Medicina

0 pages, 2071 KB

Open AccessArticle

Effect of Circadian Blood Pressure Variations on Retinal Microvascular Structures: Optical Coherence Tomography Angiography Analysis with the Nighttime Divided into Subintervals (Retinal Dawn Pattern)

by Oğuzhan Zengin, Şule Nur Polat, Canan Satılmış, Burak Göre, Melike Yakut, İrem Aydoğmuş, Merve Çelik, Mehmet Önen and İhsan Ateş

Medicina 2025, 61(10), 1801; https://doi.org/10.3390/medicina61101801 - 6 Oct 2025

Abstract

Background and Objectives: Circadian fluctuations in blood pressure, particularly the non-dipping pattern characterized by the absence of a nocturnal decline, are associated with an increased risk of microvascular complications. The retina, as a highly sensitive microvascular tissue, offers a valuable window into systemic [...] Read more.

Background and Objectives: Circadian fluctuations in blood pressure, particularly the non-dipping pattern characterized by the absence of a nocturnal decline, are associated with an increased risk of microvascular complications. The retina, as a highly sensitive microvascular tissue, offers a valuable window into systemic hemodynamic alterations. However, the literature lacks detailed structural analyses that evaluate all retinal regions by segmenting nighttime into specific time intervals. Notably, the early morning period (04:00–08:00), during which stress hormones such as cortisol and catecholamines rise physiologically, leads to increased blood pressure that may significantly affect retinal microcirculation. This prospective study aims to assess retinal microvascular structures in dipper and non-dipper individuals using structural optical coherence tomography and to investigate their relationship with blood pressure parameters by dividing nighttime into distinct time segments. Materials and Methods: A total of 60 participants were classified as dipper (n = 26) or non-dipper (n = 34) based on 24 h ambulatory blood pressure monitoring results. Structural optical coherence tomography was used to evaluate superficial and deep capillary plexus densities in the foveal, parafoveal, and perifoveal regions, along with the area and perimeter of the foveal avascular zone (FAZ) and flow density (FD). Blood pressure values, including systolic, diastolic, mean arterial, and pulse pressure, were recorded during two nighttime intervals (00:00–04:00 and 04:00–08:00), and correlations with retinal parameters were analyzed. Results: No significant differences were observed in retinal microvascular parameters between the dipper and non-dipper groups. Deep capillary densities, particularly in the parafoveal and perifoveal regions, showed significant positive correlations with serum total protein, albumin, and very low-density lipoprotein (VLDL) levels. Furthermore, systolic and mean arterial pressures measured during the 04:00–08:00 interval demonstrated significant positive correlations with deep retinal vascular densities. The FAZ perimeter was negatively correlated with pulse pressure variability, while FD showed a negative correlation with mean arterial pressure variability. Conclusions: This prospective study is among the first to investigate the effects of circadian blood pressure patterns on retinal microvascular structures by segmenting nighttime into specific intervals and employing comprehensive structural optical coherence tomography across the entire retina. The findings suggest that retinal microvascular structure may be associated with fluctuations in blood pressure. Analyses of blood pressure measurements between 04:00 and 08:00 may offer supplementary insights into the evaluation of retinal microvascular structure. Full article

(This article belongs to the Section Ophthalmology)

0 pages, 453 KB

Open AccessArticle

Predictive Factors of Lymph Node Metastasis in Papillary Thyroid Microcarcinoma (PTMC)

by Odysseas Violetis, Maria Sfakiotaki, Ariadni Spyroglou, Evangelia Pissadaki, Konstantinos Iliakopoulos, Eleni-Konstantina Syntzanaki, Panagiota Konstantakou, Eleni Chouliara, Constantinos Nastos, Nikolaos Dafnios, George Simeakis, Konstantinos Bramis, Despoina Myoteri, George Mastorakos, Paraskevi Xekouki and Krystallenia I. Alexandraki

Medicina 2025, 61(10), 1800; https://doi.org/10.3390/medicina61101800 - 6 Oct 2025

Abstract

Background and Objectives: The incidence of papillary thyroid microcarcinoma (PTMC) has increased. Some patients present with lymph node metastases (LNM), while risk factors remain unclear. This study aims to examine clinicopathological markers predictive of LNM in PTMC. Materials and Methods: We retrospectively [...] Read more.

Background and Objectives: The incidence of papillary thyroid microcarcinoma (PTMC) has increased. Some patients present with lymph node metastases (LNM), while risk factors remain unclear. This study aims to examine clinicopathological markers predictive of LNM in PTMC. Materials and Methods: We retrospectively analyzed 170 patients with a histological diagnosis of PTMC. The patients were grouped based on the presence of LNM. Results: Our cohort consisted of 133 females and 37 males, aged 47.14 ± 12.81 years. Twenty-seven (15.9%) individuals had LNM. Median tumor size was 5 mm (4.25, 0.15–10), and multifocality was present in 37.1% of patients. Thyroid capsular invasion (TCI) was observed in 22.9% of patients. Extrathyroidal extension (ETE) and aggressive variants were present in 12.9% and 8.8% of patients, respectively. Forty-four patients had a history of autoimmune thyroid disease. From univariate analysis, age < 55 years (OR: 6.317; p = 0.015), TCI (OR: 2.824; p = 0.020), and ETE (OR: 2.987; p = 0.034) were independent predictors of LNM. Multivariate analysis showed that younger patients are at a significantly increased risk of LNM in PTMC (OR: 6.30910; p = 0.016). Conclusions: The findings of this study highlight the need for greater attention to PTMC in younger patients with ultrasonographic features of TCI and ETE, as they may require a more thorough evaluation of LNM, strict follow-up, and may benefit from a surgical decision of lymphadenectomy. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Thyroid Cancer in the Precision Medicine Era)

0 pages, 545 KB

Open AccessArticle

Impact of Tumor Localization on Early Recurrence After Curative Resection in Pancreatic Ductal Adenocarcinoma

by Eda Caliskan Yildirim, Ilkay Tugba Unek, Ilhan Oztop, Mehmet Uzun, Tarkan Unek and Ozgul Sagol

Medicina 2025, 61(10), 1799; https://doi.org/10.3390/medicina61101799 - 6 Oct 2025

Abstract

Background and objectives: Early recurrence (ER) following curative-intent surgery for pancreatic ductal adenocarcinoma (PDAC) is associated with poor prognosis. Identifying preoperative risk factors for ER is essential for optimizing perioperative strategies. This study aimed to investigate perioperative predictors of ER, with a [...] Read more.

Background and objectives: Early recurrence (ER) following curative-intent surgery for pancreatic ductal adenocarcinoma (PDAC) is associated with poor prognosis. Identifying preoperative risk factors for ER is essential for optimizing perioperative strategies. This study aimed to investigate perioperative predictors of ER, with a specific focus on tumor localization. Methods: We retrospectively analyzed 163 patients who underwent R0 or R1 resection for PDAC. ER was defined as recurrence within 6 months postoperatively. Two separate multivariate logistic regression analyses were conducted: one including only preoperative variables, and one including both pre- and postoperative factors. Results: ER occurred in 35.6% of patients and was associated with significantly worse overall survival (median 9 vs. 21 months, p < 0.001) and post-recurrence survival (5 vs. 8 months, p = 0.008). Preoperative ECOG performance status > 0 (OR 3.31, p = 0.013) and CA 19-9 > 208 U/mL (OR 3.18, p = 0.022) were identified as independent predictors of ER. In the postoperative model, tumor localization in the body/tail (OR 3.23, p = 0.035), tumor size > 3.25 cm, lymph node ratio > 0.13, and absence of adjuvant therapy were also significant. Notably, tumor location did not influence overall survival. Conclusions: Tumor localization in the body/tail of the pancreas is independently associated with early recurrence but not overall survival. These findings highlight the importance of incorporating tumor site into preoperative risk stratification and support the consideration of neoadjuvant therapy in select anatomically resectable patients, particularly those with left-sided tumors. Full article

(This article belongs to the Section Oncology)

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0 pages, 1055 KB

Open AccessArticle

Analysis of Risk Factor Changes for Myopia in Korean Adolescents Before and After the COVID-19 Pandemic

by Seeun Lee, So Ra Kim and Mijung Park

Medicina 2025, 61(10), 1798; https://doi.org/10.3390/medicina61101798 - 6 Oct 2025

Abstract

Background and Objectives: To analyze changes in risk factors for refractive errors among Korean adolescents before and after the COVID-19 pandemic and examine the impact of lifestyle modifications on myopia development, Methods: this cross-sectional study utilized nationally representative data from the [...] Read more.

Background and Objectives: To analyze changes in risk factors for refractive errors among Korean adolescents before and after the COVID-19 pandemic and examine the impact of lifestyle modifications on myopia development, Methods: this cross-sectional study utilized nationally representative data from the Korea National Health and Nutrition Examination Survey (KNHANES) VII (2016) and VIII (2021). We analyzed 691 adolescents aged 10–18 years from 2016 (pre-COVID-19) and 490 from 2021 (post-COVID-19). Refractive errors were categorized as hyperopia (≥+0.50 D), emmetropia (−0.50 to +0.50 D), myopia (−6.00 to −0.50 D), and high myopia (≤−6.00 D). Complex sample linear regression analyses identified factors associated with spherical equivalent (SE) refractive errors. Results: At the population level, overall myopia prevalence declined from 84.2% in 2016 to 77.4% in 2021, whereas the prevalence of high myopia increased from 10.0% to 11.5% (p = 0.047). This indicates that although the absolute proportion of adolescents with myopia decreased, the relative contribution of high myopia to the overall myopia burden within this population increased. Mean SE was −2.77 ± 0.11 D in (−10.63~+3.00 D/median: −2.00 D) 2016 and −2.63 ± 0.13 D (−14.00~+1.63/median: −1.75 D) in 2021 (p = 0.443). Age-related myopia progression accelerated post-pandemic (−0.193 D to −0.324 D per year in univariate regression and −0.185 D to −0.312 D, in multivariate regression analysis, p < 0.001). In both the 3 h and ≥4 h near work groups, statistically significant associations were observed at both time points, but a greater myopic shift was evident after COVID-19 (B = –0.853 and –0.757 in 2016; B = –1.311 and –1.167 in 2021, p < 0.05). Conclusions: The COVID-19 pandemic altered myopia risk factors among Korean adolescents. High myopia prevalence increased despite overall myopia with underweight status and environmental factors such as digital device time and urban living identified as important considerations for post-pandemic myopia prevention. Full article

(This article belongs to the Special Issue Ophthalmology, Environment, and Lifestyle: New Pathways in Diagnosis and Treatment)

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12 pages, 771 KB

Open AccessReview

Early Initiation of Biologic Therapies to Prevent Severe Asthma Progression

by Alessandra Tomasello, Alida Benfante, Stefania Principe and Nicola Scichilone

Medicina 2025, 61(10), 1797; https://doi.org/10.3390/medicina61101797 - 6 Oct 2025

Abstract

Asthma is a chronic inflammatory disease with a heterogeneous course, often progressing silently from mild symptoms to severe, treatment-refractory disease. Current guidelines recommend biologic therapies after failure of high-dose inhaled corticosteroids and additional controllers, typically in patients with frequent exacerbations. This reactive approach [...] Read more.

Asthma is a chronic inflammatory disease with a heterogeneous course, often progressing silently from mild symptoms to severe, treatment-refractory disease. Current guidelines recommend biologic therapies after failure of high-dose inhaled corticosteroids and additional controllers, typically in patients with frequent exacerbations. This reactive approach may delay intervention until irreversible airway remodeling has occurred, limiting the potential benefits of biologic therapy. Therefore, severe asthma may be envisioned as the consequence of missed opportunities for early interventions. Early initiation of biologic therapy—guided by biomarkers such as blood eosinophil count and fractional exhaled nitric oxide (FeNO), as well as symptom burden and risk of lung function decline—may prevent progression to severe asthma and improve remission rates. This position paper advocates for a shift from severity-based to risk-based treatment strategies, recommending earlier biomarker assessment, redefinition of escalation criteria, and clinical trials designed to evaluate biologics in symptomatic non-exacerbating patients. By recognizing persistent inflammation and progression risk earlier in the disease course, clinicians may have a critical opportunity to alter the trajectory of asthma, reduce long-term morbidity, and achieve sustained control before irreversible damage occurs. Full article

(This article belongs to the Special Issue Latest Advances in Asthma and COPD)

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3 pages, 192 KB

Open AccessEditorial

Cardiovascular Disease and Hemodialysis

by Keren Cohen-Hagai

Medicina 2025, 61(10), 1796; https://doi.org/10.3390/medicina61101796 - 5 Oct 2025

Abstract

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in patients undergoing maintenance hemodialysis (HD) [...] Full article

(This article belongs to the Special Issue Cardiovascular Disease and Hemodialysis)

23 pages, 4451 KB

Open AccessArticle

Investigation of the Effect of Enamel Matrix Protein, Platelet-Rich Fibrin, and Bone Graft on New Bone Formation in Guided Tissue Regeneration in Rat Calvarium

by Tuğçe Dönmezer, Tuba Talo Yildirim, Serkan Dündar, Alihan Bozoğlan and İbrahim Hanifi Özercan

Medicina 2025, 61(10), 1795; https://doi.org/10.3390/medicina61101795 - 4 Oct 2025

Abstract

Background and Objective: The aim of this study was to evaluate the effects of enamel matrix protein, platelet-rich fibrin (PRF), and bone graft on new bone formation beyond the skeletal system by creating calvarial bone defects in rats. The effects were assessed [...] Read more.

Background and Objective: The aim of this study was to evaluate the effects of enamel matrix protein, platelet-rich fibrin (PRF), and bone graft on new bone formation beyond the skeletal system by creating calvarial bone defects in rats. The effects were assessed using histopathological and immunohistochemical analyses. Materials and Methods: In this study, calvarial bone defects were created in male Sprague Dawley rats weighing 500–550 g. The animals were randomly divided into seven groups: Control (n = 13), Emdogain (EMD, n = 13), Emdogain + Bone Graft (EMD + BG, n = 13), Platelet-Rich Fibrin (PRF, n = 13), PRF + Bone Graft (PRF + BG, n = 13), Bone Graft (BG, n = 13), and PRF + Emdogain + Bone Graft (PRF + EMD + BG, n = 13). An additional group of 36 rats was used for PRF preparation. Titanium domes were placed on the calvarial bone defects, and the animals were sacrificed after three months. Bone samples were evaluated histopathologically for new bone formation, numbers of osteoblasts and osteoclasts, angiogenesis, and fibrosis. Immunohistochemical analysis of bone formation was performed using OPG and RANKL staining kits. Data were analyzed statistically. Results: The PRF group showed a significantly higher level of moderate new bone formation compared with the PRF + BG, EMD + BG, and PRF + EMD + BG groups (p ≤ 0.05). No significant differences were observed among the groups in terms of fibrosis or angiogenesis (p > 0.05). Similarly, OPG and RANKL levels, as well as the OPG/RANKL ratio, did not differ significantly between groups (p > 0.05). Conclusions: Based on the findings of this study, the combined use of Emdogain, PRF, and bone graft appears to have beneficial effects on enhancing bone formation in calvarial defects. Full article

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

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19 pages, 819 KB

Open AccessReview

Fertility Preservation Strategies in Female Cancer Patients: Current Approaches and Future Directions

by Nicolae Gică, Ioana Vișoiu, Ioana-Catalina Mocanu, Ancuța Năstac, Romina Marina Sima, Anca Maria Panaitescu and Claudia Mehedințu

Medicina 2025, 61(10), 1794; https://doi.org/10.3390/medicina61101794 - 4 Oct 2025

Abstract

Fertility-sparing treatments (FSTs) have gained importance for young female cancer patients, especially those with early-stage cervical, ovarian, and endometrial cancers. However, concerns about the long-term safety of these procedures, particularly in more advanced cancers, persist. A literature review was conducted using databases such [...] Read more.

Fertility-sparing treatments (FSTs) have gained importance for young female cancer patients, especially those with early-stage cervical, ovarian, and endometrial cancers. However, concerns about the long-term safety of these procedures, particularly in more advanced cancers, persist. A literature review was conducted using databases such as PubMed, Scopus, and Web of Science. The search terms included “fertility preservation” and “gynaecological cancer”. Articles published between 2014 and 2024 were considered, with 39 articles cited in the paper. The inclusion criteria were female patients undergoing FST. Studies were excluded if prior treatments impacted fertility or if oncological outcomes were inadequately reported. Radical trachelectomy, laparoscopic fertility-sparing surgeries, and cryopreservation techniques, such as ovarian tissue vitrification and oocyte cryopreservation, offer viable options for preserving fertility in early-stage gynecological cancer patients. Radical trachelectomy and cryopreservation showed positive reproductive outcomes, with pregnancy rates of 30–50% in early-stage cases. GnRH analogs during chemotherapy also demonstrated benefits in maintaining fertility. Despite these advances, recurrence in more advanced stages (FIGO IA2 and beyond) remains a concern. Minimally invasive surgeries like robotic-assisted procedures demonstrated comparable fertility outcomes to traditional methods but with fewer complications. FST is a promising option for women with early-stage cancer, offering favorable reproductive and survival outcomes. However, further research is needed to confirm long-term oncological safety in advanced stages. Multidisciplinary approaches and individualized treatment planning are essential for optimizing outcomes. Full article

(This article belongs to the Special Issue From Conception to Birth: Embryonic Development and Disease)

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15 pages, 518 KB

Open AccessReview

Inner Ear Dysfunction in Thyroid Disease: A Scoping Review

by Athena Eliana Arsie, Luca Sacchetto, Carlotta Muneretto, Matteo Seno, Enrico Apa, Elisabetta Genovese, Daniele Monzani and Silvia Palma

Medicina 2025, 61(10), 1793; https://doi.org/10.3390/medicina61101793 - 4 Oct 2025

Abstract

Background and Objectives: Sensorineural hearing loss (SNHL) is influenced by various causes, including thyroid diseases. For example, hypothyroidism and thyroid autoimmunity can damage the inner ear through hormonal, immune, and vascular mechanisms. Vestibular disorders like Ménière’s disease (MD) and benign paroxysmal positional [...] Read more.

Background and Objectives: Sensorineural hearing loss (SNHL) is influenced by various causes, including thyroid diseases. For example, hypothyroidism and thyroid autoimmunity can damage the inner ear through hormonal, immune, and vascular mechanisms. Vestibular disorders like Ménière’s disease (MD) and benign paroxysmal positional vertigo (BPPV) also show possible associations with thyroid dysfunction. Materials and Methods: A review following PRISMA guidelines searched PubMed, Scopus, and Google Scholar for studies linking thyroid disorders with inner ear dysfunction. Results: Out of 985 screened records, 30 studies met inclusion criteria, involving various thyroid disorders, primarily hypothyroidism and autoimmune thyroiditis. Scientific evidence supports a correlation between hypothyroidism and hearing impairment. However, some studies also suggest a link between hyperthyroidism and inner ear disorders, particularly focusing on the role of autoimmunity in this context. Concerning vestibular dysfunction, the available studies are less abundant and support a significant association between thyroid disease and Meniere’s disease. Conclusions: There is a clear correlation between hypothyroidism and auditory function. A substantial body of literature also supports an association with vestibular disorders, although some discrepancies remain. Further research is needed to elucidate the underlying pathophysiological mechanisms (e.g., autoimmune, vascular, metabolic) involved with this correlation. Full article

(This article belongs to the Section Endocrinology)

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14 pages, 459 KB

Open AccessArticle

Impact of Age and BMI on Spinal Anesthesia Characteristics in Pediatric Patients: A Retrospective Study

by Ahmet Atlas, Nuray Altay, Evren Büyükfirat, Abdulhakim Şengel, Ramazan Aslanparçası and Abdullah Şengül

Medicina 2025, 61(10), 1792; https://doi.org/10.3390/medicina61101792 - 3 Oct 2025

Abstract

Background and Objectives: Spinal anesthesia is increasingly preferred in pediatric surgeries due to its rapid onset, high success rate, and low risk of systemic complications. However, the influence of age and body mass index (BMI) on block characteristics in adolescents remains insufficiently [...] Read more.

Background and Objectives: Spinal anesthesia is increasingly preferred in pediatric surgeries due to its rapid onset, high success rate, and low risk of systemic complications. However, the influence of age and body mass index (BMI) on block characteristics in adolescents remains insufficiently studied. Materials and Methods: This retrospective study evaluated 190 pediatric patients (aged 9–18 years; 154 male, 36 female) undergoing elective surgery with spinal anesthesia. Patients were stratified by age (Group 1: 9–14 years; Group 2: 15–18 years) and BMI (Group A: 16.00–19.65 kg/m²; Group B: 19.66–23.31 kg/m²). The primary outcome was sensory block duration. Secondary outcomes included sedation requirements, complications, analgesic requirement times, and Visual Analog Scale (VAS) scores. Results: Group 2 had significantly longer sensory block duration and lower postoperative VAS scores at 3 and 12 h compared to Group 1 (p < 0.001). Lower BMI was associated with greater sedation requirements (p < 0.001) and a higher incidence of intraoperative nausea and vomiting (p = 0.013). Complications were infrequent (hypotension 6.3%, bradycardia 2.1%, PONV 7.1%, postoperative headache 3.1%) and managed conservatively. Conclusions: Age and BMI meaningfully influence spinal anesthesia characteristics in pediatric patients. Older adolescents achieved longer sensory block durations and better postoperative analgesia, whereas younger and lower-BMI patients required more sedation and had higher nausea rates. Individualized spinal anesthesia planning, considering age, BMI, and developmental stage, may optimize clinical outcomes. Prospective studies are warranted to validate these findings. Full article

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

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13 pages, 670 KB

Open AccessArticle

Cervical Hyperextension Causes Acute Cerebral Congestion in Non-Anesthetized Healthy Adults: An Observational Self-Controlled Design Study

by Ozlem Ersoy Karka, Derya Guclu, Ilknur S. Yorulmaz, Mehmet A. Sungur, Gizem Demir Senoglu, Gulbin Sezen and Yavuz Demiraran

Medicina 2025, 61(10), 1791; https://doi.org/10.3390/medicina61101791 - 3 Oct 2025

Abstract

Background and Objectives: Severe complications associated with cervical hyperextension during general anesthesia have been reported. The question is whether some of the cerebral/spinal ischemic complications could be partially related to the position itself. Cerebral oximetric monitoring, combined with optic nerve sheath diameter [...] Read more.

Background and Objectives: Severe complications associated with cervical hyperextension during general anesthesia have been reported. The question is whether some of the cerebral/spinal ischemic complications could be partially related to the position itself. Cerebral oximetric monitoring, combined with optic nerve sheath diameter and cognitive function in non-anesthetized healthy volunteers, should provide more extensive information about the effects of cervical hyperextension, independent of anesthesia. Materials and Methods: 51 healthy volunteers with no vertebrobasilar abnormalities completed the study and were included in statistical analysis. Primary outcomes were cervical blood flow and cerebral relative hemoglobin change. The secondary outcomes were optic nerve sheath diameter and cognitive function assessment. After baseline Doppler ultrasonography of the cervical vessels, Mini-Mental State Examination, Montreal Cognitive Assessment, and optic nerve sheath diameter measurements at T0, volunteers underwent cervical hyperextension > 30°, with assessments repeated at the first and 30th minutes (T1, T30). Relative total, oxi-, and deoxyhemoglobin changes were assessed every 5 min. Results: Peak systolic velocities in the jugular veins at T1 and T30 were significantly lower than those at baseline (p1 and p2 < 0.001). After hyperextension, deoxyhemoglobin changes significantly increased at T1 and T30 (p1 < 0.001). The optic nerve sheath diameter increased at T30 compared to the baseline (p < 0.001). Cognitive scores improved at T30 (p = 0.044 and p < 0.001, respectively). Conclusions: Cervical hyperextension causes a significant increase in relative total and deoxyhemoglobin changes, which are related to acute cerebral congestion by severely impairing cerebral venous flow. A significant change in optic nerve sheath diameter indirectly indicates increased intracranial pressure. Full article

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

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11 pages, 387 KB

Open AccessArticle

Clinical Characteristics and the Prognostic Factors of Acute Peripheral Facial Palsy in Children

by Young-Soo Chang and Su Jeong You

Medicina 2025, 61(10), 1790; https://doi.org/10.3390/medicina61101790 - 3 Oct 2025

Abstract

Background and Objectives: This study aimed to investigate the clinical characteristics of children with acute peripheral facial palsy (PFP) in a single medical center. Materials and Methods: We conducted a retrospective analysis of children under 19 years of age treated for [...] Read more.

Background and Objectives: This study aimed to investigate the clinical characteristics of children with acute peripheral facial palsy (PFP) in a single medical center. Materials and Methods: We conducted a retrospective analysis of children under 19 years of age treated for acute PFP between January 2009 and July 2023. A total of 109 patients were enrolled, and 7 patients showed recurrence. Of all the patients included, only 68 patients followed up for over 1 month (the follow-up cohort), in whom clinical outcomes were analyzed. The recovery period was calculated as the duration between the first day of facial palsy development and the last follow-up day on which the patient achieved a House–Brackmann (H–B) grade of I or II. Patients were categorized into two groups depending on the initial severity of their facial palsy using the H–B grade: “incomplete palsy”, defined as H–B grade ≤III; and “complete palsy”, defined as H–B grade ≥IV. Results: When comparing the group of patients which had recurrence (n = 7) and the group with no recurrence (n = 91), the age in the group with recurrence was younger (79.1 ± 29.9 vs. 143.8 ± 52.5, months, p = 0.001, Mann–Whitney U test). In the follow-up cohort, four (5.9%) patients continued to have mild facial palsy (H–B grade II). Age, the time lag between the onset of palsy and treatment initiation, the type of etiology and the use of antiviral agents were not associated with the recovery period. The initial severity of facial palsy was significantly associated with the recovery period (incomplete palsy group 26.7 ± 18.4 days, complete palsy group 75.1 ± 96.0 days, unstandardized regression coefficient = 50.5, p = 0.001). Conclusions: The outcome of acute PFP in children showed a good prognosis. The recurrence of PFP was observed in younger patients. An initial severity of “complete palsy” entailed a significantly longer recovery period. Full article

(This article belongs to the Section Pediatrics)

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16 pages, 600 KB

Open AccessFeature PaperArticle

Uric Acid and Impulse Control Disorders in Parkinson’s Disease: A Cross-Sectional Analysis

by Mateusz Toś, Agata Dymek, Agata Morka, Paulina Włodarczyk and Joanna Siuda

Medicina 2025, 61(10), 1789; https://doi.org/10.3390/medicina61101789 - 3 Oct 2025

Abstract

Background and Objectives: Impulse control disorders (ICDs) are frequent non-motor complications of Parkinson’s disease (PD), usually related to dopaminergic therapy. Uric acid (UA) has been studied as a biomarker of PD severity and has been linked to impulsivity in non-PD populations. However, its [...] Read more.

Background and Objectives: Impulse control disorders (ICDs) are frequent non-motor complications of Parkinson’s disease (PD), usually related to dopaminergic therapy. Uric acid (UA) has been studied as a biomarker of PD severity and has been linked to impulsivity in non-PD populations. However, its association with ICDs in patients with PD (PwPs) has not been investigated. This study aimed to assess the relationship between serum UA levels, the uric acid to creatinine ratio (UA/Cr), and ICD prevalence in PwPs. Materials and Methods: We enrolled 172 PwPs hospitalized for follow-up or treatment modification. ICDs were screened with the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease (QUIP). Clinical data included demographics, disease severity, motor and non-motor symptoms, and dopaminergic treatment. Fasting serum UA and UA/Cr were determined. Results: ICDs were present in 24.42% of patients, most commonly binge eating and compulsive buying. PwPs with ICDs had longer disease duration, more motor complications, higher dopaminergic doses, and more frequent dopamine agonist use. No relationship was found between absolute UA and overall ICD occurrence. However, lower UA/Cr was observed in patients with hypersexuality and pathological gambling, as well as in those with multiple ICD subtypes. Logistic regression confirmed that higher UA/Cr reduced the odds of hypersexuality (OR = 0.55; 95% CI 0.31–0.98) and multiple ICDs (OR = 0.33; 95% CI 0.13–0.84). As a secondary finding, lower absolute UA was observed in PwPs with more advanced motor symptoms, motor complications, depressive symptoms, and cognitive impairment. Conclusions: Lower UA/Cr was selectively associated with specific ICD subtypes and with the coexistence of multiple ICDs in patients with PD. UA/Cr may serve as a marker of ICD heterogeneity. Confirmation in larger, prospective cohorts is needed to establish clinical relevance. Full article

(This article belongs to the Special Issue Non-motor Disorders in Parkinson’s Disease and Other Parkinsonian Syndromes, 2nd Edition)

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15 pages, 2167 KB

Open AccessFeature PaperReview

Combined ACL–MCL Injuries: Anatomy, Biomechanics, and Clinical Management

by Riccardo Ghiretti, Francesco Panzavolta, Gian Andrea Lucidi and Stefano Zaffagnini

Medicina 2025, 61(10), 1788; https://doi.org/10.3390/medicina61101788 - 3 Oct 2025

Abstract

Combined injuries of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) represent the most frequent pattern of two-ligament knee injury and pose significant diagnostic and therapeutic challenges. While isolated MCL lesions typically respond well to conservative treatment, persistent medial instability in [...] Read more.

Combined injuries of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) represent the most frequent pattern of two-ligament knee injury and pose significant diagnostic and therapeutic challenges. While isolated MCL lesions typically respond well to conservative treatment, persistent medial instability in the setting of ACL-MCL injuries has been associated with increased biomechanical stress on the ACL graft and a higher risk of failure. This review synthesizes current anatomical and biomechanical knowledge of the ACL-MCL complex, exploring therapeutic strategies, ranging from non-operative protocols for selected low-grade lesions to advanced surgical reconstructions tailored to injury severity, location, and associated instability patterns. Full article

(This article belongs to the Section Orthopedics)

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16 pages, 390 KB

Open AccessArticle

Distal Upper Limb Injuries in Skiing and Snowboarding: A Two-Season Study from a High-Volume Trauma Center in the Italian Dolomites

by Michele Paolo Festini Capello, Nicola Bizzotto, Fjorela Qordja, Svea Misselwitz, Chiara Sernia, Salvatore Gioitta Iachino, Giuseppe Petralia, Valerie A. A. van Es, Pier Francesco Indelli and Christian Schaller

Medicina 2025, 61(10), 1787; https://doi.org/10.3390/medicina61101787 - 3 Oct 2025

Abstract

Background and Objectives: Distal upper limb injuries are frequent in winter sports, but their functional impact is often underestimated. This study aimed to describe the epidemiology, mechanisms, and risk factors for injuries involving the forearm, wrist, hand, and fingers sustained during two consecutive [...] Read more.

Background and Objectives: Distal upper limb injuries are frequent in winter sports, but their functional impact is often underestimated. This study aimed to describe the epidemiology, mechanisms, and risk factors for injuries involving the forearm, wrist, hand, and fingers sustained during two consecutive winter seasons in the Italian Dolomites. Materials and Methods: All adult and willing patients presenting to the Emergency Department of Brixen Hospital after ski- or snowboard-related accidents between December 2023 and March 2025 completed a standardized 23-item questionnaire on demographics, experience level, environmental factors, equipment, and trauma mechanism. For the aim of this study only distal upper limb injuries were extracted and analyzed. Statistical analyses compared fracture versus non-fracture injuries, “good” versus “bad” fractures (AO classification and surgical complexity), and isolated ulnar collateral ligament (UCL) injuries. Results: A total of 195 patients were analyzed: 96 (49.2%) sustained a fracture and 33 (16.9%) presented with isolated UCL lesions. Fractures occurred more frequently on blue slopes (56.2% vs. 33.3%, p < 0.001), whereas non-fracture injuries predominated on red and off-piste slopes. Age, BMI, and skill level did not differ significantly between groups. Surgically classified complex distal forearm fractures were significantly more frequent in females (p < 0.005) but were not associated with environmental factors. UCL injuries occurred mainly on red slopes (54.5%) and were often related to pole entrapment during falls. None of the injured patients reported the use of protective wrist or thumb supports. Conclusions: Distal upper limb injuries are a common pattern of alpine sports trauma, with wrist fractures and skier’s thumb being predominant lesions. Low-speed falls on easy slopes are associated with wrist fractures, while UCL injuries are linked to intermediate slopes. Preventive strategies should include fall technique education, protective gloves, and improved pole ergonomics. Full article

(This article belongs to the Section Orthopedics)

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15 pages, 1053 KB

Open AccessReview

Vernix Caseosa Peritonitis: A Scoping Review

by Goran Augustin, Mislav Herman, Zrinka Hrgović, Ante Krešo and Jure Krstulović

Medicina 2025, 61(10), 1786; https://doi.org/10.3390/medicina61101786 - 3 Oct 2025

Abstract

Background and Objectives: Vernix caseosa peritonitis (VCP) is rare. Nonspecific symptoms of acute abdomen during early puerperium make preoperative diagnosis of VCP challenging. We aimed to identify risk factors, early diagnosis and treatment options, and the association between the timing and severity [...] Read more.

Background and Objectives: Vernix caseosa peritonitis (VCP) is rare. Nonspecific symptoms of acute abdomen during early puerperium make preoperative diagnosis of VCP challenging. We aimed to identify risk factors, early diagnosis and treatment options, and the association between the timing and severity of VCP diagnosis and maternal outcomes. Materials and Methods: We searched PubMed, PubMed Central, and Google Scholar. Articles were analyzed according to the PRISMA guidelines. The search items included: ‘vernix caseosa peritonitis, ‘vernix caseosa granuloma, ‘maternal meconium peritonitis’, ‘maternal meconium granuloma’, ‘vernix caseosa’, ‘peritonitis’, ‘pregnancy’, ‘puerperium’, ‘postpartum’, and ‘gravid’. Additional studies were extracted by reviewing the reference lists of retrieved studies. Demographic, clinical, obstetric, diagnostic, and treatment parameters, and outcomes were collected. Results: Out of 55 published VCP case reports, 46 were available. Most involved term pregnancies (84.8%) and were delivered by Cesarean section (CS) (87%), with no difference in parity distribution (χ²(2) = 1.1875, p = 0.5523) or fetal sex (m: f = 53.3%: 46.7%). Common symptoms included abdominal pain and fever over 38 °C, while dyspnea or tachypnea was unexpectedly frequent (23.9%/15.2%). The interval from delivery to surgery ranged from 4 to 13 days (average 8 days), with no difference between CS and vaginal deliveries. Preoperative VCP was diagnosed in only 4.3% of cases, and intraoperative diagnosis occurred in 60.9%. Intraoperative microbiology and histopathology (vernix components) were positive in 6.5% and 89.1%, respectively. The birth weight was normal (3656 ± 509 g), with no maternal or neonatal deaths. Conclusions: VCP primarily develops in term pregnancies delivered by CS, without other risk factors. Despite extremely low preoperative and unexpectedly low intraoperative diagnosis and treatment delay of several days, there is no maternal or fetal mortality. The time to symptom onset is similar between women who delivered vaginally and those who had a CS. All women with VCP after vaginal delivery had previous deliveries. Abdominal pain with a fever over 38 °C and dyspnea or tachypnea in the early puerperium suggests VCP. Surgical lavage is the primary treatment, while corticosteroids have been reported to be beneficial in several cases, and antibiotics seem to have a limited role. Full article

(This article belongs to the Section Obstetrics and Gynecology)

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13 pages, 1918 KB

Open AccessArticle

Characteristics of Infective Endocarditis in Intravenous Drug Users vs. Non-Users: A Retrospective Study Conducted in Bucharest, Romania

by Adina-Alexandra Nanu, Dragos Ștefan Lazăr, Corneliu Petru Popescu, Miruna-Ioana Lazăr, Maria Nica and Simin Aysel Florescu

Medicina 2025, 61(10), 1785; https://doi.org/10.3390/medicina61101785 - 2 Oct 2025

Abstract

Background and Objectives: Infective endocarditis (IE) remains a severe infection with high morbidity and mortality, particularly among people who inject drugs (PWID). Data from Eastern Europe are limited, despite the increasing burden of intravenous drug use in the region. Materials and Methods [...] Read more.

Background and Objectives: Infective endocarditis (IE) remains a severe infection with high morbidity and mortality, particularly among people who inject drugs (PWID). Data from Eastern Europe are limited, despite the increasing burden of intravenous drug use in the region. Materials and Methods: We conducted a retrospective, observational cohort study of 153 patients diagnosed with IE and admitted to the “Dr. Victor Babeș” Clinical Hospital for Infectious and Tropical Diseases in Bucharest, Romania, between August 2019 and July 2024. Patients were classified into PWID (n = 51) and non-PWID (n = 102). Clinical characteristics, microbiological profiles, echocardiographic findings, complications, and outcomes (in-hospital, 10-week, and 12-month mortality) were compared between groups. Results: PWID were significantly younger (mean 34.0 ± 6.6 years vs. 64.3 ± 13.1 years; p < 0.001), predominantly male (86.3% vs. 62.7%; p = 0.003) and had higher rates of HIV (64.7%) and HCV (98.1%). Right-sided IE and larger vegetations were more common in PWID, whereas non-PWID had more left-sided disease, pre-existing valvular pathology, and prosthetic valve involvement. Staphylococcus aureus predominated in PWID (68.6% vs. 27.5%; p < 0.001), while non-PWID had more Streptococcus spp. and Coxiella burnetii cases. Embolic complications, particularly pulmonary emboli, and valvular rupture were significantly more frequent in PWID, while non-PWID had higher rates of heart failure and surgical interventions. In-hospital mortality was similar (17.6% vs. 11.8%; p = 0.318), but 12-month mortality was higher in PWID (27.5% vs. 13.7%; p = 0.038). Conclusions: IE in PWID shows a distinct clinical and microbiological profile, with more aggressive complications and worse long-term survival. Tailored management, early diagnosis, harm reduction programs, and dedicated follow-up are urgently needed in this high-risk population. Full article

(This article belongs to the Section Infectious Disease)

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11 pages, 702 KB

Open AccessArticle

Effect of Inspiratory Muscle Training on Diaphragm and Abdominal Wall Muscle Thickness with Fatty Liver Density in Elderly Women: A Randomized Controlled Trial

by Eda Gökçelik, Coşkun Yılmaz, Cemallettin Budak, Hakan Hüseyin Soylu, Serdar Bayrakdaroğlu, Halil İbrahim Ceylan, Raul Ioan Muntean, Hamza Küçük and Levent Ceylan

Medicina 2025, 61(10), 1784; https://doi.org/10.3390/medicina61101784 - 2 Oct 2025

Abstract

Background and Objectives: Post-menopausal estrogen decline is considered a contributing factor to sarcopenia, and inspiratory muscle training (IMT) may provide benefits in this demographic. This study examined the impact of a four-week IMT program on diaphragm thickness, abdominal wall muscle thickness (AWMT; transversus [...] Read more.

Background and Objectives: Post-menopausal estrogen decline is considered a contributing factor to sarcopenia, and inspiratory muscle training (IMT) may provide benefits in this demographic. This study examined the impact of a four-week IMT program on diaphragm thickness, abdominal wall muscle thickness (AWMT; transversus abdominis, internal oblique, and external oblique), and liver fat percentage in healthy elderly women. Materials and Methods: Twenty-six women aged 60–80 years were randomly assigned to an IMT group (n = 13) or a control group (n = 13). The IMT group used the PowerBreathe^® Classic device at 40% of maximal inspiratory pressure (MIP), with weekly increments of 10%. Training was performed twice daily, five days per week, with 30 breathing cycles per session (60 per day). The control group maintained their usual routines. AWMT, diaphragm thickness (DT), and fatty liver density (FLD) were measured by a radiologist before and after the intervention. Results: After four weeks, the IMT group showed significant improvements in all parameters compared to controls. Mid-diaphragm thickness (MDT) increased by 11.44% (effect size (ES) = 0.358, p < 0.001) versus 0.76% in controls (p = 0.271). Posterior diaphragm thickness (PDT) improved by 7.48% (ES = 0.282, p < 0.001) versus 0.38% (p = 0.564). Right AWMT increased by 12.7% (ES = 0.492, p < 0.001) compared to 0.10% (p = 0.872), and left AWMT increased by 9.93% (ES = 0.395, p < 0.001) versus 2.64% (p = 0.014). FLD improved by 11.79% (ES = 0.959, p < 0.001) in the IMT group, while the control group showed no meaningful change (−0.13%, p = 0.847). Conclusions: A short-term IMT protocol significantly enhanced diaphragm and AWMT and reduced liver fat in elderly women. These findings support the use of IMT as a simple, non-invasive intervention to preserve musculoskeletal and metabolic health in aging populations. Full article

(This article belongs to the Special Issue Physical Therapy: A New Perspective)

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13 pages, 884 KB

Open AccessArticle

Comparison of the Prognostic Performance of Various Machine Learning Models in Patients with Acute Myocardial Infarction: Results from the COREA-AMI Registry

by Ji-Hoon Jung, Kyusup Lee, Kiyuk Chang, Youngkeun Ahn, Sung-Ho Her and Sangin Lee

Medicina 2025, 61(10), 1783; https://doi.org/10.3390/medicina61101783 - 2 Oct 2025

Abstract

Background and Objectives: To date, several machine learning (ML) prognostic prediction models have been investigated for patients with acute myocardial infarction (AMI). However, few studies have compared the prognostic performance of ML techniques in AMI patients who underwent percutaneous coronary intervention (PCI). [...] Read more.

Background and Objectives: To date, several machine learning (ML) prognostic prediction models have been investigated for patients with acute myocardial infarction (AMI). However, few studies have compared the prognostic performance of ML techniques in AMI patients who underwent percutaneous coronary intervention (PCI). We sought to compare the prognostic performance among various machine learning techniques to determine which one showed the best prediction ability. Materials and Methods: Using data from the large, multicenter COREA-AMI registry, this study analyzed 10,172 patients to predict major adverse cardiac events (MACEs) at 1 and 5 years. MACE was defined as a composite of cardiac death, myocardial infarction, or cerebrovascular accident. Results: Compared with the four other ML techniques and traditional logistic regression, the random forest (RF) model consistently demonstrated the highest predictive performance. At 5 years, the RF model achieved a superior area under the curve (AUC) of 0.822, an accuracy of 0.804, and an F1 score of 0.870. To ensure clinical interpretability, a SHapley Additive exPlanations analysis was performed on the RF model. It identified key independent predictors for MACEs. The top nonmodifiable predictors included age, renal function, and left ventricular ejection fraction, whereas modifiable risk factors included dual antiplatelet therapy, statin therapy, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy, and adherence to these optimal medical therapy. Conclusions: In this real-world patient cohort, the RF model provided modest improvements in long-term risk stratification, and our findings highlight the continuing importance of guideline-directed medical therapy in determining patient prognosis. Full article

(This article belongs to the Section Cardiology)

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