Medicina

13 pages, 1700 KiB

Open AccessArticle

Comparison of Cup Position and Perioperative Characteristics in Total Hip Arthroplasty Following Three Types of Pelvic Osteotomy

by Ryuichi Kanabuchi, Yu Mori, Kazuyoshi Baba, Hidetatsu Tanaka, Hiroaki Kurishima, Yasuaki Kuriyama, Hideki Fukuchi, Hiroki Kawamata and Toshimi Aizawa

Medicina 2025, 61(8), 1407; https://doi.org/10.3390/medicina61081407 (registering DOI) - 2 Aug 2025

Abstract

Background and Objectives: Total hip arthroplasty (THA) following pelvic osteotomy for developmental dysplasia of the hip (DDH) is technically challenging due to altered acetabular morphology. This study aimed to compare radiographic cup position and perioperative characteristics of THA after three common pelvic [...] Read more.

Background and Objectives: Total hip arthroplasty (THA) following pelvic osteotomy for developmental dysplasia of the hip (DDH) is technically challenging due to altered acetabular morphology. This study aimed to compare radiographic cup position and perioperative characteristics of THA after three common pelvic osteotomies—periacetabular osteotomy (PAO), shelf procedure, and Chiari osteotomy—with primary THA in Crowe type I DDH. Methods: A retrospective review identified 25 hips that underwent conversion THA after pelvic osteotomy (PAO = 12, shelf = 8, Chiari = 5) and 25 primary THAs without prior osteotomy. One-to-one matching was performed based on sex (exact match), age (within 5 years), and BMI (within 2 kg/m²) without the use of propensity scores. Cup inclination, radiographic anteversion, center-edge (CE) angle, and cup height were measured on standardized anteroposterior radiographs (ICC = 0.91). Operative time, estimated blood loss, and use of bulk bone grafts or reinforcement rings were reviewed. One-way ANOVA with Dunnett’s post hoc test and chi-square test were used for statistical comparison. Results: Cup inclination, anteversion, and CE angle did not differ significantly among groups. Cup height was significantly greater in the PAO group than in controls (29.0 mm vs. 21.8 mm; p = 0.0075), indicating a more proximal hip center. The Chiari and shelf groups showed upward trends, though not significant. Mean operative time tended to be longer after PAO (123 min vs. 93 min; p = 0.078). Bulk bone grafts and reinforcement rings were more frequently required in the PAO group (17%; p = 0.036 vs. control), and occasionally in Chiari cases, but not in shelf or control groups. Conclusions: THA after PAO is associated with higher cup placement and greater need for reconstructive devices, indicating increased technical complexity. In contrast, shelf and Chiari conversions more closely resemble primary THA. Preoperative planning should consider hip center translation and bone-stock restoration in post-osteotomy THA. Full article

(This article belongs to the Section Orthopedics)

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19 pages, 2264 KiB

Open AccessArticle

Extramedullary Plasmacytomas of the Nasal Cavity: Case-Based Perspectives into Optimizing the Diagnostic Differentiation from Inflammatory Polyps

by Carmen Aurelia Mogoantă, Codruț Sarafoleanu, Andrei Osman, Irina Enache, Shirley Tarabichi, Constantin-Ioan Busuioc, Ilona Mihaela Liliac, Dan Iovanescu and Ionuţ Tănase

Medicina 2025, 61(8), 1406; https://doi.org/10.3390/medicina61081406 (registering DOI) - 1 Aug 2025

Abstract

Background and Objectives: Extramedullary plasmacytoma (EMP) is a rare monoclonal B-cell neoplasm that typically affects the head and neck region, with a predilection for the sinonasal tract. Clinical presentation is often nonspecific, leading to delayed diagnosis. This study aims to improve our [...] Read more.

Background and Objectives: Extramedullary plasmacytoma (EMP) is a rare monoclonal B-cell neoplasm that typically affects the head and neck region, with a predilection for the sinonasal tract. Clinical presentation is often nonspecific, leading to delayed diagnosis. This study aims to improve our understanding of sinonasal EMP by reviewing the recent literature and presenting a case series from our clinical experience. Materials and Methods: A systematic review of published cases of sinonasal EMP from 2000 to 2023 was conducted using the PubMed database, yielding 28 eligible cases. Additionally, we retrospectively analyzed three patients diagnosed and treated at our institutions. Inclusion criteria included histologically and immunohistochemically confirmed EMP without evidence of systemic multiple myeloma. Data on demographics, tumor location, symptoms, treatment, and outcomes were collected and analyzed descriptively. Results: Sinonasal EMP most commonly presented with unilateral nasal obstruction and epistaxis. Tumors were primarily located in the nasal cavity and paranasal sinuses, often extending beyond a single anatomical site. In the literature cohort, the most frequent treatment was combined surgery and radiotherapy (35.71%), followed by radiotherapy alone (17.86%). Recurrence was reported in 10.71% of cases, and 7.14% of patients died due to disease progression. All three patients in our case series underwent surgical excision; two received postoperative radiotherapy. No recurrences or progression to multiple myeloma were observed during follow-up (12–24 months). Conclusions: Sinonasal EMP is a rare but radiosensitive tumor with a favorable prognosis when treated with surgery and/or radiotherapy. Early diagnosis, histopathological confirmation, and exclusion of systemic disease are essential. Multidisciplinary management and long-term follow-up are critical due to the risk of recurrence and transformation into multiple myeloma. Full article

(This article belongs to the Special Issue Optimizing Outcomes in Head and Neck Surgery)

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12 pages, 855 KiB

Open AccessArticle

Application of Integrative Medicine in Plastic Surgery: A Real-World Data Study

by David Lysander Freytag, Anja Thronicke, Jacqueline Bastiaanse, Ioannis-Fivos Megas, David Breidung, Ibrahim Güler, Harald Matthes, Sophia Johnson, Friedemann Schad and Gerrit Grieb

Medicina 2025, 61(8), 1405; https://doi.org/10.3390/medicina61081405 (registering DOI) - 1 Aug 2025

Abstract

Background and Objectives: There is a global rise of public interest in integrative medicine. The principles of integrative medicine combining conventional medicine with evidence-based complementary therapies have been implemented in many medical areas, including plastic surgery, to improve patient’s outcome. The aim [...] Read more.

Background and Objectives: There is a global rise of public interest in integrative medicine. The principles of integrative medicine combining conventional medicine with evidence-based complementary therapies have been implemented in many medical areas, including plastic surgery, to improve patient’s outcome. The aim of the present study was to systematically analyze the application and use of additional non-pharmacological interventions (NPIs) of patients of a German department of plastic surgery. Materials and Methods: The present real-world data study utilized data from the Network Oncology registry between 2016 and 2021. Patients included in this study were at the age of 18 or above, stayed at the department of plastic surgery and received at least one plastic surgical procedure. Adjusted multivariable logistic regression analyses were performed to detect associations between the acceptance of NPIs and predicting factors such as age, gender, year of admission, or length of hospital stay. Results: In total, 265 patients were enrolled in the study between January 2016 and December 2021 with a median age of 65 years (IQR: 52–80) and a male/female ratio of 0.77. Most of the patients received reconstructive surgery (90.19%), followed by hand surgery (5.68%) and aesthetic surgery (2.64%). In total, 42.5% of the enrolled patients accepted and applied NPIs. Physiotherapy, rhythmical embrocations, and compresses were the most often administered NPIs. Conclusions: This exploratory analysis provides a descriptive overview of the application and acceptance of NPIs in plastic surgery patients within a German integrative care setting. While NPIs appear to be well accepted by a subset of patients, further prospective studies are needed to evaluate their impact on clinical outcomes such as postoperative recovery, pain management, patient-reported quality of life, and overall satisfaction with care. Full article

(This article belongs to the Section Surgery)

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12 pages, 277 KiB

Open AccessArticle

Exploring the Implementation of Gamification as a Treatment Modality for Adults with Depression in Malaysia

by Muhammad Akmal bin Zakaria, Koh Ong Hui, Hema Subramaniam, Maziah Binti Mat Rosly, Jesjeet Singh Gill, Lim Yee En, Yong Zhi Sheng, Julian Wong Joon Ip, Hemavathi Shanmugam, Chow Soon Ken and Benedict Francis

Medicina 2025, 61(8), 1404; https://doi.org/10.3390/medicina61081404 (registering DOI) - 1 Aug 2025

Abstract

Background and Objectives: Depression is a leading cause of disability globally, with treatment challenges including limited access, stigma, and poor adherence. Gamification, which applies game elements such as points, levels, and storytelling into non-game contexts, offers a promising strategy to enhance engagement [...] Read more.

Background and Objectives: Depression is a leading cause of disability globally, with treatment challenges including limited access, stigma, and poor adherence. Gamification, which applies game elements such as points, levels, and storytelling into non-game contexts, offers a promising strategy to enhance engagement and augment traditional treatments. Our research is the first study designed to explore the implementation of gamification within the Malaysian context. The objective was to explore the feasibility of implementation of gamification as an adjunctive treatment for adults with depression. Materials and Methods: Focus group discussions were held with five mental health professionals and ten patients diagnosed with moderate depression. The qualitative component assessed perceptions of gamified interventions, while quantitative measures evaluated participants’ depressive and anxiety symptomatology. Results: Three key themes were identified: (1) understanding of gamification as a treatment option, (2) factors influencing its acceptance, and (3) characteristics of a practical and feasible intervention. Clinicians saw potential in gamification to boost motivation, support psychoeducation, and encourage self-paced learning, but they expressed concerns about possible addiction, stigma, and the complexity of gameplay for some patients. Patients spoke of gaming as a source of comfort, escapism, and social connection. Acceptance was shaped by engaging storylines, intuitive design, balanced difficulty, therapist guidance, and clear safety measures. Both groups agreed that gamification should be used in conjunction with standard treatments, be culturally sensitive, and be presented as a meaningful therapeutic approach rather than merely as entertainment. Conclusions: Gamification emerges as an acceptable and feasible supplementary approach for managing depression in Malaysia. Its success depends on culturally sensitive design, robust clinical oversight, and seamless integration with existing care pathways. Future studies should investigate long-term outcomes and establish guidelines for the safe and effective implementation of this approach. We recommend targeted investment into culturally adapted gamified tools, including training, policy development, and collaboration with key stakeholders to realistically implement gamification as a mental health intervention in Malaysia. Full article

(This article belongs to the Section Psychiatry)

20 pages, 865 KiB

Open AccessReview

Barriers and Facilitators to Artificial Intelligence Implementation in Diabetes Management from Healthcare Workers’ Perspective: A Scoping Review

by Giovanni Cangelosi, Andrea Conti, Gabriele Caggianelli, Massimiliano Panella, Fabio Petrelli, Stefano Mancin, Matteo Ratti and Alice Masini

Medicina 2025, 61(8), 1403; https://doi.org/10.3390/medicina61081403 (registering DOI) - 1 Aug 2025

Abstract

Background and Objectives: Diabetes is a global public health challenge, with increasing prevalence worldwide. The implementation of artificial intelligence (AI) in the management of this condition offers potential benefits in improving healthcare outcomes. This study primarily investigates the barriers and facilitators perceived by [...] Read more.

Background and Objectives: Diabetes is a global public health challenge, with increasing prevalence worldwide. The implementation of artificial intelligence (AI) in the management of this condition offers potential benefits in improving healthcare outcomes. This study primarily investigates the barriers and facilitators perceived by healthcare professionals in the adoption of AI. Secondarily, by analyzing both quantitative and qualitative data collected, it aims to support the potential development of AI-based programs for diabetes management, with particular focus on a possible bottom-up approach. Materials and Methods: A scoping review was conducted following PRISMA-ScR guidelines for reporting and registered in the Open Science Framework (OSF) database. The study selection process was conducted in two phases—title/abstract screening and full-text review—independently by three researchers, with a fourth resolving conflicts. Data were extracted and assessed using Joanna Briggs Institute (JBI) tools. The included studies were synthesized narratively, combining both quantitative and qualitative analyses to ensure methodological rigor and contextual depth. Results: The adoption of AI tools in diabetes management is influenced by several barriers, including perceived unsatisfactory clinical performance, high costs, issues related to data security and decision-making transparency, as well as limited training among healthcare workers. Key facilitators include improved clinical efficiency, ease of use, time-saving, and organizational support, which contribute to broader acceptance of the technology. Conclusions: The active and continuous involvement of healthcare workers represents a valuable opportunity to develop more effective, reliable, and well-integrated AI solutions in clinical practice. Our findings emphasize the importance of a bottom-up approach and highlight how adequate training and organizational support can help overcome existing barriers, promoting sustainable and equitable innovation aligned with public health priorities. Full article

(This article belongs to the Special Issue Advances in Public Health and Healthcare Management for Chronic Care)

19 pages, 1070 KiB

Open AccessReview

Nasal Irrigations: A 360-Degree View in Clinical Practice

by Luca Pecoraro, Elisabetta Di Muri, Gianluca Lezzi, Silvia Picciolo, Marta De Musso, Michele Piazza, Mariangela Bosoni and Flavia Indrio

Medicina 2025, 61(8), 1402; https://doi.org/10.3390/medicina61081402 (registering DOI) - 1 Aug 2025

Abstract

Nasal irrigation (NI) is an effective, safe, low-cost strategy for treating and preventing upper respiratory tract diseases. High-volume, low-pressure saline irrigations are the most efficient method for removing infectious agents, allergens, and inflammatory mediators. This article reviews clinical evidence supporting NI use in [...] Read more.

Nasal irrigation (NI) is an effective, safe, low-cost strategy for treating and preventing upper respiratory tract diseases. High-volume, low-pressure saline irrigations are the most efficient method for removing infectious agents, allergens, and inflammatory mediators. This article reviews clinical evidence supporting NI use in various conditions: nasal congestion in infants, recurrent respiratory infections, acute and chronic rhinosinusitis, allergic and gestational rhinitis, empty nose syndrome, and post-endoscopic sinus surgery care. NI improves symptoms, reduces recurrence, enhances the efficacy of topical drugs, and decreases the need for antibiotics and decongestants. During the COVID-19 pandemic, NI has also been explored as a complementary measure to reduce viral load. Due to the safe profile and mechanical cleansing action on inflammatory mucus, nasal irrigations represent a valuable adjunctive treatment across a wide range of sinonasal conditions. Full article

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13 pages, 310 KiB

Open AccessReview

Microbiome Shifts in Bladder Cancer: A Narrative Review of Urobiome Composition, Progression, and Therapeutic Impact

by Raul-Dumitru Gherasim, Călin Chibelean, Daniel Porav-Hodade, Ciprian Todea-Moga, Sabin-Octavian Tătaru, Tibor-Lorand Reman, Arpad-Oliver Vida, Maria-Veronica Ghirca, Matteo Ferro and Orsolya Katalyn Ilona Martha

Medicina 2025, 61(8), 1401; https://doi.org/10.3390/medicina61081401 (registering DOI) - 1 Aug 2025

Abstract

Background/Objectives: Bladder cancer is a common malignancy with a high rate of recurrence and progression. Recent studies have identified that the urinary microbiome can be a key factor in tumor pathogenesis, progression, and outcomes. This narrative review is designed to summarize current [...] Read more.

Background/Objectives: Bladder cancer is a common malignancy with a high rate of recurrence and progression. Recent studies have identified that the urinary microbiome can be a key factor in tumor pathogenesis, progression, and outcomes. This narrative review is designed to summarize current evidence regarding the urobiome and explore its diagnostic and therapeutic potential. Methods: Studies between 2019 and 2024 were identified through the PubMed/MEDLINE and Google Scholar databases. Case reports and non-English-language articles were excluded. Results: The main findings revealed that specific bacteria, viruses, and taxa are linked to bladder cancer presence, progression, and response to immunotherapy treatment. Urinary microbiota differ by tumor type, sex, smoking status, and occupational exposure to toxins. Conclusions: Urinary microbiome and certain types of viruses present in urine may serve as promising tools to enhance bladder cancer diagnosis and predict treatment response. However, larger longitudinal studies are needed to confirm and establish these findings. Furthermore, integration of the urinary microbiome in clinical practice and public health strategies may reduce disease-related burden. Full article

(This article belongs to the Special Issue New Advances in Urology and Nephrology Disease: From Diagnosis to Treatment—2nd Edition)

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Graphical abstract

14 pages, 483 KiB

Open AccessReview

Artificial Intelligence and Its Impact on the Management of Lumbar Degenerative Pathology: A Narrative Review

by Alessandro Trento, Salvatore Rapisarda, Nicola Bresolin, Andrea Valenti and Enrico Giordan

Medicina 2025, 61(8), 1400; https://doi.org/10.3390/medicina61081400 (registering DOI) - 1 Aug 2025

Abstract

In this narrative review, we explore the role of artificial intelligence (AI) in managing lumbar degenerative conditions, a topic that has recently garnered significant interest. The use of AI-based solutions in spine surgery is particularly appealing due to its potential applications in preoperative [...] Read more.

In this narrative review, we explore the role of artificial intelligence (AI) in managing lumbar degenerative conditions, a topic that has recently garnered significant interest. The use of AI-based solutions in spine surgery is particularly appealing due to its potential applications in preoperative planning and outcome prediction. This study aims to clarify the impact of artificial intelligence models on the diagnosis and prognosis of common types of degenerative conditions: lumbar disc herniation, spinal stenosis, and eventually spinal fusion. Additionally, the study seeks to identify predictive factors for lumbar fusion surgery based on a review of the literature from the past 10 years. From the literature search, 96 articles were examined. The literature on this topic appears to be consistent, describing various models that show promising results, particularly in predicting outcomes. However, most studies adopt a retrospective approach and often lack detailed information about imaging features, intraoperative findings, and postoperative functional metrics. Additionally, the predictive performance of these models varies significantly, and few studies include external validation. The application of artificial intelligence in treating degenerative spine conditions, while valid and promising, is still in a developmental phase. However, over the last decade, there has been an exponential growth in studies related to this subject, which is beginning to pave the way for its systematic use in clinical practice. Full article

(This article belongs to the Special Issue Clinical Applications of Modern Technologies in Neurosurgery and Spine Surgery)

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19 pages, 397 KiB

Open AccessReview

Effects of Blood-Glucose Lowering Therapies on Body Composition and Muscle Outcomes in Type 2 Diabetes: A Narrative Review

by Ioana Bujdei-Tebeică, Doina Andrada Mihai, Anca Mihaela Pantea-Stoian, Simona Diana Ștefan, Claudiu Stoicescu and Cristian Serafinceanu

Medicina 2025, 61(8), 1399; https://doi.org/10.3390/medicina61081399 (registering DOI) - 1 Aug 2025

Abstract

Background and Objectives: The management of type 2 diabetes (T2D) extends beyond glycemic control, requiring a more global strategy that includes optimization of body composition, even more so in the context of sarcopenia and visceral adiposity, as they contribute to poor outcomes. [...] Read more.

Background and Objectives: The management of type 2 diabetes (T2D) extends beyond glycemic control, requiring a more global strategy that includes optimization of body composition, even more so in the context of sarcopenia and visceral adiposity, as they contribute to poor outcomes. Past reviews have typically been focused on weight reduction or glycemic effectiveness, with limited inclusion of new therapies’ effects on muscle and fat distribution. In addition, the emergence of incretin-based therapies and dual agonists such as tirzepatide requires an updated synthesis of their impacts on body composition. This review attempts to bridge the gap by taking a systematic approach to how current blood-glucose lowering therapies affect lean body mass, fat mass, and the risk of sarcopenia in T2D patients. Materials and Methods: Between January 2015 and March 2025, we conducted a narrative review by searching the PubMed, Scopus, and Web of Science databases for English-language articles. The keywords were combinations of the following: “type 2 diabetes,” “lean body mass,” “fat mass,” “body composition,” “sarcopenia,” “GLP-1 receptor agonists,” “SGLT2 inhibitors,” “tirzepatide,” and “antidiabetic pharmacotherapy.” Reference lists were searched manually as well. The highest precedence was assigned to studies that aimed at adult type 2 diabetic subjects and reported body composition results. Inclusion criteria for studies were: (1) type 2 diabetic mellitus adult patients and (2) reporting measures of body composition (e.g., lean body mass, fat mass, or muscle function). We prioritized randomized controlled trials and large observational studies and excluded mixed diabetic populations, non-pharmacological interventions only, and poor reporting of body composition. Results: Metformin was widely found to be weight-neutral with minimal effects on muscle mass. Insulin therapy, being an anabolic hormone, often leads to fat mass accumulation and increases the risk of sarcopenic obesity. Incretin-based therapies induced substantial weight loss, mostly from fat mass. Notable results were observed in studies with tirzepatide, demonstrating superior reduction not only in fat mass, but also in visceral fat. Sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors) promote fat loss but are associated with a small yet significant decrease in lean muscle mass. Conclusions: Blood-glucose lowering therapies demonstrated clinically relevant effects on body composition. Treatment should be personalized, balancing glycemic control, cardiovascular, and renal benefits, together with optimal impact on muscle mass along with glycemic, cardiovascular, and renal benefits. Full article

(This article belongs to the Section Endocrinology)

24 pages, 6020 KiB

Open AccessArticle

Seasonal Patterns of Preterm Birth During the COVID-19 Pandemic: A Retrospective Cohort Study in Romania

by Paula Trif, Cristian Sava, Diana Mudura, Boris W. Kramer, Radu Galiș, Maria Livia Ognean, Alin Iuhas and Claudia Maria Jurca

Medicina 2025, 61(8), 1398; https://doi.org/10.3390/medicina61081398 - 1 Aug 2025

Abstract

Background and Objectives: Preterm birth and stillbirth are primary adverse pregnancy outcomes. Research during the COVID-19 pandemic revealed reductions in preterm birth in some countries, while stillbirth rates increased or remained unchanged. These findings suggest the presence of preventable risk factors associated with [...] Read more.

Background and Objectives: Preterm birth and stillbirth are primary adverse pregnancy outcomes. Research during the COVID-19 pandemic revealed reductions in preterm birth in some countries, while stillbirth rates increased or remained unchanged. These findings suggest the presence of preventable risk factors associated with changes in physical activity and lower exposure to community-acquired infections due to lockdown measures, altered social interaction patterns or reduced access to antenatal care. Assessing seasonal variation may offer insights into whether lifestyle changes during the COVID-19 lockdown period influenced preterm birth rates. Materials and Methods: This retrospective cohort study used data from the electronic medical records of Bihor and Sibiu counties. Preterm deliveries (<37 weeks) and stillbirths during the COVID-19 pandemic (2020 and 2021) were compared with the corresponding pre-pandemic (2018 and 2019) and post-pandemic (2022 and 2023) period. Preterm birth rates during summer and winter in the pre-pandemic, pandemic, and post-pandemic years were analyzed. A comparison with rates during strict lockdown was made. Results: Out of 52,021 newborn infants, 4473 were born preterm. Preterm birth rates remained stable across all three periods (p = 0.13), and no significant seasonal pattern was identified (p = 0.65). In contrast, stillbirth rates increased notably during the strict lockdown period, with the median incidence almost doubling compared to other periods (0.87%, p = 0.05), while remaining unchanged during the rest of the pandemic (p = 0.52). Conclusions: Our study found that preterm birth rates remained unaffected by the pandemic and lockdown periods, while stillbirths increased significantly during the strict lockdown. These findings highlight the importance of maintaining access to timely antenatal care during public health emergencies to prevent adverse perinatal outcomes. Full article

(This article belongs to the Special Issue Advances in Obstetrics and Maternal-Fetal Medicine)

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15 pages, 826 KiB

Open AccessReview

Complications Following Percutaneous Epidural Neuroplasty: A Narrative Review of Clinical Evidence and the Rationale for Post-Procedural 6 h Inpatient Monitoring Amid Limited Systematic Data

by Jae Hun Kim, Eun Jang Yoon, Sung Ho Jo, Sun Ok Kim, Dong Woo Lee and Hwan Hee Kim

Medicina 2025, 61(8), 1397; https://doi.org/10.3390/medicina61081397 - 1 Aug 2025

Abstract

Background: Percutaneous epidural neuroplasty (PEN) and related adhesiolysis procedures are widely used for managing chronic spinal pain. Although generally safe, complications—ranging from minor to life-threatening—have been reported. This review aimed to estimate the incidence and characteristics of complications following PEN and to [...] Read more.

Background: Percutaneous epidural neuroplasty (PEN) and related adhesiolysis procedures are widely used for managing chronic spinal pain. Although generally safe, complications—ranging from minor to life-threatening—have been reported. This review aimed to estimate the incidence and characteristics of complications following PEN and to evaluate the medical rationale for post-procedural inpatient monitoring. Methods: We systematically searched PubMed, Embase, and the Cochrane Library for studies published from January 2000 to April 2025 reporting complications associated with PEN. We performed a random-effects meta-analysis on five eligible cohort studies to estimate the pooled complication rate and evaluated heterogeneity. Risk of bias was assessed using the Newcastle–Ottawa Scale. Results: Five cohort studies (n = 1740) were included in the meta-analysis, with a pooled complication rate of 9.0% (95% CI: 4.8–13.1%, I² = 97.5%). A total of 133 complications were identified from cohort studies and case reports. Mechanical and neurological complications were most common. Serious complications, including hematoma, meningitis, and cardiopulmonary arrest, were concentrated within the first 6 h post-procedure. Conclusions: This meta-analysis highlights a quantifiable risk of complications associated with PEN. Our findings support structured inpatient monitoring during the immediate post-procedural period to enhance safety and outcomes. Full article

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

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16 pages, 875 KiB

Open AccessArticle

Association of Bioelectrical Impedance Analysis Parameters with Malnutrition in Patients Undergoing Maintenance Hemodialysis: A Cross-Sectional Study

by Minh D. Pham, Thang V. Dao, Anh T. X. Vu, Huong T. Q. Bui, Bon T. Nguyen, An T. T. Nguyen, Thuy T. T. Ta, Duc M. Cap, Toan D. Le, Phuc H. Phan, Ha N. Vu, Tuan D. Le, Toan Q. Pham, Thang V. Le, Thuc C. Luong, Thang B. Ta and Tuyen V. Duong

Medicina 2025, 61(8), 1396; https://doi.org/10.3390/medicina61081396 - 1 Aug 2025

Abstract

Background and Objectives: Malnutrition is one of the most common complications in patients undergoing hemodialysis (HD) and is closely linked to increased morbidity and mortality. This study aimed to investigate the nutritional status of HD patients and the clinical relevance of bioelectrical impedance [...] Read more.

Background and Objectives: Malnutrition is one of the most common complications in patients undergoing hemodialysis (HD) and is closely linked to increased morbidity and mortality. This study aimed to investigate the nutritional status of HD patients and the clinical relevance of bioelectrical impedance analysis (BIA) parameters such as the percent body fat (PBF), skeletal muscle mass index (SMI), extracellular water-to-total body water ratio (ECW/TBW), and phase angle (PhA) in assessing malnutrition in Vietnamese HD patients. Materials and Methods: This cross-sectional study was conducted among 184 patients undergoing hemodialysis in Hanoi, Vietnam. The BIA parameters were measured by the InBody S10 body composition analyzer, while malnutrition was assessed by the geriatric nutritional risk index (GNRI), with a GNRI <92 classified as a high risk of malnutrition. The independent BIA variables for predicting malnutrition and its cut-off values were explored using logistic regression models and a receiver operating characteristic (ROC) curve analysis, respectively. Results: Among the study population, 42.9% (79/184) of patients were identified as being at a high risk of malnutrition. The multivariate logistic regression analysis revealed that a higher ECW/TBW was independently associated with an increased risk of malnutrition, while the PBF, SMI, and PhA expressed significant and inverse associations with the malnutrition risk after adjusting for multiple confounders. The cut-off values for predicting the high risk of malnutrition in overall HD patients were determined to be 20.45%, 7.75 kg/m², 5.45°, and 38.03% for the PBF, the SMI, the PhA, and the ECW/TBW ratio, respectively. Conclusions: BIA parameters, including the PBF, SMI, PhA, and ECW/TBW ratio, could serve as indicators of malnutrition in general Vietnamese patients with HD. Full article

(This article belongs to the Special Issue End-Stage Kidney Disease (ESKD))

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11 pages, 1935 KiB

Open AccessArticle

Segmental Renal Infarction Associated with Accessory Renal Arteries After Para-Aortic Lymphadenectomy in Gynecologic Malignancies

by Ayumi Kozai, Shintaro Yanazume, Fumitaka Ejima, Shuichi Tatarano, Yusuke Kobayashi, Rintaro Kubo, Shinichi Togami, Takashi Yoshiura and Hiroaki Kobayashi

Medicina 2025, 61(8), 1395; https://doi.org/10.3390/medicina61081395 - 1 Aug 2025

Abstract

Background and Objectives: The causes and clinical outcomes of renal perfusion abnormalities occurring after para-aortic lymphadenectomy (PANDx) for gynecologic malignancies are unknown. We investigated the potential involvement of accessory renal artery (ARA) obstruction in their development by reassessing perioperative contrast-enhanced computed tomography [...] Read more.

Background and Objectives: The causes and clinical outcomes of renal perfusion abnormalities occurring after para-aortic lymphadenectomy (PANDx) for gynecologic malignancies are unknown. We investigated the potential involvement of accessory renal artery (ARA) obstruction in their development by reassessing perioperative contrast-enhanced computed tomography (CECT). Materials and Methods: This retrospective study investigated a clinical database to identify urinary contrast defects using CECT in all patients who had undergone PANDx between January 2020 and December 2024. The perfusion defects in the kidney detected by CECT were extracted by a gynecologic oncologist and evaluated by a radiologist and urologist for suspected obstruction of ARAs. Results: Postoperative renal contrast defects were observed in 3.8% (6/157) of patients. Renal parenchymal fibrosis, cortical atrophy, and parenchymal thinning were observed as universal findings in all patients showing renal contrast defects. In five of the six cases, ARAs supplying the infarcted renal segments were identified on preoperative CECT, and arterial obstruction was confirmed on postoperative imaging. The remaining case was considered to be latent pyelonephritis. All five patients underwent laparotomy, and preoperative CECT failed to detect ARAs. The median resected para-aortic lymph node was 23 nodes (range: 15–33) in five patients, showing no statistically significant difference compared to patients without perfusion abnormalities (p = 0.19). Postoperative serum creatinine levels remained stable. Conclusions: ARA obstruction appears to be a risk factor for segmental renal infarction after para-aortic lymphadenectomy in gynecological malignancies; however, the clinical impact on urinary function may be limited. Awareness of this potential complication is essential for gynecologic oncologists performing PANDx. Full article

(This article belongs to the Section Obstetrics and Gynecology)

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21 pages, 1112 KiB

Open AccessArticle

Associations Between Smoking, Stress, Quality of Life, and Oral Health Among Dental Students in Romania: A Cross-Sectional Study

by Adina Oana Armencia, Andrei Nicolau, Irina Bamboi, Bianca Toader, Anca Rapis, Tinela Panaite, Daniela Argatu and Carina Balcos

Medicina 2025, 61(8), 1394; https://doi.org/10.3390/medicina61081394 - 1 Aug 2025

Abstract

Students, particularly those in the medical field, are exposed to various stressors that can affect their health-related behaviors, including smoking habits, with implications for oral health and quality of life. Background and Objectives: to analyze the relationship between smoking, oral health, perceived [...] Read more.

Students, particularly those in the medical field, are exposed to various stressors that can affect their health-related behaviors, including smoking habits, with implications for oral health and quality of life. Background and Objectives: to analyze the relationship between smoking, oral health, perceived stress level, and self-assessed quality of life in a sample of dental students. Materials and Methods: The cross-sectional study included 338 students, who completed validated questionnaires and were clinically examined. Lifestyle was assessed using a smoking behavior questionnaire, stress levels were measured with the Student Stress Inventory (SSI), and quality of life was evaluated using the EQ-5D-5L instrument. The DMFT index was calculated to determine oral health status. Results: Among the 338 participating students, 53.8% were smokers. The lifestyle analysis revealed slightly higher average scores among non-smokers across all domains—social (3.26 vs. 3.09), attitudinal (2.75 vs. 2.97), and behavioral (3.82 vs. 3.49), but without statistically significant differences (p > 0.25). The mean DMFT score was 12.48, with no significant differences between smokers and non-smokers (p = 0.554). The SSI total score averaged 83.15, indicating a moderate level of perceived stress, again with no statistically significant differences between the groups (p > 0.05). However, slightly higher average stress scores among smokers may suggest the use of smoking as a coping mechanism. In contrast, quality of life as measured by EQ-5D-5L showed significantly worse outcomes for smokers across all five dimensions, including mobility (78.6% vs. 95.5%, p = 0.000) and self-care (93.4% vs. 100%, p = 0.001). Multivariable logistic regression identified smoking (OR = 1.935; p = 0.047) and moderate stress levels (OR = 0.258; p < 0.001) as independent predictors of oral health status. Conclusions: The results obtained suggest that smoking may function as a stress management strategy among students, supporting the relevance of integrating specific psychobehavioral interventions that address stress reduction and oral health promotion among student populations. Full article

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

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16 pages, 2218 KiB

Open AccessArticle

The Effectiveness of Semaglutide on a Composite Endpoint of Glycemic Control and Weight Reduction and Its Effect on Lipid Profile Among Obese Type 2 Diabetes Patients

by Sumaiah J. Alarfaj

Medicina 2025, 61(8), 1393; https://doi.org/10.3390/medicina61081393 - 31 Jul 2025

Abstract

Background and Objectives: Obesity and type 2 diabetes (T2D) are closely linked and associated with a higher risk of complications. This study aims to evaluate the effectiveness of once-weekly semaglutide in achieving a composite endpoint of A1C and weight reduction. Materials and Methods: [...] Read more.

Background and Objectives: Obesity and type 2 diabetes (T2D) are closely linked and associated with a higher risk of complications. This study aims to evaluate the effectiveness of once-weekly semaglutide in achieving a composite endpoint of A1C and weight reduction. Materials and Methods: This retrospective cohort study assessed the effectiveness of semaglutide in obese patients with T2D at a tertiary care hospital in Saudi Arabia. This study included patients who received semaglutide treatment for 12 months, and the endpoint was reducing A1C by ≥ 1% and body weight by ≥ 5% after 12 months of starting semaglutide. Secondary endpoints include predictors of achieving the composite endpoint and the effect on the lipid profile. Results: The present study enrolled 459 participants, with dyslipidemia and hypertension being the most common comorbidities. After 12 months of treatment with semaglutide, 42% of the patients achieved the composite endpoint. Semaglutide significantly reduced weight, BMI, A1C, FBG, total cholesterol, LDL, and triglycerides. The subgroup analysis showed that patients who achieved the composite endpoint were younger and had significantly lower use of insulin. Females in the study had significantly higher BMI, A1C, and HDL levels and lower levels of triglycerides compared to males. Multivariate analysis revealed that baseline BMI (aOR = 0.953; 95% CI: 0.915 to 0.992; p = 0.02), baseline A1C (aOR = 1.213; 95% CI: 1.062 to 1.385; p = 0.004), and receiving insulin (aOR = 0.02; 95% CI: 0.001 to 0.343; p = 0.007) were significant predictors of composite endpoint achievement. Conclusions: Semaglutide is a valuable option for the treatment of obese patients with T2D. This study found that semaglutide is effective in reducing weight and A1C and improving the lipid profile. The predictors of achievement of the composite endpoint were lower baseline BMI, higher baseline A1C, and insulin non-use. Full article

(This article belongs to the Special Issue Clinical Management of Diabetes and Complications)

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17 pages, 475 KiB

Open AccessReview

The Rationale and Explanation for Rehabilitation Interventions in the Management of Treatment-Induced Trismus in People with Head and Neck Cancer: A Scoping Review of Randomized Controlled Trials

by Ernesto Anarte-Lazo, Ana Bravo-Vazquez, Carlos Bernal-Utrera, Daniel Torres-Lagares, Deborah Falla and Cleofas Rodríguez-Blanco

Medicina 2025, 61(8), 1392; https://doi.org/10.3390/medicina61081392 - 31 Jul 2025

Abstract

Background and objectives: Trismus is a frequent and debilitating complication in people with head and neck cancer (HNC) which leads to significant functional limitations and reduced quality of life. Rehabilitation interventions are commonly recommended to manage or prevent trismus. However, in many [...] Read more.

Background and objectives: Trismus is a frequent and debilitating complication in people with head and neck cancer (HNC) which leads to significant functional limitations and reduced quality of life. Rehabilitation interventions are commonly recommended to manage or prevent trismus. However, in many randomized controlled trials (RCTs), the theoretical justification for these interventions is poorly articulated, and the underlying biological or physiological mechanisms are not described in detail, limiting our understanding of why certain treatments may (or may not) work. This review aimed to identify and analyze how RCTs report the rationale for rehabilitation interventions and the explanations used to manage this population. Materials and Methods: A scoping review was conducted in accordance with the PRISMA-ScR guidelines. Five databases (PubMed, PEDro, Web of Science, Scopus, and EMBASE) were searched up to May 2025 for RCTs evaluating rehabilitation interventions for the management or prevention of treatment-induced trismus in patients with HNC. Data were extracted and synthesized narratively, focusing on the type of intervention, the rationale for its use, and the proposed mechanisms of action. Results: Of 2215 records identified, 24 RCTs met the inclusion criteria. Thirteen studies focused on preventive interventions—primarily exercise therapy—while the remainder addressed established trismus using exercise, manual therapy, electrotherapy, or combined treatment modalities. The rationales provided for intervention selection were heterogeneous and often lacked depth, with most studies justifying interventions based on their potential to improve mouth opening or reduce fibrosis but rarely grounding these claims in detailed pathophysiological models. Only half of the studies provided any mechanistic explanation for the intervention’s effects, and these were typically generic or speculative. Conclusions: RCTs investigating rehabilitation interventions for treatment-induced trismus in patients with HNC frequently lack comprehensive rationales and mechanistic explanations for their interventions. This gap limits the ability to refine and optimize treatment approaches, as the underlying processes driving clinical improvements remain poorly understood. Future research should be guided by theoretical models and include objective outcomes to better elucidate the mechanisms of action of interventions to inform clinical practice. Full article

(This article belongs to the Special Issue Advances in Head and Neck Cancer Management)

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11 pages, 1825 KiB

Open AccessArticle

Feasibility of Ductus Venosus Doppler Screening During First Trimester Ultrasound: Prospective Multicenter Study

by Félicia Joinau-Zoulovits, Anissa Bouzidi, Françoise Etienne and Christine Levêque

Medicina 2025, 61(8), 1391; https://doi.org/10.3390/medicina61081391 - 31 Jul 2025

Abstract

Background and Objectives: Doppler abnormalities in the ductus venosus (DV) during the first trimester can serve as an early marker for the detection of congenital heart defects (CHDs), but the feasibility of systematically assessing the DV remains underexplored. This study aimed to [...] Read more.

Background and Objectives: Doppler abnormalities in the ductus venosus (DV) during the first trimester can serve as an early marker for the detection of congenital heart defects (CHDs), but the feasibility of systematically assessing the DV remains underexplored. This study aimed to evaluate the feasibility of performing DV assessments during routine first-trimester ultrasound screenings. Materials and Methods: A multicenter, prospective, and descriptive study was conducted, including singleton pregnancies undergoing routine ultrasound screening between 11 + 0 and 13 + 6 weeks of gestation. Sonographers were instructed to acquire DV Doppler images during the scan, and each image was blindly reviewed by an expert using predefined quality criteria. The images were categorized as “good”, “medium”, or “unsatisfactory”, and feasibility was defined as the proportion of “good” images. Factors associated with feasibility were analyzed, including sonographer satisfaction, the Herman score and the acquisition time. Results: Of the 87 patients included in this study, a suitable DV Doppler image was feasible in 58.6% of cases. The feasibility was significantly higher when the sonographer was satisfied with the image, when the Herman score exceeded seven (p = 0.01), and when the acquisition time was less than five minutes. A strong correlation was observed between the expert’s assessment and the sonographer’s satisfaction. However, the gestational age, maternal BMI, parity, and operator-perceived image quality were not significantly associated with feasibility. Conclusions: The Doppler assessment of the ductus venosus during first-trimester ultrasound screening is feasible and reproducible in routine clinical practice without significantly increasing the examination time. This suggests DV measurements to enhance the early nuchal translucency measurement to enhance the early detection of congenital heart defects during the first trimester. Full article

(This article belongs to the Special Issue Advances in Obstetrics and Maternal-Fetal Medicine)

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10 pages, 529 KiB

Open AccessArticle

Comparative Outcomes in Metastatic Spinal Cord Compression and Femoral Metastatic Disease: Distinct Clinical Entities with Divergent Prognoses?

by Oded Hershkovich, Mojahed Sakhnini, Eyal Ramu, Boaz Liberman, Alon Friedlander and Raphael Lotan

Medicina 2025, 61(8), 1390; https://doi.org/10.3390/medicina61081390 - 31 Jul 2025

Abstract

Background and Objectives: Acute metastatic cord compression (AMSCC) and femoral impending/pathological fracture negatively impact a patient’s quality of life, morbidity and survival, and are considered significant life events. This study aims to compare AMSCC and FMD as distinct yet overlapping metastatic orthopedic [...] Read more.

Background and Objectives: Acute metastatic cord compression (AMSCC) and femoral impending/pathological fracture negatively impact a patient’s quality of life, morbidity and survival, and are considered significant life events. This study aims to compare AMSCC and FMD as distinct yet overlapping metastatic orthopedic emergencies, addressing whether they represent sequential disease stages or distinct patient subpopulations—an analysis critical for prognosis and treatment planning. Materials and Methods: Records of all patients who underwent surgery for a femoral metastatic disease (FMD) over a decade (2004–2015) and patients who were treated for acute metastatic spinal compression (AMSCC) (2007–2017) were retrieved. There were no patients lost to follow-up. Results: The treatment cohorts were similar in terms of age, gender, tumour origin, and the number of spinal metastases. Fifty-four patients were diagnosed with AMSCC. Following treatment, the Frankel muscle grading improved by 0.5 ± 0.8 grades. Two hundred and eighteen patients underwent surgical intervention for FMD. Seventy percent of femoral metastases were located in the femoral neck and trochanteric area. Impending fractures accounted for 52% of the cohort. The FMD cohort, including impending and pathological fractures, was similar to the AMSCC cohort in terms of age and the time interval between cancer diagnosis and surgery (56.7 ± 74.2 vs. 51.6 ± 69.6, respectively, p = 0.646). The Karnofsky functional score was higher for the FMD cohort (63.3 ± 16.2) than for the AMSCC cohort (48.5 ± 19.5; p < 0.001). The mean survival time for the FMD cohort was double that of the AMSCC, at 18.4 ± 23.5 months versus 9.1 ± 13.6 months, respectively (p = 0.006). Conclusions: In conclusion, this study is novel in proposing that FMD and AMSCC are distinct clinical entities, differing in their impact on patient function and, most importantly, on patient survival. Full article

(This article belongs to the Special Issue Advances in Cancer Multimodal Approaches: Biomarkers, Mechanisms, Surgical Procedures and Oncological Therapies, 2nd Edition)

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10 pages, 2048 KiB

Open AccessArticle

Ultrasound-Guided PECS II Block Reduces Periprocedural Pain in Cardiac Device Implantation: A Prospective Controlled Study

by Mihaela Butiulca, Florin Stoica Buracinschi and Alexandra Lazar

Medicina 2025, 61(8), 1389; https://doi.org/10.3390/medicina61081389 - 30 Jul 2025

Abstract

Background and Objectives: Implantation of cardiac implantable electronic devices (CIEDs) is increasingly performed in elderly and comorbid patients, for whom minimizing perioperative complications—including pain and systemic drug use—is critical. Traditional local infiltration often provides insufficient analgesia. The ultrasound-guided PECS II block, an [...] Read more.

Background and Objectives: Implantation of cardiac implantable electronic devices (CIEDs) is increasingly performed in elderly and comorbid patients, for whom minimizing perioperative complications—including pain and systemic drug use—is critical. Traditional local infiltration often provides insufficient analgesia. The ultrasound-guided PECS II block, an interfascial regional technique, offers promising analgesic benefits in thoracic wall procedures but remains underutilized in cardiac electrophysiology. Materials and Methods: We conducted a prospective, controlled, non-randomized clinical study including 106 patients undergoing de novo CIED implantation. Patients were assigned to receive either a PECS II block (n = 53) or standard lidocaine-based local anesthesia (n = 53). Pain intensity was assessed using the numeric rating scale (NRS) intraoperatively and at 1, 6, and 12 h postoperatively. Secondary outcomes included the need for rescue analgesia, procedural duration, length of hospitalization, and patient satisfaction. Results: Patients in the PECS II group reported significantly lower NRS scores at all time points (mean intraoperative score: 2.1 ± 1.2 vs. 5.7 ± 1.6, p < 0.001; at 1 h: 2.5 ± 1.5 vs. 6.1 ± 1.7, p < 0.001). Rescue analgesia (metamizole sodium) was required in only four PECS II patients (7.5%) vs. 100% in the control group within 1 h. Hospital stay and procedural time were also modestly reduced in the PECS II group. Patient satisfaction scores were significantly higher in the intervention group. Conclusions: The ultrasound-guided PECS II block significantly reduces perioperative pain and the need for additional analgesia during CIED implantation, offering an effective, safe, and opioid-sparing alternative to conventional local infiltration. Its integration into clinical protocols for device implantation may enhance procedural comfort and recovery. Full article

(This article belongs to the Special Issue Regional and Local Anesthesia for Enhancing Recovery After Surgery)

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