Medicina

14 pages, 789 KiB

Open AccessReview

Unplanned Postoperative Angiography After Isolated Coronary Artery Bypass Grafting: State of the Art and Future Perspective

by Konrad Wisniewski, Giovanni Concistrè and Angelo Maria Dell’Aquila

Medicina 2025, 61(7), 1241; https://doi.org/10.3390/medicina61071241 (registering DOI) - 9 Jul 2025

Abstract

Unplanned postoperative coronary angiography (uCAG) following isolated coronary artery bypass grafting (CABG) represents a significant clinical challenge, reflecting postoperative myocardial ischemia (PMI) with substantial impact on outcomes. The incidence of uCAG varies from 0.39 to 5.3%, depending on institutional protocols and diagnostic thresholds. [...] Read more.

Unplanned postoperative coronary angiography (uCAG) following isolated coronary artery bypass grafting (CABG) represents a significant clinical challenge, reflecting postoperative myocardial ischemia (PMI) with substantial impact on outcomes. The incidence of uCAG varies from 0.39 to 5.3%, depending on institutional protocols and diagnostic thresholds. Elevated cardiac biomarkers (high-sensitivity troponin and CK-MB), ECG changes, and hemodynamic instability are key indicators guiding uCAG. While associated with increased short-term mortality and morbidity, timely identification and treatment of graft-related complications via uCAG can improve midterm survival. Percutaneous coronary intervention (PCI) often emerges as the preferred therapeutic strategy over redo CABG. Future efforts should focus on refining risk stratification models, expanding the role of non-invasive imaging modalities, and validating early intervention strategies through prospective studies. Establishing standardized criteria for diagnosing and managing PMI remains critical to enhance outcomes and healthcare efficiency. Full article

(This article belongs to the Section Cardiology)

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11 pages, 874 KiB

Open AccessSystematic Review

Conduction System Pacing Versus Biventricular Cardiac Resynchronization Pacing: Meta-Analysis on Outcomes in Patients with Non-Left Bundle Branch Block

by Xuanming Pung, Joe J. L. Chua, Khi Yung Fong, Yi Yi Chua, Germaine J. M. Loo, Jonathan W. S. Ong, Julian C. K. Tay, Hooi Khee Teo, Yue Wang, Colin Yeo, Eric T. S. Lim, Kah Leng Ho, Daniel T. T. Chong, Chi Keong Ching and Vern Hsen Tan

Medicina 2025, 61(7), 1240; https://doi.org/10.3390/medicina61071240 (registering DOI) - 9 Jul 2025

Abstract

Background and Objectives: The role of biventricular pacing (BVP) is less well-established in patients with heart failure with reduced ejection fraction (HFrEF) without left bundle branch block (LBBB). Conduction system pacing (CSP) has gained significant traction and may provide a safe and [...] Read more.

Background and Objectives: The role of biventricular pacing (BVP) is less well-established in patients with heart failure with reduced ejection fraction (HFrEF) without left bundle branch block (LBBB). Conduction system pacing (CSP) has gained significant traction and may provide a safe and more physiological alternative to BVP in these patients. A few small studies studying this question have reported conflicting results. This meta-analysis aims to compare procedural and clinical outcomes between CSP and BVP in this group. Materials and Methods: An online literature search was systematically conducted to retrieve studies comparing CSP and BVP in HFrEF patients with non-LBBB. Four studies with 461 patients were included. Results: Implant-derived paced QRS duration was significantly shorter (mean difference [MD] −19.7 ms, 95% confidence interval [CI] −36.2 to 3.3, p = 0.0355) with CSP. Echocardiographic response with significantly greater improvement in left ventricular ejection fraction (MD 5.6%, 95% CI 3.1 to 8.0, p = 0.0106) was also observed with CSP. There were no statistically significant differences in clinical outcomes such as all-cause mortality (relative risk [RR] 0.53, 95% CI 0.18 to 1.60, p = 0.133) and heart failure hospitalization (RR 0.54, 95% CI 0.19 to 1.56, p = 0.129). Conclusions: This meta-analysis suggests that CSP may have better electrical synchrony and echocardiographic response compared to BVP in HFrEF patients with non-LBBB. Further randomized studies with longer follow-up may be required to elucidate potential benefits in clinical outcomes. Full article

(This article belongs to the Section Cardiology)

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10 pages, 438 KiB

Open AccessArticle

Recovery and Recurrence in Bell’s Palsy: A Propensity Score-Matched Comparative Study Across ENT, Pain Medicine, and Traditional Korean Medicine

by Jaeyoon Chung, Eunsung Park, Jin Lee and Cheol Lee

Medicina 2025, 61(7), 1239; https://doi.org/10.3390/medicina61071239 (registering DOI) - 9 Jul 2025

Abstract

Background and Objectives: Bell’s palsy, characterized by acute idiopathic facial nerve paralysis, exhibits variable recovery outcomes influenced by treatment timing, modality, and patient comorbidities. This study aimed to compare the effectiveness of corticosteroid-based treatment (Ear, Nose, and Throat [ENT]), nerve blocks/physical therapy [...] Read more.

Background and Objectives: Bell’s palsy, characterized by acute idiopathic facial nerve paralysis, exhibits variable recovery outcomes influenced by treatment timing, modality, and patient comorbidities. This study aimed to compare the effectiveness of corticosteroid-based treatment (Ear, Nose, and Throat [ENT]), nerve blocks/physical therapy (Pain Medicine), and acupuncture/herbal medicine (Traditional Korean Medicine [KM]) and identify predictors of recovery and recurrence. This retrospective cohort study leverages South Korea’s pluralistic healthcare system, where patients choose specialties, to provide novel insights into departmental treatment outcomes. Materials and Methods: We analyzed 600 patients treated within 72 h of Bell’s palsy onset (2010–2024) at Wonkwang University Hospital, South Korea, using propensity score matching (PSM) (1:1:1) for age, sex, comorbidities, and initial House–Brackmann (HB) grade. The primary outcome was complete recovery (HB grade I) at 6 months; secondary outcomes included recovery time, recurrence, complications, and patient satisfaction. Multivariate logistic regression identified predictors. Results: The ENT group achieved the highest complete recovery rate (87.5%, phi = 0.18) versus Pain Medicine (74.0%) and KM (69.5%) (p < 0.001), with the shortest recovery time (4 weeks, Cohen’s d = 0.65 vs. KM). Synkinesis was lowest in the ENT group (6.0%). ENT treatment (OR: 1.75; 95% CI: 1.29–2.37) and early corticosteroid application (OR: 1.95; 95% CI: 1.42–2.68) predicted recovery. Hypertension (OR: 4.40), hyperlipidemia (OR: 8.20), and diabetes (OR: 1.40) increased recurrence risk. Subgroup analyses showed that ENT treatment was most effective for severe cases (HB grade IV: 90% recovery vs. 65% in KM, p < 0.01). Conclusions: Corticosteroid-based treatment (ENT) yielded superior recovery outcomes. Comorbidity management is critical for recurrence prevention. Early ENT referral and integrated care models are recommended to optimize outcomes in diverse healthcare settings. Full article

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13 pages, 840 KiB

Open AccessArticle

Full-Blood Inflammatory Ratios Predict Length of Stay but Not Early Death in Romanian Pulmonary Tuberculosis

by Ionut-Valentin Stanciu, Ariadna-Petronela Fildan, Barkha Rani Thakur, Adrian Cosmin Ilie, Livia Stanga, Cristian Oancea, Emanuela Tudorache, Felix Bratosin, Ovidiu Rosca, Iulia Bogdan, Anca Chisoi, Ionela Preotesoiu, Viorica Zamfir and Elena Dantes

Medicina 2025, 61(7), 1238; https://doi.org/10.3390/medicina61071238 (registering DOI) - 9 Jul 2025

Abstract

Background and Objectives: Blood-borne inflammatory ratios have been proposed as inexpensive prognostic tools across a range of diseases, but their role in pulmonary tuberculosis (TB) remains uncertain. In this retrospective case–control analysis, we explored whether composite indices derived from routine haematology—namely the [...] Read more.

Background and Objectives: Blood-borne inflammatory ratios have been proposed as inexpensive prognostic tools across a range of diseases, but their role in pulmonary tuberculosis (TB) remains uncertain. In this retrospective case–control analysis, we explored whether composite indices derived from routine haematology—namely the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the systemic immune–inflammation index (SII) and a novel CRP–Fibrinogen Index (CFI)—could enhance risk stratification beyond established cytokine measurements among Romanian adults with culture-confirmed pulmonary T. Materials and Methods: Data were drawn from 80 consecutive TB in-patients and 50 community controls. Full blood counts, C-reactive protein, fibrinogen, and four multiplex cytokines were extracted from electronic records, and composite indices were calculated according to standard formulas. The primary outcomes were in-hospital mortality within 90 days and length of stay (LOS). Results: Among TB patients, the median NLR was 3.70 (IQR 2.54–6.14), PLR was 200 (140–277) and SII was 1.36 × 10⁶ µL⁻¹ (0.74–2.34 × 10⁶), compared with 1.8 (1.4–2.3), 117 (95–140) and 0.46 × 10⁶ µL⁻¹ (0.30–0.60 × 10⁶) in controls. Those with SII above the cohort median exhibited more pronounced acute-phase responses (median CRP 96 vs. 12 mg L⁻¹; fibrinogen 578 vs. 458 mg dL⁻¹), yet median LOS remained virtually identical (29 vs. 28 days) and early mortality was low in both groups (8% vs. 2%). The CFI showed no clear gradient in hospital stay across its quartiles, and composite ratios—while tightly inter-correlated—demonstrated only minimal association with cytokine levels and LOS. Conclusions: Composite cell-count indices were markedly elevated but did not predict early death or prolonged admission. In low-event European cohorts, their chief value may lie in serving as cost-free gatekeepers, flagging those who should proceed to more advanced cytokine or genomic testing. Although routine reporting of NLR and SII may support low-cost surveillance, validation in larger, multicentre cohorts with serial sampling is needed before these indices can be integrated into clinical decision-making. Full article

(This article belongs to the Section Pulmonology)

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16 pages, 722 KiB

Open AccessArticle

Isokinetic Knee Strength as a Predictor of Performance in Elite Ski Mountaineering Sprint Athletes

by Burak Kural, Esin Çağla Çağlar, Mine Akkuş Uçar, Uğur Özer, Burcu Yentürk, Hüseyin Çayır, Nuri Muhammet Çelik, Erkan Çimen, Gökhan Arıkan and Levent Ceylan

Medicina 2025, 61(7), 1237; https://doi.org/10.3390/medicina61071237 (registering DOI) - 9 Jul 2025

Abstract

Background and Objectives: This study aims to investigate the relationship between isokinetic knee strength and competition performance in elite male ski mountaineering sprint athletes and to identify strength parameters that predict performance and contribute to injury prevention. Materials and Methods: Thirteen [...] Read more.

Background and Objectives: This study aims to investigate the relationship between isokinetic knee strength and competition performance in elite male ski mountaineering sprint athletes and to identify strength parameters that predict performance and contribute to injury prevention. Materials and Methods: Thirteen male athletes participating in the Ski Mountaineering Turkey Cup final stage were included. Isokinetic knee flexion (FLX) and extension (EXT) strength of dominant (DM) and non-dominant (NDM) legs were measured at angular velocities of 60°/s and 180°/s using the DIERS-Myolin Isometric Muscle Strength Analysis System. Competition performance was evaluated using the ISMF scoring system. Data were analyzed using SPSS 26.0 with Pearson correlation and multiple regression analyses after normality, linearity, and homoscedasticity checks. Results: Strong positive correlations were found between hamstring strength at high angular velocities (180°/s) and performance (DM FLX: r = 0.809; NDM FLX: r = 0.880). Extension strength showed moderate correlations at low velocities (60°/s) (DM EXT: r = 0.677; NDM EXT: r = 0.699). Regression analysis revealed that DM FLX at 180°/s and DM EXT at 60°/s explained 49% of performance variance (Adj. R² = 0.498). For NDM legs, only 180°/s FLX was a significant predictor (β = 1.468). Conclusions: High-velocity hamstring strength plays a critical role in ski mountaineering sprint performance, particularly during sudden directional changes and dynamic balance. Quadriceps strength at low velocities contributes to prolonged climbing phases. Moreover, identifying and addressing bilateral strength asymmetries may support injury prevention strategies in elite ski mountaineering athletes. These findings provide scientific support for designing training programs targeting explosive hamstring strength, bilateral symmetry, and injury risk reduction, essential for optimizing performance in the 2026 Winter Olympics sprint discipline. Full article

(This article belongs to the Special Issue Advances in Sports Rehabilitation and Injury Prevention)

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18 pages, 1285 KiB

Open AccessArticle

Parathyroidectomy Positively Modulates Systemic Inflammation and Nutritional Status: Immune-Inflammation Index and Prognostic Nutritional Index in Primary Hyperparathyroidism

by Yusuf Karadeniz and Melia Karakose

Medicina 2025, 61(7), 1236; https://doi.org/10.3390/medicina61071236 - 8 Jul 2025

Abstract

Background/Objectives: Primary hyperparathyroidism (PHPT) has been associated with systemic inflammation and metabolic disturbances. This study aimed to evaluate changes in the Systemic Immune-Inflammation Index (SII) and Prognostic Nutritional Index (PNI) following parathyroidectomy (PTX) in PHPT patients, and to assess their return toward [...] Read more.

Background/Objectives: Primary hyperparathyroidism (PHPT) has been associated with systemic inflammation and metabolic disturbances. This study aimed to evaluate changes in the Systemic Immune-Inflammation Index (SII) and Prognostic Nutritional Index (PNI) following parathyroidectomy (PTX) in PHPT patients, and to assess their return toward healthy control values. Materials and Methods: This retrospective study was conducted between January 2010 and March 2022. It analyzed the demographic characteristics, clinical findings, and laboratory results of patients diagnosed with and operated for PHPT, with comparisons to healthy controls. Postoperative values were recorded at least six months after surgery. Bone mineral density was classified according to World Health Organization criteria, and nephrolithiasis was assessed with imaging. Results: After applying exclusion criteria, 415 PHPT patients and 410 controls were included. PHPT patients were older (p < 0.001) and had a higher proportion of females (p = 0.016). Compared to controls, they had lower phosphorus, albumin, high-density lipoprotein cholesterol, total cholesterol, hemoglobin, and PNI (p < 0.001 for all), while triglycerides, monocytes, platelets, CRP, and SII were higher (p < 0.05). Postoperatively, albumin, platelets, total cholesterol, and triglycerides increased (p < 0.001), while calcium, white blood cell count, neutrophils, lymphocytes, and CRP decreased (p < 0.05), approaching healthy control values. In age- and sex-matched comparisons (propensity score matching, n = 259 in each group), platelets (p = 0.002) and hemoglobin (p = 0.018) were found to be higher postoperatively. Conclusions: Preoperative SII and PNI levels were significantly altered in PHPT patients compared to healthy controls. Following PTX, both of these markers and other parameters showed significant improvements, reflecting positive changes in systemic inflammation and nutritional status. Full article

(This article belongs to the Section Endocrinology)

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14 pages, 287 KiB

Open AccessArticle

Prevalence and Risk Factors of Unintentional In-Home Injuries in Older Adults

by Ok-Hee Cho and Hyekyung Kim

Medicina 2025, 61(7), 1235; https://doi.org/10.3390/medicina61071235 - 8 Jul 2025

Abstract

Background and Objectives: Older adults are a vulnerable population to unintentional injuries due to age-related physiological decline and the presence of various chronic conditions. Unintentional injuries occurring in the home, such as falls, burns, poisoning, cuts, and suffocation, have been reported at [...] Read more.

Background and Objectives: Older adults are a vulnerable population to unintentional injuries due to age-related physiological decline and the presence of various chronic conditions. Unintentional injuries occurring in the home, such as falls, burns, poisoning, cuts, and suffocation, have been reported at higher rates in this age group compared to younger populations. This study examines the prevalence and types of unintentional in-home injuries in older adults and identifies the risk factors associated with falls and cuts/collisions. Materials and Methods: A cross-sectional study was conducted on 309 older adults (aged ≥ 65 years) recruited from eight senior welfare centers in South Korea. Results: The most frequent cause of injury was falls (28.7%), followed by cuts/collisions (27.0%), burns/fire (11.4%), and other injuries (8.1%). In the model adjusted for age and sex, risk factors for falls included a history of outdoor falls or indoor cuts/collisions, dizziness, and the use of two or more medications. Risk factors for cut/collision injuries included a history of indoor burns or falls, numbness in hands and feet, and visual impairment. Conclusions: To effectively prevent home injuries among older adults, it is crucial to focus not only on falls but also on frequent minor injuries caused by cuts and collisions. Full article

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

14 pages, 936 KiB

Open AccessArticle

Study on Quality of Life of Patients with Obstructive Sleep Apnea—Pilot Study

by Olja Tanellari, Brunilda Koci, Edlira Baruti Papa, Carina Balcos, Adina Oana Armencia, Tinela Panaite and Irina Zetu

Medicina 2025, 61(7), 1234; https://doi.org/10.3390/medicina61071234 - 8 Jul 2025

Abstract

Background and Objectives: Sleep apnea (OSA) significantly impacts patients’ health, affecting cognitive, emotional, and social functioning, thus reducing overall quality of life (QoL). Despite global research interest, there are limited data on the QoL of Romanian patients with OSA. Aim of study [...] Read more.

Background and Objectives: Sleep apnea (OSA) significantly impacts patients’ health, affecting cognitive, emotional, and social functioning, thus reducing overall quality of life (QoL). Despite global research interest, there are limited data on the QoL of Romanian patients with OSA. Aim of study: This study aimed to assess the quality of life of patients diagnosed with OSA using the Sleep Apnea Quality of Life Index (SAQLI), a validated, disease-specific questionnaire. Material and Methods: A cross-sectional study was conducted between January 2021 and February 2022 on 28 adult patients from medical units in Iași (Romania) and Albania. The patients were clinically evaluated and confirmed to have OSA (AHI > 5). QoL was assessed pre-treatment using the SAQLI, covering daily activities, social interactions, emotional status, and symptomatology. Statistical analyses were performed using SPSS v26.0. Results: Most patients had moderate (32.1%) or severe OSA (53.6%). Lower QoL scores correlated with increased disease severity. Significant impairments were observed in daily functioning, social relationships, and emotional well-being. Patients with severe OSA reported the lowest scores across all domains. Conclusions: OSA severely affects quality of life, particularly in patients with moderate to severe forms. Early diagnosis and personalized, multidisciplinary management strategies are essential to improving outcomes and overall patient well-being. Full article

(This article belongs to the Special Issue Medicine and Dentistry: New Methods and Clinical Approaches—2nd Edition)

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13 pages, 588 KiB

Open AccessArticle

Prognostic Value of Blood Urea Nitrogen to Albumin Ratio in Elderly Critically Ill Patients with Acute Kidney Injury: A Retrospective Study

by Sinem Bayrakçı and Elif Eygi

Medicina 2025, 61(7), 1233; https://doi.org/10.3390/medicina61071233 - 8 Jul 2025

Abstract

Background and Objectives: Acute kidney injury (AKI) is common in intensive-care unit (ICU) patients and is associated with increased mortality. Elderly patients tend to have more comorbid chronic diseases and are more prone to AKI than younger populations, resulting in higher rates [...] Read more.

Background and Objectives: Acute kidney injury (AKI) is common in intensive-care unit (ICU) patients and is associated with increased mortality. Elderly patients tend to have more comorbid chronic diseases and are more prone to AKI than younger populations, resulting in higher rates of hospitalization and a higher incidence of AKI. Our aim in this study was to investigate the prognostic utility of BUN/albumin ratio (BAR) in predicting mortality in elderly critically ill patients with AKI. Materials and Methods: This study was conducted retrospectively on 154 elderly patients with AKI who were admitted to the ICU between October 2023 and September 2024.Data on the following demographic, clinical, and laboratory parameters were retrospectively collected from medical cards and electronic records. Results: In the non-survivor group, among comorbidities, lung disease was higher (p < 0.05), GCS was lower, and APACHE II was higher among clinical scores (p < 0.001). In the non-survivor group, diuretic use (p = 0.03), oliguria, RRT, vasopressor requirement, sepsis, and MV rates (p < 0.001),as well as BUN, phosphate, LDH, Crp, APTT, INR, and BAR rates, were higher (all p < 0.05) and albumin was lower (p = 0.01). Cut-off values of BUN, albumin, and BAR variables according to mortality status were determined by an ROC curve analysis, as follows:48.4 for BUN (p = 0.013), 31.5 for albumin (p = 0.001), and 1.507 for BAR (p = 0.001).According to the results of the ROC analysis performed to predict in-hospital mortality, the BAR level reached an AUC value of 0.655. A BAR value above 1.507 increases mortality by 3.944 times (p = 0.023). Conclusions: BAR is a simple and accessible biomarker that may serve as a predictor of in-hospital mortality in elderly patients with AKI. Its use may aid early risk stratification and decisionmaking in the ICU. Full article

(This article belongs to the Section Intensive Care/ Anesthesiology)

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24 pages, 1374 KiB

Open AccessArticle

Quantitative and Qualitative Segmental Surface Growth in Infants with Unilateral Cleft Lip and Palate: A Prospective In Vivo Study

by Sarah Bühling, Cedric Thedens, Sara Eslami, Nicolas Plein, Iulia Dahmer, Babak Sayahpour, Lukas Benedikt Seifert, Robert Sader and Stefan Kopp

Medicina 2025, 61(7), 1232; https://doi.org/10.3390/medicina61071232 - 8 Jul 2025

Abstract

Background and Objectives: Patients with unilateral cleft lip and palate (UCLP) require a phase of infant orthopedic treatment prior to surgical cleft closure. Treatment planning in this phase necessitates a thorough understanding of maxillary growth dynamics in this period. The aim of [...] Read more.

Background and Objectives: Patients with unilateral cleft lip and palate (UCLP) require a phase of infant orthopedic treatment prior to surgical cleft closure. Treatment planning in this phase necessitates a thorough understanding of maxillary growth dynamics in this period. The aim of the present study was to evaluate the quantitative and qualitative surface growth of maxillary segments in infants with UCLP. Materials and Methods: In total, 195 intraoral scans from 50 patients were obtained postnatal (T0), at monthly intervals (T1–5), and prior to surgical cleft closure at 6 months of age (T6). Surface, linear, and angle measurements of the maxillary segments were performed. Results: Significant increases in the total surface area and the surface areas of the small and large segments were observed at monthly intervals and over the overall duration. The large segment showed greater absolute growth (11.62 mm² per month, 46.57 mm² total), while the small segment had a higher percentage increase (1.49% monthly, 6.57% overall). A positive small correlation was observed between surface area growth changes in the small segment and its increase in length. Conclusions: Our results revealed distinct growth patterns of the large and small segments in amount and direction, underscoring the relevance of incorporating segment arch width in surface evaluations. Full article

(This article belongs to the Special Issue Advances in Clinical Medicine and Dentistry)

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15 pages, 436 KiB

Open AccessArticle

Laparoscopic Radical Colectomy with Complete Mesocolic Excision Offers Similar Results Compared with Open Surgery

by Vasile V. Bintintan, Vlad Fagarasan, Radu I. Seicean, David Andras, Alexandru I. Ene, Romeo Chira, Adriana Bintintan, Georgiana Nagy, Cristina Petrisor, Simona Cocu, Elena Stefanescu, Ionut Negoi, Adrian Calborean, George C. Dindelegan, Ciprian Silaghi, Iulia Lupan and Gabriel Samasca

Medicina 2025, 61(7), 1231; https://doi.org/10.3390/medicina61071231 - 7 Jul 2025

Abstract

Background and Objectives: The technique of complete mesocolic excision (CME) for colonic cancer is being advocated to improve the local control of the disease and increase the long-term survival. However, even with an open approach, CME is a complex technique and has [...] Read more.

Background and Objectives: The technique of complete mesocolic excision (CME) for colonic cancer is being advocated to improve the local control of the disease and increase the long-term survival. However, even with an open approach, CME is a complex technique and has not yet been adopted as standard care. Laparoscopy has been proven to bring significant advantages to colorectal surgery but performing a laparoscopic CME (Lap-CME) for colonic cancer is even more technically demanding than CME in open surgery. The purpose of this study is to evaluate whether Lap-CME can be offered as a standard procedure for patients with colonic cancer and to compare the results with those obtained after a conventional, open technique. Materials and methods: This study included 100 consecutive patients with colonic cancer, who were operated on by the same surgical team using a standardized medial-to-lateral open or laparoscopic complete mesocolic excision technique. The perioperative data was prospectively recorded in a database and retrospectively analyzed with the aim of identifying the proportion of patients that received Lap-CME, to evaluate the success rate of the procedure and to identify whether there are differences in the oncological quality of CME between the laparoscopic and open surgery groups. Results: Most of the patients enrolled in this study were in the advanced stages of the disease, with the incidence of pT3 tumors being 67% and the mean tumor size averaging 4.5 cm. Laparoscopic CME was performed in 39% of cases overall, with 41.4% being right colectomies, 42.5% being left colectomies and 16.1% being transverse colectomies. All of the parameters relevant to the oncological quality of resection, namely total lymph node count, resection margins, or the completeness of resection, were similar between the open and laparoscopic groups both when analyzed for the entire cohort or when analyzed for specific subgroups according to the tumor location (right, transverse, or left colon) or stage of the disease (pT3 or stage III). Conclusions: Laparoscopic complete mesocolic excision for colonic cancer can be offered as a standard procedure by experienced surgical teams in carefully selected patients and provides oncological results similar to those obtained with open surgery. Full article

(This article belongs to the Special Issue Advances and Future Perspectives in Abdominal and Gastrointestinal Surgery)

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10 pages, 674 KiB

Open AccessArticle

Impact of Treatment Duration in First-Line Atezolizumab Plus Chemotherapy in Extensive-Stage Small-Cell Lung Cancer: A Multicenter Real-World Retrospective Study

by Mehmet Nuri Baser, Bilgin Demir, Gamze Serin Ozel, Gamze Gokoz Dogu, Serdar Karakaya, Mucahit Ugar, Naziye Ak, Ahmet Ozveren, Ufuk Camanlı, Olcun Umit Unal, Merve Turan and Esin Oktay

Medicina 2025, 61(7), 1230; https://doi.org/10.3390/medicina61071230 - 7 Jul 2025

Abstract

Background and Objectives: Small-cell lung cancer (SCLC) is an exceedingly aggressive neoplasm distinguished by an unfavorable prognosis. Recent studies have confirmed chemo-immunotherapy as the conventional first treatment for extensive-stage small-cell lung cancer (ES-SCLC), but the impact of treatment duration remains unclear. The goal [...] Read more.

Background and Objectives: Small-cell lung cancer (SCLC) is an exceedingly aggressive neoplasm distinguished by an unfavorable prognosis. Recent studies have confirmed chemo-immunotherapy as the conventional first treatment for extensive-stage small-cell lung cancer (ES-SCLC), but the impact of treatment duration remains unclear. The goal of this study was to find out how the length of treatment affected progression-free survival (PFS) and overall survival (OS) in patients with ES-SCLC who were receiving first-line atezolizumab plus chemotherapy. Materials and Methods: This retrospective multicenter study comprised 82 patients from six oncology centers in Turkey between 2017 and 2024. Patients were categorized into two categories according to the quantity of chemotherapy cycles they had undergone: standard treatment (≤4 cycles) and extended treatment (≥5 cycles). For the purpose of analyzing survival outcomes and related clinical determinants, as well as the demographic structures and features of the patients, both univariate and multivariate Cox regression models were utilized. Results: The median number of atezolizumab cycles was 8 (1–63). OS was 29.46 months after 15.8 months of follow-up, while PFS was 10.63 months. When comparing the two groups, we found no statistically significant differences in either PFS (p = 0.952) or OS (p = 0.374). Significant associations with OS were seen in the standard therapy group for both ECOG PS 1 (p = 0.028). Thoracic radiation considerably decreased progression risk (HR = 0.41, p = 0.031) in the extended group. Conclusions: While prolonging chemo-immunotherapy beyond four cycles did not significantly improve survival, the selected patient subgroups may benefit from personalized approaches. Thoracic radiotherapy emerged as a key modifier of outcome. Full article

(This article belongs to the Section Oncology)

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12 pages, 977 KiB

Open AccessArticle

Vitamin D Deficiency and Supplementation in Irritable Bowel Syndrome: Retrospective Evaluation of Subtype and Sex-Based Differences

by Nur Düzen Oflas and Yonca Yılmaz Ürün

Medicina 2025, 61(7), 1229; https://doi.org/10.3390/medicina61071229 - 7 Jul 2025

Abstract

Background and Objectives: Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder with diverse subtypes. Recent evidence has suggested a link between vitamin D deficiency and IBS; however, the associations between vitamin D levels, IBS subtypes, and hematological–biochemical parameters remain unclear. The [...] Read more.

Background and Objectives: Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder with diverse subtypes. Recent evidence has suggested a link between vitamin D deficiency and IBS; however, the associations between vitamin D levels, IBS subtypes, and hematological–biochemical parameters remain unclear. The aim of this research was to investigate the associations between vitamin D status, IBS subtypes, and sex, along with their relationships with biochemical and hematological parameters. Materials and Methods: This retrospective study included 240 patients diagnosed with IBS according to the Rome IV criteria at Van Yüzüncü Yıl University Medical Faculty Hospital. The patients were classified as diarrhea-predominant (IBS-D), constipation-predominant (IBS-C), or mixed-type (IBS-M). The patients’ serum vitamin D levels and hematological (hemoglobin, white blood cell and platelet counts, and mean corpuscular volume) and biochemical (ferritin, iron, calcium, magnesium, and vitamin B12 levels) parameters were evaluated at baseline and after vitamin D supplementation. Sex-related differences were assessed. Results: Baseline vitamin D levels were low in all IBS subtypes, with no significant differences between the groups. Vitamin D supplementation resulted in a significant increase in serum vitamin D levels across all subtypes (p = 0.001). No significant correlations were identified between vitamin D levels and hematological or biochemical parameters. Sex differences in vitamin D levels were only significant in the IBS-M group, both at baseline and post-treatment (p < 0.05). Conclusions: Vitamin D deficiency is prevalent among all IBS subtypes and significantly improves with supplementation, independently of the subtype. Although no associations were found between vitamin D levels and laboratory parameters, the observed sex differences in patients with IBS-M highlight the need for further research into potential sex-related pathophysiological mechanisms. These findings support the integration of routine vitamin D assessment and supplementation into the clinical management of IBS, especially in patients with the IBS-M subtype and female sex, to potentially improve patient outcomes. Full article

(This article belongs to the Section Gastroenterology & Hepatology)

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12 pages, 290 KiB

Open AccessArticle

Age Is Not So Important for Risk Stratification in Early Cholecystectomy for Acute Calculous Cholecystitis: A Post-Hoc Analysis of the SPRiMACC Study Database

by Paola Fugazzola, Ahmed Ghaly, Luca Ansaloni, Francesca Dal Mas, Carlo Maria Bianchi, Enrico Cicuttin, Andrea Dagnoni, Simone Frassini, Matteo Tomasoni, Lorenzo Cobianchi and the SPRiMACC Collaborative Group

Medicina 2025, 61(7), 1228; https://doi.org/10.3390/medicina61071228 - 7 Jul 2025

Abstract

Background and Objectives: Early cholecystectomy (EC) is widely regarded as the first-line treatment for acute calculous cholecystitis (ACC). Current debate centers on the feasibility of EC as an option even for elderly patients. This study aims to determine whether age alone is an [...] Read more.

Background and Objectives: Early cholecystectomy (EC) is widely regarded as the first-line treatment for acute calculous cholecystitis (ACC). Current debate centers on the feasibility of EC as an option even for elderly patients. This study aims to determine whether age alone is an independent risk prediction factor for prognosis after EC for ACC. Materials and Methods: This study is a post-hoc analysis of the S.P.Ri.M.A.C.C. WSES prospective international multicenter observational study database, including patients with ACC undergoing EC. Univariate and multivariate analyses were conducted, examining different risk factors for major morbidity and mortality after EC. Results: In the univariate analyses, age was found to be a statistically significant risk factor for both 30-day major complications (p < 0.001) and 30-day mortality (p = 0.003). However, in the multivariate analysis, age alone was not a significant predictor for either outcome, with p-values of 0.419 and 0.094, respectively. The only significant risk factor associated with both 30-day mortality and major morbidity in the multivariate model was the POSSUM Physiological Score (PS). Conclusions: Age alone cannot be considered a reliable risk predictor for a complicated postoperative course after EC in patients with ACC. Frailty, rather than chronological age, should be assessed to predict the outcome of these patients. Full article

(This article belongs to the Section Surgery)

13 pages, 955 KiB

Open AccessArticle

Sex-Based Risk Evaluation in Acute Coronary Events—A Study Conducted on an Eastern-European Population

by Svetlana Mosteoru, Nilima Rajpal Kundnani, Abhinav Sharma, Roxana Pleava, Laura Gaita and Dan Ion Gaiță

Medicina 2025, 61(7), 1227; https://doi.org/10.3390/medicina61071227 - 6 Jul 2025

Abstract

Background and Objectives: Cardiovascular (CV) diseases account for about 32% of deaths in women, with differing risk factors between women and men. Our study aimed to compare sex-related risk factors and comorbidities in patients at very high CV risk. Materials and Methods: We [...] Read more.

Background and Objectives: Cardiovascular (CV) diseases account for about 32% of deaths in women, with differing risk factors between women and men. Our study aimed to compare sex-related risk factors and comorbidities in patients at very high CV risk. Materials and Methods: We consecutively enrolled adult patients hospitalized for myocardial infarction or unstable angina at a tertiary referral center in western Romania between October 2016 and June 2017. A total of 299 adults underwent clinical and biochemical evaluations between 6 months and 2 years after their coronary event. We assessed patients’ specific characteristics, comorbidities, and risk factors. Results: Women made up only a quarter of the survey participants (74 women, 24.7%) and were generally older (63.32 ± 9.3 vs. 60.51 ± 9.3, p = 0.02) and more obese (31.20 ± 6.0 vs. 29.48 ± 4.9, p = 0.02). There were no significant differences in the prevalence of hypertension, diabetes, dyslipidemia, chronic kidney disease, or peripheral artery disease, though women had slightly higher rates for most comorbidities. Regarding smoking habits, both groups had high percentages of current and former smokers, with women being significantly less likely to smoke (20.9% vs. 44.6%, p = 0.003). Multivariable logistic regression adjusting for age, BMI, smoking status, diabetes, and eGFR revealed that sex was not a statistically significant independent predictor for myocardial infarction, PCI, or CABG. Conclusions: We observed that women with previous coronary events had a worse risk factor profile, while there were no significant sex differences in overall comorbidities. Risk factor control should be based on sex-specific prediction models. Full article

(This article belongs to the Section Cardiology)

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20 pages, 976 KiB

Open AccessArticle

Disordered Eating Behaviors, Perceived Stress and Insomnia During Academic Exams: A Study Among University Students

by Elena-Gabriela Strete, Mădălina-Gabriela Cincu and Andreea Sălcudean

Medicina 2025, 61(7), 1226; https://doi.org/10.3390/medicina61071226 - 6 Jul 2025

Abstract

Background and Objectives: During exam sessions, many students experience high levels of stress caused by the large volume of material to study, tight deadlines, and pressure to achieve top grades. This study aimed to examine the relationship between academic stress, sleep disturbances, and [...] Read more.

Background and Objectives: During exam sessions, many students experience high levels of stress caused by the large volume of material to study, tight deadlines, and pressure to achieve top grades. This study aimed to examine the relationship between academic stress, sleep disturbances, and eating behaviors by using validated questionnaires administered to a student sample. As stress levels increased, the data revealed a higher frequency of insomnia symptoms and disordered eating, including behaviors such as compulsive eating and irregular meal patterns. Materials and Methods: This cross-sectional, correlational study was conducted on a convenience sample of 317 university students from various academic centers across Romania. Participants were recruited via online distribution of a self-administered questionnaire during a four-month period, including exam sessions. The survey included the Perceived Stress Scale (PSS), the Insomnia Severity Index (ISI), and the Eating Disorder Examination Questionnaire (EDE-Q), alongside additional items assessing perceived links between stress, sleep, and eating behaviors, and the use of medication. Data were analyzed using SPSS with Spearman correlations, t-tests, and linear regression. Results: Statistical analyses revealed significant and positive associations between perceived stress levels and insomnia, as indicated by Spearman’s correlation (p < 0.01). A similar significant correlation was identified between perceived stress and disordered eating behaviors among students. Specifically, the feeling of being overwhelmed by academic workload showed a strong positive correlation with a lack of control over eating behaviors (r = 0.568). Furthermore, linear regression analysis confirmed a significant predictive relationship between feeling overwhelmed and the tendency to eat excessively beyond initial intentions, with a standardized regression coefficient B = 0.581 (p < 0.001). A separate regression analysis focusing on exam-related stress and episodes of compulsive eating behavior demonstrated a comparable result (B = 0.573, p < 0.001), indicating a robust positive association. Additionally, independent samples t-tests demonstrated that students experiencing high levels of stress during the exam period reported significantly greater difficulties with sleep initiation and higher levels of disordered eating compared to their peers with lower stress levels. The difference in insomnia scores was highly significant (t = 11.516, p < 0.001), as was the difference in eating behavior scores (t = 10.931, p < 0.001). Conclusions: These findings underscore the need for emotional support services and effective stress management strategies, enabling students to navigate academic demands without compromising their mental or physical well-being. Full article

(This article belongs to the Special Issue Public Mental Health Crisis during SARS-CoV-2 Pandemic—Part 2)

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14 pages, 607 KiB

Open AccessArticle

Quantification of the Role of Teupol^® 25P and Graminex^® G96 Compared to Hexanic Extract of Serenoa repens in Patients Affected by Lower Urinary Tract Symptoms During Treatment with Silodosin

by Yazan Al Salhi, Damiano Graziani, Andrea Fuschi, Fabio Maria Valenzi, Manfredi Bruno Sequi, Paolo Pietro Suraci, Alice Antonioni, Onofrio Antonio Rera, Cosimo De Nunzio, Riccardo Lombardo, Paolo Benanti, Giuseppe Candita, Eleonora Rosato, Filippo Gianfrancesco, Giorgio Martino, Giovanni Di Gregorio, Luca Erra, Giorgio Bozzini, Antonio Carbone and Antonio Luigi Pastore

Medicina 2025, 61(7), 1225; https://doi.org/10.3390/medicina61071225 - 6 Jul 2025

Abstract

Background and Objectives: While α1-blockers like silodosin are the mainstay for treating lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), combination therapy with phytotherapeutics may provide enhanced symptom control. Xipag^® is a novel formulation containing Graminex^® G96 [...] Read more.

Background and Objectives: While α1-blockers like silodosin are the mainstay for treating lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), combination therapy with phytotherapeutics may provide enhanced symptom control. Xipag^® is a novel formulation containing Graminex^® G96 (pollen extract) and Teupol^® 25P (teupolioside), offering anti-inflammatory and antiandrogenic effects. This study aimed to evaluate the efficacy of Xipag^® versus hexanic extract of Serenoa repens (HESr), both in combination with silodosin, in patients with LUTS/BPH. Materials and Methods: We conducted a single-center, prospective, observational, comparative study involving male patients with moderate-to-severe LUTSs undergoing treatment with silodosin. Patients were allocated to receive either Xipag^® or HESr in addition to silodosin, with follow-up every 3 months for 12 months. Primary outcomes included changes in symptom scores such as IPSS, QoL, and functional improvements such as peak urinary flow rate (Qmax). Multivariable regression analyses were used to assess predictors of the response. Results: Patients receiving Xipag^® showed significantly greater improvements in Qmax at all follow-up points (p < 0.05), with earlier and more sustained benefits compared to the HESr group. QoL index scores and PSA levels were also significantly better in the Xipag^® group starting from month six onward. IPSS scores improved in both groups but were significantly lower in the Xipag^® group only at 12 months (p = 0.04). No differences in erectile function (IIEF-5) or adverse events were observed. Conclusions: Xipag^® in combination with silodosin provides superior improvement in urinary flow, symptom-related QoL, and PSA reduction compared to HESr plus silodosin, with a favorable safety profile. These findings support the use of multi-target nutraceuticals like Xipag^® as a valuable adjunct in the management of LUTS/BPH. Larger randomized trials are warranted to confirm these results and explore underlying mechanisms. Full article

(This article belongs to the Section Urology & Nephrology)

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22 pages, 331 KiB

Open AccessReview

Exploring Non-Pharmacologic Adjunctive Therapies for Patients with Neurodegenerative Diseases

by Maria Marchiș and Magdalena Iorga

Medicina 2025, 61(7), 1224; https://doi.org/10.3390/medicina61071224 - 5 Jul 2025

Abstract

Background: Alternative therapies, such as non-invasive neuromodulation techniques, cognitive therapies, virtual reality-based interventions, and psychological support, represent promising approaches for treating and supporting the management plan for patients with neurodegenerative disorders. Recent research has focused on the effectiveness of neuromodulation therapies, as [...] Read more.

Background: Alternative therapies, such as non-invasive neuromodulation techniques, cognitive therapies, virtual reality-based interventions, and psychological support, represent promising approaches for treating and supporting the management plan for patients with neurodegenerative disorders. Recent research has focused on the effectiveness of neuromodulation therapies, as they show improvements in both emotional and cognitive functions in patients with neurodegenerative disorders. Material and Methods: A literature review was conducted by searching Google Scholar, PubMed, Scopus, and Web of Science in February 2025. In total, 20 studies that met the inclusion criteria were considered for the present review, and the studies included were conducted between 2020 and 2025. Results: Innovative neuromodulation therapies have demonstrated their high potential in the management care plan of neurodegenerative disorders and as non-invasive neuromodulation therapies, both in the emotional manifestations of the patients and in the cognitive ones, with a direct impact on their caregivers’ experience. Although research is ongoing, the following preliminary findings are encouraging, suggesting that these methods may complement or even replace certain traditional interventions. Conclusions: Alternative therapies (non-invasive neuromodulation techniques, cognitive therapies, virtual reality-based interventions, and psychological support) represent promising approaches for treating and supporting the management care plan for neurodegenerative disorders, even in the cases where no other drug-based treatment option can be applied. Each method has its unique advantages, but further studies are needed to create treatment protocols and confirm their long-term effectiveness. Integrating these strategies into personalized management care plans can significantly improve cognitive function and emotional health and increase the quality of life of patients with cognitive and neurodegenerative disorders. Full article

(This article belongs to the Special Issue Treatment of Neurological Diseases—Current and Emerging Applications)

14 pages, 649 KiB

Open AccessArticle

Body Appreciation, Weight Status, and Weight Management Practices Among First-Year Students at Universities of Applied Sciences in Lithuania

by Vilma Kriaučionienė, Asta Raskilienė, Lina Šnipaitienė and Janina Petkevičienė

Medicina 2025, 61(7), 1223; https://doi.org/10.3390/medicina61071223 - 5 Jul 2025

Abstract

Background and Objectives: The associations between body appreciation, weight status, and weight management practices are influenced by societal, cultural, and psychological factors. Studies indicated that a higher level of body appreciation is linked to lower engagement in unhealthy weight management practices. The transition [...] Read more.

Background and Objectives: The associations between body appreciation, weight status, and weight management practices are influenced by societal, cultural, and psychological factors. Studies indicated that a higher level of body appreciation is linked to lower engagement in unhealthy weight management practices. The transition from high school to university is a significant life event, often accompanied by substantial lifestyle changes that can affect students’ body image and weight-related behaviours. This study aimed to assess the associations between body appreciation, weight status, and weight management behaviours among first-year students at four universities of applied sciences in Lithuania. Materials and Methods: A cross-sectional online survey was conducted in 2022 among 709 first-year students (216 males and 493 females) at the four largest universities of applied sciences in Vilnius, Kaunas, Klaipėda, and Šiauliai. Body appreciation was assessed using the Body Appreciation Scale-2 (BAS-2), whilst BMI was calculated from self-reported height and weight. Students were asked about their weight management practices. Logistic regression analysis was applied to evaluate associations between weight management behaviours, body appreciation, and weight status. Results: Female students had a significantly lower median BMI (21.1 kg/m²) than males (23.3 kg/m²) but were more likely to perceive themselves as overweight (34.5% vs. 17.1%), worry about gaining weight (40.6% vs. 11.6%), and attempt weight loss (52.5% vs. 23.6%) (all p < 0.001). Higher BAS scores were associated with greater accuracy in weight perception, higher satisfaction with body weight, and fewer concerns about weight gain. Students with lower BAS scores were more likely to engage in harmful weight-control behaviours such as smoking (OR = 0.07; 95% CI: 0.02–0.25 for high vs. low BAS) and were more strongly influenced by media beauty standards and dissatisfaction with appearance. Conclusions: Body appreciation is linked to healthier weight perceptions and behaviours. Interventions that enhance body appreciation may help reduce body dissatisfaction and prevent unhealthy weight control practices, especially among female students. Full article

(This article belongs to the Special Issue Advances in Health, Lifestyle and Environmental Risk Factors Monitoring)

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