Giants: Molecular Insights into Aging and Healthspan
by Deasy Fetarayani, Mega Kahdina, Alief Waitupu, Laras Pratiwi, Mukti Citra Ningtyas, Galih Januar Adytia and Henry Sutanto
Med. Sci. 2025, 13(3), 100; https://doi.org/10.3390/medsci13030100 - 28 Jul 2025
Viewed by 422
Abstract
Aging is associated with complex immune dysfunction that contributes to the onset and progression of the “geriatric giants”, including frailty, sarcopenia, cognitive decline, falls, and incontinence. Central to these conditions is immunosenescence, marked by thymic involution, the loss of naïve T cells, T-cell [...] Read more.
Aging is associated with complex immune dysfunction that contributes to the onset and progression of the “geriatric giants”, including frailty, sarcopenia, cognitive decline, falls, and incontinence. Central to these conditions is immunosenescence, marked by thymic involution, the loss of naïve T cells, T-cell exhaustion, impaired B-cell class switch recombination, and increased autoreactivity. Concurrently, innate immunity deteriorates due to macrophage, neutrophil, and NK cell dysfunction, while chronic low-grade inflammation—or “inflammaging”—amplifies systemic decline. Key molecular pathways such as NF-κB, mTOR, and the NLRP3 inflammasome mediate immune aging, interacting with oxidative stress, mitochondrial dysfunction, and epigenetic modifications. These processes not only impair infection control and vaccine responsiveness but also promote tissue degeneration and multimorbidity. This review explores emerging interventions—ranging from senolytics and immunonutrition to microbiome-targeted therapies and exercise—that may restore immune homeostasis and extend healthspan. Despite advances, challenges remain in translating immunological insights into clinical strategies tailored to older adults. Standardization in microbiome trials and safety optimization in senolytic therapies are critical next steps. Integrating geroscience into clinical care could help to mitigate the burden of aging-related diseases by targeting fundamental drivers of immune dysfunction. Full article
(This article belongs to the Section Immunology and Infectious Diseases)
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15 pages, 1233 KiB  
Article
Predicting Stroke Etiology with Radiomics: A Retrospective Study
by Jacobo Porto-Álvarez, Antonio Jesús Mosqueira Martínez, Javier Martínez Fernández, José L. Taboada Arcos, Miguel Blanco Ulla, José M. Pumar, María Santamaría, Emilio Rodríguez Castro, Ramón Iglesias Rey, Pablo Hervella, Pedro Vieites Pérez, Manuel Taboada Muñiz, Roberto García-Figueiras and Miguel Souto Bayarri
Med. Sci. 2025, 13(3), 98; https://doi.org/10.3390/medsci13030098 - 26 Jul 2025
Viewed by 256
Abstract
Background/Objectives: The composition of the thrombus is not taken into account in the etiology determination of patients with acute ischemic stroke (AIS); however, it varies depending on the origin of the thrombus, as atherothrombotic thrombi contain more red blood cells and cardioembolic [...] Read more.
Background/Objectives: The composition of the thrombus is not taken into account in the etiology determination of patients with acute ischemic stroke (AIS); however, it varies depending on the origin of the thrombus, as atherothrombotic thrombi contain more red blood cells and cardioembolic thrombi contain more fibrin and platelets. Radiomics has the potential to provide quantitative imaging data that may vary depending on the composition of thrombi. The aim of this study is to predict cardioembolic and atherothrombotic thrombi using radiomic features (RFs) from non-contrast computed tomography (NCCT) brain scans. Methods: A total of 845 RFs were extracted from each of the 41 patients included in the study. A predictive model was used to classify patients as either cardioembolic or atherothrombotic, and the results were compared with the TOAST criteria-based classification. Results: Ten RFs (one shape feature and nine texture features) were found to demonstrate a statistically significant correlation with cardioembolic or atherothrombotic origins. The predictive radiomics model achieved an area under the curve (AUC) of 0.842 and an accuracy of 0.902 (p < 0.001) in classifying stroke etiology. Conclusions: Radiomics based on NCCT can help to determine the etiology of AIS. Full article
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23 pages, 3689 KiB  
Article
An Innovative Medical Image Analyzer Incorporating Fuzzy Approaches to Support Medical Decision-Making
by Cristina Ticala, Camelia M. Pintea, Mihaela Chira and Oliviu Matei
Med. Sci. 2025, 13(3), 97; https://doi.org/10.3390/medsci13030097 - 24 Jul 2025
Viewed by 310
Abstract
Background/Objectives: This paper presents a medical image analysis application designed to facilitate advanced edge detection and fuzzy processing techniques within an intuitive, modular graphical user interface. Methods: Key functionalities include classical edge detection, Ant Colony Optimization (ACO)-based edge extraction, and fuzzy edge generation, [...] Read more.
Background/Objectives: This paper presents a medical image analysis application designed to facilitate advanced edge detection and fuzzy processing techniques within an intuitive, modular graphical user interface. Methods: Key functionalities include classical edge detection, Ant Colony Optimization (ACO)-based edge extraction, and fuzzy edge generation, which offer improved boundary representation in images where uncertainty and soft transitions are prevalent. Results: One of the main novelties in contrast to the initial innovative Medical Image Analyzer, iMIA, is the fact that the system includes fuzzy C-means clustering to support tissue classification and unsupervised segmentation based on pixel intensity distribution. The application also features an interactive zooming and panning module with the option to overlay edge detection results. As another novelty, fuzzy performance metrics were added, including fuzzy false negatives, fuzzy false positives, fuzzy true positives, and the fuzzy index, offering a more comprehensive and uncertainty-aware evaluation of edge detection accuracy. Conclusions: The application executable file is provided at no cost for the purposes of evaluation and testing. Full article
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8 pages, 4055 KiB  
Case Report
Atypical Carcinoid of the Thymus: Early Diagnosis in a Case Report
by Antonio Mier-Briseño, Miguel Armando Benavides-Huerto, Ismael Padilla-Ponce and Francisco Alejandro Lagunas-Rangel
Med. Sci. 2025, 13(3), 96; https://doi.org/10.3390/medsci13030096 - 24 Jul 2025
Viewed by 248
Abstract
Background: Atypical carcinoid of the thymus is an exceptionally rare neuroendocrine tumor originating from neuroendocrine cells within the thymus. These tumors often present with no symptoms or with nonspecific clinical signs, making early diagnosis particularly challenging. Despite their rarity, atypical carcinoids are [...] Read more.
Background: Atypical carcinoid of the thymus is an exceptionally rare neuroendocrine tumor originating from neuroendocrine cells within the thymus. These tumors often present with no symptoms or with nonspecific clinical signs, making early diagnosis particularly challenging. Despite their rarity, atypical carcinoids are clinically significant due to their aggressive nature and relatively poor prognosis. Early detection and appropriate management are therefore crucial to improving patient outcomes. Results: In this report, we present the case of a 64-year-old patient in whom an atypical carcinoid of the thymus was incidentally discovered following a thoracic computed tomography scan performed for unrelated reasons. Imaging revealed a suspicious anterior mediastinal mass, which was subsequently surgically resected. Histopathological examination, supported by immunohistochemical analysis, confirmed the diagnosis of an atypical carcinoid of the thymus. The tumor demonstrated coexpression of epithelial and neuroendocrine markers, consistent with this rare entity. Conclusions: This case adds to the limited body of literature on atypical carcinoid of the thymus and highlights the importance of considering this diagnosis when evaluating anterior mediastinal masses. It also underscores the value of thorough radiological and pathological assessment in identifying early-stage disease, which may significantly influence prognosis and therapeutic strategies. Full article
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11 pages, 1205 KiB  
Article
Impact of Catheter Ablation on Functional Capacity and Cardiac Stress Markers in Patients with Premature Ventricular Contractions
by Vasileios Cheilas, Athanasios Dritsas, Antonios Martinos, Evangelia Gkirgkinoudi, Giorgos Filandrianos, Anastasios Chatziantoniou, Ourania Kariki, Panagiotis Mililis, Athanasios Saplaouras, Anna Kostopoulou, Konstantinos Letsas and Michalis Efremidis
Med. Sci. 2025, 13(3), 95; https://doi.org/10.3390/medsci13030095 - 23 Jul 2025
Viewed by 252
Abstract
Background: Premature ventricular contractions (PVCs) are common arrhythmias associated with symptoms such as fatigue and, in severe cases, PVC-induced cardiomyopathy. Catheter ablation (CA) is a primary treatment for symptomatic PVCs, particularly when pharmacological therapies fail or are undesired. While improvements in: quality-of-life following [...] Read more.
Background: Premature ventricular contractions (PVCs) are common arrhythmias associated with symptoms such as fatigue and, in severe cases, PVC-induced cardiomyopathy. Catheter ablation (CA) is a primary treatment for symptomatic PVCs, particularly when pharmacological therapies fail or are undesired. While improvements in: quality-of-life following ablation are documented, its impact on functional capacity remains underexplored. Objectives: This study evaluated the impact of CA on functional capacity and cardiac stress markers in patients with symptomatic PVCs using cardiopulmonary exercise testing (CPET) and NT-proBNP levels. Methods: A total of 30 patients underwent successful PVC ablation and completed baseline and follow-up CPET evaluations under the Bruce protocol. PVC burden, left ventricular ejection fraction (LVEF), NT-proBNP levels, and CPET parameters, including VO2 max, METS, ventilatory efficiency, and anaerobic threshold (AT), were analyzed pre- and post-ablation. Results: PVC burden significantly decreased post-ablation (23,509.3 ± 10,700.47 to 1759 ± 1659.15, p < 0.001). CPET revealed improved functional capacity, with VO2 max increasing from 24.97 ± 4.16 mL/kg/min to 26.02 ± 4.34 mL/kg/min (p = 0.0096) and METS from 7.16 ± 1.17 to 7.48 ± 1.24 (p = 0.0103). NT-proBNP significantly decreased (240.93 ± 156.54 pg/mL to 138.47 ± 152.91 pg/mL, p = 0.0065). LVEF and ventilatory efficiency metrics (VE/VO2 and VE/VCO2) remained stable. Conclusions: Catheter ablation improves functional capacity, reduces cardiac stress, and minimizes medication dependency in patients with symptomatic PVCs. These findings support the utility of ablation in enhancing aerobic capacity and overall exercise performance. Full article
(This article belongs to the Section Cardiovascular Disease)
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12 pages, 218 KiB  
Article
The Role of an Educational Program in Reducing Symptom Severity in Women with High Risk for Carpal Tunnel Syndrome
by Amira Elhoufey
Med. Sci. 2025, 13(3), 94; https://doi.org/10.3390/medsci13030094 - 22 Jul 2025
Viewed by 183
Abstract
Aim: This study aimed to assess the effect of educational programs on symptom severity for women at high risk of carpal tunnel syndrome (CTS). Methods: A quasi-experimental design was applied. A purposive sample of 250 women at high risk of CTS was [...] Read more.
Aim: This study aimed to assess the effect of educational programs on symptom severity for women at high risk of carpal tunnel syndrome (CTS). Methods: A quasi-experimental design was applied. A purposive sample of 250 women at high risk of CTS was selected from the Faculty of Nursing, Assiut University, Egypt. Data collection instruments included a structured interview questionnaire and the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Results: Most participants were middle-aged (41–50 years), married, and had higher education. At baseline, 61.2% of participants reported mild symptoms, 24.8% moderate, and 11.6% were asymptomatic. Following the educational program, symptom severity was significantly improved (p = 0.007). The proportion of asymptomatic participants increased from 11.6% to 20.4%, while those with moderate symptoms decreased from 24.8% to 6.4%. Functional status also improved significantly, with the percentage of participants reporting no difficulty increasing from 17.6% to 30% (p = 0.008). We found a significant reduction in symptom severity scores (p = 0.05) and functional impairment (p = 0.008). Conclusions: The educational program effectively reduced CTS symptoms and improved hand function, demonstrating its potential as a preventive and therapeutic intervention for women at high risk of CTS. However, this study’s quasi-experimental design without a control group and a short follow-up period limits conclusions regarding long-term effectiveness and causal inference. Full article
(This article belongs to the Section Nursing Research)
21 pages, 913 KiB  
Article
An Innovative Strategy for Sustainability Assurance in Orthopedic Surgery
by Flaviu Moldovan and Liviu Moldovan
Med. Sci. 2025, 13(3), 93; https://doi.org/10.3390/medsci13030093 - 22 Jul 2025
Viewed by 166
Abstract
Background/Objectives: Due to the aging population, orthopedics has become the surgical field with the fastest and greatest growth, and health systems must therefore ensure the sustainable development of this field. The objective of this study is to identify the key areas and the [...] Read more.
Background/Objectives: Due to the aging population, orthopedics has become the surgical field with the fastest and greatest growth, and health systems must therefore ensure the sustainable development of this field. The objective of this study is to identify the key areas and the most relevant activities for sustainability assurance in orthopedic surgery, as well as appropriate evaluation tools. Methods: Consisted in designing the key areas for sustainable surgery and evaluating them with the support of new indicators. These areas are based on the most current and relevant practices reported by hospitals around the world. This process was followed by practical validation in an orthopedic hospital. Results: Four key areas were revealed: rationalization and reduction of consumption, correct separation and recycling of waste, reuse of textiles and equipment, and anesthetics and alternative interventions. The indicators for the evaluation of these areas were developed with the support of results reported in international studies. Each indicator has five levels of fulfilment. Their importance is evaluated on a scale from 1 to 5. Conclusions: The practical implementation at an orthopedic emergency hospital highlighted the suitability of the indicators within the purpose of the research. Sustaining the values of these changes by surgeons and patients facilitates long-term results and the orientation towards assuring the sustainability of orthopedic surgery. Full article
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10 pages, 3728 KiB  
Technical Note
Cervical Lateral Mass and Pedicle Fracture Reduced with a Herbert Screw: A Technical Note
by Antonio Colamaria, Francesco Carbone, Augusto Leone, Giuseppe Palmieri, Savino Iodice, Bianca Maria Baldassarre, Giovanni Cirrottola, Valeria Ble, Uwe Spetzger and Giuseppe Di Perna
Med. Sci. 2025, 13(3), 92; https://doi.org/10.3390/medsci13030092 - 19 Jul 2025
Viewed by 296
Abstract
Background: Traumatic fractures of the cervical spine pose significant challenges in management, particularly in young patients, where preserving mobility is crucial. Patient Characteristics: A 30-year-old woman presented with a C3 lateral mass and pedicle fracture following a motor vehicle collision. Initial conservative management [...] Read more.
Background: Traumatic fractures of the cervical spine pose significant challenges in management, particularly in young patients, where preserving mobility is crucial. Patient Characteristics: A 30-year-old woman presented with a C3 lateral mass and pedicle fracture following a motor vehicle collision. Initial conservative management with a rigid cervical collar for three months failed to reduce the diastasis, and the debilitating neck pain worsened. Preoperative imaging confirmed fracture instability without spinal cord compression. Intervention and Outcome: Preoperative screw trajectory planning was conducted with the My Spine MC system (Medacta), and fine-tuning was achieved on a 3D-printed model of the vertebra. A posterior midline approach was employed to expose the C3 vertebra, and a Herbert screw was inserted under fluoroscopic guidance. Imaging at three months demonstrated significant fracture reduction and early bone fusion. The patient achieved substantial improvement in functional mobility without complications. Conclusion: Herbert screw fixation holds potential as a less-invasive alternative to conventional posterior stabilization for selected cervical fractures. This technical note provides the reader with the required information to support surgical planning and execution. Full article
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11 pages, 812 KiB  
Systematic Review
Efficacy and Safety of Nifedipine Compared to Intravenous Hydralazine for Severe Hypertensive Disorders in Pregnancy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials
by Vaisnavy Govindasamy, Mohammed Amer Kamel, Gabriele Volucke, Aashir Javed, Upayan Palchaudhuri, Sayed Irfan Kazi, Ahmad Albanna, Mays Akileh, Rohit Mukherjee, Rabia Nusrat, Tayyaba Qaiser, Eman Ibrahim Elzain Hassan, Muhammad Muneeb Azhar, Tallal Mushtaq Hashmi, Mushood Ahmed, Ali Hasan and Raheel Ahmed
Med. Sci. 2025, 13(3), 91; https://doi.org/10.3390/medsci13030091 - 13 Jul 2025
Viewed by 470
Abstract
Background: Severe maternal hypertension is linked to adverse perinatal outcomes. Both nifedipine and hydralazine are commonly used antihypertensive agents in this setting. Methods: A comprehensive literature search was conducted in PubMed, Cochrane Library, and EMBASE from inception to April 2024 to identify randomized [...] Read more.
Background: Severe maternal hypertension is linked to adverse perinatal outcomes. Both nifedipine and hydralazine are commonly used antihypertensive agents in this setting. Methods: A comprehensive literature search was conducted in PubMed, Cochrane Library, and EMBASE from inception to April 2024 to identify randomized controlled trials comparing oral or sublingual nifedipine with intravenous hydralazine for the management of severe hypertension, with or without preeclampsia/eclampsia. A random-effects meta-analysis was performed using RevMan. Results: Seven randomized controlled trials were included. The pooled analysis demonstrated no significant difference between the two agents regarding time to achieve optimal blood pressure control (MD = −1.08 min, 95% CI = −6.66 to 4.49), caesarean delivery (OR = 0.62, 95% CI = 0.38 to 1.03), neonatal birth weight (MD = 57.65 g, 95% CI = −209.09 to −324.40), NICU admissions (OR = 0.90, 95% CI = 0.41 to 1.98), and 5-min APGAR scores (MD = 0.1, 95% CI = −0.20 to 0.39). However, patients receiving nifedipine had significantly lower odds of experiencing medication-related adverse events (OR = 0.62, 95% CI = 0.40 to 0.97). Conclusions: Nifedipine and intravenous hydralazine showed comparable efficacy in achieving optimal blood pressure control and similar maternal and neonatal outcomes. However, nifedipine was associated with significantly fewer maternal adverse effects, indicating superior tolerability. Full article
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15 pages, 452 KiB  
Systematic Review
The Efficacy of Neoantigen-Loaded Dendritic Cell Vaccine Immunotherapy in Non-Metastatic Gastric Cancer
by Menelaos Papakonstantinou, Paraskevi Chatzikomnitsa, Areti Danai Gkaitatzi, Athanasia Myriskou, Alexandros Giakoustidis, Dimitrios Giakoustidis and Vasileios N. Papadopoulos
Med. Sci. 2025, 13(3), 90; https://doi.org/10.3390/medsci13030090 - 11 Jul 2025
Viewed by 930
Abstract
Introduction: Gastric cancer (GC) is the third leading cause of cancer-related deaths worldwide. Even though surgery and chemotherapy are the mainstay of treatment, immunotherapy, and more specifically anti-tumor vaccination, has gained popularity over the past years due to the lower related toxicity and [...] Read more.
Introduction: Gastric cancer (GC) is the third leading cause of cancer-related deaths worldwide. Even though surgery and chemotherapy are the mainstay of treatment, immunotherapy, and more specifically anti-tumor vaccination, has gained popularity over the past years due to the lower related toxicity and fewer long-term side effects. Dendritic cell (DC) vaccines have been shown to induce tumor specific cytotoxic T-cell (CTL) responses both in vitro and in vivo; however, due to the nature of the disease, resistance to immunotherapy is often developed. Various modifications, such as the implementation of viral vectors, tumor RNA, or even tumor-specific peptides (neoantigens), have been studied as a means to avoid resistance and enhance the effectiveness of the vaccines. In this review, we aim to assess the effects of neoantigen-loaded DC vaccines (naDCVs) on the immune response against gastric cancer cells. Materials and methods: A thorough literature search was conducted on PubMed and clinicaltrials.gov for studies assessing the efficacy of naDCVs against gastric cancer both in vivo and in vitro. The studies were assessed for eligibility by two independent reviewers based on predetermined inclusion and exclusion criteria. The search was completed following the PRISMA guidelines. Results: Eleven studies were included in our systematic review. In five of the studies, the effects of the naDCVs were tested in vitro; in two and in four they were examined both in vitro and in vivo. The in vitro studies showed that the naDCVs resulted in a more robust immune response against the cancer cells in the study groups compared to the control groups. The in vivo studies conducted on mice showed that tumor volume was reduced in the groups treated with the naDCV compared to the untreated groups. What is more, the cytotoxic effect of CTLs against tumor cells was also increased in the vaccine groups. One of the studies was conducted on humans as a phase I study. The results show increased CTL proliferation and cytokine production in the vaccinated group compared to the control, but no difference regarding the tumor size was observed. Conclusions: Neoantigen-loaded DC vaccines can stimulate a strong immune response against specific gastric cancer cell peptides and enhance tumor cell lysis, therefore hindering or even reversing disease progression, offering great potential for the treatment of patients with gastric cancer. Full article
(This article belongs to the Special Issue Feature Papers in Section Cancer and Cancer-Related Diseases)
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16 pages, 755 KiB  
Review
Hip Fracture as a Systemic Disease in Older Adults: A Narrative Review on Multisystem Implications and Management
by Silvia Andaloro, Stefano Cacciatore, Antonella Risoli, Rocco Maria Comodo, Vincenzo Brancaccio, Riccardo Calvani, Simone Giusti, Mathias Schlögl, Emanuela D’Angelo, Matteo Tosato, Francesco Landi and Emanuele Marzetti
Med. Sci. 2025, 13(3), 89; https://doi.org/10.3390/medsci13030089 - 11 Jul 2025
Viewed by 621
Abstract
Hip fractures are among the most serious health events in older adults, frequently leading to disability, loss of independence, and elevated mortality. In 2019, an estimated 9.6 million new cases occurred globally among adults aged ≥ 55 years, with an incidence rate of [...] Read more.
Hip fractures are among the most serious health events in older adults, frequently leading to disability, loss of independence, and elevated mortality. In 2019, an estimated 9.6 million new cases occurred globally among adults aged ≥ 55 years, with an incidence rate of 681 per 100,000. Despite improved surgical care, one-year mortality remains high (15–30%), and fewer than half of survivors regain their pre-fracture functional status. Traditionally regarded as mechanical injuries, hip fractures are now increasingly recognized as systemic events reflecting and accelerating biological vulnerability and frailty progression. We synthesize evidence across biological, clinical, and social domains to explore the systemic implications of hip fracture, from the acute catabolic response and immune dysfunction to long-term functional decline. The concept of intrinsic capacity, introduced by the World Health Organization, offers a resilience-based framework to assess the multidimensional impact of hip fracture on physical, cognitive, and psychological function. We highlight the importance of orthogeriatric co-management, early surgical intervention, and integrated rehabilitation strategies tailored to the individual’s functional reserves and personal goals. Innovations such as digital health tools, biological aging biomarkers, and personalized surgical approaches represent promising avenues to enhance recovery and autonomy. Ultimately, we advocate for a shift toward interdisciplinary, capacity-oriented models of care that align with the goals of healthy aging and enable recovery that transcends survival, focusing instead on restoring function and quality of life. Full article
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10 pages, 426 KiB  
Article
Pulmonary Function Among COVID-19 Patients in Home Isolation Program
by Narongkorn Saiphoklang, Pitchayapa Ruchiwit, Apichart Kanitsap, Pichaya Tantiyavarong, Pasitpon Vatcharavongvan, Srimuang Palungrit, Kanyada Leelasittikul, Apiwat Pugongchai and Orapan Poachanukoon
Med. Sci. 2025, 13(3), 88; https://doi.org/10.3390/medsci13030088 - 9 Jul 2025
Viewed by 301
Abstract
Background: Patients with mild coronavirus disease 2019 (COVID-19) are usually managed in an outpatient setting. Pulmonary functions in this setting have not been explored. This study aimed to determine abnormal lung functions in COVID-19 patients under a home isolation program. Methods: [...] Read more.
Background: Patients with mild coronavirus disease 2019 (COVID-19) are usually managed in an outpatient setting. Pulmonary functions in this setting have not been explored. This study aimed to determine abnormal lung functions in COVID-19 patients under a home isolation program. Methods: A prospective study was conducted in asymptomatic or mild COVID-19 patients with normal chest radiographs at two medical centers in Thailand. Spirometry data, including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), forced expiratory flow at 25–75% of FVC (FEF25–75), and bronchodilator responsiveness (BDR), were collected. Spirometry was performed after disease resolution at baseline and 3-month follow-up. Abnormal lung functions were classified into airway obstruction, restrictive defect, mixed defect, small airway disease, and BDR. Results: A total of 250 patients (58% female) were included. The mean age was 37.4 ± 15.2 years. Asymptomatic patients accounted for 7.6%. Common symptoms included fever (55.6%) and cough (60.0%). Abnormal lung functions were observed in 28.4% of patients, with a restrictive lung pattern (14.4%), airway obstruction (4.8%), mixed defect (0.4%), small airway disease (8.4%), and BDR (2.8%). Significant changes from baseline were noted in FVC (1.21%), FEV1/FVC (−1.51%predicted), PEF (0.06%), and FEF25–75 (−2.76%). Logistic regression analysis indicated that a higher body mass index was associated with a lower risk of abnormal lung function. Conclusions: Ventilatory defects were observed in one-third of patients with mild COVID-19 who did not require hospitalization, mainly presenting as restrictive patterns and small airway disease. Even mild cases may have residual pulmonary impairment, warranting further long-term studies. Full article
(This article belongs to the Section Pneumology and Respiratory Diseases)
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53 pages, 2662 KiB  
Review
Pathophysiological Mechanisms of Diabetes-Induced Macrovascular and Microvascular Complications: The Role of Oxidative Stress
by Bipradas Roy
Med. Sci. 2025, 13(3), 87; https://doi.org/10.3390/medsci13030087 - 2 Jul 2025
Cited by 1 | Viewed by 902
Abstract
Diabetic vascular diseases have emerged as a significant concern in medical research due to their considerable impact on human health. The challenge lies in the insufficient understanding of the intricate pathophysiological mechanisms associated with different forms of diabetic vascular diseases, which hampers our [...] Read more.
Diabetic vascular diseases have emerged as a significant concern in medical research due to their considerable impact on human health. The challenge lies in the insufficient understanding of the intricate pathophysiological mechanisms associated with different forms of diabetic vascular diseases, which hampers our ability to identify effective treatment targets. Addressing this knowledge gap is essential for developing successful interventions. Unraveling the molecular pathways through which diabetes leads to microvascular and macrovascular complications in vital organs such as the heart, brain, kidneys, retina, and extremities is crucial. Notably, oxidative stress resulting from hyperglycemia is the key factor in initiating these complications. This review aims to elucidate the specific molecular mechanisms by which oxidative stress drives microvascular and macrovascular diseases and to highlight promising therapeutic advancements that offer hope for effective treatment solutions. Full article
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15 pages, 2032 KiB  
Article
Emergency Laparoscopic Cholecystectomy Pathway Reduces Elective Waiting Times and Preoperative Admissions: A Prospective Propensity-Matched Cohort Study
by Mohammed Hamid, Omar E. S. Mostafa, Maria Kausar, Amina Amin, Oladapo Olajumoke, Abhinav Singhal, Gowtham Bharnala, Akinfemi Akingboye, Ricardo Camprodon and Chaminda Sellahewa
Med. Sci. 2025, 13(3), 86; https://doi.org/10.3390/medsci13030086 - 27 Jun 2025
Viewed by 508
Abstract
Background: Emergency laparoscopic cholecystectomy (ELC) has emerged as a viable alternative to delayed elective surgery for acute gallstone disease, although its widespread adoption is hindered by cultural barriers. This study compares outcomes between elective and emergency laparoscopic cholecystectomy and evaluates the impact of [...] Read more.
Background: Emergency laparoscopic cholecystectomy (ELC) has emerged as a viable alternative to delayed elective surgery for acute gallstone disease, although its widespread adoption is hindered by cultural barriers. This study compares outcomes between elective and emergency laparoscopic cholecystectomy and evaluates the impact of implementing an ELC pathway on elective waiting times, patient outcomes, and overall service delivery. Methods: A prospective cohort study was conducted between December 2021 and December 2023, including all patients undergoing emergency or elective laparoscopic cholecystectomy. One-to-one propensity score matching, correlation statistics, and multivariate logistic regression were used to analyse outcomes. Results: Of 585 patients, 314 (53.4%) underwent emergency and 271 (46.3%) elective cholecystectomies. After matching, 474 patients were analysed (237 per group). The ELC pathway achieved an 81.4% first-presentation procedure rate, with 69.2% managed as day cases and 84.4% discharged the following day. Emergency cases had longer operative times (+9 min), higher rates of subtotal cholecystectomy (8.9% vs. 3.0%, p < 0.001), and more frequent postoperative ERCP (16.9% vs. 4.6%, p < 0.001). Other outcomes were comparable. Introduction of the ELC pathway significantly reduced elective waiting times from a median of nine to three months (R = −0.219, R2 = 0.059, p < 0.001) and preoperative admissions (IQR 0–1, R = −0.223, R2 = 0.050, p = 0.002). Conclusions: An ELC pathway is a safe and effective alternative to elective gallstone surgery, offering substantial benefits to patients and healthcare systems, while serving as a strategic, cost-conscious approach to reducing surgical waiting times and preoperative admissions. Its success hinges upon surgical expertise in acute decision making, skill in performing subtotal cholecystectomy, and access to institutional resources such as advanced imaging and ERCP services. Full article
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12 pages, 218 KiB  
Article
Sleep Characteristics in Individuals with Ehlers-Danlos Syndrome
by Caitlin Crews-Stowe, Frank Tudini, Min-Kyung Jung, Jake Forman, Bernadette Riley, Stephanie Eton and David Levine
Med. Sci. 2025, 13(3), 85; https://doi.org/10.3390/medsci13030085 - 27 Jun 2025
Viewed by 1114
Abstract
Background/Objectives: The presence of Ehlers–Danlos Syndromes (EDSs) has significant effects on overall health and results in varying levels of pain and disability. The effects of sleep are not well documented in this population. The purpose of this study is to report the sleep [...] Read more.
Background/Objectives: The presence of Ehlers–Danlos Syndromes (EDSs) has significant effects on overall health and results in varying levels of pain and disability. The effects of sleep are not well documented in this population. The purpose of this study is to report the sleep characteristics of people with EDS. Methods: An electronic survey regarding sleep characteristics was created and distributed through the EDS website. Results: Sleep disturbance is common in people with EDS, with 65.3% of respondents sleeping fewer than 8 h and 26.2% averaging fewer than 6 h. Those who slept fewer than 6 h reported more days of poor mental and physical health days. Sleep aids were commonly used with 41.40% of patients regularly taking prescription medication to get to sleep. Sleep latency of greater than 30 min was also found in 67.5% of subjects. Conclusions: The results demonstrate an association between people with EDS and poorer sleep duration, increased sleep latency, and increased use of sleep aids including prescription sleep medication compared to the general population. While more research needs to be completed in this area, sleep may be an important aspect to address in the management of EDS. Full article
12 pages, 1312 KiB  
Systematic Review
Transcranial Direct Current Stimulation in Episodic Migraine: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
by Faraidoon Haghdoost, Abdul Salam, Fatemeh Zahra Seyed-Kolbadi, Deepika Padala, Candice Delcourt and Anthony Rodgers
Med. Sci. 2025, 13(3), 84; https://doi.org/10.3390/medsci13030084 - 26 Jun 2025
Viewed by 586
Abstract
Background: Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique for migraine prevention. This study evaluates the efficacy of tDCS compared to sham in preventing episodic migraine in adults. Methods: PubMed and Embase databases were searched until May 2025 to identify randomized [...] Read more.
Background: Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique for migraine prevention. This study evaluates the efficacy of tDCS compared to sham in preventing episodic migraine in adults. Methods: PubMed and Embase databases were searched until May 2025 to identify randomized controlled trials comparing tDCS with sham for the prevention of episodic migraine in adults. Risk of bias in the included trials was assessed using the Cochrane Risk of Bias Tool version 2. A random effect meta-analysis was conducted to evaluate the effects of cathodal and anodal tDCS on migraine frequency (days per month and attacks per month). Results: The meta-analysis included six trials with 172 participants (mean age 34 years, 82% females). Both cathodal (three studies, over the occipital area) and anodal (three studies, over the occipital or primary motor area) tDCS reduced the mean number of monthly migraine days and migraine attacks compared to sham. After pooling the outcomes and excluding two studies at high risk of bias, anodal tDCS over the occipital or primary motor area (standardized difference in means = −0.7, 95% CI: −1.7, 0.2, p = 0.124) and cathodal tDCS over the occipital area (standardized difference in means = −0.7, 95% CI: −1.1, −0.3, p = 0.000) reduced headache frequency compared to sham. However, the reduction with anodal tDCS was not statistically significant. Summary: tDCS may be effective in preventing episodic migraine. However, the evidence is limited by the small number of heterogeneous trials, with variation in electrode placement and stimulation intervals. Full article
(This article belongs to the Section Neurosciences)
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15 pages, 2226 KiB  
Article
National Trends in Admissions, Treatments, and Outcomes for Dilated Cardiomyopathy (2016–2021)
by Vivek Joseph Varughese, Abdifitah Mohamed, Vignesh Krishnan Nagesh and Adam Atoot
Med. Sci. 2025, 13(3), 83; https://doi.org/10.3390/medsci13030083 - 23 Jun 2025
Viewed by 408
Abstract
Background: Dilated Cardiomyopathy (DCM) is one of the leading causes of non-ischemic cardiomyopathy in the United States (US). The aim of our study is to analyze the general trends in DCM admissions between 2016 and 2021, and analyze social and healthcare disparities in [...] Read more.
Background: Dilated Cardiomyopathy (DCM) is one of the leading causes of non-ischemic cardiomyopathy in the United States (US). The aim of our study is to analyze the general trends in DCM admissions between 2016 and 2021, and analyze social and healthcare disparities in terms of treatments and outcomes. Methods: National Inpatient Sample (NIS) data for the years 2016 to 2021 were used for the analysis. General population trends were analyzed. Normality of data distribution was tested using the Kolmogorov–Smirnov test and homogeneity was assessed using Levine’s test. One-way ANOVA was used after confirmation of normality of distribution to analyze social and healthcare disparities. Subgroup analysis was conducted, with the paired t-test for continuous variables and Fischer’s exact t-test for categorical variables to analyze statistical differences. Multivariate regression analysis was conducted to analyze the association of factors that were significant in the one-way ANOVA and paired t/chi square tests. A two-tailed p-value < 0.05 was used to determine statistical significance. Results: A total of 5262 admissions for DCM were observed between 2016 and 2021. A general declining trend was observed in the total number of DCM admissions, with a 33.51% decrease in total admissions in 2021 compared to 2016. All-cause in-hospital mortality remained stable across the years (between 3.5% and 4.5%). A total of 15.3% of admissions had CRT/ICD devices in place. A total of 425 patients (8.07%) for DCM underwent HT, and 214 admissions for DCM (4.06%) underwent LVAD placements between 2016 and 2021 In terms of interventions for DCM, namely Cardiac Resynchronization Therapy (CRT), Left Ventricular Assist Devices (LVADs) and Heart Transplantations (HTs), significant variance was observed in the mean age of the admissions with admissions over the mean age of 55 had lower number of interventions. Significant variance in terms of sex was observed for DCM admissions receiving HT, with lower rates observed for females. In terms of quarterly income, patients belonging to the lowest fourth quartile had higher rates of LVAD and HT compared to general DCM admissions. In the multivariate regression analysis, age at admission had significant association with lower chances of receiving LVADs and HT among DCM admissions, and significant association with higher chances of all-cause mortality during the hospital stay. Conclusions: A general declining trend in the total number of DCM admissions was observed between 2016 and 2021. Significant gender disparities were seen with lower rates of females with DCM receiving LVADs and HT. DCM admissions with mean age of 55 and above were found to have significantly lower rates of receiving LVADs and HT, and higher chances of all-cause mortality during the admission. Full article
(This article belongs to the Section Cardiovascular Disease)
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16 pages, 1117 KiB  
Article
Interprofessional Approaches to the Treatment of Mild Traumatic Brain Injury: A Literature Review and Conceptual Framework Informed by 94 Professional Interviews
by John F. Shelley-Tremblay and Teri Lawton
Med. Sci. 2025, 13(3), 82; https://doi.org/10.3390/medsci13030082 - 23 Jun 2025
Viewed by 388
Abstract
Background/Objectives: Mild traumatic brain injury (mTBI) presents with persistent, heterogeneous symptoms requiring multifaceted care. Although interdisciplinary rehabilitation is increasingly recommended, implementation remains inconsistent. This study aimed to synthesize existing literature and clinician perspectives to construct a practice-informed conceptual framework for interprofessional mTBI rehabilitation. [...] Read more.
Background/Objectives: Mild traumatic brain injury (mTBI) presents with persistent, heterogeneous symptoms requiring multifaceted care. Although interdisciplinary rehabilitation is increasingly recommended, implementation remains inconsistent. This study aimed to synthesize existing literature and clinician perspectives to construct a practice-informed conceptual framework for interprofessional mTBI rehabilitation. Methods: Structured interviews were conducted with 94 clinicians—including neurologists, neuropsychologists, optometrists, occupational and physical therapists, speech-language pathologists, neurosurgeons, and case managers—across academic, private, and community settings in the United States. Interviews followed a semi-structured format adapted for the NIH I-Corps program and were analyzed thematically alongside existing rehabilitation literature. Results: Clinicians expressed strong consensus on the value of function-oriented, patient-centered care. Key themes included the prevalence of persistent cognitive and visual symptoms, emphasis on real-world goal setting, and barriers such as fragmented communication, reimbursement restrictions, and referral delays. Disciplinary differences were noted in perceptions of symptom persistence and professional roles. Rehabilitation technologies were inconsistently adopted due to financial, training, and interoperability barriers. Equity issues included geographic and insurance-based disparities. A four-domain conceptual framework emerged: discipline-specific expertise, coordinated training, technological integration, and care infrastructure, all shaped by systemic limitations. Conclusions: Despite widespread clinician endorsement of interprofessional mTBI care, structural barriers hinder consistent implementation. Targeted reforms—such as embedding interdisciplinary models in clinical education, expanding access to integrated technology, and improving reimbursement mechanisms—may enhance care delivery. The resulting framework provides a foundation for scalable, patient-centered rehabilitation models in diverse settings. Full article
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11 pages, 980 KiB  
Article
Trends in MitraClip Placements and Predictors of 90-Day Heart Failure Rehospitalization: A Nationwide Analysis
by Vivek Joseph Varughese, Vignesh Krishnan Nagesh, Seetharamaprasad Madala, Ruchi Bhuju, Carra Lyons, Simcha Weissman, Adam Atoot, Dominic Vacca and Budoor Alqinai
Med. Sci. 2025, 13(3), 81; https://doi.org/10.3390/medsci13030081 - 20 Jun 2025
Viewed by 461
Abstract
Background: Chronic mitral regurgitation (MR) is categorized into primary and secondary MR (SMR). While primary MR arises from structural abnormalities of the mitral valve apparatus, SMR is a consequence of cardiac remodeling, typically due to heart failure or atrial fibrillation. Management strategies differ [...] Read more.
Background: Chronic mitral regurgitation (MR) is categorized into primary and secondary MR (SMR). While primary MR arises from structural abnormalities of the mitral valve apparatus, SMR is a consequence of cardiac remodeling, typically due to heart failure or atrial fibrillation. Management strategies differ significantly, with primary MR requiring direct valvular intervention and SMR necessitating a comprehensive approach incorporating guideline-directed medical therapy (GDMT), revascularization, and resynchronization strategies. The MitraClip, a transcatheter edge-to-edge repair (TEER) device, has emerged as a recommended intervention for symptomatic severe SMR despite optimal GDMT. Objectives: This study aims to evaluate national trends in MitraClip placements in the U.S. from 2016 to 2021 and to assess 90-day readmission events following the procedure. Additionally, we analyze patient and socioeconomic factors associated with heart failure readmissions post-MitraClip placement to optimize patient selection criteria. Methods: The study utilized data from the National Inpatient Sample (NIS) for the years 2016–2021 and the National Readmissions Database (NRD) for 2021. Patients who underwent MitraClip placement were identified using ICD-10 code 02UG3JZ. We stratified the population based on demographics, hospital resource utilization, and comorbidities. Index admissions were classified based on the presence or absence of heart failure remissions within 90 days post-procedure. Statistical analyses, including ANOVA and logistic regression, were conducted to identify factors associated with readmissions. Results: MitraClip utilization demonstrated a rising trend from 2016 to 2021, with total annual procedures increasing from 869 to 2488. Mean patient age remained stable at 76–79 years, with a nearly equal sex distribution. In-hospital mortality remained low (1–3%) throughout the study period. A steady increase in hospital charges was observed, alongside a decline in the mean length of stay. Analysis of 4918 index admissions for MitraClip placement in 2021 identified 780 total readmissions within 90 days, with 206 (26.4%) attributed to heart failure. Factors significantly associated with increased risk of heart failure readmissions included atrial fibrillation (OR 3.77, CI 1.82–4.23), pulmonary hypertension (OR 3.96, CI 1.49–5.55), and chronic lung disease (OR 1.91, CI 1.32–2.77). Conclusions: The increasing adoption of MitraClip underscores its growing role in managing SMR. However, heart failure readmissions remain a significant concern. Identifying high-risk patient profiles can refine selection criteria and enhance post-procedural management strategies to improve clinical outcomes. Further research is needed to optimize patient selection and refine risk stratification for MitraClip interventions. Full article
(This article belongs to the Section Cardiovascular Disease)
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