Medicina

6 pages, 1825 KiB

Open AccessCase Report

Sandwiched Strut Allografts with Stem Retention to Treat Fragile Periprosthetic Femoral Fractures: A Case Report

by Hyoung Tae Kim, Hyun Jun Lee and Suenghwan Jo

Medicina 2025, 61(1), 166; https://doi.org/10.3390/medicina61010166 - 20 Jan 2025

Viewed by 687

Managing periprosthetic femoral fractures is challenging, particularly in osteoporotic patients with fragile bones. Revision with a long stem is commonly considered but may fail to provide adequate fixation and stability in fragile bones. A novel approach using sandwiched strut allografts and controlled bone [...] Read more.

Managing periprosthetic femoral fractures is challenging, particularly in osteoporotic patients with fragile bones. Revision with a long stem is commonly considered but may fail to provide adequate fixation and stability in fragile bones. A novel approach using sandwiched strut allografts and controlled bone crushing with robust cable fixation can offer mechanical support and provide secondary stability to the loosened femoral stem and can be considered a treatment option for low-demand patients. A 73-year-old female with 23 years of hemodialysis experienced pain and instability in her right thigh following a slip. She had extremely low bone mineral density, and radiographs revealed a periprosthetic femoral fracture with a loosened femoral prosthesis, classified as Vancouver type B3. The patient underwent surgical fixation using a long anatomical plate augmented with dual strut allografts sandwiched anterior and posterior femur. Robust cable fixation was performed to partially crush the native cortical bone against the stem to enhance stability. Postoperative imaging at 18 months confirmed successful bone union and implant stability, and the patient regained preoperative functional capacity without pain. This case demonstrates that partially crushing native bone with dual strut allografts may provide stability to the loosened femoral stem and can be an effective alternative to long-stem revision surgery for patients with highly fragile bones. This approach may provide immediate mechanical stability and can be a potential treatment option for managing fragile periprosthetic femoral fractures. Full article

(This article belongs to the Special Issue New Strategies in the Management of Geriatric Bone Fracture)

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14 pages, 1999 KiB

Open AccessArticle

Phlorofucofuroeckol-A: A Natural Compound with Potential to Attenuate Inflammatory Diseases Caused by Airborne Fine Dust

by Eun-Gyeong Lee, Sung-Kun Yim, Sang-Min Kang, Byung Jae Ahn, Chang-Kwon Kim, Mina Lee, Dongseob Tark and Gun-Hee Lee

Medicina 2025, 61(1), 165; https://doi.org/10.3390/medicina61010165 - 20 Jan 2025

Viewed by 614

Abstract

Background and Objectives: Persistent exposure to airborne fine dust (FD) particles contributing to air pollution has been linked to various human health issues, including respiratory inflammation, allergies, and skin diseases. We aimed to identify potential seaweed anti-inflammatory bioactive reagents and determine their [...] Read more.

Background and Objectives: Persistent exposure to airborne fine dust (FD) particles contributing to air pollution has been linked to various human health issues, including respiratory inflammation, allergies, and skin diseases. We aimed to identify potential seaweed anti-inflammatory bioactive reagents and determine their effects on systemic inflammatory responses induced by FD particles. Materials and Methods: While exploring anti-inflammatory bioactive reagents, we purified compounds with potential anti-inflammatory effects from the seaweed extracts of Ecklonia cava, Ecklonia stolonifera, and Codium fragile. Structural analyses of the purified compounds siphonaxanthin (Sx), fucoxanthin (Fx), dieckol (Dk), and phlorofucofuroeckol-A (PFF-A) were performed using NMR and LC-MS/MS. Results: Notably, these compounds, especially PFF-A, showed significant protective effects against FD-induced inflammatory responses in RAW 264.7 cells without cytotoxicity. Further investigation of inflammatory-associated signaling demonstrated that PFF-A inhibited IL-1β expression by modulating the NF-κB/MAPK signal pathway in FD-induced RAW 264.7 cells. Additionally, gene profiling revealed the early activation of various signature genes involved in the production of inflammatory cytokines and chemokines using gene profiling. Treatment with PFF-A markedly reduced the expression levels of pro-inflammatory and apoptosis-related genes and even elevated the Bmp gene families. Conclusions: These results suggested that PFF-A is a potential natural therapeutic candidate for managing FD-induced inflammatory response. Full article

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12 pages, 1373 KiB

Open AccessReview

Telling Ghost Stories Around a Bonfire—A Literature Review of Acute Bleeding Secondary to Pancreatitis

by Gabriele Bellio, Silvia Fattori, Andrea Sozzi, Matteo Maria Cimino and Hayato Kurihara

Medicina 2025, 61(1), 164; https://doi.org/10.3390/medicina61010164 - 20 Jan 2025

Viewed by 454

Abstract

Bleeding is a rare but serious complication of pancreatitis, significantly increasing morbidity and mortality. It can arise from various sources, including erosion of blood vessels by inflammatory processes, formation of pseudoaneurysms, and gastrointestinal bleeding. Early diagnosis and timely intervention are crucial for patient [...] Read more.

Bleeding is a rare but serious complication of pancreatitis, significantly increasing morbidity and mortality. It can arise from various sources, including erosion of blood vessels by inflammatory processes, formation of pseudoaneurysms, and gastrointestinal bleeding. Early diagnosis and timely intervention are crucial for patient survival. Imaging modalities such as computed tomography and angiography are essential for identifying the bleeding source, where endoscopy may help in detecting and treating intraluminal hemorrhage. Management strategies for patients with extraluminal bleeding may involve angioembolization or surgical intervention, depending on the severity and location of the bleeding. While advances in diagnostic and therapeutic techniques have improved outcomes, bleeding in pancreatitis remains a challenging clinical problem requiring a multidisciplinary approach. This review aims to focus its attention specifically on the bleeding complications of pancreatitis. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Acute Pancreatitis)

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16 pages, 1381 KiB

Open AccessArticle

Differences in Characteristics of Peripartum Patients Who Did and Did Not Require an Upgrade to the Intensive Care Unit: A Propensity Score Matching Study

by Jennifer A. Walker, Jerry M. Yang, Saad Pirzada, Manahel Zahid, Samantha Asuncion, Amanda Tuchler, Gillian Cooper, Allison Lankford, Emad Elsamadicy and Quincy K. Tran

Medicina 2025, 61(1), 163; https://doi.org/10.3390/medicina61010163 - 20 Jan 2025

Viewed by 607

Abstract

Background and Objectives: This study sought to identify predictors for peripartum patients admitted to non-intensive care wards who later upgraded to the Intensive Care Unit (ICU). Materials and Methods: This was a retrospective observational study of patients admitted to the Maternal Fetal Ward [...] Read more.

Background and Objectives: This study sought to identify predictors for peripartum patients admitted to non-intensive care wards who later upgraded to the Intensive Care Unit (ICU). Materials and Methods: This was a retrospective observational study of patients admitted to the Maternal Fetal Ward between 01/2017 and 12/2022, who later upgraded to the ICU. Upgraded patients were 1:1 propensity score matched with those who remained on the Maternal Fetal Ward (control). The Classification And Regression Tree, a machine learning algorithm, was used to identify significant predictors of ICU upgrade. Multivariable ordinal regression analysis was used to assess the time interval to upgrade. Results: From 1855 peripartum patients, we analyzed 37 control and 34 upgrade patients. Mean maternal age (±Standard Deviation) and gestational age for the group was 29.5 (±5.8) years and 31.5 (±7.5) weeks, respectively. The Median Sequential Organ Failure Assessment Score [Interquartile] at ward admission for the controls was 0 [0–1] versus 2 [0–3.3, p = 0.001] for upgrade patients. The Sequential Organ Failure Assessment score at Maternal Fetal Ward admission was most predictive, followed by the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and lactate dehydrogenase levels. The APACHE II score was also associated with ICU upgrade within 12 h of hospital admission (OR 1.4, 95% CI 1.08–1.91, p = 0.01). Conclusions: Compared to control patients, peripartum patients upgraded to the ICU are associated with higher physiologic scores at Maternal Fetal Ward admission. Until further studies are performed to confirm our observation, clinicians should pay attention to these physiologic scores, since they may be associated with higher-risk patients. Full article

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

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16 pages, 1499 KiB

Open AccessArticle

The Platelet-Specific Gene Signature in the Immunoglobulin G4-Related Disease Transcriptome

by Ali Kemal Oguz, Cagdas Sahap Oygur, Bala Gur Dedeoglu, Irem Dogan Turacli, Sibel Serin Kilicoglu and Ihsan Ergun

Medicina 2025, 61(1), 162; https://doi.org/10.3390/medicina61010162 - 19 Jan 2025

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Abstract

Background and Objectives: Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated, fibroinflammatory, multiorgan disease with an obscure pathogenesis. Findings indicating excessive platelet activation have been reported in systemic sclerosis, which is another autoimmune, multisystemic fibrotic disorder. The immune-mediated, inflammatory, and fibrosing intersections of IgG4-RD [...] Read more.

Background and Objectives: Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated, fibroinflammatory, multiorgan disease with an obscure pathogenesis. Findings indicating excessive platelet activation have been reported in systemic sclerosis, which is another autoimmune, multisystemic fibrotic disorder. The immune-mediated, inflammatory, and fibrosing intersections of IgG4-RD and systemic sclerosis raised a question about platelets’ role in IgG4-RD. Materials and Methods: By borrowing transcriptomic data from Nakajima et al. (GEO repository, GSE66465) we sought a platelet contribution to the pathogenesis of IgG4-RD. GEO2R and BRB-ArrayTools were used for class comparisons, and WebGestalt for functional enrichment analysis. During the selection of differentially expressed genes (DEGs), the translationally active but significantly low amount of platelet mRNA was specifically considered. The platelet-specific gene signature derived was used for cluster analysis of patient and control groups. Results: When IgG4-RD patients were compared with controls, 268 DEGs (204 with increased and 64 with decreased expression) were detected. Among these, a molecular signature of 22 platelet-specific genes harbored genes important for leukocyte–platelet aggregate formation (i.e., CLEC1B, GP1BA, ITGA2B, ITGB3, SELP, and TREML1) and extracellular matrix synthesis (i.e., CLU, PF4, PPBP, SPARC, and THBS1). Functional enrichment analysis documented significantly enriched terms related to platelets, including but not limited to “platelet reactivity”, “platelet degranulation”, “platelet aggregation”, and “platelet activation”. During clustering, the 22 gene signatures successfully discriminated IgG4-RD and the control and the IgG4-RD before and after treatment groups. Conclusions: Patients with IgG4-RD apparently display an activated platelet phenotype with a potential contribution to disease immunopathogenesis. If the platelets’ role is validated through further carefully designed research, the therapeutic potentials of selected conventional and/or novel antiplatelet agents remain to be evaluated in patients with IgG4-RD. Transcriptomics and/or proteomics research with platelets should take into account the relatively low amounts of platelet mRNA, miRNA, and protein. Secondary analysis of omics data sets has great potential to reveal new and valuable information. Full article

(This article belongs to the Section Hematology and Immunology)

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Graphical abstract

10 pages, 2467 KiB

Open AccessArticle

Comparison of Proximal Tibiofibular Joint Detachment with Tibial-Sided Osteotomy for Fibular Untethering in Lateral Closing-Wedge High Tibial Osteotomy: A Cadaveric Study

by Ryu Kyoung Cho, Keun Young Choi, Dai-Soon Kwak, Man Soo Kim and Yong In

Medicina 2025, 61(1), 161; https://doi.org/10.3390/medicina61010161 - 19 Jan 2025

Viewed by 446

Abstract

Background and Objectives: Proximal tibiofibular joint detachment (PTFJD) is a fibular untethering procedure during lateral closing-wedge high tibial osteotomy (LCWHTO) for varus knee osteoarthritis. However, the PTFJD procedure is technically demanding, and confirmation of clear joint separation is not straightforward. The aim of [...] Read more.

Background and Objectives: Proximal tibiofibular joint detachment (PTFJD) is a fibular untethering procedure during lateral closing-wedge high tibial osteotomy (LCWHTO) for varus knee osteoarthritis. However, the PTFJD procedure is technically demanding, and confirmation of clear joint separation is not straightforward. The aim of this study was to compare the degree of completion and safety of PTFJD versus tibial-sided osteotomy (TSO); this latter procedure is our novel technique for fibular untethering during LCWHTO. Materials and Methods: Sixteen fresh frozen cadaver knees from eight cadavers were included in the study. Among the eight pairs of knees, one knee was randomly assigned to undergo PTFJD and the other knee to undergo TSO, which separates the fibula by osteotomizing the lateral cortex of the proximal tibia at the medial side of the proximal tibiofibular joint for fibular untethering during LCWHTO. After each procedure with LCWHTO, the posterior compartment of each knee was dissected to compare the degree of procedural completion and the distance from the posterior detachment or osteotomy site to posterior neurovascular structures between PTFJD and TSO groups. The pass-through test crossing the separation site from anterior to posterior using an osteotome was also performed to evaluate the protective effect of the muscular structures of the posterior compartment. Results: In the PTFJD group, four of eight cases (50%) showed fibular head fractures rather than division of the proximal tibiofibular joint. In contrast, in all TSO cases, the lateral cortex of the proximal tibia was clearly osteotomized from the medial side of the posterior proximal tibiofibular joint. Distances from the posterior detachment or osteotomy site to the common peroneal nerve, popliteal artery, and anterior tibial artery in the PTFJD and TSO groups were 20.8 ± 3.3 mm and 22.9 ± 3.6 mm (p = 0.382), 11.0 ± 2.4 mm and 9.8 ± 2.8 mm (p = 0.382), and 14.8 ± 1.9 mm and 14.9 ± 2.5 mm (p = 0.721), respectively. In the pass-through test, an osteotome was able to pass anteriorly to posteriorly in all eight PTFJD group cases. However, the osteotome was blocked posteriorly by the popliteus muscle in the TSO group cases, indicating protection of posterior neurovascular structures during the TSO procedure. Conclusions: TSO, a novel fibular untethering procedure for LCWHTO, resulted in clear separation of the fibula from the lateral tibial cortex, and protection of posterior neurovascular structures by the popliteus muscle during the procedure. We anticipate that our novel surgical technique will provide more clear-cut and safer fibular untethering for LCWHTO. Full article

(This article belongs to the Special Issue Cutting-Edge Concepts in Knee Surgery)

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13 pages, 289 KiB

Open AccessArticle

Depression and Associated Factors Among Patients with Spinocerebellar Ataxia

by Sirivipa Jekpoo, Nahathai Wongpakaran, Tinakon Wongpakaran, Chayasak Wantaneeyawong, Punjaree Wiriyacosol and Pised Methapatara

Medicina 2025, 61(1), 160; https://doi.org/10.3390/medicina61010160 - 19 Jan 2025

Viewed by 438

Abstract

Background and Objectives: Spinocerebellar ataxia (SCA) is a progressive neurodegenerative disease often accompanied by depression. This cross-sectional study investigated the prevalence of depression and the associated mental health factors in SCA patients. Material and Methods: Eleven Thai SCA patients completed questionnaires assessing depression, [...] Read more.

Background and Objectives: Spinocerebellar ataxia (SCA) is a progressive neurodegenerative disease often accompanied by depression. This cross-sectional study investigated the prevalence of depression and the associated mental health factors in SCA patients. Material and Methods: Eleven Thai SCA patients completed questionnaires assessing depression, anxiety, inner strengths, perceived social support, personality traits and perceived stress. Results: Participants’ average age was 50.27 years old. The prevalence of depression was 27.27%. Depression scores were positively correlated with OI-anxiety score (r = 0.887, 95%CI 0.586 to 0.968), perceived stress (r = 0781, 95%CI 0.305 to 0.936) and personality traits including aggression (r = 0.73, 95% CI 0.197 to 0.920), activity (r = 0.651, 95%CI 0.052 to 0.893) and neuroticism (r = 0.80, 95% CI 0.351 to 0.942). Conversely, depression negatively correlated with inner strengths (r = −0.70, 95%CI −0.910 to −0.139) and perceived social support, particularly from family (r = −0.88, 95%CI −0.966 to −0.564). Conclusions: These findings highlight the need for comprehensive mental health assessment and intervention in SCA patients. Strengthening inner strengths, promoting social support, and managing negative mental health factors may improve quality of life for patients with SCA. Full article

(This article belongs to the Section Psychiatry)

12 pages, 874 KiB

Open AccessArticle

Comparison of Asymptomatic Brain Lesions Between Thalassemia Major and Sickle Cell Anemia Patients

by Derya Yavuz Demiray, Özge Eriş Davut and Gönül Oktay

Medicina 2025, 61(1), 159; https://doi.org/10.3390/medicina61010159 - 19 Jan 2025

Viewed by 567

Abstract

Background and Objectives: This study aimed to identify asymptomatic brain lesions in patients with β-thalassemia major (TM) and sickle cell anemia (SCA) and evaluate the correlation of these lesions with factors such as splenectomy, thrombocytosis, and blood transfusions. Materials and Methods: A total [...] Read more.

Background and Objectives: This study aimed to identify asymptomatic brain lesions in patients with β-thalassemia major (TM) and sickle cell anemia (SCA) and evaluate the correlation of these lesions with factors such as splenectomy, thrombocytosis, and blood transfusions. Materials and Methods: A total of 26 patients with thalassemia major and 23 patients with sickle cell anemia were included. Ischemic lesions were categorized as lacunar, small vessel, or multifocal. Variables including age, years of education, presence and type of MRI-detected ischemia, smoking status, hemoglobin, hematocrit, platelet count, ferritin levels, vitamin B12 levels, fasting blood sugar, splenectomy status, chelation therapy, and hydroxyurea treatment were compared between the two groups. Results: The mean age was 27.33 years in the thalassemia major group and 32.65 years in the sickle cell anemia group (p = 0.010). No statistically significant difference was observed in the distribution of ischemia types between the groups (p = 0.303). The thalassemia major group had a lower mean hemoglobin level (8.37 g/dL) compared to the sickle cell anemia group (9.57 g/dL) (p = 0.003). Ferritin levels were significantly higher in the thalassemia major group (2018.92 ng/mL) than in the sickle cell anemia group (660.39 ng/mL) (p < 0.001). Conclusions: Although ischemic lesions were more frequently observed in patients with sickle cell anemia, the difference was not statistically significant. These findings emphasize the importance of ongoing surveillance and individualized management to mitigate cerebrovascular risks in both patient populations. Full article

(This article belongs to the Section Hematology and Immunology)

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10 pages, 686 KiB

Open AccessArticle

Congenital Bullous Syphilis: A Case Report from Italy and a Comprehensive Literature Review

by Edoardo Cammarata, Elia Esposto, Nunzia Di Cristo, Chiara Airoldi, Elena Bernascone, Valentina Burzio and Paola Savoia

Medicina 2025, 61(1), 158; https://doi.org/10.3390/medicina61010158 - 18 Jan 2025

Viewed by 606

Abstract

Background and Objectives: Congenital syphilis remains a significant global health concern, with severe morbidity and mortality if undiagnosed and untreated. Although many infants appear asymptomatic at birth, subtle clinical signs—including bullous lesions (congenital bullous syphilis, also known as pemphigus syphiliticus)—may facilitate early detection. [...] Read more.

Background and Objectives: Congenital syphilis remains a significant global health concern, with severe morbidity and mortality if undiagnosed and untreated. Although many infants appear asymptomatic at birth, subtle clinical signs—including bullous lesions (congenital bullous syphilis, also known as pemphigus syphiliticus)—may facilitate early detection. Recognizing this rare manifestation is crucial for timely intervention, reducing serious outcomes. Materials and Methods: We systematically reviewed Medline (PubMed), Embase, and the Cochrane Central Register of Controlled Trials from inception to December 2024 for cases of congenital bullous syphilis, also known as pemphigus syphiliticus. We extracted demographic, clinical, laboratory, radiological, treatment, and outcome data. Additionally, we included clinical information from a newly documented case of congenital bullous syphilis managed in our center. Results: Twenty-four cases of congenital syphilis with bullous lesions were identified, twenty with sufficient detail for analysis. Patients presented three distinct clinical patterns: confined palmoplantar lesions, acrally distributed lesions, and diffuse bullous-erosive involvement. Despite variable severity, cutaneous manifestations provided a key diagnostic clue. Nontreponemal and treponemal serologic tests were central to diagnosis, supported by maternal screening and imaging. Intravenous penicillin G was the most frequently employed therapy. While most infants achieved remission, severe respiratory involvement was associated with mortality. Our new case aligned with these findings, demonstrating full resolution after appropriate antibiotic therapy. Conclusions: Bullous syphilis, though rare, is an important early sign of congenital syphilis. Prompt recognition and diagnosis—enabled by diligent maternal screening, targeted neonatal testing, and careful clinical examination—are essential to initiate timely penicillin therapy and prevent severe complications or death. This review underscores the need for heightened clinical vigilance and adherence to established guidelines for syphilis screening and treatment during pregnancy, ultimately improving neonatal outcomes. Full article

(This article belongs to the Section Dermatology)

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17 pages, 642 KiB

Open AccessSystematic Review

Short-Term and Long-Term Effects of Bariatric Surgery on Diabetic Retinopathy: A Systematic Review

by Erika Butkutė, Monika Zieniūtė, Agnė Morkūnaitė and Vilma Jūratė Balčiūnienė

Medicina 2025, 61(1), 157; https://doi.org/10.3390/medicina61010157 - 18 Jan 2025

Viewed by 440

Abstract

Background and Objectives: Diabetic retinopathy (DR) is a common diabetes complication and a leading cause of blindness. Although bariatric surgery (BS) is well studied for diabetes management, its effects on DR onset and progression, particularly long-term outcomes, remain underexplored. This review seeks [...] Read more.

Background and Objectives: Diabetic retinopathy (DR) is a common diabetes complication and a leading cause of blindness. Although bariatric surgery (BS) is well studied for diabetes management, its effects on DR onset and progression, particularly long-term outcomes, remain underexplored. This review seeks to evaluate the short- and long-term retinal outcomes of BS in diabetic patients. Materials and Methods: A systematic search of PubMed, Web of Science, and Cochrane Library was conducted following PRISMA 2020 guidelines, including the use of the PRISMA checklist and flow diagram. The search included English-language articles (2014–2024) using keywords like “diabetic retinopathy” and “bariatric surgery”. The review excluded studies published in languages other than English, as well as reviews, case reports, and those lacking adequate data or relevance. The risk of bias was determined by using the Downs and Black checklist. A systematic review of the literature was conducted, and the results were organized and displayed in tables to summarize and compare the main findings. Results: After screening 158 articles, 13 studies involving 17,903 patients were selected, focusing on the effects of BS on DR progression and regression. Short-term data suggest that BS may stabilize or improve DR but poses risks of worsening in advanced cases, requiring careful monitoring. However, long-term findings are inconsistent, with evidence of both DR regression and progression. These variations highlight the need for further research. Discussion: BS generally improves DR progression, but its effect depends on preoperative severity and glycemic control. Further studies should explore additional risk factors to better predict DR outcomes post-surgery. Conclusions: BS improves weight management, blood pressure, and diabetes control, potentially benefiting DR. However, the long-term effects remain uncertain due to conflicting findings. Rapid glycemic changes after surgery may pose risks of DR progression. Large-scale, longitudinal studies are needed to clarify the role of BS in DR progression and regression. Full article

(This article belongs to the Section Ophthalmology)

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17 pages, 326 KiB

Open AccessArticle

Genomic Insights into Blood Pressure Regulation: Exploring Ion Channel and Transporter Gene Variations in Jordanian Hypertensive Individuals

by Mansour Abdullah Alghamdi, Laith AL-Eitan, Rasheed Ibdah, Islam Bani Khalid, Salma Darabseh, Maryam Alasmar and Asaad Ataa

Medicina 2025, 61(1), 156; https://doi.org/10.3390/medicina61010156 - 17 Jan 2025

Viewed by 686

Abstract

Background and Objectives: Hypertension (HTN) constitutes a significant global health burden, yet the specific genetic variant responsible for blood pressure regulation remains elusive. This study investigates the genetic basis of hypertension in the Jordanian population, focusing on gene variants related to ion [...] Read more.

Background and Objectives: Hypertension (HTN) constitutes a significant global health burden, yet the specific genetic variant responsible for blood pressure regulation remains elusive. This study investigates the genetic basis of hypertension in the Jordanian population, focusing on gene variants related to ion channels and transporters, including KCNJ1, WNK1, NPPA, STK39, LUC7L2, NEDD4L, NPHS1, BDKRB2, and CACNA1C. Materials and Methods: This research involved 200 hypertensive patients and 224 healthy controls. Whole blood samples were collected from each participant, and genomic DNA was extracted. The genetic distribution of the polymorphisms was analyzed. The haplotype frequencies were investigated using the SNPStats web tool, and the genotype and allele frequencies of the studied variants were assessed using the χ² test. Results: Sixteen single nucleotide polymorphisms (SNPs) from nine genes were evaluated. A significant association was observed between the rs880054 variant of the WNK1 gene and hypertension susceptibility, with the T allele elevating the risk of hypertension. This association remained important in the codominant model (p = 0.049) and the dominant model (p = 0.029). In addition, rs880054 was associated with clinical characteristics such as triglyceride levels and cerebrovascular accidents (p-value > 0.05). Conclusions: Our findings reveal a significant link between the rs880054 SNP and an increased hypertension risk, suggesting that variations in WNK1 may be crucial in regulating blood pressure. This study provides new insights into the genetic factors contributing to hypertension and highlights the potential of WNK1 as a target for future therapeutic interventions. Full article

(This article belongs to the Section Cardiology)

12 pages, 627 KiB

Open AccessArticle

Systemic Lupus Erythematosus in Hemodialysis: Survival Comparison and Mortality-Related Factors

by Hwajeong Lee and Seok-Hui Kang

Medicina 2025, 61(1), 155; https://doi.org/10.3390/medicina61010155 - 17 Jan 2025

Viewed by 541

Abstract

Background and Objectives: We aimed to evaluate the outcome of systemic lupus erythematosus (SLE) patients undergoing hemodialysis (HD) by comparing the survival among HD patients with SLE, diabetes mellitus (DM), or other diseases in the Korean population. We also analyzed the factors [...] Read more.

Background and Objectives: We aimed to evaluate the outcome of systemic lupus erythematosus (SLE) patients undergoing hemodialysis (HD) by comparing the survival among HD patients with SLE, diabetes mellitus (DM), or other diseases in the Korean population. We also analyzed the factors affecting the survival of SLE patients undergoing HD. Materials and Methods: This retrospective study analyzed laboratory data from a national HD quality assessment program and claims data. The programs included maintenance HD patients aged ≥18 years. The patients were divided into three groups according to underlying comorbidities as follows: SLE (n = 569), DM (n = 24,665), and others (n = 31,004). Results: The Kaplan–Meier curve showed that the SLE group had better survival than the other two groups. Multivariate analysis showed that the hazard ratios were 0.89 (p = 0.334) in the others group and 1.32 (p = 0.015) in the DM group compared to those in the SLE group. In the SLE group, age, the Charlson Comorbidity Index (CCI) score, hemoglobin, serum creatinine levels, and systolic blood pressure (SBP) were associated with patient survival. Conclusions: This study showed that HD patients with SLE had better patient survival than those with DM and comparable survival with those with other diseases, except SLE or DM. In addition, age, CCI score, hemoglobin, serum creatinine level, and SBP were associated with survival in HD patients with SLE. Full article

(This article belongs to the Section Urology & Nephrology)

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18 pages, 1134 KiB

Open AccessArticle

Evaluating the Effectiveness of Cyclin-Dependent Kinase 4/6 Inhibitors in Early- and Very Early-Onset Metastatic Breast Cancer: A Multicenter Study

by Akif Doğan, Nurullah İlhan, Goncagül Akdağ, Sedat Yıldırım, Mustafa Seyyar, Zeynep Yüksel Yaşar, Hande Nur Erölmez, Heves Sürmeli, Buğra Öztosun, Özlem Nuray Sever, Hatice Odabaş, Mahmut Emre Yıldırım, Devrim Çabuk, Nedim Turan and Mahmut Gümüş

Medicina 2025, 61(1), 154; https://doi.org/10.3390/medicina61010154 - 17 Jan 2025

Viewed by 587

Abstract

Background and Objectives: Early-onset breast cancer (EOBC), particularly in patients under 40, presents with distinct biological characteristics and worse survival outcomes compared to late-onset cases. Despite intensive treatments, EOBC patients, especially those with hormone receptor-positive, HER2-negative (HR+/HER2-) subtypes, show poorer prognosis. CDK4/6 inhibitors, combined [...] Read more.

Background and Objectives: Early-onset breast cancer (EOBC), particularly in patients under 40, presents with distinct biological characteristics and worse survival outcomes compared to late-onset cases. Despite intensive treatments, EOBC patients, especially those with hormone receptor-positive, HER2-negative (HR+/HER2-) subtypes, show poorer prognosis. CDK4/6 inhibitors, combined with endocrine therapy (ET) have become the standard for HR+/HER2- metastatic breast cancer, yet younger patients are underrepresented in clinical trials. This study aims to evaluate the efficacy of ribociclib and palbociclib with ET in HR+/HER2- metastatic breast cancer, addressing the critical gap in understanding treatment outcomes in younger patient populations. Materials and Methods: This multicenter, retrospective study evaluated the efficacy and safety of cyclin-dependent kinase 4 and 6 (CDK 4/6) inhibitors, ribociclib, and palbociclib, in combination with endocrine therapy in patients with hormone receptor-positive and human epidermal growth factor receptor 2-negative metastatic breast cancer. Results: A total of 198 patients treated between 2019 and 2023 were analyzed for progression-free survival, overall survival, and prognostic factors. Very early-onset breast cancer, which is diagnosed before the age of 35, was identified as an independent prognostic factor for poor progression-free survival. Additional factors associated with poorer outcomes included liver metastasis, progesterone receptor negativity, high tumor grade, and the concurrent use of fulvestrant with CDK4/6 inhibitors. Both ribociclib and palbociclib demonstrated similar efficacy, and dose reductions due to treatment-related adverse events did not compromise therapeutic outcomes. Conclusions: This study is the first to focus specifically on the treatment of early-onset breast cancer with CDK4/6 inhibitors, providing critical insights into the unique challenges faced by this patient population. The findings underscore the urgent need for personalized treatment strategies, routine genetic testing, and dedicated clinical trials designed to address the specific needs of these high-risk subgroups. By advancing our understanding of the clinical and molecular landscape of early-onset breast cancer and very early-onset breast cancer, this study lays the groundwork for improving outcomes in these underserved patients through tailored therapeutic approaches. Full article

(This article belongs to the Section Oncology)

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12 pages, 448 KiB

Open AccessReview

Enhancing Therapy Adherence: Impact on Clinical Outcomes, Healthcare Costs, and Patient Quality of Life

by Urszula Religioni, Rocío Barrios-Rodríguez, Pilar Requena, Mariola Borowska and Janusz Ostrowski

Medicina 2025, 61(1), 153; https://doi.org/10.3390/medicina61010153 - 17 Jan 2025

Viewed by 869

Abstract

Adherence to therapy, defined as the extent to which a patient follows prescribed therapeutic recommendations, is a pivotal factor in the effective management of chronic diseases such as diabetes, hypertension, and cardiovascular conditions. This review highlights the profound influence of adherence on clinical [...] Read more.

Adherence to therapy, defined as the extent to which a patient follows prescribed therapeutic recommendations, is a pivotal factor in the effective management of chronic diseases such as diabetes, hypertension, and cardiovascular conditions. This review highlights the profound influence of adherence on clinical outcomes, healthcare costs, and patient quality of life. Despite its critical importance, non-adherence remains a pervasive challenge globally, contributing to suboptimal treatment results, higher rates of complications, increased hospitalizations, and substantial healthcare expenditures. This narrative review examines the multifaceted impact of adherence, focusing on its role in achieving clinical efficacy, mitigating economic burdens, and enhancing patient well-being. The findings reveal that poor adherence exacerbates the risk of disease progression, complications, and higher healthcare costs. Conversely, improved adherence promotes better disease control, fewer complications, and enhanced patient quality of life. Interventions such as patient education, streamlined treatment regimens, and the integration of digital health tools have shown promise in addressing adherence barriers. Furthermore, the role of healthcare professionals is underscored as fundamental, with their continuous support, effective communication, and efforts to build patient trust being essential to fostering better adherence. In conclusion, adherence significantly affects clinical outcomes, healthcare costs, and patient quality of life. Addressing barriers to adherence requires a comprehensive and personalized approach, considering individual patient needs and circumstances. Future research should prioritize the long-term evaluation of emerging technologies and the development of tailored strategies to improve adherence across diverse patient populations. Strengthening adherence is not only crucial for individual patient outcomes, but also for enhancing the sustainability and efficiency of healthcare systems. Full article

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

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12 pages, 1267 KiB

Open AccessArticle

Evaluation of Bone Mineral Metabolism in Pre-Dialysis Chronic Kidney Disease: Quantitative Computed Tomography vs. Dual-Energy Absorptiometry and Correlation with Bone Turnover Markers

by Aydan Mutis Alan, Zehra Sezer, Ahmet Oz, Cebrail Karaca, Mevlüt Tamer Dinçer, Ahmet Murt, Fatma Beyza Sag, Selma Alagoz, Serdar Sahin, Mustafa Sait Gonen, Elif Güzel, Sinan Trabulus and Nurhan Seyahi

Medicina 2025, 61(1), 152; https://doi.org/10.3390/medicina61010152 - 17 Jan 2025

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Abstract

Background and Objectives: Bone and mineral disease (BMD) is a prevalent complication of advanced chronic kidney disease (CKD). The risk of fractures can be assessed via dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT). This study aims to evaluate the effectiveness [...] Read more.

Background and Objectives: Bone and mineral disease (BMD) is a prevalent complication of advanced chronic kidney disease (CKD). The risk of fractures can be assessed via dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT). This study aims to evaluate the effectiveness of two imaging modalities in identifying bone mineral status in individuals with pre-dialysis chronic renal disease and to assess their correlation with bone turnover markers. Materials and Methods: This controlled cross-sectional study, conducted at a single center from 2019 to 2022, assessed two groups of individuals aged 18 to 50. The patient cohort consisted of individuals with stage 4–5 chronic kidney disease, whereas the control cohort consisted of healthy participants. The participants’ bone and mineral status was evaluated using both QCT and DXA methods. Diagnostic measurements of the lumbar spine and femoral neck, obtained using DXA and QCT, were compared. Z-scores were utilized to evaluate low bone mineral density, with low Z-scores identified in either lumbar spine or femoral neck measures being seen as indicative of low bone mineral density. Results: Data from 38 participants (patient group: 18; control group: 20) who underwent QCT and/or DXA were evaluated. Thirty-three subjects were assessed using both QCT and DXA (patient group: 14; control group: 19). The median age of the patient cohort was 44 (range: 22–50), whereas the median age of the control cohort was 42 (range: 27–48) (p = 0.72). Women constituted 33% of the patient cohort and 50% of the control cohort (p = 0.23). In the patient cohort, low bone mineral density was detected in four individuals (28%) through QCT, and in just two patients (14%) through DXA. Compared to DXA, QCT identified a higher number of cases of low bone mineral density in the CKD cohort; however, no statistically significant difference was observed (p = 0.06). In addition, our study found that TRACP5b had a strong negative correlation with the DXA L1–L4 Z-score. Conclusions: This study revealed that QCT may be more sensitive than DXA for detecting low bone density in pre-dialysis CKD patients. Additionally, DXA may overestimate lumbar spine BMD in this population, and the strong negative correlation between TRACP5b levels and the DXA L1–L4 Z-score highlights the potential role of biochemical markers in assessing bone status in CKD Full article

(This article belongs to the Section Urology & Nephrology)

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9 pages, 571 KiB

Open AccessArticle

Comparison of the Effects of Sugammadex Recommended Dose (2 mg/kg) and Fixed Dose of 200 mg on the Reversal of Moderate Neuromuscular Block and Recovery Profile in Adult Patients

by Ji-Yoon Jung, Sung-Ae Cho, Woojin Kwon, Hongwook Kim and Tae-Yun Sung

Medicina 2025, 61(1), 151; https://doi.org/10.3390/medicina61010151 - 17 Jan 2025

Viewed by 474

Abstract

Background and Objectives: Neuromuscular blocking agents are essential to ensure optimal surgical conditions during general anesthesia. Sugammadex, a selective binding agent, is widely used to reverse neuromuscular blockade. While weight-based dosing (2 mg/kg for moderate blockade) is recommended, many clinicians administer a [...] Read more.

Background and Objectives: Neuromuscular blocking agents are essential to ensure optimal surgical conditions during general anesthesia. Sugammadex, a selective binding agent, is widely used to reverse neuromuscular blockade. While weight-based dosing (2 mg/kg for moderate blockade) is recommended, many clinicians administer a fixed dose of 200 mg in clinical practice, potentially leading to overdosing. This study aimed to compare the efficacy and recovery profiles of weight-based and fixed-dose sugammadex in patients undergoing general anesthesia. Materials and Methods: In this randomized controlled trial, 20 patients were divided into two groups: the recommended dose group (R group, 2 mg/kg) and the fixed dose group (F group, 200 mg). Primary outcomes included time to achieve a normalized train-of-four (TOF) ratio of 0.9. Secondary outcomes included recovery time, time to spontaneous respiration, response to verbal commands and extubation, and adverse events. Results: The median time to achieve a normalized TOF ratio of 0.9 was 2.3 min in the R group and 2.0 min in the F group (p = 0.529). Secondary outcomes, including recovery time and time to extubation showed no significant differences. Adverse events were minimal and comparable between groups. Conclusions: The fixed-dose sugammadex (200 mg) demonstrated similar efficacy and safety to weight-based dosing (2 mg/kg) in reversing moderate neuromuscular blockade. These findings do not allow abandoning the recommendation of adjustment for body weight, particularly in patients with low body weight or comorbidities. Full article

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

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12 pages, 469 KiB

Open AccessArticle

Association of Sociodemographic Variables and Healthy Habits with Body and Visceral Fat Values in Spanish Workers

by María Gordito Soler, Ángel Arturo López-González, Pedro Juan Tárraga López, Emilio Martínez-Almoyna Rifá, Cristina Martorell Sánchez, María Teófila Vicente-Herrero, Hernan Paublini and José Ignacio Ramírez-Manent

Medicina 2025, 61(1), 150; https://doi.org/10.3390/medicina61010150 - 17 Jan 2025

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Abstract

Background and Objectives: The accumulation of fat in the body, especially visceral fat, is associated with various cardiometabolic conditions such as diabetes mellitus and fatty liver. The reasons for the accumulation of this fat are diverse. Some studies, also in the working [...] Read more.

Background and Objectives: The accumulation of fat in the body, especially visceral fat, is associated with various cardiometabolic conditions such as diabetes mellitus and fatty liver. The reasons for the accumulation of this fat are diverse. Some studies, also in the working population, have shown a clear association between sociodemographic variables and health habits with scales that assess overweight and obesity. This study aims to determine how certain sociodemographic variables, such as age, gender, and socioeconomic level, as well as certain healthy habits like physical activity and tobacco consumption, affect the levels of body and visceral fat. Materials and Methods: We conducted a descriptive and cross-sectional study involving 8590 Spanish workers. The percentage of body and visceral fat was measured using a bioimpedance analysis with a Tanita DC 430MA device. Results: Both the average values and the prevalence of elevated body and visceral fat increase with age and decrease with social class and lower levels of physical activity. These values are higher in smokers. A multivariate analysis shows that the variables most influential in increasing the risk of high levels of both body and visceral fat are age and low levels of physical activity. Conclusions: The profile of a person at high risk of having elevated body and visceral fat levels is an older male with a low socioeconomic status who smokes and leads a sedentary lifestyle. Full article

(This article belongs to the Special Issue Dyslipidemia, Obesity and Metabolic Dysfunction-Associated Fatty Liver Disease: From Roots to Management)

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15 pages, 2149 KiB

Open AccessArticle

Retrospective Analysis of the Prevalence and Risk Factors of Retinopathy of Prematurity in a Single-Center Cohort in Romania and Comparison with National and European Data

by Zsuzsánna Simon-Szabó, Sándor Pál, Aliz Pándi, Zsuzsanna Gáll, Hajnal Finta, Zsuzsánna Incze-Bartha, Cristina Maki and Manuela Cucerea

Medicina 2025, 61(1), 149; https://doi.org/10.3390/medicina61010149 - 17 Jan 2025

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Abstract

Background and Objectives: This study investigated and compared with European literature data the incidence, severity, and perinatal risk factors of retinopathy of prematurity (ROP) in preterm infants admitted to the Premature Department of Mureş County Clinical Hospital over a two-year period (January 2022–December [...] Read more.

Background and Objectives: This study investigated and compared with European literature data the incidence, severity, and perinatal risk factors of retinopathy of prematurity (ROP) in preterm infants admitted to the Premature Department of Mureş County Clinical Hospital over a two-year period (January 2022–December 2023). Materials and Methods: ROP screening was performed in 96 infants (76.8%) according to professional guidelines. A literature review was conducted to compare our findings with national and European data. Significant differences were identified in comparisons with studies from Cluj-Napoca (p = 0.0125), Timișoara, and Bucharest (p < 0.0074), as well as Serbia and Croatia when stratified by gestational age limits. The variations in GA thresholds (32 vs. 34 weeks) between studies required stratified analyses to ensure meaningful comparisons. The included European studies provided data on screening criteria, prevalence, and associated risk factors, offering a comprehensive perspective on screening effectiveness. Results: Among the 149 admitted patients, 125 were preterm (n = 125). Of the screened patients, 20 (20.83%) infants were diagnosed with ROP, including 13 boys (65%) and 7 girls (35%), all requiring prolonged respiratory support, and 55% of them needed blood transfusion. The average birth weight of affected infants was 1030.5 g (550–1700 g ), and the mean gestational age was 28.3 weeks (25–34 weeks). In those found to have stage 2 and 3 ROP in zone II with plus disease (n = 6), intravitreal anti-VEGF injections and/or retinal laser treatments were performed. Notably, no cases of ROP-related blindness were recorded. Conclusions: To our knowledge, this is the first study to compare ROP prevalence and screening outcomes across Romanian national centers. Identified risk factors in this cohort, such as respiratory distress syndrome, oxygen therapy, blood transfusion, and intraventricular hemorrhage, are consistent with the existing literature data. These findings underscore the importance of standardized screening criteria and effective management protocols to prevent ROP-related blindness. The comparative approach of this study highlights the necessity of harmonized internationally applied criteria to facilitate robust comparisons and, more importantly, improve patient care outcomes. Full article

(This article belongs to the Special Issue Retinopathies: A Challenge for Early Diagnosis, Innovative Treatments and Reliable Follow-Up)

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13 pages, 943 KiB

Open AccessArticle

The Role of Butirprost^® as an Adjuvant in Enhancing the Effect of Antibiotics in Patients Affected by Chronic Bacterial Prostatitis: A Randomized Prospective Trial

by Felice Crocetto, Armando Calogero, Michele Santangelo, Agostino Fernicola, Filippo Varlese, Benito Fabio Mirto, Fabio Machiella, Alfonso Falcone, Giovanni Pagano, Fabrizio Dinacci, Gaetano Giampaglia, Domenico Varriale, Francesco Trama, Salvatore Iaconis, Francesco Del Giudice, Gian Maria Busetto, Matteo Ferro, Francesco Lasorsa, Giuseppe Lucarelli, Ciro Imbimbo and Biagio Barone Show full author list Hide full author list

Medicina 2025, 61(1), 148; https://doi.org/10.3390/medicina61010148 - 17 Jan 2025

Viewed by 509

Abstract

Bacterial prostatitis (BP) is a common prostatic infection characterized by pain and urinary symptoms, often with negative bacterial cultures from prostatic secretions. It affects young and older men bimodally and impacts quality of life (QoL) significantly. Background and Objectives: Treatment typically involves [...] Read more.

Bacterial prostatitis (BP) is a common prostatic infection characterized by pain and urinary symptoms, often with negative bacterial cultures from prostatic secretions. It affects young and older men bimodally and impacts quality of life (QoL) significantly. Background and Objectives: Treatment typically involves antibiotics, but a multimodal approach with additional nutraceuticals may enhance outcomes. This study aimed to assess the efficacy of Butirprost^® in association with fluoroquinolones in patients with chronic bacterial prostatitis (CBP). Materials and Methods: Patients diagnosed with prostatitis (positive Meares–Stamey test and symptom duration > 3 months) at the University of Naples “Federico II”, Italy, from March 2024 to July 2024 were included in this study. All patients underwent bacterial cultures. Patients were randomized into two groups: Group A received antibiotics plus Butirprost^® (sodium hyaluronate plus Plantago major) for one month, while Group B received antibiotics alone. International Prostatic Symptoms Score (IPSS) and National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) questionnaires were administered at baseline and at 15 and 30 days. Results: Out of 60 patients (Group A: 30, Group B: 30), Group A showed significant improvement in IPSS and NIH-CPSI scores at 15 and 30 days compared to Group B. Notable improvements were observed in pain, urinary symptoms, and QoL. Conclusions: The administration of Butirprost^® along with fluoroquinolones resulted in a significant improvement in pain, urinary symptoms, and quality of life along with improvements in both IPSS and NIH-CPSI scores, in patients affected by chronic bacterial prostatitis compared with fluoroquinolones alone. Full article

(This article belongs to the Section Urology & Nephrology)

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14 pages, 620 KiB

Open AccessArticle

Relationship Between Perilesional Skin Condition and Survival in Terminally Ill Patients with Pressure Ulcers

by María Isabel Pastor-Orduña, Federico Palomar-Llatas, David Palomar-Albert, María Teresa Murillo-Llorente, Ignacio Ventura, Francisco Tomás-Aguirre and Marcelino Pérez-Bermejo

Medicina 2025, 61(1), 147; https://doi.org/10.3390/medicina61010147 - 17 Jan 2025

Viewed by 497

Abstract

Background and Objectives: In the context of palliative care, the aim is to alleviate suffering and improve quality of life, with particular attention to PUs, which have a significant impact on quality of life and survival. This study examines the relationship between perilesional [...] Read more.

Background and Objectives: In the context of palliative care, the aim is to alleviate suffering and improve quality of life, with particular attention to PUs, which have a significant impact on quality of life and survival. This study examines the relationship between perilesional skin condition and survival in terminally ill patients with pressure ulcers (PUs). Materials and Methods: A descriptive and observational study was conducted in two hospitals in Valencia with a sample of 100 terminally ill patients. Sociodemographic, clinical and PPU-specific variables were assessed using validated scales such as FEDPALLA-II and the Barthel Index. Results: Although it is a study of an observational nature, which may preclude establishing causality, the results showed that functional capacity, perilesional tissue epithelialization, and albumin levels were significant predictors of survival, while the number and location of PUs had no direct impact. Perilesional tissue epithelialization was highlighted as a critical indicator reflecting the systemic stability of the patient. Conclusions: The study highlights the importance of a comprehensive approach to palliative care that addresses both the local aspects of the lesions and the patient’s systemic and functional status. These findings support the implementation of therapeutic interventions based on a structured perilesional tissue assessment to improve quality of life and prolong survival in terminally ill patients. In addition, a positive correlation was found between Barthel Score and survival, suggesting that patients with greater functional independence have a longer life expectancy. On the other hand, the negative correlation between total lymphocyte count and survival suggests that lymphocytopenia may be a marker of adaptive immunosuppression. Perilesional tissue epithelialization, overall functionality and serum albumin levels are key factors in predicting survival, highlighting the need for a comprehensive palliative care approach to optimize quality of life and prolong survival in terminally ill patients with PUs. Full article

(This article belongs to the Section Dermatology)

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10 pages, 1248 KiB

Open AccessArticle

The Effect of Local Melatonin Application on Bone Fracture Healing in Rat Tibias

by Murat Tanrisever, Bahar Tekin, Umit Koray Can, Ozmen Istek, Erhan Cahit Ozcan, Ibrahim H. Ozercan, Turker Gelic and Serkan Dundar

Medicina 2025, 61(1), 146; https://doi.org/10.3390/medicina61010146 - 16 Jan 2025

Viewed by 683

Abstract

Background and Objectives: This study aimed to histologically evaluate the effects of local melatonin application at different doses on bone fracture healing. Materials and Methods: Thirty rats were divided into three groups, with ten rats in each group. In the control group ( [...] Read more.

Background and Objectives: This study aimed to histologically evaluate the effects of local melatonin application at different doses on bone fracture healing. Materials and Methods: Thirty rats were divided into three groups, with ten rats in each group. In the control group (n = 10), a fracture line was created in the tibial bones, and fracture osteosynthesis was performed without any additional procedure. In the local melatonin dose 1 (MLT D-1) group (n = 10), a fracture line was created in the tibial bones, and 1.2 mg of lyophilized powder melatonin was applied locally before fracture osteosynthesis. In the local melatonin dose 2 (MLT D-2) group (n = 10), a fracture line was created in the tibial bones, and 3 mg of lyophilized powder melatonin was applied locally before fracture osteosynthesis. After a 12-week healing period, all subjects were sacrificed, and tibial bones were collected for histomorphometric analysis. Results: The percentage of bone formation was significantly higher in the MLT D-1 and MLT D-2 groups than in the control group. There was no statistically significant difference between the MLT D-1 and MLT D-2 groups. Conclusions: In conclusion, the study demonstrated that local melatonin application supports bone fracture by increasing bone formation, although different doses of melatonin did not lead to significant variations in fracture healing. Full article

(This article belongs to the Section Orthopedics)

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9 pages, 1612 KiB

Open AccessCase Report

Prenatal Detection of Silver–Russell Syndrome: A First Trimester Suspicion and Diagnostic Approach

by Slavyana Galeva, Giuliana Diglio, Boris Stoilov, Ekaterina Uchikova and Lucian Pop

Medicina 2025, 61(1), 145; https://doi.org/10.3390/medicina61010145 - 16 Jan 2025

Viewed by 608

Abstract

Background and Objectives: Silver–Russell Syndrome (SRS) is a rare genetic disorder characterized by prenatal and postnatal growth restriction, distinctive facial features, and body asymmetry. Early suspicion during the first trimester remains challenging but crucial for optimizing clinical outcomes. This study aims to highlight [...] Read more.

Background and Objectives: Silver–Russell Syndrome (SRS) is a rare genetic disorder characterized by prenatal and postnatal growth restriction, distinctive facial features, and body asymmetry. Early suspicion during the first trimester remains challenging but crucial for optimizing clinical outcomes. This study aims to highlight a diagnostic approach to the early suspicion of SRS. Materials and Methods: A 28-year-old primigravida presented for routine first-trimester prenatal care. An ultrasound revealed asymmetric growth restriction with normal anatomical findings. The first-trimester biochemical markers, including PAPP-A and β-hCG, were within the normal range. A further evaluation, including amniocentesis and genetic testing, was performed. Results: Genetic testing identified hypomethylation at the 11p15 imprinting control region, confirming the diagnosis of SRS. Parental testing excluded the maternal uniparental disomy of chromosome 7, suggesting an epigenetic mechanism. The findings were consistent with a clinical diagnosis of SRS, and appropriate counseling and multidisciplinary management were initiated. Conclusions: This case underscores the importance of the early recognition of atypical growth patterns, the integration of advanced genetic testing, and multidisciplinary counseling to guide parental decision-making and improve outcomes. Full article

(This article belongs to the Section Obstetrics and Gynecology)

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12 pages, 1041 KiB

Open AccessArticle

The Effect of Systemic Inflammation and Clinicopathologic Features on Survival in Malignant Pleural Mesothelioma: A Multicenter Analysis

by Nadiye Sever, Sedat Yıldırım, Ali Fuat Gurbuz, Delyadil Karakaş Kılıç, Esra Zeynelgil, Yunus Emre Altintaş, Berivan Deniz Çimik, Yeşim Ağyol, Ali Kaan Güren, Pınar Erel, Erkam Kocaaslan, Burak Paçacı, Mustafa Alperen Tunç, Abdussamet Çelebi, Nazım Can Demircan, Selver Işık, Rukiye Arıkan, Murat Araz, Serdar Karakaya, Murat Sarı, Osman Köstek and İbrahim Vedat Bayoğlu Show full author list Hide full author list

Medicina 2025, 61(1), 144; https://doi.org/10.3390/medicina61010144 - 16 Jan 2025

Viewed by 547

Abstract

Background and Objectives: Malignant pleural mesothelioma (MPM) is a rare and aggressive malignancy with a poor prognosis. Identifying reliable prognostic factors is crucial for risk stratification and optimizing treatment strategies. This study aimed to evaluate the impact of clinicopathologic factors and systemic inflammatory [...] Read more.

Background and Objectives: Malignant pleural mesothelioma (MPM) is a rare and aggressive malignancy with a poor prognosis. Identifying reliable prognostic factors is crucial for risk stratification and optimizing treatment strategies. This study aimed to evaluate the impact of clinicopathologic factors and systemic inflammatory markers on survival outcomes in patients with MPM. Materials and Methods: This retrospective, multicenter study included 217 patients diagnosed with MPM between January 2009 and March 2024. Data on age, gender, histology, disease stage, treatment modalities, and inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein/albumin ratio (CAR) were collected. Survival outcomes were analyzed using Kaplan–Meier methods, and prognostic factors were evaluated using Cox regression analysis. Results: CAR was identified as an independent prognostic factor for both overall survival (OS) and progression-free survival (PFS). Patients with CAR < 0.98 had significantly longer OS (87.0 months vs. 14.0 months, p < 0.001) and PFS (17.61 months vs. 8.96 months, p = 0.010). While NLR was significant in univariate analysis (OS: 25.0 months for NLR < 2.58 vs. 21.0 months for NLR ≥ 2.58, p = 0.040), it did not retain significance in the multivariate model (p = 0.180). Epithelioid histology and early-stage disease were strongly associated with improved survival outcomes (OS: 32.0 vs. 11.0 months for epithelioid vs. non-epithelioid histology, p < 0.001; 32.0 vs. 12.0 months for early-stage vs. metastatic disease, p < 0.001). Conclusions: CAR is a strong independent prognostic factor in MPM, reflecting systemic inflammation and nutritional status. Epithelioid histology and early-stage disease are associated with significantly longer survival, underscoring the critical role of early detection in improving patient outcomes. Full article

(This article belongs to the Section Oncology)

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10 pages, 440 KiB

Open AccessCase Report

Hemoadsorption in Multiorgan Failure Due to Viscerocutaneous Loxoscelism

by Raúl Valenzuela Córdova, David Rivera Estrella, José F. Bernardo, Darío Jiménez, Celia Rodríguez Tudero, Raúl Elías and José C. De La Flor

Medicina 2025, 61(1), 143; https://doi.org/10.3390/medicina61010143 - 16 Jan 2025

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Abstract

Background: The bite of the Loxosceles spider is a public health problem around the world, mainly in Latin America. The viscerocutaneous presentation is related to the inoculation of toxins (phospholipase-D) that generates a systemic inflammatory reaction with a subsequent increase in cytokines [...] Read more.

Background: The bite of the Loxosceles spider is a public health problem around the world, mainly in Latin America. The viscerocutaneous presentation is related to the inoculation of toxins (phospholipase-D) that generates a systemic inflammatory reaction with a subsequent increase in cytokines and chemokines. Hemoadsorption is proposed as a therapy that allows for the removal of the toxin and modulation of the inflammatory response in this disease. Case Report: We present the case of a 31-year-old woman who was admitted to the hospital due to decreased urinary flow and jaundice 48 h after a spider bite. Despite treatment with intravenous (IV) monovalent antiloxoscelism serum, antibiotic therapy, and corticosteroids, the patient’s evolution was poor, and she was admitted to the critical care unit for severe multi-organ involvement, including hepatic and kidney damage and coagulation disorders, eventually requiring hemodialysis support and hemoadsorption therapy. After the therapy was administered, rapid improvement was evident with the suspension of vasopressor support and a decrease in inflammatory markers. Conclusions: This case presents hemoadsorption as a therapeutic option, based on its capacity to reduce the intensity of hyperinflammation and to regulate the immunological response. Full article

(This article belongs to the Special Issue Infectious and Tropical Diseases: Symptoms, Diagnosis and Treatment)

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15 pages, 985 KiB

Open AccessArticle

Three-Dimensional Evaluation of the Effects of Different Treatment Methods on Pharyngeal Airways in Patients with Skeletal Class III Malocclusion

by Mevlude Yuce Polat and İsmail Ceylan

Medicina 2025, 61(1), 142; https://doi.org/10.3390/medicina61010142 - 16 Jan 2025

Viewed by 464

Abstract

Background and Objectives: The aim of this prospective study was to assess the effects of rapid maxillary expansion (RME) and/or face mask (FM) treatments on the pharyngeal airway in patients with skeletal Class III malocclusion caused by maxillary deficiency. This study utilized [...] Read more.

Background and Objectives: The aim of this prospective study was to assess the effects of rapid maxillary expansion (RME) and/or face mask (FM) treatments on the pharyngeal airway in patients with skeletal Class III malocclusion caused by maxillary deficiency. This study utilized cone beam computed tomography (CIBT) for a three-dimensional (3D) analysis of airway changes, comparing the results with those of a control group consisting of untreated skeletal Class III patients. Materials and Methods: The study included 60 participants (34 boys, 26 girls) aged 9 to 14 years, all diagnosed with skeletal Class III malocclusion due to maxillary underdevelopment. The participants were divided into four treatment groups, each consisting of 15 individuals: Group 1—RME; Group 2—RME/FM; Group 3—FM; Group 4—Control group. The pharyngeal airway measurements were evaluated using CBCT and analyzed with Dolphin 3D software (version 11.9). Volumetric parameters and minimal axial area (MAA) were measured in the nasopharyngeal, retropalatal, retroglossal, and total airway regions. The collected data were statistically analyzed using SPSS 20.0 software. Results: The results indicated significant changes in pharyngeal airway volumes across all treatment groups compared to the control group. A statistically significant increase in nasopharyngeal, retropalatal, and total airway volume were observed in all treatment groups. Only the RME group demonstrated a significant increase in retroglossal volume. Significant increases in MAA were found in the RME/FM and FM groups in the nasopharyngeal and retropalatal regions. However, minimal changes were observed in the retroglossal region across all treatment groups. The control group showed no significant changes in any of the measured parameters, underscoring the effects of the treatments. Conclusions: The findings of this study suggest that both RME and/or FM treatments result in significant positive changes in the pharyngeal airways, particularly in the nasopharyngeal and retropalatal regions. The retroglossal region showed more limited response to the treatments. The combined RME/FM therapy was found to be particularly effective in improving airway dimensions in the anterior and mid-pharyngeal regions. These results highlight that early orthodontic interventions, such as RME and FM, can improve both airway patency and overall respiratory function, in addition to addressing skeletal Class III malocclusion. Full article

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

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12 pages, 938 KiB

Open AccessArticle

Catastrophizing as a Predictor for Pain Perception and Disability Among Patients Undergoing Spinal Cord Stimulation

by Juan Vicente-Mampel, Felipe Hernández-Zaballos, Francisco Javier Falaguera-Vera, David Sánchez-Poveda, Eloy Jaenada-Carrilero, Borja Huertas-Ramírez and Francisco Jose Sánchez-Montero

Medicina 2025, 61(1), 141; https://doi.org/10.3390/medicina61010141 - 16 Jan 2025

Viewed by 502

Abstract

Background and Objectives: The International Society for Modulation defines persistent spinal pain syndrome type 2 (PSPS-type 2), formerly known as failed back surgery syndrome, as a condition where patients continue to experience pain or develop new pain following spinal surgery intended to [...] Read more.

Background and Objectives: The International Society for Modulation defines persistent spinal pain syndrome type 2 (PSPS-type 2), formerly known as failed back surgery syndrome, as a condition where patients continue to experience pain or develop new pain following spinal surgery intended to alleviate back or lower-limb discomfort. PSPS-type 2 is characterized by pain and significant disability, affecting quality of life. Spinal cord stimulation has proven effective in treating this syndrome, although the role of psychological factors, such as pain catastrophizing and central sensitization, remain unclear. This study seeks to examine the potential connection between psychosocial responses and both functionality and pain perception in patients with persistent spinal pain syndrome type 2 who have undergone spinal cord stimulation treatment. Materials and Methods: A single-site, cross-sectional study was conducted on individuals diagnosed with persistent spinal pain syndrome type 2 who were receiving spinal cord stimulation. Study participants were required to meet specific eligibility criteria and were assessed for disability, pain perception, fear of movement, pain catastrophizing, and central sensitization. The spinal cord stimulation procedure involved the placement of electrodes at vertebral levels T8–T11 for precise pain control, with a particular focus on targeting the dorsal root ganglion to alleviate chronic pain. Results: Thirty-seven patients with persistent spinal pain syndrome type 2 have undergone spinal cord stimulation treatment for 4.68 ± 5.25 years. Clinical assessments indicated a pain perception score of 5.6 ± 1.96, Central Sensitization Inventory score of 42.08 ± 18.39, disability score of 37.62 ± 16.13, fear of movement score of 33.11 ± 8.76, and pain catastrophizing score of 28.43 ± 13.14. Finally, pain catastrophizing was significantly associated with pain perception (β = 0.075 and p = 0.008) and disability (β = 0.90 and p < 0.01). Conclusions: Catastrophizing plays a crucial role in pain perception and disability among patients with persistent spinal pain syndrome type 2 receiving spinal cord stimulation. Integrating psychological interventions may improve clinical outcomes for these patients. Full article

(This article belongs to the Section Neurology)

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10 pages, 528 KiB

Open AccessArticle

Asthma Risk Prevalence and Associated Factors in Stunted Children: A Study Using Asthma Predictive Index

by Gartika Sapartini, Gary W. K. Wong, Agnes Rengga Indrati, Cissy B. Kartasasmita and Budi Setiabudiawan

Medicina 2025, 61(1), 140; https://doi.org/10.3390/medicina61010140 - 16 Jan 2025

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Abstract

Background and Objectives: The prevalence of stunted children under 5 years in Indonesia is relatively high. Stunting is a significant risk factor for wheezing disorders. The asthma predictive index (API) identifies children with a recurrent wheezing disorder at risk of developing asthma [...] Read more.

Background and Objectives: The prevalence of stunted children under 5 years in Indonesia is relatively high. Stunting is a significant risk factor for wheezing disorders. The asthma predictive index (API) identifies children with a recurrent wheezing disorder at risk of developing asthma during the first 3 years. However, the risk of developing asthma and its associated factors among stunted children has not been studied. This study aims to determine the asthma risk prevalence in stunted children via the API score and associated factors. Materials and Methods: This cross-sectional study was conducted at the Bandung District Health Center from October 2021 to January 2022. This study included stunted children aged 24–59 months living in Bandung District whose parents could answer the API and asthma risk factor questionnaires. Results: A total of 422 participants with an average age of 43.1 ± 9.7 months were included. Among the stunted children, 4.7% (20/422) met the positive API criteria, and 50.0% were malnourished (stunted–underweight). The participants with positive API results had a parental medical diagnosis of asthma (45%), eczema (10.0%), allergic rhinitis (20.0%), and wheezing apart from colds (40.0%) (p < 0.05). Significant risk factors for developing asthma in the participants with a positive API were dog ownership in the past 12 months and parents and siblings with allergic diseases. Conclusions: The asthma risk prevalence in stunted children was 4.7%. The associated risk factors included a history of allergic diseases in parents and siblings, as well as dog ownership; however, further investigation is needed. Full article

(This article belongs to the Section Pediatrics)

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14 pages, 6567 KiB

Open AccessArticle

Unraveling the Beneficial Role of Resveratrol in Fructose-Induced Non-Alcoholic Steatohepatitis with a Focus on the AMPK/Nrf2 Signaling Axis

by Soha S. Zakaria and Safaa M. Hanafy

Medicina 2025, 61(1), 139; https://doi.org/10.3390/medicina61010139 - 16 Jan 2025

Viewed by 562

Abstract

Background and Objectives: High fructose intake is associated with non-alcoholic fatty liver disease (NAFLD), a chronic liver disease that is on the rise worldwide. New alternatives for treatment, such as bioactive phytochemicals, are needed. The aim of this study was to investigate [...] Read more.

Background and Objectives: High fructose intake is associated with non-alcoholic fatty liver disease (NAFLD), a chronic liver disease that is on the rise worldwide. New alternatives for treatment, such as bioactive phytochemicals, are needed. The aim of this study was to investigate the beneficial role of resveratrol in treating non-alcoholic steatohepatitis (NASH). Materials and Methods: Sixty male albino rats were allocated to three groups: group I, the normal control group; group II, the fructose-enriched diet group (FED), which was fed a 70% fructose diet for six weeks to induce NASH; and group III, the resveratrol–FED group (RES + FED), which was given the same FED diet plus an oral dose of 70 mg/kg resveratrol (RES) every day for an additional six weeks. We performed histological evaluations and assessed blood lipids and liver enzymes to study resveratrol’s impact on NASH. Quantitative real-time PCR was used to assess the mRNA expression of nuclear factor E2-related factor 2 (Nrf2) in the liver samples. ELISA was used to measure Beclin 1, AMPK, IL-6, and the DNA-binding activity of Nrf2. Oxidative stress indicators, including GSH, SOD, and MDA, were evaluated spectrophotometrically. Results: Resveratrol effectively alleviated the biochemical and histopathological abnormalities associated with NASH, improving autophagy by raising Beclin 1 levels while reducing inflammation by decreasing IL-6 levels. Furthermore, resveratrol restored the liver architecture and the oxidative balance, as evidenced by the decreased MDA levels and improved antioxidant status via elevated GSH and SOD activities, as well as the activation of the AMPK/Nrf2 signaling axis. Conclusions: This study specifically examines resveratrol’s therapeutic effects in a high-fructose diet-induced NASH model, focusing on the AMPK/Nrf2 signaling pathway to address oxidative stress and autophagy, providing novel insights into its molecular mechanism of action. Resveratrol reduces NASH by boosting autophagy and activating the AMPK/Nrf2 pathway. These findings underscore the potential of resveratrol as a promising therapeutic agent that can support treatment alongside conventional medications in the management of non-alcoholic steatohepatitis (NASH). Full article

(This article belongs to the Section Pharmacology)

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15 pages, 368 KiB

Open AccessArticle

The Impact of COVID-19 Pandemic on the Diagnosis, Treatment, and Outcomes of Colorectal Cancer in Singapore

by Hui Lionel Raphael Chen, Piea Peng Lee, Yun Zhao, Wei Hao Caleb Ng, Jiashen Zhao, Yu En Christopher Tan, Bo Jie Sean Loh, Kah-Hoe Pierce Chow, Hiang Khoon Tan and Kwong-Wei Emile Tan

Medicina 2025, 61(1), 138; https://doi.org/10.3390/medicina61010138 - 16 Jan 2025

Viewed by 514

Abstract

Background and Objectives: During the COVID-19 pandemic, many countries implemented lockdowns and social distancing measures, which may delay the early diagnosis of colorectal cancer (CRC). This study aims to review the impact of the pandemic on the diagnosis and treatment outcomes of [...] Read more.

Background and Objectives: During the COVID-19 pandemic, many countries implemented lockdowns and social distancing measures, which may delay the early diagnosis of colorectal cancer (CRC). This study aims to review the impact of the pandemic on the diagnosis and treatment outcomes of CRC. Materials and Methods: Patients who underwent colonoscopy or surgery for CRC were included. The study was divided into the pre-COVID-19 (January 2019–January 2020), early COVID-19 (February–May 2020), recovery (June–December 2020), and heightened alert (January–December 2021) periods. Cox regression was used to model the waiting time to colonoscopy. Multivariable logistic regression identified associations between time periods and incidence of CRC diagnosed. The characteristics and outcomes of the surgical procedures that were performed were compared across the time periods. Results: A total of 18,662 colonoscopies and 1462 surgical procedures were performed in the study period. Compared to the pre-COVID-19 period, there was a longer time to colonoscopy during the recovery (HR: 0.91; 95% CI: 0.87, 0.94) and heightened alert periods (HR: 0.88; 95% CI 0.85, 0.91). The early COVID-19 (OR: 1.36; 95% CI: 1.04, 1.77) and recovery (OR: 1.20; 95% CI: 1.01, 1.43) periods were associated with higher odds of diagnosing CRC. Compared to the pre-COVID-19 period, there was a higher proportion of ASA 4 patients (4.3% vs. 1.3%; p < 0.001) and stage 4 CRC patients (22.2% vs. 16.9%; p = 0.001) that required surgery during the heightened alert period. Similarly, there was a higher proportion of emergency surgeries (22% vs. 13.3%; p = 0.002); diverting stomas (13.5% vs. 10.5%; p = 0.005), and Hartmann’s procedures (4.4% vs. 0.4%; p = 0.001) performed during the heightened alert period. Conclusions: The pandemic was associated with a higher proportion of metastatic CRC patients requiring surgery. Healthcare policies should facilitate early cancer screening, diagnosis, and treatment to reduce cancer-related morbidity for future pandemics. Full article

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

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10 pages, 3582 KiB

Open AccessArticle

Clinical Efficacy of Three-Dimensional-Printed Pure Titanium Fracture Plates with Locking Screw Systems in Distal Tibia Fractures

by Ji Hye Choi, Jun Hyoung Lee, Seung Hyeop Lee and Woo Young Jang

Medicina 2025, 61(1), 137; https://doi.org/10.3390/medicina61010137 - 15 Jan 2025

Viewed by 664

Abstract

Background and Objectives: Distal tibia fractures are high-energy injuries characterized by a mismatch between standard plate designs and the patient’s specific anatomical bone structure, which can lead to severe soft tissue damage. Recent advancements have focused on the development of customized metal plates [...] Read more.

Background and Objectives: Distal tibia fractures are high-energy injuries characterized by a mismatch between standard plate designs and the patient’s specific anatomical bone structure, which can lead to severe soft tissue damage. Recent advancements have focused on the development of customized metal plates using three-dimensional (3D) printing technology. However, 3D-printed metal plates using titanium alloys have not incorporated a locking system due to the brittleness of these alloys. Therefore, this study aimed to determine whether a locking mechanism can be effectively implemented using 3D-printed pure titanium and further evaluate the clinical outcomes of such implants in patients with distal tibia fractures. Materials and Methods: Between March 2021 and June 2022, nine patients who underwent open reduction and internal fixation for distal tibia fractures using 3D-printed pure titanium plates were enrolled. Pure titanium powder (Ti Gr.2, Type A, 3D Systems, USA) was spread to a thickness of 30 μm and partially sintered using a 500 W laser to produce the 3D-printed metal plates. The locking screws were fabricated using a milling process. Open reduction and internal fixation were performed on the nine patients using 10 customized plates. The clinical efficacy was analyzed using the union rate, and complications, such as infection and skin irritation, were evaluated to ensure a comprehensive outcome assessment. Results: Surgical treatment was successfully performed on nine patients, with nine of ten plates remaining stable and undamaged. However, one patient with neurofibromatosis experienced a fractured metal plate, which necessitated revision surgery using a metal rod. No screw loosening or surgical wound complications occurred. Conclusions: This study showed that 3D-printed pure titanium plates with integrated locking screw systems provide a viable and effective solution for managing distal tibia fractures. Three-dimensional printing and pure titanium show promise for orthopedic advancements. Full article

(This article belongs to the Section Orthopedics)

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Medicina, Volume 61, Issue 1 (January 2025) – 166 articles

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