Medicina

13 pages, 1285 KB

Open AccessEditor’s ChoiceArticle

Temporal Trends of Dengue Surveillance in Sardinia, Italy: Implications of Climate Change on Human and Entomological Monitoring

by Giovanna Deiana, Isabella Figoni, Antonella Arghittu, Guglielmo Campus, Giuseppe Satta, Cipriano Foxi, Andrea Piana, Paolo Castiglia and Marco Dettori

Medicina 2025, 61(11), 2024; https://doi.org/10.3390/medicina61112024 - 12 Nov 2025

Cited by 1 | Viewed by 1020

Abstract

Background and Objectives: Climate change is modifying the ecological and climatic conditions that influence the distribution and activity of arthropod vectors. Rising temperatures and prolonged warm seasons have favored the establishment of Aedes albopictus in Mediterranean regions, increasing the risk of autochthonous Dengue [...] Read more.

Background and Objectives: Climate change is modifying the ecological and climatic conditions that influence the distribution and activity of arthropod vectors. Rising temperatures and prolonged warm seasons have favored the establishment of Aedes albopictus in Mediterranean regions, increasing the risk of autochthonous Dengue transmission. Therefore, this study describes the evolution of Dengue surveillance in Sardinia between 2018 and 2024, integrating human and entomological data to assess trends, system performance, and implications for prevention and control. Materials and Methods: Data on human cases were retrieved from national notification systems (namely PREMAL, arbo.iss.it) and the New Health Information System. Entomological surveillance data were obtained from the Experimental Zooprophylactic Institute of Sardinia. Mosquitoes were collected using BG-Sentinel^® traps and ovitraps, covering major cities and points of entry. Descriptive analyses were conducted for both datasets. Results: Sixteen Dengue cases were reported during the study period, all imported and laboratory-confirmed in 81% of cases. Most patients were adults (mean age 38 years), and 77% required hospitalization. The most frequent travel origins were Southeast Asia, Africa, and Latin America. No autochthonous cases were identified. Entomological surveillance showed a progressive increase in Aedes albopictus captures from 2020 onwards, with seasonal peaks between September and October. Despite intensified sampling and expanded geographic coverage, no mosquito pools tested positive for the Dengue virus. Conclusions: Although no locally acquired Dengue infections have been detected, the widespread and increasing presence of Aedes albopictus indicates that Sardinia meets the ecological prerequisites for possible autochthonous transmission. Strengthening the timeliness and completeness of human surveillance, improving clinicians’ awareness of reporting requirements, promoting vaccination for travelers, and maintaining continuous entomological monitoring are essential to prevent and promptly manage future outbreaks. Full article

(This article belongs to the Special Issue Emerging Trends in Infectious Disease Prevention and Control)

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13 pages, 354 KB

Open AccessEditor’s ChoiceSystematic Review

Applications of Artificial Intelligence in Alpha-1 Antitrypsin Deficiency: A Systematic Review from a Respiratory Medicine Perspective

by Manuel Casal-Guisande, Laura Villar-Aguilar, Alberto Fernández-Villar, Esmeralda García-Rodríguez, Ana Casal and María Torres-Durán

Medicina 2025, 61(10), 1768; https://doi.org/10.3390/medicina61101768 - 30 Sep 2025

Cited by 2 | Viewed by 1075

Abstract

Background and Objectives: Alpha-1 antitrypsin deficiency (AATD) is a rare genetic condition associated with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) and emphysema, and with liver involvement through a distinct toxic gain-of-function mechanism. Despite its clinical relevance, AATD remains [...] Read more.

Background and Objectives: Alpha-1 antitrypsin deficiency (AATD) is a rare genetic condition associated with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) and emphysema, and with liver involvement through a distinct toxic gain-of-function mechanism. Despite its clinical relevance, AATD remains underdiagnosed and exhibits marked phenotypic heterogeneity. Artificial intelligence (AI) has shown growing potential in respiratory medicine, yet its application to AATD is still limited. This systematic review synthesizes the clinical evidence on AI in AATD, primarily in the respiratory domain and, where available, in hepatic outcomes. Materials and Methods: We conducted a PRISMA-guided search (PubMed, Web of Science, IEEE Xplore) for original, peer-reviewed articles (January 2014–September 2025) applying AI to detection, classification, stratification, or prediction tasks in AATD. Results: Six studies met eligibility criteria. Supervised models (e.g., XGBoost, penalized regression, Transformer-based architectures) and one unsupervised approach were identified. Applications included screening in COPD populations, prediction of emphysema progression from CT, proteomic modeling of lung function, identification of clinical subgroups, and prediction of clinical outcomes in AATD-associated liver disease. External validation and genotype diversity remained limited across studies. Conclusions: Although AI shows promise in improving detection, prognosis, and patient stratification in AATD across both respiratory and hepatic manifestations, the current evidence remains limited. Broader, multicenter validation in genotype-diverse cohorts is required to confirm its clinical utility and support the implementation of precision medicine in AATD. Full article

(This article belongs to the Section Pulmonology)

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16 pages, 5095 KB

Open AccessEditor’s ChoiceArticle

Nationwide Epidemiology of Hospitalized Acute ACL Ruptures in Romania: A 7-Year Analysis (2017–2023)

by Gloria Alexandra Tolan, Ionut Daniel Raducan, Bogdan Uivaraseanu, Delia Mirela Tit, Gabriela S. Bungau, Andrei-Flavius Radu and Cristian George Furau

Medicina 2025, 61(9), 1672; https://doi.org/10.3390/medicina61091672 - 15 Sep 2025

Cited by 2 | Viewed by 1124

Abstract

Background and Objectives: Anterior cruciate ligament (ACL) rupture is one of the most frequent and debilitating knee injuries, especially among young, physically active individuals. While extensively studied in Western countries, large-scale epidemiological data from Eastern Europe remain scarce. This study offers the first [...] Read more.

Background and Objectives: Anterior cruciate ligament (ACL) rupture is one of the most frequent and debilitating knee injuries, especially among young, physically active individuals. While extensively studied in Western countries, large-scale epidemiological data from Eastern Europe remain scarce. This study offers the first nationwide assessment of hospitalization-based incidence of acute ACL rupture in Romania. Materials and Methods: We conducted a retrospective analysis of all hospital discharges coded as S83.53 (ACL rupture) between 2017 and 2023, using national public health datasets. Incidence rates were calculated per 100,000 inhabitants based on the 2021 national census. Data were analyzed by sex, age, year, and region. Results: A total of 4332 ACL-related discharges were recorded (3130 males and 1202 females), yielding an average incidence of 3.23 per 100,000 per year. Incidence in males was consistently higher (up to 5.63) than in females (up to 2.10). The peak incidence occurred in 2023, while the lowest was observed in 2020, likely due to COVID-19-related restrictions. Linear regression showed a significant upward trend over time (R² = 0.966, p < 0.001). The highest age-specific incidence was found in males aged 25–29 years (116.3/100,000) and in females aged 15–19 years (35.4/100,000). Cases were rare above the age of 50. Geographically, incidence varied widely, with Bucharest, Timiș, and Bihor recorded the highest rates, while several other counties reported near-zero values. Conclusions: This study provides the first nationwide analysis of hospitalization-based ACL rupture incidence in Romania, revealing marked differences by age, sex, and region. While the findings reflect only acute cases requiring inpatient care, they underscore the need for more comprehensive injury surveillance, improved access to orthopedic services, and targeted prevention strategies tailored to high-risk populations. Full article

(This article belongs to the Special Issue Anterior Cruciate Ligament (ACL) Injury)

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20 pages, 382 KB

Open AccessEditor’s ChoiceArticle

Association Between Redox and Inflammatory Biomarkers with the Presence and Severity of Obstructive Sleep Apnea

by Ana Ninić, Branislava Rajkov, Jelena Kotur-Stevuljević, Sanja Erceg, Miron Sopić, Jelena Munjas, Vesna Spasojević-Kalimanovska, Marija Mitrović, Lidija Memon, Vera Gardijan, Milica Brajković, Slobodan Klašnja and Marija Zdravković

Medicina 2025, 61(9), 1557; https://doi.org/10.3390/medicina61091557 - 29 Aug 2025

Cited by 2 | Viewed by 1173

Abstract

Background and Objectives: Obstructive sleep apnea (OSA) represents an increasing public health concern, closely linked with cardiovascular, metabolic, and neurocognitive disorders, as well as impaired quality of life. The complex pathophysiology of OSA involves upper airway dysfunction, oxidative stress, and inflammation, with endothelial [...] Read more.

Background and Objectives: Obstructive sleep apnea (OSA) represents an increasing public health concern, closely linked with cardiovascular, metabolic, and neurocognitive disorders, as well as impaired quality of life. The complex pathophysiology of OSA involves upper airway dysfunction, oxidative stress, and inflammation, with endothelial dysfunction considered central to its associated comorbidities. Despite notable advances in OSA research, the biological mechanisms driving these complications remain insufficiently understood. The present study aimed to examine the associations between redox status, proinflammatory biomarkers, and the gene expression of full-length receptor for advanced glycation end products (flRAGE) and transforming growth factor beta 1 (TGF-β1) in relation to the presence and severity of OSA. Materials and Methods: The study cohort comprised 125 participants with diagnosed OSA and 42 controls without evidence of OSA. General and clinical characteristics were recorded for all participants. Laboratory analyses included the assessment of redox and inflammatory markers in serum and plasma, while flRAGE and TGF-β1 messenger ribonucleic acids (mRNA) were quantified in peripheral blood mononuclear cells. Results: Patients with OSA demonstrated elevated oxidative stress and inflammation, characterized by increased total antioxidant status (TAS) and C-reactive protein CRP levels, together with reduced concentrations of soluble RAGE (sRAGE). The severity of OSA, indicated by the apnea-hypopnea index, increases total oxidative status (TOS) and TGF-β1 mRNA, while sRAGE decreases. The sRAGE–ROS-related factor was negatively associated with OSA, whereas the redox status factor showed a positive association. TOS was independently and positively correlated with OSA severity. Conclusions: Individuals with OSA exhibit a state of enhanced oxidative stress and inflammation. Increasing severity of OSA was associated with rising TOS and TGF-β1 mRNA expression, accompanied by declining sRAGE concentrations. A combined redox–inflammatory biomarker profile was found to be associated with both the presence and severity of OSA. Full article

(This article belongs to the Section Pulmonology)

22 pages, 1072 KB

Open AccessEditor’s ChoiceSystematic Review

Using Computerised Gait Analysis to Assess Changes After Rehabilitation in Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Gait Speed Improvement

by Mihaela Minea, Sermina Ismail, Lucian Cristian Petcu, Andreea-Dalila Nedelcu, Adina Petcu, Alexandra-Elena Minea and Mădălina-Gabriela Iliescu

Medicina 2025, 61(9), 1540; https://doi.org/10.3390/medicina61091540 - 27 Aug 2025

Cited by 3 | Viewed by 4789

Abstract

Background and objectives: Knee osteoarthritis (KOA) is a degenerative joint disorder often associated with altered gait mechanics. This systematic review aims to evaluate the effect of rehabilitation treatment on walking, with a focus on gait speed. Material and methods: A systematic [...] Read more.

Background and objectives: Knee osteoarthritis (KOA) is a degenerative joint disorder often associated with altered gait mechanics. This systematic review aims to evaluate the effect of rehabilitation treatment on walking, with a focus on gait speed. Material and methods: A systematic search was conducted in PubMed, Scopus, Web of Science, Cochrane, and PEDro databases, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Randomised controlled trials published in English between 2015 and 2025, involving patients with KOA undergoing rehabilitation and using computerised gait measurements, including 3D motion capture, force plates, and instrumented treadmills, were included. A meta-analysis was conducted on the selected studies assessing gait speed, with the risk of bias being evaluated using the Cochrane Risk of Bias 2 tool for RCTs. Results: Out of 2143 articles, 7 studies met the inclusion criteria. These studies showed increased gait speed in patients with KOA following exercise therapy, various walking training programmes, massage, or dietary interventions. The meta-analysis revealed a standardised mean difference (SMD) of 1.807, with a 95% confidence interval (CI) of [1.637, 1.977] (p < 0.001). The interventions were associated with improvements in walking parameters and quality of life, as well as reductions in pain and fall risk. Substantial heterogeneity was noted, likely due to variations in intervention types and study populations. Conclusions: The results suggest an overall improvement in gait speed in the intervention groups compared to the control groups. However, only a limited number of studies have investigated the effects of physiotherapy, bath therapy, or mud therapy on gait mechanics in patients with KOA. Full article

(This article belongs to the Special Issue Advances in Pathogenesis, Rehabilitation, and Treatment of Knee Osteoarthritis)

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15 pages, 392 KB

Open AccessEditor’s ChoiceArticle

Systemic Immune-Inflammation Index and Related Hematologic Markers as Prognostic Tools in Type 2 Diabetes

by Raluca Cosma-Lăzuran, Daniel-Corneliu Leucuta and Mihaela-Simona Popoviciu

Medicina 2025, 61(8), 1433; https://doi.org/10.3390/medicina61081433 - 9 Aug 2025

Cited by 7 | Viewed by 2583

Abstract

Background and Objectives: Chronic low-grade inflammation plays a key role in the pathogenesis of type 2 diabetes mellitus (T2DM) and its vascular complications. Hematological indices derived from routine blood counts, such as neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte [...] Read more.

Background and Objectives: Chronic low-grade inflammation plays a key role in the pathogenesis of type 2 diabetes mellitus (T2DM) and its vascular complications. Hematological indices derived from routine blood counts, such as neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI), have been proposed as surrogate markers for systemic inflammation and predictors of cardiovascular risk. This study aimed to evaluate the predictive value of these inflammatory indices concerning the presence of micro- and macrovascular complications and cardiovascular mortality in patients with type 2 diabetes mellitus. Materials and Methods: We conducted a retrospective cohort study including 237 patients with T2DM. We assessed the association between hematological indices and cardiovascular mortality, followed by a ROC curve analysis to evaluate their predictive performance, and a multiple logistic regression. Results: Thirty patients (12.66%) died during the study period. ROC analysis showed that SIRI (AUC = 0.680 [95% CI 0.576–0.779]), LMR (AUC = 0.667 [95% CI 0.564–0.763]), AISI (AUC = 0.662 [95% CI 0.553–0.768]), and NLR (AUC = 0.657 [95% CI 0.545–0.764]) had the best discriminative capacity, all with specificity >70%. The relation remained significant even after adjustments for confounding variables in multiple logistic regression. For microvascular complications, Monocyte count (AUC = 0.611 [95% CI 0.532–0.69]) and LMR (AUC = 0.608 [95% CI 0.521–0.695]) showed minimal but notable predictive value. Conclusions: SIRI, LMR, AISI, and NLR were significantly associated with mortality and demonstrated modest discriminative ability. These markers, accessible and cost-effective, may be useful tools for risk stratification in T2DM patients. Further validation in prospective cohorts is warranted. Full article

(This article belongs to the Section Endocrinology)

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17 pages, 1157 KB

Open AccessEditor’s ChoiceReview

Multidisciplinary Postoperative Ileus Management: A Narrative Review

by Sun Yu, Katrina Kerolus, Zhaosheng Jin, Sandi Bajrami, Paula Denoya and Sergio D. Bergese

Medicina 2025, 61(8), 1344; https://doi.org/10.3390/medicina61081344 - 25 Jul 2025

Cited by 6 | Viewed by 7153

Abstract

Postoperative ileus is a prolonged impairment of gastrointestinal motility following surgical procedures. This often leads to increased morbidity, extended hospital stays, and high healthcare expenditures. In this review, we discuss the pathophysiology underlying postoperative ileus, its epidemiology, and perioperative management strategies. Patient characteristics, [...] Read more.

Postoperative ileus is a prolonged impairment of gastrointestinal motility following surgical procedures. This often leads to increased morbidity, extended hospital stays, and high healthcare expenditures. In this review, we discuss the pathophysiology underlying postoperative ileus, its epidemiology, and perioperative management strategies. Patient characteristics, as well as expected perioperative course, could be used to stratify the risks of postoperative ileus. Preventive measures hinge upon a multimodal approach, minimally invasive surgical techniques, fluid management, early postoperative ambulation, and opioid-sparing analgesia strategies. Adjuvant interventions such as alvimopan, caffeine, and chewing gum have demonstrated efficacy in modulating the neurogenic and inflammatory components of postoperative ileus. Minimally invasive approaches, comprehensive perioperative management, and adjuvant therapies hold promise for prevention. Current management relies heavily on supportive care, underscoring the need for research into the underlying neurogenic and inflammatory mechanisms to guide the development of targeted treatments. Full article

(This article belongs to the Section Surgery)

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24 pages, 743 KB

Open AccessEditor’s ChoiceReview

Surgical Treatment, Rehabilitative Approaches and Functioning Assessment for Patients Affected by Breast Cancer-Related Lymphedema: A Comprehensive Review

by Paola Ciamarra, Alessandro de Sire, Dicle Aksoyler, Giovanni Paolino, Carmen Cantisani, Francesco Sabbatino, Luigi Schiavo, Renato Cuocolo, Carlo Pietro Campobasso and Luigi Losco

Medicina 2025, 61(8), 1327; https://doi.org/10.3390/medicina61081327 - 23 Jul 2025

Cited by 2 | Viewed by 4292

Abstract

Introduction: Breast cancer therapy is a common cause of lymphedema. The accumulation of protein-rich fluid in the affected extremity leads to a progressive path—swelling, inflammation, and fibrosis—namely, irreversible changes. Methods: A scientific literature analysis was performed on PubMed/Medline, Scopus, Web of Science (WoS), [...] Read more.

Introduction: Breast cancer therapy is a common cause of lymphedema. The accumulation of protein-rich fluid in the affected extremity leads to a progressive path—swelling, inflammation, and fibrosis—namely, irreversible changes. Methods: A scientific literature analysis was performed on PubMed/Medline, Scopus, Web of Science (WoS), the Cochrane Central Register of Controlled Trials (CENTRAL), and the Physiotherapy Evidence Database (PEDro) from inception until 30 June 2024. Results: Breast cancer-related lymphedema (BCRL) is indeed an important healthcare burden both due to the significant patient-related outcomes and the overall social impact of this condition. Even though lymphedema is not life-threatening, the literature underlined harmful consequences in terms of pain, infections, distress, and functional impairment with a subsequent and relevant decrease in quality of life. Currently, since there is no cure, the therapeutic approach to BCRL aims to slow disease progression and prevent related complications. A comprehensive overview of postmastectomy lymphedema is offered. First, the pathophysiology and risk factors associated with BCRL were detailed; then, diagnosis modalities were depicted highlighting the importance of early detection. According to non-negligible changes in patients’ everyday lives, novel criteria for patients’ functioning assessment are reported. Regarding the treatment modalities, a wide array of conservative and surgical methods both physiologic and ablative were analyzed with their own outcomes and downsides. Conclusions: Combined strategies and multidisciplinary protocols for BCRL, including specialized management by reconstructive surgeons and physiatrists, along with healthy lifestyle programs and personalized nutritional counseling, should be compulsory to address patients’ demands and optimize the treatment of this harmful and non-curable condition. The Lymphedema-specific ICF Core Sets should be included more often in the overall outcome evaluation with the aim of obtaining a comprehensive appraisal of the treatment strategies that take into account the patient’s subjective score. Full article

(This article belongs to the Section Surgery)

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22 pages, 1269 KB

Open AccessEditor’s ChoiceArticle

Pre- and Post- COVID-19 Pandemic Pneumonia Rates in Hospitalized Schizophrenia Patients

by Ana-Aliana Miron, Petru Iulian Ifteni, Alexandra-Elena Lungu, Elena-Luiza Dragomirescu, Lorena Dima and Andreea Teodorescu

Medicina 2025, 61(7), 1251; https://doi.org/10.3390/medicina61071251 - 10 Jul 2025

Cited by 3 | Viewed by 1623

Abstract

Background and Objectives: Schizophrenia is a disabling psychiatric condition, affecting around 1% of people worldwide. It has been ranked among the ten most disabling conditions globally. Alongside the psychological and social burdens imposed on individuals suffering from this disease, there are also [...] Read more.

Background and Objectives: Schizophrenia is a disabling psychiatric condition, affecting around 1% of people worldwide. It has been ranked among the ten most disabling conditions globally. Alongside the psychological and social burdens imposed on individuals suffering from this disease, there are also serious complications regarding the physical health of these patients. Pneumonia is a significant cause of death in patients with schizophrenia. This group of patients also has a higher risk of developing pneumonia and all-cause mortality compared to those without schizophrenia, along with an increased overall mortality rate. A retrospective study revealed that advanced age, underweight, smoking, and the use of high-dose atypical antipsychotics increase the risk of pneumonia-related mortality in hospitalized patients. Our study aims to examine differences in factors associated with pneumonia in hospitalized patients with schizophrenia, before and after the COVID-19 pandemic, as well as to identify potential changes in clinical characteristics and outcomes. Materials and Methods: This is an observational, retrospective analysis, based on the review of medical records of psychiatric inpatients diagnosed with schizophrenia according to the DSM-5 criteria. Patients were selected according to the following criteria: both schizophrenia and pneumonia diagnoses, hospitalized in Spitalul Clinic de Psihiatrie si Neurologie Brasov during 1 March 2018–1 March 2020, and 1 March 2022–1 March 2024, respectively. Results: A total of 27 patients met the inclusion criteria; 13 patients (48%) were in the pre-pandemic group and 14 patients (52%) in the post-pandemic group. Contrary to other reports, our results showed relatively low pneumonia rates in hospitalized schizophrenia patients (1.02% pre-pandemic and 1.63% post-pandemic), and rates were higher in female patients (61.54% pre-pandemic and 71.43% post-pandemic). Post-pandemic, most cases (42.86%) were registered during summer, in a schizophrenia population with mostly urban residence and with lower smoking rates than the pre-pandemic group. Physical restraints were, however, more frequently utilized in the post-pandemic group. Conclusions: Pneumonia risk factors might register a change in the post-pandemic years. Polypharmacy and physical restraints are probably underestimated risk factors for pneumonia in schizophrenia patients, while a multidisciplinary approach and preventive measures might exert a protective role. Full article

(This article belongs to the Special Issue Mental Health Care: Pandemic and Beyond)

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13 pages, 840 KB

Open AccessEditor’s ChoiceArticle

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 - 9 Jul 2025

Cited by 4 | Viewed by 1074

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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17 pages, 451 KB

Open AccessEditor’s ChoiceReview

Biomarkers and Neuropsychological Tools in Attention-Deficit/Hyperactivity Disorder: From Subjectivity to Precision Diagnosis

by Ion Andrei Hurjui, Ruxandra Maria Hurjui, Loredana Liliana Hurjui, Ionela Lacramioara Serban, Irina Dobrin, Mihai Apostu and Romeo Petru Dobrin

Medicina 2025, 61(7), 1211; https://doi.org/10.3390/medicina61071211 - 3 Jul 2025

Cited by 3 | Viewed by 4686

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder with chronic inattention, hyperactivity, and impulsivity and is linked with significant functional impairment. Despite being highly prevalent, diagnosis of ADHD continues to rely on subjective assessment reports of behavior and is often delayed or inaccurate. [...] Read more.

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder with chronic inattention, hyperactivity, and impulsivity and is linked with significant functional impairment. Despite being highly prevalent, diagnosis of ADHD continues to rely on subjective assessment reports of behavior and is often delayed or inaccurate. This review summarizes current advances in biomarkers and neuropsychological tests for the improvement of ADHD diagnosis and treatment. Key biomarkers are neuroimaging methods (e.g., structural and functional MRI), electrophysiological measures (e.g., EEG, ERP), and biochemical measures (e.g., cortisol, vitamin D). Additionally, novel experimental measures, e.g., eye-tracking, pupillometry, and microbiome analysis, hold the promise to be objective and dynamic measures of ADHD symptoms. The review also comments on the impact of the burden of ADHD on quality of life, e.g., emotional well-being, academic achievement, and social functioning. Additionally, differences between individuals, such as age, sex, comorbidities, and the impact of social and family support, are also addressed in relation to ADHD outcomes. In summary, we highlight the potential of these emerging biomarkers and tools to revolutionize ADHD diagnosis and guide personalized treatment strategies. These insights have significant implications for improving patient outcomes. Full article

(This article belongs to the Section Psychiatry)

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12 pages, 1740 KB

Open AccessEditor’s ChoiceArticle

Which B2 Fractures Can Be Treated with ORIF? Validation of the “Beyond the Vancouver Classification”

by Karl Stoffel, Martin Clauss and Marlene Mauch

Medicina 2025, 61(7), 1138; https://doi.org/10.3390/medicina61071138 - 24 Jun 2025

Cited by 3 | Viewed by 1206

Abstract

Background and objectives: The objective was to validate the Beyond the Vancouver classification. Based on this algorithm, it was hypothesized that cemented polished tapered stems with an intact cement mantle and cementless stable stems with defined criteria could be classified as stable and [...] Read more.

Background and objectives: The objective was to validate the Beyond the Vancouver classification. Based on this algorithm, it was hypothesized that cemented polished tapered stems with an intact cement mantle and cementless stable stems with defined criteria could be classified as stable and therefore treated with open reduction and internal fixation (ORIF). Materials and Methods: This retrospective, single-center cohort study re-analyzed patients initially diagnosed with Vancouver type B2 fractures treated with ORIF between 2007 and 2020. Clinical and radiological outcomes were extracted from medical reports. A combined radiological and clinical score was used as the main outcome measure. Patients categorized according to the Beyond the Vancouver classification were compared for functional outcome. Results: 42 patients (25 male, 17 female) with a median (range) age of 83 years (75–88 years) and follow-up time of 25 weeks (12–35 weeks) were reviewed. It was found that ORIF achieved excellent or good results in 81% of cases for stems classified as stable (n = 16) and in 30% of cases for stems classified as loose (n = 23). Successful cases (30%), although classified as loose, all had the same fracture pattern: an intact greater trochanter and a fracture fragment attached laterally to the stem with distal fixation of the stem. Conclusions: This case series suggests that certain Vancouver B2 fractures can be treated with ORIF. The Beyond the Vancouver classification may support the categorization of ‘stable’ and ‘loose’ stems. The validity of the algorithm was supported by the observation that ORIF provided excellent and good results for the majority of stems classified as ‘stable’, but poor results for stems classified as ‘loose’. Furthermore, the fracture pattern has been shown to be a crucial factor that should be considered when treating distally fixed cementless stems. The classification was therefore expanded to include the specific fracture patterns in cementless distally fixed stems that can be successfully treated with ORIF. The Beyond the Vancouver classification can provide further guidance in the identification of ‘loose’ or ‘stable’ stems. Full article

(This article belongs to the Section Orthopedics)

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35 pages, 8088 KB

Open AccessEditor’s ChoiceSystematic Review

Mind over Malignancy: A Systematic Review and Meta-Analysis of Psychological Distress, Coping, and Therapeutic Interventions in Oncology

by Ana Maria Paslaru, Alina Plesea-Condratovici, Lavinia-Alexandra Moroianu, Oana-Maria Isailă, Laura Florentina Rebegea, Liliana Lacramioara Pavel and Anamaria Ciubară

Medicina 2025, 61(6), 1086; https://doi.org/10.3390/medicina61061086 - 13 Jun 2025

Cited by 10 | Viewed by 5588

Abstract

Background and Objectives: Psychological distress is a pervasive yet often undertreated aspect of the cancer experience, contributing to reduced quality of life, poorer treatment adherence, and worse health outcomes. This systematic review and meta-analysis evaluated the efficacy of non-pharmacological, evidence-based psychological interventions on [...] Read more.

Background and Objectives: Psychological distress is a pervasive yet often undertreated aspect of the cancer experience, contributing to reduced quality of life, poorer treatment adherence, and worse health outcomes. This systematic review and meta-analysis evaluated the efficacy of non-pharmacological, evidence-based psychological interventions on distress, depression, anxiety, coping capacity, and quality of life in adult cancer patients. Interventions were grouped into three domains: structured psychotherapeutic therapies (e.g., Cognitive Behavioral Therapy [CBT], Acceptance and Commitment Therapy [ACT], Meaning-Centered Psychotherapy [MCP]); mindfulness and stress reduction programs (e.g., Mindfulness-Based Stress Reduction [MBSR], Mindfulness-Based Cognitive Therapy [MBCT]); and coping and resilience-enhancing modalities (e.g., Promoting Resilience in Stress Management [PRISM], expressive writing). Materials and Methods: Following PRISMA guidelines, 42 randomized controlled trials published between 2015 and 2025 were included. A stratified meta-analytic approach calculated pooled standardized mean differences for each intervention class and outcome. Heterogeneity, subgroup, and moderator analyses explored drivers of effect variability. Results: Structured psychotherapeutic interventions yielded the largest effects, especially for depression. Mindfulness-based interventions produced moderate but significant improvements in distress and emotional regulation. Coping and resilience programs provided smaller yet statistically significant gains in adaptive coping. Between-study heterogeneity was moderate, partly explained by intervention type, delivery modality, and cancer subtype. Conclusions: These findings support integrating psychosocial care into standard oncology protocols and endorse its routine implementation as a core component of comprehensive cancer treatment. Full article

(This article belongs to the Special Issue New Insights into the Diagnosis, Management, and Interventions of Mood Disorders)

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14 pages, 2937 KB

Open AccessEditor’s ChoiceReview

Use of JAK Inhibitors in Lichen Planus: An Update

by Dario Didona, Raffaele Dante Caposiena Caro, Laura Calabrese, Martina D’Onghia, Giulia Galluccio, Matteo Riccardo Di Nicola, Alessandra Rallo and Giovanni Paolino

Medicina 2025, 61(6), 1056; https://doi.org/10.3390/medicina61061056 - 8 Jun 2025

Cited by 4 | Viewed by 5633

Abstract

Lichen planus (LP) is a chronic inflammatory disorder affecting approximately 1% of the population. It presents with a wide range of clinical manifestations, mainly involving the skin, mucosal surfaces, and skin appendages, and is often characterized by a relapsing course and variable response [...] Read more.

Lichen planus (LP) is a chronic inflammatory disorder affecting approximately 1% of the population. It presents with a wide range of clinical manifestations, mainly involving the skin, mucosal surfaces, and skin appendages, and is often characterized by a relapsing course and variable response to treatment. Although several therapeutic strategies are available, many are off-label and show limited efficacy in resistant forms. Increasing evidence points to the central role of the JAK/STAT signaling pathway in the immunopathogenesis of LP, with cytokines such as interferon-gamma and interleukin-21 playing key roles in sustaining chronic inflammation. Based on this rationale, Janus kinase (JAK) inhibitors have recently been proposed as potential therapeutic agents in LP. This review explores the biological basis for their use and systematically summarizes the existing clinical evidence on the use of JAK inhibitors in cutaneous, mucosal, appendageal, and nail variants of LP. The preliminary data suggests favorable outcomes in many patients with difficult-to-treat disease, with an acceptable safety profile. Further prospective trials are needed to establish their definitive role in the management of LP. Full article

(This article belongs to the Special Issue Chronic Inflammatory Skin Diseases: Where We Are and Where We Are Going: 2nd Edition)

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13 pages, 2691 KB

Open AccessEditor’s ChoiceArticle

Arthroscopic Resection of Infrapatellar Fat Pad Impingement Syndrome: Long-Term Clinical Results at Minimum 10-Year Follow-Up

by Young-Cheol Park, Young-Mo Kim and Yong-Bum Joo

Medicina 2025, 61(6), 997; https://doi.org/10.3390/medicina61060997 - 28 May 2025

Cited by 3 | Viewed by 3938

Abstract

Background and Objectives: Infrapatellar fat pad impingement syndrome (IFPIS) is a relatively underdiagnosed cause of anterior knee pain. While conservative management is the initial approach, some patients require surgical intervention. This study aimed to evaluate the long-term clinical and radiologic outcomes following [...] Read more.

Background and Objectives: Infrapatellar fat pad impingement syndrome (IFPIS) is a relatively underdiagnosed cause of anterior knee pain. While conservative management is the initial approach, some patients require surgical intervention. This study aimed to evaluate the long-term clinical and radiologic outcomes following arthroscopic resection of the infrapatellar fat pad in patients with IFPIS. Materials and Methods: Eighteen patients (10 females, 8 males; median age 22) diagnosed with IFPIS and unresponsive to conservative therapy underwent arthroscopic partial or subtotal resection between 2007 and 2013. Diagnosis was based on physical examination (Hoffa’s test), MRI findings, and response to lidocaine injection. Clinical outcomes (VAS, IKDC-2000, Kujala, Lysholm, Tegner activity scores) and radiologic assessments (ISR, CDI, PFJ osteoarthritis grade) were evaluated preoperatively, at 2 years, and at a final follow-up (mean 148.7 months). Results: All clinical scores significantly improved postoperatively. VAS decreased from 7.25 ± 0.79 to 2.43 ± 1.50 at 2 years, and to 3.66 ± 1.50 at the final follow-up (p < 0.001). Similar long-term improvements were observed in the Kujala, IKDC-2000, Lysholm, and Tegner scores (all p < 0.001). Radiographic parameters including ISR and CDI remained stable, and there was no statistically significant progression in patellofemoral osteoarthritis. However, 5 of 18 patients (27.8%) reported persistent symptoms at long-term follow-up. Conclusions: Arthroscopic resection of the infrapatellar fat pad in patients with IFPIS showed favorable and sustained clinical outcomes over a 10-year follow-up, without significant radiological changes. These results suggest that arthroscopic resection is a viable treatment option when accurate diagnosis is established. Full article

(This article belongs to the Section Orthopedics)

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15 pages, 303 KB

Open AccessEditor’s ChoiceReview

The Role of Skin Substitutes in the Therapeutical Management of Burns Affecting Functional Areas

by Matei Iordache, Luca Avram, Ioan Lascar and Adrian Frunza

Medicina 2025, 61(6), 947; https://doi.org/10.3390/medicina61060947 - 22 May 2025

Cited by 3 | Viewed by 4879

Abstract

Considered one of the most severe types of trauma with a high impact upon patient survival, burns are the leading cause of disability-adjusted life-years (DALYs), and are responsible for high morbidity, prolonged hospitalization, disfigurement and social stigma. Of particular interest are injuries that [...] Read more.

Considered one of the most severe types of trauma with a high impact upon patient survival, burns are the leading cause of disability-adjusted life-years (DALYs), and are responsible for high morbidity, prolonged hospitalization, disfigurement and social stigma. Of particular interest are injuries that affect the functional areas: face, neck, hand and fingers, joints, feet and soles and perineum. Burns to these regions highly influence the day-to-day activities of patients due to the formation of vicious scars and contractures, which may affect both quality of life and functional capacity. One of the primary challenges in the management of burn patients is the effective coverage of tissue defects resulting from such injuries. Cases that have a large area of burned surface also have a limited amount of total available skin. As such, the importance of skin substitutes increases, particularly in the treatment of these areas. Skin substitutes are widely utilized in plastic surgery due to their ability to promote wound healing by providing an extracellular matrix. Consequently, ongoing research has focused on developing skin substitutes that can serve as alternatives to autografts, addressing the challenges associated with large-scale tissue loss. This article aims to present and compare the most used skin substitutes, highlighting their respective advantages and limitations. This topic continues to be a subject of significant debate, as an ideal substitute has yet to be created. The cost–efficiency ratio is a practical consideration that must be tailored to each specific medical system. The available data in the literature usually present general guidelines, not rules, and as such, they need to be adapted to each patient’s necessities. Full article

(This article belongs to the Special Issue Recent Research and Trends in Plastic, Aesthetic and Regenerative Surgery)

19 pages, 2245 KB

Open AccessEditor’s ChoiceArticle

Core Exercise as Non-Pharmacological Strategy for Improving Metabolic Health in Prediabetic Women

by Nuray Yiğiter, Faruk Akçınar, Yavuz Yasul, Vedat Çınar, Taner Akbulut and Gian Mario Migliaccio

Medicina 2025, 61(5), 942; https://doi.org/10.3390/medicina61050942 - 21 May 2025

Cited by 5 | Viewed by 3134

Abstract

Background and Objectives: Prediabetes (PD) is characterized by impaired glucose metabolism and is associated with an elevated risk of type 2 diabetes and cardiovascular diseases. This study aimed to investigate the effects of an 8-week core exercise intervention on glycemic control, lipid [...] Read more.

Background and Objectives: Prediabetes (PD) is characterized by impaired glucose metabolism and is associated with an elevated risk of type 2 diabetes and cardiovascular diseases. This study aimed to investigate the effects of an 8-week core exercise intervention on glycemic control, lipid profiles, insulin sensitivity, body composition, and physical performance in prediabetic women. Materials and Methods: Eighteen prediabetic women aged 20–55 years were randomly allocated to either a core exercise group (n = 9) or a control group (n = 9). The intervention group completed 24 supervised core exercise sessions over 8 weeks, whereas the control group remained sedentary. Pre- and post-intervention evaluations included anthropometric measurements, flexibility and strength tests, fasting and postprandial glucose levels, HbA1c, insulin, HOMA-IR, lipid profiles, and serum iron levels. Non-parametric tests were used for statistical analysis, and a Principal Component Analysis (PCA) and hierarchical clustering were conducted to explore multidimensional metabolic changes. Results: Core exercise significantly improved the body weight, BMI, fat percentage, and circumferences (shoulder, chest, and hip), along with an enhanced flexibility and back-leg strength (p < 0.05). Glycemic indices (FBG, PBG, and HbA1c), insulin, and HOMA-IR levels were significantly reduced, while serum iron and HDL-C increased (p < 0.05). Lipid markers, including the TG, LDL-C, CHOL, and TG/HDL-C ratio, showed significant improvements. The PCA and cluster analyses identified three clusters reflecting metabolic risk, body composition, and protective factors. Conclusions: This study demonstrates that an 8-week structured core exercise program significantly improves glycemic control, lipid profiles, insulin sensitivity, and body composition in women with prediabetes. Multivariate analyses (PCA and hierarchical clustering) corroborate a metabolic shift towards a reduced insulin resistance and a more favorable cardiometabolic profile, supporting core training as a viable, evidence-based non-pharmacological intervention to mitigate metabolic risk. Full article

(This article belongs to the Special Issue Novel Innovations in Diabetes Mellitus Prevention, Screening and Management)

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11 pages, 1630 KB

Open AccessEditor’s ChoiceArticle

Clinical Effectiveness, Clinical Stability, and Effects on Serum Galectin-7 Levels of Dupilumab and JAK Inhibitors in Moderate-to-Severe Atopic Dermatitis: A Real-World, Single-Center Analysis

by Akihiro Horie, Tomomitsu Miyagaki, Chikako Hiranuma, Mami Iijima, Yoshiaki Hara, Shinya Oba, Mina Hashimoto, Reina Omori, Tatsuro Okano and Takafumi Kadono

Medicina 2025, 61(5), 926; https://doi.org/10.3390/medicina61050926 - 20 May 2025

Cited by 2 | Viewed by 1621

Abstract

Background and Objectives: Several biologics and oral Janus kinase (JAK) inhibitors have been developed and shown in clinical trials and real-world studies to be effective and safe in moderate-to-severe atopic dermatitis (AD). In this study, we aimed to evaluate the real-world outcomes of [...] Read more.

Background and Objectives: Several biologics and oral Janus kinase (JAK) inhibitors have been developed and shown in clinical trials and real-world studies to be effective and safe in moderate-to-severe atopic dermatitis (AD). In this study, we aimed to evaluate the real-world outcomes of patients with moderate-to-severe AD treated with dupilumab and JAK inhibitors in our facility, focusing on their short-term effect on serum galectin-7 levels, a biomarker reflecting skin barrier impairment, and one-year stability based on patient-oriented outcomes. Materials and Methods: In a single-center, retrospective study of AD patients treated with dupilumab or JAK inhibitors between January 2018 and December 2024, we assessed physician-oriented outcomes until 16 weeks and patient-oriented outcomes until 52 weeks. Serum galectin-7 levels at baseline and 4 and/or 16 weeks after treatment were measured in 14 patients. Results: A total of 45 patients starting dupilumab and 10 patients starting JAK inhibitors were enrolled. Percentage reductions in EASI scores from baseline at 4, 8, and 16 weeks were 58.36 ± 22.09, 69.59 ± 20.96, and 75.98 ± 19.70, with no significant differences between patients treated with dupilumab and JAK inhibitors. Serum galectin-7 levels were significantly reduced after treatment at 4 and 16 weeks in the entire population. Both DLQI and POEM scores were reduced at 4 weeks and gradually decreased until 52 weeks. The reduction was faster with JAK inhibitors than with dupilumab. Visits with unstable effectiveness, defined as a visit with a three-point or greater increase in the POEM score at 28, 40, and 52 weeks, were more frequent in JAK inhibitor patients. Conclusions: Both dupilumab and JAK inhibitors showed high effectiveness on skin inflammation and decreased a marker of skin barrier dysfunction within 16 weeks. JAK inhibitors improved patient-reported outcomes more quickly than dupilumab, but instability of effectiveness during 16 and 52 weeks was higher with JAK inhibitors. Full article

(This article belongs to the Special Issue Chronic Inflammatory Skin Diseases: Where We Are and Where We Are Going: 2nd Edition)

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12 pages, 18426 KB

Open AccessEditor’s ChoiceArticle

Osteogenic Potential and Bone Matrix Maturity: Comparison of Demineralized Bone Matrix and P15 Polypeptide iFactor^® in an In Vitro Study

by Anell Olivos-Meza, Monica Maribel Mata-Miranda, Marcelo Robles-Rodríguez, Gustavo Jesús Vázquez-Zapién, Melissa Guerrero-Ruiz and Carlos Landa-Solís

Medicina 2025, 61(5), 914; https://doi.org/10.3390/medicina61050914 - 18 May 2025

Cited by 3 | Viewed by 1362

Abstract

Background and Objectives: Demineralized bone matrix (DBM) is a widely used bone graft substitute due to its osteoconductive and osteoinductive properties. However, its efficacy varies due to differences in donor, processing, and storage conditions. Synthetic alternatives, such as iFactor^®, combine non-organic [...] Read more.

Background and Objectives: Demineralized bone matrix (DBM) is a widely used bone graft substitute due to its osteoconductive and osteoinductive properties. However, its efficacy varies due to differences in donor, processing, and storage conditions. Synthetic alternatives, such as iFactor^®, combine non-organic bone mineral and a small peptide (P-15) to enhance the cellular attachment and osteogenesis. To compare the osteogenic potential and bone matrix maturity of iFactor^® and a commercial DBM scaffold through calcium nodule formation and Fourier transform infrared spectroscopy (FTIR) analysis. Materials and Methods: Human mesenchymal stem cells (hMSCs) were cultured and exposed to iFactor^® or DBM in paracrine culture conditions for 21 days. Calcium nodule formation was assessed using alizarin red staining and quantified spectrophotometrically. The FTIR analysis of hMSCs exposed to the scaffolds for three months evaluated the biomolecular composition and bone matrix maturity. Results: Calcium nodules formed in both groups but in smaller quantities than in the positive control (p < 0.05). The biomolecular components of the DBM were similar to healthy bone (p > 0.05) than those of the iFactor^® group (p < 0.005). A different rate of bone regeneration was observed through the formation of a greater number of calcium nodule aggregates identified in the extracellular matrix of mesenchymal stem cell cultures exposed to iFactor^® compared to those cultures enriched with DBM. Conclusions: Both experimental matrices demonstrated similar osteogenic potential at the 3-month follow-up. Although DBM has a closer biomolecular composition and carbonate substitution compared to healthy bone, iFactor^® showed faster matrix maturity expressed through the formation of a greater number of calcium nodule aggregates and higher hMSCs proliferation. Full article

(This article belongs to the Section Orthopedics)

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35 pages, 1235 KB

Open AccessEditor’s ChoiceReview

Multimodal Prehabilitation in Major Abdominal Surgery—Rationale, Modalities, Results and Limitations

by George Andrei Popescu, Dana Galieta Minca, Nader Mugurel Jafal, Cristian Valentin Toma, Sorin Tiberiu Alexandrescu, Radu Virgil Costea and Catalin Vasilescu

Medicina 2025, 61(5), 908; https://doi.org/10.3390/medicina61050908 - 17 May 2025

Cited by 10 | Viewed by 5573

Abstract

Recent evidence revealed that an adequate preoperative physiological reserve is crucial to overcome surgical stress response. Consequently, a new concept, called prehabilitation, emerged, aiming to improve the preoperative functional reserve of patients who will undergo major abdominal surgery. During the interval between diagnosis [...] Read more.

Recent evidence revealed that an adequate preoperative physiological reserve is crucial to overcome surgical stress response. Consequently, a new concept, called prehabilitation, emerged, aiming to improve the preoperative functional reserve of patients who will undergo major abdominal surgery. During the interval between diagnosis and surgery, a multimodal approach consisting of physical exercise and nutritional and psychological support could be employed to enhance physiologic reserve. Physical activity interventions aim to improve aerobic capacity, muscle strength and endurance. Nutritional support addressing malnutrition and sarcopenia also contributes to the achievement of the above-mentioned goals, particularly in patients undergoing cancer-related procedures. Psychological interventions targeting anxiety, depression and self-efficacy, as well as risk behavior modification (e.g., smoking cessation) seem to enhance recovery. However, there is a lack of standardization regarding these interventions, and the evidence about the impact of this multidisciplinary approach on the postoperative outcomes is still contradictory. This narrative review focuses on the physiological basis of surgical stress response and on the efficacy of prehabilitation, reflected mainly in the length of hospitalization and rates of postoperative complications. Multidisciplinary collaboration between surgeons, nutritionists, psychologists and physiotherapists was identified as the key to the success of prehabilitation programs. Synergizing prehabilitation and ERAS protocols significantly improves short-term surgical outcomes. Recent well-designed, randomized clinical trials revealed that this approach not only enhanced functional reserve, but also decreased the rates of postoperative complications and enhanced patient’s overall quality of life, emphasizing the importance of its implementation in routine, elective, surgical care. Full article

(This article belongs to the Section Surgery)

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19 pages, 347 KB

Open AccessEditor’s ChoiceReview

Bone Marrow Aspirate Concentrate (BMAC) for Knee Osteoarthritis: A Narrative Review of Clinical Efficacy and Future Directions

by Dojoon Park, Hae-Seok Koh, Youn-Ho Choi and Ilkyu Park

Medicina 2025, 61(5), 853; https://doi.org/10.3390/medicina61050853 - 6 May 2025

Cited by 6 | Viewed by 7303

Abstract

Bone marrow aspirate concentrate (BMAC) is an autologous regenerative therapy enriched with mesenchymal stem cells (MSCs) and bioactive growth factors, offering potential disease-modifying effects in knee osteoarthritis (OA). Compared to conventional intra-articular treatments, including hyaluronic acid (HA), platelet-rich plasma (PRP), and corticosteroids, BMAC [...] Read more.

Bone marrow aspirate concentrate (BMAC) is an autologous regenerative therapy enriched with mesenchymal stem cells (MSCs) and bioactive growth factors, offering potential disease-modifying effects in knee osteoarthritis (OA). Compared to conventional intra-articular treatments, including hyaluronic acid (HA), platelet-rich plasma (PRP), and corticosteroids, BMAC promotes cartilage regeneration, modulates inflammation, and enhances subchondral bone remodeling. Clinical evidence suggests that BMAC provides short- to mid-term symptomatic relief and functional improvement, with some studies indicating a potential to delay total knee arthroplasty (TKA). However, findings remain inconsistent, and long-term efficacy compared to PRP or autologous conditioned serum (ACS) is yet to be firmly established. Variability in BMAC preparation methods, injection protocols (single vs. repeated administration, intra-articular vs. subchondral delivery), and patient selection criteria complicates its clinical application, highlighting the need for standardized guidelines. Additionally, economic feasibility and cost-effectiveness concerns limit its widespread adoption. This review synthesizes current clinical evidence, evaluates optimal administration strategies, and explores future directions for improving treatment standardization and patient-specific therapy. Future research should prioritize well-designed, multicenter randomized controlled trials (RCTs) with long-term follow-up to confirm the sustained efficacy and therapeutic potential of BMAC in OA management. Full article

(This article belongs to the Special Issue State-of-the-Art Therapeutics and Imaging in Knee Surgery)

10 pages, 2632 KB

Open AccessEditor’s ChoiceArticle

Relationship Between Intracranial Pressure, Ocular Blood Flow and Vessel Density: Insights from OCTA and Doppler Imaging

by Arminas Zizas, Keren Wood, Austėja Judickaitė, Vytautas Petkus, Arminas Ragauskas, Viktorija Bakstytė, Alon Harris and Ingrida Janulevičienė

Medicina 2025, 61(5), 800; https://doi.org/10.3390/medicina61050800 - 25 Apr 2025

Cited by 3 | Viewed by 1285

Abstract

Background and Objectives: Despite the growing amount of new research, the pathophysiology of glaucoma remains unclear. The aim of this study was to determine the relationship between intracranial pressure (ICP), ocular blood flow and structural optic nerve parameters. Materials and Methods: A [...] Read more.

Background and Objectives: Despite the growing amount of new research, the pathophysiology of glaucoma remains unclear. The aim of this study was to determine the relationship between intracranial pressure (ICP), ocular blood flow and structural optic nerve parameters. Materials and Methods: A prospective clinical study was conducted involving 24 patients with open-angle glaucoma and 25 healthy controls. Routine clinical examination was performed. Swept-source optical coherence tomography (SS-OCT) and OCT angiography (OCTA) images were taken (DRI-OCT Triton, Topcon). The vessel density (VD) values of the ONH were calculated around the optic nerve head (ONH). An orbital Doppler device (Vittamed 205, Kaunas, Lithuania) was used for non-invasive ICP measurements. Color Doppler imaging (CDI) (Mindray M7, Shenzhen, China) was used for retrobulbar blood flow measurements in the ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (SPCAs). Results: ICP was 8.35 ± 2.8 mmHg in the glaucoma group and 8.45 ± 3.19 mmHg in the control group (p = 0.907). In the glaucoma group, the VD of the superficial vascular plexus in the inferior-nasal (NI) sector of the ONH showed a correlation with ICP (r = 0.451, p = 0.05). In contrast, the control group exhibited weaker correlations. CRA peak systolic velocity (PSV) demonstrated significant moderate correlations with VD in multiple retinal layers, including the avascular retina layer in the temporal (T) sector (r = 0.637, p = 0.001). Conclusions: Lower ICP was significantly associated with the lower VD of the superficial plexus layer in the inferior-nasal sector in the glaucoma group, with the control group exhibiting weaker correlations in all sectors. Further longitudinal studies with larger sample sizes are needed to establish associations between intracranial pressure, ocular blood flow and ONH parameters. Full article

(This article belongs to the Special Issue Clinical Update on Optic Nerve Disorders)

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22 pages, 8782 KB

Open AccessEditor’s ChoiceArticle

Anatomical Variables of the Superior Thyroid Artery on Computed Tomography Angiograms

by Rodica Narcisa Calotă, Mugurel Constantin Rusu, Marius Ioan Rusu, Cătălin Constantin Dumitru and Alexandra Diana Vrapciu

Medicina 2025, 61(5), 775; https://doi.org/10.3390/medicina61050775 - 22 Apr 2025

Cited by 4 | Viewed by 1669

Abstract

Background and Objectives: The superior thyroid artery (STA) typically has its origin inferiorly to the greater hyoid horn (GHHB) either from the external carotid artery (ECA) or from the carotid bifurcation (CB) or the common carotid artery (CCA). We aimed to determine [...] Read more.

Background and Objectives: The superior thyroid artery (STA) typically has its origin inferiorly to the greater hyoid horn (GHHB) either from the external carotid artery (ECA) or from the carotid bifurcation (CB) or the common carotid artery (CCA). We aimed to determine the topographic variants of the STA related to the GHHB and the artery of origin and to check their bilateral symmetry. Materials and Methods: Determinations were performed in a sample of 85 archived angio CT adult cases, comprising 53 men and 32 women. The origins of the STAs from the CCA/CB/ECA were classified as types A–C. We defined the vertical topographies of the STA as follows in relation to the GHHB: type 1 (infrahyoid), type 2 (hyoid), and type 3 (suprahyoid). Subtypes of the STA course were added: “a”, lateral to the GHHB; “b”, medial; and “c”, posterior to it. Unilateral combinations of types and bilateral associations of these were established. Results: In 170 carotid axes, we detected STA type A in 8.82%, type B in 28.82%, and type C in 60% of cases. It was absent in 2.35% of the cases. The infrahyoid type 1 of STA was found in 47.06% of cases. The hyoid type 2 was found in 20.59% (2a), 0.59% (2b), and 4.71% (2c). The suprahyoid type 3 was found in 21.18% (3a), 0% (3b), and 3.53% (3c). Thirteen unilateral combinations of types were found. The most prevalent ones were C1 (27.71%), C3a (17.47%), and B1 (15.66%). We established thirty-seven bilateral associations of unilateral combinations of types. The cases with asymmetrical bilateral associations of unilateral combinations of types prevailed. A lowered hyoid bone overlapping the thyroid cartilage was found in one of these cases. The prevailing associations were C1-C1 (bilateral infrahyoid origin of the STA from the ECA, 13/85, 15.29%), C3a-C3a (suprahyoid origins of the STAs from the ECAs and lateral courses over the GHHB, 9/85, 10.58%) and C1-B1 (infrahyoid origins from the ECA and CB, 8/85, 9.41%). Conclusions: The vertical topography of the STA is highly variable and hardly predictable but can be examined in imaging studies. The GHHB may be of use to identify and manage the artery. The STA is rarely absent. Full article

(This article belongs to the Section Endocrinology)

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9 pages, 731 KB

Open AccessEditor’s ChoiceReview

Rho-Kinase Inhibitors in the Management of Fuchs Endothelial Corneal Dystrophy: A Review

by Anđela Jukić, Ana Pupić Bakrač, Biljana Đapic Ivančić, Andrijana Kopić, Ana Meter, Rajka Kasalica Žužul, Josip Pavan and Tomislav Jukić

Medicina 2025, 61(5), 772; https://doi.org/10.3390/medicina61050772 - 22 Apr 2025

Cited by 3 | Viewed by 4100

Abstract

Fuchs endothelial corneal dystrophy (FECD) is the most common corneal endothelial dystrophy. It is characterized by the progressive loss of corneal endothelial cells (CECs), guttae formation on the Descemet membrane, and corneal edema, leading to visual impairment. Corneal transplantation remains the standard treatment, [...] Read more.

Fuchs endothelial corneal dystrophy (FECD) is the most common corneal endothelial dystrophy. It is characterized by the progressive loss of corneal endothelial cells (CECs), guttae formation on the Descemet membrane, and corneal edema, leading to visual impairment. Corneal transplantation remains the standard treatment, but it has limitations such as donor shortages, infection risk, and graft rejection. Rho-kinase (ROCK) inhibitors have emerged as a promising pharmacological alternative. These agents promote CEC proliferation, migration, and adhesion while inhibiting apoptosis and enhancing corneal endothelial wound healing. Several studies have demonstrated the efficacy of ROCK inhibitors in improving corneal clarity and endothelial function, particularly when used as an adjunct to Descemet Stripping Only (DSO) surgery. Additionally, they show potential in preventing corneal edema in FECD patients undergoing cataract surgery. The methodology involved a literature search through the PubMed and Medline databases using relevant keywords. Only peer-reviewed articles in English were included, with additional references from selected articles reviewed to ensure comprehensive coverage. ROCK inhibitors offer a novel pharmacological approach to managing FECD. They have shown potential in promoting endothelial cell regeneration and improving corneal functIion. Despite promising results, further research is required to determine ROCK inhibitors’ long-term safety, optimal dosing, and efficacy in surgical and non-surgical FECD patients. Their potential to delay or prevent corneal transplantation represents a significant advancement in FECD management. Full article

(This article belongs to the Special Issue Advances in Corneal Management)

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12 pages, 3749 KB

Open AccessEditor’s ChoiceArticle

3D CT-Based Preoperative Planning and Intraoperative Navigation in Reverse Shoulder Arthroplasty: Early Clinical Outcomes

by Elisa Troiano, Azzurra Masini, Giovanni Battista Colasanti, Caterina Drago, Stefano Giannotti and Nicola Mondanelli

Medicina 2025, 61(4), 749; https://doi.org/10.3390/medicina61040749 - 18 Apr 2025

Cited by 4 | Viewed by 2214

Abstract

Background and Objectives: Reverse shoulder arthroplasty (RSA) is an effective surgical procedure for treating end-stage rotator cuff arthropathy, but it is burdened by a relatively high complication rate, mainly due to glenoid component failure. Preoperative planning and intraoperative navigation based on three-dimensional [...] Read more.

Background and Objectives: Reverse shoulder arthroplasty (RSA) is an effective surgical procedure for treating end-stage rotator cuff arthropathy, but it is burdened by a relatively high complication rate, mainly due to glenoid component failure. Preoperative planning and intraoperative navigation based on three-dimensional computed tomography (3D CT) scans have proven to be efficient tools for improving the accuracy and stability of the glenoid component. However, this technology is still developing, and there is currently little available research on the subject, especially where clinical outcomes are concerned. The purpose of this retrospective observational study is to report the radiographic and clinical outcomes of a consecutive series of patients that underwent RSA with the use of these new technologies, compared to a standard procedure. Materials and Methods: A consecutive series of 80 patients underwent RSA for shoulder osteoarthritis by a single surgeon at a single institution with a mean follow-up of 41.9 ± 23.6 months (range 24–108) and were divided into two groups according to the surgical technique employed (conventional or navigated surgery), and they were clinically and radiographically assessed at 1, 3, 6, and 12 months after surgery, and then annually. Results: No statistically significant differences were highlighted among the two groups according to complication rate, radiographical glenoid notching, and clinical outcomes. However, a statistically significant difference was observed in screw number and length and surgical time. In the navigated group, fewer screws with longer lengths had been implanted, with a longer surgical time. Conclusions: The use of 3D CT-based preoperative planning and intraoperative navigation is a safe procedure and produces comparable results with respect to standard instrumentation, without an increased risk of complications. It allowed to achieve higher stability of the implant, saving bone stock due to the use of fewer and longer screws than in a conventional procedure. This could also eventually result in a higher longevity of the implant itself. Full article

(This article belongs to the Special Issue Cutting-Edge Topics in Joint Arthroplasties)

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16 pages, 1021 KB

Open AccessEditor’s ChoiceReview

Use of Artificial Intelligence on Imaging and Preoperatory Planning of the Knee Joint: A Scoping Review

by Luca Bertolino, Marta Bianca Maria Ranzini, Alberto Favaro, Elena Bardi, Flavio Lorenzo Ronzoni and Tommaso Bonanzinga

Medicina 2025, 61(4), 737; https://doi.org/10.3390/medicina61040737 - 16 Apr 2025

Cited by 6 | Viewed by 2963

Abstract

Background and Objectives: This scoping review explores the current state of the art of AI-based applications in the field of orthopedics, focusing on its implementation in diagnostic imaging and preoperative planning of knee joint procedures. Materials and Methods: The search was [...] Read more.

Background and Objectives: This scoping review explores the current state of the art of AI-based applications in the field of orthopedics, focusing on its implementation in diagnostic imaging and preoperative planning of knee joint procedures. Materials and Methods: The search was carried out using the recognized scholarly databases PubMed, Medline and Embase and was set to identify original research addressing AI applied to imaging in knee diagnosis and surgical planning, written in English and published up to January 2025. Results: The search produced 1612 papers, of which 36 were included in our review. All papers addressed AI applied to common imaging methods in clinical practice. Of these, thirty integrated AI-based tools with X-rays, one applied AI to X-rays to produce CT-like 3D reproductions, and two studies applied AI to MRI. Conclusions: Several AI tools have already been validated for enhancing the accuracy of measurements and detecting additional parameters in a shorter time compared to standard assessments. We expect these may soon be introduced into routine clinical practice to streamline a number of technical tasks and in some cases to replace the need for human intervention. Full article

(This article belongs to the Section Orthopedics)

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15 pages, 1348 KB

Open AccessEditor’s ChoiceReview

New Frontiers in Nutritional and Therapeutic Interventions for Obesity Phenotypes

by Angelo Maria Patti, Rosaria Vincenza Giglio, Marcello Ciaccio, Anca Pantea Stoian, Teodor Salmen, Ioana-Cristina Bica, Imran Rangraze, Mohamed El Tanani, Manfredi Rizzo and Ali Abbas Rizvi

Medicina 2025, 61(4), 664; https://doi.org/10.3390/medicina61040664 - 3 Apr 2025

Cited by 5 | Viewed by 5414

Abstract

The heterogeneity among patients with obesity is particularly evident in the weight loss response to interventions such as diets, drugs, devices and surgery. Obesity can be “catalogued” into four phenotypes: hungry brain (abnormal satiety for alteration of gut–brain axis), emotional hunger (hedonic eating), [...] Read more.

The heterogeneity among patients with obesity is particularly evident in the weight loss response to interventions such as diets, drugs, devices and surgery. Obesity can be “catalogued” into four phenotypes: hungry brain (abnormal satiety for alteration of gut–brain axis), emotional hunger (hedonic eating), hungry gut (abnormal duration of satiety for faster gastric emptying) and slow burning (slowing of the metabolic rate). Phenotypes are grafted onto this complexity, the recognition of which allows for personalized medicine and increasingly targeted therapies. Although there are no standardized treatment protocols, we present management options consisting of lifestyle modifications and pharmacologic therapies. Nutritional advice and encouragement of adequate physical activity lead to increased self-efficacy and promote a sense of well-being when coupled with psychological approaches involving mindful eating. In summary, obesity has a complex pathophysiology best addressed through a therapeutic process suited to the phenotype encountered and in synergy with multifactorial interventions. Full article

(This article belongs to the Section Endocrinology)

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16 pages, 2481 KB

Open AccessEditor’s ChoiceReview

Quercetin as a Potential Therapeutic Agent for Malignant Melanoma—A Review of Current Evidence and Future Directions

by Teodora Hoinoiu, Victor Dumitrascu, Daniel Pit, David-Alexandru Schipor, Madalina Jabri-Tabrizi, Bogdan Hoinoiu, David Emanuel Petreuș and Corina Seiman

Medicina 2025, 61(4), 656; https://doi.org/10.3390/medicina61040656 - 2 Apr 2025

Cited by 5 | Viewed by 2801

Abstract

Neoplastic disorders, particularly malignant carcinomas, are complex systemic diseases characterized by unregulated cellular proliferation, the invasion of adjacent tissues, and potential metastasis to distant bodily sites. Among the diverse spectrum of cancer subtypes, malignant melanoma is a highly aggressive form of cutaneous cancer [...] Read more.

Neoplastic disorders, particularly malignant carcinomas, are complex systemic diseases characterized by unregulated cellular proliferation, the invasion of adjacent tissues, and potential metastasis to distant bodily sites. Among the diverse spectrum of cancer subtypes, malignant melanoma is a highly aggressive form of cutaneous cancer originating in melanocytes, the pigment-producing cells resident in the skin. This malignancy is distinguished by its rapid and uncontrolled growth, as well as its propensity for metastasis to vital organs, thereby posing significant challenges to therapeutic intervention and prognostication. Early detection of melanoma is crucial for optimizing patient outcomes, as diagnosis at an advanced stage often yields a poor prognosis and limited treatment options. Diagnostic modalities for melanoma encompass comprehensive clinical evaluations by dermatologists; radiological imaging techniques such as ultrasonography, magnetic resonance imaging (MRI), computed tomography (CT) scans; and excisional biopsies for accurate histopathological assessment. Malignant melanoma is typically treated with surgery to remove the tumor, followed by immunotherapy to enhance the immune response, targeted therapy for tumors with specific genetic mutations, chemotherapy for advanced stages, radiation therapy to manage metastasis, and other adjunct therapies. This review presents the properties and possible adjunct therapeutic effects against malignant melanoma of quercetin found in the literature and explores, based on the observed physicochemical properties and biological activity, its potential development as a topical formulation for cutaneous application. Quercetin is a naturally occurring flavonoid compound abundant in various plant-based food sources, including apples, onions, berries, and citrus fruits, and has exhibited promising antiproliferative, antioxidant, and anticancer properties. Its distinctive biochemical structure enables quercetin to effectively neutralize reactive oxygen species and modulate key carcinogenic pathways, thereby rendering it a potential candidate for therapeutic intervention in managing malignant tumors, including melanoma. Full article

(This article belongs to the Special Issue Advances in the Diagnosis, Prevention and Treatment of Skin Tumors)

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16 pages, 324 KB

Open AccessEditor’s ChoiceReview

New and Emerging Biologics and Jak Inhibitors for the Treatment of Prurigo Nodularis: A Narrative Review

by Matteo Bianco, Francesco D’Oria, Costanza Falcidia, Giulio Foggi, Elena Matteodo, Sara Di Giulio, Paola Facheris, Luciano Ibba, Chiara Perugini, Mario Valenti, Carlo Alberto Vignoli, Antonio Costanzo, Alessandra Narcisi and Luigi Gargiulo

Medicina 2025, 61(4), 631; https://doi.org/10.3390/medicina61040631 - 29 Mar 2025

Cited by 5 | Viewed by 5810

Abstract

Prurigo nodularis (PN) is a chronic dermatological condition characterized by intensely pruritic nodules resulting from repeated scratching. Its pathogenesis involves neuroimmune dysregulation, inflammatory cytokines, and neural proliferation. Conventional treatments often provide limited relief, necessitating novel therapeutic approaches. This narrative review explores emerging biologics [...] Read more.

Prurigo nodularis (PN) is a chronic dermatological condition characterized by intensely pruritic nodules resulting from repeated scratching. Its pathogenesis involves neuroimmune dysregulation, inflammatory cytokines, and neural proliferation. Conventional treatments often provide limited relief, necessitating novel therapeutic approaches. This narrative review explores emerging biologics and small molecules for PN treatment, assessing their mechanisms, efficacy, and safety. A comprehensive literature search was conducted using PubMed, Google Scholar, and Web of Science for relevant studies up to February 2025. Additionally, ongoing clinical trials were identified through a verified international website. The search terms included “prurigo nodularis”, “biologic treatments”, “monoclonal antibodies”, “small molecules”, and “JAK inhibitors”. Among new treatment options, dupilumab, an IL-4 receptor antagonist, and nemolizumab, an IL-31 receptor inhibitor, demonstrated significant efficacy in reducing pruritus and lesion severity in PN patients. Other promising monoclonal antibodies include vixarelimab (OSMRβ inhibitor) and barzolvolimab (KIT inhibitor). Small molecules such as JAK inhibitors (upadacitinib, povorcitinib) also show potential by modulating inflammatory pathways. Clinical trials highlight their efficacy, safety, and long-term benefits. Emerging biologics and small molecules represent a transformative approach for PN management, offering targeted therapies that address underlying immunological and neurological mechanisms. Ongoing research and long-term studies are crucial to optimizing treatment strategies and improving patient outcomes. Full article

(This article belongs to the Special Issue Chronic Inflammatory Skin Diseases: Where We Are and Where We Are Going: 2nd Edition)

12 pages, 1798 KB

Open AccessEditor’s ChoiceSystematic Review

Atherogenic Index of Plasma in Metabolic Syndrome—A Systematic Review and Meta-Analysis

by Leia Mossane Andraschko, Gabi Gazi, Daniel-Corneliu Leucuta, Stefan-Lucian Popa, Bogdan Augustin Chis and Abdulrahman Ismaiel

Medicina 2025, 61(4), 611; https://doi.org/10.3390/medicina61040611 - 27 Mar 2025

Cited by 7 | Viewed by 3330

Abstract

Background and Objectives: Numerous studies have explored the biomarker atherogenic index of plasma (AIP) in relation to metabolic syndrome (MetS), showing its potential utility in assessing this condition. However, the existing evidence remains inconsistent and inconclusive. Therefore, this study aimed to evaluate [...] Read more.

Background and Objectives: Numerous studies have explored the biomarker atherogenic index of plasma (AIP) in relation to metabolic syndrome (MetS), showing its potential utility in assessing this condition. However, the existing evidence remains inconsistent and inconclusive. Therefore, this study aimed to evaluate the association between AIP and MetS and assess its predictive accuracy. Materials and Methods: A comprehensive search of PubMed, EMBASE, and Scopus was conducted using a predefined search strategy to identify relevant studies. Eligible studies diagnosed MetS based on the International Diabetes Federation criteria. The primary outcomes were the mean difference (MD) in AIP between MetS patients and healthy controls, as well as the area under the curve (AUC) for AIP in predicting MetS. Results: Thirteen studies involving 17,689 participants met the inclusion criteria and were included in the systematic review and meta-analysis. AIP levels were significantly higher in MetS patients compared to healthy controls, with an MD of 0.309 (95% CI 0.214, 0.405). In contrast, the difference in AIP levels between type 2 diabetes mellitus (T2DM) patients with MetS and normoglycemic MetS patients was not statistically significant (MD 0.142, 95% CI −0.091, 0.376). The predictive accuracy of AIP for MetS yielded an AUC of 0.864 (95% CI 0.856, 0.871). Conclusions: AIP levels are significantly elevated in MetS patients compared to healthy individuals, supporting AIP’s potential role as a biomarker for MetS. However, AIP levels did not differ significantly between T2DM patients with MetS and normoglycemic MetS patients. The predictive accuracy of AIP for MetS is acceptable, indicating that AIP may serve as a useful tool in MetS diagnosis. Further research is warranted to clarify its diagnostic and prognostic significance in clinical settings. Full article

(This article belongs to the Special Issue Epidemiology of Autiommune and Metabolic Diseases)

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15 pages, 966 KB

Open AccessEditor’s ChoiceReview

Immunosuppressive Therapy for Usual Interstitial Pneumonia in Autoimmune Rheumatic Diseases: A Review

by Domenico Sambataro, Giulia Morina, Alessandro Libra, Stefano Palmucci, Francesco Pallotti, Giulio Geraci, Gaetano La Rocca, Francesco Ferro, Michele Moretti, Chiara Baldini, Carlo Vancheri and Gianluca Sambataro

Medicina 2025, 61(4), 599; https://doi.org/10.3390/medicina61040599 - 26 Mar 2025

Cited by 3 | Viewed by 3346

Abstract

Usual Interstitial Pneumonia (UIP) is the most severe radiological/histological pattern of Interstitial Lung Disease (ILD). It is typical of Idiopathic Pulmonary Fibrosis (IPF), but is also frequently described in Autoimmune Rheumatic Diseases (ARDs), sharing with IPF common risk factors, genetic backgrounds, and in [...] Read more.

Usual Interstitial Pneumonia (UIP) is the most severe radiological/histological pattern of Interstitial Lung Disease (ILD). It is typical of Idiopathic Pulmonary Fibrosis (IPF), but is also frequently described in Autoimmune Rheumatic Diseases (ARDs), sharing with IPF common risk factors, genetic backgrounds, and in some cases, disease progression and prognosis. Following the results of the PANTHER study, immunosuppressive drugs are now not recommended for the treatment of IPF; however, their use for the treatment of UIP secondary to ARDs is still under debate. The aim of this review is to summarize existing knowledge on the clinical presentation of autoimmune UIP and its treatment with immunosuppressive drugs. We searched PubMed for English language clinical trials and studies on treatment of ARDs-ILD, looking for specific treatments of UIP-ARDs. The available clinical trials rarely stratify patients by ILD pattern, and clinical studies generally lack a comparison with a placebo group. In Systemic Sclerosis, UIP patients showed a non-significant trend of worsening under immunosuppression. On the contrary, in Interstitial Pneumonia with Autoimmune Features and, above all, Rheumatoid Arthritis, immunosuppressive treatment produced promising results in the management of UIP patients. In conclusion, the current evidence about the immunosuppressive treatment of UIP-ARDs is limited and conflicting. There is an urgent need to adequately assess this topic with specific clinical trials, as has already been performed for IPF. The possibility should be considered that different ARDs can respond differently to immunosuppression. Finally, a wider use of histological samples could produce valuable information from a diagnostic, therapeutic, and research point of view. Full article

(This article belongs to the Section Pulmonology)

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10 pages, 3278 KB

Open AccessEditor’s ChoiceArticle

Augmented Reality in Scoliosis Correction Surgery: Efficiency and Accuracy in Pedicle Screw Instrumentation

by Chia-Ning Chang, Chi-Ruei Li, Sian-Siang Liao, Chiung-Chyi Shen, Kai-Yuan Chen, Chung-Hsin Lee and Meng-Yin Yang

Medicina 2025, 61(4), 576; https://doi.org/10.3390/medicina61040576 - 24 Mar 2025

Cited by 2 | Viewed by 2168

Abstract

Background and Objectives: Recent advancements in spinal navigation methodologies, particularly augmented reality (AR) techniques, have significantly enhanced the precision of spinal instrumentation procedures. This study aimed to evaluate the efficacy of AR-assisted navigation in spinal instrumentation surgery for thoracolumbar scoliosis. Materials and [...] Read more.

Background and Objectives: Recent advancements in spinal navigation methodologies, particularly augmented reality (AR) techniques, have significantly enhanced the precision of spinal instrumentation procedures. This study aimed to evaluate the efficacy of AR-assisted navigation in spinal instrumentation surgery for thoracolumbar scoliosis. Materials and Methods: This retrospective observational study included 10 patients with thoracolumbar scoliosis who met specific inclusion criteria and were recruited at a single medical center. Two neurosurgeons and one neuroradiologist used the Gertzbein–Robbins scale (GRS) for radiological evaluation. Preoperative and postoperative Cobb angles were measured to assess the correction of scoliosis. Overall, 257 screws were placed using the AR-assisted navigation system during thoracic and lumbar spinal deformity surgeries. Results: Among the 257 screws, 197 were placed in the thoracic spine and 60 in the lumbar spine, achieving an overall instrumentation accuracy of 98%. The preoperative Cobb angle of 69.5 ± 22.2° significantly improved to 10.1 ± 4.1° postoperatively. Regarding first-attempt screw placement accuracy, 97.4% of the screws in the thoracic spine (graded as GRS A or B) and 100% in the lumbar spine were placed with precision. Five grade C thoracic screws were identified, one of which required re-instrumentation. Conclusions: The AR navigation technique substantially improved the precision of spinal deformity surgery, with a high screw placement accuracy rate and significant scoliosis correction. The benefits of reduced attention diversion and an intuitive surgical experience suggest that AR technology could significantly improve spinal surgery practices and training programs, indicating potential for broader applicability in the future. Full article

(This article belongs to the Special Issue New Frontiers in Spine Surgery and Spine Disorders)

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12 pages, 1611 KB

Open AccessEditor’s ChoiceArticle

Non-Invasive Monitoring of Intracranial Pressure Pulse Waves from Closed Eyelids in Patients with Normal-Tension Glaucoma

by Laimonas Bartusis, Solventa Krakauskaite, Ugne Kevalaite, Austeja Judickaite, Arminas Zizas, Akvile Stoskuviene, Edvinas Chaleckas, Mantas Deimantavicius, Yasin Hamarat, Fabien Scalzo, Kristina Berskiene, Ingrida Januleviciene and Arminas Ragauskas

Medicina 2025, 61(4), 566; https://doi.org/10.3390/medicina61040566 - 22 Mar 2025

Cited by 2 | Viewed by 1438

Abstract

Background and Objectives: Normal-tension glaucoma (NTG) is a subtype of primary open-angle glaucoma characterized by progressive optic nerve damage despite intraocular pressure (IOP) remaining within the normal range. The underlying pathophysiology of NTG remains incompletely understood, and its diagnosis is often delayed [...] Read more.

Background and Objectives: Normal-tension glaucoma (NTG) is a subtype of primary open-angle glaucoma characterized by progressive optic nerve damage despite intraocular pressure (IOP) remaining within the normal range. The underlying pathophysiology of NTG remains incompletely understood, and its diagnosis is often delayed due to the lack of a definitive screening tool. This study aimed to evaluate differences in intracranial pressure pulse wave amplitude recorded from closed eyelids between NTG patients and control subjects using a novel non-invasive monitoring technology. Materials and Methods: A cross-sectional observational study was conducted, enrolling NTG patients and age-matched controls. Intracranial pressure pulse wave signals were recorded from closed eyelids using the ’Archimedes’ 02 device, which employs a highly sensitive digital pressure sensor and hydromechanical coupling for signal transmission. The amplitude of recorded intracranial pressure pulse waves was analyzed and compared between groups. Statistical analyses were performed using IBM SPSS Statistics 30.0, with significance set at p < 0.05. Results: A total of 140 participants were enrolled, including 68 NTG patients and 72 controls. After applying exclusion criteria, 63 NTG patients and 68 controls were included in the final analysis. The median intracranial pressure pulse wave amplitude was significantly higher in NTG patients (0.1326 a.u.) than in controls (0.0889 a.u.), with p = 0.01. Conclusions: These findings suggest that intracranial pressure pulse wave monitoring may serve as a potential biomarker for NTG. Further studies are needed to determine the diagnostic accuracy, sensitivity, and specificity of this technology for NTG detection. Full article

(This article belongs to the Special Issue Ophthalmology: New Diagnostic and Treatment Approaches)

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19 pages, 5417 KB

Open AccessEditor’s ChoiceReview

Scar Management in Pediatric Patients

by Sydney Barone, Eric Bao, Stephanie Rothberg, Jose F. Palacios, Isabelle T. Smith, Neil Tanna and Nicholas Bastidas

Medicina 2025, 61(4), 553; https://doi.org/10.3390/medicina61040553 - 21 Mar 2025

Cited by 4 | Viewed by 10779

Abstract

Background and Objectives: Pediatric patients can acquire scars from both accidental injury and surgical procedures. While scars cannot be avoided if a full-thickness injury occurs, scar visibility may be minimized through a variety of approaches. In this narrative review, we evaluate the [...] Read more.

Background and Objectives: Pediatric patients can acquire scars from both accidental injury and surgical procedures. While scars cannot be avoided if a full-thickness injury occurs, scar visibility may be minimized through a variety of approaches. In this narrative review, we evaluate the current evidence and propose an algorithm for scar management in pediatric patients. Materials and Methods: A review of the literature was performed for scar management techniques for pediatric patients. Management modalities based on the type of scar and dosing, treatment regimen, and safety profiles are described in this article and used to create a scar management algorithm. Results: The initial step to scar management in the pediatric population involves ensuring minimal wound tension, which can be achieved through making the incision along relaxed skin tension lines, and early, minimal tension wound closure. Subsequent treatments to optimize scar care should begin 2–3 weeks following wound closure and involve the application of silicone gel or sheets and scar massaging. When topical products are insufficient, laser therapy can be utilized for the management of immature erythematous or thick scars. When mature, pathological scars form such as atrophic scars, hyperpigmentation, hypertrophic scars, or keloids, a combination of modalities is recommended. These modalities vary by scar type and include retinoids and dermabrasion for atrophic scars; retinoids, hydroquinone, and laser therapy for hyperpigmentation; and pressure therapy, corticosteroids, and laser therapy for hypertrophic scars and keloids. When mature, pathological scars persist following 12 months of non-invasive therapies, surgical excision should be considered. Conclusions: Several treatment options are available to manage scars in the pediatric population depending on scar type. Full article

(This article belongs to the Section Surgery)

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16 pages, 353 KB

Open AccessEditor’s ChoiceArticle

SGLT-2i—A Useful Tool for Real-Life Metabolic and Body Weight Control in Type 2 Diabetes Mellitus Patients

by Mihaela-Simona Popoviciu, Teodor Salmen, Delia Reurean-Pintilei, Vlad Voiculescu and Anca Pantea Stoian

Medicina 2025, 61(3), 548; https://doi.org/10.3390/medicina61030548 - 20 Mar 2025

Cited by 4 | Viewed by 4417

Abstract

Background and Objectives: Elevated blood sugar poses an increasingly significant challenge to healthcare systems worldwide. We aimed to assess the efficacy of the SGLT-2i class in achieving metabolic control in patients with T2DM within a real-world standard-of-care regimen. Material and Methods: A prospective [...] Read more.

Background and Objectives: Elevated blood sugar poses an increasingly significant challenge to healthcare systems worldwide. We aimed to assess the efficacy of the SGLT-2i class in achieving metabolic control in patients with T2DM within a real-world standard-of-care regimen. Material and Methods: A prospective analysis was conducted over 6 months including individuals receiving care in an outpatient department, with baseline assessments and follow-ups at 3 and 6 months. Results: A total of 280 patients were assessed, with a mean age of 63.69 ± 9.16, 53.9% of which were males, with a mean DM duration of 9.06 ± 5.64 years, and a DM duration varying from 6 months to 24 years. Discussion: Real-world evidence bridges the gap between guidelines and practice. It emphasizes the need to overcome clinical inertia in order to optimize patient outcomes and contributes to the body of evidence supporting the efficacy of fixed-dose SGLT-2i combinations in managing T2DM and associated comorbidities. Conclusions: We demonstrate the significant clinical and therapeutic impact of SGLT-2i in T2DM patients in a real-world setting. This class of medication not only positively influences glycemic and weight control but also reduces CV risk factors and visceral adiposity. Full article

(This article belongs to the Special Issue Novel Innovations in Diabetes Mellitus Prevention, Screening and Management)

15 pages, 1251 KB

Open AccessEditor’s ChoicePerspective

Breaking Barriers—The Promise and Challenges of Limb Osseointegration Surgery

by Agnieszka Wnuk-Scardaccione and Jan Bilski

Medicina 2025, 61(3), 542; https://doi.org/10.3390/medicina61030542 - 20 Mar 2025

Cited by 3 | Viewed by 4632

Abstract

Limb amputation remains a significant global health issue, affecting millions of individuals annually. A substantial proportion of these patients struggle with the inadequate fit and discomfort of conventional prosthetic sockets, leading to diminished quality of life. Osseointegration surgery, a promising alternative, offers the [...] Read more.

Limb amputation remains a significant global health issue, affecting millions of individuals annually. A substantial proportion of these patients struggle with the inadequate fit and discomfort of conventional prosthetic sockets, leading to diminished quality of life. Osseointegration surgery, a promising alternative, offers the direct skeletal attachment of bone, implant, and prosthetic, providing a more stable and functional interface. Osseointegration remains an emerging procedure, and while exact global figures are difficult to pinpoint, estimates suggest that over 10,000 patients worldwide have received osseointegration implants since the technique was first introduced. This perspective article analyzes recent advancements in the field of limb osseointegration, highlighting key achievements such as improved implant materials, surgical techniques, and comprehensive prosthetic integration strategies. Additionally, it explores future directions for development and discusses the latest research trends shaping the evolution of this field. Despite these developments, the widespread adoption of osseointegration faces significant barriers, including complications, limited access to multidisciplinary care, economic constraints, and the need for further long-term clinical evidence. In this paper, we present an extensive perspective on the current state of osseointegration, discuss the challenges impeding its broader implementation, and offer recommendations to address these obstacles, with the goal of enhancing patient outcomes and facilitating the integration of osseointegration into mainstream clinical practice. Full article

(This article belongs to the Section Orthopedics)

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23 pages, 947 KB

Open AccessEditor’s ChoiceReview

The Role of Empathy in ADHD Children: Neuropsychological Assessment and Possible Rehabilitation Suggestions—A Narrative Review

by Antony Casula, Giulia Belluardo, Carmine Antenucci, Federica Bianca, Francesco Corallo, Francesca Ferraioli, Domenica Gargano, Salvatore Giuffrè, Alice Lia Carmen Giunta, Antonella La Torre, Simona Massimino, Alessio Mirabile, Giuliana Parisi, Cono Daniele Pizzuto, Maria Cristina Spartà, Alessia Tartaglia, Francesco Tomaiuolo and Laura Culicetto

Medicina 2025, 61(3), 505; https://doi.org/10.3390/medicina61030505 - 15 Mar 2025

Cited by 3 | Viewed by 7040

Abstract

Background and Objectives: Theory of mind (ToM) deficits in children with ADHD are closely related to social difficulties and problems in interpersonal interactions. Evidence suggests that these cognitive deficits negatively affect the ability to understand and respond to others’ emotions and intentions, thus [...] Read more.

Background and Objectives: Theory of mind (ToM) deficits in children with ADHD are closely related to social difficulties and problems in interpersonal interactions. Evidence suggests that these cognitive deficits negatively affect the ability to understand and respond to others’ emotions and intentions, thus contributing to social isolation and a lower quality of life. However, the findings across studies vary, indicating that ADHD subtype and comorbidities, such as anxiety and mood disorders, can significantly influence sociocognitive deficits, modulating the extent of social problems. Materials and Methods: This review examines the relationship among ADHD, ToM, and empathy, analyzing studies comparing children with ADHD with peers with typical development or other neurodevelopmental conditions. A search in PubMed, Scopus, and the Cochrane Library prior to January 10, without time restrictions, using “ADHD”, “Cognitive Empathy”, and “Theory of Mind” identified relevant studies assessing these abilities through neuropsychological tests or questionnaires. Results: Of the initial 243 studies, 23 studies met the inclusion criteria. Children with ADHD exhibited significant impairments in ToM and empathy, affecting social cognition and interpersonal understanding. Various assessment tools revealed difficulties in understanding beliefs, emotions, and intentions, with executive function deficits playing a crucial role in shaping these social challenges. Conclusions: This review highlights the need for targeted therapeutic interventions that not only address cognitive deficits but consider emotional and metacognitive aspects, such as emotion regulation and self-awareness. Future research should focus on integrating executive function training with approaches that develop metacognitive and emotional skills, thus providing more comprehensive support. Full article

(This article belongs to the Section Psychiatry)

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17 pages, 2366 KB

Open AccessEditor’s ChoiceArticle

Role of DPP-4 and NPY Family Peptides in Gastrointestinal Symptoms Associated with Obesity and Type 2 Diabetes Mellitus

by Mantas Malinauskas, Deimante Paskeviciene, Rūta Steponaitienė, Rita Gudaityte, Limas Kupčinskas, Anna Casselbrant and Almantas Maleckas

Medicina 2025, 61(3), 504; https://doi.org/10.3390/medicina61030504 - 15 Mar 2025

Cited by 2 | Viewed by 2057

Abstract

Background and Objectives: Neuropeptide Y (NPY) family peptides and dipeptidyl peptidase-4 (DPP-4) are involved in gastrointestinal regulation and may contribute to obesity and type 2 diabetes mellitus (T2DM) pathophysiology. This study investigates their expression in jejunal muscular tissue and associations with gastrointestinal [...] Read more.

Background and Objectives: Neuropeptide Y (NPY) family peptides and dipeptidyl peptidase-4 (DPP-4) are involved in gastrointestinal regulation and may contribute to obesity and type 2 diabetes mellitus (T2DM) pathophysiology. This study investigates their expression in jejunal muscular tissue and associations with gastrointestinal symptoms in patients with obesity, with (OB+/DM+) and without T2DM (OB+/DM−). Materials and Methods: This cross-sectional study includes forty-four patients undergoing laparoscopic Roux-en-Y gastric bypass divided based on T2DM status. Gastrointestinal symptoms were assessed using the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire, and jejunal tissue samples were analyzed for DPP-4, NPY, peptide YY (PYY), and pancreatic polypeptide (PP) mRNA and protein levels. Results: DPP-4, NPY, PYY, and PP gene expression in jejunal muscular tissue was similar between groups. In the OB+/DM+ group, PP protein was higher, while DPP-4 and PYY were lower compared to the OB+/DM− group. Significant positive correlations between DPP-4 and NPY, PYY, and PP were found in the OB+/DM− group, while only DPP-4 and PYY correlated in the OB+/DM+ group. Gastrointestinal symptoms in the OB+/DM− group showed positive correlations with PP (abdominal pain), DPP-4 (indigestion), and NPY (constipation). Conclusions: The study demonstrates significant differences in DPP-4, PYY, and PP protein expression between patients with obesity, with or without T2DM. Peptide correlations with gastrointestinal symptoms in non-diabetic patients suggest distinct regulatory mechanisms, warranting further research. Full article

(This article belongs to the Special Issue Diabetes and Obesity: What Is New in 2025)

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14 pages, 2997 KB

Open AccessEditor’s ChoiceArticle

Knee-Sparing Resection and Reconstruction Surgery for Bone Sarcoma Using 3D-Surgical Approach: Average of 5-Year Follow-Up

by Amit Benady, Noy Yehiel, Ortal Segal, Omri Merose, Amir Sterenheim, Osnat Sher, Ben Efrima, Eran Golden, Yair Gortzak and Solomon Dadia

Medicina 2025, 61(3), 476; https://doi.org/10.3390/medicina61030476 - 8 Mar 2025

Cited by 4 | Viewed by 2135

Abstract

Background and Objectives: To date, the gold standard of care for bone sarcomas is limb salvage surgical resection. In cases where the tumor arises in the distal femur or proximal tibia near the joint line, knee-sacrificing surgery is typically performed, followed by [...] Read more.

Background and Objectives: To date, the gold standard of care for bone sarcomas is limb salvage surgical resection. In cases where the tumor arises in the distal femur or proximal tibia near the joint line, knee-sacrificing surgery is typically performed, followed by reconstruction with oncological megaprostheses. This study aims to evaluate the effectiveness of a precise 3D-based surgical approach for knee-sparing tumor resections, assessing its feasibility and its impact on surgical, oncological, and functional outcomes. Materials and Methods: This single-center retrospective study presents the surgical and oncological outcomes of knee-sparing surgeries following bone sarcoma resections. All patients underwent either intercalary or geographic resection, and reconstruction was tailored to each patient, using either an allograft or a titanium alloy Ti64 implant, depending on the specific requirements of the case. Results: A total of 23 patients (average age 21.04 years, 14 males) were included, with an average postoperative follow-up of 58 months (range: 12–102 months). Clear surgical margins were achieved in all patients, with 16 patients (69.5%) showing wide negative margins (R0) and the rest showing close negative margins (R1). Resections were primarily intercalary (17 patients, 73.9%), with 6 patients (26.1%) undergoing geographic resections. Reconstruction methods included allografts (9 patients, 39.3%), vascularized fibula and allograft (8 patients, 34.7%), and printed Ti64 cage reconstructions (6 patients, 26.0%). At the last follow-up, 19 patients (82.6%) were disease-free, 3 patients (13.4%) were alive with evidence of disease, and 1 patient (4%) was dead of disease. Complications included four cases of non-union that required revision surgery, as well as two local recurrences, which necessitated revision surgery to a modular endoprosthesis and above-knee amputation. The average MSTS at the final follow-up was 23.16 ± 5.91. Conclusions: The use of 3D-printed PSIs for knee-sparing bone tumor resections has emerged as the gold standard, enhancing both surgical and oncological outcomes. A future challenge lies in improving reconstruction techniques, shifting from traditional allografts to customized Ti64 printed lattice implants. As personalized healthcare and additive manufacturing continue to advance, the future of orthopedic oncology will likely see more precise, durable, and biologically integrated implants, further improving patient outcomes. Full article

(This article belongs to the Section Orthopedics)

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82 pages, 3264 KB

Open AccessEditor’s ChoiceSystematic Review

Next-Generation Cognitive-Behavioral Therapy for Depression: Integrating Digital Tools, Teletherapy, and Personalization for Enhanced Mental Health Outcomes

by Evgenia Gkintoni, Stephanos P. Vassilopoulos and Georgios Nikolaou

Medicina 2025, 61(3), 431; https://doi.org/10.3390/medicina61030431 - 28 Feb 2025

Cited by 34 | Viewed by 39041

Abstract

Background and Objectives: This systematic review aims to present the latest developments in next-generation CBT interventions of digital support tools, teletherapies, and personalized treatment modules in enhancing accessibility, improving treatment adherence, and optimizing therapeutic outcomes for depression. Materials and Methods: This review analyzed [...] Read more.

Background and Objectives: This systematic review aims to present the latest developments in next-generation CBT interventions of digital support tools, teletherapies, and personalized treatment modules in enhancing accessibility, improving treatment adherence, and optimizing therapeutic outcomes for depression. Materials and Methods: This review analyzed 81 PRISMA-guided studies on the efficacy, feasibility, and applicability of NG-CBT approaches. Other important innovations include web-based interventions, AI-operated chatbots, and teletherapy platforms, each of which serves as a critical challenge in delivering mental health care. Key messages have emerged regarding technological readiness, patient engagement, and the changing role of therapists within the digital context of care. Results: Findings indicate that NG-CBT interventions improve treatment accessibility and engagement while maintaining clinical effectiveness. Personalized digital tools enhance adherence, and teletherapy platforms provide scalable and cost-effective alternatives to traditional therapy. Conclusions: Such developments promise great avenues for decreasing the global burden of depression and enhancing the quality of life through novel, accessible, and high-quality therapeutic approaches. Full article

(This article belongs to the Section Psychiatry)

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15 pages, 5207 KB

Open AccessEditor’s ChoiceReview

Advances in Metabolic Bariatric Surgeries and Endoscopic Therapies: A Comprehensive Narrative Review of Diabetes Remission Outcomes

by Wissam Ghusn, Jana Zeineddine, Richard S. Betancourt, Aryan Gajjar, Wah Yang, Andrew G. Robertson and Omar M. Ghanem

Medicina 2025, 61(2), 350; https://doi.org/10.3390/medicina61020350 - 17 Feb 2025

Cited by 6 | Viewed by 4305

Abstract

Background and Objectives: Type 2 diabetes (T2D), closely associated with obesity, contributes to increased morbidity and mortality due to complications such as cardiometabolic disease. This review aims to evaluate the effectiveness of metabolic and bariatric surgeries (MBS) and endoscopic bariatric therapies (EBTs) [...] Read more.

Background and Objectives: Type 2 diabetes (T2D), closely associated with obesity, contributes to increased morbidity and mortality due to complications such as cardiometabolic disease. This review aims to evaluate the effectiveness of metabolic and bariatric surgeries (MBS) and endoscopic bariatric therapies (EBTs) in achieving diabetes remission and to examine key predictors influencing remission outcomes. Materials and Methods: This review synthesizes data from studies on MBS and EBT outcomes, focusing on predictors for diabetes remission such as preoperative insulin use, diabetes duration, HbA1c, and C-peptide levels. Additionally, predictive scoring systems, including the Individualized Metabolic Surgery (IMS), DiaRem, Advanced-DiaRem, ABCD, and Robert et al. scores, were analyzed for their utility in forecasting remission likelihood. Results: Key predictors of T2D remission include shorter diabetes duration, lower HbA1c, and higher C-peptide levels, while prolonged insulin use, and higher insulin doses are associated with lower remission rates. Scoring models like IMS and DiaRem demonstrate that lower scores correlate with a higher likelihood of remission, especially for procedures such as Roux-En-Y gastric bypass (RYGB). RYGB generally shows higher remission rates compared to sleeve gastrectomy (SG), particularly among patients with mild disease severity, while EBTs like ESG and IGBs contribute 5–20% total weight loss (TWL) and moderate glycemic control improvements. Conclusions: Both MBS and EBTs are effective for T2D management, with predictive scoring models aiding in individualized patient selection to optimize remission outcomes. Further research to validate these predictive tools across diverse populations could enhance treatment planning for both surgical and endoscopic interventions. Full article

(This article belongs to the Section Surgery)

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15 pages, 1700 KB

Open AccessEditor’s ChoiceReview

Sarcoidosis-Associated Pulmonary Hypertension

by Yoshitaka Morimatsu, Nobuhiro Tahara, Masaki Okamoto, Munehisa Bekki, Atsuko Tahara, Yoshiko Eto, Tadahiro Kugai, Yuki Koga, Shoko Maeda-Ogata, Akihiro Honda, Sachiyo Igata, Yoshiaki Zaizen, Shuichi Tanoue, Tomoaki Hoshino, Tatsuya Ishitake and Yoshihiro Fukumoto

Medicina 2025, 61(2), 342; https://doi.org/10.3390/medicina61020342 - 14 Feb 2025

Cited by 2 | Viewed by 3606

Abstract

Sarcoidosis is a granulomatous disorder of unknown etiology characterized by multisystem non-caseating granulomas. Pulmonary hypertension (PH) is a well-known complication of sarcoidosis and is associated with increased morbidity and mortality. The actual epidemiology of sarcoidosis-associated PH (SAPH) remains unknown, and its pathogenesis has [...] Read more.

Sarcoidosis is a granulomatous disorder of unknown etiology characterized by multisystem non-caseating granulomas. Pulmonary hypertension (PH) is a well-known complication of sarcoidosis and is associated with increased morbidity and mortality. The actual epidemiology of sarcoidosis-associated PH (SAPH) remains unknown, and its pathogenesis has not been fully elucidated. SAPH is classified under the miscellaneous category (group 5 of the PH classification). The clinical presentation of SAPH is variable and not always proportional to the severity of sarcoidosis. Appropriate management for SAPH by an experienced physician is important; however, no treatment algorithm for SAPH has been established. Lung transplantation should be considered in refractory cases. Pulmonary arterial hypertension-specific vasodilators targeting the endothelin pathway, nitric oxide pathway, and prostacyclin pathway have improved the clinical functions and hemodynamics in some patients with SAPH. Full article

(This article belongs to the Special Issue Current Developments in the Diagnosis of and Therapy for Respiratory Disease-Associated Pulmonary Hypertension)

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17 pages, 2811 KB

Open AccessEditor’s ChoiceSystematic Review

Effectiveness and Safety of SYSADOAs Used in Eastern and Western Regions for the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials—SYSADOAs Are Effective and Safe for Knee OA

by Yong-Beom Park and Jun-Ho Kim

Medicina 2025, 61(2), 331; https://doi.org/10.3390/medicina61020331 - 13 Feb 2025

Cited by 2 | Viewed by 7436

Abstract

Background and Objective: According to international guidelines, glucosamine and chondroitin, regarded as slow-acting drugs for osteoarthritis (SYSADOAs), have been first-line treatments for knee osteoarthritis (OA); however, their efficacies remain controversial. Additionally, the efficacies of plant extract cocktails, SKI306X, and its newer formulation, [...] Read more.

Background and Objective: According to international guidelines, glucosamine and chondroitin, regarded as slow-acting drugs for osteoarthritis (SYSADOAs), have been first-line treatments for knee osteoarthritis (OA); however, their efficacies remain controversial. Additionally, the efficacies of plant extract cocktails, SKI306X, and its newer formulation, SKCPT, have not been well investigated. To evaluate the effectiveness and safety of symptomatic slow-acting drugs for osteoarthritis (SYSADOAs) in patients with knee OA. Materials and Methods: Electronic databases were systematically searched to identify randomized controlled trials (RCTs) assessing the effectiveness and safety of SYSADOAs, including chondroitin sulfate, glucosamine sulfate, and SKCPT/SKI306X. The outcomes included pain relief, functional improvements, and safety profiles. The outcome measurements were compared between the treatment and control groups, including placebo and non-placebo groups, within and after 3 months of follow-up. Results: Analysis of 21 RCTs showed significantly greater improvement in pain relief in the treatment group compared with the placebo group both within (standard mean difference [SMD], 0.38; 95% confidence interval [CI], 0.18–0.57; p < 0.001) and after 3 months of follow-up (SMD, 0.22; 95%CI, 0.03–0.42 p = 0.023). The treatment group also showed significantly greater functional improvements regardless of follow-up. Pain and functional improvement did not differ significantly between the treatment and non-placebo groups. Regarding the safety profile, the risk ratios did not differ significantly between the treatment and control groups, including the placebo and non-placebo subgroups. Conclusions: Glucosamine, chondroitin, and SKCPT/SKI306X improved the pain and function and were non-inferior to pharmacologic drugs for up to 12 months. These findings support the clinical use of these SYSADOAs to treat knee OA. Level of Evidence: Therapeutic Level II. Full article

(This article belongs to the Special Issue Updates on Risk Factors, Prevention and Treatment of Knee Disease)

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11 pages, 4559 KB

Open AccessEditor’s ChoiceArticle

Standard to Handheld: A New Wave in Thoracic Ultrasound and Patient Care—A Direct Comparison of Portable Handheld Against Standard in Thoracic Ultrasound

by Dzufar Halim, Alan Kelly, James Hayes, Kathleen Bennett, Argyrios Tzouvelekis, Dimitrios Ampazis and Fotios Sampsonas

Medicina 2025, 61(2), 313; https://doi.org/10.3390/medicina61020313 - 11 Feb 2025

Cited by 4 | Viewed by 1593

Abstract

Background and Objective: Ultrasound has become more popular and useful over the last few years in improving healthcare. While handheld devices offer portability and convenience, their diagnostic accuracy and clinical utility require further scrutiny. This study attempted to evaluate the non-inferiority of handheld [...] Read more.

Background and Objective: Ultrasound has become more popular and useful over the last few years in improving healthcare. While handheld devices offer portability and convenience, their diagnostic accuracy and clinical utility require further scrutiny. This study attempted to evaluate the non-inferiority of handheld portable ultrasound devices compared to standard ultrasound devices for common lung pathologies. Materials and Methods: Videos of various common lung pathologies from 20 patients were recorded by a single operator using both portable handheld and standard ultrasound devices in a single setting. These videos were then assessed via online questionnaires by clinicians of various levels of experience from respiratory and non-respiratory departments. A Likert scale was used, ranging from strongly disagree to strongly agree (ranging from 1 to 5) in terms of overall image quality, clear anatomical visualization, similar clinical interpretations/decisions, and the perception of non-inferiority. Median values with interquartile ranges were reported; a rating of 3 or above was defined as indicating non-inferiority. Results: Thirty participants completed the questionnaires, of which the majority were at trainee level (n = 20, 73%) and from a respiratory department (n = 20, 67%). The participants had mixed levels of experience in terms of the years and frequency of use of the ultrasound. Overall median ratings were 4.0 for overall image quality, clear anatomical visualization, and similar clinical interpretations/decisions, with slight variations in interquartile ranges. No significant differences were observed between subgroups. The portable ultrasound device was rated similarly for the overall perception of non-inferiority, but clinicians from respiratory departments and clinicians with less experience showed statistically significant variability in their assessments. Conclusions: The portable handheld device demonstrated potential as a reliable alternative to standard models in standard clinical settings without compromising clinical decision. Further evaluation is needed that includes a direct comparison of various types of handheld ultrasound devices, across different operators’ levels of experience, to further solidify their suitability in patient care. Full article

(This article belongs to the Section Pulmonology)

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18 pages, 1575 KB

Open AccessEditor’s ChoiceSystematic Review

Anterior Cruciate Ligament Reconstruction Using Lateral Extra-Articular Procedures: A Systematic Review

by Filippo Migliorini, Ludovico Lucenti, Ying Ren Mok, Tommaso Bardazzi, Riccardo D’Ambrosi, Angelo De Carli, Domenico Paolicelli and Nicola Maffulli

Medicina 2025, 61(2), 294; https://doi.org/10.3390/medicina61020294 - 8 Feb 2025

Cited by 25 | Viewed by 4625

Abstract

Background and Objectives: The present systematic review investigated the efficacy of lateral extra-articular tenodesis (LET) and anterolateral ligament (ALL) as lateral extra-articular procedures (LEAPs) for anterior cruciate ligament (ACL) reconstruction. ACL reconstruction using LEAP may reduce graft rupture and rotatory laxity and [...] Read more.

Background and Objectives: The present systematic review investigated the efficacy of lateral extra-articular tenodesis (LET) and anterolateral ligament (ALL) as lateral extra-articular procedures (LEAPs) for anterior cruciate ligament (ACL) reconstruction. ACL reconstruction using LEAP may reduce graft rupture and rotatory laxity and allow a quicker return to sports. The outcomes of interest were patient-reported outcome measures (PROMs), return to sport, laxity, failure rate, and safety profile. Materials and Methods: The present systematic review followed the 2020 PRISMA guidelines. In December 2024, PubMed, EMBASE, and Web of Science were accessed without constraints. All clinical investigations evaluating LEAP for ACL reconstruction were considered. Only studies that considered LET and ALL as LEAP were considered. Only studies using a hamstring tendon autograft associated with LET or ALL were considered. Results: Data from 27 clinical studies (3423 patients) were retrieved. The mean length of follow-up was 61.8 ± 39.5 months. ACL reconstruction using LEAP led to a statistically significant improvement in the Lysholm score (p < 0.01) and IKDC (p < 0.01). The mean joint laxity, as measured by the arthrometer, was 1.5 ± 1.8 mm. Finally, 72.3% (623 of 668) of patients returned to their pre-injury level of sport at a mean of 6.3 ± 4.4 months. At the last follow-up, the LET group showed greater IKDC (p = 0.04). On the other hand, there was a statistically significant greater rate of patients positive to the Lachman test (p < 0.01), return to sport (p < 0.01), and reoperation (p = 0.01). No significant differences were found in Lysholm scores (p = 0.6), Tegner scores (p = 0.2), arthrometer measurements (p = 0.2), Pivot shift test results (p = 0.1), time to return to sport (p = 0.3), and failure rates (p = 0.7). Conclusions: LEAP for ACL reconstructions seems to be effective and safe. Most patients returned to their pre-injury level of sport after a mean of 6 months. LET-based ACL reconstruction may be associated with greater clinical outcomes and a higher reoperation rate compared to ALL-based reconstruction. Full article

(This article belongs to the Special Issue Anterior Cruciate Ligament (ACL) Injury)

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19 pages, 671 KB

Open AccessEditor’s ChoiceSystematic Review

Review of Psychological Interventions in Oncology: Current Trends and Future Directions

by Teodora Anghel, Bratu Lavinia Melania, Iuliana Costea, Oana Albai, Amalia Marinca, Codrina Mihaela Levai and Lavinia Maria Hogea

Medicina 2025, 61(2), 279; https://doi.org/10.3390/medicina61020279 - 6 Feb 2025

Cited by 19 | Viewed by 15007

Abstract

Background and Objectives: Cancer imposes a profound burden on both physical and psychological health, particularly at advanced stages, which are associated with a poor prognosis and heightened emotional distress. Psychotherapeutic interventions have gained recognition for their role in alleviating distress, enhancing the [...] Read more.

Background and Objectives: Cancer imposes a profound burden on both physical and psychological health, particularly at advanced stages, which are associated with a poor prognosis and heightened emotional distress. Psychotherapeutic interventions have gained recognition for their role in alleviating distress, enhancing the quality of life, and supporting a holistic approach to cancer care. This review examines the effectiveness of psychotherapeutic interventions in improving psychological well-being in cancer patients. Materials and Methods: Conducted as a literature review following PRISMA guidelines, this study analyzed experimental research on psychotherapeutic interventions for cancer patients published in the past decade. Literature searches were performed in PubMed, Google Scholar, the Cochrane Library, Web of Science, PsycINFO, and Consensus, supplemented by manual reference checks. The inclusion criteria focused on randomized controlled trials (RCTs). Results: The analysis included 20 RCTs spanning over three decades, evaluating interventions such as individual meaning-centered psychotherapy (IMCP), Mindfulness-Based Cognitive Therapy (MBCT), and supportive–expressive group therapy (SEGT). IMCP emerged as being particularly effective in reducing depression, anxiety, and demoralization while enhancing spiritual well-being. MBCT demonstrated significant reductions in the fear of recurrence, while SEGT effectively addressed traumatic stress and fostered social support. Although the survival benefits were inconsistently reported, psychosocial improvements, including an enhanced quality of life and emotional resilience, were consistently observed. The methodological quality varied, with nine studies meeting high-quality standards. Conclusions: Psychotherapeutic interventions, particularly IMCP and MBCT, play a critical role in oncology by alleviating distress, fostering resilience, and improving the quality of life. Integrating these approaches into routine cancer care can ensure a more holistic treatment framework that prioritizes the emotional and psychological needs of patients. Full article

(This article belongs to the Section Psychiatry)

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19 pages, 688 KB

Open AccessEditor’s ChoiceSystematic Review

The Therapeutic Potential of Psychedelics in Treating Substance Use Disorders: A Review of Clinical Trials

by Lavinia Hogea, Dana Cătălina Tabugan, Iuliana Costea, Oana Albai, Laura Nussbaum, Adriana Cojocaru, Leonardo Corsaro and Teodora Anghel

Medicina 2025, 61(2), 278; https://doi.org/10.3390/medicina61020278 - 6 Feb 2025

Cited by 9 | Viewed by 18008

Abstract

Background and Objectives: Substance use disorders (SUDs) affect millions worldwide. Despite increasing drug use, treatment options remain limited. Psychedelic-assisted therapy (PAT), integrating psychedelic substances with psychotherapy, offers a promising alternative by addressing underlying neural mechanisms. Materials and Methods: This review’s purpose [...] Read more.

Background and Objectives: Substance use disorders (SUDs) affect millions worldwide. Despite increasing drug use, treatment options remain limited. Psychedelic-assisted therapy (PAT), integrating psychedelic substances with psychotherapy, offers a promising alternative by addressing underlying neural mechanisms. Materials and Methods: This review’s purpose is to investigate the current understanding of psychedelic therapy for treating SUDs, including tobacco, alcohol, and drug addiction. The systematic review approach focused on clinical trials and randomized controlled trials conducted from 2013 to 2023. The search was performed using PubMed, Google Scholar, and Consensus AI, following PRISMA guidelines. Studies involving psychedelics like LSD, psilocybin, ibogaine, and ayahuasca for treating various addictions were included, excluding naturalistic studies and reviews. Results: Our results highlight the key findings from 16 clinical trials investigating psychedelic therapy for SUDs. Psychedelics like psilocybin and ayahuasca showed promise in reducing alcohol and tobacco dependence, with psilocybin being particularly effective in decreasing cravings and promoting long-term abstinence. The studies revealed significant improvements in substance use reduction, especially when combined with psychotherapy. However, the variability in dosages and study design calls for more standardized approaches. These findings emphasize the potential of psychedelics in SUD treatment, though further large-scale research is needed to validate these results and develop consistent protocols. Conclusions: This research reviewed the past decade’s international experience, emphasizing the growing potential of psychedelic therapy in treating SUDs pertaining to alcohol, tobacco, and cocaine dependence. Psychedelics such as psilocybin and ketamine can reduce cravings and promote psychological well-being, especially when combined with psychotherapy. However, regulatory barriers and specialized clinical training are necessary to integrate these therapies into mainstream addiction treatment safely. Psychedelics offer a promising alternative for those unresponsive to conventional methods. Full article

(This article belongs to the Section Psychiatry)

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14 pages, 1016 KB

Open AccessEditor’s ChoiceArticle

Predictive Factors of Wound Healing and Limb Salvage After Successful Below-the-Knee Endovascular Angioplasty in Patients with Diabetic Foot Ulcer: A Retrospective Study

by Chang Sik Shin and Kwon Cheol Yoo

Medicina 2025, 61(2), 277; https://doi.org/10.3390/medicina61020277 - 6 Feb 2025

Cited by 3 | Viewed by 2932

Abstract

Background and Objectives: The primary objective of this study was to determine the predictive factors of limb salvage and wound healing in patients presenting with diabetic foot ulcers (DFUs) following successful below-the-knee endovascular angioplasty. Materials and Methods: Between January 2014 and [...] Read more.

Background and Objectives: The primary objective of this study was to determine the predictive factors of limb salvage and wound healing in patients presenting with diabetic foot ulcers (DFUs) following successful below-the-knee endovascular angioplasty. Materials and Methods: Between January 2014 and January 2019, we retrospectively analyzed the wound healing and limb salvage rates of 85 patients (88 limbs) who underwent infra-popliteal endovascular treatment (EVT) for DFUs. Numerous variables were explored, including age, sex, comorbidities, and the scores from three DFU grading systems (Wagner grade, University of Texas (UT) grade and stage, and Wound, Ischemia, and foot Infection (WIfI) stage). Univariate and multivariate Cox proportional hazards analyses were conducted to determine the associations between adverse events and these variables. Results: During follow-up, 44 wounds healed completely, 47 limb amputations (major, 25; minor, 22) were required, and 17 limbs needed reintervention for wound healing. Nine patients who received treatment died of cardiovascular and cerebrovascular diseases, pneumonia, and other causes. At 1, 3, 6, 9, and 12 months, total wound healing rates were 4.6%, 16.9%, 27.5%, 34.5%, and 64.5%, respectively. At 6 months, 1 year, 2 years, and 5 years, amputation-free survival rates were 77.6%, 72.4%, 63.3%, and 63.3%, respectively. In multivariate Cox analyses, the UT grade and stage were associated with increased wound non-healing, while the UT grade and Wagner grade were associated with increased major lower-extremity amputation rates. Importantly, the UT grade was the only simultaneous risk factor predicting both wound healing and limb salvage. Conclusions: Despite successful below-the-knee angioplasty, a significant proportion of patients experienced wound non-healing and major amputation. The UT grade may serve as a predictor for both wound healing and limb salvage outcomes. Full article

(This article belongs to the Section Surgery)

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11 pages, 3763 KB

Open AccessEditor’s ChoiceArticle

Optical Coherence Tomography Angiography Flow Signal in Non-Treatment-Naïve Patients with Neovascular Age-Related Macular Degeneration Treated with Faricimab

by Max Brinkmann, Tom Müller, Marco Köster, Jakob Schweighofer, Mathis Danckwardt, Giuseppe Giannaccare, Paola Marolo, Enrico Borrelli, Michele Reibaldi, Yosuf El-Shabrawi and Mario Damiano Toro

Medicina 2025, 61(2), 260; https://doi.org/10.3390/medicina61020260 - 3 Feb 2025

Cited by 4 | Viewed by 1670

Abstract

Background and Objectives: Age-related macular degeneration (AMD) remains a leading cause of legal blindness. Anti-Vascular Endothelial Growth Factor (VEGF) agents are the first-line treatment for neovascular AMD (nAMD). The choroid plays a key role in AMD and is affected by the anti-VEGF treatment. [...] Read more.

Background and Objectives: Age-related macular degeneration (AMD) remains a leading cause of legal blindness. Anti-Vascular Endothelial Growth Factor (VEGF) agents are the first-line treatment for neovascular AMD (nAMD). The choroid plays a key role in AMD and is affected by the anti-VEGF treatment. Faricimab, a bispecific antibody additionally targeting angiopoietin 2 (Ang2), was recently approved for nAMD treatment. This study investigates the effect of Faricimab on choroidal flow signal. Materials and Methods: Optical coherence tomography angiography images of 29 nAMD eyes were examined retrospectively. Patients had received treatment with other anti-VEGF agents before Faricimab application. The flow signal in the choroid was measured before, after one and after a series of ≥2 Faricimab injections. Results: The flow signal decreased significantly (p = 0.026) at the choriocapillaris (CC) level after ≥2 injections. The flow signal did not show a significant change in Haller’s layer but increased slightly in Sattler’s layer (p = 0.034). Conclusions: In conclusion, our results show that the flow signal, especially at the CC level, changed during treatment. Despite the known influence of anti-VEGF treatment on the choroid, auxiliary inhibition of Ang2 might enhance this effect. Due to the retrospective nature, moderate sample size and non-treatment, naïve patients, care must be taken while interpreting our observations. Prospective studies with larger sample sizes and treatment-naïve patients will be needed. Full article

(This article belongs to the Special Issue Retinopathies: A Challenge for Early Diagnosis, Innovative Treatments and Reliable Follow-Up)

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18 pages, 2034 KB

Open AccessEditor’s ChoiceArticle

Depression and Its Effect on Geriatric Rehabilitation Outcomes in Switzerland’s Aging Population

by Bojan Miletic, Antonia Plisic, Lejla Jelovica, Jan Saner, Marcus Hesse, Silvije Segulja, Udo Courteney and Gordana Starcevic-Klasan

Medicina 2025, 61(2), 257; https://doi.org/10.3390/medicina61020257 - 2 Feb 2025

Cited by 3 | Viewed by 3445

Abstract

Background and Objectives: Depression is a common mental problem in the older population and has a significant impact on recovery and general well-being. A comprehensive understanding of the prevalence of depressive symptoms and their effects on functional outcomes is essential for improving [...] Read more.

Background and Objectives: Depression is a common mental problem in the older population and has a significant impact on recovery and general well-being. A comprehensive understanding of the prevalence of depressive symptoms and their effects on functional outcomes is essential for improving care strategies. The primary aim of this study was to determine the prevalence of depressive symptoms in older patients undergoing geriatric rehabilitation and to assess their specific impact on their functional abilities. Materials and Methods: A retrospective study was conducted at the Lucerne Cantonal Hospital in Wolhusen, Switzerland, spanning from 2015 to 2020 and including 1159 individuals aged 65 years and older. The presence of depressive symptoms was assessed using the Geriatric Depression Scale (GDS) Short Form, while functional abilities were evaluated using the Functional Independence Measure (FIM) and the Tinetti test. Data analysis was performed using TIBCO Statistica 13.3, with statistical significance set at p < 0.05. Results: Of the participants, 22.9% (N = 266) exhibited depressive symptoms, with no notable differences between genders. Although all patients showed functional improvements, the duration of rehabilitation was prolonged by two days (p = 0.012, d = 0.34) in those with depressive symptoms. Alarmingly, 76% of participants were classified as at risk of falling based on the Tinetti score. However, no significant correlation was found between the GDS and Tinetti scores at admission (p = 0.835, r = 0.211) or discharge (p = 0.336, r = 0.184). The results from the non-parametric Wilcoxon matched-pairs test provide compelling evidence of significant changes in FIM scores when comparing admission scores to those at discharge across all FIM categories. Conclusions: Depressive symptoms are particularly common in geriatric rehabilitation patients, leading to prolonged recovery time and increased healthcare costs. While depressive symptoms showed no correlation with mobility impairments, improvements in functional status were directly associated with reduced GDS scores. Considering mental health during admission and planning is critical in optimizing rehabilitation outcomes. Full article

(This article belongs to the Section Psychiatry)

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