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Editor’s Choice Articles

Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Editors select a small number of articles recently published in the journal that they believe will be particularly interesting to readers, or important in the respective research area. The aim is to provide a snapshot of some of the most exciting work published in the various research areas of the journal.

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14 pages, 2480 KiB  
Article
Brain Abnormalities in Schizophrenia: A Comparative Imagistic Study
by Paula Simina Petric, Petru Ifteni, Ana Aliana Miron, Gabriela Sechel and Andreea Teodorescu
Medicina 2024, 60(4), 564; https://doi.org/10.3390/medicina60040564 - 29 Mar 2024
Cited by 4 | Viewed by 4715
Abstract
Background and Objectives: Neuroimaging reveals a link between psychiatric conditions and brain structural–functional changes, prompting a paradigm shift in viewing schizophrenia as a neurodevelopmental disorder. This study aims to identify and compare structural brain changes found during the first schizophrenia episode with [...] Read more.
Background and Objectives: Neuroimaging reveals a link between psychiatric conditions and brain structural–functional changes, prompting a paradigm shift in viewing schizophrenia as a neurodevelopmental disorder. This study aims to identify and compare structural brain changes found during the first schizophrenia episode with those found after more than 5 years of illness. Materials and Methods: This prospective study involved 149 participants enrolled between 1 January 2019 and 31 December 2021. The participants were categorized into three groups: the first comprises 51 individuals with an initial psychotic episode, the second consists of 49 patients diagnosed with schizophrenia for over 5 years, and a control group comprising 50 individuals without a diagnosis of schizophrenia or any other psychotic disorder. All participants underwent brain CT examinations. Results: The study examined all three groups: first-episode schizophrenia (FES), schizophrenia (SCZ), and the control group. The FES group had a mean age of 26.35 years and a mean duration of illness of 1.2 years. The SCZ group, with a mean age of 40.08 years, had been diagnosed with schizophrenia for an average of 15.12 years. The control group, with a mean age of 34.60 years, had no schizophrenia diagnosis. Structural measurements revealed widening of frontal horns and lateral ventricles in the SCZ group compared to FES and the FES group compared to the control group. Differences in the dimensions of the third ventricle were noted between SCZ and FES, while no distinction was observed between FES and the control group. The fourth ventricle had similar measurements in FES and SCZ groups, both exceeding those of the control group. Our results showed higher densities in the frontal lobe in schizophrenia patients compared to FES and the control group, with the control group consistently displaying the lowest densities. Conclusions: In summary, our comparative imaging analysis of schizophrenia patients, first-episode schizophrenia, and control patients revealed distinct ventricular patterns, with SCZ showing greater widening than FES and FES wider than the control group. Frontal lobe density, assessed via cerebral CT scans, indicated a higher density in the SCZ group in both anterior and posterior cortex portions compared to FES and the control group, while the left posterior cortex in FES had the highest density. These findings highlight unique neuroanatomical features across groups, shedding light on structural differences associated with different stages of schizophrenia. Full article
(This article belongs to the Section Psychiatry)
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12 pages, 627 KiB  
Review
Current Status of Anti-Reflux Surgery as a Treatment for GERD
by Jooyeon Lee, Inhyeok Lee, Youjin Oh, Jeong Woo Kim, Yeongkeun Kwon, Ahmad Alromi, Mohannad Eledreesi, Alkadam Khalid, Wafa Aljarbou and Sungsoo Park
Medicina 2024, 60(3), 518; https://doi.org/10.3390/medicina60030518 - 21 Mar 2024
Cited by 6 | Viewed by 6166
Abstract
Anti-reflux surgery (ARS) is an efficient treatment option for gastroesophageal reflux disease (GERD). Despite growing evidence of the efficacy and safety of ARS, medications including proton pump inhibitors (PPIs) remain the most commonly administered treatments for GERD. Meanwhile, ARS can be an effective [...] Read more.
Anti-reflux surgery (ARS) is an efficient treatment option for gastroesophageal reflux disease (GERD). Despite growing evidence of the efficacy and safety of ARS, medications including proton pump inhibitors (PPIs) remain the most commonly administered treatments for GERD. Meanwhile, ARS can be an effective treatment option for patients who need medications continuously or for those who are refractory to PPI treatment, if proper candidates are selected. However, in practice, ARS is often regarded as a last resort for patients who are unresponsive to PPIs. Accumulating ARS-related studies indicate that surgery is equivalent to or better than medical treatment for controlling typical and atypical GERD symptoms. Furthermore, because of overall reduced medication expenses, ARS may be more cost-effective than PPI. Patients are selected for ARS based on endoscopic findings, esophageal acid exposure time, and PPI responsiveness. Although there is limited evidence, ARS may be expanded to include patients with normal acid exposure, such as those with reflux hypersensitivity. Additionally, other factors such as age, body mass index, and comorbidities are known to affect ARS outcomes; and such factors should be considered. Nissen fundoplication or partial fundoplication including Dor fundoplication and Toupet fundoplication can be chosen, depending on whether the patient prioritizes symptom improvement or minimizing postoperative symptoms such as dysphagia. Furthermore, efforts to reduce and manage postoperative complications and create awareness of the long-term efficacy and safety of the ARS are recommended, as well as adequate training programs for new surgeons. Full article
(This article belongs to the Section Surgery)
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17 pages, 5386 KiB  
Review
Sacral Neuromodulation: Device Improvement and Current Applications in Urology
by Marco Spilotros, Salvatore Gerbasi, Francesco Lasorsa, Gaetano de Rienzo, Lorenzo Balducci, Pasquale Ditonno and Giuseppe Lucarelli
Medicina 2024, 60(3), 509; https://doi.org/10.3390/medicina60030509 - 20 Mar 2024
Cited by 9 | Viewed by 6003
Abstract
Sacral neuromodulation (SNM) offers a therapeutic approach to urological patients suffering from idiopathic overactive bladder (OAB) syndrome, with or without incontinence and non-obstructive urinary retention (NOR), who are not responding to or are not compliant with conservative or medical therapies. The exact mechanism [...] Read more.
Sacral neuromodulation (SNM) offers a therapeutic approach to urological patients suffering from idiopathic overactive bladder (OAB) syndrome, with or without incontinence and non-obstructive urinary retention (NOR), who are not responding to or are not compliant with conservative or medical therapies. The exact mechanism of action of SNM is not fully understood but modulation of the spinal cord reflexes and brain networks by peripheral afferents is regarded as the main pathway. Over the years, surgical techniques improved, leading to the development of the modern two-stage implantation technique. The quadripolar lead is positioned percutaneously under fluoroscopy guidance through the third sacral foramen following the trajectory of S3. The procedure can be performed under local or general anesthesia with the patient in prone position. Current applications of sacral neuromodulation in urology are increasing thanks to the recent improvements of the devices that make this a valuable option not only in conditions such as overactive bladder and non-obstructing urinary retention but also neurogenic lower urinary tract dysfunction. Full article
(This article belongs to the Special Issue New Advances in Urology and Nephrology Disease: From Diagnosis to Treatment)
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13 pages, 368 KiB  
Article
Exposure to Environmental Pesticides and the Risk of Autism Spectrum Disorders: A Population-Based Case-Control Study
by Pablo Román, Cristofer Ruiz-González, Lola Rueda-Ruzafa, Diana Cardona, Mar Requena and Raquel Alarcón
Medicina 2024, 60(3), 479; https://doi.org/10.3390/medicina60030479 - 14 Mar 2024
Cited by 9 | Viewed by 4280
Abstract
Background and Objectives: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by challenges in communication, social interactions, and repetitive behaviors. Although the factors that influence the development of this condition are unknown, certain chemical compounds such as pesticides have been proposed as [...] Read more.
Background and Objectives: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by challenges in communication, social interactions, and repetitive behaviors. Although the factors that influence the development of this condition are unknown, certain chemical compounds such as pesticides have been proposed as possible contributors. Due to the lack of an established causal link between pesticide exposure and ASD, this study aimed to evaluate this potential association. Materials and Methods: A case-control study was carried out to ascertain the prevalence and risk associated with ASD in relation to pesticide exposure over a 21-year study period (2000–2021). Results: We included 2821 individuals diagnosed with ASD residing in areas of both high and low pesticide exposure in southern Spain. There was a rise in the ASD prevalence rate in regions with elevated pesticide use when compared to regions with low use [odds ratio (OR): 1.34, 95% confidence interval (CI), (1.24–1.44)]. Notably, men had the highest likelihood, with an OR: 1.42, 95% CI, (1.30–1.55). Furthermore, after performing multiple binary logistic regression adjusted for age, sex, and geographical area, males exhibited a higher likelihood compared to females [OR: 2.41, 95% CI, (2.21–2.62)]. Conclusions: Overall, this research suggests a connection between heightened environmental pesticide exposure due to increased agricultural use and autism. Full article
(This article belongs to the Section Neurology)
12 pages, 2006 KiB  
Systematic Review
The Association between Red Blood Cell Distribution Width and Mortality Risk after Hip Fracture: A Meta-Analysis
by Bao Tu Thai Nguyen, Duy Nguyen Anh Tran, Tan Thanh Nguyen, Yi-Jie Kuo and Yu-Pin Chen
Medicina 2024, 60(3), 485; https://doi.org/10.3390/medicina60030485 - 14 Mar 2024
Cited by 8 | Viewed by 2991
Abstract
Background and Objectives: Hip fractures in the elderly pose a considerable health risk and cause concern. Red blood cell distribution width (RDW) is a valuable marker for identifying patients at high risk of age-related mortality and various disorders and diseases. However, its [...] Read more.
Background and Objectives: Hip fractures in the elderly pose a considerable health risk and cause concern. Red blood cell distribution width (RDW) is a valuable marker for identifying patients at high risk of age-related mortality and various disorders and diseases. However, its association with poor patient outcomes following hip fractures has yet to be fully established. Hence, the purpose of this meta-analysis was to investigate and gain a better understanding of the relationship between RDW levels and the risk of mortality after hip fractures. Materials and Methods: PubMed, Embase, Web of Science, and other databases were comprehensively searched until April 2023 to identify relevant studies. The meta-analysis included observational studies finding the association between RDW at admission or preoperation and short-term and long-term mortality rates following hip fractures. The results were presented in terms of odds ratios (ORs) or hazard ratios (HRs) with corresponding 95% confidence intervals (CIs). Results: This meta-analysis included 10 studies involving 5834 patients with hip fractures. Patients with preoperative RDW of over 14.5% had higher risks of 1-year (OR: 5.40, 95% CI: 1.89–15.48, p = 0.002) and 3-month (OR: 2.91, 95% CI: 1.42–5.95, p = 0.004) mortality. Higher admission or preoperative RDW was significantly associated with an 11% higher mortality risk after 1 year (HR: 1.11, 95% CI: 1.06–1.17, p < 0.00001). Patients with higher preoperative RDW had a significantly higher risk of 6-month mortality, which was three times that of those with lower preoperative RDW (OR: 3.00, 95% CI: 1.60–5.61, p = 0.0006). Higher preoperative RDW was correlated to a higher 30-day mortality risk (OR: 6.44, 95% CI: 3.32–12.47, p < 0.00001). Conclusions: Greater RDW values at admission or before surgery were associated with a higher risk of short-term and long-term mortality following hip fractures. Because RDW can be easily measured using a routine blood test at a low cost, this parameter is promising as an indicator of mortality in elderly patients with hip fractures. Full article
(This article belongs to the Special Issue Current Updates and Future Perspectives on Orthopedic Trauma, Fracture Management and Rehabilitation)
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15 pages, 3665 KiB  
Review
Integrating Retrieval-Augmented Generation with Large Language Models in Nephrology: Advancing Practical Applications
by Jing Miao, Charat Thongprayoon, Supawadee Suppadungsuk, Oscar A. Garcia Valencia and Wisit Cheungpasitporn
Medicina 2024, 60(3), 445; https://doi.org/10.3390/medicina60030445 - 8 Mar 2024
Cited by 62 | Viewed by 12999
Abstract
The integration of large language models (LLMs) into healthcare, particularly in nephrology, represents a significant advancement in applying advanced technology to patient care, medical research, and education. These advanced models have progressed from simple text processors to tools capable of deep language understanding, [...] Read more.
The integration of large language models (LLMs) into healthcare, particularly in nephrology, represents a significant advancement in applying advanced technology to patient care, medical research, and education. These advanced models have progressed from simple text processors to tools capable of deep language understanding, offering innovative ways to handle health-related data, thus improving medical practice efficiency and effectiveness. A significant challenge in medical applications of LLMs is their imperfect accuracy and/or tendency to produce hallucinations—outputs that are factually incorrect or irrelevant. This issue is particularly critical in healthcare, where precision is essential, as inaccuracies can undermine the reliability of these models in crucial decision-making processes. To overcome these challenges, various strategies have been developed. One such strategy is prompt engineering, like the chain-of-thought approach, which directs LLMs towards more accurate responses by breaking down the problem into intermediate steps or reasoning sequences. Another one is the retrieval-augmented generation (RAG) strategy, which helps address hallucinations by integrating external data, enhancing output accuracy and relevance. Hence, RAG is favored for tasks requiring up-to-date, comprehensive information, such as in clinical decision making or educational applications. In this article, we showcase the creation of a specialized ChatGPT model integrated with a RAG system, tailored to align with the KDIGO 2023 guidelines for chronic kidney disease. This example demonstrates its potential in providing specialized, accurate medical advice, marking a step towards more reliable and efficient nephrology practices. Full article
(This article belongs to the Section Urology & Nephrology)
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19 pages, 2227 KiB  
Review
Hepatic Hemangioma: Review of Imaging and Therapeutic Strategies
by Arkadiusz Kacała, Mateusz Dorochowicz, Iwona Matus, Michał Puła, Adrian Korbecki, Michał Sobański, Jagoda Jacków-Nowicka, Dariusz Patrzałek, Dariusz Janczak and Maciej Guziński
Medicina 2024, 60(3), 449; https://doi.org/10.3390/medicina60030449 - 8 Mar 2024
Cited by 11 | Viewed by 11678
Abstract
Hepatic hemangiomas are the most common benign liver tumors. Typically, small- to medium-sized hemangiomas are asymptomatic and discovered incidentally through the widespread use of imaging techniques. Giant hemangiomas (>5 cm) have a higher risk of complications. A variety of imaging methods are used [...] Read more.
Hepatic hemangiomas are the most common benign liver tumors. Typically, small- to medium-sized hemangiomas are asymptomatic and discovered incidentally through the widespread use of imaging techniques. Giant hemangiomas (>5 cm) have a higher risk of complications. A variety of imaging methods are used for diagnosis. Cavernous hemangioma is the most frequent type, but radiologists must be aware of other varieties. Conservative management is often adequate, but some cases necessitate targeted interventions. Although surgery was traditionally the main treatment, the evolution of minimally invasive procedures now often recommends transarterial chemoembolization as the treatment of choice. Full article
(This article belongs to the Special Issue Editorial Board Members’ Collection Series: Gastrointestinal and Hepatic Diseases)
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18 pages, 15766 KiB  
Review
Infraocclusion in the Primary and Permanent Dentition—A Narrative Review
by Paulina Adamska, Hanna Sobczak-Zagalska, Marcin Stasiak, Łukasz Jan Adamski, Dorota Pylińska-Dąbrowska, Sandra Barkowska, Adam Zedler and Michał Studniarek
Medicina 2024, 60(3), 423; https://doi.org/10.3390/medicina60030423 - 1 Mar 2024
Cited by 7 | Viewed by 5174
Abstract
The gradual movement of a tooth away from the occlusal plane is called infraocclusion or reinclusion. Reincluded teeth are most often deciduous molars, and permanent teeth are less frequently affected. Depending on the level of the infraocclusion, the severity of the disorder is [...] Read more.
The gradual movement of a tooth away from the occlusal plane is called infraocclusion or reinclusion. Reincluded teeth are most often deciduous molars, and permanent teeth are less frequently affected. Depending on the level of the infraocclusion, the severity of the disorder is classified as mild, moderate, or severe. The etiology of the phenomenon is not fully known. Tooth submerging can lead to serious complications, such as abnormal position of adjacent teeth, displacement of the bud of the permanent successor, shortening of the dental arch, or developmental disturbances of alveolar process. Early diagnosis of the tooth infraocclusion and regular monitoring of its progression help to avoid serious permanent sequelae. The treatment of reinclusion often involves only observation. However, in some cases, the therapeutic procedure requires interdisciplinary treatment by specialists from various fields of dentistry. This study presents current methods of diagnosis and treatment of patients with submerged teeth. Full article
(This article belongs to the Special Issue Medicine and Dentistry: New Methods and Clinical Approaches)
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21 pages, 1974 KiB  
Review
Vitamin D Deficiency, Chronic Kidney Disease and Periodontitis
by Imaan Ganimusa, Emily Chew and Emily Ming-Chieh Lu
Medicina 2024, 60(3), 420; https://doi.org/10.3390/medicina60030420 - 29 Feb 2024
Cited by 13 | Viewed by 9971
Abstract
Vitamin D has important anti-inflammatory, anti-microbial properties and plays a central role in the host immune response. Due to the crucial role of the kidneys in the metabolism of vitamin D, patients with chronic kidney disease (CKD) are prone to vitamin D deficiency. [...] Read more.
Vitamin D has important anti-inflammatory, anti-microbial properties and plays a central role in the host immune response. Due to the crucial role of the kidneys in the metabolism of vitamin D, patients with chronic kidney disease (CKD) are prone to vitamin D deficiency. The resultant reduction in the production of calcitriol, the activated form of vitamin D, in patients with CKD is responsible for exacerbating the existing renal impairment and periodontal inflammation. Recent evidence suggests a bidirectional, causal relationship between periodontitis and renal functional status. Both conditions have shared pathophysiological mechanisms including oxidative stress, increases in the systemic inflammatory burden and impaired host response. This review explores the association between vitamin D, CKD and periodontitis. The review summarises the current evidence base for the classical and non-classical vitamin D metabolic pathways, the biological mechanisms linking vitamin D deficiency, CKD and periodontitis, as well as the bidirectional relationship between the two chronic inflammatory conditions. Finally, the paper explores the impact of vitamin D deficiency on CKD, periodontitis, and related co-morbidities. Full article
(This article belongs to the Special Issue Vitamin D Deficiency in the Etiology and Progression of Noncommunicable Diseases)
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21 pages, 934 KiB  
Review
Evolution of Liver Transplantation Indications: Expanding Horizons
by Sara Battistella, Marco Grasso, Elisa Catanzaro, Francesca D’Arcangelo, Giorgia Corrà, Giacomo Germani, Marco Senzolo, Alberto Zanetto, Alberto Ferrarese, Martina Gambato, Patrizia Burra and Francesco Paolo Russo
Medicina 2024, 60(3), 412; https://doi.org/10.3390/medicina60030412 - 28 Feb 2024
Cited by 8 | Viewed by 5244
Abstract
Liver transplantation (LT) has significantly transformed the prognosis of patients with end-stage liver disease and hepatocellular carcinoma (HCC). The traditional epidemiology of liver diseases has undergone a remarkable shift in indications for LT, marked by a decline in viral hepatitis and an increase [...] Read more.
Liver transplantation (LT) has significantly transformed the prognosis of patients with end-stage liver disease and hepatocellular carcinoma (HCC). The traditional epidemiology of liver diseases has undergone a remarkable shift in indications for LT, marked by a decline in viral hepatitis and an increase in metabolic dysfunction-associated steatotic liver disease (MASLD), along with expanded indications for HCC. Recent advancements in surgical techniques, organ preservation and post-transplant patients’ management have opened new possibilities for LT. Conditions that were historically considered absolute contraindications have emerged as potential new indications, demonstrating promising results in terms of patient survival. While these expanding indications provide newfound hope, the ethical dilemma of organ scarcity persists. Addressing this requires careful consideration and international collaboration to ensure equitable access to LT. Multidisciplinary approaches and ongoing research efforts are crucial to navigate the evolving landscape of LT. This review aims to offer a current overview of the primary emerging indications for LT, focusing on acute-on-chronic liver failure (ACLF), acute alcoholic hepatitis (AH), intrahepatic and perihilar cholangiocarcinoma (i- and p-CCA), colorectal liver metastasis (CRLM), and neuroendocrine tumor (NET) liver metastases. Full article
(This article belongs to the Section Gastroenterology & Hepatology)
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16 pages, 1413 KiB  
Article
A Chronic Obstructive Pulmonary Disease Self-Management Intervention for Improving Patient-Reported Outcomes in Primary Care in Greece
by Filothei Tsaousi, Izolde Bouloukaki, Antonios Christodoulakis, Despo Ierodiakonou, Nikos Tzanakis and Ioanna Tsiligianni
Medicina 2024, 60(3), 377; https://doi.org/10.3390/medicina60030377 - 23 Feb 2024
Cited by 4 | Viewed by 4156
Abstract
Background and Objectives: Self-management programs are essential for increasing COPD patient participation and autonomy in making appropriate decisions about their chronic condition. The present study aimed to assess the impact of COPD self-management interventions on quality of life, functional status, patient education, [...] Read more.
Background and Objectives: Self-management programs are essential for increasing COPD patient participation and autonomy in making appropriate decisions about their chronic condition. The present study aimed to assess the impact of COPD self-management interventions on quality of life, functional status, patient education, depression, and anxiety in primary care. Materials and Methods: We conducted a randomized controlled trial recruiting patients with COPD (GOLD A and B) from four primary care centers in Crete, Greece, with one intervention group (n = 40) receiving self-management educational support and one control group (n = 80) receiving usual care. To measure quality of life, functional status, patient education, depression, and anxiety, we used patient-reported outcome measures (PROMs) at baseline and 6 months post-intervention, including the Short-Form Health survey (SF-12), Clinical COPD Questionnaire (CCQ), mMRC, Beck Anxiety Inventory (BAI), Beck Depression Inventory, Health Education Impact Questionnaire (HeiQ), and Health Literacy Questionnaire (HLQ). Results: At the end of the 6-month intervention, most PROMs improved significantly in the intervention group (p < 0.05) but did not show significant changes in the control group. The greatest improvements at follow-up compared to baseline measurements were observed for dyspnea (mMRC—38.6%), anxiety (BAI—35%), depression (BDI—20.2%), COPD health status (CCQ—34.1%), and the actively managing my health subscale of HLQ (23.5%). Conclusions: Our results suggest that a self-management intervention could be an effective strategy for improving PROMs in primary care. Although more research is needed to identify the long-term effects of such interventional programs, policymakers could implement similar programs to improve the overall health of these patients. Full article
(This article belongs to the Section Pulmonology)
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14 pages, 963 KiB  
Review
Psoriasis: What Is New in Markers of Disease Severity?
by Mircea Tampa, Madalina Irina Mitran, Cristina Iulia Mitran, Clara Matei and Simona Roxana Georgescu
Medicina 2024, 60(2), 337; https://doi.org/10.3390/medicina60020337 - 18 Feb 2024
Cited by 7 | Viewed by 5046
Abstract
Introduction. Psoriasis is a chronic inflammatory skin disease and is the result of the interaction between numerous external and internal factors. Psoriasis presents a wide range of skin manifestations encompassing individual lesions varying from pinpoint to large plaques that can evolve into [...] Read more.
Introduction. Psoriasis is a chronic inflammatory skin disease and is the result of the interaction between numerous external and internal factors. Psoriasis presents a wide range of skin manifestations encompassing individual lesions varying from pinpoint to large plaques that can evolve into generalised forms. The lesions mirror the pathophysiological mechanisms involved in psoriasis pathogenesis, such as inflammation, dysregulation of immune response, uncontrolled proliferation of keratinocytes and angiogenesis. In this article, we present the latest advances achieved regarding markers that correlate with psoriasis severity. Material and method. We have performed a narrative review on markers of psoriasis severity, including articles published between March 2018–March 2023. Results. We have identified four categories of markers: inflammation markers, oxidative stress markers, hormonal markers and cancer-related markers. The main focus was on inflammation biomarkers, including immunomodulatory molecules, haematological parameters, inflammatory cells and costimulatory molecules. Conclusions. The analysed data indicate that markers associated with inflammation, oxidative stress and hormones, and cancer-related markers could be useful in assessing the severity of psoriasis. Nevertheless, additional research is required to ascertain the practical importance of these biomarkers in clinical settings. Full article
(This article belongs to the Special Issue Chronic Inflammatory Skin Disease: Where We Are and Where We Are Going)
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17 pages, 6983 KiB  
Review
Endoscopic Ultrasound-Guided Drainage of Pancreatic Fluid Collections: Not All Queries Are Already Solved
by Cecilia Binda, Stefano Fabbri, Barbara Perini, Martina Boschetti, Chiara Coluccio, Paolo Giuffrida, Giulia Gibiino, Chiara Petraroli and Carlo Fabbri
Medicina 2024, 60(2), 333; https://doi.org/10.3390/medicina60020333 - 16 Feb 2024
Cited by 5 | Viewed by 4263
Abstract
Pancreatic fluid collections (PFCs) are well-known complications of acute pancreatitis. The overinfection of these collections leads to a worsening of the prognosis with an increase in the morbidity and mortality rate. The primary strategy for managing infected pancreatic necrosis (IPN) or symptomatic PFCs [...] Read more.
Pancreatic fluid collections (PFCs) are well-known complications of acute pancreatitis. The overinfection of these collections leads to a worsening of the prognosis with an increase in the morbidity and mortality rate. The primary strategy for managing infected pancreatic necrosis (IPN) or symptomatic PFCs is a minimally invasive step-up approach, with endosonography-guided (EUS-guided) transmural drainage and debridement as the preferred and less invasive method. Different stents are available to drain PFCs: self-expandable metal stents (SEMSs), double pigtail stents (DPPSs), or lumen-apposing metal stents (LAMSs). In particular, LAMSs are useful when direct endoscopic necrosectomy is needed, as they allow easy access to the necrotic cavity; however, the rate of adverse events is not negligible, and to date, the superiority over DPPSs is still debated. Moreover, the timing for necrosectomy, the drainage technique, and the concurrent medical management are still debated. In this review, we focus attention on indications, timing, techniques, complications, and particularly on aspects that remain under debate concerning the EUS-guided drainage of PFCs. Full article
(This article belongs to the Special Issue Latest Advances in Pancreatobiliary Endoscopy)
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26 pages, 2577 KiB  
Systematic Review
Virtual, Augmented, and Mixed Reality Applications for Surgical Rehearsal, Operative Execution, and Patient Education in Spine Surgery: A Scoping Review
by Tim Bui, Miguel A. Ruiz-Cardozo, Harsh S. Dave, Karma Barot, Michael Ryan Kann, Karan Joseph, Sofia Lopez-Alviar, Gabriel Trevino, Samuel Brehm, Alexander T. Yahanda and Camilo A Molina
Medicina 2024, 60(2), 332; https://doi.org/10.3390/medicina60020332 - 15 Feb 2024
Cited by 20 | Viewed by 6988
Abstract
Background and Objectives: Advances in virtual reality (VR), augmented reality (AR), and mixed reality (MR) technologies have resulted in their increased application across many medical specialties. VR’s main application has been for teaching and preparatory roles, while AR has been mostly used [...] Read more.
Background and Objectives: Advances in virtual reality (VR), augmented reality (AR), and mixed reality (MR) technologies have resulted in their increased application across many medical specialties. VR’s main application has been for teaching and preparatory roles, while AR has been mostly used as a surgical adjunct. The objective of this study is to discuss the various applications and prospects for VR, AR, and MR specifically as they relate to spine surgery. Materials and Methods: A systematic review was conducted to examine the current applications of VR, AR, and MR with a focus on spine surgery. A literature search of two electronic databases (PubMed and Scopus) was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The study quality was assessed using the MERSQI score for educational research studies, QUACS for cadaveric studies, and the JBI critical appraisal tools for clinical studies. Results: A total of 228 articles were identified in the primary literature review. Following title/abstract screening and full-text review, 46 articles were included in the review. These articles comprised nine studies performed in artificial models, nine cadaveric studies, four clinical case studies, nineteen clinical case series, one clinical case–control study, and four clinical parallel control studies. Teaching applications utilizing holographic overlays are the most intensively studied aspect of AR/VR; the most simulated surgical procedure is pedicle screw placement. Conclusions: VR provides a reproducible and robust medium for surgical training through surgical simulations and for patient education through various platforms. Existing AR/MR platforms enhance the accuracy and precision of spine surgeries and show promise as a surgical adjunct. Full article
(This article belongs to the Special Issue Clinical Application of Augmented Reality (AR) in Neurosurgery)
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23 pages, 479 KiB  
Review
Sports Diet and Oral Health in Athletes: A Comprehensive Review
by Antina Schulze and Martin Busse
Medicina 2024, 60(2), 319; https://doi.org/10.3390/medicina60020319 - 13 Feb 2024
Cited by 15 | Viewed by 7923
Abstract
Food and fluid supply is fundamental for optimal athletic performance but can also be a risk factor for caries, dental erosion, and periodontal diseases, which in turn can impair athletic performance. Many studies have reported a high prevalence of oral diseases in elite [...] Read more.
Food and fluid supply is fundamental for optimal athletic performance but can also be a risk factor for caries, dental erosion, and periodontal diseases, which in turn can impair athletic performance. Many studies have reported a high prevalence of oral diseases in elite athletes, notably dental caries 20–84%, dental erosion 42–59%, gingivitis 58–77%, and periodontal disease 15–41%, caused by frequent consumption of sugars/carbohydrates, polyunsaturated fats, or deficient protein intake. There are three possible major reasons for poor oral health in athletes which are addressed in this review: oxidative stress, sports diet, and oral hygiene. This update particularly summarizes potential sports nutritional effects on athletes’ dental health. Overall, sports diet appropriately applied to deliver benefits for performance associated with oral hygiene requirements is necessary to ensure athletes’ health. The overall aim is to help athletes, dentists, and nutritionists understand the tangled connections between sports diet, oral health, and oral healthcare to develop mitigation strategies to reduce the risk of dental diseases due to nutrition. Full article
(This article belongs to the Section Dentistry and Oral Health)
12 pages, 302 KiB  
Article
Quality of Life of Women with Polycystic Ovary Syndrome
by Natalia Ligocka, Karolina Chmaj-Wierzchowska, Katarzyna Wszołek, Maciej Wilczak and Katarzyna Tomczyk
Medicina 2024, 60(2), 294; https://doi.org/10.3390/medicina60020294 - 9 Feb 2024
Cited by 8 | Viewed by 8540
Abstract
Background and Objectives: Polycystic ovary syndrome (PCOS) is an endocrine disorder characterized by multiple hormonal and metabolic abnormalities, including insulin resistance, hyperandrogenism, and disturbances in lipid and carbohydrate metabolism. The objective of this study is to assess the quality of life of [...] Read more.
Background and Objectives: Polycystic ovary syndrome (PCOS) is an endocrine disorder characterized by multiple hormonal and metabolic abnormalities, including insulin resistance, hyperandrogenism, and disturbances in lipid and carbohydrate metabolism. The objective of this study is to assess the quality of life of women diagnosed with polycystic ovary syndrome (PCOS) and to identify any factors within the study group that may impact the scores related to quality of life. Materials and Methods: This research was carried out among women diagnosed with PCOS. An original questionnaire, developed through an online Google Forms survey, was utilized as the research instrument and distributed through social networks and support groups to women facing PCOS. This study encompassed a participant pool of 200 women with PCOS, aged 24 years or older. For the analytical component, Pearson’s χ2 test was employed—a nonparametric test designed to assess the relationship between two variables measured on a qualitative scale. The chosen level of statistical significance was set at p < 0.05. Results: The analysis revealed that the quality of life of the women under study was not linked to the duration of the disease or comorbidities. However, a significant association was observed with the inconvenience caused by PCOS symptoms. Women experiencing very bothersome symptoms of PCOS reported a lower quality of life compared to those with symptoms rated as not very bothersome. Despite the majority of women with PCOS rating their quality of life as good or very good, they often find the associated symptoms of PCOS bothersome. Women reporting lower quality of life tend to acknowledge the impact of PCOS on their lives, experience a sense of lack of control over the disease, struggle with depression, and do not accept their physical appearance. Conclusions: Hence, the support from specialists like endocrinologists, gynecologists, and nutritionists becomes crucial for many women dealing with PCOS. Adopting a healthy lifestyle, incorporating a balanced diet, and engaging in regular physical activity can assist in managing the troublesome symptoms of PCOS, thereby enhancing overall quality of life. In instances of emotional difficulties, seeking psychological support is equally important, and the significance of support and acceptance from loved ones should not be overlooked. Full article
(This article belongs to the Section Epidemiology & Public Health)
16 pages, 602 KiB  
Review
A Narrative Review of Self-Reported Scales to Evaluate Depression and Anxiety Symptoms in Adult Obstructive Sleep Apnea Patients
by Diana Raluca Velescu, Monica Steluta Marc, Daniel Traila, Camelia Corina Pescaru, Patricia Hogea, Noemi Suppini, Alexandru Florian Crisan, Norbert Wellmann and Cristian Oancea
Medicina 2024, 60(2), 261; https://doi.org/10.3390/medicina60020261 - 2 Feb 2024
Cited by 7 | Viewed by 4341
Abstract
Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent chronic condition that has been associated with mental disorders like depression and anxiety. This study intends to provide a practical overview of the most relevant self-reported and self-rating scales that assess depression [...] Read more.
Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent chronic condition that has been associated with mental disorders like depression and anxiety. This study intends to provide a practical overview of the most relevant self-reported and self-rating scales that assess depression and anxiety in OSA patients. Materials and Methods: A search for articles was performed using PubMed, Google Scholar, and Semantic Scholar using a combination of words for obstructive sleep apnea, depression, anxiety, and scales. The tools were ordered by type (screening and rating) and arranged chronologically according to the year of publication. Results: Three scales were identified for assessing depression, which were the Center for Epidemiologic Studies Depression Scale (CES-D), the Hospital Anxiety and Depression Scale (HADS-D), and the Patient Health Questionnaire-9 (PHQ-9). For rating depression, two scales were discussed: the Zung Self-Rating Depression Scale (SDS) and the Beck Depression Inventory (BDI), which has three versions (the BDI, the BDI-II, and the Fast Screen (BDI-FS)). For assessing anxiety, the Generalized Anxiety Disorder-7 (GAD-7) scale was identified. Two scales were reviewed for rating anxiety: the State-Trait Anxiety Inventory (STAI) and the Beck Anxiety Inventory (BAI). Each scale is accompanied by a brief description of its practicality and psychometric qualities and an analysis of its strengths and limitations. Conclusions: The findings of this review will contribute to the understanding of the importance of assessing mental health comorbidities in the context of OSA, ultimately guiding clinical practice and future research in this area. Full article
(This article belongs to the Section Psychiatry)
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12 pages, 1318 KiB  
Article
Next-Generation Sequencing in Lung Cancers—A Single-Center Experience in Taiwan
by Wei-An Lai, Yen-Shuo Huang, Kung-Chao Chang, Sheau-Fang Yang, Chih-Jen Yang, Yu-Wei Liu and Huan-Da Chen
Medicina 2024, 60(2), 236; https://doi.org/10.3390/medicina60020236 - 29 Jan 2024
Cited by 5 | Viewed by 4049
Abstract
Background and Objectives: Lung cancer is a leading cause of cancer mortality in Taiwan. With rapid advancement of targeted therapeutics in non-small cell lung cancers, next-generation sequencing (NGS) is becoming an important tool for biomarker testing. In this study, we describe institutional [...] Read more.
Background and Objectives: Lung cancer is a leading cause of cancer mortality in Taiwan. With rapid advancement of targeted therapeutics in non-small cell lung cancers, next-generation sequencing (NGS) is becoming an important tool for biomarker testing. In this study, we describe institutional experience of NGS analysis in non-small cell carcinoma (NSCLC). Materials and Methods: A cohort of 73 cases was identified from the institutional pathology archive in the period between November 2020 and December 2022. Results: Adenocarcinoma was the most common histologic type (91.8%). Most patients presented with stage IIIB and beyond (87.7%). Twenty-nine patients (39.7%) were evaluated at the time of initial diagnosis, while the others had received prior chemotherapy or targeted therapy. The most frequently mutated gene was EGFR (63%), and this was followed by TP53 (50.7%), KRAS (13.7%), RB1 (13.7%), and CDKN2A (13.7%). Clinically actionable mutations associated with a guideline-suggested targeted therapy were identified in 55 cases (75.3%) overall, and in 47.1% of cases excluding EGFR TKI-sensitizing mutation. Biomarkers other than EGFR TKI-sensitizing mutations were compared. Cases without TKI-sensitizing EGFR mutation had more level 1 or 2 biomarkers (excluding EGFR TKI-sensitizing mutations) than cases with TKI-sensitizing EGFR mutations (47.1% versus 20.1%, p = 0.016). Progressive disease was associated with co-occurrence of clinically actionable mutations (20.5% versus 0%, p < 0.05). Eight of the nine cases with co-occurring actionable genetic alternations had an EGFR mutation. After an NGS test, 46.1% of actionable or potentially actionable genetic alternations led to patients receiving a matched therapy. Conclusions: Our study demonstrated that NGS analysis identifies therapeutic targets and may guide treatment strategies in NSCLC. NGS tests may be advantageous over multiple single-gene tests for optimization of treatment plans, especially for those with non-EGFR mutations or those with progressive disease. Full article
(This article belongs to the Section Pulmonology)
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17 pages, 897 KiB  
Article
From Anxiety to Hardiness: The Role of Self-Efficacy in Spanish CCU Nurses in the COVID-19 Pandemic
by Fernanda Gil-Almagro, Fernando José García-Hedrera, Francisco Javier Carmona-Monge and Cecilia Peñacoba-Puente
Medicina 2024, 60(2), 215; https://doi.org/10.3390/medicina60020215 - 26 Jan 2024
Cited by 5 | Viewed by 2363
Abstract
Background and Objectives: Evidence shows that throughout the COVID-19 pandemic, nurses suffered from emotional symptoms, yet in spite of this, few studies within “positive psychology” have analyzed the emergence/promotion of positive traits, such as hardiness. In this context, the present study aimed [...] Read more.
Background and Objectives: Evidence shows that throughout the COVID-19 pandemic, nurses suffered from emotional symptoms, yet in spite of this, few studies within “positive psychology” have analyzed the emergence/promotion of positive traits, such as hardiness. In this context, the present study aimed to test a model regarding the mediating role of self-efficacy between anxiety experienced at the beginning of the COVID-19 pandemic and hardiness assessed six months later among nurses in critical care units (CCU) in Spain. Materials and Methods: An observational, descriptive, prospective longitudinal study with two data collection periods: (1) from the 1 to the 21 June 2020 (final phase of the state of alarm declared in Spain on 14 March) in which socio-demographic and occupational variables, anxiety (Depression, Anxiety and Stress Scale, DASS-21), self-efficacy (General Self-Efficacy Scale, GSES) and basal resilience (Resilience Scale-14, RS-14) were assessed, and (2) a follow-up 6 months later (January–March 2021) in which hardiness (Occupational Hardiness Questionnaire, OHQ) was evaluated. To analyze the data, multivariate regressions were performed using the PROCESS macro (simple mediation, model 4). Results: A total of 131 Spanish nurses from CCUs, with a mean age of 40.54 years (88.5% women) participated in the study. Moderate and severe levels of anxiety were observed in 19.1% of the sample. Significant and positive correlations were observed between self-efficacy, hardiness and resilience (all p < 0.001). Significant negative correlations were observed between anxiety and self-efficacy (p < 0.001), hardiness (p = 0.027) and resilience (p = 0.005). The indirect effect of anxiety on hardiness through self-efficacy was significant (Effect (SE) = −0.275 (0.100); LLCI = −0.487, ULCI = −0.097), contributing to 28% of the variance, including resilience (p = 0.015), age (p = 0.784), gender (p = 0.294) and years of experience (p = 0.652) as covariates. A total mediation was observed (non-significant anxiety-hardiness direct effect; Effect (SE) = −0.053 (0.215), t = 0.248, p = 0.804, LLCI = −0.372, ULCI = 0.479). Conclusions: The results suggest that in Spanish CCU nurses, anxiety experienced at the beginning of the COVID-19 pandemic may contribute to the development of hardiness through positive resources such as self-efficacy. Full article
(This article belongs to the Section Psychiatry)
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23 pages, 3739 KiB  
Article
A Preliminary Report Regarding the Morphological Changes of Nano-Enabled Pharmaceutical Formulation on Human Lung Carcinoma Monolayer and 3D Bronchial Microtissue
by Cătălin Prodan-Bărbulescu, Claudia-Geanina Watz, Elena-Alina Moacă, Alexandra-Corina Faur, Cristina-Adriana Dehelean, Flaviu Ionut Faur, Laura Octavia Grigoriţă, Anca Laura Maghiari, Paul Tuţac, Ciprian Duţă, Sorin Bolintineanu and Laura Andreea Ghenciu
Medicina 2024, 60(2), 208; https://doi.org/10.3390/medicina60020208 - 25 Jan 2024
Cited by 10 | Viewed by 2732
Abstract
Background and Objectives: Nowadays, the development of enabled pharmaceutical nanoparticles of solid lipid type is continuously growing, because they have the potential to be used for targeted drug release leading to an increased effect of chemotherapy, being used in lung cancer nano-diagnosis [...] Read more.
Background and Objectives: Nowadays, the development of enabled pharmaceutical nanoparticles of solid lipid type is continuously growing, because they have the potential to be used for targeted drug release leading to an increased effect of chemotherapy, being used in lung cancer nano-diagnosis and nano-therapy. The current study reports the preliminary results obtained regarding the biological effect of a new nano-enabled pharmaceutical formulation in terms of its cytotoxic and biosafety profile. Materials and Methods: The pharmaceutical formulations consist of solid lipid nanoparticles (SLN) obtained via the emulsification–diffusion method by loading green iron oxide nanoparticles (green-IONPs) with a pentacyclic triterpene (oleanolic acid—OA). Further, a complex biological assessment was performed, employing three-dimensional (3D) bronchial microtissues (EpiAirwayTM) to determine the biosafety profile of the SLN samples. The cytotoxic potential of the samples was evaluated on human lung carcinoma, using an in vitro model (A549 human lung carcinoma monolayer). Results: The data revealed that the A549 cell line was strongly affected after treatment with SLN samples, especially those that contained OA-loaded green-IONPs obtained with Ocimum basilicum extract (under 30% viability rates). The biosafety profile investigation of the 3D normal in vitro bronchial model showed that all the SLN samples negatively affected the viability of the bronchial microtissues (below 50%). As regards the morphological changes, all the samples induce major changes such as loss of the surface epithelium integrity, loss of epithelial junctions, loss of cilia, hyperkeratosis, and cell death caused by apoptosis. Conclusions: In summary, the culprit for the negative impact on viability and morphology of 3D normal bronchial microtissues could be the too-high dose (500 µg/mL) of the SLN sample used. Nevertheless, further adjustments in the SLN synthesis process and another complex in vitro evaluation will be considered for future research. Full article
(This article belongs to the Special Issue New Small Molecule Inhibitors Used in Cancers)
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12 pages, 446 KiB  
Article
The Role of Family Factors in the Development of Dental Anxiety in Children
by Dorotea Petrović, Odri Cicvarić, Marija Šimunović-Erpušina, Nataša Ivančić Jokić, Danko Bakarčić, Petra Bučević Sojčić and Hrvoje Jurić
Medicina 2024, 60(1), 180; https://doi.org/10.3390/medicina60010180 - 19 Jan 2024
Cited by 6 | Viewed by 2991
Abstract
Background and Objectives: In the literature, the influence of parents who suffer from dental anxiety and a previous unpleasant experience at the dentist are cited as the two most common causes of dental anxiety in children. The aim of this study is [...] Read more.
Background and Objectives: In the literature, the influence of parents who suffer from dental anxiety and a previous unpleasant experience at the dentist are cited as the two most common causes of dental anxiety in children. The aim of this study is to investigate the relationship between socioeconomic factors and the development of dental anxiety in children aged 9 to 12 years. Materials and Methods: A total of 131 children and their accompanying parents/guardians participated in the cross-sectional study. The children were divided into an experimental group, which visited a specialised office for paediatric and preventive dentistry for the examination, and a control group, which visited a primary care dental office. During the visit, the children completed questionnaires on dental anxiety (CFSS-DS). Parents completed a socioeconomic questionnaire and a dental anxiety questionnaire for adults (CDAS). Results: The results showed a statistically significant positive predictor: parental dental anxiety as measured by the CDAS. In addition, the t-test showed that children who visited a specialised dental office did not show a statistically significant increase in dental anxiety compared to children who visited a primary care dental office. Conclusions: With this study, we confirm the influence of parental dental anxiety on the development of dental anxiety in children. The socioeconomic status of the family and the type of dental office do not play a statistically significant role in the development of dental anxiety in children. Full article
(This article belongs to the Special Issue Recent Advances in Pediatric Oral Health)
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27 pages, 1555 KiB  
Review
Exploring Biomarkers in Breast Cancer: Hallmarks of Diagnosis, Treatment, and Follow-Up in Clinical Practice
by Laura Lopez-Gonzalez, Alicia Sanchez Cendra, Cristina Sanchez Cendra, Eduardo David Roberts Cervantes, Javier Cassinello Espinosa, Tatiana Pekarek, Oscar Fraile-Martinez, Cielo García-Montero, Ana María Rodriguez-Slocker, Laura Jiménez-Álvarez, Luis G. Guijarro, Soledad Aguado-Henche, Jorge Monserrat, Melchor Alvarez-Mon, Leonel Pekarek, Miguel A. Ortega and Raul Diaz-Pedrero
Medicina 2024, 60(1), 168; https://doi.org/10.3390/medicina60010168 - 17 Jan 2024
Cited by 33 | Viewed by 15583
Abstract
Breast cancer is a prevalent malignancy in the present day, particularly affecting women as one of the most common forms of cancer. A significant portion of patients initially present with localized disease, for which curative treatments are pursued. Conversely, another substantial segment is [...] Read more.
Breast cancer is a prevalent malignancy in the present day, particularly affecting women as one of the most common forms of cancer. A significant portion of patients initially present with localized disease, for which curative treatments are pursued. Conversely, another substantial segment is diagnosed with metastatic disease, which has a worse prognosis. Recent years have witnessed a profound transformation in the prognosis for this latter group, primarily due to the discovery of various biomarkers and the emergence of targeted therapies. These biomarkers, encompassing serological, histological, and genetic indicators, have demonstrated their value across multiple aspects of breast cancer management. They play crucial roles in initial diagnosis, aiding in the detection of relapses during follow-up, guiding the application of targeted treatments, and offering valuable insights for prognostic stratification, especially for highly aggressive tumor types. Molecular markers have now become the keystone of metastatic breast cancer diagnosis, given the diverse array of chemotherapy options and treatment modalities available. These markers signify a transformative shift in the arsenal of therapeutic options against breast cancer. Their diagnostic precision enables the categorization of tumors with elevated risks of recurrence, increased aggressiveness, and heightened mortality. Furthermore, the existence of therapies tailored to target specific molecular anomalies triggers a cascade of changes in tumor behavior. Therefore, the primary objective of this article is to offer a comprehensive review of the clinical, diagnostic, prognostic, and therapeutic utility of the principal biomarkers currently in use, as well as of their clinical impact on metastatic breast cancer. In doing so, our goal is to contribute to a more profound comprehension of this complex disease and, ultimately, to enhance patient outcomes through more precise and effective treatment strategies. Full article
(This article belongs to the Special Issue Advances in Cancer Multimodal Approach: Biomarkers, Mechanisms, Surgical Procedures and Oncological Therapies)
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15 pages, 1005 KiB  
Article
Mind the Gap: A Questionnaire on the Distance between Diagnostic Advances and Clinical Practice in Skin Cancer Treatment
by Giuseppe Diluiso, Mirco Pozzi, Flavio Giulio Liso, Vanessa Marron Mendes, Jenna Hannouille, Luigi Losco, Alberto Bolletta, Emanuele Cigna and Michela Schettino
Medicina 2024, 60(1), 155; https://doi.org/10.3390/medicina60010155 - 15 Jan 2024
Cited by 6 | Viewed by 1944
Abstract
Background and Objectives: Significant progress has been made in skin cancer diagnosis, with a surge in available technologies in recent years. Despite this, the practical application and integration of these technologies in dermatology and plastic surgery remain uneven. Materials and Methods: [...] Read more.
Background and Objectives: Significant progress has been made in skin cancer diagnosis, with a surge in available technologies in recent years. Despite this, the practical application and integration of these technologies in dermatology and plastic surgery remain uneven. Materials and Methods: A comprehensive 20-question survey was designed and distributed using online survey administration software (Google Forms, 2018, Google, Mountain View, CA, USA) from June 2023 to September 2023. The survey aimed to assess the knowledge and utilization of dermatologic diagnostic advancements among plastic surgeons in various European countries. Results: Data were obtained from 29 plastic surgeons across nine European countries, revealing a notable gap between diagnostic technologies and their routine use in surgical practice. The gap for some technologies was both cognitive and applicative; for electrical impedance spectroscopy (EIS) and multispectral imaging, only 6.9% of the sample knew of the technologies and no surgeons in the sample used them. In the case of other technologies, such as high-frequency ultrasound (HFUS), 72.4% of the sample knew about them but only 34.5% used them, highlighting a more significant application problem. Conclusions: Spotlighting this discrepancy provides a valuable foundation for initiating collaborative efforts between units and facilitating knowledge exchange among diverse specialists. This, in turn, contributes to advancing clinical practice by integrating the innovative opportunities presented by ongoing research. Full article
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8 pages, 261 KiB  
Article
Women’s Awareness of Reproductive Health
by Oliwia Zalewska, Katarzyna Wszołek, Małgorzata Pięt, Maciej Wilczak and Karolina Chmaj-Wierzchowska
Medicina 2024, 60(1), 158; https://doi.org/10.3390/medicina60010158 - 15 Jan 2024
Cited by 8 | Viewed by 3366
Abstract
Background and Objectives: reproductive disorders are a serious global concern in medical, social, and demographic contexts. According to estimates, approximately 10–15% of couples around the world suffer from infertility. Numerous studies have shown that modifiable lifestyle factors, such as a high-fat diet, [...] Read more.
Background and Objectives: reproductive disorders are a serious global concern in medical, social, and demographic contexts. According to estimates, approximately 10–15% of couples around the world suffer from infertility. Numerous studies have shown that modifiable lifestyle factors, such as a high-fat diet, a postponed decision to start a family, tobacco smoking, alcohol consumption, risky sexual behavior, psychiatric diseases, and chronic stress, have a negative influence on the fertility of women. The main goal of this study is to assess the knowledge of women about reproductive health, infertility risk factors, and causes of infertility and to determine whether the level of this knowledge varies based on sociodemographic variables. Materials and Methods: a survey was conducted among 111 patients who anonymously filled in a questionnaire comprising questions regarding fertility and its deficiencies. The results were analyzed using the Chi-square test and Fisher’s test. Results: the survey results indicated that women had a good or very good level of knowledge of the causes of infertility. The obtained test results were statistically significant (p < 0.05), but the studied group did not possess sufficient knowledge of the symptoms characterizing the diseases related to limited fertility (p > 0.05). The level of knowledge on the diagnosis of infertility did not depend on the age of the examined people, their educational level, or personal experience in this field (p > 0.05). The results also revealed that the awareness of women on reproductive health was poor. The studied women had a low level of knowledge of infertility risk factors, and their knowledge did not correlate with age, educational level, or personal experiences. Conclusions: information on the aspects of reproductive health should be widely disseminated through public educational campaigns, aimed at correcting erroneous convictions among women about the risk factors for infertility and assisting them in improving fertility. Full article
(This article belongs to the Special Issue Health Risk Factors, Prevention, and Inequalities)
32 pages, 2649 KiB  
Review
Use of Infrared Thermography in Medical Diagnosis, Screening, and Disease Monitoring: A Scoping Review
by Dorothea Kesztyüs, Sabrina Brucher, Carolyn Wilson and Tibor Kesztyüs
Medicina 2023, 59(12), 2139; https://doi.org/10.3390/medicina59122139 - 9 Dec 2023
Cited by 38 | Viewed by 10862
Abstract
Thermography provides non-invasive, radiation-free diagnostic imaging. Despite the extensive literature on medical thermography, a comprehensive overview of current applications is lacking. Hence, the aim of this scoping review is to identify the medical applications of passive infrared thermography and to catalogue the technical [...] Read more.
Thermography provides non-invasive, radiation-free diagnostic imaging. Despite the extensive literature on medical thermography, a comprehensive overview of current applications is lacking. Hence, the aim of this scoping review is to identify the medical applications of passive infrared thermography and to catalogue the technical and environmental modalities. The diagnostic performance of thermography and the existence of specific reference data are evaluated, and research gaps and future tasks identified. The entire review process followed the Joanna Briggs Institute (JBI) approach and the results are reported according to PRISMA-ScR guidelines. The scoping review protocol is registered at the Open Science Framework (OSF). PubMed, CENTRAL, Embase, Web of Science, OpenGrey, OSF, and PROSPERO were searched using pretested search strategies based on the Population, Concept, Context (PCC) approach. According to the eligibility criteria, references were screened by two researchers independently. Seventy-two research articles were identified describing screening, diagnostic, or monitoring studies investigating the potential of thermography in a total of 17,314 participants within 38 different health conditions across 13 therapeutic areas. The use of several camera models from various manufacturers is described. These and other facts and figures are compiled and presented in a detailed, descriptive tabular and visual format. Thermography offers promising diagnostic capabilities, alone or in addition to conventional methods. Full article
(This article belongs to the Special Issue Thermology Health Care Applications and Medical Thermography)
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12 pages, 642 KiB  
Article
Is Systemic Immune-Inflammation Index a Real Non-Invasive Biomarker to Predict Oncological Outcomes in Patients Eligible for Radical Cystectomy?
by Pierluigi Russo, Filippo Marino, Francesco Rossi, Francesco Pio Bizzarri, Mauro Ragonese, Francesco Dibitetto, Giovanni Battista Filomena, Denise Pires Marafon, Chiara Ciccarese, Roberto Iacovelli, Savio Domenico Pandolfo, Achille Aveta, Simone Cilio, Luigi Napolitano and Nazario Foschi
Medicina 2023, 59(12), 2063; https://doi.org/10.3390/medicina59122063 - 22 Nov 2023
Cited by 22 | Viewed by 2319
Abstract
Background and Objectives: To assess the potential prognostic role of the systemic immune-inflammation index (SII) in predicting oncological outcomes in a cohort of patients treated with radical cystectomy (RC). Materials and Methods: From 2016 to 2022, a retrospective monocentric study enrolled [...] Read more.
Background and Objectives: To assess the potential prognostic role of the systemic immune-inflammation index (SII) in predicting oncological outcomes in a cohort of patients treated with radical cystectomy (RC). Materials and Methods: From 2016 to 2022, a retrospective monocentric study enrolled 193 patients who were divided into two groups based on their SII levels using the optimal cutoff determined by the Youden index. The SII was obtained from a preoperative blood test approximately one month before RC. Univariable and multivariable logistic regression analyses were conducted to investigate the capacity of SII to predict lymph node invasion (N), advanced pT stage (pT3/pT4), and locally advanced condition at the time of RC. Multivariable Cox regression models adjusted for preoperative and postoperative features were used to analyze the prognostic effect of SII on recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). Results: The optimal cutoff value of the SII was 640.27. An elevated SII was seen in 113 (58.5%) patients. Using the multivariable preoperative logistic regression models, an elevated SII was correlated with nodal invasion (N; p = 0.03), advanced pT stage (p = 0.04), and locally advanced disease (p = 0.005), with enhancement of AUCs for predicting locally advanced disease (p = 0.04). In multivariable Cox regression models that considered preoperative clinicopathologic factors, an elevated SII was linked to poorer RFS (p = 0.005) and OS (p = 0.01). Moreover, on multivariable Cox regression postoperative models, a high SII was linked to RFS (p = 0.004) and to OS (p = 0.01). Conclusions: In this monocentric retrospective study, higher preoperative SII values predicted worse oncological outcomes in patients with bladder cancer (BCa) who underwent RC. Full article
(This article belongs to the Section Urology & Nephrology)
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12 pages, 1122 KiB  
Brief Report
Ultrasound Prevalence and Clinical Features of Nonalcoholic Fatty Liver Disease in Patients with Inflammatory Bowel Diseases: A Real-Life Cross-Sectional Study
by Ludovico Abenavoli, Rocco Spagnuolo, Giuseppe Guido Maria Scarlata, Emidio Scarpellini, Luigi Boccuto and Francesco Luzza
Medicina 2023, 59(11), 1935; https://doi.org/10.3390/medicina59111935 - 1 Nov 2023
Cited by 17 | Viewed by 2887
Abstract
Background and Objectives: Inflammatory bowel disease (IBD) is a condition characterized by chronic intestinal inflammation. We can identify two major forms: Crohn’s disease (CD) and ulcerative colitis (UC). One of the extraintestinal manifestations of IBD is nonalcoholic fatty liver disease (NAFLD). IBD [...] Read more.
Background and Objectives: Inflammatory bowel disease (IBD) is a condition characterized by chronic intestinal inflammation. We can identify two major forms: Crohn’s disease (CD) and ulcerative colitis (UC). One of the extraintestinal manifestations of IBD is nonalcoholic fatty liver disease (NAFLD). IBD and NAFLD share common pathogenetic mechanisms. Ultrasound (US) examination is the most commonly used imaging method for the diagnosis of NAFLD. This cross-sectional observational retrospective study aimed to evaluate the US prevalence of NAFLD in IBD patients and their clinical features. Materials and Methods: A total of 143 patients with IBD underwent hepatic US and were divided into two different groups according to the presence or absence of NAFLD. Subsequently, new exclusion criteria for dysmetabolic comorbidities (defined as plus) were applied. Results: The US prevalence of NAFLD was 23% (21% in CD and 24% in UC, respectively). Most IBD–NAFLD patients were male and older and showed significantly higher values for body mass index, waist circumference, disease duration, and age at onset than those without NAFLD. IBD–NAFLD patients showed a significantly higher percentage of stenosing phenotype and left-side colitis. Regarding metabolic features, IBD–NAFLD patients showed a significantly higher percentage of hypertension and IBD plus dysmetabolic criteria. Also, higher values of alanine aminotransferase and triglycerides and lower levels of high-density lipoproteins are reported in these patients. Conclusions: We suggest performing liver US screening in subjects affected by IBD to detect NAFLD earlier. Also, patients with NAFLD present several metabolic comorbidities that would fall within the new definition of metabolic-associated fatty liver disease. Finally, we encourage larger longitudinal studies, including healthy controls, to provide further confirmation of our preliminary data. Full article
(This article belongs to the Special Issue Editorial Board Members’ Collection Series: Gastrointestinal and Hepatic Diseases)
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28 pages, 1190 KiB  
Review
Oxidative Stress and Male Infertility: The Protective Role of Antioxidants
by Aris Kaltsas
Medicina 2023, 59(10), 1769; https://doi.org/10.3390/medicina59101769 - 4 Oct 2023
Cited by 74 | Viewed by 18512
Abstract
Oxidative stress is a significant factor in male infertility, compromising sperm function and overall reproductive health. As male infertility garners increasing attention, effective therapeutic interventions become paramount. This review investigates the therapeutic role of antioxidants in addressing male infertility. A detailed examination was [...] Read more.
Oxidative stress is a significant factor in male infertility, compromising sperm function and overall reproductive health. As male infertility garners increasing attention, effective therapeutic interventions become paramount. This review investigates the therapeutic role of antioxidants in addressing male infertility. A detailed examination was conducted on antioxidants such as vitamin C, E, B12, D, coenzyme Q10, zinc, folic acid, selenium, l-carnitine, l-arginine, inositols, and alpha-lipoic acid. This analysis examines the methodologies, outcomes, and constraints of current clinical studies. Antioxidants show notable potential in counteracting the negative effects of oxidative stress on sperm. Based on the evidence, these antioxidants, individually or synergistically, can enhance sperm health and reproductive outcomes. However, certain limitations in the studies call for careful interpretation. Antioxidants are integral in tackling male infertility attributed to oxidative stress. The current findings underscore their therapeutic value, yet there’s a pressing need for deeper, comprehensive research. Future studies should focus on refining dosage guidelines, identifying potential side effects, and discerning the most efficacious antioxidant combinations for male infertility solutions. Full article
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16 pages, 1031 KiB  
Review
Augmented Reality in Neurosurgery: A New Paradigm for Training
by Grace Hey, Michael Guyot, Ashley Carter and Brandon Lucke-Wold
Medicina 2023, 59(10), 1721; https://doi.org/10.3390/medicina59101721 - 26 Sep 2023
Cited by 34 | Viewed by 7573
Abstract
Augmented reality (AR) involves the overlay of computer-generated images onto the user’s real-world visual field to modify or enhance the user’s visual experience. With respect to neurosurgery, AR integrates preoperative and intraoperative imaging data to create an enriched surgical experience that has been [...] Read more.
Augmented reality (AR) involves the overlay of computer-generated images onto the user’s real-world visual field to modify or enhance the user’s visual experience. With respect to neurosurgery, AR integrates preoperative and intraoperative imaging data to create an enriched surgical experience that has been shown to improve surgical planning, refine neuronavigation, and reduce operation time. In addition, AR has the potential to serve as a valuable training tool for neurosurgeons in a way that minimizes patient risk while facilitating comprehensive training opportunities. The increased use of AR in neurosurgery over the past decade has led to innovative research endeavors aiming to develop novel, more efficient AR systems while also improving and refining present ones. In this review, we provide a concise overview of AR, detail current and emerging uses of AR in neurosurgery and neurosurgical training, discuss the limitations of AR, and provide future research directions. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), 386 articles were initially identified. Two independent reviewers (GH and AC) assessed article eligibility for inclusion, and 31 articles are included in this review. The literature search included original (retrospective and prospective) articles and case reports published in English between 2013 and 2023. AR assistance has shown promise within neuro-oncology, spinal neurosurgery, neurovascular surgery, skull-base surgery, and pediatric neurosurgery. Intraoperative use of AR was found to primarily assist with surgical planning and neuronavigation. Similarly, AR assistance for neurosurgical training focused primarily on surgical planning and neuronavigation. However, studies included in this review utilize small sample sizes and remain largely in the preliminary phase. Thus, future research must be conducted to further refine AR systems before widespread intraoperative and educational use. Full article
(This article belongs to the Special Issue Clinical Application of Augmented Reality (AR) in Neurosurgery)
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18 pages, 763 KiB  
Systematic Review
New Robotic Platforms in General Surgery: What’s the Current Clinical Scenario?
by Francesco Marchegiani, Leandro Siragusa, Alizée Zadoroznyj, Vito Laterza, Orsalia Mangana, Carlo Alberto Schena, Michele Ammendola, Riccardo Memeo, Paolo Pietro Bianchi, Giuseppe Spinoglio, Paschalis Gavriilidis and Nicola de’Angelis
Medicina 2023, 59(7), 1264; https://doi.org/10.3390/medicina59071264 - 7 Jul 2023
Cited by 36 | Viewed by 7936
Abstract
Background and Objectives: Robotic surgery has been widely adopted in general surgery worldwide but access to this technology is still limited to a few hospitals. With the recent introduction of new robotic platforms, several studies reported the feasibility of different surgical procedures. [...] Read more.
Background and Objectives: Robotic surgery has been widely adopted in general surgery worldwide but access to this technology is still limited to a few hospitals. With the recent introduction of new robotic platforms, several studies reported the feasibility of different surgical procedures. The aim of this systematic review is to highlight the current clinical practice with the new robotic platforms in general surgery. Materials and Methods: A grey literature search was performed on the Internet to identify the available robotic systems. A PRISMA compliant systematic review was conducted for all English articles up to 10 February 2023 searching the following databases: MEDLINE, EMBASE, and Cochrane Library. Clinical outcomes, training process, operating surgeon background, cost-analysis, and specific registries were evaluated. Results: A total of 103 studies were included for qualitative synthesis after the full-text screening. Of the fifteen robotic platforms identified, only seven were adopted in a clinical environment. Out of 4053 patients, 2819 were operated on with a new robotic device. Hepatopancreatobiliary surgery specialty performed the majority of procedures, and the most performed procedure was cholecystectomy. Globally, 109 emergency surgeries were reported. Concerning the training process, only 45 papers reported the background of the operating surgeon, and only 28 papers described the training process on the surgical platform. Only one cost-analysis compared a new robot to the existing reference. Two manufacturers promoted a specific registry to collect clinical outcomes. Conclusions: This systematic review highlights the feasibility of most surgical procedures in general surgery using the new robotic platforms. Adoption of these new devices in general surgery is constantly growing with the extension of regulatory approvals. Standardization of the training process and the assessment of skills’ transferability is still lacking. Further studies are required to better understand the real clinical and economical benefit. Full article
(This article belongs to the Section Surgery)
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11 pages, 1720 KiB  
Article
Ultrasound-Guided Infiltrative Treatment Associated with Early Rehabilitation in Adhesive Capsulitis Developed in Post-COVID-19 Syndrome
by Danilo Donati, Fabio Vita, Roberto Tedeschi, Stefano Galletti, Alessandro Biglia, Tommaso Gistri, Pasquale Arcuri, Flavio Origlio, Francesco Castagnini, Cesare Faldini, Davide Pederiva and Maria Grazia Benedetti
Medicina 2023, 59(7), 1211; https://doi.org/10.3390/medicina59071211 - 28 Jun 2023
Cited by 14 | Viewed by 2661
Abstract
Background and Objectives: Post-COVID-19 syndrome is commonly used to describe signs and symptoms that continue or develop after acute COVID-19 for more than 12 weeks. The study aimed to evaluate a treatment strategy in patients with adhesive capsulitis (phase 1) developed in post-COVID-19 [...] Read more.
Background and Objectives: Post-COVID-19 syndrome is commonly used to describe signs and symptoms that continue or develop after acute COVID-19 for more than 12 weeks. The study aimed to evaluate a treatment strategy in patients with adhesive capsulitis (phase 1) developed in post-COVID-19 syndrome. Materials and Methods: The method used was an interventional pilot study in which 16 vaccinated patients presenting with the clinical and ultrasound features of adhesive capsulitis (phase 1) developed during post-COVID-19 syndrome were treated with infiltrative hydrodistension therapy under ultrasound guidance associated with early rehabilitation treatment. Results: Sixteen patients with post-COVID-19 syndrome treated with ultrasound-guided infiltration and early rehabilitation treatment showed an important improvement in active joint ROM after 10 weeks, especially in shoulder elevation and abduction movements. The VAS mean score before the treatment was 6.9 ± 1.66. After 10 weeks of treatment, the VAS score was 1 ± 0.63. Conclusions: The study demonstrated that the management of adhesive capsulitis (phase 1) developed in post-COVID-19 syndrome, as conducted by physiotherapists in a primary care setting using hydrodistension and a rehabilitation protocol, represented an effective treatment strategy. Full article
(This article belongs to the Topic Orthopaedic Diseases and Innovative Intervention Strategies)
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12 pages, 1682 KiB  
Review
Hypermagnesemia in Clinical Practice
by Aya Hasan Aal-Hamad, Abdullah M. Al-Alawi, Masoud Salim Kashoub and Henrik Falhammar
Medicina 2023, 59(7), 1190; https://doi.org/10.3390/medicina59071190 - 24 Jun 2023
Cited by 38 | Viewed by 15799
Abstract
Hypermagnesemia is a relatively uncommon but potentially life-threatening electrolyte disturbance characterized by elevated magnesium concentrations in the blood. Magnesium is a crucial mineral involved in various physiological functions, such as neuromuscular conduction, cardiac excitability, vasomotor tone, insulin metabolism, and muscular contraction. Hypomagnesemia is [...] Read more.
Hypermagnesemia is a relatively uncommon but potentially life-threatening electrolyte disturbance characterized by elevated magnesium concentrations in the blood. Magnesium is a crucial mineral involved in various physiological functions, such as neuromuscular conduction, cardiac excitability, vasomotor tone, insulin metabolism, and muscular contraction. Hypomagnesemia is a prevalent electrolyte disturbance that can lead to several neuromuscular, cardiac, or nervous system disorders. Hypermagnesemia has been associated with adverse clinical outcomes, particularly in hospitalized patients. Prompt identification and management of hypermagnesemia are crucial to prevent complications, such as respiratory and cardiovascular negative outcomes, neuromuscular dysfunction, and coma. Preventing hypermagnesemia is crucial, particularly in high-risk populations, such as patients with impaired renal function or those receiving magnesium-containing medications or supplements. Clinical management of hypermagnesemia involves discontinuing magnesium-containing therapies, intravenous fluid therapy, or dialysis in severe cases. Furthermore, healthcare providers should monitor serum magnesium concentration in patients at risk of hypermagnesemia and promptly intervene if the concentration exceeds the normal range. Full article
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8 pages, 321 KiB  
Article
Predictors of Short-Term Mortality in Patients with Ischemic Stroke
by Silvina Iluţ, Ştefan Cristian Vesa, Vitalie Văcăraș and Dafin-Fior Mureșanu
Medicina 2023, 59(6), 1142; https://doi.org/10.3390/medicina59061142 - 13 Jun 2023
Cited by 15 | Viewed by 2267
Abstract
Background and Objectives: The purpose of this study is to investigate the predictive factors for intrahospital mortality in ischemic stroke patients. We will examine the association between a range of clinical and demographic factors and intrahospital mortality, including age, sex, comorbidities, laboratory [...] Read more.
Background and Objectives: The purpose of this study is to investigate the predictive factors for intrahospital mortality in ischemic stroke patients. We will examine the association between a range of clinical and demographic factors and intrahospital mortality, including age, sex, comorbidities, laboratory values, and medication use. Materials and Methods: This retrospective, longitudinal, analytic, observational cohort study included 243 patients over 18 years old with a new ischemic stroke diagnosis who were hospitalized in Cluj-Napoca Emergency County Hospital. Data collected included the patient demographics, baseline characteristics at hospital admission, medication use, carotid artery Doppler ultrasound, as well as cardiology exam, and intrahospital death. Results: Multivariate logistic regression was used to determine which variables were independently associated with intrahospital death. An NIHSS score > 9 (OR—17.4; p < 0.001) and a lesion volume > 22.3 mL (OR—5.8; p = 0.003) were found to be associated with the highest risk of death. In contrast antiplatelet treatment (OR—0.349; p = 0.04) was associated with lower mortality rates. Conclusions: Our study identified a high NIHSS score and large lesion volume as independent risk factors for intrahospital mortality in ischemic stroke patients. Antiplatelet therapy was associated with lower mortality rates. Further studies are needed to explore the potential mechanisms underlying these associations and to develop targeted interventions to improve patient outcomes. Full article
(This article belongs to the Section Neurology)
21 pages, 892 KiB  
Review
Angiogenesis and Hepatocellular Carcinoma: From Molecular Mechanisms to Systemic Therapies
by Elisa Pinto, Filippo Pelizzaro, Fabio Farinati and Francesco Paolo Russo
Medicina 2023, 59(6), 1115; https://doi.org/10.3390/medicina59061115 - 9 Jun 2023
Cited by 18 | Viewed by 5150
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver malignancy. The hypervascular nature of the majority of HCCs and the peculiar vascular derangement occurring during liver carcinogenesis underscore the importance of angiogenesis in the development and progression of these tumors. Indeed, several angiogenic [...] Read more.
Hepatocellular carcinoma (HCC) is the most common primary liver malignancy. The hypervascular nature of the majority of HCCs and the peculiar vascular derangement occurring during liver carcinogenesis underscore the importance of angiogenesis in the development and progression of these tumors. Indeed, several angiogenic molecular pathways have been identified as deregulated in HCC. The hypervascular nature and the peculiar vascularization of HCC, as well as deregulated angiogenic pathways, represent major therapeutic targets. To a large extent, intra-arterial locoregional treatments (transarterial-(chemo)embolization) rely on tumor ischemia caused by embolization of tumor feeding arteries, even though this may represent the “primum movens” of tumor recurrence through the activation of neoangiogenesis. Considering systemic therapies, the currently available tyrosine kinase inhibitors (sorafenib, regorafenib, cabozantinib and lenvatinib) and monoclonal antibodies (ramucirumab and bevacizumab, in combination with the anti-PD-L1, atezolizumab) primarily target, among others, angiogenic pathways. Considering the importance of angiogenesis in the pathogenesis and treatment of liver cancer, in this paper, we aim to review the role of angiogenesis in HCC, addressing the molecular mechanisms, available antiangiogenic therapies and prognostic biomarkers in patients receiving these treatments. Full article
(This article belongs to the Special Issue Advances in the Diagnosis, Treatment and Prognosis of Hepatocellular Carcinoma)
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32 pages, 1351 KiB  
Review
Alzheimer’s Disease Treatment: The Search for a Breakthrough
by Allison B. Reiss, Dalia Muhieddine, Berlin Jacob, Michael Mesbah, Aaron Pinkhasov, Irving H. Gomolin, Mark M. Stecker, Thomas Wisniewski and Joshua De Leon
Medicina 2023, 59(6), 1084; https://doi.org/10.3390/medicina59061084 - 4 Jun 2023
Cited by 20 | Viewed by 10154
Abstract
As the search for modalities to cure Alzheimer’s disease (AD) has made slow progress, research has now turned to innovative pathways involving neural and peripheral inflammation and neuro-regeneration. Widely used AD treatments provide only symptomatic relief without changing the disease course. The recently [...] Read more.
As the search for modalities to cure Alzheimer’s disease (AD) has made slow progress, research has now turned to innovative pathways involving neural and peripheral inflammation and neuro-regeneration. Widely used AD treatments provide only symptomatic relief without changing the disease course. The recently FDA-approved anti-amyloid drugs, aducanumab and lecanemab, have demonstrated unclear real-world efficacy with a substantial side effect profile. Interest is growing in targeting the early stages of AD before irreversible pathologic changes so that cognitive function and neuronal viability can be preserved. Neuroinflammation is a fundamental feature of AD that involves complex relationships among cerebral immune cells and pro-inflammatory cytokines, which could be altered pharmacologically by AD therapy. Here, we provide an overview of the manipulations attempted in pre-clinical experiments. These include inhibition of microglial receptors, attenuation of inflammation and enhancement of toxin-clearing autophagy. In addition, modulation of the microbiome-brain-gut axis, dietary changes, and increased mental and physical exercise are under evaluation as ways to optimize brain health. As the scientific and medical communities work together, new solutions may be on the horizon to slow or halt AD progression. Full article
(This article belongs to the Special Issue Commemorative Issue Celebrating the 20th Anniversary of the Alzheimer’s Foundation of America: Understanding and Treating Alzheimer’s Disease)
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15 pages, 5347 KiB  
Article
Transcatheter Arterial Embolization (TAE) in the Management of Bleeding in the COVID-19 Patient
by Roberto Minici, Federico Fontana, Massimo Venturini, Giuseppe Guzzardi, Agostino Siciliano, Filippo Piacentino, Raffaele Serra, Andrea Coppola, Pasquale Guerriero, Biagio Apollonio, Rita Santoro, MGJR Research Team, Luca Brunese and Domenico Laganà
Medicina 2023, 59(6), 1062; https://doi.org/10.3390/medicina59061062 - 1 Jun 2023
Cited by 9 | Viewed by 4280
Abstract
Background and Objectives: Increasing attention is being paid to the coagulation disorders associated with SARS-CoV-2 infection. Bleeding accounts for 3–6% of COVID-19 patient deaths, and is often a forgotten part of the disease. The bleeding risk is enhanced by several factors, including [...] Read more.
Background and Objectives: Increasing attention is being paid to the coagulation disorders associated with SARS-CoV-2 infection. Bleeding accounts for 3–6% of COVID-19 patient deaths, and is often a forgotten part of the disease. The bleeding risk is enhanced by several factors, including spontaneous heparin-induced thrombocytopenia, thrombocytopenia, the hyperfibrinolytic state, the consumption of coagulation factors, and thromboprophylaxis with anticoagulants. This study aims to assess the efficacy and safety of TAE in the management of bleeding in COVID-19 patients. Materials and Methods: This multicenter retrospective study analyzes data from COVID-19 patients subjected to transcatheter arterial embolization for the management of bleeding from February 2020 to January 2023. Results: Transcatheter arterial embolization was performed in 73 COVID-19 patients for acute non-neurovascular bleeding during the study interval (February 2020–January 2023). Coagulopathy was observed in forty-four (60.3%) patients. The primary cause of bleeding was spontaneous soft tissue hematoma (63%). A 100% technical success rate was recorded; six cases of rebleeding resulted in a 91.8% clinical success rate. No cases of non-target embolization were observed. Complications were recorded in 13 (17.8%) patients. The efficacy and safety endpoints did not differ significantly between the coagulopathy and non-coagulopathy groups. Conclusions: Transcatheter Arterial Embolization (TAE) is an effective, safe and potentially life-saving option for the management of acute non-neurovascular bleeding in COVID-19 patients. This approach is effective and safe even in the subgroup of COVID-19 patients with coagulopathy. Full article
(This article belongs to the Section Surgery)
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20 pages, 1704 KiB  
Opinion
Laser Treatment Monitoring with Reflectance Confocal Microscopy
by Stefania Guida, Caterina Longo, Simone Amato, Anthony M. Rossi, Marco Manfredini, Silvana Ciardo, Marco Spadafora, Steven P. Nisticò, Santo R. Mercuri, Franco Rongioletti, Nicola Zerbinati and Giovanni Pellacani
Medicina 2023, 59(6), 1039; https://doi.org/10.3390/medicina59061039 - 28 May 2023
Cited by 22 | Viewed by 2833
Abstract
Laser treatments have become popular in Dermatology. In parallel to technologic development enabling the availability of different laser wavelengths, non-invasive skin imaging techniques, such as reflectance confocal microscopy (RCM), have been used to explore morphologic and qualitative skin characteristics. Specifically, RCM can be [...] Read more.
Laser treatments have become popular in Dermatology. In parallel to technologic development enabling the availability of different laser wavelengths, non-invasive skin imaging techniques, such as reflectance confocal microscopy (RCM), have been used to explore morphologic and qualitative skin characteristics. Specifically, RCM can be applied to cosmetically sensitive skin areas such as the face, without the need for skin biopsies. For these reasons, apart from its current use in skin cancer diagnosis, our systematic review reveals how RCM can be employed in the field of laser treatment monitoring, being particularly suitable for the evaluation of variations in epidermis and dermis, and pigmentary and vascular characteristics of the skin. This systematic review article aims to provide an overview on current applications of RCM laser treatment monitoring, while describing RCM features identified for different applications. Studies on human subjects treated with laser treatments, monitored with RCM, were included in the current systematic review. Five groups of treatments were identified and described: skin rejuvenation, scar tissue, pigmentary disorders, vascular disorders and other. Interestingly, RCM can assist treatments with lasers targeting all chromophores in the skin and exploiting laser induced optical breakdown. Treatment monitoring encompasses assessment at baseline and examination of changes after treatment, therefore revealing details in morphologic alterations underlying different skin conditions and mechanisms of actions of laser therapy, as well as objectify results after treatment. Full article
(This article belongs to the Special Issue Advances in Laser Treatment for Skin Diseases)
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11 pages, 2681 KiB  
Review
Sex Differences in Epidemiology, Morphology, Mechanisms, and Treatment of Mitral Valve Regurgitation
by Gregorio Tersalvi, Lorenzo Gaiero, Michele Capriolo, Yvonne Cristoforetti, Stefano Salizzoni, Gaetano Senatore, Giovanni Pedrazzini and Luigi Biasco
Medicina 2023, 59(6), 1017; https://doi.org/10.3390/medicina59061017 - 24 May 2023
Cited by 15 | Viewed by 4650
Abstract
Sex-related disparities have been recognized in incidence, pathological findings, pathophysiological mechanisms, and diagnostic pathways of non-rheumatic mitral regurgitation. Furthermore, access to treatments and outcomes for surgical and interventional therapies among women and men appears to be different. Despite this, current European and US [...] Read more.
Sex-related disparities have been recognized in incidence, pathological findings, pathophysiological mechanisms, and diagnostic pathways of non-rheumatic mitral regurgitation. Furthermore, access to treatments and outcomes for surgical and interventional therapies among women and men appears to be different. Despite this, current European and US guidelines have identified common diagnostic and therapeutic pathways that do not consider patient sex in decision-making. The aim of this review is to summarize the current evidence on sex-related differences in non-rheumatic mitral regurgitation, particularly regarding incidence, imaging modalities, surgical-derived evidence, and outcomes of transcatheter edge-to-edge repair, with the goal of informing clinicians about sex-specific challenges to consider when making treatment decisions for patients with mitral regurgitation. Full article
(This article belongs to the Special Issue New Advances in Mitral Valve Diseases Management)
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12 pages, 623 KiB  
Systematic Review
Remission of Type 2 Diabetes Mellitus (T2DM) after Sleeve Gastrectomy (SG), One-Anastomosis Gastric Bypass (OAGB), and Roux-en-Y Gastric Bypass (RYGB): A Systematic Review
by Vignesh Balasubaramaniam and Sjaak Pouwels
Medicina 2023, 59(5), 985; https://doi.org/10.3390/medicina59050985 - 19 May 2023
Cited by 22 | Viewed by 5437
Abstract
Background and Objectives: The three most widely performed bariatric surgeries are Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and one-anastomosis gastric bypass (OAGB). Aside from the benefits of weight loss, current findings suggest that these procedures can also induce remission of T2DM [...] Read more.
Background and Objectives: The three most widely performed bariatric surgeries are Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and one-anastomosis gastric bypass (OAGB). Aside from the benefits of weight loss, current findings suggest that these procedures can also induce remission of T2DM (type 2 diabetes mellitus). There are limited data that directly compare these three procedures. This study aims to compare the short-term and long-term remission of T2DM after RYGB, SG, and OAGB. Materials and Methods: Three databases (Embase, PubMed, and Cochrane) were searched for randomised controlled trials, prospective studies, and retrospective studies that compared the effects of RYGB, SG, and OAGB on T2DM remission. Studies published between 2001 and 2022 were analysed. Only patients with T2DM and who had primary bariatric surgery were included. Results: After applying the inclusion and exclusion criteria, seven articles were included in the review. It was found that all three procedures had comparable T2DM remission. RYGB was noted to have the highest complication rate when compared to SG and OAGB. Importantly, it was noted that other predictive factors such as age, duration of diabetes, baseline HbA1c, BMI, and use of antidiabetic medication play a crucial role in T2DM remission. Conclusions: This systematic literature review confirms the existing data that all three bariatric surgeries induce remission of T2DM. Increasing in popularity, OAGB had comparable outcomes to RYGB and SG in inducing T2DM remission. In addition to the choice of bariatric surgery, there are other independent predictive factors that have an impact on T2DM remission. Further studies with larger sample sizes, longer follow-up periods, and studies that control confounding factors are required in this field. Full article
(This article belongs to the Special Issue Combining Gastroenterology and Surgery: New Treatment Insights)
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12 pages, 470 KiB  
Systematic Review
Fluoride Exposure and ADHD: A Systematic Review of Epidemiological Studies
by Gianluca Fiore, Federica Veneri, Rosaria Di Lorenzo, Luigi Generali, Marco Vinceti and Tommaso Filippini
Medicina 2023, 59(4), 797; https://doi.org/10.3390/medicina59040797 - 19 Apr 2023
Cited by 16 | Viewed by 7615
Abstract
Background and objectives: Attention deficit hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental disorder characterized by two dimensions: inattentiveness and hyperactivity/impulsivity. ADHD may be the result of complex interactions between genetic, biological and environmental factors possibly including fluoride exposure. Materials and methods: [...] Read more.
Background and objectives: Attention deficit hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental disorder characterized by two dimensions: inattentiveness and hyperactivity/impulsivity. ADHD may be the result of complex interactions between genetic, biological and environmental factors possibly including fluoride exposure. Materials and methods: A literature search was performed on 31 March 2023 in the following databases: PubMed, Embase and Web of Science. We defined the following inclusion criteria according to the PECOS statement: a healthy child and adolescent population (P), fluoride exposure of any type (E), comparison with low or null exposure (C), ADHD spectrum disorder (O), and ecological, cross-sectional, case–control and cohort studies (S). Results: We found eight eligible records corresponding to seven different studies investigating the effect of fluoride exposure on children and adolescents. One study had a cohort design and one a case–control one, while five were cross-sectional. Only three studies applied validated questionnaires for the purpose of ADHD diagnosis. As regards exposure assessment, levels of fluoride in urine and tap water were, respectively used in three and two studies, while two used both. Three studies reported a positive association with ADHD risk, all assessing exposure through fluoride levels. By using urinary fluoride, conversely, a positive correlation with inattention, internalizing symptoms, cognitive and psychosomatic problems was found in three studies, but no relation was found in the other one. Conclusions: The present review suggests that early exposure to fluoride may have neurotoxic effects on neurodevelopment affecting behavioral, cognitive and psychosomatic symptoms related to ADHD diagnosis. However, due to the heterogeneity of the studies included, current evidence does not allow to conclusively confirm that fluoride exposure is specifically linked to ADHD development. Full article
(This article belongs to the Special Issue Attention-Deficit/Hyperactivity Disorder in Adulthood and Adolescence)
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13 pages, 941 KiB  
Review
The Promise of Artificial Intelligence in Digestive Healthcare and the Bioethics Challenges It Presents
by Miguel Mascarenhas, João Afonso, Tiago Ribeiro, Patrícia Andrade, Hélder Cardoso and Guilherme Macedo
Medicina 2023, 59(4), 790; https://doi.org/10.3390/medicina59040790 - 18 Apr 2023
Cited by 19 | Viewed by 6414
Abstract
With modern society well entrenched in the digital area, the use of Artificial Intelligence (AI) to extract useful information from big data has become more commonplace in our daily lives than we perhaps realize. Medical specialties that rely heavily on imaging techniques have [...] Read more.
With modern society well entrenched in the digital area, the use of Artificial Intelligence (AI) to extract useful information from big data has become more commonplace in our daily lives than we perhaps realize. Medical specialties that rely heavily on imaging techniques have become a strong focus for the incorporation of AI tools to aid disease diagnosis and monitoring, yet AI-based tools that can be employed in the clinic are only now beginning to become a reality. However, the potential introduction of these applications raises a number of ethical issues that must be addressed before they can be implemented, among the most important of which are issues related to privacy, data protection, data bias, explainability and responsibility. In this short review, we aim to highlight some of the most important bioethical issues that will have to be addressed if AI solutions are to be successfully incorporated into healthcare protocols, and ideally, before they are put in place. In particular, we contemplate the use of these aids in the field of gastroenterology, focusing particularly on capsule endoscopy and highlighting efforts aimed at resolving the issues associated with their use when available. Full article
(This article belongs to the Special Issue Artificial Intelligence in Gastrointestinal Endoscopy: Disrupting Landscape in GI Practice)
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25 pages, 1772 KiB  
Article
Five Level Triage vs. Four Level Triage in a Quaternary Emergency Department: National Analysis on Waiting Time, Validity, and Crowding—The CREONTE (Crowding and RE-Organization National TriagE) Study Group
by Gabriele Savioli, Iride Francesca Ceresa, Maria Antonietta Bressan, Gaia Bavestrello Piccini, Angelica Varesi, Viola Novelli, Alba Muzzi, Sara Cutti, Giovanni Ricevuti, Ciro Esposito, Antonio Voza, Antonio Desai, Yaroslava Longhitano, Angela Saviano, Andrea Piccioni, Fabio Piccolella, Abdel Bellou, Christian Zanza and Enrico Oddone
Medicina 2023, 59(4), 781; https://doi.org/10.3390/medicina59040781 - 17 Apr 2023
Cited by 12 | Viewed by 8032
Abstract
Background and Objectives: Triage systems help provide the right care at the right time for patients presenting to emergency departments (EDs). Triage systems are generally used to subdivide patients into three to five categories according to the system used, and their performance must [...] Read more.
Background and Objectives: Triage systems help provide the right care at the right time for patients presenting to emergency departments (EDs). Triage systems are generally used to subdivide patients into three to five categories according to the system used, and their performance must be carefully monitored to ensure the best care for patients. Materials and Methods: We examined ED accesses in the context of 4-level (4LT) and 5-level triage systems (5LT), implemented from 1 January 2014 to 31 December 2020. This study assessed the effects of a 5LT on wait times and under-triage (UT) and over-triage (OT). We also examined how 5LT and 4LT systems reflected actual patient acuity by correlating triage codes with severity codes at discharge. Other outcomes included the impact of crowding indices and 5LT system function during the COVID-19 pandemic in the study populations. Results: We evaluated 423,257 ED presentations. Visits to the ED by more fragile and seriously ill individuals increased, with a progressive increase in crowding. The length of stay (LOS), exit block, boarding, and processing times increased, reflecting a net raise in throughput and output factors, with a consequent lengthening of wait times. The decreased UT trend was observed after implementing the 5LT system. Conversely, a slight rise in OT was reported, although this did not affect the medium-high-intensity care area. Conclusions: Introducing a 5LT improved ED performance and patient care. Full article
(This article belongs to the Section Emergency Medicine)
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9 pages, 693 KiB  
Case Report
Autoimmune Thyroiditis Shifting from Hashimoto’s Thyroiditis to Graves’ Disease
by Narantsatsral Daramjav, Junko Takagi, Hideyuki Iwayama, Kaori Uchino, Daisuke Inukai, Kazuo Otake, Tetsuya Ogawa and Akiyoshi Takami
Medicina 2023, 59(4), 757; https://doi.org/10.3390/medicina59040757 - 13 Apr 2023
Cited by 16 | Viewed by 5319
Abstract
In 15–20% of cases, Graves’ disease (GD) shifts to Hashimoto’s thyroiditis (HT), while the shift from HT to GD is rare. We present a case of a patient in whom HT shifted to GD, along with a literature review. A 50-year-old woman with [...] Read more.
In 15–20% of cases, Graves’ disease (GD) shifts to Hashimoto’s thyroiditis (HT), while the shift from HT to GD is rare. We present a case of a patient in whom HT shifted to GD, along with a literature review. A 50-year-old woman with myxedema was diagnosed with Hashimoto’s disease due to hypothyroidism and the presence of antibodies against thyroid peroxidase (TPOAb) and thyroglobulin (TgAb); she also had thyroid stimulating antibodies (TSAb) without any signs of GD. Although thyroid hormone replacement therapy improved her thyroid function, 2 months later, hyperthyroidism appeared and did not improve after discontinuation of the replacement therapy. The patient was diagnosed with GD, which improved with antithyroid agent administration. To date, only 50 cases regarding conversion from HT to GD have been reported. The median age is 44 years (range, 23–82 years), and the median time of conversion is 7 years (range, 0.1–27 years). The male-to-female ratio of HT conversion to GD is 1:9, closer to that of regular GD (1:10) than that of general HT (1:18). All patients received thyroid hormone replacement therapy for hypothyroidism due to HT. Continuous evaluation of TSAb levels is recommended in HT, particularly in cases of TSAb-positive and those under replacement, since it may help predict conversion to GD. Evaluating the clinical characteristics of patients with HT preceding GD is crucial to ensure appropriate treatment and reduce the risk of adverse events. Full article
(This article belongs to the Section Endocrinology)
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17 pages, 412 KiB  
Review
Risk Factors for Testicular Cancer: Environment, Genes and Infections—Is It All?
by Sertac Yazici, Dario Del Biondo, Giorgio Napodano, Marco Grillo, Francesco Paolo Calace, Domenico Prezioso, Felice Crocetto and Biagio Barone
Medicina 2023, 59(4), 724; https://doi.org/10.3390/medicina59040724 - 7 Apr 2023
Cited by 41 | Viewed by 7672
Abstract
The incidence of testicular cancer is steadily increasing over the past several decades in different developed countries. If on one side better diagnosis and treatment have shone a light on this disease, on the other side, differently from other malignant diseases, few risk [...] Read more.
The incidence of testicular cancer is steadily increasing over the past several decades in different developed countries. If on one side better diagnosis and treatment have shone a light on this disease, on the other side, differently from other malignant diseases, few risk factors have been identified. The reasons for the increase in testicular cancer are however unknown while risk factors are still poorly understood. Several studies have suggested that exposure to various factors in adolescence as well as in adulthood could be linked to the development of testicular cancer. Nevertheless, the role of environment, infections, and occupational exposure are undoubtedly associated with an increase or a decrease in this risk. The aim of this narrative review is to summarize the most recent evidence regarding the risk factors associated with testicular cancer, starting from the most commonly evaluated (cryptorchidism, family history, infections) to the newer identified and hypothesized risk factors. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Testicular Cancer)
18 pages, 3353 KiB  
Article
Efficacy and Safety of Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs) in Transcatheter Arterial Embolization (TAE) of Acute Non-Neurovascular Bleeding: A Multicenter Retrospective Cohort Study
by Roberto Minici, Massimo Venturini, Federico Fontana, Giuseppe Guzzardi, Armando Pingitore, Filippo Piacentino, Raffaele Serra, Andrea Coppola, Rita Santoro and Domenico Laganà
Medicina 2023, 59(4), 710; https://doi.org/10.3390/medicina59040710 - 4 Apr 2023
Cited by 16 | Viewed by 5271
Abstract
Background and Objectives: Transcatheter arterial embolization (TAE) is part of the daily practice of most interventional radiologists worldwide. The ideal liquid embolic agent is far from being identified. Non-adhesive liquid embolic agents (NALEA) harden from the outside to the inside, resulting in deep [...] Read more.
Background and Objectives: Transcatheter arterial embolization (TAE) is part of the daily practice of most interventional radiologists worldwide. The ideal liquid embolic agent is far from being identified. Non-adhesive liquid embolic agents (NALEA) harden from the outside to the inside, resulting in deep penetration, known as “magma-like” progression, which permits a more distal embolization with good control of the embolic material. This multicenter retrospective cohort study aims to assess the efficacy, feasibility and safety of transcatheter arterial embolization (TAE) with ethylene-vinyl alcohol (EVOH)-based NALEAs (Onyx and Squid) in acute bleeding outside of the neurovascular area. Materials and Methods: This study is a multicenter analysis of retrospectively collected data of consecutive patients who had undergone, from January 2015 to December 2022, transcatheter arterial embolization with non-adhesive EVOH-based agents in the setting of acute non-neurovascular bleeding. Results: Fifty-three patients underwent transcatheter arterial embolization for acute non-neurovascular bleeding. Eight (15.1%) procedures were performed in patients with coagulopathy. The most used concentration of EVOH-based NALEAs was 34 (i.e., 8%), with a mean dose of 0.5 (±0.3) mL. The mean CT-to-groin time, the mean procedure time, the mean CT-to-embolization time and the mean fluoroscopy time were 22.9 (±12.4) min, 27.5 (±7) min, 50.3 (±13.1) min and 7.5 (±2.8) min, respectively. Technical success was achieved in all cases with a 96.2% clinical success rate. Complications were recorded in six (11.3%) patients. No statistically significant differences were observed between the group of patients with coagulopathy and the group of patients without coagulopathy in terms of efficacy and safety endpoints. Conclusions: Transcatheter arterial embolization (TAE) performed with non-adhesive EVOH-based embolic agents is an effective, feasible and safe strategy for the management of acute non-neurovascular bleeding, even in the subgroup of patients with coagulopathy. Full article
(This article belongs to the Special Issue New Insights in Bleeding: From Diagnosis to Therapy)
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11 pages, 706 KiB  
Perspective
Changes in the Global Epidemiology of Type 1 Diabetes in an Evolving Landscape of Environmental Factors: Causes, Challenges, and Opportunities
by Ioannis Ogrotis, Theocharis Koufakis and Kalliopi Kotsa
Medicina 2023, 59(4), 668; https://doi.org/10.3390/medicina59040668 - 28 Mar 2023
Cited by 34 | Viewed by 7619
Abstract
The worldwide incidence of type 1 diabetes mellitus (T1DM) has increased in recent decades. The reasons behind this phenomenon are not yet fully understood. Early life infections, prenatal and perinatal factors, and diet composition have been associated with the triggering of autoimmunity and [...] Read more.
The worldwide incidence of type 1 diabetes mellitus (T1DM) has increased in recent decades. The reasons behind this phenomenon are not yet fully understood. Early life infections, prenatal and perinatal factors, and diet composition have been associated with the triggering of autoimmunity and the risk of presentation of T1DM. However, the rapid increase in new cases of the disease raises the hypothesis that lifestyle factors, which have traditionally been associated with type 2 diabetes, such as obesity and unhealthy eating patterns could also play a role in the genesis of autoimmune diabetes. This article aims to highlight the changing epidemiology of T1DM and the importance of properly recognizing the environmental factors behind it, as well as the connections with the pathogenesis of the disorder and the need to prevent or delay T1DM and its long-term complications. Full article
(This article belongs to the Special Issue Clinical Research in the Diagnosis and Treatment of Pediatric Endocrinology)
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8 pages, 3898 KiB  
Article
Short-Term Outcomes of Intravitreal Faricimab Injection for Diabetic Macular Edema
by Sentaro Kusuhara, Maya Kishimoto-Kishi, Wataru Matsumiya, Akiko Miki, Hisanori Imai and Makoto Nakamura
Medicina 2023, 59(4), 665; https://doi.org/10.3390/medicina59040665 - 27 Mar 2023
Cited by 18 | Viewed by 4684
Abstract
Background and Objectives: Faricimab is a novel bispecific antibody with Fab regions inhibiting both vascular endothelial growth factor-A and angiopoietin-2. Therefore, this study aimed to obtain short-term outcomes of intravitreal injection of faricimab (IVF) for the treatment of diabetic macular edema (DME) [...] Read more.
Background and Objectives: Faricimab is a novel bispecific antibody with Fab regions inhibiting both vascular endothelial growth factor-A and angiopoietin-2. Therefore, this study aimed to obtain short-term outcomes of intravitreal injection of faricimab (IVF) for the treatment of diabetic macular edema (DME) in daily clinical practice. Materials and Methods: A retrospective review was carried out on consecutive patients with DME who had been treated with IVF and were followed up for at least 1 month. Outcome measures included changes in logMAR best-corrected visual acuity (logMAR BCVA), central retinal thickness (CRT), number of IVF administrations, and safety. Clinical outcomes were also compared between the treatment-naïve and switch groups. Results: A total of 21 consecutive DME eyes from 19 patients were identified. The mean number of IVFs was 1.6 ± 0.8 during the mean follow-up time of 5.5 months. The overall mean logMAR BCVA following IVF was 0.236, 0.204, 0.190, and 0.224 at baseline, 1, 3, and 6 months, respectively, without a significant change from baseline to 1 month (p = 0.176) or for 6 months (p = 0.923). The overall mean CRT (μm) following IVF was 400.6, 346.6, 342.1, and 327.5 at baseline, 1, 3, and 6 months, respectively. CRT significantly decreased from baseline to 1 month (p = 0.001) but did not reach a significant level over 6 months following IVF (p = 0.070). No significant difference in BCVA or CRT was observed between the treatment-naïve and switch groups. No serious safety concerns were noted. Conclusions: IVF for the treatment of DME may preserve visual acuity and improve macular thickness without serious safety concerns in the short term in a real-world clinical setting. Full article
(This article belongs to the Special Issue Multidisciplinary Approaches for Managing Ophthalmic Complications of Diabetes)
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18 pages, 1609 KiB  
Review
A Comprehensive Review on Bariatric Endoscopy: Where We Are Now and Where We Are Going
by Aurelio Mauro, Francesca Lusetti, Davide Scalvini, Marco Bardone, Federico De Grazia, Stefano Mazza, Lodovica Pozzi, Valentina Ravetta, Laura Rovedatti, Carmelo Sgarlata, Elena Strada, Francesca Torello Viera, Letizia Veronese, Daniel Enrique Olivo Romero and Andrea Anderloni
Medicina 2023, 59(3), 636; https://doi.org/10.3390/medicina59030636 - 22 Mar 2023
Cited by 21 | Viewed by 8724
Abstract
Background: Obesity is a chronic disease that impairs quality of life and leads to several comorbidities. When conservative therapies fail, bariatric surgical options such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most effective therapies to induce persistent weight loss. [...] Read more.
Background: Obesity is a chronic disease that impairs quality of life and leads to several comorbidities. When conservative therapies fail, bariatric surgical options such as Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most effective therapies to induce persistent weight loss. Over the last two decades, bariatric endoscopy has become a valid alternative to surgery in specific settings. Primary bariatric endoscopic therapies: Restrictive gastric procedures, such as intragastric balloons (IGBs) and endoscopic gastroplasty, have been shown to be effective in inducing weight loss compared to diet modifications alone. Endoscopic gastroplasty is usually superior to IGBs in maintaining weight loss in the long-term period, whereas IGBs have an established role as a bridge-to-surgery approach in severely obese patients. IGBs in a minority of patients could be poorly tolerated and require early removal. More recently, novel endoscopic systems have been developed with the combined purpose of inducing weight loss and improving metabolic conditions. Duodenal mucosal resurfacing demonstrated efficacy in this field in its early trials: significant reduction from baseline of HbA1c values and a modest reduction of body weight were observed. Other endoscopic malabsorptive have been developed but need more evidence. For example, a pivotal trial on duodenojejunal bypasses was stopped due to the high rate of severe adverse events (hepatic abscesses). Optimization of these more recent malabsorptive endoscopic procedures could expand the plethora of bariatric patients that could be treated with the intention of improving their metabolic conditions. Revisional bariatric therapies: Weight regain may occur in up to one third of patients after bariatric surgery. Different endoscopic procedures are currently performed after both RYGB and SG in order to modulate post-surgical anatomy. The application of argon plasma coagulation associated with endoscopic full-thickness suturing systems (APC-TORe) and Re-EndoSleeve have shown to be the most effective endoscopic treatments after RYGB and SG, respectively. Both procedures are usually well tolerated and have a very low risk of stricture. However, APC-TORe may sometimes require more than one session to obtain adequate final results. The aim of this review is to explore all the currently available primary and revisional endoscopic bariatric therapies focusing on their efficacy and safety and their potential application in clinical practice. Full article
(This article belongs to the Special Issue Digestive Endoscopy: Inside the Evidence and Outside)
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24 pages, 32179 KiB  
Review
Anatomical Variations of the External Jugular Vein: A Pictorial and Critical Review
by Mugurel Constantin Rusu, Răzvan Costin Tudose, Alexandra Diana Vrapciu, Corneliu Toader and Şerban Arghir Popescu
Medicina 2023, 59(3), 622; https://doi.org/10.3390/medicina59030622 - 21 Mar 2023
Cited by 12 | Viewed by 15122
Abstract
(1) Background: The external jugular vein (EJV) descends on the sternocleidomastoid muscle to drain deep into the subclavian vein. Anatomical variations of the EJV are relevant for identification of the greater auricular nerve, flap design and preparation, or EJV cannulation. (2) Methods [...] Read more.
(1) Background: The external jugular vein (EJV) descends on the sternocleidomastoid muscle to drain deep into the subclavian vein. Anatomical variations of the EJV are relevant for identification of the greater auricular nerve, flap design and preparation, or EJV cannulation. (2) Methods: Different publications were comprehensively reviewed. Dissections and three-dimensional volume renderings of peculiar cases were used to sample the review. (3) Results: Different anatomical possibilities of the EJV were critically reviewed and documented: fenestrations and double fenestrations, true or false duplications, triplication, absence, aberrant origin or course, or bifurcation. Tributaries of the EJV, such as the facial and posterior external jugular veins, are discussed. The internal jugular vein termination of the EJV is also presented. (4) Conclusions: Care should be taken when different morphological features of the EJV are encountered or reported. Full article
(This article belongs to the Topic Human Anatomy and Pathophysiology, 2nd Volume)
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9 pages, 1116 KiB  
Article
Tinnitus Prevalence in the Adult Population—Results from the Gutenberg Health Study
by Berit Hackenberg, Karoline O’Brien, Julia Döge, Karl J. Lackner, Manfred E. Beutel, Thomas Münzel, Norbert Pfeiffer, Andreas Schulz, Irene Schmidtmann, Philipp S. Wild, Christoph Matthias and Katharina Bahr-Hamm
Medicina 2023, 59(3), 620; https://doi.org/10.3390/medicina59030620 - 20 Mar 2023
Cited by 20 | Viewed by 8101
Abstract
Background and Objectives: Tinnitus is a common symptom in medical practice, although data on its prevalence vary. As the underlying pathophysiological mechanism is still not fully understood, hearing loss is thought to be an important risk factor for the occurrence of tinnitus. [...] Read more.
Background and Objectives: Tinnitus is a common symptom in medical practice, although data on its prevalence vary. As the underlying pathophysiological mechanism is still not fully understood, hearing loss is thought to be an important risk factor for the occurrence of tinnitus. The aim of this study was to assess tinnitus prevalence in a large German cohort and to determine its dependence on hearing impairment. Materials and Methods: The Gutenberg Health Study (GHS) is a population-based cohort study and representative for the population of Mainz and its district. Participants were asked whether they suffer from tinnitus and how much they are burdened by it. Extensive audiological examinations using bone- and air-conduction were also performed. Results: 4942 participants (mean age: 61.0, 2550 men and 2392 women) were included in the study. The overall prevalence of tinnitus was 26.1%. Men were affected significantly more often than women. The prevalence of tinnitus increased with age, peaking at ages 75 to 79 years. Considering only annoying tinnitus, the prevalence was 9.8%. Logistic regression showed that participants with severe to complete hearing loss (>65 dB) were more likely to have tinnitus. Conclusions: Tinnitus is a common symptom, and given demographic changes, its prevalence is expected to increase. Full article
(This article belongs to the Section Epidemiology & Public Health)
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