Journal Description
Medicina
Medicina
is an international, peer-reviewed, open access journal that covers all problems related to medicine. The journal is owned by the Lithuanian University of Health Sciences (LUHS) and is published monthly online by MDPI. Partner Societies are the Lithuanian Medical Association, Vilnius University, Rīga Stradiņš University, the University of Latvia, and the University of Tartu.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, SCIE (Web of Science), PubMed, MEDLINE, PMC, and other databases.
- Journal Rank: JCR - Q1 (Medicine, General and Internal) / CiteScore - Q1 (General Medicine)
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 17.8 days after submission; acceptance to publication is undertaken in 2.5 days (median values for papers published in this journal in the first half of 2024).
- Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
Impact Factor:
2.4 (2023);
5-Year Impact Factor:
2.7 (2023)
Latest Articles
Immune mRNA Expression and Fecal Microbiome Composition Change Induced by Djulis (Chenopodium formosanum Koidz.) Supplementation in Aged Mice: A Pilot Study
Medicina 2024, 60(9), 1545; https://doi.org/10.3390/medicina60091545 (registering DOI) - 20 Sep 2024
Abstract
Background and Objectives: The aging process has always been associated with a higher susceptibility to chronic inflammatory lung diseases. Several studies have demonstrated the gut microbiome’s influence on the lungs through cross-talk or the gut–lungs axis maintaining nutrient-rich microenvironments. Taiwan djulis (Chenopodium
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Background and Objectives: The aging process has always been associated with a higher susceptibility to chronic inflammatory lung diseases. Several studies have demonstrated the gut microbiome’s influence on the lungs through cross-talk or the gut–lungs axis maintaining nutrient-rich microenvironments. Taiwan djulis (Chenopodium formosanum Koidz.) provides antioxidant and anti-inflammatory characteristics that could modulate the gut microbiome. This could induce the gut–lung axis through microbial cross-talk, thus favoring the modulation of lung inflammation. Materials and Methods: Here, we investigate the immune mRNA expression in the spleen, fecal microbiome composition, and hyperplasia of the bronchial epithelium in aged 2-year-old BALB/c mice after 60 days of supplementation of djulis. Results: The pro-inflammatory cytokines IFN-γ, TNF-α, and IL-1β, T; cells CD4 and CD8; and TLRs TLR3, TLR4, TLR5, TLR7, TLR8, and TLR9 were reduced in their mRNA expression levels, while the anti-inflammatory cytokines IL-2, IL-4, and IL-10 were highly expressed in the C. formosanum-treated group. Interestingly, the fecal microbiome composition analysis indicated higher diversity in the C. formosanum-treated group and the presence of butyrate-producing bacteria that are beneficial in the gut microbiome. The histopathology showed reduced hyperplasia of the bronchial epithelium based on the degree of lesions. Conclusion: Our findings suggest that Taiwan djulis can modulate the gut microbiome, leading to microbial cross-talk; reducing the mRNA expression of pro-inflammatory cytokines, T cells, and TLRs; and increasing anti-inflammatory cytokines in the spleen, as cytokines migrate in the lungs, preventing lung inflammation damage in aged mice or the gut–lung axis. Thus, Taiwan djulis could be considered a beneficial dietary component for the older adult population. The major limitation includes a lack of protein validation of cytokines and TLRs and quantification of the T cell population in the spleen as a marker of the gut–lung axis.
Full article
(This article belongs to the Section Hematology and Immunology)
Open AccessArticle
Correlation between Overweight, Obesity, Gestational Diabetes Mellitus, Adipokines (Adipolin and Adiponectin), and Adverse Pregnancy Outcomes: A Pilot Study
by
Muntean Mihai, Săsăran Vladut, Luca Sonia-Teodora, Suciu Laura Mihaela, Nyulas Victoria, Muntean Irina Elena and Mărginean Claudiu
Medicina 2024, 60(9), 1544; https://doi.org/10.3390/medicina60091544 (registering DOI) - 20 Sep 2024
Abstract
Background: The prevalence of overweight (OW), obesity (OB), and gestational diabetes mellitus (GDM) has been increasing worldwide in recent years. Adipolin is a new adipokine with reduced circulating levels in obesity and type 2 diabetes mellitus (T2DM). Objectives: Our prospective case-control study aimed
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Background: The prevalence of overweight (OW), obesity (OB), and gestational diabetes mellitus (GDM) has been increasing worldwide in recent years. Adipolin is a new adipokine with reduced circulating levels in obesity and type 2 diabetes mellitus (T2DM). Objectives: Our prospective case-control study aimed to evaluate the maternal serum levels of adipolin and adiponectin, metabolic parameters, and anthropometric characteristics at the time of oral glucose tolerance test (OGTT) in pregnant women with a pre-pregnancy body mass index (BMI) ≥ 25 Kg/m2 and correlate them with newborn adipolin, adiponectin levels, and anthropometric characteristics of the newborns, and secondly to evaluate pregnancy outcomes. Material and Methods: After the OGTT results, we had 44 OW/OB pregnant women with GDM, 30 OW/OB pregnant women without GDM, and 92 lean healthy (LH) pregnant women. Data were analyzed by ANOVA and correlation tests, with a p-value < 0.05 considered significant. Results: We found no differences between adipolin values of the OW/OB pregnant women with GDM and the LH group (p > 0.99), OW/OB without GDM and the LH group (p = 0.56), and between OW/OB groups (p = 0.57). OW/OB pregnant women with GDM had a higher rate of gestational hypertension compared with the LH group (p < 0.0001). Newborns from OW/OB pregnant women with GDM were more frequently diagnosed with jaundice (p = 0.02), and they required more frequent admission to the neonatal intensive care unit (NICU) for treatment of respiratory distress (p = 0.01) compared with newborns from LH mothers. Conclusions: Our study revealed that the serum levels of adipolin in the second trimester among the group of OW/OB pregnant women with GDM, matched for age and BMI with OW/OB pregnant women without GDM, were not significantly different. This suggests that adipolin may not play an essential role in the occurrence of GDM in these patients. Despite good glycemic control during pregnancy, OW/OB pregnant women with GDM and their newborns tend to have more complications (gestational hypertension, jaundice, NICU admission) than LH pregnant women and their newborns, highlighting the importance of weight control before pregnancy.
Full article
(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy: Part II)
Open AccessCase Report
Symptomatic Vasospasm Refractory to Clazosentan after Subarachnoid Hemorrhage of Ruptured Vertebral Artery Dissecting Aneurysm: Clinical Implications from Two Contrasting Cases
by
Yasuyuki Yoshida, Tatsushi Mutoh, Junta Moroi and Tatsuya Ishikawa
Medicina 2024, 60(9), 1543; https://doi.org/10.3390/medicina60091543 (registering DOI) - 20 Sep 2024
Abstract
Clazosentan prevents vasospasms after aneurysmal subarachnoid hemorrhage (SAH). However, clinical data on patients with SAH with ruptured vertebral artery dissecting aneurysms (VADAs) are limited. We report the case of a 49-year-old male patient with mild-grade (WFNS grade 1) thick and diffuse (modified Fisher
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Clazosentan prevents vasospasms after aneurysmal subarachnoid hemorrhage (SAH). However, clinical data on patients with SAH with ruptured vertebral artery dissecting aneurysms (VADAs) are limited. We report the case of a 49-year-old male patient with mild-grade (WFNS grade 1) thick and diffuse (modified Fisher grade 3) SAH who underwent endovascular trapping of a ruptured VADA, resulting in a poor functional outcome with a modified Rankin Scale score of 4 due to severe symptomatic vasospasm refractory to clazosentan, requiring repeated rescue endovascular therapies and chronic communicating hydrocephalus. A retrospective analysis of the clot density in the basal and Sylvian cisterns, assessed by the Hounsfield unit (HU) values of serial CT scans, in this patient showed persistent higher values, distinct from another VADA case that showed a decline in HU values with a good clinical course. These results imply the limited effectiveness of clazosentan in cases of thick and diffuse SAH after a ruptured VADA, even in good-clinical-grade patients treated with less invasive modalities. The HU values may become a simple quantitative marker for predicting symptomatic vasospasms and chronic hydrocephalus.
Full article
(This article belongs to the Special Issue Intracranial Aneurysms, Subarachnoid Hemorrhage and Delayed Cerebral Ischemia)
Open AccessReview
Cardiovascular Effectiveness and Safety of Antidiabetic Drugs in Patients with Type 2 Diabetes and Peripheral Artery Disease: Systematic Review
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Antonio Cimellaro, Michela Cavallo, Marialaura Mungo, Edoardo Suraci, Francesco Spagnolo, Desirée Addesi, Medea Pintaudi and Carmelo Pintaudi
Medicina 2024, 60(9), 1542; https://doi.org/10.3390/medicina60091542 (registering DOI) - 20 Sep 2024
Abstract
Peripheral artery disease (PAD) is an atherosclerotic condition commonly complicating type 2 diabetes (T2D), leading to poor quality of life and increased risk of major adverse lower-limb (MALE) and cardiovascular (CV) events (MACE). Therapeutic management of PAD in T2D patients is much more
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Peripheral artery disease (PAD) is an atherosclerotic condition commonly complicating type 2 diabetes (T2D), leading to poor quality of life and increased risk of major adverse lower-limb (MALE) and cardiovascular (CV) events (MACE). Therapeutic management of PAD in T2D patients is much more arduous, often due to bilateral, multi-vessel, and distal vascular involvement, in addition to increased systemic polyvascular atherosclerotic burden. On the other hand, the pathophysiological link between PAD and T2D is very complex, involving mechanisms such as endothelial dysfunction and increased subclinical inflammation in addition to chronic hyperglycemia. Therefore, the clinical approach should not ignore vascular protection with the aim of reducing limb and overall CV events besides a mere glucose-lowering effect. However, the choice of the best medications in this setting is challenging due to low-grade evidence or lacking targeted studies in PAD patients. The present review highlighted the strong relationship between T2D and PAD, focusing on the best treatment strategy to reduce CV risk and prevent PAD occurrence and worsening in patients with T2D. The Medline databases were searched for studies including T2D and PAD up to June 2024 and reporting the CV effectiveness and safety of the most used glucose-lowering agents, with no restriction on PAD definition, study design, or country. The main outcomes considered were MACE—including nonfatal acute myocardial infarction, nonfatal stroke, and CV death—and MALE—defined as lower-limb complications, amputations, or need for revascularization. To the best of our current knowledge, GLP-1 receptor agonists and SGLT2 inhibitors represent the best choice to reduce CV risk in T2D and PAD settings, but a personalized approach should be considered. GLP-1 receptor agonists should be preferred in subjects with prevalent atherosclerotic burden and a history of previous MALE, while SGLT2 inhibitors should be used in those with heart failure if overall CV benefits outweigh the risk of lower-limb complications.
Full article
(This article belongs to the Special Issue Peripheral Artery Disease in Diabetes: Prevention, Diagnosis and New Therapeutic Paradigms)
Open AccessArticle
Vaping: The Key to Quitting Cigarettes or a Gateway to Addiction?
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Jessica Emily Hill, Marepalli Bhaskara Rao and Tianyuan Guan
Medicina 2024, 60(9), 1541; https://doi.org/10.3390/medicina60091541 (registering DOI) - 20 Sep 2024
Abstract
Background and Objectives: In 2022, the Centers for Disease Control and Prevention (CDC) discovered that 2.55 million middle and high school students were using electronic cigarettes (e-cigarettes) in the US alone. E-cigarettes allow people to inhale a nicotine solution (e-liquid) into their
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Background and Objectives: In 2022, the Centers for Disease Control and Prevention (CDC) discovered that 2.55 million middle and high school students were using electronic cigarettes (e-cigarettes) in the US alone. E-cigarettes allow people to inhale a nicotine solution (e-liquid) into their bodies. While e-cigarettes are often advertised as a way to help people quit traditional tobacco products, the World Health Organization (WHO) has stated that there is no proof of e-cigarettes being effective at reducing an individual’s tobacco use. The objective of this study is to determine why adolescents start smoking e-cigarettes. Materials and Methods: For the following study, the National Youth Tobacco Survey (NYTS) 2021 was used. This is a nationally representative cross-sectional survey that includes middle and high school students. The data were analyzed using SAS v.9.4. The odds ratio for smoking e-cigarettes was evaluated for both sex and race via a logistic regression. Results: It was discovered that the percentage of only e-cigarette smokers (12.10%) was 5.5 times the percentage of only traditional smokers (2.19%). Additionally, the median age at which adolescents started smoking e-cigarettes was fifteen years with an IQR (Inter Quartile Range) of two. We used a logistic regression to show that biological sex and race were significant predictors of e-cigarette usage. Conclusions: In general, we saw that adolescents were mostly starting to smoke e-cigarettes because their friends were doing it, out of curiosity, they were depressed or anxious, and/or to get a “high”, implying that adolescents mostly started smoking in order to fit in and/or to numb themselves. Interestingly, reasons like cost, using them to quit smoking, seeing them in the media, and ease of attainment were ranked the lowest when it came to smoking e-cigarettes. However, their lower costs naturally lead to increased accessibility compared to traditional cigarettes, making them easier to reach the hands of teenagers. Overall, in this paper, we aim to identify if adolescents are choosing e-cigarettes as their first foray into tobacco products and why.
Full article
(This article belongs to the Section Epidemiology & Public Health)
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Open AccessArticle
Sanger Sequencing Reveals Novel Variants in GLO-1, ACE, and CBR1 Genes in Patients of Early and Severe Diabetic Nephropathy
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Syed Zubair Hussain Shah, Amir Rashid, Asifa Majeed, Tariq Ghafoor and Nadeem Azam
Medicina 2024, 60(9), 1540; https://doi.org/10.3390/medicina60091540 (registering DOI) - 20 Sep 2024
Abstract
Background and Objectives: Diabetes is a global health issue, with approximately 50% of patients developing diabetic nephropathy (DN) and 25% experiencing early and severe forms of the disease. The genetic factors contributing to rapid disease progression in a subset of these patients are
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Background and Objectives: Diabetes is a global health issue, with approximately 50% of patients developing diabetic nephropathy (DN) and 25% experiencing early and severe forms of the disease. The genetic factors contributing to rapid disease progression in a subset of these patients are unclear. This study investigates genetic variations in the GLO-1, CBR-1, and ACE genes associated with early and severe DN. Materials and Methods: Sanger DNA sequencing of the exons of CBR1, GLO1, and ACE genes was conducted in 113 patients with early and severe DN (defined as occurring within 10 years of the diagnosis of diabetes and with eGFR < 45 mL/min/1.73 m2) and 100 controls. The impact of identified genetic variations was analyzed using computational protein models created in silico with SWISS-Model and SWISS-Dock for ligand binding interactions. Results: In GLO1, two heterozygous missense mutations, c.102G>T and c.147C>G, and one heterozygous nonsense mutation, c.148G>T, were identified in patients. The SNP rs1049346 (G>A) at location 6:38703061 (GRCh38) was clinically significant. The c.147C>G mutation (C19S) was associated with ligand binding disruption in the GLO1 protein, while the nonsense mutation resulted in a truncated, non-functional protein. In CBR1, two heterozygous variations, one missense c.358G>A, and one silent mutation c.311G>C were observed, with the former (D120N) affecting the active site. No significant changes were noted in ACE gene variants concerning protein structure or function. Conclusions: The study identifies four novel and five recurrent mutations/polymorphisms in GLO1, ACE, and CBR1 genes associated with severe DN in Pakistani patients. Notably, a nonsense mutation in GLO1 led to a truncated, non-functional protein, while missense mutations in GLO1 and CBR1 potentially disrupt enzyme function, possibly accelerating DN progression.
Full article
(This article belongs to the Section Urology & Nephrology)
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Open AccessArticle
Impact of Treatment with Direct Antivirals on Coagulation Parameters in Patients with Hepatitis C Virus-Related Liver Cirrhosis and Sustained Virological Response
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Laura Huiban, Carol Stanciu, Cristina Maria Muzica, Irina Girleanu, Raluca Avram, Ioana Damian, Robert Nastasa, Ermina Stratina, Sebastian Zenovia, Horia Minea, Remus Stafie, Adrian Rotaru, Ana-Maria Singeap, Stefan Chiriac, Ioana-Miruna Balmus and Anca Trifan
Medicina 2024, 60(9), 1539; https://doi.org/10.3390/medicina60091539 (registering DOI) - 20 Sep 2024
Abstract
Background and Objectives: Sustained virologic responses (SVRs) lead to a decrease in portal hypertension, the regression of fibrosis, and the improvement in the hepatic synthesis of procoagulant and anticoagulant factors. We aimed to assess the influence of SVR on coagulation parameters in
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Background and Objectives: Sustained virologic responses (SVRs) lead to a decrease in portal hypertension, the regression of fibrosis, and the improvement in the hepatic synthesis of procoagulant and anticoagulant factors. We aimed to assess the influence of SVR on coagulation parameters in cirrhotic patients with HCV treated with DAAs. Methods: We performed a prospective study in the Institute of Gastroenterology and Hepatology Iasi, Romania, between January 2022 and February 2024. We included patients diagnosed with compensated and decompensated HCV-related liver cirrhosis, treated with direct antivirals (PrOD ± RBV or SOF/LED ± RBV) for 12/24 weeks. Blood samples for biochemical, immunological, and coagulation tests were collected at the baseline, end of treatment (EOT), and once sustained virological response had been achieved over a period of 12/24 weeks (SVR12/24). Results: We analyzed a group of 52 patients with HCV-related liver cirrhosis, predominantly female (68.0%), and the degree of severity of cirrhosis placed the patients mainly in Child–Pugh classes B (40%) and C (36%). All patients achieved SVRs. The MELD score decreased at EOT (13.48 ± 4.273; p = 0.001) and SVR (9.88 ± 2.774; p = 0.000), compared to the baseline (14.92 ± 4.707). The FibroScan values decreased at SVR (17.596 ± 3.7276; p = 0.000) compared to the baseline (26.068 ± 7.0954). For all common coagulation parameters (platelets, INR, PT, fibrinogen, aPTT), there was a trend towards improvement during treatment, including changes which were statistically significant for the majority of patients. Factor II was low at the baseline (75.40 ± 7.506) but increased at EOT (87.40 ± 9.587) and, later, at SVR (99.12 ± 11.695; p = 0.000). The FVIII values increased at the baseline (175.52 ± 16.414) and decreased at EOT (151.48 ± 13.703) and SVR (143.40 ± 13.937). The FvW values decreased during treatment (146.84 ± 9.428, at baseline; 141.32 ± 9.690, p = 0.000, at EOT; and 126.68 ± 17.960, at SVR). In regard to the anticoagulant factors (PC, PS, ATIII), a significant improvement was brought on by SVR. Advanced stages of liver disease showed the most diminished FII activity, while at the baseline and in Child–Pugh C patients we recorded the highest values of FVIII and FvW. Conclusions: Our study proved that the “reset” of coagulopathy might be due to the improvement in liver function due to viral eradication secondary to AAD therapy.
Full article
(This article belongs to the Section Gastroenterology & Hepatology)
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Open AccessArticle
Development of a Short-Term Embolic Agent Based on Cilastatin for Articular Microvessels
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Hyun Jin Kim, Areum Jeon, Eun Kyung Kang, Wen An, So Jung Lim, Kyu Chul Shin, Dong Hun Shin, Inyoung Hwang and Ju Seop Kang
Medicina 2024, 60(9), 1538; https://doi.org/10.3390/medicina60091538 (registering DOI) - 20 Sep 2024
Abstract
Background and Objectives: This study aimed to develop an embolic agent with short-term embolic effects using cilastatin as the basic material. Materials and Methods: The particle size distribution of 25 mg cilastatin-based short-term embolic agents was evaluated microscopically under three different
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Background and Objectives: This study aimed to develop an embolic agent with short-term embolic effects using cilastatin as the basic material. Materials and Methods: The particle size distribution of 25 mg cilastatin-based short-term embolic agents was evaluated microscopically under three different mixing conditions. A total of thirty-six healthy male Sprague Dawley rats were divided into four groups. Each group of six rats was injected once into the tail artery with 0.4 mL each of (A) Cilastatin + D-Mannitol Mixture, (B) Iohexol, (C) Prepenem, and (D) embolization promoter (EGgel). Results: A visual inspection of the tail appearance of rats in each group was performed at 0, 3, 7, 15, and 21 days. At weeks 1 and 3, three rats per group were euthanized, and histopathological analyses were performed on the specimens obtained from each group. No significant differences were observed on day 7, but mild inflammation was observed in Group (D) on day 15. Histopathological inflammation scoring of tail central artery embolization was performed using a six-point scale (from 0 = absent to 5 = marked inflammation). Three groups were formed consisting of six male New Zealand white rabbits each: control, positive control, and test groups. The control group received an Iohexol injection (rabbits: 0.8 mL). The positive control and experimental groups were injected with prepenem and cilastatin/D-mannitol compound, respectively (0.8 mL), and vascular angiography was performed. The order of occlusion progression after embolization was as follows: test group, positive control group, and control group. Conclusions: We developed a cilastatin/D-mannitol compound that exhibits characteristics of short-term embolization by utilizing the pharmacokinetic properties of cilastatin and the crystalline material D-mannitol. We evaluated its particle size distribution microscopically, conducted histopathological evaluation including inflammation via animal experiments, and assessed the embolization effect.
Full article
(This article belongs to the Special Issue Molecular and Cellular Advances on Drug Discovery, Pharmacology and Toxicology, 2nd Edition)
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Open AccessArticle
Echocardiographic Indices in Patients with End-Stage Renal Disease and Their Association with Hemodialysis-to-Hemodiafiltration Transfer: A Prospective Observational Study
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Josipa Domjanović Matetić, Darija Baković Kramarić, Tea Domjanović Škopinić, Ivo Jeličić, Dijana Borić Škaro, Joško Božić and Andrija Matetic
Medicina 2024, 60(9), 1537; https://doi.org/10.3390/medicina60091537 (registering DOI) - 20 Sep 2024
Abstract
Background and Objectives: The assessment of cardiac function in patients with end-stage renal disease (ESRD) is vital due to their high cardiovascular risk. However, contemporary echocardiographic indices and their association with hemodialysis-to-hemodiafiltration transfer are underreported in this population. Materials and Methods:
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Background and Objectives: The assessment of cardiac function in patients with end-stage renal disease (ESRD) is vital due to their high cardiovascular risk. However, contemporary echocardiographic indices and their association with hemodialysis-to-hemodiafiltration transfer are underreported in this population. Materials and Methods: This prospective cohort study enrolled 36 ESRD patients undergoing hemodialysis-to-hemodiafiltration transfer, with baseline and 3-month post-transfer comprehensive echocardiographic assessments. The key parameters included the global work index, global constructed work, global wasted work (GWW), global work efficiency (GWE), and global longitudinal strain (GLS), with secondary measures from conventional echocardiography. The baseline measures were compared to general population reference values and changes pre- to post-transfer were analyzed using the Mann–Whitney U test. Results: Patients exhibited significant deviations from reference ranges in GWW (179.0 vs. 53.0–122.2 mmHg%), GWE (90.0 vs. 53.0–122.2%), and GLS (−16.0 vs. −24.0–(−16.0)%). Post-transfer left ventricular myocardial work and longitudinal strain remained unchanged (p > 0.05), except for increased GWW (179.0, IQR 148.0–217.0 to 233.5, IQR 159.0-315.0 mmHg%, p = 0.037) and improved mid-inferior peak systolic longitudinal strain ((−17.0, IQR −19.0–(−11.0) to −18.7, IQR −20.0–(−18.0)%, p = 0.016). The enrolled patients also showed higher left atrial diameters, left ventricular volumes, and mass, with impaired systolic function in both ventricles compared to reference values. Conclusions: This study highlights baseline impairments in contemporary echocardiographic measures (GWW, GWE, GLS) in ESRD patients versus reference values, but found no association between hemodialysis-to-hemodiafiltration transfer and most myocardial work and strain parameters.
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(This article belongs to the Special Issue Cardiovascular Disease and Hemodialysis)
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Open AccessReview
Oncologic Outcomes after Percutaneous Ablation for Colorectal Liver Metastases: An Updated Comprehensive Review
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David-Dimitris Chlorogiannis, Vlasios S. Sotirchos and Constantinos T. Sofocleous
Medicina 2024, 60(9), 1536; https://doi.org/10.3390/medicina60091536 - 20 Sep 2024
Abstract
Colorectal cancer is a major cause of cancer-related mortality, with liver metastases occurring in over a third of patients, and is correlated with poor prognosis. Despite surgical resection being the primary treatment option, only about 20% of patients qualify for surgery. Current guidelines
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Colorectal cancer is a major cause of cancer-related mortality, with liver metastases occurring in over a third of patients, and is correlated with poor prognosis. Despite surgical resection being the primary treatment option, only about 20% of patients qualify for surgery. Current guidelines recommend thermal ablation either alone or combined with surgery to treat limited hepatic metastases, provided that all visible disease can be effectively eradicated. Several ablation modalities, including radiofrequency ablation, microwave ablation, cryoablation, irreversible electroporation and histotripsy, are part of the percutaneous ablation armamentarium. Thermal ablation, including radiofrequency, microwave ablation and cryoablation, can offer local tumor control rates comparable to limited resection for selected tumors that can be ablated with margins. This review aims to encapsulate the current clinical evidence regarding the efficacy and oncologic outcomes after percutaneous ablation for the treatment of colorectal liver metastatic disease.
Full article
(This article belongs to the Special Issue Percutaneous Ablation: Hot Topics, Established and Advanced Indications)
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Open AccessArticle
Incidence of Rotational Malalignment after Intertrochanteric Fracture Intramedullary Nailing: A CT-Based Prospective Study
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Michail Vavourakis, Dimitrios Zachariou, Athanasios Galanis, Panagiotis Karampinas, Meletis Rozis, Evangelos Sakellariou, Christos Vlachos, Iordanis Varsamos, John Vlamis, Elias Vasiliadis and Spiros Pneumaticos
Medicina 2024, 60(9), 1535; https://doi.org/10.3390/medicina60091535 - 20 Sep 2024
Abstract
Background and Objectives: Rotational malformation after intramedullary nailing of intertrochanteric fractures is a relatively common, possibly severe, and difficult-to-detect complication, since intraoperative radiographic imaging allows for the assessment of the quality of reduction in the frontal and sagittal planes, but not in the
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Background and Objectives: Rotational malformation after intramedullary nailing of intertrochanteric fractures is a relatively common, possibly severe, and difficult-to-detect complication, since intraoperative radiographic imaging allows for the assessment of the quality of reduction in the frontal and sagittal planes, but not in the transverse plane. The purpose of this study is to evaluate the rotational malalignment after intramedullary nailing of intertrochanteric fractures and to investigate a possible connection with specific patients’ or fractures’ characteristics. Materials and Methods: 74 patients treated with intramedullary nailing due to an intertrochanteric fracture underwent a postoperative CT of the pelvis-hips and knees. The value of the anteversion was measured both in the operated-on (angle 1) and in the healthy hip (angle 2) based on the technique described by Jeanmart et al. and the difference in anteversion (D angle = angle 1 minus angle 2) was calculated. A positive D angle indicated the presence of excessive internal overcorrection of the distal fragment during fracture reduction, while a negative D angle indicated the presence of excessive external overcorrection. The absolute value of the D angle represents the postoperative difference in anteversion between the two hips. The patients were divided into three groups according to this value: group A, with D < 5° (physiological difference); group B, with 5° < D < 15° (acceptable rotational alignment); and group C, with D ≥ 15° (rotational deformity). Results: Group A constitutes 56.8%, group B 12.2%, and group C 31.1% of the study population. Overall, 79.7% of the patients presented a positive angle D, while, for group C, the percentage was even higher at 91.3%. According to the AO/OTA classification system, 37.8% of the cases were stable fractures, 47.3% were unstable fractures, and 14.9% were reverse oblique fractures. Based on our analysis, the type of fracture has a serious impact on the rotational alignment, since the statistical significance of the mean angle D for the three types of fracture is reliable (p = 0.029). Stable fractures present the lowest anteversion difference values, while reverse oblique fractures present the highest difference. Conclusions: Our study reveals that the percentage of rotational malalignment after the intramedullary nailing of intertrochanteric fractures remains high (31.1%), despite the proper use of radiographic imaging during the intraoperative fracture reduction. In most cases (91.3%), this malalignment appears to be a matter of internal overcorrection. A clear correlation between hip’s rotational deformity and patients′ functional outcome has yet to be proven, and constitutes our objective in the near future.
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(This article belongs to the Section Orthopedics)
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Open AccessArticle
Is Complete Excision Always Enough? A Quality of Sexual Life Assessment in Patients with Deep Endometriosis
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Raluca Gabriela Enciu, Octavian Enciu, Dragoș Eugen Georgescu, Adrian Tulin and Adrian Miron
Medicina 2024, 60(9), 1534; https://doi.org/10.3390/medicina60091534 - 20 Sep 2024
Abstract
Background and Objectives: The aim of this study was to find the factors associated with the severe impairment of QoSL and the factors associated with a better score in QoSL, as well as the evaluation of pain symptoms and QoSL after the
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Background and Objectives: The aim of this study was to find the factors associated with the severe impairment of QoSL and the factors associated with a better score in QoSL, as well as the evaluation of pain symptoms and QoSL after the complete and incomplete excision of rectovaginal nodules. Materials and methods: The present prospective study was conducted in a single tertiary center for endometriosis where 116 patients underwent laparoscopic surgery for deep endometriosis during a 3-year period. The goal of the intervention was to excise all endometriotic implants while conserving the rectum. Intraoperative findings were recorded after the intervention, and the patients were classified according to the ENZIAN classification and rASRM scores. QoSL was assessed using the EHP-30 Module C (QoSL Score). Results: When comparing the mean scores before and 2 years after the surgery, a highly significant improvement was found for QoSL and dysmenorrhea (p < 0.0001). The complete excision of rectovaginal nodules led to a significantly better QoSL and lower dyspareunia (p < 0.0001) than incomplete resection (p < 0.02). Conclusions: This prospective study proves that the complete laparoscopic excision of all endometriotic implants improved the QoSL and decreased the pain score of dyspareunia. Incomplete rectovaginal nodule excision was correlated with a poorer QoSL and a lower improvement of dysmenorrhea, dyspareunia, and chronic pelvic pain scores than complete excision.
Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Endometriosis: Priorities, Advances and Challenges)
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Open AccessCase Report
Novel Nipple Reinnervation Technique Using N. Suralis Graft
by
Jānis Lapiņš, Beatriz Soares Domingues Polita, Linda Kalniņa, Michal Grucki, Dzintars Ozols, Ansis Ģīlis, Arvīds Irmejs, Jānis Gardovskis and Jeļena Maksimenko
Medicina 2024, 60(9), 1533; https://doi.org/10.3390/medicina60091533 - 20 Sep 2024
Abstract
Following nipple-sparing mastectomy (NSM), patients commonly experience significant impairment or total loss of nipple sensitivity, which negatively impacts the patients’ quality of life, whereas patients who retain nipple sensation postoperatively experience enhanced physical, psychosocial, and sexual well-being. Reinnervation techniques such as nerve allografting
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Following nipple-sparing mastectomy (NSM), patients commonly experience significant impairment or total loss of nipple sensitivity, which negatively impacts the patients’ quality of life, whereas patients who retain nipple sensation postoperatively experience enhanced physical, psychosocial, and sexual well-being. Reinnervation techniques such as nerve allografting have been utilized to retain sensation. Despite the benefits of nerve allografts, such as lack of donor site morbidity, ease of use, and potentially shorter surgery time, there are shortcomings, such as the cost of commercially available acellular nerve allografts, and, most importantly, decreased sensory and motor function recovery for acellular nerve allografts with a diameter greater than 3 mm or a length greater than 50 mm. We present a technique where we performed immediate implant-based breast reconstruction combined with nipple–areola complex reinnervation using an autologous nerve graft. Following the procedure, the patient had improved sensory outcomes in the reconstructed breast and good quality-of-life indices. This report highlights the potential for sural nerve autografts in restoring breast sensation following mastectomy.
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(This article belongs to the Section Surgery)
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Open AccessArticle
Bariatric Surgery and Metabolic Status
by
Anna Różańska-Walędziak, Krzysztof Wyszomirski, Małgorzata Kaszuba, Anna Mierzejewska, Ewa Skopińska and Maciej Walędziak
Medicina 2024, 60(9), 1532; https://doi.org/10.3390/medicina60091532 - 20 Sep 2024
Abstract
Background and Objectives: Obesity is associated with numerous co-morbidities, including dyslipidemia, insulin resistance and diabetes mellitus. Bariatric surgery is the mainstay of treatment for obesity as the only method with confirmed long-term effects in weight reduction and the remission of comorbidities. Postoperative
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Background and Objectives: Obesity is associated with numerous co-morbidities, including dyslipidemia, insulin resistance and diabetes mellitus. Bariatric surgery is the mainstay of treatment for obesity as the only method with confirmed long-term effects in weight reduction and the remission of comorbidities. Postoperative recommendations leading to changes in dietary habits and changes in digestion and absorption in the gastrointestinal tract after bariatric surgery may additionally influence the levels of laboratory parameters that reflect the metabolic and nutritional status. The purpose of the study was to analyze the possible influence of changes in dietary habits after bariatric surgery on those laboratory results that reflect the metabolic and nutritional status. Materials and Methods: This was a retrospective study of 88 patients with a history of bariatric surgery. Data were gathered from before the surgery and at 6 months after the surgery and included diet structure and selected laboratory parameters reflecting the metabolic and nutritional status, i.e., levels of fasting glucose, glycated hemoglobin, cholesterol, low- and high-density lipoproteins, triglycerides, alanine and aspartate aminotransferases, proteins, ferrum, ferritin, vitamin B12, folic acid, vitamin D and calcium, the red blood cell count and the hematocrit. Results: Postoperative festive glucose levels were reduced by 14% and were more significant in patients after Roux-en-Y gastric bypass. There was an increase of 22% in concentrations of high-density lipoproteins. Triglyceride concentrations were reduced by 32%. Aminotransferase levels decreased by 43% for alanine aminotransferase and by 14% for aspartate aminotransferase. Among the changes in dietary habits, post-bariatric patients had a reduced consumption of red meat and an increased consumption of fish, milk and dairy products and wholegrain products. Vitamin D and ferrum levels were higher after the surgery, whereas vitamin B12 and folic acid levels remained unchanged. Conclusions: Improved dietary habits of patients after bariatric surgery may lead to changes in laboratory parameters that reflect the ameliorated metabolic and nutritional status of patients after bariatric surgery.
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(This article belongs to the Special Issue Gastric Sleeve Surgery: Techniques, Outcomes, and Future Directions)
Open AccessArticle
The HCV-Melanoma Paradox: First Multi-Cohort and Molecular Net-Work Analysis Reveals Lower Incidence but Worse Outcomes—Integrating Clinical, Real-World, and In Silico Data
by
Essam Al Ageeli, Jawaher A. Abdulhakim, Mohammad H. Hussein, Maryam M. Alnoman, Samia S. Alkhalil, Peter P. Issa, Nader A. Nemr, Ahmed Abdelmaksoud, Dhaifallah A. Alenizi, Manal S. Fawzy and Eman A. Toraih
Medicina 2024, 60(9), 1531; https://doi.org/10.3390/medicina60091531 (registering DOI) - 19 Sep 2024
Abstract
Background and Objectives: The relationship between hepatitis C virus (HCV) infection and melanoma remains poorly understood. This study aimed to investigate the association between HCV and melanoma, assess outcomes in patients with both conditions, and explore potential molecular mechanisms connecting the two
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Background and Objectives: The relationship between hepatitis C virus (HCV) infection and melanoma remains poorly understood. This study aimed to investigate the association between HCV and melanoma, assess outcomes in patients with both conditions, and explore potential molecular mechanisms connecting the two diseases. Materials and Methods: We conducted a retrospective cohort study of 142 melanoma patients, including 29 with HCV-related cirrhosis, and analyzed their clinical outcomes. For external validation, we used the TriNetX Global Collaborative Network database, comprising 219,960 propensity-matched patients per group. An in silico analysis was performed to identify the molecular pathways linking HCV and melanoma. Results: In the retrospective cohort, HCV-positive melanoma patients showed an increased risk of early relapse (41.4% vs. 18.6%, p = 0.014), recurrence (65.5% vs. 39.8%, p = 0.020), and mortality (65.5% vs. 23.0%, p < 0.001) compared to HCV-negative patients. TriNetX data analysis revealed that HCV-positive patients had a 53% lower risk of developing melanoma (RR = 0.470, 95% CI: 0.443–0.498, p < 0.001). However, HCV-positive melanoma patients had higher all-cause mortality (HR = 1.360, 95% CI: 1.189–1.556, p < 0.001). An in silico analysis identified key molecular players, including IL-6 and CTLA4, in the HCV-melanoma network. Conclusions: While HCV infection may be associated with a lower risk of melanoma development, HCV-positive patients who develop melanoma have poorer outcomes. The identified molecular pathways provide potential targets for future research and therapeutic interventions.
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(This article belongs to the Section Dermatology)
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Open AccessArticle
Evaluation of Maternal Ischemia-Modified Albumin Levels during Pregnancy and Their Effect on Fetal Birth Weight
by
Uğur Çobanoğlu, Özer Birge, Mustafa Çetin and Emine Seda Güvendağ Güven
Medicina 2024, 60(9), 1530; https://doi.org/10.3390/medicina60091530 - 19 Sep 2024
Abstract
Background and Objectives: The purpose of this study is to evaluate the impact of maternal ischemia-modified albumin (IMA) levels on pregnancy-related complications, fetal growth, and development over time. Materials and Methods: The prospective longitudinal and single-center study included 43 pregnant women
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Background and Objectives: The purpose of this study is to evaluate the impact of maternal ischemia-modified albumin (IMA) levels on pregnancy-related complications, fetal growth, and development over time. Materials and Methods: The prospective longitudinal and single-center study included 43 pregnant women ages 18 to 43. Routine pregnancy follow-up began at the first antenatal examination for all pregnant women before 14 weeks gestation, with IMA levels measured during the first, second, and third trimesters. The albumin cobalt binding test was used to determine the amount of ischemia-modified albumin (IMA). The patients’ medical, sociodemographic, and nutritional data were analyzed. The primary outcome was to investigate how changes in maternal ischemia affected albumin levels during pregnancy and the relationship between these changes and newborn weight. Results: This study included 43 cases with a mean age of 28.5 ± 5.2 years and a mean gestation period of 39.2 ± 1.3 weeks. The mean IMA levels for cases in the first trimester, second trimester, and third trimester were 0.53 ± 0.06, 0.64 ± 0.11, and 0.64 ± 0.06, respectively. The second and third trimesters showed significantly higher levels of ischemia-modified albumin (IMA) than the first trimester (p < 0.01). There was no statistically significant difference in IMA levels between the second and third trimesters (p = 1.000; p > 0.05). There was no statistically significant correlation between fetal birth and percentage changes in IMA measurements between the first and second trimesters, the first and third trimesters, or the second and third trimesters (p > 0.05). Conclusions: Our study determined that maternal ischemia-modified albumin levels during pregnancy did not correlate with fetal birth weight. Our findings revealed that age, sociodemographic changes, BMI, weight gain, and pregnancy complications had no effect on the change in IMA levels during pregnancy. We believe that this result will serve as a benchmark for future studies on IMA levels during pregnancy.
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(This article belongs to the Section Obstetrics and Gynecology)
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Open AccessReview
Mortality Risk and Antibiotic Therapy for Patients with Infections Caused by Elizabethkingia Species—A Meta-Analysis
by
Chienhsiu Huang, Sufang Kuo and Lichen Lin
Medicina 2024, 60(9), 1529; https://doi.org/10.3390/medicina60091529 - 19 Sep 2024
Abstract
Background and Objectives: Patients with infections caused by Elizabethkingia species require prompt identification and effective antibiotic treatment since these spp. are typically resistant to multiple antibiotics and variable susceptibility patterns. Understanding the mortality risk of this disease is difficult because of the
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Background and Objectives: Patients with infections caused by Elizabethkingia species require prompt identification and effective antibiotic treatment since these spp. are typically resistant to multiple antibiotics and variable susceptibility patterns. Understanding the mortality risk of this disease is difficult because of the relatively low incidence of infections caused by Elizabethkingia spp. and the lack of published systematic evaluations of the risk factors for mortality. The aim of the present study was to investigate risk factors for mortality in patients with infections caused by Elizabethkingia spp. by conducting a meta-analysis of existing studies on these infections. Materials and Methods: Studies comparing patients who died from infections caused by Elizabethkingia spp. with patients who survived were considered for inclusion. Studies that reported one or more risk factors for mortality were considered. Clinical predisposing variables, predisposing comorbidities, and clinical outcomes of antibiotic treatment were among the risk factors for mortality. Results: The meta-analysis included twenty studies with 990 patients, and 298 patients (30.1%) died. The following risk factors for mortality were identified: intensive care unit admission, the need for mechanical ventilation, immunosuppressive or steroid therapy use, pneumonia, comorbid liver disease, and the use of inappropriate antimicrobial therapy. Conclusions: The use of appropriate antimicrobial therapy is critical for the effective management of infections caused by Elizabethkingia spp. Antimicrobial susceptibility testing would be a more reliable means of guiding treatment. The identification of the best antimicrobial drugs is needed to ensure optimal treatment recommendations for treating Elizabethkingia-related infections.
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(This article belongs to the Section Infectious Disease)
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Predominance of blaNDM- and blaIMP-Harboring Escherichia coli Belonging to Clonal Complexes 131 and 23 in a Major University Hospital
by
Muhammad Shafiq, Iftikhar Ahmed, Muhammad Saeed, Abdul Malik, Sabiha Fatima, Suhail Akhtar, Mohsin Khurshid and Muhammad Zeeshan Hyder
Medicina 2024, 60(9), 1528; https://doi.org/10.3390/medicina60091528 - 19 Sep 2024
Abstract
Background and Objectives: Carbapenem resistance is a growing global challenge for healthcare, and, therefore, monitoring its prevalence and patterns is crucial for implementing targeted interventions to mitigate its impact on patient outcomes and public health. This study aimed to determine the prevalence
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Background and Objectives: Carbapenem resistance is a growing global challenge for healthcare, and, therefore, monitoring its prevalence and patterns is crucial for implementing targeted interventions to mitigate its impact on patient outcomes and public health. This study aimed to determine the prevalence of carbapenem resistance among Escherichia coli (E. coli) strains in the largest tertiary care hospital of the capital territory of Pakistan and to characterize the isolates for the presence of antimicrobial resistance genes. Additionally, the most prevalent sequence types were analyzed. Materials and Methods: A total of 15,467 clinical samples were collected from November 2020 to May 2022, underwent antimicrobial susceptibility testing, and were analyzed for antimicrobial resistance genes through conventional PCR and sequence typing using MLST. Results: In carbapenem-resistant E. coli (CR-EC), 74.19% of isolates harbored the blaNDM gene, with blaNDM-1 (66.96%), blaNDM-5 (12.17%), and blaNDM-7 (20.87%) variants detected. Additionally, blaIMP was found in 25.81% and blaOXA-48 in 35.48% of isolates. The presence of blaCTX-M15 and blaTEM was identified in 83.87% and 73.55% of CR-EC isolates, respectively, while armA and rmtB were detected in 40% and 65.16% of isolates, respectively. Colistin and tigecycline were the most effective drugs against CR-EC isolates, with both showing an MIC50 of 0.5 µg/mL. The MIC90 for colistin was 1 µg/mL, while for tigecycline, it was 2 µg/mL. MLST analysis revealed that the CR-EC isolates belonged to ST131 (24.52%), ST2279 (23.87%), ST3499 (16.13%), ST8051 (15.48%), ST8900 (9.68%), ST3329 (7.10%), ST88 (1.94%), and ST6293 (1.29%). The ST131 complex (70.97%) was the most prevalent, harboring 95.65% of the blaNDM gene, while the ST23 complex (18.06%) harbored 62.50% of the blaIMP gene. Conclusions: Implementing large-scale surveillance studies to monitor the spread of specific pathogens, along with active infection control policies, is crucial for the effective containment and prevention of future epidemics.
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(This article belongs to the Special Issue Antimicrobial Stewardship and Antimicrobial Resistance)
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Open AccessCase Report
The Impact of a Topical Oxygen-Releasing Gel (blue®m) on Deep Periodontal Pockets: A Case Report
by
Haya Alayadi, Arwa Talakey, Hajer Aldulaijan and Marwa Y. Shaheen
Medicina 2024, 60(9), 1527; https://doi.org/10.3390/medicina60091527 - 19 Sep 2024
Abstract
Periodontitis represents a prevalent oral pathological condition. Various supplementary local therapies are utilized in clinical practice. Recently introduced, topical oxygen therapy exhibits the potential to effectively hinder the growth of plaque (bacterial biofilm). Delivered in the form of an oral gel, this formulation
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Periodontitis represents a prevalent oral pathological condition. Various supplementary local therapies are utilized in clinical practice. Recently introduced, topical oxygen therapy exhibits the potential to effectively hinder the growth of plaque (bacterial biofilm). Delivered in the form of an oral gel, this formulation contains cellulose, glycerol, and sodium peroxoborate, releasing topical oxygen in a regulated manner. Additionally, it discharges topical oxygen and lactoferrin in a controlled manner, with the former showcasing antibacterial properties and the latter stimulating bone cell activity. The primary objective of this particular case study is to present a scenario of periodontitis featuring deep periodontal pockets, which was effectively managed through clinical treatment with the use of adjunctive topical oxygen-releasing gel (blue®m).
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(This article belongs to the Section Dentistry and Oral Health)
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Open AccessHypothesis
Assessment of the Vertical Dimension of Occlusion Using Palm Width and Finger Length
by
Cecilia Bacali, Mariana Constantiniuc, Antarinia Craciun and Daniela Popa
Medicina 2024, 60(9), 1526; https://doi.org/10.3390/medicina60091526 - 19 Sep 2024
Abstract
Background and Objectives: The vertical dimension of occlusion’s (VDO) assessment is a highly important issue in the everyday dentist’s practice. Patients with unstable occlusion, lost occlusal stops, extensive tooth loss in the lateral area, or complete edentulism need a proper assessment of
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Background and Objectives: The vertical dimension of occlusion’s (VDO) assessment is a highly important issue in the everyday dentist’s practice. Patients with unstable occlusion, lost occlusal stops, extensive tooth loss in the lateral area, or complete edentulism need a proper assessment of the VDO before the prosthetic restoration is carried out. Subjective and objective methods were used over time for the restoration of VDO. The study aimed to investigate the possible correlation between finger length, palm width and the vertical dimension of occlusion. Materials and Methods: Assessment of the VDO for 236 subjects, Romanian and French dental students, was performed using the Willis Bite Gauge. The left hand of the subjects was scanned using a flat-bed scanner, and then measurements of palm width and finger length were carried out for each subject. Comparison between VDO values and finger length/palm width was conducted using one-way ANOVA and Student t-Test. Results: Higher VDO average values were found in French subjects compared with Romanian students. The same results were found according to gender; in both female and male subjects, lower values of VDO were found in the Romanian group. Higher values were obtained for women within each group when comparing to men. Statistically significant correlations of the analyzed parameters and VDO values were found. Higher statistical correlations of the studied variables were found for men compared to women in both groups. The highest statistical correlation was obtained between the VDO and the palm width measured at the fingerbase, followed by the middle finger length. Conclusions: The results showed the highest statistical correlation between the vertical dimension of occlusion and the palm width measured at the fingers’ base. Statistical correlations were also found between the VDO and the middle finger length. Simple formulas using finger length/palm width can be used for a rapid VDO determination.
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(This article belongs to the Section Dentistry and Oral Health)
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