Life | Special Issue : Feature Papers in Medical Research: 3rd Edition

Research

16 pages, 1329 KiB

Open AccessArticle

Comparison of Postoperative Analgesic Profiles Between Transversus Abdominis Plane Block and Local Wound Infiltration in Living Donor Kidney Transplantation Recipients: A Propensity Score-Matched Analysis

by Min Suk Chae, Kyung Kwan Lee, Jin-Oh Jeong, Wonwoo Jeong, Young Wook Moon and Ji Young Min

Life 2025, 15(5), 687; https://doi.org/10.3390/life15050687 - 23 Apr 2025

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Abstract

Effective postoperative pain management is crucial for optimizing recovery and clinical outcomes in living donor kidney transplantation (LDKT). This retrospective study compared the efficacy and safety of transversus abdominis plane (TAP) block and local wound infiltration (LWI) for postoperative analgesia. A total of [...] Read more.

Effective postoperative pain management is crucial for optimizing recovery and clinical outcomes in living donor kidney transplantation (LDKT). This retrospective study compared the efficacy and safety of transversus abdominis plane (TAP) block and local wound infiltration (LWI) for postoperative analgesia. A total of 524 LDKT recipients, matched through propensity scoring, were analyzed (262 per group). Pain intensity was assessed using the visual analog scale (VAS) at multiple postoperative time points, while opioid consumption was evaluated based on intravenous patient-controlled analgesia (IV-PCA) usage and rescue fentanyl doses. The TAP block group had significantly lower VAS pain scores at 1, 4, and 8 h postoperatively (p < 0.001) and required fewer opioids, as evidenced by reduced IV-PCA usage (55.9 ± 10.2 mL vs. 69.7 ± 18.2 mL; p < 0.001) and lower rescue fentanyl doses (67.7 ± 30.6 µg vs. 119.1 ± 71.8 µg; p < 0.001). Despite these differences in analgesic efficacy, no significant differences were observed between the groups in terms of postoperative nausea and vomiting or complications such as systemic toxicity and nerve injury. These findings suggest that the TAP block provides more effective early postoperative pain relief and reduces opioid requirements without increasing adverse events. Given its favorable safety profile and effectiveness, the TAP block is a valuable component of multimodal analgesia in LDKT recipients, supporting enhanced recovery while minimizing opioid-related complications. Full article

(This article belongs to the Special Issue Feature Papers in Medical Research: 3rd Edition)

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12 pages, 941 KiB

Open AccessArticle

Efficacy of Age-Adjusted Dyspnea, Eosinopenia, Consolidation, Acidemia and Atrial Fibrillation Score in Predicting Long-Term Survival in COPD-Related Persistent Hypercapnic Respiratory Failure

by Maşide Ari and Emrah Ari

Life 2025, 15(4), 533; https://doi.org/10.3390/life15040533 - 24 Mar 2025

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Abstract

Background and Objectives: Hypercapnic respiratory failure (HRF) is a critical clinical condition commonly encountered in acute exacerbations of chronic obstructive pulmonary disease (COPD), leading to high morbidity and mortality rates. The existing scoring systems have primarily been developed for short-term mortality prediction, [...] Read more.

Background and Objectives: Hypercapnic respiratory failure (HRF) is a critical clinical condition commonly encountered in acute exacerbations of chronic obstructive pulmonary disease (COPD), leading to high morbidity and mortality rates. The existing scoring systems have primarily been developed for short-term mortality prediction, and their impact on long-term survival has not been sufficiently investigated. This study aims to identify the prognostic factors affecting long-term survival in patients with persistent HRF due to COPD and to evaluate the effectiveness of the Age-Adjusted DECAF (A-DECAF) score, which was created by incorporating the age variable into the existing DECAF score, in predicting long-term survival. Materials and Methods: This retrospective study included patients admitted to an intensive care unit from an emergency department with HRF between April 2022 and November 2023. The demographic data, comorbidities, the laboratory results, and the treatment protocols were recorded. The A-DECAF scores were calculated and analyzed using Kaplan–Meier and ROC analyses. Survival assessment was conducted with Kaplan–Meier analysis, while univariate and multivariate Cox regression analyses were performed to identify the prognostic factors. Results: Among 357 patients, 24.4% died within one year after discharge. The deceased patients were significantly older (p < 0.001) and had higher APACHE-II, DECAF, and A-DECAF scores (p < 0.001 for all). ROC analysis showed that the A-DECAF score had the highest sensitivity (93.1%) and accuracy (AUC = 0.813) for survival prediction. Kaplan–Meier analysis indicated lower survival rates with increasing A-DECAF scores. Cox regression identified the A-DECAF score as the strongest independent predictor (p < 0.001), while lung cancer (p = 0.044) and invasive mechanical ventilation (p = 0.039) also negatively impacted survival. Conclusions: The A-DECAF score is an effective tool for predicting long-term survival in patients with COPD and persistent HRF, particularly aiding clinical decisions regarding elderly populations. Further research is needed to validate its use in diverse patient groups. Full article

(This article belongs to the Special Issue Feature Papers in Medical Research: 3rd Edition)

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14 pages, 1961 KiB

Open AccessArticle

Radiation Diagnostics of the Maxillofacial Region and Skeleton Bone Density in the Case of Vitamin D Insufficiency: A Pilot Study

by Ekaterina Diachkova, Svetlana Tarasenko, Marina Skachkova, Yury Zhilkov, Natalia Serova, Anna Babkova, Beatrice Volel, Ekaterina Blinova, Elizaveta Kytko, Renata Meylanova, Victoria Zaborova and Olesya Kytko

Life 2025, 15(3), 480; https://doi.org/10.3390/life15030480 - 17 Mar 2025

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Abstract

(1) Background: A decrease in bone mineral density has been noted not only in at-risk patients (e.g., postmenopausal women) but also in young and middle-aged individuals due to changes in lifestyle. The aim of the study was to find a possible correlation for [...] Read more.

(1) Background: A decrease in bone mineral density has been noted not only in at-risk patients (e.g., postmenopausal women) but also in young and middle-aged individuals due to changes in lifestyle. The aim of the study was to find a possible correlation for dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT) with cone beam computed tomography (CBCT) of the jaws. (2) Methods: A total of 24 patients (14 women and 10 men aged 25 to 50 years) with partial secondary tooth loss and vitamin D insufficiency underwent cone beam computed tomography of the jaws and skeletal mineral density assessment using DXA (n = 12) and QCT (n = 12). (3) Results: When conducting CBCT of the jaws, a predominance of bone tissue type D3 (350–850 Hu) on the upper jaw (p > 0.05 (F = 0.68) and D2 (850–1350 Hu) on the lower jaw (p > 0.05 (F = 1) was revealed. According to the results of QCT densitometry of the skeleton, signs of osteopenia were found in four patients (with vitamin D3 deficiency) (33%) according to DXA; signs of osteopenia were found in six patients (with severe deficiency and deficiency of vitamin D3) (50%). The difference between QCT and DXA was not significant (p > 0.05) for each group. The significant strong correlation between CBCT and DXA or QCT was not found (p > 0.05). (4) Conclusions: Primary changes in bone density can be detected earlier in the dental system using cone beam computed tomography of the jaws. At the same time, the question of using a specific densitometry method—DXA or QCT—remains open, as their results correlating with CBCT optical density was not approved. Full article

(This article belongs to the Special Issue Feature Papers in Medical Research: 3rd Edition)

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17 pages, 816 KiB

Open AccessArticle

Clinical Outcomes and Patterns of Traumatic Injuries Associated with Subway Incidents at a Level 1 Trauma Center

by Bharti Sharma, Aubrey May B. Agcon, George Agriantonis, Sittha Cheerasarn, Navin D. Bhatia, Zahra Shafaee, Jennifer Whittington and Kate Twelker

Life 2025, 15(1), 51; https://doi.org/10.3390/life15010051 - 3 Jan 2025

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Abstract

Objectives: Subway-related accidents have risen with advancements in the system. We aim to study the injury patterns from these incidents. Methods: This is a retrospective study from a single center, covering patients from 1 January 2016 to 31 December 2023. Patients were identified [...] Read more.

Objectives: Subway-related accidents have risen with advancements in the system. We aim to study the injury patterns from these incidents. Methods: This is a retrospective study from a single center, covering patients from 1 January 2016 to 31 December 2023. Patients were identified using International Classification of Diseases (ICD) injury descriptions and Abbreviated Injury Scale (AIS) body regions. Results: Out of 360 patients (total), 23.5% presented with head injuries with an AIS score ≥ 3. Patients with blunt trauma (93.99%) were in higher numbers than penetrating (5.74%) and burn trauma (0.3%). Overall, the mean Injury Severity Score (ISS) was 10.69, suggesting a broad range of traumatic injuries. ISSs for severe injuries (17–24) comprised 9.2%, moderate injuries (10–16) comprised 17.5%, and minor injuries (1–9) comprised 60.8%. Falls had the highest percentage of traumatic brain injuries (TBI) (65.60%) and fractures (67.50%). Assaults showed a significant occurrence of traumatic thoracic injuries (28.90%). Suicide attempts demonstrated a high percentage of traumatic amputations (30.80%). In the emergency department (ED), most patients (69.4%) were admitted for further care, such as trauma, neurosurgery, or other care. Of these patients, 0.5% died in the ED, 0.5% died on arrival, and 1.04% died within 15 min of arrival. The mortality rate among serious fall patients was 17.20% compared to the suicide and train-struck groups at 37.90% each. Conclusions: There were high occurrences of TBIs, and fractures, thoracic injuries, and amputations. Numbers of patients with blunt trauma were a lot higher than those with penetrating and burn trauma. The mortality rates observed in the suicide and train-struck groups were higher than those in patients with severe falls. Full article

(This article belongs to the Special Issue Feature Papers in Medical Research: 3rd Edition)

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14 pages, 4943 KiB

Open AccessArticle

Long-Term Efficacy of Combined Focused and Radial Extracorporeal Shockwave Therapy for Gluteus Medius Tendon Pathology: A Pilot Study

by Federica Fulceri, Larisa Ryskalin, Gabriele Morucci, Francesco Busoni, Paola Soldani and Marco Gesi

Life 2024, 14(12), 1698; https://doi.org/10.3390/life14121698 - 21 Dec 2024

Viewed by 1376

Abstract

Background: Gluteus medius tendinopathy is amongst the most prevalent lower limb tendinopathies and is now recognized as the primary cause of insidious lateral hip pain. Typically affecting middle-aged women, this condition causes disability and reduced quality of life as it negatively impacts most [...] Read more.

Background: Gluteus medius tendinopathy is amongst the most prevalent lower limb tendinopathies and is now recognized as the primary cause of insidious lateral hip pain. Typically affecting middle-aged women, this condition causes disability and reduced quality of life as it negatively impacts most daily life activities. Several studies demonstrate that extracorporeal shockwave therapy is effective in reducing pain and promoting functional recovery in several musculoskeletal disorders including tendinopathies. However, most published data are limited to evaluating focal or radial shockwaves as single interventions. Contrariwise, there is little evidence reporting the use of combined ESWT treatment and outcomes for managing tendon pathologies, and no data are reported on combined ESWT for gluteus medius tendinopathy. Objectives: The aim of this study was to evaluate the clinical outcomes of combined ESWT in gluteus medius tendinopathy. Methods: Medical charts of 11 consecutive patients with gluteal tendinopathy confirmed by ultrasound who underwent a combined ESWT protocol were reviewed. Changes in pain severity and lower limb function were evaluated using the numerical rating scale, the Victorian Institute of Sports Assessment for Gluteal tendinopathy questionnaire, and the Roles and Maudsley score. Clinical outcome measurements were collected at baseline (T0), 2 months after combined ESWT (T1), and at long-term follow-up (T2), at least 10 months post-treatment (mean 26 months). Results: The mean age of the sample was 62.55 ± 3.17 years. A marked prevalence of females was recorded (nine subjects, 81.8%). A significant improvement was observed in all outcome criteria both at short- and long-term follow-up after combined ESWT compared to baseline (p < 0.05). Treatment success rates were 90.9% and 81.8% at T1 and T2, respectively. Conclusions: Combined ESWT is effective and safe for patients with gluteal tendinopathy, with good long-term results in terms of pain relief and improved functional impairment. Full article

(This article belongs to the Special Issue Feature Papers in Medical Research: 3rd Edition)

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8 pages, 634 KiB

Open AccessArticle

Neurosurgical Outcomes for Intracerebral Hemorrhage in Patients Undergoing Dialysis

by Takuma Maeda, Mayuko Miyata, Nobuaki Naito, Koki Onodera, Yushiro Take, Aoto Shibata, Kaima Suzuki, Hidetoshi Ooigawa and Hiroki Kurita

Life 2024, 14(11), 1366; https://doi.org/10.3390/life14111366 - 24 Oct 2024

Viewed by 1119

Abstract

Patients on hemodialysis (HD) are at a very high risk of stroke, especially hemorrhagic stroke, with worse outcomes than the general population. We have determined the indications for urgent neurosurgery for intracerebral hemorrhage (ICH) based on the hematoma volume and neurological severity, regardless [...] Read more.

Patients on hemodialysis (HD) are at a very high risk of stroke, especially hemorrhagic stroke, with worse outcomes than the general population. We have determined the indications for urgent neurosurgery for intracerebral hemorrhage (ICH) based on the hematoma volume and neurological severity, regardless of HD status. This study aimed to evaluate the neurosurgical outcomes of ICH in patients undergoing HD. We retrospectively reviewed 38 cases of surgical removal of ICH performed in patients on HD. Patients were categorized into poor or better (0–4) and very poor (5 or 6) groups according to their modified Rankin Scale (mRS) score at discharge. Patient demographics, clinical characteristics, and operative records were retrospectively analyzed. The median Glasgow Coma Scale (GCS) score and hematoma volume were 6 and 99 mL, respectively. A total of 30 patients (78.9%) had very poor outcomes at discharge. Significant differences were observed in GCS score (13 vs. 6) and hematoma volume (53 vs. 114 mL) between the poor or better and very poor groups. The receiver operating characteristic curve analysis showed the cut-off values were 9 for GCS (AUC = 0.821) and 63.3 mL for hematoma volume (AUC = 0.812). The most common complication was rebleeding (10.5%), followed by seizures (7.9%), infection (7.9%), and cerebral edema (7.9%). In conclusion, neurosurgical outcomes of ICH in patients undergoing HD remain poor, but 21.1% of these patients achieved an mRS ≤ 4. ICH patients on HD with a GCS score > 9 or hematoma volume < 63 mL are more likely to demonstrate mRS ≤ 4 after surgical evacuation. The postoperative management of patients on HD should be performed considering specific risks, such as seizures and rebleeding. Full article

(This article belongs to the Special Issue Feature Papers in Medical Research: 3rd Edition)

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9 pages, 1090 KiB

Open AccessArticle

Preliminary Results of Developing Imaging Complexity Biomarkers for the Incidence of Severe Radiation Pneumonitis Following Radiotherapy in Non-Small Cell Lung Cancer Patients with Underlying Idiopathic Pulmonary Fibrosis

by Jeongeun Hwang, Hakyoung Kim, Sun Myung Kim and Dae Sik Yang

Life 2024, 14(7), 897; https://doi.org/10.3390/life14070897 - 19 Jul 2024

Cited by 2 | Viewed by 1366

Abstract

Background: Idiopathic pulmonary fibrosis (IPF) has the potential to cause fatal pulmonary toxicity after radiotherapy and can increase the morbidity and mortality of non-small-cell lung cancer (NSCLC) patients. In this context, we aimed to develop imaging complexity biomarkers to predict the incidence of [...] Read more.

Background: Idiopathic pulmonary fibrosis (IPF) has the potential to cause fatal pulmonary toxicity after radiotherapy and can increase the morbidity and mortality of non-small-cell lung cancer (NSCLC) patients. In this context, we aimed to develop imaging complexity biomarkers to predict the incidence of severe pulmonary toxicity in patients with NSCLC who have underlying IPF and are treated with radiotherapy. Methods: We retrospectively reviewed the medical records of 19 patients with NSCLC who had underlying IPF and were treated with radiotherapy at the Korea University Guro Hospital between March 2018 and December 2022. To quantify the morphometric complexity of the lung parenchyma, box-counting fractal dimensions and lacunarity analyses were performed on pre-radiotherapy simulation chest computed tomography scans. Results: Of the 19 patients, the incidence of grade 3 or higher radiation pneumonitis was observed in 8 (42.1%). After adjusting for age, sex, smoking status, histology, and diffusing capacity of the lung for carbon monoxide, eight patients with a lower fractal dimension showed a significantly higher hazard ratio of 7.755 (1.168–51.51) for grade 3 or higher pneumonitis than those with a higher fractal dimension. Patients with lower lacunarity exhibited significantly lower hazards in all models, both with and without adjustments. The lower-than-median lacunarity group also showed significantly lower incidence curves for all models built in this study. Conclusions: We devised a technique for quantifying morphometric complexity in NSCLC patients with IPF on radiotherapy and discovered lacunarity as a potential imaging biomarker for grade 3 or higher pneumonitis. Full article

(This article belongs to the Special Issue Feature Papers in Medical Research: 3rd Edition)

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12 pages, 798 KiB

Open AccessArticle

A More Targeted and Selective Use of Implantable Loop Recorders Improves the Effectiveness of Syncope Units: A Single-Center Experience

by Stefanos Archontakis, Evangelos Oikonomou, Konstantinos Sideris, Panagiotis Dourvas, Nikias Milaras, Panagiotis Kostakis, Tzonatan Klogkeri, Epameinondas Triantafyllou, Panagiotis Theofilis, Ioannis Ntalakouras, Petros Arsenos, Athanasia Gkika, Konstantinos Gatzoulis, Skevos Sideris and Dimitris Tousoulis

Life 2024, 14(7), 871; https://doi.org/10.3390/life14070871 - 12 Jul 2024

Viewed by 1261

Abstract

Purpose: Syncope remains a common medical problem. Recently, the role of dedicated syncope units and implantable loop recorders has emerged in the investigation of unexplained syncope. This study aims to investigate the possibilities for a more rational and targeted use of various diagnostic [...] Read more.

Purpose: Syncope remains a common medical problem. Recently, the role of dedicated syncope units and implantable loop recorders has emerged in the investigation of unexplained syncope. This study aims to investigate the possibilities for a more rational and targeted use of various diagnostic tools. Methods: In this retrospective single-center study, 196 patients with unexplained syncope were included between March 2019 and February 2023. Various diagnostic tools were utilized during the investigation, according to clinical judgement. Patients were retrospectively allocated into Group A (including those who, among other tests, underwent loop recorder insertion) and Group B (including patients investigated without loop recorder implantation). Data were compared with Group C, including patients assessed prior to syncope unit establishment. Results: There was no difference between Group A (n = 133) and Group B (n = 63) in the diagnostic yield (74% vs. 76%, p = 0.22). There were significant differences between Groups A and B regarding age (67.3 ± 16.9 years vs. 48.3 ± 19.1 years, p < 0.001) and cause of syncope (cardiogenic in 69% of Group A, reflex syncope in 77% of Group B, p < 0.001). Electrocardiography-based diagnosis occurred in 55% and 19% of Groups A and B, respectively (p < 0.001). The time to diagnosis was 4.2 ± 2.7 months in Group A and 7.5 ± 5.6 months in Group B (p < 0.001). In Group C, the diagnostic yield was 57.9% and the electrocardiography-based diagnostic yield was 18.3%. Conclusions: A selective use of loop recorders according to clinical and electrocardiographic characteristics increases the effectiveness of the structured syncope unit approach and further preserves financial resources. Full article

(This article belongs to the Special Issue Feature Papers in Medical Research: 3rd Edition)

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Review

Jump to: Research, Other

16 pages, 1075 KiB

Open AccessReview

International Nephrology Masterclass in Chronic Kidney Disease: Rationale, Summary, and Future Perspectives

by Francesco Pesce, Maria Vadalà, Edgar Almeida, Beatriz Fernandez, Denis Fouque, Jolanta Malyszko, Kai Schmidt-Ott, Peter Stenvinkel, David C. Wheeler, Samuel Seidu, Ana Cebrian, Nikolay Dimov, Marta Blanco Pardo, Ieva Ziedina, Nayaf Habashi, Joaquin Manrique, Sofia Homem De Melo Marques, Marco Antonio Vaca Gallardo, Larisa Shehaj, Milena Krasimirova Nikolova Vlahova, Luis Mendonça, Sara Ksiazek, Pierangelo Veltri, Giuseppe Pezzi, Gemma Patella, Greta Borelli, Michele Provenzano and Loreto Gesualdo Show full author list Hide full author list

Life 2024, 14(12), 1668; https://doi.org/10.3390/life14121668 - 17 Dec 2024

Cited by 1 | Viewed by 1665

Abstract

Chronic kidney disease (CKD) is a progressive condition that affects more than 10% of the population worldwide, accounting for more than 843 million (M) individuals. The prevalence of CKD (844 M patients) is higher than that of diabetes mellitus (422 M patients), cancer [...] Read more.

Chronic kidney disease (CKD) is a progressive condition that affects more than 10% of the population worldwide, accounting for more than 843 million (M) individuals. The prevalence of CKD (844 M patients) is higher than that of diabetes mellitus (422 M patients), cancer (42 M patients), and HIV (37 M patients), but people are often less aware of it. Global expert groups predict reductions in the nephrology workforce in the next decade, with a declining interest in nephrology careers. Over time, KDIGO guidelines have also focused on topics related to the prevention or management of CKD patients in real-life settings. On these premises, a new educational program with international experts in the field of nephrology took place from November 2022 until March 2023 in Milan, Italy. This multinational masterclass provided an educational platform providing unbiased education on diagnosis and treatment by sharing the most recent research data on CKD and comorbidities, therefore creating a snowball effect to increase the implementation of best practices worldwide, using examples from ‘real-life’ patient outcomes. This paper provides an overview of the International Nephrology Masterclass (INM) concept, summarizing the key lectures and discussions, and giving an outline of future key developments. Full article

(This article belongs to the Special Issue Feature Papers in Medical Research: 3rd Edition)

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Other

Jump to: Research, Review

1 pages, 160 KiB

Open AccessCorrection

Correction: Vulcănescu et al. Systematic Review: Maternal Risk Factors, Socioeconomic Influences, Neonatal Biomarkers and Management of Early-Onset Sepsis in Late Preterm and Term Newborns—A Focus on European and Eastern European Contexts. Life 2025, 15, 292

by Anca Vulcănescu, Mirela-Anișoara Siminel, Sorin-Nicolae Dinescu, Mihail-Virgil Boldeanu, Anda-Lorena Dijmărescu, Maria-Magdalena Manolea and Constantin-Cristian Văduva

Life 2025, 15(4), 616; https://doi.org/10.3390/life15040616 - 7 Apr 2025

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In the original publication [...] Full article

(This article belongs to the Special Issue Feature Papers in Medical Research: 3rd Edition)

18 pages, 1823 KiB

Open AccessStudy Protocol

Clinical Validation of a Machine Learning-Based Biomarker Signature to Predict Response to Cytotoxic Chemotherapy Alone or Combined with Targeted Therapy in Metastatic Colorectal Cancer Patients: A Study Protocol and Review

by Duilio Pagano, Vincenza Barresi, Alessandro Tropea, Antonio Galvano, Viviana Bazan, Adele Caldarella, Cristina Sani, Gianpaolo Pompeo, Valentina Russo, Rosa Liotta, Chiara Scuderi, Simona Mercorillo, Floriana Barbera, Noemi Di Lorenzo, Agita Jukna, Valentina Carradori, Monica Rizzo, Salvatore Gruttadauria and Marco Peluso

Life 2025, 15(2), 320; https://doi.org/10.3390/life15020320 - 19 Feb 2025

Cited by 1 | Viewed by 677

Abstract

Metastatic colorectal cancer (mCRC) is a severe condition with high rates of illness and death. Current treatments are limited and not always effective because the cancer responds differently to drugs in different patients. This research aims to use artificial intelligence (AI) to improve [...] Read more.

Metastatic colorectal cancer (mCRC) is a severe condition with high rates of illness and death. Current treatments are limited and not always effective because the cancer responds differently to drugs in different patients. This research aims to use artificial intelligence (AI) to improve treatment by predicting which therapies will work best for individual patients. By analyzing large sets of patient data and using machine learning, we hope to create a model that can identify which patients will respond to chemotherapy, either alone or combined with other targeted treatments. The study will involve dividing patients into training and validation sets to develop and test the models, avoiding overfitting. Various machine learning algorithms, like random survival forest and neural networks, will be integrated to develop a highly accurate and stable predictive model. The model’s performance will be evaluated using statistical measures such as sensitivity, specificity, and the area under the curve (AUC). The aim is to personalize treatments, improve patient outcomes, reduce healthcare costs, and make the treatment process more efficient. If successful, this research could significantly impact the medical community by providing a new tool for better managing and treating mCRC, leading to more personalized and effective cancer care. In addition, we examine the applicability of learning methods to biomarker discovery and therapy prediction by considering recent narrative publications. Full article

(This article belongs to the Special Issue Feature Papers in Medical Research: 3rd Edition)

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20 pages, 852 KiB

Open AccessSystematic Review

Systematic Review: Maternal Risk Factors, Socioeconomic Influences, Neonatal Biomarkers and Management of Early-Onset Sepsis in Late Preterm and Term Newborns—A Focus on European and Eastern European Contexts

by Anca Vulcănescu, Mirela-Anișoara Siminel, Sorin-Nicolae Dinescu, Mihail-Virgil Boldeanu, Anda-Lorena Dijmărescu, Maria-Magdalena Manolea and Constantin-Cristian Văduva

Life 2025, 15(2), 292; https://doi.org/10.3390/life15020292 - 13 Feb 2025

Cited by 1 | Viewed by 1019 | Correction

Abstract

Early-onset sepsis (EOS) remains a major cause of neonatal morbidity and mortality worldwide, with significant differences in the incidence and outcome of the disease in Europe. Eastern European countries face particular challenges due to differences in access to healthcare, diagnostic facilities, and prevention [...] Read more.

Early-onset sepsis (EOS) remains a major cause of neonatal morbidity and mortality worldwide, with significant differences in the incidence and outcome of the disease in Europe. Eastern European countries face particular challenges due to differences in access to healthcare, diagnostic facilities, and prevention strategies. This review summarizes the results of recent research to provide insights into maternal risk factors, regional inequalities in access to healthcare, diagnostic biomarkers, pathogen patterns, and treatment protocols for EOS. This review also examines how healthcare infrastructure and socioeconomic factors influence EOS outcomes in Eastern Europe. Introduction: Early-onset sepsis (EOS) presents a significant health challenge for newborns, characterized by sepsis occurring within the first 72 h of life, primarily caused by the vertical transmission of pathogens from mother to child. Despite advancements in medical care, EOS remains particularly burdensome in resource-poor settings, especially in Eastern Europe, where disparities in healthcare access and maternal health are pronounced. This systematic review aims to provide insights into maternal risk factors, regional inequalities in healthcare access, diagnostic biomarkers, pathogen patterns, and treatment protocols for EOS. Background/Objectives: EOS is increasingly recognized as a public health issue, with outcomes significantly influenced by maternal health, socioeconomic status, and healthcare infrastructure. The review seeks to summarize the existing literature on EOS, particularly focusing on differences between high-income Western and low-resource Eastern European countries. The influence of maternal access to antenatal care, pathogen prevalence, and antibiotic resistance on EOS outcomes across regions will also be examined. Methods: To achieve the review’s objectives, a comprehensive search was conducted across multiple databases including PubMed, Google Scholar, ScienceDirect, and Scopus, adhering to PRISMA guidelines for systematic reviews. The inclusion criteria encompassed studies published within the last 20 years (January 2004–August 2024) that addressed EOS in late preterm or term infants, emphasizing maternal health, risk factors, diagnostic approaches, and treatment protocols pertinent to European populations. Exclusion criteria included non-English publications and studies lacking a focus on maternal and neonatal health. A total of 29 peer-reviewed articles meeting the specified criteria were ultimately included in the analysis. Results: The findings highlight significant regional disparities in EOS management between Western and Eastern Europe. Key issues include maternal risk factors, socioeconomic barriers to healthcare, diagnostic biomarkers, and pathogen resistance trends. Limited access to prenatal screenings and healthcare infrastructure in Eastern European countries, especially in rural regions in Romania, exacerbate the challenges faced by expectant mothers. Financial burdens, such as high out-of-pocket expenses, were shown to further restrict access to necessary maternal care. Conclusions: This systematic review emphasizes the urgent need for targeted investments in maternal healthcare infrastructure in Eastern Europe to mitigate the impacts of EOS. Enhanced screening programs, standardized surveillance systems, and ensuring equitable health policies are essential to improving neonatal outcomes. Additionally, tailored education and awareness campaigns for disadvantaged groups and comprehensive health policy reforms, including universal antenatal care and Group B Streptococcus (GBS), are essential to bridging healthcare gaps. Full article

(This article belongs to the Special Issue Feature Papers in Medical Research: 3rd Edition)

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17 pages, 1886 KiB

Open AccessSystematic Review

Surgical Management of Pediatric Obstructive Sleep Apnea: Efficacy, Outcomes, and Alternatives—A Systematic Review

by Gianna Dipalma, Angelo Michele Inchingolo, Irene Palumbo, Mariafrancesca Guglielmo, Lilla Riccaldo, Roberta Morolla, Francesco Inchingolo, Andrea Palermo, Ioannis Alexandros Charitos and Alessio Danilo Inchingolo

Life 2024, 14(12), 1652; https://doi.org/10.3390/life14121652 - 12 Dec 2024

Cited by 1 | Viewed by 1497

Abstract

Aim: Obstructive sleep apnea (OSA) is the most prevalent sleep-related breathing disorder. OSA affects approximately 2 million Italians, although only 3% receive a diagnosis and correct treatment. This review aims to provide an overview to guide clinical decision making, ensuring that patients receive [...] Read more.

Aim: Obstructive sleep apnea (OSA) is the most prevalent sleep-related breathing disorder. OSA affects approximately 2 million Italians, although only 3% receive a diagnosis and correct treatment. This review aims to provide an overview to guide clinical decision making, ensuring that patients receive the most appropriate treatment for their specific condition. Material and Methods: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered at PROSPERO under the ID CRD42024593760. A search on PubMed, Scopus, and Web of Science was performed to find papers that matched the topic, using the following Boolean keywords: (“obstructive sleep apnea” OR “OSA” OR “sleep apnea, obstructive”) AND (“surgery” OR “surgical” OR “surgical techniques” OR “surgical treatment” OR “operative” OR “surgical procedures”) AND (“treatment” OR “therapy” OR “management”). Result: The electronic database search found 20337 publications. After the screening and eligibility phase, 15 papers were chosen for the qualitative analysis. Conclusions: Adenotonsillectomy (AT) significantly improves secondary outcomes like behavioral issues and quality of life, compared to watchful waiting with supportive care (WWSC). Alternative approaches such as tonsillotomy and adenopharyngoplasty (APP) offer promising results, with less postoperative discomfort and lower complication rates. However, further large-scale studies are needed to refine surgical techniques, assess long-term outcomes, and optimize individualized treatment strategies for OSA. Full article

(This article belongs to the Special Issue Feature Papers in Medical Research: 3rd Edition)

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