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Biologically-Based Notions About Uterine Bleeding During Myomectomy: Reasoning on Tradition and New Concepts
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The Potential Effects of Sensor-Based Virtual Reality Telerehabilitation on Lower Limb Function in Patients with Chronic Stroke Facing the COVID-19 Pandemic: A Retrospective Case-Control Study
Journal Description
Medical Sciences
Medical Sciences
is an international, peer-reviewed, open access journal, providing a platform for advances in basic, translational and clinical research, published quarterly online by MDPI. The Korean Society of Physical Medicine (KSPM) is affiliated with Medical Sciences and its members receive discounts on the article processing charges.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, ESCI (Web of Science), PubMed, PMC, MEDLINE, CAPlus / SciFinder, and other databases.
- Journal Rank: JCR - Q1 (Medicine, General and Internal) / CiteScore - Q1 (General Medicine)
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 24.3 days after submission; acceptance to publication is undertaken in 2.9 days (median values for papers published in this journal in the first half of 2025).
- Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
- Sections: published in 12 topical sections.
Impact Factor:
4.4 (2024)
Latest Articles
Beyond Obesity
Med. Sci. 2025, 13(3), 176; https://doi.org/10.3390/medsci13030176 - 4 Sep 2025
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Diagnosis of clinical obesity has been highlighted by the recent publication from a Commission Report in The Lancet, suggesting the addition of a new diagnostic category, “Preclinical Obesity,” to the already existing ones. Diagnostic criteria for obesity began in the first half
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Diagnosis of clinical obesity has been highlighted by the recent publication from a Commission Report in The Lancet, suggesting the addition of a new diagnostic category, “Preclinical Obesity,” to the already existing ones. Diagnostic criteria for obesity began in the first half of the 20th century, when life insurance companies provided information tables of ideal body weight levels and/or desirable body weight levels based on actuarial associations with mortality. This was replaced by the body mass index or BMI in the third quarter of the 20th century. This tool documented the epidemic of obesity in the US in the last three decades of the 20th century. The recognition of the importance of fat distribution, pioneered by the work of Jean Vague in France, provided a new understanding of obesity. The limitations of BMI and the availability of effective new treatments have heightened the need for new diagnostic guidelines. Obesity represents an increase in body fat and an alteration in its distribution and function. But at the same time, obesity is a stigmatized word and a pejorative term. This communication discusses ways to better diagnose the increase in body fat and its abnormal distribution. We ask whether there is an alternative word to replace obesity and suggest that adiposity or healthy weight could be options.
Full article
Open AccessSystematic Review
Diagnostic Accuracy of Neutrophil Gelatinase-Associated Lipocalin in Peritoneal Effluent and Ascitic Fluid for Early Detection of Peritonitis: A Systematic Review and Meta-Analysis
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Manuel Luis Prieto-Magallanes, José David González-Barajas, Violeta Aidee Camarena-Arteaga, Bladimir Díaz-Villavicencio, Juan Alberto Gómez-Fregoso, Ana María López-Yáñez, Ruth Rodríguez-Montaño, Judith Carolina De Arcos-Jiménez and Jaime Briseno-Ramírez
Med. Sci. 2025, 13(3), 175; https://doi.org/10.3390/medsci13030175 - 4 Sep 2025
Abstract
Background: Peritonitis in peritoneal dialysis and cirrhosis remains common and leads to morbidity. Neutrophil gelatinase-associated lipocalin (NGAL) has been evaluated as a rapid adjunctive biomarker. Methods: Following PRISMA-DTA and PROSPERO registration (CRD420251105563), we searched MEDLINE, Embase, Cochrane Library, LILACS, Scopus, and Web of
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Background: Peritonitis in peritoneal dialysis and cirrhosis remains common and leads to morbidity. Neutrophil gelatinase-associated lipocalin (NGAL) has been evaluated as a rapid adjunctive biomarker. Methods: Following PRISMA-DTA and PROSPERO registration (CRD420251105563), we searched MEDLINE, Embase, Cochrane Library, LILACS, Scopus, and Web of Science from inception to 31 December 2024, and ran an update on 30 June 2025 (no additional eligible studies). Diagnostic accuracy studies measuring NGAL in peritoneal/ascitic fluid against guideline reference standards were included. When 2 × 2 data were not reported, we reconstructed cell counts from published metrics using a prespecified, tolerance-bounded algorithm (two studies). Accuracy was synthesized with a bivariate random effects (Reitsma) model; 95% prediction intervals (PIs) were used to express heterogeneity; small-study effects were assessed by Deeks’ test. Results: Thirteen studies were included qualitatively and ten were entered into a meta-analysis (573 cases; 833 controls). The pooled sensitivity was 0.95 (95% CI, 0.90–0.97) and specificity was 0.86 (0.70–0.94); likelihood ratios were LR+ ≈7.0 and LR− 0.06. Between-study variability was concentrated on specificity: the PI for a new setting was 0.75–0.98 for sensitivity and 0.23–0.99 for specificity. Deeks’ test showed evidence of small-study effects in the primary analysis; assay/platform and thresholding contributed materially to heterogeneity. Conclusions: NGAL in peritoneal/ascitic fluid demonstrates high pooled sensitivity but variable specificity across settings. Given the wide prediction intervals and the signal for small-study effects, NGAL should be interpreted as an adjunct to guideline-based criteria—not as a stand-alone rule-out test. Standardization of pre-analytics and assay-specific, locally verified thresholds, together with prospective multicenter validations and impact/economic evaluations, are needed to define its clinical role.
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(This article belongs to the Section Hepatic and Gastroenterology Diseases)
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Open AccessSystematic Review
Systemic Lupus Erythematosus in Pregnancy
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Angeliki Gerede, Efthymios Oikonomou, Sofoklis Stavros, Anastasios Potiris, Panagiota Papasozomenou, Menelaos Zafrakas, Ekaterini Domali, Nikolaos Nikolettos and Makarios Eleutheriades
Med. Sci. 2025, 13(3), 174; https://doi.org/10.3390/medsci13030174 - 4 Sep 2025
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Background/Objectives: The reciprocal relationship between Systemic Lupus Erythematosus (SLE) and pregnancy continues to elude the scientific community’s approaches for a clear understanding. Multiple studies have reached dissimilar results regarding the impact that SLE exerts on pregnancy, whilst the potential risks of lupus pregnancies
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Background/Objectives: The reciprocal relationship between Systemic Lupus Erythematosus (SLE) and pregnancy continues to elude the scientific community’s approaches for a clear understanding. Multiple studies have reached dissimilar results regarding the impact that SLE exerts on pregnancy, whilst the potential risks of lupus pregnancies continue to encumber women of childbearing age. Whether SLE predisposes to a complicated pregnancy and conversely whether pregnancy impacts the progression of the disease is aimed to be assessed by this systematic review. Methods: A thorough search of original research articles was conducted using online databases (PubMed, Google Scholar), initially identifying 877 potential studies. Results: Upon further assessment for relevance and eligibility, 65 articles were selected for detailed analysis. Conclusions: We concluded that, even though advanced approaches have optimized SLE prognosis and treatment, the complexity of the disease requires further extensive study in order to grasp the mechanism behind the susceptibility to adverse complications. SLE pregnancy cannot be considered without risk. Comprehensive, multidisciplinary, and continuous monitoring of the disease course prior to, during, and after pregnancy is necessary to ensure optimal recovery and minimal maternal and fetal complications. Tailored treatments and novel biomarkers would move us towards precise patient-centered care that addresses each patient’s unique disease profile and pregnancy needs, ultimately improving both maternal and fetal outcomes in women with systemic lupus erythematosus.
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Open AccessSystematic Review
Minimally Invasive Left Ventricular Assist Device Implantation: A Systematic Review of Current Evidence on Clinical Outcomes and Surgical Approaches
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Baglan Turtabayev, Seitkhan Joshibayev, Umit Kervan, Samat Zharmenov, Yerbol Ustemirov, Almas Begdildayev and Gali Iskakbayev
Med. Sci. 2025, 13(3), 173; https://doi.org/10.3390/medsci13030173 - 4 Sep 2025
Abstract
Background/Objectives: Minimally invasive cardiac surgical (MICS) approaches to the implantation of left ventricular assist devices (LVADs) have gained increasing interest as alternatives to full median sternotomy (FS), particularly in patients with prior cardiac surgeries or elevated surgical risk. However, evidence regarding their safety,
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Background/Objectives: Minimally invasive cardiac surgical (MICS) approaches to the implantation of left ventricular assist devices (LVADs) have gained increasing interest as alternatives to full median sternotomy (FS), particularly in patients with prior cardiac surgeries or elevated surgical risk. However, evidence regarding their safety, feasibility, and clinical outcomes remains fragmented. This systematic review aimed to evaluate the effectiveness and safety of minimally invasive techniques for LVAD implantation in comparison to standard sternotomy, with a focus on mortality, perioperative complications, intensive care unit (ICU) stay, and infection rates. Methods: A comprehensive literature search was conducted in PubMed, Web of Science, Science Direct, Cochrane Library, and Google Scholar up to 1 January 2025. Studies were included if they reported on adult patients undergoing LVAD implantation via minimally invasive thoracotomy or sternotomy-sparing approaches, with or without comparator groups. Data were extracted and synthesized qualitatively; the Newcastle–Ottawa Scale (NOS) was applied to assess the methodological quality of the included cohort and retrospective comparative studies. Results: A total of 12 studies involving 1448 patients were included (584 received MICS and 862 received FS). MICS techniques have demonstrated comparable short and mid-term survival outcomes, with trends toward reduced ICU stay, fewer reoperations for bleeding, and lower incidence of driveline infections. Some studies reported longer operative and cardiopulmonary bypass times in the MICS group. Among high-risk cohorts, such as patients with prior sternotomies or significant comorbidities, MICS was associated with lower morbidity and acceptable safety profiles. However, heterogeneity in patient selection, surgical protocols, and outcome definitions limited quantitative synthesis. Conclusions: Minimally invasive LVAD implantation is a viable alternative to conventional sternotomy in selected patient populations. While current data suggest favorable perioperative outcomes and equivalent survival, high-quality prospective studies are needed to confirm long-term benefits and to guide patient selection. MICS approaches should be considered within multidisciplinary teams experienced in advanced heart failure surgery.
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(This article belongs to the Section Cardiovascular Disease)
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Open AccessReview
The Association of MicroRNA-21 with Carotid Artery Disease and Ischemic Stroke: From Pathophysiology to Clinical Implications and Potential Therapy
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Aleksandar Sič, Marko Atanasković, Alyan Ahmed, Ivan Petrović, Filip Simović, Boris Burnjaković, Una Tonković, Aarish Manzar, Simra Shadab, Selena Gajić, Danka Bjelić, Vidna Karadžić Ristanović and Marko Baralić
Med. Sci. 2025, 13(3), 172; https://doi.org/10.3390/medsci13030172 - 3 Sep 2025
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Ischemic stroke is one of the leading causes of morbidity and mortality worldwide, with carotid atherosclerosis being its key etiological factor. MicroRNA-21 (miR-21) regulates intracellular signal pathways responsible for vascular changes and ischemic brain injury, and is recognized as a potential diagnostic and
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Ischemic stroke is one of the leading causes of morbidity and mortality worldwide, with carotid atherosclerosis being its key etiological factor. MicroRNA-21 (miR-21) regulates intracellular signal pathways responsible for vascular changes and ischemic brain injury, and is recognized as a potential diagnostic and prognostic biomarker. It modifies the activity of macrophages (MΦ) and vascular smooth muscle cells, causing inflammation and affecting the stability of atherosclerotic plaques. A deficiency of miR-21 in macrophages stimulates the inflammatory response and plaque growth. It promotes both the synthesis of extracellular matrix, stabilizing the plaque, and the degradation of the fibrin cap, which leads to plaque instability. The effect of miR-21 on endothelial cells differs: it stimulates both NO· synthesis and inflammation. During ischemic stroke, miR-21 demonstrates neuroprotective effects by modulating post-ischemic inflammation and protecting the integrity of the blood–brain barrier. Therapy targeting miR-21 shows potential in experimental models, but it requires cell-specific delivery and precise timing. Further research efforts should focus on the effects of miR-21 on different cell types, as well as the development of new technologies for diagnostic and therapeutic applications.
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Open AccessArticle
Sociodemographic, Lifestyle, and Social Isolation Correlates of TyG, METS-IR, and SPISE-IR Scores in a Large Spanish Working Population
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Pere Riutord-Sbert, Pedro Juan Tárraga López, Ángel Arturo López-González, Irene Coll Campayo, Carla Busquets-Cortés and José Ignacio Ramírez Manent
Med. Sci. 2025, 13(3), 171; https://doi.org/10.3390/medsci13030171 - 3 Sep 2025
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Background: Insulin resistance (IR) is a central feature in the pathophysiology of type 2 diabetes and a major determinant of cardiovascular morbidity. While sociodemographic and lifestyle factors are established contributors, the role of social isolation as a potential determinant of IR remains underexplored
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Background: Insulin resistance (IR) is a central feature in the pathophysiology of type 2 diabetes and a major determinant of cardiovascular morbidity. While sociodemographic and lifestyle factors are established contributors, the role of social isolation as a potential determinant of IR remains underexplored in working populations. Objectives: To assess the association between sociodemographic variables, lifestyle habits, and social isolation with three validated insulin resistance indexes—Triglyceride–Glucose (TyG), Metabolic Score for Insulin Resistance (METS-IR), and Single Point Insulin Sensitivity Estimator (SPISE-IR)—in a large cohort of Spanish workers. Methods: A cross-sectional study was conducted involving 117,298 workers from occupational health centers across Spain. Sociodemographic data, lifestyle factors (Mediterranean diet adherence, physical activity, and smoking), and social support levels (ENRICHD Social Support Instrument) were recorded. Biochemical and anthropometric parameters were obtained through standardized protocols. Logistic regression models estimated the odds ratios (ORs) and 95% confidence intervals (CIs) for high IR risk across the three indexes, adjusting for potential confounders. Results: Male sex, older age, lower social class, smoking, low Mediterranean diet adherence, physical inactivity, and low social support were independently associated with higher odds of IR in all three indexes. The strongest associations were observed for physical inactivity (OR range 6.21–9.95) and low social support (OR range 1.98–3.76). Although effect sizes varied by index, patterns of association were consistent. Conclusions: Sociodemographic, lifestyle, and psychosocial factors, including social isolation, are strongly associated with insulin resistance in working populations. Integrating social support assessment into occupational health strategies may enhance early detection and prevention of IR and related cardiometabolic diseases.
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Open AccessArticle
Clinical and Paraclinical Predictors of Survival in Amyotrophic Lateral Sclerosis: Results from a Three-Year Longitudinal Cohort Study
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Anca Motataianu, Laura Barcutean, Ioana Ormenisan, Medeea Roman, Rodica Balasa, Zoltan Bajko and Mihai Dumitreasa
Med. Sci. 2025, 13(3), 170; https://doi.org/10.3390/medsci13030170 - 3 Sep 2025
Abstract
Background: Amyotrophic Lateral Sclerosis (ALS) is a heterogeneous neurodegenerative disorder with highly variable progression and survival. Identifying early prognostic indicators is essential for patient stratification and management. Objectives: To evaluate clinical, respiratory, and functional predictors of survival in a prospective cohort of ALS
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Background: Amyotrophic Lateral Sclerosis (ALS) is a heterogeneous neurodegenerative disorder with highly variable progression and survival. Identifying early prognostic indicators is essential for patient stratification and management. Objectives: To evaluate clinical, respiratory, and functional predictors of survival in a prospective cohort of ALS patients over a three-year period. Methods: A cohort of 44 ALS patients was followed from 2022 to 2025. Demographic and anthropometric characteristics, clinical data including ALS subtypes and phenotypes, site of onset, revised ALS functional rating scale (ALSFRS-R) and subscores, ALSFRS-R progression rate, time to diffusion and generalization, spirometric parameters, and progression patterns were assessed. Survival analysis was performed using Kaplan–Meier estimates and univariate and multivariate Cox proportional hazard regression analysis. Results: The overall median survival time was 53 months. Univariate Cox regression revealed that older age at onset, shorter diagnostic delay, lower respiratory function, lower vitamin D levels, and rapid vertical progression were associated with reduced survival. Bulbar-onset phenotype and rapid disease progression rate (ΔPR) were significant predictors of mortality. Specific ALSFRS-R subscores also showed prognostic relevance. A longer time to diffusion as well as a longer time to generalization were significantly associated with prolonged survival. Multivariate analysis confirmed the independent prognostic value of ΔPR, time to diagnosis, and ALSFRS-R swallowing and handwriting subscores. Conclusions: This study supports the prognostic value of previously studied clinical and paraclinical markers in ALS and proposes novel predictors, ALSFRS-R handwriting, and time to diffusion, which require further validation in larger prospective cohorts.
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(This article belongs to the Section Neurosciences)
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Evaluation of the Clinical Efficacy of a Novel Palmitoylethanolamide–Equisetum arvense Supplement for the Management of Chronic Pain: Findings from a Prospective Clinical Trial
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Marco Invernizzi, Simone Mulè, Lorenzo Lippi, Rebecca Galla, Arianna Folli, Sara Ferrari, Domenico Tiso and Francesca Uberti
Med. Sci. 2025, 13(3), 169; https://doi.org/10.3390/medsci13030169 - 3 Sep 2025
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Background: Chronic pain represents a major therapeutic challenge due to the limited efficacy and tolerability of conventional pharmacological treatments. Equisetum arvense L., a medicinal plant with potent antioxidant properties, and palmitoylethanolamide (PEA), an endogenous fatty acid amide with well-established anti-inflammatory and analgesic
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Background: Chronic pain represents a major therapeutic challenge due to the limited efficacy and tolerability of conventional pharmacological treatments. Equisetum arvense L., a medicinal plant with potent antioxidant properties, and palmitoylethanolamide (PEA), an endogenous fatty acid amide with well-established anti-inflammatory and analgesic effects, are increasingly recognised as promising nutraceutical agents. Methods: This prospective, single-centre clinical trial aimed to evaluate the efficacy and safety of a novel oral supplement (Assonal®PEA) combining 600 mg of PEA and 300 mg of Equisetum arvense L. in improving the reduction of pain and quality of life in patients with chronic pain, also obtaining information on the patient’s state of satisfaction after the treatment. Fifty patients suffering from chronic pain (low back pain and radiculopathy) for two months were enrolled and received the supplement over eight weeks in a tapered regimen (two tablets daily for two weeks, followed by one tablet daily). Results: Clinical outcomes were evaluated using validated instruments, including the Numeric Pain Rating Scale (NPRS), Verbal Rating Scale (VRS), Short-Form McGill Pain Questionnaire (SF-MPQ), Global Perceived Effect (GPE), and EuroQol-5D-5L. Results showed a significant decrease in pain intensity (NPRS: −3.8 points; VRS: −2.1 points; p < 0.0001), along with meaningful improvements in patient-perceived benefit, pain descriptors, and quality of life (EQ-5D-5L: +35%; p < 0.0001). Conclusions: These findings endorse the use of this novel PEA–Equisetum arvense formulation as a safe, well-tolerated, and potentially effective supplementary intervention for managing chronic pain. No adverse events were reported, and the overall response rate reached 94%.
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Open AccessSystematic Review
Comparison of HyFoSy, HyCoSy and X-Ray Hysterosalpingography in the Assessment of Tubal Patency in Women with Infertility: A Systematic Review and Meta-Analysis
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Emmanouil M. Xydias, Vasileios Emmanouil, Maria Koutini, Anna Ntanika, Elias Tsakos, Matthew Prior, Ippokratis Sarris, Ioannis Thanasas, Alexandros Daponte and Apostolos C. Ziogas
Med. Sci. 2025, 13(3), 168; https://doi.org/10.3390/medsci13030168 - 2 Sep 2025
Abstract
Background/Objectives: Tubal dysfunction may be a contributing factor in up to 35% of infertility cases, rendering tubal patency assessment a vital component of the infertility workup. In this review we examined the diagnostic efficacy and tolerability of hysterosalpingo-foam sonography (HyFoSy) and compared
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Background/Objectives: Tubal dysfunction may be a contributing factor in up to 35% of infertility cases, rendering tubal patency assessment a vital component of the infertility workup. In this review we examined the diagnostic efficacy and tolerability of hysterosalpingo-foam sonography (HyFoSy) and compared it to hysterosalpingography (HSG) and hysterosalpingo-contrast sonography (HyCoSy). Methods: Online databases were systematically searched and evaluated according to the PRISMA 2020 guidelines. Statistical heterogeneity was assessed. Diagnostic sensitivity, specificity and inter-method agreement were evaluated, along with mean pain scores. Results: This analysis included data from 9 studies and 1354 patients with conclusive diagnostic data from 2422 tubes and 1294 patients with data on intra-procedural pain. With regard to HyFoSy and HyCoSy comparison, pooled sensitivity was 87% and 69%, respectively (p = 0.074), while pooled specificity was 95% and 85%, respectively, favoring HyFoSy (p < 0.001). HyFoSy was more tolerable with regard to pain, but this was not statistically significant. Regarding the HyFoSy and HSG comparison, pooled Cohen’s k was 0.38, indicating fair-moderate agreement. In subsequent analysis, with HSG as a reference standard, HyFoSy demonstrated low sensitivity (61%) but high specificity (87%). With regard to experienced pain, HyFoSy and HSG had a difference of 2.4 units on a 10-point scale, favoring HyFoSy (p < 0.001). Conclusions: HyFoSy was superior to HyCoSy and may be used as a first-line tubal assessment method, with HSG being utilized in inconclusive cases. However, further research is still required due to the small number of available studies.
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(This article belongs to the Section Gynecology)
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Open AccessArticle
Is Basic Training in Palliative Care Sufficient to Guarantee the Improvement of Knowledge and Skills in This Area?—A Medical Knowledge Assessment Study
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Rita Monteiro, Hugo Ribeiro, César Vinicius José, Joana Brandão Silva, Ricardo Marinho, João Rocha Neves and Marília Dourado
Med. Sci. 2025, 13(3), 167; https://doi.org/10.3390/medsci13030167 - 2 Sep 2025
Abstract
Background: With the growing population requiring palliative care (PC), it is essential to enhance and expand the availability of this care in Portugal. Throughout both pre-graduate and post-graduate training for doctors, there are limited learning opportunities in this area, necessitating further training
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Background: With the growing population requiring palliative care (PC), it is essential to enhance and expand the availability of this care in Portugal. Throughout both pre-graduate and post-graduate training for doctors, there are limited learning opportunities in this area, necessitating further training to improve the knowledge and skills needed to support patients at the end of their lives. Studies conducted on doctors and medical students have demonstrated a clear need for improved training. Additionally, others have noted significant benefits for residents who underwent post-graduate training in this field while caring for patients nearing the end of life. This study aims to evaluate the impact of a basic training program on improving palliative care knowledge among medical doctors. Methods: This was a cross-sectional study, carried out by sharing a questionnaire with the participants enrolled in the “Intensive Palliative Medicine Course” organized by a group of doctors in November 2021. The questionnaire was completed by participants at three moments of training (before, immediately after the course, and 6 months after the course), and it contained questions to assess the theoretical knowledge, skills, and abilities obtained. Results: In total, 93 out of 204 (45.58%) doctors responded before training, 80 (39.21%) immediately after training, and 36 (17.64%) six months after training. After training, an improvement in knowledge was observed (p = 0.014), which did not appear to persist six months after the course (p = 0.574). However, six months after training, an increase in doctors’ confidence in referring patients to Palliative Care Teams or Units (p = 0.009) and medicating patients who may be in the last months of their lives (p = 0.005) was observed. Conclusions: The results regarding theoretical medical knowledge did not seem to stabilize over time, so it may be necessary to create more specific training opportunities for the medical profession. An increase in doctors’ self-confidence in referring and medicating patients with palliative care needs was observed, which may be associated with better medical care provided. It is necessary to carry out more studies to evaluate the impact of combined theoretical and practical training on the knowledge and confidence of doctors in PC.
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Open AccessArticle
Lavender–Neroli Aromatherapy for Reducing Dental Anxiety and Pain in Children During Anesthesia: A Two-Arm Randomized Controlled Trial
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Rama Abdalhai, Yasser Alsayed Tolibah, Racha Alkhatib, Chaza Kouchaji and Ziad D. Baghdadi
Med. Sci. 2025, 13(3), 166; https://doi.org/10.3390/medsci13030166 - 1 Sep 2025
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Objective. This randomized controlled trial evaluated the efficacy of lavender–neroli oil aromatherapy in managing dental anxiety and pain in children undergoing inferior alveolar nerve block (IANB) anesthesia. Methods. Fifty-four children aged 6–11 years were randomly assigned to either a control group or an
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Objective. This randomized controlled trial evaluated the efficacy of lavender–neroli oil aromatherapy in managing dental anxiety and pain in children undergoing inferior alveolar nerve block (IANB) anesthesia. Methods. Fifty-four children aged 6–11 years were randomly assigned to either a control group or an aromatherapy group. Children in the control group were asked to wear a regular scented-free nitrous oxide mask. Children in the control group were asked to wear a regular scented-free nitrous oxide mask. Children in the intervention group inhaled lavender–neroli oil via a nitrous oxide nasal mask for 5 min before and during IANB administration. Anxiety and pain levels were assessed pre-and post-treatment using the Facial Image Scale (FIS), Face–Legs–Activity–Cry–Consolability (FLACC) scale, and vital signs (heart rate, blood pressure, oxygen saturation). The collected data were statistically analyzed using SPSS software 20. The Mann–Whitney U test was used for analyzing FIS results, and the independent T test and T Paired test were used for analyzing heart rate, blood pressure, and oxygen saturation results. Results. Results demonstrated significantly lower anxiety, heart rate, blood pressure, and pain scores in the aromatherapy group compared to the control group (p < 0.05), with no significant change in oxygen saturation. Conclusions. Lavender–neroli aromatherapy is a safe, low-cost, and effective adjunct to reduce anxiety and discomfort during pediatric dental anesthesia.
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Open AccessArticle
Impact of Nutritional Status on Pulmonary Function in Pediatric Cystic Fibrosis: A Retrospective Multicenter Study from Upper Egypt
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Khaled Saad, Eman F. Gad, Samaher F. Taha, Sherin A. Taha, Hamada K. Fayed, Mahmoud Elsaeed, Thamer A. M. Alruwaili, Mohamed Fahmy M. Ibrahim, Amira Elhoufey, Ahmed M. Esmat Mansour and Amir M. Aboelgheet
Med. Sci. 2025, 13(3), 165; https://doi.org/10.3390/medsci13030165 - 1 Sep 2025
Abstract
Aim: This study aimed to evaluate the nutritional status of children with cystic fibrosis (CF) and investigate the correlation between malnutrition and the decline of pulmonary function in this population. Methods: We retrospectively analyzed the clinical data of children with CF admitted to
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Aim: This study aimed to evaluate the nutritional status of children with cystic fibrosis (CF) and investigate the correlation between malnutrition and the decline of pulmonary function in this population. Methods: We retrospectively analyzed the clinical data of children with CF admitted to four large tertiary centers in Upper Egypt. We compared clinical characteristics among children with different nutritional statuses and evaluated the correlation between malnutrition and pulmonary functions. Results: A total of 104 children with CF, including 54 males (52%), aged 3 to 18 years, were analyzed. Respiratory symptoms were present in all cases (100%). Malnutrition was observed in 72% (75/104) of the participants, with affected children exhibiting significantly lower body weight and serum albumin levels. Pulmonary function tests showed that vital capacity (VC) and the predicted values for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, and expiratory flow at 25%, 50%, and 75% of FVC were all lower in the malnourished group compared to children with normal nutrition. Correlation analysis demonstrated that the body mass index (BMI) Z-score was positively correlated with these pulmonary function indicators. Conclusions: Malnutrition is highly prevalent among Egyptian children with CF and is associated with decreased pulmonary function. Improving nutritional status may enhance lung function in this population.
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(This article belongs to the Section Pneumology and Respiratory Diseases)
Open AccessArticle
Use of Benzodiazepines in Medical Students: A Comparative Analysis Between Medical and Other University Degrees
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Paula Fernández de Frutos, Francisco Javier García-Sánchez, Natalia Mudarra-García, Fernando Roque-Rojas, Syed Ihtisham-Kakakhel and Davide Luordo-Tedesco
Med. Sci. 2025, 13(3), 164; https://doi.org/10.3390/medsci13030164 - 1 Sep 2025
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Background: The use of benzodiazepines among university students has been scarcely investigated. This situation raises particular concerns in medical students, due to their exposure to stressful situations and, especially, their familiarity with psychotropic drugs. Material and methods: A descriptive cross-sectional observational study was
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Background: The use of benzodiazepines among university students has been scarcely investigated. This situation raises particular concerns in medical students, due to their exposure to stressful situations and, especially, their familiarity with psychotropic drugs. Material and methods: A descriptive cross-sectional observational study was conducted using an anonymous online survey disseminated among universities in the Community of Madrid during April 2024. Results: 25.07% of students stated they had used benzodiazepines at least once, especially from the third academic year onwards. The prevalence was higher among medical students (32.34%). Use was mainly occasional, although 20.21% reported daily use. Among the reasons for use, managing academic stress reached 45.74%. Up to 15.96% of respondents reported a feeling of dependence, and 32.26% noticed concentration difficulties as a side effect of benzodiazepine use. Conclusions: Benzodiazepine use is a relevant phenomenon among university students, with particular incidence in medical degrees. Its onset usually coincides with advanced stages of the degree, which underscores the need for preventive interventions tailored to the academic environment and for the rational use of psychotropic drugs in young populations.
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Open AccessArticle
Vitamin D Deficiency and Risk of Surgical Site Infections: A Retrospective Chart Review from a Tertiary Care Center in Qatar
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Rana Farsakoury, Ahmad Hamdan, Muhammad Naseem Khan, Habib H. Farooqui, Sara Al Harami and Susu M. Zughaier
Med. Sci. 2025, 13(3), 163; https://doi.org/10.3390/medsci13030163 - 1 Sep 2025
Abstract
Background/Objectives: Vitamin D deficiency is common in the Middle East, where it affects about 90% of the population. 25-hydroxyvitamin D [25(OH)D]. plays a key role in immune function and antimicrobial defense. Its deficiency has been implicated in surgical site infections (SSIs) also,
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Background/Objectives: Vitamin D deficiency is common in the Middle East, where it affects about 90% of the population. 25-hydroxyvitamin D [25(OH)D]. plays a key role in immune function and antimicrobial defense. Its deficiency has been implicated in surgical site infections (SSIs) also, which lead to increased healthcare costs and morbidity. Around 60% SSIs are preventable by addressing factors like 25(OH)D levels among others. In Qatar, 55.8% of the population is 25(OH)D deficient, but no direct link has been established between 25(OH)D deficiency and SSI risk. This study aims to investigate the relationship between deficient 25(OH)D levels and SSI development in surgical patients at Hamad Medical Corporation (HMC), Qatar. Methods: A retrospective chart review was conducted on adult patients who underwent surgery at HMC, Qatar, between January 2021 and December 2023, with known 25(OH)D levels measured within three months before surgery. A multivariate logistic regression analysis was conducted to evaluate the relationship between 25(OH)D levels and SSIs. Results: This retrospective chart review included 24,097 patients, with 3818 (15.8%) being 25(OH)D deficient. The mean age of the patients was 45 years, and 55% of them were female. The proportion of SSIs was highest in the 25(OH)D deficient group (2.7%) compared to the insufficient (1.8%) and sufficient (1.9%) groups, with a p-value of <0.01. The mean 25(OH)D level was 23 ng/mL in the SSI group, compared to 25 ng/mL in the no SSI group, with a p-value of <0.01. Multivariate logistic regression analysis identified several independent risk factors for SSIs, including 25(OH)D deficiency, male gender, intermediate and major case levels, longer operative times, lower preoperative serum albumin, and contaminated and dirty wounds, all with p-values of <0.05. Conclusions: Preoperative lower 25(OH)D levels increase the risk of SSIs. This study emphasizes the importance of optimizing 25(OH)D levels before surgery to reduce the occurrence of SSIs.
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(This article belongs to the Section Immunology and Infectious Diseases)
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Open AccessArticle
Looking for Fabry, Finding More: LVH Screening Yields Unexpected Gaucher Diagnosis
by
Sylwia Szczepara, Klaudia Pacia, Katarzyna Trojanowicz, Klaudia Bielecka, Michał Tworek, Zuzanna Sachajko, Katarzyna Holcman, Piotr Podolec and Monika Komar
Med. Sci. 2025, 13(3), 162; https://doi.org/10.3390/medsci13030162 - 1 Sep 2025
Abstract
Objective: Fabry disease (FD) is a rare, X-linked lysosomal storage disorder resulting from deficient α-galactosidase A activity, which can manifest as left ventricular hypertrophy (LVH). We aimed to assess the prevalence of FD in an unselected cohort of patients with unexplained LVH. Methods
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Objective: Fabry disease (FD) is a rare, X-linked lysosomal storage disorder resulting from deficient α-galactosidase A activity, which can manifest as left ventricular hypertrophy (LVH). We aimed to assess the prevalence of FD in an unselected cohort of patients with unexplained LVH. Methods and results: We screened 202 unrelated adults with LVH using enzymatic assays for α-galactosidase A in dried blood spots. Patients with low activity underwent GLA gene sequencing. Echocardiographic parameters were evaluated according to ESC guidelines. FD was diagnosed in 4 women (2%), each carrying distinct pathogenic GLA mutations. All affected individuals showed normal or borderline enzyme activity. Cardiac, renal, or neurological symptoms were observed variably among patients. Echocardiographic findings revealed slightly lower wall thickness and preserved systolic function in FD patients compared to those without FD. Cascade genetic screening identified 16 additional family members with the same mutations. One patient (0.5%) was incidentally diagnosed with Gaucher disease based on syndromic features and enzymatic testing. Conclusions: FD was identified in 2% of patients with unexplained LVH, who were females. Enzyme-based screening followed by targeted genetic testing is a cost-effective strategy for FD detection. Early diagnosis is essential for prompt treatment and family counselling, underscoring the importance of routine FD screening in patients with LVH of unclear aetiology. Our findings support the use of targeted screening for Fabry disease in patients with LVH and systemic features, and highlight the potential to identify other lysosomal disorders in selected cases.
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(This article belongs to the Section Cardiovascular Disease)
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Open AccessSystematic Review
A Systematic Review Exploring the Phytochemical Composition and Anticancer Activities of Acacia catechu
by
Navya Rana, Madhu Bala, Vinod Kumar, Rohitash Yadav, Neeraj Jain, Don Mathew, Khushboo Bisht, Rakesh Kumar and Sunil Kumar
Med. Sci. 2025, 13(3), 161; https://doi.org/10.3390/medsci13030161 - 1 Sep 2025
Abstract
Background: Acacia catechu is an important traditional medicinal plant that has been used to manage several ailments. Many in vitro and in vivo studies have demonstrated that it exhibits chemopreventive and antineoplastic effects by modulating diverse signaling pathways and molecular targets involved in
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Background: Acacia catechu is an important traditional medicinal plant that has been used to manage several ailments. Many in vitro and in vivo studies have demonstrated that it exhibits chemopreventive and antineoplastic effects by modulating diverse signaling pathways and molecular targets involved in cancer progression. This review attempts to systematically investigate the anticancer mechanisms of A. catechu, encompassing antiapoptotic, antioxidant, and antiproliferative activities. Material and Methods: This review was conducted using scientific databases such as Scopus, Web of Science, and Google Scholar, covering the studies from 2000 to 2024. The PRISMA methodology was applied, using the keywords A. catechu, phytoconstituents, and cancer. Results: A total of 39 studies were compiled from various databases that cited the biological use of A. catechu. The plant has an abundance of phenolic compounds, including catechin, epicatechin, epigallocatechin-3-O-gallate, and epicatechin-3-O-gallate, which show strong anticancer activities. The anticancer potential of A. catechu is explained as it regulates several modulators like reactive oxygen species and cytokines, and downregulates oncogenic molecules like c-myc and various signaling pathways, such as c-Jun and NF-κB. Conclusions: Our findings suggest that A. catechu and its bioactive constituents have the potential for cancer prevention and therapy. However, further mechanistic investigations using pure compounds, along with preclinical and clinical trials, are essential to translate this potential into clinical applications.
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(This article belongs to the Special Issue Feature Papers in Section Cancer and Cancer-Related Diseases)
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Open AccessArticle
Diagnostic Accuracy of Anthropometric and Metabolic Indicators for Predicting MASLD: Evidence from a Large Cohort of Spanish Workers Using FLI and LAP
by
Juan José Guarro Miguel, Pedro Juan Tárraga López, María Dolores Marzoa Jansana, Ángel Arturo López-González, Pere Riutord Sbert, Carla Busquets-Cortés and José Ignacio Ramirez-Manent
Med. Sci. 2025, 13(3), 160; https://doi.org/10.3390/medsci13030160 - 1 Sep 2025
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Background: Metabolic-dysfunction-associated steatotic liver disease (MASLD) is a major global health concern associated with insulin resistance, metabolic syndrome, and cardiovascular morbidity. Early identification of at-risk individuals through simple, non-invasive methods is essential, particularly in working populations. Objectives: This study aimed to assess and
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Background: Metabolic-dysfunction-associated steatotic liver disease (MASLD) is a major global health concern associated with insulin resistance, metabolic syndrome, and cardiovascular morbidity. Early identification of at-risk individuals through simple, non-invasive methods is essential, particularly in working populations. Objectives: This study aimed to assess and compare the diagnostic accuracy of four widely used anthropometric and metabolic indicators—body mass index (BMI), waist-to-height ratio (WtHR), triglyceride–glucose index (TyG), and waist–triglyceride index (WTI)—in identifying individuals at risk of metabolic-dysfunction-associated steatotic liver disease (MASLD), as determined by the Fatty Liver Index (FLI) and the Lipid Accumulation Product (LAP), within a large sample of Spanish workers. Methods: A cross-sectional analysis was performed on data from 386,924 Spanish employees aged between 18 and 69 years. Standardized anthropometric and laboratory measurements were obtained as part of routine occupational medical examinations conducted from 2021 to 2023. The presence of NAFLD was inferred using two validated surrogate markers: FLI and LAP. Receiver operating characteristic (ROC) curves and area under the curve (AUC) values were used to assess the discriminatory ability of each index, stratified by sex. Results: WTI and TyG demonstrated the highest diagnostic accuracy for both FLI- and LAP-defined NAFLD, with AUC values >0.95 in both sexes. WTI showed the best overall performance, followed closely by TyG. WtHR outperformed BMI but was less accurate than the metabolic indices. Sex-stratified analyses confirmed consistent patterns, with slightly higher AUCs for TyG and WTI in women. BMI consistently yielded the lowest discriminatory performance. Conclusions: WTI and TyG are superior to BMI and WtHR for non-invasive screening of MASLD in occupational settings. Their simplicity, low cost, and strong predictive value support their integration into routine workplace health surveillance. Sex-specific thresholds and prospective validation are warranted to enhance clinical application.
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Open AccessSystematic Review
Artificial Intelligence Models for Diagnosis of Periodontitis Using Non-Invasive Biological Markers: A Systematic Review and Meta-Analysis of Patient-Based Studies
by
Carlos M. Ardila, Anny M. Vivares-Builes and Pradeep Kumar Yadalam
Med. Sci. 2025, 13(3), 159; https://doi.org/10.3390/medsci13030159 - 1 Sep 2025
Abstract
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Background/Objectives: Early diagnosis of periodontitis remains challenging using traditional clinical methods. This systematic review and meta-analysis evaluated the diagnostic accuracy of artificial intelligence (AI) models trained on non-invasive or minimally invasive biomarkers—including saliva, gingival crevicular fluid (GCF), and immunologic profiles—for diagnosing and
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Background/Objectives: Early diagnosis of periodontitis remains challenging using traditional clinical methods. This systematic review and meta-analysis evaluated the diagnostic accuracy of artificial intelligence (AI) models trained on non-invasive or minimally invasive biomarkers—including saliva, gingival crevicular fluid (GCF), and immunologic profiles—for diagnosing and classifying periodontitis in human subjects. Methods: A comprehensive search of PubMed/MEDLINE, Scopus, Web of Science, EMBASE, and Cochrane CENTRAL was conducted from database inception to June 2025. Eligible studies used AI or machine learning models with patient-derived biomarker data and reported diagnostic performance metrics. Results: Seven studies were included, employing various AI models such as random forest, artificial neural networks, and gradient boosting. Biomarkers were derived from saliva (n = 4), saliva-derived biomarkers from oral rinse (n = 1), immunologic profiles (n = 1), and tissue-based gene expression (n = 1). Reported area under the receiver operating characteristic (ROC) curve (AUC) ranged from 0.83 to 0.96. Meta-analysis of studies with comparable outcomes showed a pooled sensitivity of 0.89 (95% CI: 0.84–0.93), a specificity of 0.87 (95% CI: 0.80–0.92), and a summary AUC of 0.92. Subgroup analysis revealed that models using salivary biomarkers achieved a higher pooled AUC (0.94) than those using GCF or immunologic markers (AUC: 0.89). Sensitivity analyses excluding studies with unclear bias did not significantly alter pooled estimates, affirming robustness. The overall certainty of evidence was rated as moderate to high. Conclusions: AI-based diagnostic models utilizing salivary, microbiome, or immunologic biomarkers demonstrated quantitatively high accuracy; however, the overall certainty of evidence was rated as moderate to high due to limitations in study design and validation.
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Open AccessBrief Report
Rural–Urban Disparities in Treatment and Disease-Specific Survival for Patients with Intrahepatic Cholangiocarcinoma: A Retrospective Cohort Analysis of the 2000 to 2021 SEER Database
by
Odelia H. Moon, Mitchell A. Taylor, Omar Hamadi, Aditya Sharma and Peter Silberstein
Med. Sci. 2025, 13(3), 158; https://doi.org/10.3390/medsci13030158 - 1 Sep 2025
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Background: Intrahepatic cholangiocarcinoma (ICC) is an aggressive malignancy with very poor survival. Prior research suggests rural–urban disparities on a regional scale. We aimed to elucidate these disparities in treatment and disease-specific survival (DSS) for ICC patients on a national scale using the SEER
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Background: Intrahepatic cholangiocarcinoma (ICC) is an aggressive malignancy with very poor survival. Prior research suggests rural–urban disparities on a regional scale. We aimed to elucidate these disparities in treatment and disease-specific survival (DSS) for ICC patients on a national scale using the SEER database. Methods: The SEER database was queried to identify biopsy-confirmed cases of ICC from 2000 to 2021. Differences in clinicopathologic features and treatment between rural and urban patients were assessed using Chi-square and Fischer’s exact tests. Disease-specific survival was compared using Kaplan–Meier and log-rank tests as well as multivariable Cox regressions. Results: A total of 14,940 ICC patients were identified. Rural patients were less likely than urban patients to receive chemotherapy (789 of 1588 [49.7%] vs. 7112 of 13,352 [53.3%], p = 0.006) and surgical treatment (305 of 1588 [19.2%] vs. 2922 of 13,352 [21.9%], p = 0.013). Rural patients experienced reduced 5- and 10-year DSS rates (7.0% and 4.0%) compared to urban patients (9.0% and 6.0%, p < 0.001). In multivariable analysis, rural residence independently demonstrated a 17% increased risk of disease-specific mortality compared to their urban counterparts (aHR 1.17, 95% CI 1.03–1.32). Conclusions: This study demonstrates significant rural–urban disparities in ICC treatment and survival throughout the US, independent of other prognostic factors. Further investigation into factors driving these disparities is warranted to improve outcomes for rural ICC patients.
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Open AccessArticle
Effect of Lokomat® Robotic Rehabilitation on Balance, Postural Control, and Functional Independence in Subacute and Chronic Stroke Patients: A Quasi-Experimental Study
by
Marina Esther Cabrera-Brito, María del Carmen Carcelén-Fraile, Agustín Aibar-Almazán, Fidel Hita-Contreras, Paulino Vico-Rodríguez, Marta Cano-Orihuela and Yolanda Castellote-Caballero
Med. Sci. 2025, 13(3), 157; https://doi.org/10.3390/medsci13030157 - 28 Aug 2025
Abstract
Background/Objectives: Balance, postural control, and functional independence are essential components for the autonomy of people with neurological conditions. Robotic technologies such as the Lokomat® have emerged as promising tools in rehabilitation, but their effectiveness when integrated into functional programs requires further
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Background/Objectives: Balance, postural control, and functional independence are essential components for the autonomy of people with neurological conditions. Robotic technologies such as the Lokomat® have emerged as promising tools in rehabilitation, but their effectiveness when integrated into functional programs requires further evidence. The objective of this study was to evaluate the impact of an intensive robotic intervention on these three functional variables. Methods: A single-group, quasi-experimental pretest–posttest study was conducted with 136 participants who received a robotic rehabilitation intervention using the Lokomat® device, and focused on functional tasks over several weeks. Balance (using the Berg scale), postural control (using the PASS), and functional independence (using the Barthel index) were assessed, comparing pre- and post-intervention results using parametric and non-parametric tests. Results: The results showed statistically significant improvements in all three variables after the intervention. The mean Berg score increased from 11.76 to 21.91 points (p < 0.001), postural control increased from 15.53 to 21.90 points (p < 0.001), and the Barthel index increased from 24.71 to 41.76 points (p < 0.001). In all cases, the effect sizes were large (d > 0.90). Conclusions: A rehabilitation program including intensive, task-oriented Lokomat® training was associated with improvements in balance, postural control, and functional independence. Given the single-group design without a control arm, these findings reflect associations and do not establish causality.
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