Medicina

14 pages, 476 KiB

Open AccessArticle

Assessment of the Abnormalities in Chest Computed Tomography and Pulmonary Function Test in Convalescents Six Months After COVID-19

by Katarzyna Guziejko, Anna Moniuszko-Malinowska, Robert Flisiak, Piotr Czupryna, Sebastian Sołomacha, Paweł Sowa, Marlena Dubatówka, Magda Łapińska, Łukasz Kiszkiel, Łukasz Szczerbiński, Piotr Paweł Laskowski, Maciej Alimowski, Gabriela Trojan and Karol Adam Kamiński

Medicina 2025, 61(5), 823; https://doi.org/10.3390/medicina61050823 (registering DOI) - 29 Apr 2025

Abstract

Background: Despite the multiple waves of the COVID-19 pandemic, follow-up strategies for recovered patients remain inconclusive. This study aimed to evaluate chest computed tomography (CT) and pulmonary function test (PFT) abnormalities in convalescents six months after COVID-19 and to compare these findings with [...] Read more.

Background: Despite the multiple waves of the COVID-19 pandemic, follow-up strategies for recovered patients remain inconclusive. This study aimed to evaluate chest computed tomography (CT) and pulmonary function test (PFT) abnormalities in convalescents six months after COVID-19 and to compare these findings with those from a representative population cohort. The goal was to support more individualized pulmonary management of post-COVID-19 sequelae. Methods: This study population consisted of 2 groups: I—232 post-COVID-19 patients and II—543 patients from a population cohort. Chest CT was performed during the acute phase of COVID-19 and six months after. The PFTs were conducted six months after COVID-19. Results: There were no significant differences in FEV1, FVC, TLC, and DLCO in the two study groups. A singular GGO in 24 patients (20%), a crazy paving pattern in 1 patient (0.8%), thickening of interlobular septa in 4 patients (3.5%), consolidations in 4 patients (3.5%), traction bronchiectasis in 6 patients (5%), fibrosis in 6 patients (5%), and singular nodular densities in 68 patients (58%) were observed in chest CT 6 months after COVID-19. Most radiological abnormalities were clinically insignificant and did not require further diagnostic evaluation. No significant differences in chest CT and PFT six months after infection were observed between patients differing in the severity of inflammation during the acute disease or SARS-CoV-2 variant. Conclusions: The majority of chest CT abnormalities resolved within six months of recovery, regardless of SARS-CoV-2 variant or initial disease severity. Pulmonary function tests should be prioritized in post-COVID-19 follow-up, as PFT results in convalescents were comparable to those observed in the general population. Full article

(This article belongs to the Special Issue Advances in Imaging and Diagnostics in Lung Disease: A Multimodal Approach)

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17 pages, 488 KiB

Open AccessReview

The Effects of Multicomponent Training on Clinical, Functional, and Psychological Outcomes in Cardiovascular Disease: A Narrative Review

by Luca Poli, Alessandro Petrelli, Francesco Fischetti, Stefania Morsanuto, Livica Talaba, Stefania Cataldi and Gianpiero Greco

Medicina 2025, 61(5), 822; https://doi.org/10.3390/medicina61050822 (registering DOI) - 29 Apr 2025

Abstract

Cardiovascular diseases (CVDs) remain the leading cause of death globally. In recent years, interest in multicomponent interventions has grown as a response to the multifactorial complexity of CVDs. However, the literature still shows little systematic investigation into the effectiveness of multicomponent training (MCT) [...] Read more.

Cardiovascular diseases (CVDs) remain the leading cause of death globally. In recent years, interest in multicomponent interventions has grown as a response to the multifactorial complexity of CVDs. However, the literature still shows little systematic investigation into the effectiveness of multicomponent training (MCT) in the field of CVDs, accompanied by terminological confusion. This study aims to summarize and critically appraise the recent literature through a narrative review. A narrative review was conducted, synthesizing evidence from studies published between 2010 and January 2025. The databases searched included PubMed, Scopus, and Google Scholar using predefined search terms related to CVDs and MCT, and medical subject headings (MeSHs) and Boolean syntax. Two team authors independently extracted relevant information from the included studies. MCT significantly improved hemodynamic parameters in CVD patients, with reductions in systolic, diastolic, mean blood pressure, and heart rate. Physical fitness measures showed consistent enhancements whereas anthropometric improvements often corresponded with blood pressure reductions. Psychological outcomes varied across studies, with intervention duration emerging as a key factor in effectiveness. MCT interventions could lead to improvements in clinical outcomes, risk factor reduction, and patient adherence. Although findings on psychological parameters remain inconsistent, the overall evidence supports their integration into both clinical and community settings. Full article

(This article belongs to the Section Cardiology)

12 pages, 260 KiB

Open AccessArticle

Sarcopenia and Frailty in Cirrhotic Patients: Evaluation of Prevalence and Risk Factors in a Single-Centre Cohort Study

by Kadri Atay, Seval Aydin and Billur Canbakan

Medicina 2025, 61(5), 821; https://doi.org/10.3390/medicina61050821 (registering DOI) - 29 Apr 2025

Abstract

Background and Objectives: Sarcopenia and frailty adversely affect morbidity and mortality in patients with liver cirrhosis. This study aimed to investigate the prevalence of sarcopenia and frailty in cirrhotic patients and to identify the contributing factors. Materials and Methods: This study [...] Read more.

Background and Objectives: Sarcopenia and frailty adversely affect morbidity and mortality in patients with liver cirrhosis. This study aimed to investigate the prevalence of sarcopenia and frailty in cirrhotic patients and to identify the contributing factors. Materials and Methods: This study was conducted in adult patients diagnosed with cirrhosis in a single-center cohort study who were under follow-up in the gastroenterology outpatient clinic. Patients were evaluated using the SARC-F questionnaire, FRAIL index, handgrip strength measurements, and various biochemical parameters. Results: Of the 100 patients included in the study, 58.7% were male, with a median age of 66.5 years. The prevalence of sarcopenia was 32%. Patients with sarcopenia had significantly lower body mass index (BMI) and higher model for end-stage liver disease (MELD)-Na and Child–Turcotte–Pugh (CTP) scores. According to the FRAIL scale, pre-frailty was highly prevalent among patients (60%). Significant negative correlations were observed between the SARC-F score and BMI, handgrip strength, albumin, vitamin D, and sodium levels. Conversely, significant positive correlations were identified between the SARC-F score and age, CTP score, MELD-Na score, bilirubin, AST, ALT, and ferritin levels. Conclusions: This study demonstrated a high prevalence of sarcopenia and frailty among cirrhotic patients. These findings warrants further investigation in longitudinal studies for hard clinical outcome and mortality. Full article

(This article belongs to the Section Gastroenterology & Hepatology)

16 pages, 6755 KiB

Open AccessArticle

Investigating the Associations Between Hmga2 Overexpression, R-Loop Reduction, and Bone Loss in Aging Mice

by Yangyang Cao, Yantong Wang and Dengsheng Xia

Medicina 2025, 61(5), 820; https://doi.org/10.3390/medicina61050820 (registering DOI) - 29 Apr 2025

Abstract

Background and Objectives: Aging-related bone loss still lacks interventions. As bone marrow-derived mesenchymal stem cells (BMSCs) undergo aging, R-loop-induced DNA replication stress impairs the osteogenic ability of BMSCs. High-mobility group A-2 (Hmga2) acts as a DNA-binding protein, and the understanding of its underlying [...] Read more.

Background and Objectives: Aging-related bone loss still lacks interventions. As bone marrow-derived mesenchymal stem cells (BMSCs) undergo aging, R-loop-induced DNA replication stress impairs the osteogenic ability of BMSCs. High-mobility group A-2 (Hmga2) acts as a DNA-binding protein, and the understanding of its underlying mechanisms is crucial for developing effective preventive and therapeutic strategies. Materials and Methods: Aging mice were used as the experimental model, and mouse BMSCs were isolated from their femurs. Hmga2 was achieved through specific gene delivery methods. R-loop formation was detected using dot blotting, chromatin immunoprecipitation (ChIP), and DNA–RNA immunoprecipitation (DRIP) assays. Osteogenic differentiation was evaluated. Results: R-loops were highly accumulated in aging BMSCs. Notably, the key regulator Hmga2 reversed the accumulation of R-loops in aging BMSCs. Hmga2 overexpression significantly decreased the senescence and improved the osteogenic differentiation of aging mBMSCs. Mechanistically, R-loop-forming sequence (RLFS) regions were confirmed in key osteogenesis-related genes, including runt-related transcription factor 2 (Runx2). Hmga2 bound to the RLFS region of Runx2 and promoted its expression by reducing the R-loop level. More, Hmga2 treatment delivered via the AAV system effectively decreased bone loss in aging mice and increased the serum bone turnover biomarkers and collagen remodeling. Conclusions: Our study demonstrates that Hmga2 acts as an activator of aging BMSCs, significantly promoting their osteogenic ability by eliminating the aging-induced DNA replication stress caused by R-loops. Our findings provide new insights into the mechanisms of aging-related bone loss, suggesting that Hmga2 may be a new strategy for alleviating the bone loss phenotype in aging individuals. Full article

(This article belongs to the Section Genetics and Molecular Medicine)

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8 pages, 1088 KiB

Open AccessArticle

Impact of HER2 Status Assessed by Immunohistochemistry on Treatment Response in Patients with Metastatic Breast Cancer Receiving Trastuzumab Emtansine

by Sila Oksuz, Oguzcan Kinikoglu, Ugur Ozkerim, Yunus Emre Altintas, Deniz Isik, Heves Surmeli, Hatice Odabas, Seval Ay, Tugba Basoglu and Nedim Turan

Medicina 2025, 61(5), 819; https://doi.org/10.3390/medicina61050819 (registering DOI) - 29 Apr 2025

Abstract

Background and Objectives: HER2-positive breast cancer accounts for approximately 20–30% of all breast cancer cases and is associated with aggressive tumor behavior. Trastuzumab emtansine (T-DM1), an antibody-drug conjugate targeting HER2, is a standard second-line therapy for patients with metastatic disease. However, the [...] Read more.

Background and Objectives: HER2-positive breast cancer accounts for approximately 20–30% of all breast cancer cases and is associated with aggressive tumor behavior. Trastuzumab emtansine (T-DM1), an antibody-drug conjugate targeting HER2, is a standard second-line therapy for patients with metastatic disease. However, the impact of HER2 immunohistochemistry (IHC) expression levels on T-DM1 efficacy remains unclear. Materials and Methods: This retrospective study examined 87 patients with HER2-positive metastatic breast cancer who received T-DM1 following trastuzumab-based therapy. Patients were divided into IHC 2+ and IHC 3+ groups. Progression-free survival (PFS) and overall survival (OS) were evaluated via Kaplan–Meier analysis, and group comparisons were conducted using the log-rank test. Results: The median progression-free survival (PFS) for the entire cohort was 7.3 months (95% CI: 5.277–9.323), with a numerically longer PFS in the IHC 3+ group (8.4 months, 95% CI: 5.915–10.952) compared to the IHC 2+ group (6.3 months, 95% CI: 4.178–8.422). However, this difference was insignificant (HR: 0.91, 95% CI: 0.61–1.35; p = 0.778). Similarly, the median overall survival (OS) was 23.3 months (95% CI: 18.039–28.495), with the IHC 3+ group exhibiting a slightly longer OS (24.5 months, 95% CI: 18.600–30.400) compared to the IHC 2+ group (23.2 months, 95% CI: 12.387–34.147). Again, this difference did not reach statistical significance (HR: 0.93, 95% CI: 0.63–1.42; p = 0.369). Conclusions: Although the association between HER2 IHC 3+ expression and longer PFS and OS is promising, the lack of statistical significance suggests that IHC-based HER2 stratification alone may not be sufficient to predict the response to T-DM1. The potential of conducting prospective studies with larger cohorts and comprehensive molecular profiling to refine predictive biomarkers for optimizing therapeutic outcomes in HER2-positive metastatic breast cancer is a beacon of hope and should be pursued with optimism. Full article

(This article belongs to the Section Oncology)

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11 pages, 609 KiB

Open AccessArticle

Serum α-Synuclein in Pediatric Refractory Epilepsy: Correlation with Diagnosis and Clinical Severity

by Aida M. S. Salem, Dalia Saber Morgan, Marwa O. Elgendy, Mohamed E. A. Abdelrahim, Noura Mostafa Mohamed Mostafa, Asmaa Saleh, Manar M. Abdel-Aziz and Asmaa K. Ramadan

Medicina 2025, 61(5), 818; https://doi.org/10.3390/medicina61050818 (registering DOI) - 29 Apr 2025

Abstract

Background and Objectives: Epilepsy is a common neurological disrupt that involves recurring seizures. α-Synuclein (α-Syn), one of the most abundant proteins in the nervous system, is implicated in both neurodegenerative conditions and epilepsy. This study aimed to assess serum α-Syn levels in children [...] Read more.

Background and Objectives: Epilepsy is a common neurological disrupt that involves recurring seizures. α-Synuclein (α-Syn), one of the most abundant proteins in the nervous system, is implicated in both neurodegenerative conditions and epilepsy. This study aimed to assess serum α-Syn levels in children with drug-resistant epilepsy (DRE) and explore the relationship with diagnosis and clinical severity. Materials and Methods: This cross-sectional study was carried out at the Pediatric Neurology Outpatient Clinic of Beni-Suef University Hospital. It involved 30 children with DRE, 30 with drug-responsive epilepsy, and 30 age- and sex-matched healthy controls. Serum α-Syn levels were evaluated using enzyme-linked immunosorbent assay (ELISA). Results: Serum α-Syn levels were significantly higher in children with epilepsy compared to healthy controls (p < 0.001), with significantly high levels observed in drug-resistant cases versus drug-responsive ones (p < 0.001). Receiver operating characteristic (ROC) investigation confirmed that α-Syn effectively distinguished epilepsy patients from healthy controls, yielding an area under the curve (AUC) of 0.773. It also successfully differentiated between drug-responsive and drug-resistant epilepsy, with an AUC of 0.858. Further analysis revealed significant positive correlations between serum α-Syn levels and the frequency of hospitalizations due to seizures, the number of anti-epileptic drugs (AEDs) prescribed, and monthly seizure frequency (p = 0.018, 0.009, and <0.001, respectively). In contrast, α-Syn levels were negatively associated with the time since the last seizure and the age at seizure onset (p = 0.001 and 0.016, respectively). Conclusions: Serum α-Syn levels are elevated in epilepsy patients, particularly those with drug-resistant epilepsy, suggesting its potential role as a biomarker for disease severity and treatment resistance. Full article

(This article belongs to the Section Pediatrics)

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13 pages, 612 KiB

Open AccessReview

Management of Myomectomy Scar Pregnancy: A Scoping Review

by Felice Sorrentino, Lorenzo Vasciaveo, Francesca Greco, Elisa Giansiracusa, Francesco D’Antonio, Alessandro Lucidi, Andrea Etrusco, Antonio Simone Laganà, Guglielmo Stabile and Luigi Nappi

Medicina 2025, 61(5), 817; https://doi.org/10.3390/medicina61050817 (registering DOI) - 29 Apr 2025

Abstract

Background: Ectopic pregnancy (EP) is defined as the implantation of an embryo outside the uterine cavity, which can lead to high morbidity and mortality if not diagnosed and treated promptly. A rare form of EP is myomectomy scar pregnancy (MSP), where the [...] Read more.

Background: Ectopic pregnancy (EP) is defined as the implantation of an embryo outside the uterine cavity, which can lead to high morbidity and mortality if not diagnosed and treated promptly. A rare form of EP is myomectomy scar pregnancy (MSP), where the embryo implants in a scar from a prior myomectomy. Due to its rarity, MSP presents unique diagnostic and therapeutic challenges. This scoping review aims to map the existing literature on MSP to better understand the diagnostic strategies, management options, and clinical outcomes associated with this condition, and to identify gaps in current research. Methods: We conducted a scoping review by searching databases such as PubMed, Scopus, Web of Science, and MEDLINE for studies published between 2003 and 2023. Keywords used in combination included “myomectomy scar pregnancy”, “scar pregnancy”, “leiomyoma”, “uterine myomectomy”, “PAS disorders”, “placenta previa”, and “placenta accreta”. Studies were screened for relevance and eligibility by two independent reviewers. Data were extracted from case reports, retrospective studies, and reviews discussing MSP. Results: From an initial set of 111 studies, 28 papers met the inclusion criteria, comprising 4 retrospective studies and 24 case reports. A total of 44 cases of MSP were analyzed. The majority of diagnoses were made through ultrasound, with magnetic resonance imaging (MRI) used in more complex cases. Surgical interventions, primarily cesarean sections and myometrial repairs, were the most common treatments, while medical therapy with methotrexate was less frequently applied. Conclusions: This scoping review highlights the challenges of diagnosing and managing MSP due to its rarity. Although surgical management remains the primary approach, there is a lack of consensus on the optimal treatment for different clinical scenarios. Further research is needed to establish standardized diagnostic and therapeutic protocols for MSP and to evaluate the long-term outcomes of affected patients. Full article

(This article belongs to the Special Issue Recent Advances in Gynecological Surgery)

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33 pages, 7603 KiB

Open AccessReview

Assessment of Decongestion Status Before Discharge in Acute Decompensated Heart Failure: A Review of Clinical, Biochemical, and Imaging Tools and Their Impact on Management Decisions

by Diana-Ligia Pena, Adriana-Mihaela Ilieșiu, Justin Aurelian, Mihai Grigore, Andreea-Simona Hodorogea, Ana Ciobanu, Emma Weiss, Elisabeta Badilă and Ana-Maria Balahura

Medicina 2025, 61(5), 816; https://doi.org/10.3390/medicina61050816 (registering DOI) - 28 Apr 2025

Abstract

Acute decompensated heart failure (ADHF) represents a major healthcare burden, with residual congestion at discharge being a critical determinant of poor outcomes. Despite its prognostic significance, the assessment of decongestion status before discharge remains suboptimal, highlighting the need for a more comprehensive evaluation [...] Read more.

Acute decompensated heart failure (ADHF) represents a major healthcare burden, with residual congestion at discharge being a critical determinant of poor outcomes. Despite its prognostic significance, the assessment of decongestion status before discharge remains suboptimal, highlighting the need for a more comprehensive evaluation approach. This descriptive review synthesizes current evidence on congestion assessment methods in ADHF, focusing on their role in discharge decision-making and prognostic value. We describe various evaluation tools, including clinical examination, biomarkers, imaging techniques, and congestion scores, presenting their integration into a practical assessment algorithm. A comprehensive algorithm for congestion assessment before discharge is presented, incorporating multimodal evaluation techniques, with the aim of highlighting the practical utility of various assessment methods in guiding treatment decisions and determining optimal discharge timing. Integration of multiple parameters provides superior accuracy in evaluating decongestion status compared to single-method approaches. A standardized, multimodal approach to congestion assessment before discharge is essential for optimal ADHF management. The proposed assessment algorithm, combining clinical, biochemical, and imaging parameters, offers a practical framework for more reliable discharge decision-making, potentially improving patient outcomes. Full article

(This article belongs to the Special Issue Updates on Prevention of Acute Heart Failure)

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13 pages, 960 KiB

Open AccessArticle

Halitosis and Quality of Life in Young Orthodontic Patients: A Cross-Sectional Assessment of Mouthwash Use and Traditional, Rotative, and Sonic Toothbrushes

by Hamsah Musa, Ioana Georgiana Pașca, Malina Popa, Octavia Bălean, Ramona Dumitrescu, Ruxadra Sava Roșianu, Atena Gălușcan and Roxana Oancea

Medicina 2025, 61(5), 815; https://doi.org/10.3390/medicina61050815 (registering DOI) - 28 Apr 2025

Abstract

Background and Objectives: Halitosis is common among orthodontic patients, potentially exacerbated by plaque retention around brackets. It was hypothesized that patients using sonic toothbrushes would report lower halitosis impact scores compared to those using traditional or rotative toothbrushes. This study aimed to [...] Read more.

Background and Objectives: Halitosis is common among orthodontic patients, potentially exacerbated by plaque retention around brackets. It was hypothesized that patients using sonic toothbrushes would report lower halitosis impact scores compared to those using traditional or rotative toothbrushes. This study aimed to compare the Halitosis-Associated Life Quality Test (HALT) and Short Form (SF-36) domains among different toothbrush users and to evaluate mouthwash subgroups and “during” vs. “after” appliance removal. Methods: Based on a power calculation (effect size f = 0.30, α = 0.05, 1 − β = 0.80), 174 patients were required. A total of 174 orthodontic patients (57 traditional, 64 rotative, and 53 sonic; mean age 18.0 ± 1.5 years) completed the Halitosis-Associated Life Quality Test (HALT), SF-36, and organoleptic assessments. Results: Sonic toothbrush users reported significantly lower HALT scores (34.8 ± 5.8) vs. rotative (38.1 ± 6.0) and traditional (42.7 ± 6.2) toothbrush users. Spearman’s correlation (r = −0.49 to +0.54) demonstrated that sonic brushing had a moderate negative relationship with halitosis scores, indicating lower malodor for this technique. Patients using chlorhexidine-based mouthwash had the most favorable HALT (34.3 ± 5.7) and organoleptic (1.5 ± 0.4) scores. Those who completed orthodontic treatment showed better outcomes than active treatment patients. Conclusions: Optimized plaque control with sonic brushing and chlorhexidine-based mouthwash correlates with reduced halitosis and improved quality of life during orthodontic treatment. Full article

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

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12 pages, 1342 KiB

Open AccessArticle

Exploring the Possibility of Medical Device Surveillance in Patients on Peritoneal Dialysis Using a Common Data Model

by Seon Min Kim, Sooin Choi, You Kyoung Lee, Cheol Wan Lim, Byung Chul Yu, Moo Yong Park, Jin Kuk Kim, Seng Chan You, Seo Jeong Shin and Soo Jeong Choi

Medicina 2025, 61(5), 814; https://doi.org/10.3390/medicina61050814 (registering DOI) - 28 Apr 2025

Abstract

Background and Objectives: Peritoneal dialysis (PD) requires well-functioning medical devices (MDs). PD complications can result in significant adverse events, including the discontinuation of PD, hospitalization, and death. This study aimed to evaluate the feasibility of detecting various PD complications and data related [...] Read more.

Background and Objectives: Peritoneal dialysis (PD) requires well-functioning medical devices (MDs). PD complications can result in significant adverse events, including the discontinuation of PD, hospitalization, and death. This study aimed to evaluate the feasibility of detecting various PD complications and data related to MDs. Materials and Methods: A retrospective study was conducted on patients who received PD catheter insertions between January 2001 and March 2021 to evaluate PD-related complications. PD complications were evaluated through diagnostic, procedural, and MD codes using a common data model (CDM) and were compared with those from electronic health records (EHRs). The results from one CDM database were compared with those from another CDM database. Results: A total of 342 patients were enrolled. One hundred and ninety-five patients experienced PD complications more than once. Nineteen prescription codes and twenty diagnostic codes from the EHR were identified, covering 11 procedures, three MDs, and seven complications related to PD. Infectious complications were detected using the CDM, whereas mechanical complications were missed. Although data on PD catheters and adaptors were available in the EHR, they were not detected via the CDM. Some infectious and mechanical complications were identified via the CDM in the other database. After implementing amended matching, these data were detected. Conclusions: While some PD-related medical data recorded in EHRs were misrepresented or omitted during the CDM database extraction, transformation, and loading process, the CDM shows potential to serve as a source of real-world data for active surveillance. Full article

(This article belongs to the Section Urology & Nephrology)

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11 pages, 1919 KiB

Open AccessArticle

Evaluating the Anchorflow Suture Technique Versus Conventional Continuous Suturing in Vaginal Cuff Closure During TLH: A Multicenter Retrospective Analysis

by Gizem Berfin Uluutku Bulutlar, Gizem Boz İzceyhan, Eralp Bulutlar and Fisun Vural

Medicina 2025, 61(5), 813; https://doi.org/10.3390/medicina61050813 (registering DOI) - 28 Apr 2025

Abstract

Background and Objectives: Total laparoscopic hysterectomy (TLH) is a commonly performed gynecological procedure. Vaginal cuff closure significantly impacts operative time and outcomes. This study evaluates the newly developed Anchorflow Suture (AFS) technique compared to conventional continuous suturing in terms of efficiency and [...] Read more.

Background and Objectives: Total laparoscopic hysterectomy (TLH) is a commonly performed gynecological procedure. Vaginal cuff closure significantly impacts operative time and outcomes. This study evaluates the newly developed Anchorflow Suture (AFS) technique compared to conventional continuous suturing in terms of efficiency and safety. Materials and Methods: A multicenter retrospective cohort study was conducted at two tertiary referral hospitals involving 208 women who underwent TLH for benign indications. Women were divided into two groups based on vaginal cuff closure technique: AFS and continuous suturing. Demographic characteristics, surgical parameters, and postoperative outcomes were analyzed using appropriate statistical tests, with a significance level of p < 0.05. Results: No significant differences were found between groups in age, BMI (body mass index), gravida, parity, or menopausal status. Vaginal cuff closure time was significantly shorter with AFS (10.26 ± 2.3 min) compared to continuous suturing (13.36 ± 2.8 min, p < 0.001). Operative time was shorter in the AFS group, though not statistically significant (p = 0.15). Both techniques demonstrated similar safety profiles, with no cases of vaginal cuff dehiscence and comparable rates of granulation tissue formation, bleeding, and urinary incontinence. The AFS group showed a slightly lower incidence of postoperative bleeding (five cases vs. three cases). Conclusions: The AFS technique significantly reduces vaginal cuff closure time and demonstrates a comparable safety profile to continuous suturing. This method enhances surgical efficiency without increasing complications. Further prospective studies are needed to evaluate its long-term effects on pelvic floor integrity, sexual function, and surgeon proficiency. Full article

(This article belongs to the Special Issue Recent Advances in Gynecological Surgery)

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12 pages, 1051 KiB

Open AccessArticle

Associations of Thyroid and Parathyroid Hormones with Arterial Stiffness in Emergency Department Patients: A Prospective Cross-Sectional Study

by Roman Brock, Andrea Kornfehl, Julia Oppenauer, Felix Eibensteiner, Marco Neymayer, Christoph Veigl, Carina Cuhaj, Oliver Erbes, Sophia Wirth, Thomas Perkmann, Helmuth Haslacher, Markus Müller, Oliver Schlager, Peter Wolf and Sebastian Schnaubelt

Medicina 2025, 61(5), 812; https://doi.org/10.3390/medicina61050812 (registering DOI) - 28 Apr 2025

Abstract

Background and Objectives: Cardiovascular diseases are prevalent entities, especially in emergency patients. Arterial stiffness is a known predictor of cardiovascular risk and mortality and is quantified by carotid-femoral pulse wave velocity (cfPWV). It is caused in part by vascular calcification, but exact details [...] Read more.

Background and Objectives: Cardiovascular diseases are prevalent entities, especially in emergency patients. Arterial stiffness is a known predictor of cardiovascular risk and mortality and is quantified by carotid-femoral pulse wave velocity (cfPWV). It is caused in part by vascular calcification, but exact details of the underlying mechanisms are yet to be elucidated, and current data suggest endocrine influences. This study thus aimed to assess the associations of endocrine parameters, particularly thyroid and parathyroid hormones, calcium, inorganic phosphate, and vitamin D, with cfPWV as a surrogate for arterial stiffness. Materials and Methods: Adults presenting to a single tertiary care emergency department in Vienna between 2018 and 2023 were prospectively enrolled. CfPWV was measured non-invasively, and levels of thyroid and parathyroid hormones and 25-hydroxyvitamin D, calcium, and inorganic phosphate were assessed. Results: In total, data from 827 patients, predominantly male (57%) and around 60 (47–72) years of age, were assessed. We observed a significant worsening of cfPWV with increasing parathyroid hormone levels (p < 0.001) and TSH levels (p = 0.03). No significant influences of calcium, inorganic phosphate, or 25-hydroxyvitamin D were observed. Conclusions: Thyroid and parathyroid hormone levels are associated with arterial stiffness in emergency department patients, suggesting a need for a comprehensive workup in patients at risk because of comorbidities and age. Additional prospective studies are needed to further elucidate the role of endocrinology in arterial stiffness and the subsequent relevance in emergency medicine. Full article

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

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40 pages, 2063 KiB

Open AccessReview

The Multifactorial Pathogenesis of Endometriosis: A Narrative Review Integrating Hormonal, Immune, and Microbiome Aspects

by Zaure Datkhayeva, Ainur Iskakova, Alla Mireeva, Aida Seitaliyeva, Raikhan Skakova, Gulshat Kulniyazova, Aiman Shayakhmetova, Gaukhar Koshkimbayeva, Chapen Sarmuldayeva, Lazzat Nurseitova, Lyailya Koshenova, Gulzhan Imanbekova, Dina Maxutova, Sandugash Yerkenova, Aigerim Shukirbayeva, Ulzhan Pernebekova, Zaure Dushimova and Akerke Amirkhanova

Medicina 2025, 61(5), 811; https://doi.org/10.3390/medicina61050811 (registering DOI) - 27 Apr 2025

Abstract

Endometriosis (EM) is a common estrogen-dependent chronic inflammatory disorder affecting reproductive-aged women, yet its pathogenesis remains incompletely understood. Recent evidence suggests that the gut microbiota significantly influence immune responses, estrogen metabolism, and systemic inflammation, potentially contributing to EM progression. This narrative review explores [...] Read more.

Endometriosis (EM) is a common estrogen-dependent chronic inflammatory disorder affecting reproductive-aged women, yet its pathogenesis remains incompletely understood. Recent evidence suggests that the gut microbiota significantly influence immune responses, estrogen metabolism, and systemic inflammation, potentially contributing to EM progression. This narrative review explores the relationship between the gut microbiota and EM, emphasizing microbial dysbiosis, inflammation, estrogen regulation, and potential microbiome-targeted therapies. Studies published within the last 30 years were included, focusing on the microbiota composition, immune modulation, estrogen metabolism, and therapeutic interventions in EM. The selection criteria prioritized peer-reviewed articles, clinical trials, meta-analyses, and narrative reviews investigating the gut microbiota’s role in EM pathophysiology and treatment. Microbial dysbiosis in EM is characterized by a reduced abundance of beneficial bacteria (Lactobacillus, Bifidobacterium, and Ruminococcaceae) and an increased prevalence of pro-inflammatory taxa (Escherichia/Shigella, Streptococcus, and Bacteroides). The gut microbiota modulate estrogen metabolism via the estrobolome, contributing to increased systemic estrogen levels and lesion proliferation. Additionally, lipopolysaccharides (LPS) from Gram-negative bacteria activate the TLR4/NF-κB signaling pathway, exacerbating inflammation and EM symptoms. The interaction between the gut microbiota, immune dysregulation, and estrogen metabolism suggests a critical role in EM pathogenesis. While microbiota-targeted interventions offer potential therapeutic benefits, further large-scale, multi-center studies are needed to validate microbial biomarkers and optimize microbiome-based therapies for EM. Integrating microbiome research with precision medicine may enhance the diagnostic accuracy and improve the EM treatment efficacy. Full article

(This article belongs to the Special Issue Addressing the Right Strategy in the Treatment of Gynecological Diseases)

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14 pages, 1479 KiB

Open AccessArticle

Potential Risk of Cognitive Impairment Due to Irradiation of Neural Structures in Locally Advanced Nasopharyngeal Cancer Treated by Curative Radiotherapy

by Camil Ciprian Mireștean, Călin Gheorghe Buzea, Alexandru Dumitru Zară, Roxana Irina Iancu and Dragoș Petru Teodor Iancu

Medicina 2025, 61(5), 810; https://doi.org/10.3390/medicina61050810 (registering DOI) - 27 Apr 2025

Abstract

Background and Objectives: Brain radionecrosis is an under-recognized but potentially life-altering late complication of radiotherapy in patients with locally advanced nasopharyngeal cancer. Temporal lobe radionecrosis and high-dose exposure to the hippocampus are strongly associated with cognitive decline and radiation-induced dementia, negatively impacting [...] Read more.

Background and Objectives: Brain radionecrosis is an under-recognized but potentially life-altering late complication of radiotherapy in patients with locally advanced nasopharyngeal cancer. Temporal lobe radionecrosis and high-dose exposure to the hippocampus are strongly associated with cognitive decline and radiation-induced dementia, negatively impacting patients’ long-term quality of life (QoL). This study aimed to evaluate and compare radiation dose distributions to critical brain structures across three radiotherapy techniques—3D conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and volumetric-modulated arc therapy (VMAT)—in order to assess potential neurocognitive risks and support hippocampal-sparing protocols. Materials and Methods: Ten patients previously treated with 3D-CRT were retrospectively replanned using IMRT and VMAT techniques on the Eclipse v13.3 (VARIAN) planning system. Bilateral hippocampi and temporal lobes were delineated as organs at risk (OARs) according to the RTOG atlas, and dosimetric parameters including D_max, D_mean, and D_min were recorded. V7.3 values were evaluated for hippocampal avoidance regions. Results: While IMRT and VMAT provided improved target volume coverage and reduced high-dose exposure to many standard OARs, both techniques were associated with increased D_mean and D_min to the hippocampus and temporal lobes compared to 3D-CRT. The highest D_max values to the temporal lobes were observed in 3D-CRT plans, indicating a potential risk of radionecrosis. VMAT plans showed hippocampal mean doses exceeding 10 Gy in some cases, with V7.3 > 40%, breaching established neurocognitive risk thresholds. Conclusions: These findings support the routine delineation of the hippocampus and temporal lobes as OARs in radiotherapy planning for nasopharyngeal cancer. The implementation of hippocampal-sparing strategies, particularly in IMRT and VMAT, is recommended to reduce the risk of radiation-induced cognitive toxicity and preserve long-term QoL in survivors. Full article

(This article belongs to the Special Issue Head and Neck Cancers: Modern Management)

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22 pages, 7258 KiB

Open AccessArticle

AI in 2D Mammography: Improving Breast Cancer Screening Accuracy

by Sebastian Ciurescu, Simona Cerbu, Ciprian Nicușor Dima, Florina Borozan, Raluca Pârvănescu, Diana-Gabriela Ilaș, Cosmin Cîtu, Corina Vernic and Ioan Sas

Medicina 2025, 61(5), 809; https://doi.org/10.3390/medicina61050809 (registering DOI) - 26 Apr 2025

Abstract

Background and Objectives: Breast cancer is a leading global health challenge, where early detection is essential for improving survival outcomes. Two-dimensional (2D) mammography is the established standard for breast cancer screening; however, its diagnostic accuracy is limited by factors such as breast [...] Read more.

Background and Objectives: Breast cancer is a leading global health challenge, where early detection is essential for improving survival outcomes. Two-dimensional (2D) mammography is the established standard for breast cancer screening; however, its diagnostic accuracy is limited by factors such as breast density and inter-reader variability. Recent advances in artificial intelligence (AI) have shown promise in enhancing radiological interpretation. This study aimed to assess the utility of AI in improving lesion detection and classification in 2D mammography. Materials and Methods: A retrospective analysis was performed on a dataset of 578 mammographic images obtained from a single radiology center. The dataset consisted of 36% pathologic and 64% normal cases, and was partitioned into training (403 images), validation (87 images), and test (88 images) sets. Image preprocessing involved grayscale conversion, contrast-limited adaptive histogram equalization (CLAHE), noise reduction, and sharpening. A convolutional neural network (CNN) model was developed using transfer learning with ResNet50. Model performance was evaluated using sensitivity, specificity, accuracy, and area under the receiver operating characteristic (AUC-ROC) curve. Results: The AI model achieved an overall classification accuracy of 88.5% and an AUC-ROC of 0.93, demonstrating strong discriminative capability between normal and pathologic cases. Notably, the model exhibited a high specificity of 92.7%, contributing to a reduction in false positives and improved screening efficiency. Conclusions: AI-assisted 2D mammography holds potential to enhance breast cancer detection by improving lesion classification and reducing false-positive findings. Although the model achieved high specificity, further optimization is required to minimize false negatives. Future efforts should aim to improve model sensitivity, incorporate multimodal imaging techniques, and validate results across larger, multicenter prospective cohorts to ensure effective integration into clinical radiology workflows. Full article

(This article belongs to the Special Issue New Developments in Diagnosis and Management of Breast Cancer)

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11 pages, 835 KiB

Open AccessArticle

The Significance of Density Measurement and the Modified Bhalla and Reiff Scores in Predicting Exacerbations and Hospital Admissions in Cystic Fibrosis Patients

by Oğuz Karcıoğlu and Selin Ardalı Düzgün

Medicina 2025, 61(5), 808; https://doi.org/10.3390/medicina61050808 (registering DOI) - 26 Apr 2025

Abstract

Background and Objective: This study’s objective was to determine the impact of the percentage of lung tissue within the normal density range (PLND) on exacerbations and hospitalizations compared with the modified Bhalla and Reiff scores. We also investigated the effects of these [...] Read more.

Background and Objective: This study’s objective was to determine the impact of the percentage of lung tissue within the normal density range (PLND) on exacerbations and hospitalizations compared with the modified Bhalla and Reiff scores. We also investigated the effects of these measures on pulmonary function tests (PFTs). Materials and Methods: This retrospective analysis involved adult cystic fibrosis (CF) patients who had thoracic computed tomography (CT) while in a stable clinical condition. A dedicated radiologist analyzed CT images and conducted modified Bhalla, Reiff, and PLND assessments. We analyzed the exacerbations and hospitalizations in the year after the CT scan. We also examined PFTs at the time of the CT scan and one year later. Results: This study’s population consisted of 63 subjects (33 men), with a median age of 23.2 years. The median modified Bhalla score was 9.0 (IQR: 7.0–12.0), the median Reiff score was 11.0 (IQR: 8.0–15.0), and the median PLND was 79.4% (IQR: 74.5–82.0). The Bhalla score had the strongest relationship with both the number of exacerbations (p < 0.001, r: −0.559) and hospitalizations the following year (p < 0.001, r: −0.636), followed by the PLND score and the Reiff score. Youden’s index shows that the optimum cut-off values for hospitalization at ≤2 and >2 are 6.5 for the modified Bhalla score, 13.5 for the Reiff score, and 76.5% for the PLND. Conclusions: The measurement of PLND may serve as a predictor for exacerbation and hospitalization rates, aligning with the modified Bhalla and Reiff scores, and shows potential for application in follow-up assessments. Full article

(This article belongs to the Section Pulmonology)

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16 pages, 1325 KiB

Open AccessArticle

Prognostic Value of Urinary Biomarkers in Proteinuria Progression in IgA Nephropathy Patients Treated with Budesonide

by Christodoulos Keskinis, Eleni Moysidou, Stamatia Stai, Michalis Christodoulou, Georgios Lioulios, Sotirios-Spyridon Vamvakas, Maria Stella Trivyza, Panagiotis Pateinakis, Marios Papasotiriou and Maria Stangou

Medicina 2025, 61(5), 807; https://doi.org/10.3390/medicina61050807 (registering DOI) - 26 Apr 2025

Abstract

Background & Objectives: Targeted-release budesonide (TRB) is the first approved agent aimed at targeting the early pathogenetic cascade in IgA nephropathy (IgAN). Materials and Methods: This prospective study included Caucasian IgAN patients diagnosed within the last 5 years, who had started [...] Read more.

Background & Objectives: Targeted-release budesonide (TRB) is the first approved agent aimed at targeting the early pathogenetic cascade in IgA nephropathy (IgAN). Materials and Methods: This prospective study included Caucasian IgAN patients diagnosed within the last 5 years, who had started a 10-month TRB treatment and were followed in the outpatient clinic. All participants had been on the maximal supportive care dose for at least the previous 6 months. Kidney function and proteinuria levels were recorded at the start of TRB treatment (T0) and at 3, 6, and 10 months (T3, T6, and T10, respectively), while urinary monocyte chemotactic protein-1 (MCP-1), matrix metalloproteinase-9 (MMP-9) and clusterin (CLU) levels were measured at T0 and T3. Results: In the cohort of all patients (mean age 53.24 ± 12.76 years, estimated glomerular filtration rate (eGFR 52.84 ± 25.93 mL/min/1.73 m², proteinuria 2.84 ± 1.26 g/24 h), significant correlations were observed at T0 between MMP-9 and MCP-1 (r = 0.74, p = 0.004), MMP-9 and uCLU (r = 0.77, p = 0.002), and MCP-1 and uCLU (r = 0.65, p = 0.01). At T3, a significant correlation between MMP-9 and urinary CLU (uCLU) persisted (r = 0.71, p = 0.03). Higher MCP-1 (r = −0.560, p = 0.046) and MMP-9 (r = −0.330, p = 0.012) levels at T0 were associated with reduced proteinuria. Conversely, increased clusterin at T3 (r = 0.599, p = 0.031) was associated with worsening proteinuria. Conclusions: The treatment response to TRB was heterogeneous, with recent diagnosis (RD) patients showing improved kidney function and proteinuria, while older diagnosis (OD) patients exhibited worsening biomarkers and declining kidney function. Therefore, early interventions are crucial in IgAN patients. Finally, the biomarkers studied can be used prognostically to monitor disease progression. Full article

(This article belongs to the Section Urology & Nephrology)

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13 pages, 936 KiB

Open AccessArticle

Seroprevalence and Shifting Endemicities of Hepatitis A Virus Infection in Two Contrasting Geographical Areas in Indonesia

by Dwi Prasetyo, Yudith Setiati Ermaya, Gustavo Hernandez-Suarez, Adriana Guzman-Holst and Cissy B. Kartasasmita

Medicina 2025, 61(5), 806; https://doi.org/10.3390/medicina61050806 (registering DOI) - 26 Apr 2025

Abstract

Background and Objectives: Hepatitis A is an infectious disease caused by the hepatitis A virus (HAV), which is transmitted via the fecal–oral route, either through the consumption of contaminated food and water or through direct contact with an infected individual. The incidence of [...] Read more.

Background and Objectives: Hepatitis A is an infectious disease caused by the hepatitis A virus (HAV), which is transmitted via the fecal–oral route, either through the consumption of contaminated food and water or through direct contact with an infected individual. The incidence of HAV is closely associated with socioeconomic factors, access to clean drinking water, sanitation safety, and hygiene. This study aimed to determine HAV seroprevalence and shifting endemicities of hepatitis A virus infection. The seroprevalence and endemicity status were assessed based on the age at the midpoint of population immunity (AMPI). Materials and Methods: A cross-sectional seroprevalence study was conducted in two contrasting areas (urban vs. rural) in Bandung, Indonesia. All participants underwent serological testing for anti-HAV IgG using a chemiluminescent microparticle immunoassay (CMIA) and participated in questionnaire interviews. Socioeconomic status was assessed using the Water/sanitation, Assets, Maternal education, and Income (WAMI) index. All statistical analyses were performed using SPSS 18, with a p-value of <0.05 considered significant. Results: A total of 1280 participants were tested (640 living in urban areas; 640 living in rural areas). The total prevalence of HAV seropositivity was 50.5% (95% confidence interval [CI]: 47.7–53.3%), with prevalences of 46.1% (95% CI: 42.5–54.4%) across urban sites and 54.7% (95% CI: 50.7–58.6%) across rural sites. The AMPI was within the 20–24-year age group, with an age point of 22 years, classified as an intermediate HAV endemicity status. Conclusions: the study found a shift in HAV endemicity status from low to intermediate, supporting the need for large-scale national hepatitis A vaccination in Indonesia. Full article

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

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14 pages, 2032 KiB

Open AccessArticle

Five-Year Sales Trends of Osteoporosis Medications in Korea: A Market Analysis Based on IMS Health Sales Audit Data (2018–2023)

by Jung Yoon Park, Youn-Jee Chung, Mee-Ran Kim and Jae-Yen Song

Medicina 2025, 61(5), 805; https://doi.org/10.3390/medicina61050805 (registering DOI) - 26 Apr 2025

Abstract

Background and Objectives: Osteoporosis is a common chronic condition after menopause that increases the risk of fractures. In South Korea, the prevalence of osteoporosis among adults aged 50 and older is 22.4%, with 94.4% of treated patients being women, highlighting its significant [...] Read more.

Background and Objectives: Osteoporosis is a common chronic condition after menopause that increases the risk of fractures. In South Korea, the prevalence of osteoporosis among adults aged 50 and older is 22.4%, with 94.4% of treated patients being women, highlighting its significant impact on postmenopausal health. In this study, we examine the sales trends of osteoporosis medications in Korea from 2018 to 2023 to understand current usage patterns and market dynamics. Materials and Methods: This study is a retrospective analysis based on pre-recorded sales data from Intercontinental Marketing Services (IMS). Data covering a five-year period (2018–2023) were analyzed to examine the sales trends of osteoporosis medications, including bisphosphonates, selective estrogen receptor modulators (SERMs), parathyroid hormone analogs, denosumab, romosozumab, and others. Romosozumab, approved in November 2019, was included in the analysis. Given the nature of this study, no direct patient data or clinical interventions were involved. Results: The total market size for osteoporosis medications in South Korea reached USD 285.42 million in 2023, reflecting a 15.3% increase from 2022. Bisphosphonates, previously the dominant therapy, experienced an 11% decline in market share over five years. Meanwhile, denosumab, a receptor activator of the nuclear factor-κB ligand inhibitor, showed a remarkable growth rate of 957.6% from 2018 to 2023, surpassing bisphosphonates in their market share. Romosozumab, a newly introduced anabolic agent, accounted for 7.4% of the market, with sales increasing by 59% in 2023. Conclusions: This analysis revealed major shifts in treatment preferences, with newer drugs like denosumab and romosozumab gaining prominence over traditional bisphosphonates. These trends highlight the increasing clinical adoption of anabolic agents for high-risk patients and the impact of expanded reimbursement policies on osteoporosis management. Given the increasing use of advanced therapies, it is essential to monitor treatment access, patient adherence, and long-term clinical outcomes. Understanding these sales trends can aid healthcare professionals and policymakers in optimizing osteoporosis treatment strategies and ensuring better patient care. Full article

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

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