Medicina

13 pages, 2979 KiB

Open AccessArticle

The Underdiagnosis of Chronic Kidney Disease in Patients with a Documented Estimated Glomerular Filtration Rate and/or Urine Albumin–Creatinine Ratio in Germany

by Karel Kostev, Martina Lang, Sven-Oliver Tröbs, Sophia Urbisch and Maximilian Gabler

Medicina 2025, 61(5), 843; https://doi.org/10.3390/medicina61050843 (registering DOI) - 2 May 2025

Abstract

Background and Objectives: The underdiagnosis of chronic kidney disease (CKD) is a critical issue worldwide. This present study aimed to explore the CKD subpopulation regarding underdiagnosed CKD in individuals with a pathological estimated glomerular filtration rate (eGFR) and/or urine albumin–creatinine ratio (UACR) values [...] Read more.

Background and Objectives: The underdiagnosis of chronic kidney disease (CKD) is a critical issue worldwide. This present study aimed to explore the CKD subpopulation regarding underdiagnosed CKD in individuals with a pathological estimated glomerular filtration rate (eGFR) and/or urine albumin–creatinine ratio (UACR) values in Germany. Materials and Methods: This analysis used data from the IQVIA^TM Disease Analyzer database and included adult outpatients with at least two pathological consecutive eGFR and/or UACR values, documented at least 60 days apart between October 2018 and September 2023 in 758 general practices. According to the 2024 KDIGO clinical practical guidelines, CKD was defined based on both eGFR and UACR values. UACR values were used when no pathological eGFR values were documented. The main outcome of the study was the proportion of patients with a documented CKD in the total population as well as in defined subgroups. Results: A total of 113,996 CKD patients (mean age: 76.5 (SD: 10.1) years; 60.2% female; 71.5% with mildly to moderately, 21.1% with moderately to severely, and 4.6% with a severely decreased eGFR value; and 1.0% with end-stage kidney disease) were available for analyses. CKD diagnosis was documented in 46.9% of CKD patients and was more frequent in male than in female patients (53.3% versus 42.7%). The highest proportion was observed in patients with heart failure (57.0%), followed by patients with type 2 diabetes (52.7%). In patients without diabetes and heart failure, CKD was documented in 38.2%. The proportion of CKD diagnoses increased with decreasing eGFR values, from 22.0% in patients with nonpathological eGFR but moderately or severely increased UACR to 87.7% in patients with end-stage kidney disease. Conclusions: The study provides valuable insights into the subpopulation of underdiagnosed CKD patients among a large patient population. These results underscore the need for improved screening, timely diagnosis documentation, and treatment strategies for CKD, particularly among high-risk populations. Moreover, it raises the need to increase awareness of micro- and macroalbuminuria as diagnostic criteria for CKD independent of eGFR. Full article

(This article belongs to the Section Urology & Nephrology)

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15 pages, 3358 KiB

Open AccessReview

From Biopsy to Diagnosis: Navigating Aggressive B-Cell Lymphomas in Practice

by Georgian Halcu, Anca Evsei-Seceleanu, Mihai Cerbu, Marina Alina Bara, Andrei Turbatu and Mihail Constantin Ceausu

Medicina 2025, 61(5), 842; https://doi.org/10.3390/medicina61050842 (registering DOI) - 2 May 2025

Abstract

Diffuse large B-cell lymphoma (DLBCL), recognized as the most prevalent variant of adult non-Hodgkin lymphoma, presents considerable challenges in diagnosis owing to its diverse morphological features and frequent extranodal involvement, which may frequently mimic nonhematopoietic neoplasms. The 2022 WHO Classification of Lymphoid [...] Read more.

Diffuse large B-cell lymphoma (DLBCL), recognized as the most prevalent variant of adult non-Hodgkin lymphoma, presents considerable challenges in diagnosis owing to its diverse morphological features and frequent extranodal involvement, which may frequently mimic nonhematopoietic neoplasms. The 2022 WHO Classification of Lymphoid and Hematopoietic Tissues provides essential updates, highlighting the necessity of combining morphology, immunohistochemistry, cytogenetics, and molecular testing for precise subclassification. This review presents a practical method for differentiating DLBCL from other aggressive B-cell neoplasms, such as Burkitt lymphoma, B-lymphoblastic lymphoma, and mantle cell lymphoma. It highlights vital diagnostic tools, including CD45, B/T-cell markers, germinal center markers, and the Hans algorithm, as well as the role of FISH in identifying rearrangements of key genes MYC, BCL2, and BCL6, which are significant for recognizing double-hit and triple-hit lymphomas. Special focus is given to EBV-associated DLBCL and uncommon subtypes featuring plasmablastic or ALK-positive traits. This review aims to enhance diagnostic accuracy and ensure appropriate treatment strategies for patients with large B-cell lymphomas by emphasizing thorough morphological evaluation, specific adjunct testing, and adherence to the most recent classification standards. Full article

(This article belongs to the Special Issue Towards Improved Cancer Diagnosis: New Developments in Histopathology)

18 pages, 2210 KiB

Open AccessArticle

The Effects of Propofol and Thiopental on Nitric Oxide Production and Release in Erythrocytes

by Ulku Arslan, Pinar Ulker, Ahmet Yildirim, Melike Cengiz, Murat Yilmaz, Ayse Gulbin Arici, Emel Gunduz, Ali Sait Kavakli, Arzu Hizay, Oguzhan Arslan, Zeynep Yasemin Tavsanoglu and Nihal Ozturk

Medicina 2025, 61(5), 841; https://doi.org/10.3390/medicina61050841 (registering DOI) - 2 May 2025

Abstract

Background: Hypotension is a common adverse effect associated with the use of propofol and sodium thiopental. The objective of this study was to examine the impact of thiopental and propofol on erythrocyte (RBC) nitric oxide (NO) synthase activity and RBC-mediated NO release. [...] Read more.

Background: Hypotension is a common adverse effect associated with the use of propofol and sodium thiopental. The objective of this study was to examine the impact of thiopental and propofol on erythrocyte (RBC) nitric oxide (NO) synthase activity and RBC-mediated NO release. Methods: A prospective, interventional in vitro trial. Male patients aged between 18 and 45 years with a classification of American Society of Anesthesiologists (ASA) class I, defined as healthy individuals, were included in this study. Venous blood samples (20 mL) were obtained from patients who met the inclusion criteria. Measurements were performed using the specific fluorescent probes for NO and calcium (Ca²⁺). Propofol and sodium thiopental were added to the suspensions at doses of 100, 250, 500, and 1000 μM and incubated for 30 min. All suspensions were proceeded to flow cytometric analysis. Nitrite/nitrate concentration was measured in the supernatant of RBC suspensions after centrifugation. RBC deformability and aggregation were measured by laser diffraction analysis using an ektacytometer. The primary outcome was to evaluate the effects of sodium thiopental and propofol on RBC-NOS activity. Results: Sodium thiopental caused significant increase in intracellular NO concentrations at all doses studied (p < 0.001). Importantly, the intracellular NO concentration increment was positively correlated with sodium thiopental concentration in the suspensions. The presence of L-N-acetylmethyl-arginine in the experimental medium abolished NO production in RBCs in response to sodium thiopental. Sodium thiopental caused increased nitrite and nitrate levels in the suspension medium in a dose-dependent manner. Incubation with thiopental caused an increase in intracellular free Ca⁺² levels while propofol induced no change. Sodium thiopental and propofol caused significant decrement in RBC aggregation. Conclusions: This study presents the initial evidence of augmented RBC-mediated NO production and release in response to sodium thiopental administration. In contrast to the effects observed with sodium thiopental, our results demonstrated that propofol had no impact on RBC-mediated NO production. Full article

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

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14 pages, 1574 KiB

Open AccessArticle

Effect of Intensive Face Yoga on Facial Muscles Tonus, Stiffness, and Elasticity in Middle-Aged Women: A Pre-Experimental Clinical Trial

by Hazel Çelik Güzel, Şule Keçelioğlu, Ahmet Kurtoğlu and Safaa M. Elkholi

Medicina 2025, 61(5), 840; https://doi.org/10.3390/medicina61050840 (registering DOI) - 2 May 2025

Abstract

Background and Objectives: The effects of face yoga, which continues to be popular as an anti-aging technique, on facial muscles in relation to aging represent an area of interest. The aim of this study was to investigate the effect of 8 weeks [...] Read more.

Background and Objectives: The effects of face yoga, which continues to be popular as an anti-aging technique, on facial muscles in relation to aging represent an area of interest. The aim of this study was to investigate the effect of 8 weeks of intensive face yoga on facial muscles’ tonus, stiffness, and elasticity in middle-aged women. Materials and Methods: Twelve female participants with a mean age of 49.75 ± 3.76 were included in this pre-experimental clinical trial. Face yoga was applied to the participants for 8 weeks, 2 days a week face-to-face, and 5 days a week as a home program. At the beginning and the end of 8 weeks, the tonus, stiffness, and elasticity of the participants’ facial muscles were evaluated with the Myoton^®PRO device. Results: Following the face yoga program, the tonus and stiffness of the frontalis (p = 0.008, p = 0.002), corrugator supercilii (p = 0.008, p = 0.019), orbicularis oculi (p = 0.023, p = 0.034), and orbicularis oris (p = 0.007, p = 0.015) muscles decreased significantly, while the tonus and stiffness of the buccinator (p = 0.008, p = 0.002) and digastric (p = 0.008, p = 0.023) muscles increased. Elasticity values increased in all evaluated facial muscles (p = 0.045, p = 0.045, p = 0.034, p = 0.023, p = 0.028, p = 0.005, respectively). Conclusions: The results reveal that face yoga has different effects depending on the physiological structure and function of the muscles and positively affects connective tissue. Future studies should reproduce the results presented here to further our understanding of the effects of face yoga. Full article

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

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27 pages, 791 KiB

Open AccessSystematic Review

Late-Onset Depression and Dementia: A Systematic Review of the Temporal Relationships and Predictive Associations

by Josheil Kaur Boparai, Megan Clemens and Khalid Jat

Medicina 2025, 61(5), 839; https://doi.org/10.3390/medicina61050839 (registering DOI) - 1 May 2025

Abstract

Background: Late-onset depression (LOD) has been increasingly recognized as a risk factor for dementia, yet the temporal and causal nature of this relationship remains unclear. Objective: The purpose of this review is to investigate the temporal association between LOD and dementia. [...] Read more.

Background: Late-onset depression (LOD) has been increasingly recognized as a risk factor for dementia, yet the temporal and causal nature of this relationship remains unclear. Objective: The purpose of this review is to investigate the temporal association between LOD and dementia. Methods: A comprehensive search for studies examining the temporal relationship between LOD and dementia was conducted using MEDLINE via Ovid. The end date of the search was 9 September 2024. A total of 3450 studies were identified, of which 27 met the inclusion criteria. This review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and an article quality assessment was completed. Results: The review demonstrated a significant temporal association between LOD and the risk of dementia, with the highest risk observed within the first decade following depression onset. LOD was consistently associated with an increased likelihood of developing dementia, particularly Alzheimer’s disease, compared to depression at earlier life stages. Conclusions: This systematic review highlights the significant association between LOD and dementia risk, emphasizing the need for early recognition and intervention. Future research should investigate the age at which LOD becomes a risk factor for dementia, the relationship between depression severity, family history of dementia, and dementia risk, as well as the efficacy of preventative treatments. Full article

(This article belongs to the Section Psychiatry)

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17 pages, 996 KiB

Open AccessReview

The Impact of Hydration on Metabolic Outcomes: From Arginine-Vasopressin Signaling to Clinical Implications

by Andrijana Koceva, Andrej Janež and Mojca Jensterle

Medicina 2025, 61(5), 838; https://doi.org/10.3390/medicina61050838 (registering DOI) - 1 May 2025

Abstract

Arginine-vasopressin peptide (AVP) plays a critical role in water balance and osmoregulation. However, emerging evidence suggests that AVP’s actions may expand beyond its traditional role, significantly influencing metabolic regulation, including glucose homeostasis, insulin sensitivity, lipid metabolism and energy balance. Elevated AVP levels are [...] Read more.

Arginine-vasopressin peptide (AVP) plays a critical role in water balance and osmoregulation. However, emerging evidence suggests that AVP’s actions may expand beyond its traditional role, significantly influencing metabolic regulation, including glucose homeostasis, insulin sensitivity, lipid metabolism and energy balance. Elevated AVP levels are seen in various metabolic conditions, such as insulin resistance, metabolic syndrome, type 2 diabetes (T2D) and obesity, further highlighting its potential role as a metabolic regulator. As AVP levels are regulated by hydration status, studies have proposed that chronic hypohydration and persistently elevated AVP levels may contribute to metabolic dysfunction, where increased hydration and therefore AVP suppression may lead to potential metabolic improvements. By analyzing data from animal studies, human observational research and interventional trials, this review evaluates the current evidence on the potential causal relationships and impact of AVP on metabolic regulation, as well as exploring the role of hydration in AVP-mediated metabolic outcomes. Full article

(This article belongs to the Section Endocrinology)

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13 pages, 578 KiB

Open AccessReview

Oral Manifestations in Menopause—A Scoping Review

by Anca Labunet, Adriana Objelean, Andreea Kui, Laura Rusu, Alexandra Vigu and Sorina Sava

Medicina 2025, 61(5), 837; https://doi.org/10.3390/medicina61050837 (registering DOI) - 1 May 2025

Abstract

Background and Objectives: Menopause is a natural physiological process involving hormone production changes, affecting many functions and systems. This scoping review offers a contemporary outlook on oral issues related to menopause, such as saliva production, periodontal and alveolar bone issues, and changes [...] Read more.

Background and Objectives: Menopause is a natural physiological process involving hormone production changes, affecting many functions and systems. This scoping review offers a contemporary outlook on oral issues related to menopause, such as saliva production, periodontal and alveolar bone issues, and changes in the microbiome, and it also investigates the effects of hormonal therapy. Materials and Methods: A literature search from 2019 to 2024 was conducted according to PRISMA-ScR guidelines. Articles investigating the oral effects of menopause were included. Results: A total of 30 studies were covered; 8 focused on salivary alterations, 5 on periodontal issues, 7 on bone, 3 on the microbiome, and 7 on multiple oral problems, showing that xerostomia and altered taste are the most common oral manifestations, followed by indirect causal effects on periodontitis. Many of these alterations can be contained through regular consultations and adequate hygiene. Some alveolar bone changes may occur after menopause and are associated with osteoporosis. Conclusions: Postmenopausal women experience notable reductions in salivary flow, pH levels, and taste sensitivity, which are associated with hormonal fluctuations as well as factors such as age, medication use, and treatments for climacteric symptoms. This population is at increased risk for periodontitis, tooth loss, altered taste, lichen planus, candidiasis, and decreased bone mineral density, which also affect the peri-implant area. Osteoporosis and hormonal changes can play a significant role in causing these increased risks. Maintaining proper oral hygiene and consistently monitoring bone health are essential. While changes in the oral microbiome are more heavily influenced by reductions in salivary flow than by menopause itself, hormone therapy may help improve periodontal health by reducing harmful bacteria and fostering a more balanced microbial environment. The intricate impact of hormones on oral health highlights the necessity for further research. Full article

(This article belongs to the Section Dentistry and Oral Health)

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8 pages, 540 KiB

Open AccessArticle

Parathyroid Involvement by Thyroid Carcinoma: Results from a Single Institution and a Review of the Literature

by Ran Hong

Medicina 2025, 61(5), 836; https://doi.org/10.3390/medicina61050836 (registering DOI) - 1 May 2025

Abstract

Background and Objectives: Thyroid cancer (TC) is a common malignancy that accounts for approximately 1% of all human cancers. Given their anatomical proximity to the thyroid, the parathyroid glands (PTGs) are theoretically at risk of tumor involvement. However, PTG metastases are rare [...] Read more.

Background and Objectives: Thyroid cancer (TC) is a common malignancy that accounts for approximately 1% of all human cancers. Given their anatomical proximity to the thyroid, the parathyroid glands (PTGs) are theoretically at risk of tumor involvement. However, PTG metastases are rare and may be underdiagnosed because of routine PTG preservation during thyroidectomy. This study aimed to identify cases of PTG invasion by TC through a 10-year retrospective review at Chosun University Hospital, along with an analysis of the existing literature. Materials and Methods: A total of 1032 thyroidectomy cases were reviewed, and PTG involvement was detected in 10 cases (0.97%). Clinicopathological characteristics were evaluated, and literature data were analyzed. Results: The affected patients included nine females and one male, with a mean age of 46 years (range: 25–77 years). Histological examination confirmed papillary thyroid carcinoma (PTC) in all cases. Tumor invasion into the perithyroid soft tissues was observed in nine patients, and central cervical lymph node metastases were present in four. All patients exhibited PTG Pattern A (direct invasion). Conclusions: Based on our findings and literature data, PTG involvement by TC has an incidence rate of 0.05–3.9%, predominantly affects women in their sixth to seventh decade of life, and appears to have no impact on prognosis unless accompanied by extensive extrathyroidal invasion. Further studies are necessary to determine whether PTG invasion should be integrated into the TNM staging system and to assess its prognostic and therapeutic implications. Full article

(This article belongs to the Section Oncology)

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11 pages, 1241 KiB

Open AccessArticle

Variations in Oppel–Kundt Illusion Strength Among Depressive and Schizophrenia Spectrum Disorder Groups: Impact of Benzodiazepine Use

by Edgaras Diržius, Rasa Pakanavičiūtė, Deimantė Andriuškevičiūtė, Darius Leskauskas and Aleksandr Bulatov

Medicina 2025, 61(5), 835; https://doi.org/10.3390/medicina61050835 (registering DOI) - 1 May 2025

Abstract

Background and Objectives: The Oppel–Kundt (O–K) geometric optical illusion has been studied among people with mental disorders to understand the differences in their visual perception. Earlier studies were mainly focused on patients with schizophrenia, while less is known about patients with depression [...] Read more.

Background and Objectives: The Oppel–Kundt (O–K) geometric optical illusion has been studied among people with mental disorders to understand the differences in their visual perception. Earlier studies were mainly focused on patients with schizophrenia, while less is known about patients with depression and the influence of medication use. The objectives were to compare illusion manifestation for schizophrenia, depression, and to evaluate possible differences depending on drug use. Materials and Methods: The stimuli consisted of three horizontally arranged dots, which were considered as terminators specifying the ends of the reference and the test stimulus intervals. The reference interval was filled with a set of distracting dots and changed, at random, from 0 to 19. The participants were asked to place the central terminator in the middle, between the outer ones. The trial consisted of 10 different figures, and each trial was repeated 10 times. This study involved 35 patients with depression and schizophrenia spectrum disorders and a comparison group of 35 persons. Information about drug use by patients was retrieved from their medical records. Results: OK illusion manifested stronger in patients with depression compared to the other subjects. The patients who were taking benzodiazepines made greater errors evaluating OK figures than those who were not. No differences were found regarding other drug use. The limitations include a limited sample and possible interfering effects of other drugs, especially antidepressants, which have been shown to affect illusion perception. Conclusions: The OK illusion was more prominent in the patients with depression and in those who were taking benzodiazepines. Full article

(This article belongs to the Section Psychiatry)

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13 pages, 666 KiB

Open AccessArticle

Retinal Microvascular Profile of Patients with Coronary Artery Disease

by Alexandra Cristina Rusu, Raluca Ozana Chistol, Grigore Tinica, Cristina Furnica, Simona Irina Damian, Sofia Mihaela David, Klara Brînzaniuc and Karin Ursula Horvath

Medicina 2025, 61(5), 834; https://doi.org/10.3390/medicina61050834 (registering DOI) - 30 Apr 2025

Abstract

Background and Objectives: Screening, primary prevention, and the early identification of high-risk individuals are crucial for minimising the burden of cardiovascular diseases (CVDs). In this study, we aimed to evaluate the association of retinal microvascular features with myocardial dysfunction and CVD risk [...] Read more.

Background and Objectives: Screening, primary prevention, and the early identification of high-risk individuals are crucial for minimising the burden of cardiovascular diseases (CVDs). In this study, we aimed to evaluate the association of retinal microvascular features with myocardial dysfunction and CVD risk factors in a group of patients with significant coronary artery disease (CAD) compared to patients with newly diagnosed isolated arterial hypertension and healthy controls. Materials and Methods: We performed a single-centre cross-sectional study on 214 individuals divided into three groups: a group of 99 cases diagnosed with significant CAD, a group of 61 cases with newly diagnosed isolated arterial hypertension, and a control group of 54 cases with no confirmed cardiovascular pathology. Colour optic disc-centred retinal photographs were taken in all cases, and the following parameters were quantified using MONA REVA 3.0.0 software (VITO Health, Mol, Belgium): central retinal arteriolar equivalent, central retinal venular equivalent, arteriovenous ratio, fractal dimension, tortuosity index, and lacunarity. Univariable and multivariable statistical analyses were performed to assess changes in retinal microvascular features in CVD. Results: Dyslipidaemia (p = 0.009), systolic blood pressure (p = 0.008), and LDL cholesterol (p = 0.003) were negatively associated while left ventricular (LV) strain (0.043) was positively associated with the CRAE. In the case of the CRVE, the coronary Agatston score (p = 0.016) proved a positive and HDL cholesterol (p = 0.018) a negative association. A lower fractal dimension was associated with the presence of diabetes mellitus (p = 0.006), dyslipidaemia (p = 0.011), and a history of acute myocardial infarction (p = 0.018), while a higher fractal dimension was associated with increased left ventricular ejection fraction (LVEF) (p = 0.006) and medical treatment (p = 0.005). Lacunarity was higher in patients of female gender (p = 0.005), with decreased HDL (p = 0.014) and LVEF (0.005), and with increased age (p < 0.001) and Agatston score (p = 0.001). The vessel tortuosity index increased with LV strain (p = 0.05), medical treatment (p = 0.043), and male gender (p = 0.006). Conclusions: Retinal microvascular features may serve as additional risk stratification tools in patients with CVD, particularly CAD, pending prospective validation. Full article

(This article belongs to the Special Issue Advances in Bypass Surgery in Cardiology)

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20 pages, 2067 KiB

Open AccessArticle

Explainable Boosting Machines Identify Key Metabolomic Biomarkers in Rheumatoid Arthritis

by Fatma Hilal Yagin, Cemil Colak, Abdulmohsen Algarni, Ali Algarni, Fahaid Al-Hashem and Luca Paolo Ardigò

Medicina 2025, 61(5), 833; https://doi.org/10.3390/medicina61050833 (registering DOI) - 30 Apr 2025

Abstract

Background and Objectives: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterised by joint inflammation and pain. Metabolomics approaches, which are high-throughput profiling of small molecule metabolites in plasma or serum in RA patients, have so far provided biomarker discovery in the [...] Read more.

Background and Objectives: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterised by joint inflammation and pain. Metabolomics approaches, which are high-throughput profiling of small molecule metabolites in plasma or serum in RA patients, have so far provided biomarker discovery in the literature for clinical subgroups, risk factors, and predictors of treatment response using classical statistical approaches or machine learning models. Despite these recent developments, an explainable artificial intelligence (XAI)-based methodology has not been used to identify RA metabolomic biomarkers and distinguish patients with RA. This study constructed a XAI-based EBM model using global plasma metabolomics profiling to identify metabolites predictive of RA patients and to develop a classification model that can distinguish RA patients from healthy controls. Materials and Methods: Global plasma metabolomics data were analysed from RA patients (49 samples) and healthy individuals (10 samples). SMOTE technique was used for class imbalance in data preprocessing. EBM, LightGBM, and AdaBoost algorithms were applied to generate a discriminatory model between RA and controls. Comprehensive performance metrics were calculated, and the interpretability of the optimal model was assessed using global and local feature descriptions. Results: A total of 59 samples were analysed, 49 from RA patients, and 10 from healthy subjects. The EBM generated better results than LightGBM and AdaBoost by attaining an AUC of 0.901 (95% CI: 0.847–0.955) with 87.8% sensitivity which helps prevent false negative early RA diagnosis. The primary biomarkers EBM-based XAI identified were N-acetyleucine, pyruvic acid, and glycerol-3-phosphate. EBM global explanation analysis indicated that elevated pyruvic acid levels were significantly correlated with RA, whereas N-acetyleucine exhibited a nonlinear relationship, implying possible protective effects at specific concentrations. Conclusions: This study underscores the promise of XAI and evidence-based medicine methodology in developing biomarkers for RA through metabolomics. The discovered metabolites offer significant insights into RA pathophysiology and may function as diagnostic biomarkers or therapeutic targets. Incorporating EBM methodologies integrated with XAI improves model transparency and increases the therapeutic applicability of predictive models for RA diagnosis/management. Furthermore, the transparent structure of the EBM model empowers clinicians to understand and verify the reasoning behind each prediction, thereby fostering trust in AI-assisted decision-making and facilitating the integration of metabolomic insights into routine clinical practice. Full article

(This article belongs to the Special Issue New Strategies for the Diagnosis and Treatment of Rheumatic and Musculoskeletal Diseases)

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3 pages, 191 KiB

Open AccessReply

Reply to Broomfield et al. Comment on “Jankovic et al. Understanding the Benefits of CO₂ Laser Treatment for Vulvovaginal Atrophy. Medicina 2024, 60, 1059”

by Svetlana Jankovic, Marija Rovcanin, Ana Tomic, Aleksandar Jurisic, Zagorka Milovanovic and Milena Zamurovic

Medicina 2025, 61(5), 832; https://doi.org/10.3390/medicina61050832 (registering DOI) - 30 Apr 2025

Abstract

Thank you for bringing these concerns [...] Full article

(This article belongs to the Section Obstetrics and Gynecology)

2 pages, 180 KiB

Open AccessComment

Comment on Jankovic et al. Understanding the Benefits of CO₂ Laser Treatment for Vulvovaginal Atrophy. Medicina 2024, 60, 1059

by Catherine Broomfield, Fiona Li and Jason Abbott

Medicina 2025, 61(5), 831; https://doi.org/10.3390/medicina61050831 (registering DOI) - 30 Apr 2025

Abstract

We write with concerns regarding the recent publication of “Understanding the Benefits of CO₂ Laser Treatment for Vulvovaginal Atrophy” [...] Full article

(This article belongs to the Section Obstetrics and Gynecology)

12 pages, 2589 KiB

Open AccessArticle

Understanding Cyclic Fatigue in Three Nickel–Titanium Pediatric Files: An In Vitro Study for Enhanced Patient Care

by Alwaleed Abushanan, Rajashekhara Bhari Sharanesha, Fahd Aljarbou, Hadi Alamri, Mohammed Hamad Almasud, Abdulfatah AlAzmah, Sara Alghamdi and Mubashir Baig Mirza

Medicina 2025, 61(5), 830; https://doi.org/10.3390/medicina61050830 (registering DOI) - 30 Apr 2025

Abstract

Background and Objectives: Nickel–titanium (Niti) instruments have enhanced root canal cleaning in primary teeth, but file fractures are still common. Materials and Methods: This study evaluated the cyclic fatigue resistance of 120 Niti files from four different systems, A: Kedo SG (n [...] Read more.

Background and Objectives: Nickel–titanium (Niti) instruments have enhanced root canal cleaning in primary teeth, but file fractures are still common. Materials and Methods: This study evaluated the cyclic fatigue resistance of 120 Niti files from four different systems, A: Kedo SG (n = 30); B: Neoendo Pedoflex (n = 30); C: Pedoflex Waldent files (n = 30); and D: Vortex Blue files (n = 30). All the files had similar tip diameters (0.25 mm) and tapers (0.4%) and underwent heat treatment during manufacturing. Cyclic fatigue tests showed notable variations in cycles to fracture (NCF) across groups. All fracture surfaces of the files were assessed through scanning electron microscopy. Results: The mean values achieved in the experimental groups (A, B, C) were less than those in the control Group D (976.90 ± 1085.19). Files in Group A demonstrated the highest NCF (697.01 ± 420.09), while Pedoflex files in Group C showed the lowest values (203.88 ± 155.46). Statistical analysis using the Mann–Whitney test revealed significant differences between Group C and Groups A, B, and D and no differences among Groups A, B, and D. Conclusions: These findings suggest that Kedo SG and Neoendo Pedoflex files offer comparable cyclic fatigue resistance to Vortex Blue files. In contrast, Pedoflex Waldent files exhibit lower resistance to fracture. Full article

(This article belongs to the Special Issue Current and Future Trends in Dentistry and Oral Health)

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13 pages, 1902 KiB

Open AccessArticle

Suramin Exerts an Ameliorative Effect on Acetic Acid-Induced Acute Colitis in Rats by Demonstrating Potent Antioxidant and Anti-Inflammatory Properties

by Gulcin Ercan, Hatice Aygün, Ahmet Akbaş, Osman Sezer Çınaroğlu and Oytun Erbas

Medicina 2025, 61(5), 829; https://doi.org/10.3390/medicina61050829 (registering DOI) - 30 Apr 2025

Abstract

Background and Objectives: The purpose of this study was to evaluate potential protective effects of suramin on inflammation, oxidative stress, and histopathological damage a rat model of acute colitis created with acetic acid. Materials and Methods: Wistar albino (male) rats were [...] Read more.

Background and Objectives: The purpose of this study was to evaluate potential protective effects of suramin on inflammation, oxidative stress, and histopathological damage a rat model of acute colitis created with acetic acid. Materials and Methods: Wistar albino (male) rats were randomly assigned to three groups: control (n = 10), colitis + saline (n = 10), and colitis + suramin (n = 10). Rectal instillation of 4% acetic acid was used to induce acute colitis. Suramin (10 mg/kg/day) or saline was administered intraperitoneally for 15 days. Plasma concentrations of pentraxin 3 (PTX3), tumor necrosis factor-alpha (TNF-α), neutrophil extracellular traps (NETs), and malondialdehyde (MDA) were determined using enzyme-linked immunosorbent assay (ELISA) and spectrophotometric methods. In addition, vascular endothelial growth factor (VEGF) and TNF-α levels in colonic tissue were also measured. Histopathological evaluations were conducted using hematoxylin and eosin staining. Results: Significant increases in plasma and tissue inflammatory markers, oxidative stress parameters, and histopathological scores were observed when compared to control group; values were higher in colitis group. Suramin treatment significantly reduced plasma PTX3, TNF-α, NETs, and MDA levels, and colonic TNF-α and VEGF concentrations compared to the untreated colitis group. Histological analysis showed reduced epithelial injury and leukocyte presence in rats receiving suramin. Conclusions: Our findings demonstrate that suramin significantly attenuates inflammatory and oxidative damage in an experimental model of acute colitis. These results suggest that suramin may possess therapeutic potential in intestinal inflammation; however, this effect requires further support through advanced experimental and clinical studies. Full article

(This article belongs to the Section Gastroenterology & Hepatology)

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18 pages, 1406 KiB

Open AccessSystematic Review

Treatment Strategies and Prognostic Outcomes in Acute Limb Ischemia: A Systematic Review and Meta-Analysis Comparing Thrombolytic Therapy and Open Surgical Interventions

by Mircea Cătălin Coșarcă, Nicolae Alexandru Lazăr, Suzana Vasilica Șincaru, Bogdan Corneliu Bandici, Eduard Costin Argatu, Cosmin Carașca, Ráduly Gergő, Dorin Constantin Dorobanțu, Cristian Trâmbițaș and Adrian Vasile Mureșan

Medicina 2025, 61(5), 828; https://doi.org/10.3390/medicina61050828 (registering DOI) - 30 Apr 2025

Abstract

Background and Objectives: Acute limb ischemia (ALI) is a life-threatening vascular emergency that requires immediate intervention to restore perfusion and prevent limb loss or mortality. Management strategies primarily include thrombolysis and surgical revascularization, each with distinct risks and benefits. This review evaluates [...] Read more.

Background and Objectives: Acute limb ischemia (ALI) is a life-threatening vascular emergency that requires immediate intervention to restore perfusion and prevent limb loss or mortality. Management strategies primarily include thrombolysis and surgical revascularization, each with distinct risks and benefits. This review evaluates and compares the outcomes of thrombolysis and surgical revascularization in ALI management, emphasizing their efficacy, safety, and patient selection criteria. Materials and Methods: A systematic review was conducted in adherence to PRISMA guidelines, analyzing data from 15 studies, including randomized controlled trials and large retrospective analyses, encompassing over 3500 patients with varying demographics and clinical presentations. Study quality was assessed using the Cochrane risk of bias tool and the Newcastle–Ottawa Scale. Results: Thrombolysis, utilizing agents such as urokinase or recombinant tissue plasminogen activator (rt-PA), demonstrated limb salvage rates up to 90% in acute cases, with 30-day mortality rates of 4–6%. It was particularly effective in patients with embolic occlusions or short symptom durations. However, bleeding complications associated with thrombolysis were reported in up to 47% of cases. Conversely, surgical revascularization remains crucial for those with advanced ischemia or contraindications to thrombolysis, offering reliable perfusion restoration but with higher perioperative morbidity, especially in older patients with significant comorbidities. Recent advancements, including hybrid approaches combining catheter-directed thrombolysis with percutaneous mechanical thrombectomy, have shown promise in improving outcomes by reducing procedure times and enhancing clot resolution. Conclusions: While thrombolysis and surgical revascularization are effective, optimizing patient selection remains a key challenge. Future research should focus on refining treatment algorithms, investigating novel thrombolytic agents, and expanding the role of minimally invasive techniques to improve long-term outcomes while mitigating complications such as bleeding and reperfusion injuries. Full article

(This article belongs to the Section Surgery)

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16 pages, 1105 KiB

Open AccessArticle

Comorbidity Burden in Chronic Thromboembolic Pulmonary Hypertension: Implications and Outcome

by Burcak Kilickiran Avci, Ibrahim Basarici, Mehmet Akbulut, Halil Atas, Yalin Tolga Yaylali, Umit Yasar Sinan, Ersan Atahan, Murat Meric, Baris Kaya, Kardelen Ohtaroglu Tokdil, Ozden Calay, Hasan Tokdil, Bulent Mutlu, Mehmet Serdar Kucukoglu and Zeki Ongen

Medicina 2025, 61(5), 827; https://doi.org/10.3390/medicina61050827 (registering DOI) - 30 Apr 2025

Abstract

Background and Objectives: Comorbidities, the coexistence of additional conditions with a primary disease, are increasingly prevalent, complicating disease management and clinical outcomes. While CTEPH is a well-studied condition in terms of risk factors and outcomes, the specific impact of comorbidity burden on [...] Read more.

Background and Objectives: Comorbidities, the coexistence of additional conditions with a primary disease, are increasingly prevalent, complicating disease management and clinical outcomes. While CTEPH is a well-studied condition in terms of risk factors and outcomes, the specific impact of comorbidity burden on clinical presentation, treatment decisions, and survival remains insufficiently explored. This study aims to assess the prevalence and burden of comorbidities in CTEPH and to examine their associations with initial clinical characteristics, treatment allocation, and survival, stratified by pulmonary endarterectomy (PEA) status. Materials and Methods: We included 187 CTEPH patients from eight tertiary PH centers (2009–2020). Cardiovascular and non-cardiovascular comorbidities were identified and categorized as 0, 1–2, or ≥3. Their impact on baseline six-minute walk distance (6MWD), hemodynamic parameters, operability decision, and survival was assessed. Results: Comorbidities were prevalent (90%), with 49% of patients having three or more. Hypertension, diabetes, coronary artery disease, and chronic kidney disease (CKD) were associated with lower 6MWD. Hypertension, atrial fibrillation, left heart failure, and CKD were linked to elevated right atrial and pulmonary arterial wedge pressures. Comorbidities rendered 39% of anatomically operable patients ineligible for surgery. No single comorbidity predicted survival. Among PEA patients, those with ≥3 cardiovascular comorbidities had worse survival (p = 0.010). In contrast, the comorbidity burden did not impact survival in non-PEA patients. PEA surgery (HR 0.342, 95% CI 0.130–0.899, p = 0.030) and baseline 6MWD (HR 0.997, 95% CI 0.994–1.000, p = 0.036) were identified as independent predictors of mortality. Conclusions: A high comorbidity burden is common in CTEPH and influences functional status, hemodynamics, and operability decisions. It may worsen long-term outcomes after PEA but appears to be less prognostic in non-operated patients, where disease severity seems to be the primary determinant of outcomes. These findings underscore the importance of careful operability assessment and proactive comorbidity management. Full article

(This article belongs to the Section Cardiology)

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20 pages, 1753 KiB

Open AccessReview

Telemedicine and Digital Tools in Dentistry: Enhancing Diagnosis and Remote Patient Care

by Amelia Surdu, Cezar Ilie Foia, Ionut Luchian, Daniela Trifan, Dana Gabriela Budala, Mihaela Monica Scutariu, Corina Ciupilan, Bogdan Puha and Diana Tatarciuc

Medicina 2025, 61(5), 826; https://doi.org/10.3390/medicina61050826 (registering DOI) - 30 Apr 2025

Abstract

Teledentistry enhances access to oral healthcare by enabling remote consultations, diagnosis, and patient management. This paper explores its applications, benefits, challenges, and impact on modern dentistry. A comprehensive review of existing literature and case studies was conducted to examine the effectiveness of teledentistry. [...] Read more.

Teledentistry enhances access to oral healthcare by enabling remote consultations, diagnosis, and patient management. This paper explores its applications, benefits, challenges, and impact on modern dentistry. A comprehensive review of existing literature and case studies was conducted to examine the effectiveness of teledentistry. Key aspects analyzed include digital imaging, AI (artificial intelligence)-assisted diagnostics, and cloud-based patient records, which facilitate early disease detection, reduce wait times, and minimize unnecessary visits. The review also highlights how teledentistry improves collaboration among dental professionals for better treatment planning. Challenges include legal barriers, data security concerns, and limited digital infrastructure. Standardized protocols and professional training are essential for effective implementation. Future advancements in AI and telecommunication technologies will further integrate teledentistry into standard practice, improving accessibility and efficiency in oral healthcare. Full article

(This article belongs to the Special Issue Current and Future Trends in Dentistry and Oral Health)

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14 pages, 3222 KiB

Open AccessArticle

Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Postoperative Analgesia After Laparoscopic Colorectal Surgery

by Mihaela Roxana Oliță, Mihai Adrian Eftimie, Bogdan Obrișcă, Bogdan Sorohan, Dragoș Eugen Georgescu, Liliana Elena Mirea and Dana Rodica Tomescu

Medicina 2025, 61(5), 825; https://doi.org/10.3390/medicina61050825 (registering DOI) - 30 Apr 2025

Abstract

Background and Objectives: Extensive research has demonstrated that various approaches to the quadratus lumborum (QL) block offer superior postoperative analgesia compared to the transversus abdominis plane (TAP) block, particularly in reducing opioid consumption. This study aims to compare postoperative analgesia between the [...] Read more.

Background and Objectives: Extensive research has demonstrated that various approaches to the quadratus lumborum (QL) block offer superior postoperative analgesia compared to the transversus abdominis plane (TAP) block, particularly in reducing opioid consumption. This study aims to compare postoperative analgesia between the blocks in laparoscopic colorectal surgery. Materials and Methods: A retrospective analysis was performed on patients with elective colorectal surgeries who received bilateral US TAP blocks in the supine position or US anterior QL block in the lateral position at the end of the surgery and before extubating, with Ropivacaine 0.25%. Total opioid consumption and time to first intravenous analgesic were noted. Results: Between January 2020 and December 2024, 410 patients underwent elective laparoscopic colorectal oncology surgery under general anesthesia, with peripheral nerve blocks. Of these, we analyzed 116 patients with localized diseases who underwent elective surgeries and who did not require conversion to classical surgery and received either QL or TAP blocks. A total of 62 patients underwent QL block and 54 received TAP block. For the primary outcome, in the QL group, significantly fewer opioids were used than in the TAP group (p < 0.001), and time to first rescue analgesic was prolonged in the QL group at 16 h (IQR 14–18) compared to the TAP group, where the requirement occurred earlier at 8 h (IQR 8–8) postoperatively (p < 0.001). Conclusions: Postoperative bilateral US anterior QL block reduced morphine consumption and improved time to rescue analgesia and LOS compared with midaxillary line bilateral US TAP block. Full article

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

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