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Search Results (591)

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16 pages, 1508 KiB  
Article
Altered Expression of the MEG3, FTO, ATF4, and Lipogenic Genes in PBMCs from Children with Obesity and Its Associations with Added Sugar Intake
by Adrián Hernández-DíazCouder, Pablo J. Paz-González, Maryori Valdez-Garcia, Claudia I. Ramírez-Silva, Karol Iliana Avila-Soto, Araceli Pérez-Bautista, Miguel Vazquez-Moreno, Ana Nava-Cabrera, Rodrigo Romero-Nava, Fengyang Huang and Miguel Cruz
Nutrients 2025, 17(15), 2546; https://doi.org/10.3390/nu17152546 - 2 Aug 2025
Viewed by 300
Abstract
Background: Obesity and its complications have increased in both adults and children, with pediatric populations developing metabolic disorders at earlier ages. Long non-coding RNAs, particularly MEG3, are involved in obesity through regulation of lipogenic genes including ATF4, FTO, SREBP1, [...] Read more.
Background: Obesity and its complications have increased in both adults and children, with pediatric populations developing metabolic disorders at earlier ages. Long non-coding RNAs, particularly MEG3, are involved in obesity through regulation of lipogenic genes including ATF4, FTO, SREBP1, FASN, and ACACA. However, data on MEG3 expression in pediatric obesity are limited. This study evaluated MEG3, FTO, and ATF4 expression in PBMCs from children with obesity and their associations with added sugar intake and lipid metabolism genes. Methods: In this cross-sectional study 71 children within the age range of 6 to 12 years were included (28 normal weight and 43 with obesity). Anthropometrical and clinical parameters and dietary added sugar consumption were analyzed. Real-time PCR was performed to assess MEG3, FTO, ATF4, SREBP1, FASN, and ACACA gene expression in peripheral blood mononuclear cells. Results: The expression of MEG3, ATF4, FTO, SREBP1, FASN, and ACACA was decreased in children with obesity. MEG3 and FTO showed sex-dependent expression in children without obesity, while additional sex-related differences were observed for SREBP1, FASN, ACACA, FTO, and MEG3 in children with obesity. MEG3 was associated with the expression of SREBP1, FASN, ACACA, FTO, and ATF4. In insulin-resistant (IR) children, MEG3, ATF4, FTO, ACACA, and SREBP1 were reduced, while FASN was increased. Added sugar intake negatively correlated with FTO, SREBP1, and ACACA. Conclusions: The MEG3, FTO, and ATF4 expression was altered in children with obesity, showing sex- and IR-related differences. Added sugar intake correlated negatively with lipogenic gene expression. Full article
(This article belongs to the Special Issue Dietary Effects on Gene Expression and Metabolic Profiles)
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14 pages, 1726 KiB  
Systematic Review
Mucous Fistula Refeeding in Newborns: Why, When, How, and Where? Insights from a Systematic Review
by Layla Musleh, Ilaria Cozzi, Anteo Di Napoli and Fabio Fusaro
Nutrients 2025, 17(15), 2490; https://doi.org/10.3390/nu17152490 - 30 Jul 2025
Viewed by 221
Abstract
Background/Objectives: Infants with high-output enterostomies often require prolonged parenteral nutrition (PN), increasing risks of infections, liver dysfunction, and impaired growth. Mucous fistula refeeding (MFR) is proposed to enhance intestinal adaptation, weight gain, and distal bowel maturation. This systematic review and meta-analysis assessed [...] Read more.
Background/Objectives: Infants with high-output enterostomies often require prolonged parenteral nutrition (PN), increasing risks of infections, liver dysfunction, and impaired growth. Mucous fistula refeeding (MFR) is proposed to enhance intestinal adaptation, weight gain, and distal bowel maturation. This systematic review and meta-analysis assessed its effectiveness, safety, and technical aspects. Methods: Following PRISMA guidelines, studies reporting MFR-related outcomes were included without data or language restrictions. Data sources included PubMed, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Library, and UpToDate. Bias risk was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Meta-analysis employed random- and fixed-effects models, with outcomes reported as odds ratios (ORs) and 95% confidence interval (CI). Primary outcomes assessed were weight gain, PN duration, and complications and statistical comparisons were made between MFR and non-MFR groups. Results: Seventeen studies involving 631 infants were included; 482 received MFR and 149 did not. MFR started at 31 postoperative days and lasted for 50 days on average, using varied reinfusion methods, catheter types, and fixation strategies. MFR significantly improved weight gain (4.7 vs. 24.2 g/day, p < 0.05) and reduced PN duration (60.3 vs. 95 days, p < 0.05). Hospital and NICU stays were also shorter (160 vs. 263 days, p < 0.05; 122 vs. 200 days, p < 0.05). Cholestasis risk was lower (OR 0.151, 95% CI 0.071–0.319, p < 0.0001), while effects on bilirubin levels were inconsistent. Complications included sepsis (3.5%), intestinal perforation (0.83%), hemorrhage (0.62%), with one MFR-related death (0.22%). Conclusions: Despite MFR benefits neonatal care, its practices remain heterogeneous. Standardized protocols are required to ensure MFR safety and efficacy. Full article
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16 pages, 646 KiB  
Article
Psychometric Properties of the Diabetes Eating Problem Survey—Revised in Arab Adolescents with Type 1 Diabetes: A Cross-Cultural Validation Study
by Abdullah M. Alguwaihes, Shuliweeh Alenezi, Renad Almutawa, Rema Almutawa, Elaf Almusahel, Metib S. Alotaibi, Mohammed E. Al-Sofiani and Abdulmajeed AlSubaihin
Behav. Sci. 2025, 15(8), 1026; https://doi.org/10.3390/bs15081026 - 29 Jul 2025
Viewed by 324
Abstract
Objectives: The objective of this manuscript is to translate, adapt, and validate an Arabic version of the Diabetes Eating Problem Survey—Revised (DEPS-R) questionnaire to assess disordered eating behaviors (DEBs) in adolescents with T1D in Saudi Arabia. Additionally, the study sought to estimate the [...] Read more.
Objectives: The objective of this manuscript is to translate, adapt, and validate an Arabic version of the Diabetes Eating Problem Survey—Revised (DEPS-R) questionnaire to assess disordered eating behaviors (DEBs) in adolescents with T1D in Saudi Arabia. Additionally, the study sought to estimate the prevalence of DEBs and analyze its associations with glycemic control and diabetes-related complications. Methods: A cross-cultural validation study was conducted following the COSMIN guidelines. The DEPS-R questionnaire was translated into Arabic through forward and backward translation involving expert panels, including psychiatrists, diabetologists, and linguists. A sample of 409 people with type 1 diabetes (PwT1D) (58.4% females) aged 12–20 years was recruited from outpatient diabetes clinics in the five main regions of Saudi Arabia. Participants completed the Arabic DEPS-R and the validated Arabic version of the SCOFF questionnaire. Sociodemographic, anthropometric, and biochemical data were collected, and statistical analyses, including confirmatory factor analysis (CFA) and internal consistency tests, were conducted. Results: The Arabic DEPS-R exhibits strong internal consistency (Cronbach’s alpha = 0.829) and high test–retest reliability (ICC = 0.861), with a CFA supporting a three-factor structure, namely body weight perception, disordered eating behaviors (DEBs), and bulimic tendencies. Notably, higher DEPS-R scores are significantly linked to elevated HbA1c levels, increased BMI, and more frequent insulin use. Alarmingly, 52.8% of participants show high-risk DEB, which is directly associated with poor glycemic control (HbA1c ≥ 8.1%) and a heightened risk of diabetic ketoacidosis (DKA). Conclusions: The Arabic DEPS-R is a valid and reliable tool for screening DEBs among Saudi adolescents with T1D. Findings underscore the necessity for early identification and intervention to mitigate the impact of EDs on diabetes management and overall health outcomes. Full article
(This article belongs to the Section Child and Adolescent Psychiatry)
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14 pages, 839 KiB  
Article
Biochemical Profile Variations Among Type 2 Diabetic Patients Stratified by Hemoglobin A1c Levels in a Saudi Cohort: A Retrospective Study
by Abdulrahman Alshalani, Nada AlAhmari, Hajar A. Amin, Abdullah Aljedai and Hamood AlSudais
J. Clin. Med. 2025, 14(15), 5324; https://doi.org/10.3390/jcm14155324 - 28 Jul 2025
Viewed by 381
Abstract
Background: The global increase in type 2 diabetes mellitus (T2DM) cases necessitates the need for early detection of metabolic changes. This study investigated variations in liver enzymes, renal markers, electrolytes, and lipid profiles among T2DM patients stratified by hemoglobin A1c (HbA1c) categories [...] Read more.
Background: The global increase in type 2 diabetes mellitus (T2DM) cases necessitates the need for early detection of metabolic changes. This study investigated variations in liver enzymes, renal markers, electrolytes, and lipid profiles among T2DM patients stratified by hemoglobin A1c (HbA1c) categories to support early identification and better management of diabetes-related complications. Methods: A retrospective observational study at King Khalid University Hospital (KKUH), Riyadh, included 621 adult patients diagnosed with T2DM categorized into four HbA1c groups: normal (<5.7%), prediabetes (5.7–6.4%), controlled diabetes (6.5–7.9%), and uncontrolled diabetes (≥8.0%). Biochemical parameters included the liver profile: alkaline phosphatase (ALP) and bilirubin, renal profile: creatinine, blood urea nitrogen (BUN), glucose, sodium, and chloride, and lipid profile: cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides. Regression models identified predictors of ALP, cholesterol, and LDL. Results: ALP was higher in uncontrolled diabetes (89.0 U/L, Q1–Q3: 106.3–72.0) than in the prediabetes group (75.0 U/L, Q1–Q3: 96.8–62.3). Sodium and chloride were lower in uncontrolled diabetes (Na: 138.3 mmol/L, Q1–Q3: 140.3–136.4; Cl: 101.1 mmol/L, Q1–Q3: 102.9–99.4) compared to the normal group (Na: 139.5 mmol/L, Q1–Q3: 142.4–136.9; Cl: 103.5 mmol/L, Q1–Q3: 106.1–101.7). LDL was lower in uncontrolled diabetes (2.1 mmol/L, Q1–Q3: 2.8–1.7) than in the normal group (2.8 mmol/L, Q1–Q3: 3.7–2.2), while triglycerides were higher in patients with uncontrolled diabetes compared to the normal group (1.45 mmol/L, Q1–Q3: 2.02–1.11 vs. 1.26 mmol/L, Q1–Q3: 1.44–0.94). Regression models showed low explanatory power (R2 = 2.1–7.3%), with weight, age, and sex as significant predictors of select biochemical markers. Conclusions: The study observed biochemical variations across HbA1c categories in T2DM patients, likely reflecting insulin resistance. Monitoring these markers in conjunction with HbA1c can enhance early detection and improve the management of complications. Full article
(This article belongs to the Section Endocrinology & Metabolism)
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10 pages, 204 KiB  
Article
Evaluation of Pre-Treatment Assessment of Semaglutide Users: Balancing the Benefits of Weight Loss vs. Potential Health Consequences
by Faten F. Bin Dayel, Rakan J. Alanazi, Miteb A. Alenazi, Sahar Alkhalifah, Mohammed Alfaifi, Sultan Alghadeer and Abdulrahman Alwhaibi
Healthcare 2025, 13(15), 1827; https://doi.org/10.3390/healthcare13151827 - 26 Jul 2025
Viewed by 389
Abstract
Background: Although semaglutide (Ozempic®) is being prescribed off-label to individuals with obesity, some concerns have arisen regarding its use, particularly regarding the risk of thyroid and pancreatic disorders. Therefore, it is crucial to screen patients’ medical and family disease histories, as [...] Read more.
Background: Although semaglutide (Ozempic®) is being prescribed off-label to individuals with obesity, some concerns have arisen regarding its use, particularly regarding the risk of thyroid and pancreatic disorders. Therefore, it is crucial to screen patients’ medical and family disease histories, as well as certain clinical parameters, before initiating this treatment for obesity or weight management. However, there is limited research investigating whether pretreatment assessment is adopted in clinical practice. Method: This is a single-center retrospective study involving adults who were prescribed semaglutide for obesity or weight management. Demographic data, comorbid conditions, semaglutide-related lab work, and disease history assessments, including pancreatitis, thyroid abnormalities, oculopathy, neuropathy, and any family history of thyroid cancer, were evaluated and documented prior to treatment initiation. Results: In total, 715 patients were included in the study, with an average age of 40.2 ± 12.0 years, and 49.5% of participants were male. The average weight and BMI prior to using semaglutide were 99.8 ± 18.1 kg and 36.3 ± 8.3 kg/m2, respectively, with predominantly overweight and obese individuals (collectively 91.3%). Approximately 69% of patients had 3–5 complications, with a high prevalence of cardiovascular and metabolic diseases before using semaglutide. Although HbA1c, serum creatinine, TSH, T3, T4, triglycerides, HDL, LDL, total cholesterol, and total bilirubin were monitored prior to semaglutide use, none of the patients’ pancreatic lipase, amylase, or calcitonin levels were measured. Although it is important to investigate all personal and family disease histories, including thyroid abnormalities, thyroid cancer, pancreatitis, retinopathy, eye problems, and neuropathy prior to semaglutide initiation, checks were only conducted in 1.8% of patients, despite 98.6% having at least one of the diseases assessed pretreatment. Conclusions: The current pretreatment assessment approach for patients prescribed semaglutide for weight reduction is underdeveloped, particularly with regard to assessing the influence of disease history on semaglutide use. This predisposes patients to a risk of severe clinical outcomes, including thyroid cancer, pancreatitis, and retinopathy. Full article
12 pages, 839 KiB  
Article
Counting Limb Length Ratios in Roux-en-Y Gastric Bypass: A Demonstration of Safety and Feasibility Using a 25-Patient Case Series in a High-Volume Academic Center
by Doua Elamin, Mélissa V. Wills, Juan Aulestia, Valentin Mocanu, Andrew Strong, Jerry Dang, Xiaoxi Feng, Matthew Kroh, Ricard Corcelles and Salvador Navarrete
J. Clin. Med. 2025, 14(15), 5262; https://doi.org/10.3390/jcm14155262 - 25 Jul 2025
Viewed by 206
Abstract
Background: Despite being one of the most performed bariatric procedures, there is no consensus regarding optimal limb lengths for Roux-en-Y gastric bypass (RYGB), which may impact weight loss and obesity-related comorbidity resolution. We hypothesize that a ratio-adjusted small bowel to Roux and BP [...] Read more.
Background: Despite being one of the most performed bariatric procedures, there is no consensus regarding optimal limb lengths for Roux-en-Y gastric bypass (RYGB), which may impact weight loss and obesity-related comorbidity resolution. We hypothesize that a ratio-adjusted small bowel to Roux and BP limb lengths in RYGB results in superior outcomes. Objectives: This study aims to define total intestinal length (TIL) and the feasibility of its intraoperative measurement during RYGB. The findings will serve as a foundation for a subsequent randomized trial evaluating different limb length ratios and their effect on postoperative outcomes. Setting: This was a single-center prospective cohort study conducted at Cleveland Clinic Foundation-Main Campus, a tertiary referral center in the United States. Methods: Between January and June 2023, 25 patients with BMI > 40 undergoing RYGB were enrolled. Total small bowel length was measured intraoperatively, and feasibility of measurement was assessed. Patient outcomes, including total weight loss, 30-day complications, and comorbidities at 1 year were captured. Results: Mean preoperative BMI was 47.6 ± 8.0 kg/m2. Mean total small bowel length was 592 ± 93.3 cm, with a mean biliopancreatic (BP) limb length of 109 ± 29 cm (18.86% ± 5.84 of total length) and Roux limb length of 103 ± 15 cm (17.71% ± 3.06 of total length). Measurement added an average of 11.5 min to operative time. Measurement feasibility was rated as “moderate” or easier in 80% of cases. One-year postoperative outcomes included a mean total weight loss of 31% and significant reductions in antihypertensive and anti-diabetic medication use. Conclusions: Total small bowel length measurement during RYGB is safe and feasible. High variability in bowel length was observed, with no significant correlation to demographic factors. Establishing individualized limb length ratios may improve weight loss outcomes and comorbidity resolution. Further studies are warranted to evaluate the impact of tailored limb length strategies. Full article
(This article belongs to the Section General Surgery)
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16 pages, 848 KiB  
Review
Current Data on the Role of Amino Acids in the Management of Obesity in Children and Adolescents
by Diana Zamosteanu, Nina Filip, Laura Mihaela Trandafir, Elena Ţarcă, Mihaela Pertea, Gabriela Bordeianu, Jana Bernic, Anne Marie Heredea and Elena Cojocaru
Int. J. Mol. Sci. 2025, 26(15), 7129; https://doi.org/10.3390/ijms26157129 - 24 Jul 2025
Viewed by 1371
Abstract
Childhood obesity is a major global health problem, and its management involves a multidisciplinary approach that includes lifestyle changes, dietary interventions, and the use of dietary supplements. In this review, we summarize current findings on the role of amino acids in pediatric obesity, [...] Read more.
Childhood obesity is a major global health problem, and its management involves a multidisciplinary approach that includes lifestyle changes, dietary interventions, and the use of dietary supplements. In this review, we summarize current findings on the role of amino acids in pediatric obesity, with a particular focus on their involvement in metabolic pathways and weight regulation. The involvement of branched-chain and aromatic amino acids in the pathophysiology and potential management of pediatric obesity is highlighted in recent studies. Both experimental and clinical studies have shown that obese children often exhibit altered plasma amino acid profiles, including increased levels of leucine, isoleucine, valine, phenylalanine, and tyrosine, as well as decreased levels of glycine and serine. These imbalances are correlated with insulin resistance, inflammation, and early metabolic dysfunction. One of the mechanisms through which branched-chain amino acids can promote insulin resistance is the activation of the mammalian target of rapamycin (mTOR) signaling pathway. Metabolomic profiling has demonstrated the potential of specific amino acid patterns to predict obesity-related complications before they become clinically evident. Early identification of these biomarkers could be of great help for individualized interventions. Although clinical studies indicate that changes in dietary amino acids could lead to modest weight loss, improved metabolic profiles, and increased satiety, further studies are needed to establish standardized recommendations. Full article
(This article belongs to the Special Issue New Insights into the Treatment of Metabolic Syndrome and Diabetes)
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13 pages, 444 KiB  
Review
Key Aspects in the Nutritional Management of Polycystic Liver Disease Patients
by Saniya Khan, Simone Di Cola, Silvia Lai, Flaminia Ferri, Vincenzo Cardinale and Manuela Merli
Nutrients 2025, 17(14), 2380; https://doi.org/10.3390/nu17142380 - 21 Jul 2025
Viewed by 420
Abstract
Polycystic liver disease (PLD) is a rare genetic disorder characterized by the development of >10 fluid-filled cysts in the liver. While PLD can occur in isolation, it is most commonly associated with autosomal dominant polycystic kidney disease, adding complexity to its management. PLD [...] Read more.
Polycystic liver disease (PLD) is a rare genetic disorder characterized by the development of >10 fluid-filled cysts in the liver. While PLD can occur in isolation, it is most commonly associated with autosomal dominant polycystic kidney disease, adding complexity to its management. PLD is often asymptomatic but can lead to hepatomegaly, causing symptoms such as abdominal distension, pain and discomfort, early satiety, gastroesophageal reflux, and malnutrition, ultimately affecting patients’ quality of life. Current treatment strategies, including pharmacological and interventional approaches, focus on reducing liver volume and alleviating symptoms. However, management remains largely symptomatic, as no definitive therapies exist to halt cyst progression. Liver transplantation is the only curative option for patients with severe, progressive disease and refractory complications. The EASL guidelines recognize that PLD-related symptoms, primarily due to hepatomegaly, can contribute to involuntary weight loss and recommend assessing symptomatic patients for malnutrition and sarcopenia. Although evidence suggests that patients with PLD may be at risk of malnutrition, original data on the quality and extent of nutritional alterations remain scarce. The potential influence of nutrition on disease progression, symptom burden, and overall well-being is also largely unexplored. Given these knowledge gaps, addressing nutritional challenges, such as early satiety, is essential for optimizing symptom management and maintaining overall nutritional status. This review outlines a possible pathophysiology of malnutrition, specific dietary considerations and recommendations, and weight management in patients with PLD. Additionally, dietary complexities in patients with concurrent renal involvement are discussed, offering a practical framework for clinicians and dietitians in managing this challenging condition. Full article
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17 pages, 3334 KiB  
Article
Alterations in P-glycoprotein Expression in the Placenta of Obese Rats and Humans
by Péter Szatmári, Kata Kira Kemény, Andrea Surányi, Yakov Rachamim and Eszter Ducza
Int. J. Mol. Sci. 2025, 26(14), 6976; https://doi.org/10.3390/ijms26146976 - 20 Jul 2025
Viewed by 270
Abstract
Obesity affects approximately 30% of pregnancies worldwide and is one of the leading metabolic disorders among pregnant women. Maternal obesity is often associated with placental dysfunction and structural alterations, which increase the risk of developing complications. Efflux transporters, including P-glycoprotein (P-gp), may impact [...] Read more.
Obesity affects approximately 30% of pregnancies worldwide and is one of the leading metabolic disorders among pregnant women. Maternal obesity is often associated with placental dysfunction and structural alterations, which increase the risk of developing complications. Efflux transporters, including P-glycoprotein (P-gp), may impact placental function and fetal development. Consequently, our research examined the effects of obesity on P-glycoprotein expression in both a rat model and human placental tissue. P-gp expression was measured by RT-PCR and Western blot techniques in human and rat placental tissues. Moreover, we further characterized the high-fat and high-sugar diet (HFHSD)-induced gestational obesity rat model by measuring tissue weights. Significant decreases were observed in fetal, placental, and uterus weights in the obese animals near the end of pregnancy. In obese rats, mRNA and protein expression of placental P-gp showed a reduction on gestation days 15, 20, and 22. A similar P-gp reduction was observed in the term placenta in obese women in mRNA and protein levels. We hypothesize that the reduced expression of P-gp may heighten the susceptibility of both the fetus and placenta to P-gp substrates. This alteration could potentially result in an increased risk of pregnancy complications and obesity-related drug contraindications linked to P-gp transport during pregnancy. Full article
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12 pages, 1565 KiB  
Case Report
Severe Rectal Syphilis in the Setting of Profound HIV Immunosuppression: A Case Report Highlighting ERG/CD38 Immunophenotyping and a Review of the Literature
by Diana Marcela Carmona Valencia, Juan Diego López, Shirley Vanessa Correa Forero, Diana Marcela Bonilla Bonilla, Jorge Karim Assis and Yamil Liscano
Infect. Dis. Rep. 2025, 17(4), 85; https://doi.org/10.3390/idr17040085 - 16 Jul 2025
Viewed by 362
Abstract
Background and Aim: Syphilis, caused by Treponema pallidum, classically presents with genital or anal chancres; rectal involvement is rare and frequently misdiagnosed as inflammatory bowel disease or malignancy. We describe an unusually severe case of syphilitic proctitis in the setting of advanced [...] Read more.
Background and Aim: Syphilis, caused by Treponema pallidum, classically presents with genital or anal chancres; rectal involvement is rare and frequently misdiagnosed as inflammatory bowel disease or malignancy. We describe an unusually severe case of syphilitic proctitis in the setting of advanced HIV-related immunosuppression (CD4 39 cells/µL), in which targeted immunophenotyping (ERG and CD38) was a valuable adjunctive tool in the differential diagnosis. Case Presentation: A 46-year-old man with a recent history of erosive gastritis and esophageal candidiasis presented after six months of unintentional 20 kg weight loss, profound fatigue, intermittent fevers, profuse diarrhea, and two episodes of hematemesis. Workup revealed a new diagnosis of HIV infection (CD4: 39 cells/µL; viral load: 87,837 copies/mL). Contrast-enhanced CT demonstrated uniform, concentric rectal wall thickening (“target sign”). Colonoscopic biopsy showed exuberant granulation tissue and dense plasma cell infiltrates. Immunohistochemistry revealed a dense infiltrate of CD38-positive plasma cells and ERG-positive endothelial proliferation. These findings, in the context of positive serology, were highly supportive of a spirochetal etiology and helped differentiate it from potential mimics. Serology was positive for latent late syphilis (VDRL 1:64). The patient received three weekly doses of intramuscular benzathine penicillin; lumbar puncture excluded neurosyphilis. Discussion: This is among the first reported cases of syphilitic proctitis in a patient with CD4 < 50 cells/µL, where advanced immunophenotyping differentiated syphilitic inflammation from neoplastic or inflammatory mimics. Profound immunosuppression accelerates disease progression and yields atypical clinical features. Conclusion: In HIV-infected patients with chronic rectal symptoms, especially those with CD4 < 50 cells/µL, syphilitic proctitis must be considered. Integration of radiologic assessment, histopathology with ERG/CD38 staining, and serologic testing permits prompt diagnosis. Early benzathine penicillin therapy and rigorous clinical and serologic follow-up are essential to prevent complications, including neurosyphilis. Full article
(This article belongs to the Section Bacterial Diseases)
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30 pages, 2419 KiB  
Systematic Review
Rehabilitation Protocols for Surgically Treated Acetabular Fractures in Older Adults: Current Practices and Outcomes
by Silviya Ivanova, Ondrej Prochazka, Peter V. Giannoudis, Theodoros Tosounidis, Moritz Tannast and Johannes D. Bastian
J. Clin. Med. 2025, 14(14), 4912; https://doi.org/10.3390/jcm14144912 - 10 Jul 2025
Viewed by 443
Abstract
Background/Objectives: Acetabular fractures in older adults pose significant challenges due to bone fragility, complex fracture patterns, and increased comorbidities. Surgical management, including isolated open reduction and internal fixation (ORIF) and ORIF combined with acute total hip arthroplasty (THA) (combined hip procedure—CHP), have [...] Read more.
Background/Objectives: Acetabular fractures in older adults pose significant challenges due to bone fragility, complex fracture patterns, and increased comorbidities. Surgical management, including isolated open reduction and internal fixation (ORIF) and ORIF combined with acute total hip arthroplasty (THA) (combined hip procedure—CHP), have advanced considerably. Nevertheless, optimal postoperative rehabilitation and particularly weight-bearing (WB) recommendations remain controversial and inconsistent. This review aims to assess rehabilitation protocols, focusing on WB strategies following the surgical treatment of acetabular fractures in older adults. It also examines differences in WB restrictions by surgical technique (ORIF vs. CHP) and their impact on recovery, complications, reoperations, and mortality. Methods: A systematic review of PubMed, Embase, and the Cochrane Library (2006–2024) included studies involving patients aged ≥65 years treated surgically for displaced acetabular fractures. Data included WB protocols (full, partial, toe-touch), length of stay (LOS), healing, functional outcomes (mobility, Harris and Oxford Hip Scores), complications, reoperations, delayed THA, compliance, readmission, and mortality. Due to heterogeneity, findings were narratively synthesized. Risk of bias was assessed using ROBINS-I and RoB2. Results: Twenty studies involving 929 patients (530 isolated ORIF, 399 CHP) were analyzed. The overall mean follow-up was 3.5 years (range: 1–5.25 years). Postoperative WB protocols were reported in 19 studies (95%). Immediate full WB was permitted in 0% of isolated ORIF studies (0/13), with partial WB recommended by 62% (8/13) for durations typically between 6 and 12 weeks. On the other hand, immediate full WB was allowed in 53% (9/17) of CHP studies. Functional outcomes were moderate following isolated ORIF (mean HHS: 63–82 points), with delayed THA conversion rates ranging from 16.5% to 45%. CHP demonstrated superior functional outcomes (mean HHS: 70–92 points), earlier independent ambulation, and higher patient satisfaction (74–90%), yet increased orthopedic complications, including dislocations (8–11%) and implant loosening (up to 18%). LOS varied from 12 to 21 days (mean 16 days) for isolated ORIF and from 8 to 25 days (mean 17 days) for CHP. Readmission within 30 days was not explicitly reported in any study. Mortality at 1 year varied significantly (ORIF: 0–25%; CHP: 0–14%), increasing markedly at long-term follow-up (up to 42% ORIF, up to 70% CHP at five years). Compliance with WB restrictions was monitored in only two studies (11%). Conclusions: Postoperative rehabilitation after acetabular fracture surgery in older adults remains inconsistent and lacks standardization. Combining ORIF with acute THA may enable earlier weight-bearing and improved short-term function but carries risks such as dislocation and implant loosening. In contrast, isolated ORIF avoids these implant-related complications but often requires prolonged weight-bearing restrictions. Robust evidence is still missing. Future trials are essential to establish standardized protocols that balance mechanical protection and functional recovery. Full article
(This article belongs to the Special Issue The “Orthogeriatric Fracture Syndrome”—Issues and Perspectives)
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14 pages, 2179 KiB  
Article
Hepatic Artery Thrombosis After Orthotopic Liver Transplant: A 20-Year Monocentric Series
by Vincenzo Tondolo, Gianluca Rizzo, Giovanni Pacini, Luca Emanuele Amodio, Federica Marzi, Giada Livadoti, Giuseppe Quero and Fausto Zamboni
J. Clin. Med. 2025, 14(13), 4804; https://doi.org/10.3390/jcm14134804 - 7 Jul 2025
Viewed by 432
Abstract
Background/Objectives: Hepatic artery thrombosis (HAT) is a serious vascular complication in patients undergoing orthotopic liver transplantation (OLT). It is associated with a high risk of graft loss, re-transplantation (re-OLT), and mortality. This study aimed to evaluate the incidence and management of HAT, [...] Read more.
Background/Objectives: Hepatic artery thrombosis (HAT) is a serious vascular complication in patients undergoing orthotopic liver transplantation (OLT). It is associated with a high risk of graft loss, re-transplantation (re-OLT), and mortality. This study aimed to evaluate the incidence and management of HAT, analyzing potential risk factors. The secondary objectives included quantifying 90-day postoperative morbidity and mortality rates. Methods: In this retrospective, observational, single-center study, data from liver transplant donors and recipients who underwent OLT between 2004 and 2024 were analyzed. HAT was classified as early (e-HAT, ≤30 days) or late (l-HAT, >30 days). Univariate statistical analysis was performed to identify the risk factors associated with HAT occurrence. Multivariate analysis was not performed due to the small number of HAT events, which would increase the risk of model overfitting. Results: In the 20 year study period, a total of 532 OLTs were performed, including 37 re-OLTs. The rates of major morbidity, reoperation, and mortality within 90 days were 44.5%, 22.3%, and 7.1%, respectively. HAT occurred in 2.4% of cases (e-HAT: 1.6%; l-HAT: 0.7%). Among e-HAT cases, 66.6% were asymptomatic and identified through routine postoperative Doppler ultrasound. All e-HAT cases were surgically treated, with a re-OLT rate of 33.3%. Three l-HAT cases required re-OLT. Overall, the HAT-related mortality and re-OLT rates were 7.6% and 46.1%, respectively. At a follow-up of 86 months, the rate of graft loss was 9.2%, and the rate of post-OLT survival was 77%. Patients who developed HAT had a higher donor-to-recipient body weight ratio and longer warm ischemia times (WITs). Additionally, patients undergoing re-OLT had a higher risk of developing HAT. Conclusions: Although the incidence of HAT is low, its clinical consequences are severe. Early Doppler ultrasound surveillance is crucial for detecting e-HAT and preventing graft loss. A high donor-to-recipient body weight ratio, a prolonged warm ischemia time, and re-OLT seem to be associated with a high risk of HAT. Full article
(This article belongs to the Section General Surgery)
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23 pages, 1090 KiB  
Article
Air Pollution, Socioeconomic Status, and Avoidable Hospitalizations: A Multifaceted Analysis
by Carlos Minutti-Martinez, Miguel F. Mata-Rivera, Magali Arellano-Vazquez, Boris Escalante-Ramírez and Jimena Olveres
Math. Comput. Appl. 2025, 30(4), 69; https://doi.org/10.3390/mca30040069 - 30 Jun 2025
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Abstract
This study investigates the combined effects of air pollution and socioeconomic factors on disease incidence and severity, addressing gaps in prior research that often analyzed these factors separately. Using data from 86,170 hospitalizations in Mexico City (2015–2019), we employed multivariate statistical methods (PCA [...] Read more.
This study investigates the combined effects of air pollution and socioeconomic factors on disease incidence and severity, addressing gaps in prior research that often analyzed these factors separately. Using data from 86,170 hospitalizations in Mexico City (2015–2019), we employed multivariate statistical methods (PCA and factor analysis) to construct composite measures of social and economic status and grouped correlated pollutants. Logistic and negative binomial regression models assessed their associations with hospitalization risk and frequency. Results showed that economic status significantly influenced diabetes complications, while social factors affected prenatal care-related diseases and hypertension. The PM10PM2.5–CO group increased the incidence of asthma, influenza, and epilepsy, whereas NO2NOx impacted diabetes complication severity and influenza. Nonlinear effects and interactions (e.g., age and weight) were also identified, highlighting the need for integrated analyses in environmental health research. Full article
(This article belongs to the Special Issue New Trends in Computational Intelligence and Applications 2024)
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17 pages, 7173 KiB  
Article
Inhibition of Matrix Metalloproteinase-7 Attenuates Subpleural Fibrosis in Rheumatoid Arthritis-Associated Interstitial Lung Disease
by Li Xiong, Li-Mei Liang, Shu-Yi Ye, Xiao-Lin Cui, Shi-He Hu, Chen-Yue Lian, Wen-Jia Sun, Yang-Ping Lv, He-De Zhang, Meng Wang, Fei Xiang, Liang Xiong, Hong Ye, Wan-Li Ma and Lin-Jie Song
Biomedicines 2025, 13(7), 1581; https://doi.org/10.3390/biomedicines13071581 - 27 Jun 2025
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Abstract
Background: Rheumatoid arthritis-related interstitial lung disease (RA-ILD) is a significant complication of RA which lacks effective treatments with high mortality. This study aimed to investigate the role of matrix metalloproteinase-7 (MMP-7) in mediating RA-ILD. Methods: Based on the database of RA-ILD [...] Read more.
Background: Rheumatoid arthritis-related interstitial lung disease (RA-ILD) is a significant complication of RA which lacks effective treatments with high mortality. This study aimed to investigate the role of matrix metalloproteinase-7 (MMP-7) in mediating RA-ILD. Methods: Based on the database of RA-ILD patients, a bioinformatics analysis was performed. A protein–protein interaction (PPI) network focusing on MMP-7 was simulated. Pleural mesothelial cells (PMCs) were treated with RA-ILD patients’ serum or RA-ILD-related inflammatory factors, and the protein expressions of collagen-I and MMP-7 were examined. An arthritis model was established using complete Freund’s adjuvant (CFA). Changes in the weight and joints of mice were recorded, and lung tissues were evaluated by Masson staining and Sirius red stain techniques. MMP-7 inhibitor, MMP-7 siRNA and MMP shRNA lentivirus were used to inhibit MMP-7 and investigate changes in collagen-I and fibrosis in vivo and in vitro. Results: MMP-7 was found to be significantly expressed in RA-ILD lung tissue by bioinformatics analysis, and MMP-7 to maybe interact with collagen-I. In vitro experiments indicated cytokines IL-1β, IL-6 and TNF-α promoted MMP-7 and collagen-I expression in PMCs. Serum obtained from patients with RA-ILD also upregulated MMP-7 and collagen-I expression in PMCs. Inhibition of MMP-7 with MMP-7 siRNA or MMP inhibitor prevented collagen-I synthesis in PMCs. In vivo, CFA induced arthritis and subpleural lung inflammation in rats, but the MMP-7 inhibitor and MMP-7 siRNA attenuated CFA-induced lung inflammation and subpleural lung fibrosis. Conclusions: MMP-7 mediated subpleural lung inflammation as well as fibrosis in RA-ILD. It provided theoretical and experimental support for MMP-7 being a therapeutic target in RA-ILD. Full article
(This article belongs to the Special Issue Pathogenesis, Diagnostics, and Therapeutics for Rheumatic Diseases)
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18 pages, 571 KiB  
Article
Incidence of Gallstones in Patients with Obesity After Bariatric Surgery in Northern Saudi Arabia: A Cross-Sectional Study
by Abdulrahman Omar A. Alali, Abdualaziz Fayez Alhumidi Alanazi, Mohammed Abdulaziz M. Albarghash, Rakan Nasser Abdullah Alruweli, Mohammed Bader H. Alanazi, Ibrahim Farhan B. Alanazi, Turkey Saleh H. Alrowaily, Rakan Khalid Marzouq Alanazi, Baraah AbuAlsel, Fadih Nada M. Alenezi, Rashad Qasem Ali Othman and Manal S. Fawzy
Clin. Pract. 2025, 15(7), 115; https://doi.org/10.3390/clinpract15070115 - 23 Jun 2025
Viewed by 665
Abstract
Background/Objectives: Gallstone formation (cholelithiasis) is a common and important consequence following bariatric surgery, though regional data from the Northern Border Region are limited. This study aimed to investigate the incidence and risk factors of gallstones in this population, with the goal of optimizing [...] Read more.
Background/Objectives: Gallstone formation (cholelithiasis) is a common and important consequence following bariatric surgery, though regional data from the Northern Border Region are limited. This study aimed to investigate the incidence and risk factors of gallstones in this population, with the goal of optimizing postoperative treatment and reducing morbidity. Methods: We conducted a cross-sectional study using a non-probability convenience sampling technique to recruit 509 participants with varying degrees of obesity. Four hundred and ten study participants underwent bariatric surgery, of whom 73 were excluded for preoperative cholelithiasis and/or cholecystectomy. Data were collected through a self-administered, pre-validated questionnaire distributed via various social media platforms. These data included demographics, type/timing of surgery, pre/postoperative BMI, medical history, use of gallstone prophylaxis, and gallstone outcomes. Logistic regression analysis was used to identify independent predictors of gallstone formation. Results: Postoperative cholelithiasis developed in 60.8% of patients, most commonly within the first postoperative year, with risk peaking between 7 and 12 months after surgery. Rapid and substantial postoperative weight loss, as reflected in a lower current BMI and a transition to normal or overweight status within one year, was significantly associated with an increased incidence of gallstones. Female sex (OR: 2.62, 95% CI: 1.38–4.98, p = 0.003) and non-use of gallstone prevention medication (OR: 4.12, 95% CI: 1.34–12.64, p = 0.013) were independent predictors of gallstone formation. A longer time since surgery (OR: 0.76, 95% CI: 0.63–0.91, p = 0.004) and a lower current BMI (OR: 0.48, 95% CI: 0.28–0.83, p = 0.008) were associated with a reduced risk. Smoking status and comorbidities were not significantly related to the risk of gallstones. Conclusions: Gallstone formation after bariatric surgery in this population is influenced by female sex, rapid postoperative weight loss, and lack of prophylactic medication, while the type of surgical procedure does not significantly affect risk. Focused monitoring and preventive strategies, particularly in high-risk groups, are recommended to reduce gallstone-related complications following bariatric surgery. Full article
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