Medicina

10 pages, 243 KiB

Open AccessArticle

Who Are Suitable Patients for Omitting Breast Surgery as an Exceptional Responder in Selected Molecular Subtypes of Breast Cancer After Neoadjuvant Systemic Treatment?

by Ebru Sen, Mehmet Ali Nazlı, Göktürk Maralcan, Bekir Sıtkı Said Ulusoy, Mahmut Kaan Demircioğlu, Tuce Söylemez Akkurt, Mehmet Sökücü, Gökmen Umut Erdem and Mustafa Yıldırım

Medicina 2025, 61(1), 48; https://doi.org/10.3390/medicina61010048 - 31 Dec 2024

Abstract

Background and Objectives: Among breast cancer molecular types, HER2 positive and triple negative (TN) subtypes have the highest likelihood of pathological complete response (pCR), which is a surrogate marker for reduced recurrence and improved patient survival after neoadjuvant systemic treatment (NST). Preoperative [...] Read more.

Background and Objectives: Among breast cancer molecular types, HER2 positive and triple negative (TN) subtypes have the highest likelihood of pathological complete response (pCR), which is a surrogate marker for reduced recurrence and improved patient survival after neoadjuvant systemic treatment (NST). Preoperative pathological identification of these exceptional responders is a new era. Therefore, we aimed to determine the accuracy of trucut biopsy in identifying the exceptional responders in selected molecular subtypes of breast cancer patients. Materials and Methods: This two-centre, observational, single-arm, prospective, pilot study was conducted between January and September 2024. The patients with TN or HER2 positive breast cancer whose breast tumour had completely disappeared on the radiological assessment including MRI after neoadjuvant therapy were enrolled. To assess neoadjuvant treatment response, a standardised biopsy protocol was used, consisting of 10 samples from the marked tumour area per patient by 12 G core needle. Then, all patients underwent surgery. The pathological results of both postchemo-presurgical biopsy and surgical breast specimen were compared. Results: The study included 20 patients. The mean age of the patients was 47.3 years. The median tumour size at diagnosis was 23.1 mm. All biopsy results were concordant with the findings of surgical specimen. Seventeen patients had a complete response. The remaining 3 patients had residual disease. Conclusions: Along with thorough patient selection, post-chemo radiological assessment and the reliable biopsy technique are the key points in accurately predicting response to neoadjuvant treatment. If an image-guided core biopsy confirms elimination of tumour tissue at the marked tumour area with a radiological complete response on MRI after NST in breast cancer patients with selected molecular subtypes, these may be suitable patients as exceptional responders in whom we can omit breast surgery. Full article

(This article belongs to the Section Oncology)

20 pages, 3264 KiB

Open AccessArticle

Standardized Mortality Ratios (SMRs) and Radon Exposure Analysis for Lung Cancer and All-Cause Mortality in Locorotondo, Southern Italy

by Giovanni Maria Ferri, Luigi De Maria, Giuseppe Delvecchio, Antonio Caputi, Stefano Sole, Gianmarco Giannelli, Gianfranco Sifanno, Ilaria Maria Di Somma, Floriana Pentimone, Domenica Cavone, Angela Stufano, Piero Lovreglio, Vitantonio Ricci and Luigi Vimercati

Medicina 2025, 61(1), 47; https://doi.org/10.3390/medicina61010047 - 31 Dec 2024

Abstract

Background and Objectives: Radon is a known risk factor for lung cancer, and residential radon exposure is the leading cause of lung cancer in never smokers; however, in Italy, there is still a lack of public awareness regarding the risk caused by [...] Read more.

Background and Objectives: Radon is a known risk factor for lung cancer, and residential radon exposure is the leading cause of lung cancer in never smokers; however, in Italy, there is still a lack of public awareness regarding the risk caused by residential radon exposure. In this mortality study, which was carried out in an Italian Apulian town (Locorotondo) of the Bari province, we aimed to analyze lung cancer mortality and all-cause mortality in a population highly exposed to radon. Materials and Methods: The study period was 1998–2021. Local and Italian population and national mortality data were collected from the Italian National Institute of Statistics (ISTAT) website platform. Local mortality data were collected using copies of the Local Health Authority death certificates. Results: We identified 117 lung cancers in the studied period. The mortality data trends revealed a decrease in the all-causes standardized mortality ratios (SMRs), increases in the incidence rates of lung cancer and colorectal cancer in recent years, and a decrease in the incidence of noncancer diseases. We also found high SMRs for colorectal cancer until 2016 among older females. With respect to the cardio-circulatory system, only in 2014 did the male SMRs significantly influence the total SMR; after this period, a decreasing stable trend was observed. Conclusions: The natural balance of the population is decreasing, and mortality is decreasing for all causes. A future study will be needed to assess the associations between observed lung cancer cases and domestic radon exposure to drive radon mitigation and public health strategies. Full article

(This article belongs to the Section Oncology)

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10 pages, 736 KiB

Open AccessOpinion

Joint Group and Multi Institutional Position Opinion: Cirrhotic Cardiomyopathy—From Fundamentals to Applied Tactics

by Ivan Rankovic, Ivana Babic, Jelena Martinov Nestorov, Jelena Bogdanovic, Maja Stojanovic, Jovanka Trifunovic, Nikola Panic, Mihailo Bezmarevic, Jelena Jevtovic, Dusan Micic, Vladimir Dedovic, Nemanja Djuricic, Filip Pilipovic, Elena Curakova Ristovska, Tijana Glisic, Sanja Kostic, Nemanja Stojkovic, Nata Joksimovic, Mileva Bascarevic, Aleksandra Bozovic, Lewis Elvin, Ajibola Onifade, Keith Siau, Elizaveta Koriakovskaia and Vladimir Milivojevic Show full author list Hide full author list

Medicina 2025, 61(1), 46; https://doi.org/10.3390/medicina61010046 - 31 Dec 2024

Abstract

Cirrhotic cardiomyopathy (CCM) is a diagnostic entity defined as cardiac dysfunction (diastolic and/or systolic) in patients with liver cirrhosis, in the absence of overt cardiac disorder. Pathogenically, CCM stems from a combination of systemic and local hepatic factors that, through hemodynamic and neurohormonal [...] Read more.

Cirrhotic cardiomyopathy (CCM) is a diagnostic entity defined as cardiac dysfunction (diastolic and/or systolic) in patients with liver cirrhosis, in the absence of overt cardiac disorder. Pathogenically, CCM stems from a combination of systemic and local hepatic factors that, through hemodynamic and neurohormonal changes, affect the balance of cardiac function and lead to its remodeling. Vascular changes in cirrhosis, mostly driven by portal hypertension, splanchnic vasodilatation, and increased cardiac output alongside maladaptively upregulated feedback systems, lead to fluid accumulation, venostasis, and cardiac dysfunction. Autocrine and endocrine proinflammatory cytokines (TNF-alpha, IL-6), as well as systemic endotoxemia stemming from impaired intestinal permeability, contribute to myocardial remodeling and fibrosis, which further compromise the contractility and relaxation of the heart. Additionally, relative adrenal insufficiency is often present in cirrhosis, further potentiating cardiac dysfunction, ultimately leading to the development of CCM. Considering its subclinical course, CCM diagnosis remains challenging. It relies mostly on stress echocardiography or advanced imaging techniques such as speckle-tracking echocardiography. Currently, there is no specific treatment for CCM, as it vastly overlaps with the treatment of heart failure. Diuretics play a central role. The role of non-selective beta-blockers in treating portal hypertension is established; however, their role in CCM remains somewhat controversial as their effect on prognosis is unclear. However, our group still advocates them as essential tools in optimizing the neurohumoral pathologic axis that perpetuates CCM. Other targeted therapies with direct anti-inflammatory and antioxidative effects still lack sufficient evidence for wide approval. This is not only a review but also a comprehensive distillation of the insights from practicing clinical hepatologists and other specialties engaged in advanced approaches to treating liver disease and its sequelae. Full article

(This article belongs to the Special Issue Editorial Board Members’ Collection Series: Gastrointestinal and Hepatic Diseases)

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7 pages, 1349 KiB

Open AccessCase Report

Fibrous Dysplasia of the Ethmoid Bone Diagnosed in a 10-Year-Old Patient

by Zofia Resler, Monika Morawska-Kochman, Katarzyna Resler and Tomasz Zatoński

Medicina 2025, 61(1), 45; https://doi.org/10.3390/medicina61010045 - 31 Dec 2024

Abstract

Fibrous dysplasia is an uncommon bone disorder affecting various parts of the skeleton, often affecting facial and cranial bones. In this case, a 10-year-old patient was diagnosed with fibrous dysplasia of the ethmoid sinus at an early age. The patient has experienced nasal [...] Read more.

Fibrous dysplasia is an uncommon bone disorder affecting various parts of the skeleton, often affecting facial and cranial bones. In this case, a 10-year-old patient was diagnosed with fibrous dysplasia of the ethmoid sinus at an early age. The patient has experienced nasal congestion, snores, and worsening nasal patency since 2019. A CT scan revealed an expansive proliferative lesion, likely from the frontal or ethmoid bone, protruding into the nasal cavity, ethmoid sinus, and right orbit. The tumor causes bone defects in the area of the nasal bone, leading to fluid retention in the peripheral parts of the right maxillary sinus. The patient’s parents decided not to undergo surgery to remove the diseased tissue and reconstruct the area, as it would be very extensive, risky, and disfiguring. The patient is being treated conservatively with an MRI, with a contrast performed approximately every six months and infusions of bisphosphonates. Despite the lesion’s size, the patient does not experience pain characteristic of dysplasia, and functions typically. Fibrous dysplasia of bone is a rare condition that presents with the most visually apparent manifestations, often mistaken for other bone conditions. Advanced diagnostic tools, like CT and MRI, are used to identify conditions affecting the ethmoid sinus more frequently. However, diagnostic errors often occur in imaging studies, leading to confusion. The most common period for clinical manifestations and diagnosis is around 10 years of age. The preferred approach in managing fibrous dysplasia involves symptomatic treatment, which can alleviate airway obstruction, restore normal globe position and visual function, and address physical deformities. Surgical intervention is recommended only for patients with severe functional impairment, progressive deformities, or malignant transformation. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Diseases of the Facial Skeleton, Oral Cavity, and Paranasal Sinuses)

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11 pages, 1135 KiB

Open AccessCase Report

Primary Biliary Cholangitis Associated with Ulcerative Colitis: Case Series and Literature Review

by Qi Li and Ye Zong

Medicina 2025, 61(1), 44; https://doi.org/10.3390/medicina61010044 - 30 Dec 2024

Abstract

Purpose: To study the coexistence of ulcerative colitis (UC) and primary biliary cholangitis (PBC). Methods: The Beijing Friendship Hospital patient database was explored to identify patients presenting both UC and PBC from January 2015 to July 2024. By a review of [...] Read more.

Purpose: To study the coexistence of ulcerative colitis (UC) and primary biliary cholangitis (PBC). Methods: The Beijing Friendship Hospital patient database was explored to identify patients presenting both UC and PBC from January 2015 to July 2024. By a review of the literature, the characteristics of UC patients who experienced PBC was summarized. Results: We identified 890 UC patients and reported 4 individuals who suffered from UC and PBC. Compared to the general population, UC patients seem to have a higher risk of PBC. Only 28 cases of UC with PBC have been reported so far. Most patients were diagnosed with UC prior to PBC. Once UC patients are complicated with PBC, they might experience more than one extraintestinal manifestation (EIM). Shared susceptibility genes, certain bacterial infections, and common immune-mediated mechanisms may be involved in the pathogenesis of UC patients with PBC. Conclusions: Although the coexistence of UC and PBC is uncommon, PBC should be considered in UC patients with hepatobiliary disorders. Full article

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12 pages, 1299 KiB

Open AccessArticle

The Role of Omega-3 Polyunsaturated Fatty Acids in Patients with Metabolic Syndrome and Endothelial Dysfunction

by Andrej Dzupina, Dominik Pella, Pavol Zenuch, Zuzana Zenuchova, Jaipaul Singh, Monika Jankajova and Jan Fedacko

Medicina 2025, 61(1), 43; https://doi.org/10.3390/medicina61010043 - 30 Dec 2024

Abstract

Background and Objectives: Metabolic syndrome (MS) represents several diseases encompassing a heterogeneous group of biochemical and physiological abnormalities characterized by structural and functional alterations in the myocardium, including the endothelium of the coronary arteries. MS also affects a substantial portion of the global [...] Read more.

Background and Objectives: Metabolic syndrome (MS) represents several diseases encompassing a heterogeneous group of biochemical and physiological abnormalities characterized by structural and functional alterations in the myocardium, including the endothelium of the coronary arteries. MS also affects a substantial portion of the global population. Understanding the risk factors, the development and treatment associated with MS are of paramount importance for early identification, treatment and prevention. This study was designed to evaluate the role of the supplementation of omega-3 polyunsaturated fatty acids (n-3 PUFAs) on endothelial function in patients with MS. Materials and Methods: A total of 80 patients with MS were enrolled in two groups. The study evaluated endothelial function (EF) in subjects before and after a three-month treatment with n-3 PUFAs in a dose of 2.4 g daily (800 mg, three times a day) vs. placebo, using an Endo-PAT2000 device (Itamar Medical Ltd., Caesarea, Israel) measuring the reactive hyperemia index (a parameter of EF) and augmentation index (a parameter of arterial stiffness). Plasmatic levels of glutathione peroxidase, homocysteine, apolipoprotein B and lipoprotein were also evaluated for comparison. Results: The results showed that the average value of reactive hyperemia index before the treatment with n-3 PUFAs was 1.62 ± 0.42, compared to 1.96 ± 0.62 at the end of the study (p < 0.005). The augmentation index changed from 14.66 ± 19.55 to 9.21 ± 15.64 after the treatment (p = 0.003) with n-3 PUFA. The results also revealed a statistically significant decrease in apolipoprotein B (0.94 ± 0.36 vs. 1.13 ± 0.35, p = 0.001) and homocysteine (19.31 ± 5.29 vs. 13.78 ± 3.05, p = 0.001) and an increase in glutathione peroxidase plasma levels (41.65 ± 8.90 vs. 45.20 ± 8.01), p = 0.001. Conclusions: The results of this prospective study showed a significant improvement in EF in subjects with MS treated with n-3 PUFAs in a dose of 2.4 g daily. Full article

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

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10 pages, 276 KiB

Open AccessArticle

Comparison of Renal Tubular Damage with Kidney Injury Molecule-1 in Open and Laparoscopic Colorectal Cancer Surgery

by Abdullah Gürhan Duyan, Celalettin Vatansev, Rahim Kocabaş, Melek Yalçın Koç and Muhammed Ali Akbulut

Medicina 2025, 61(1), 42; https://doi.org/10.3390/medicina61010042 - 30 Dec 2024

Abstract

Background and Objectives: Colorectal cancer is the third most common type of cancer in men and women. With advancements in technology, minimally invasive treatment options have become increasingly prominent in colorectal cancer surgery. This study aimed to compare the increased intra-abdominal pressure in laparoscopic [...] Read more.

Background and Objectives: Colorectal cancer is the third most common type of cancer in men and women. With advancements in technology, minimally invasive treatment options have become increasingly prominent in colorectal cancer surgery. This study aimed to compare the increased intra-abdominal pressure in laparoscopic colon and rectal surgery with open procedures using kidney injury molecule-1 (KIM-1) secreted from renal tubules. Materials and Methods: We enrolled 46 patients diagnosed with colon cancer who underwent laparoscopic and open surgical procedures at our clinic. The patients were prospectively randomized into five groups: 10 laparoscopic right hemicolectomies (Group 1), 8 open right hemicolectomies (Group 2), 8 laparoscopic anterior resections (LARs) (Group 3), 11 open anterior resections (Group 4), and 9 laparoscopic low anterior resections (Group 5). Urine samples were collected from the patients preoperatively, postoperatively at the 4th hour, and postoperatively on the 14th day, and the urine KIM-1 levels and urine creatinine (Cr) values were measured. The urine KIM-1/Cr ratios were subsequently calculated. Results: The urinary KIM-1/Cr levels increased at the 4th postoperative hour after the open and laparoscopic procedures. On postoperative day 14, the urinary KIM-1/Cr levels were lower than those in the preoperative period in all groups, except the LAR group. Conclusions: Our study shown that the average pressure in laparoscopic colon and rectal surgery did not have a long-term impact on kidney injury in comparison to open colon and rectal surgery. Full article

12 pages, 563 KiB

Open AccessArticle

Long-Term Outcome Following Concomitant Surgical Ablation for Atrial Fibrillation at University Hospital Basel: A Retrospective Study

by Elodie Hersperger, Nicolas Schaerli, Brigitta Gahl, Oliver Reuthebuch, Friedrich S. Eckstein, Bernhard Winkler and Martin T. R. Grapow

Medicina 2025, 61(1), 41; https://doi.org/10.3390/medicina61010041 - 30 Dec 2024

Abstract

Background and Objectives: This study aims to examine the success of concomitant surgical ablation in patients with atrial fibrillation after one, three, and five years. Additionally, important predictors for rhythm outcome and rates of permanent pacemaker implantations were analyzed. Materials and Methods [...] Read more.

Background and Objectives: This study aims to examine the success of concomitant surgical ablation in patients with atrial fibrillation after one, three, and five years. Additionally, important predictors for rhythm outcome and rates of permanent pacemaker implantations were analyzed. Materials and Methods: In this retrospective study, we included patients who were referred to the University Hospital of Basel, Switzerland, between 2011 and 2017. Primary outcome was one-year success of surgical ablation. Secondary outcomes include heart rhythm during entire follow-up, three- and five-years success, and need for additional arrhythmia interventions (incl. pacemaker implantation). Results: A total of 120 patients were analyzed and divided into two groups: pulmonary vein isolation (n = 55) and left atrial (n = 65). The median follow-up time was 4.4 years. Sinus rhythm was present in 66%, 64%, and 67% after one, three, and five years, respectively. When adjusted for preoperative type of atrial fibrillation, left atrial lesion set increased the chance of achieving sinus rhythm within 5 years by factor 6.5. The pacemaker-implantation rate was 22%, with significantly more pacemaker implantations in the left atrial group (9% vs. 32%, p = 0.0043). Conclusions: These real-world data demonstrate the high success rate of concomitant surgical ablation for atrial fibrillation. Our study highlights the importance of preoperative discussion in an interdisciplinary heart team to weigh the effectiveness of surgical ablation against the risk of a pacemaker implantation. Full article

(This article belongs to the Section Cardiology)

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12 pages, 1475 KiB

Open AccessArticle

Improving Outcomes with Sequential Fixation Using Long-Threaded Screws for Valgus-Impacted Femoral Neck Fractures

by Jeong-Hyun Koh, Seungyeob Sakong, Won-Tae Cho, Sumin Lim and Hyung Keun Song

Medicina 2025, 61(1), 40; https://doi.org/10.3390/medicina61010040 - 30 Dec 2024

Abstract

Background and Objectives: Valgus-impacted femoral neck fractures (OTA 31B1.1 and 31B1.2) are considered stable fractures with favorable outcomes compared to displaced fractures. However, complications such as femoral neck shortening, screw sliding, and suboptimal recovery can occur, particularly in severe deformities. This study evaluated [...] Read more.

Background and Objectives: Valgus-impacted femoral neck fractures (OTA 31B1.1 and 31B1.2) are considered stable fractures with favorable outcomes compared to displaced fractures. However, complications such as femoral neck shortening, screw sliding, and suboptimal recovery can occur, particularly in severe deformities. This study evaluated the outcomes of a sequential fixation technique using short-threaded screws followed by long-threaded screws. Materials and Methods: This prospective study included 135 patients aged 60 years or older with valgus-impacted femoral neck fractures (OTA 31B1.1 and 31B1.2) treated between March 2017 and February 2021. Patients were divided into two groups: those treated solely with short-threaded screws (the control group) and those treated using a sequential fixation technique involving initial compression with short-threaded screws followed by stabilization with long-threaded screws. Exclusion criteria included follow-up < 12 months, pathological fractures, high-energy trauma, or periprosthetic fractures. Clinical outcomes, including the Harris Hip Score (HHS), and radiological parameters, such as screw sliding distance (SDS) and fixation failure, were analyzed. Multivariate regression identified predictors of outcomes to assess the effectiveness of the sequential fixation technique. Results: The mean follow-up was 38.3 months. Multivariate regression revealed that posterior tilt > 15° (β = 2.944, p < 0.001) and the use of long-threaded screws (β = −1.906, p < 0.001) were significant predictors of reduced SDS. Posterior tilt > 15° (OR 15.085, p = 0.002), valgus tilt > 15° (OR 28.616, p = 0.002), and bone mineral density (OR 0.285, p = 0.005) were predictors of fixation failure, while long-threaded screws significantly reduced fixation failure risk (OR 0.062, p = 0.005). Conclusions: The sequential use of short-threaded screws for compression, followed by long-threaded screws for stabilization, effectively reduced screw sliding and fixation failure while improving functional and radiological outcomes. This technique shows promise as an effective treatment for valgus-impacted femoral neck fractures. Full article

(This article belongs to the Special Issue Clinical Care and Updates on Hip Fractures)

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15 pages, 9881 KiB

Open AccessArticle

Evaluation of Sacroiliac Joint Shape in Women with Ankylosing Spondylitis According to Mode of Birth Delivery: A Retrospective Study

by Sakine Rahimli Ocakoglu, Alper Vatansever, Zeliha Atak, Nurefsan Yanardag, Belkis Nihan Coskun, Sinem Akselim and Gokhan Ocakoglu

Medicina 2025, 61(1), 39; https://doi.org/10.3390/medicina61010039 - 30 Dec 2024

Abstract

Background and Objectives: Ankylosing spondylitis (AS) is a chronic progressive inflammatory process of the axial skeleton and sacroiliac joints (SIJ). Symptoms typically appear between the ages of 20 and 40, although there are also cases of juvenile-onset AS. This suggests that most [...] Read more.

Background and Objectives: Ankylosing spondylitis (AS) is a chronic progressive inflammatory process of the axial skeleton and sacroiliac joints (SIJ). Symptoms typically appear between the ages of 20 and 40, although there are also cases of juvenile-onset AS. This suggests that most patients with AS are of reproductive age at the time of diagnosis. The study aimed to identify differences in the shape of the sacroiliac joint depending on the type of birth (vaginal delivery (V/D) and the cesarean section(C/S) in patients with ankylosing spondylitis. Materials and Methods: On pelvis X-ray images of women n = 36 with AS and n = 34 in the control group, 12 landmarks were marked, and differences in SIJ shape between the study groups were assessed using generalized Procrustes Analysis. Results: The results showed that the anterior point of the SIJ had an enlarged shape in the V/D group compared with the C/S group, even in the control group. There was a difference between the mean right and left SIJ shapes of the AS group patients with V/D and the controls with C/S (p = 0.007 and p < 0.001). The superior part of the right SIJ tended to be enlarged in V/D-delivered AS patients, compared to the C/S control group. On the left side, the middle region of the SIJ was statistically enlarged in AS patients with V/D compared to the healthy C/S group. Conclusions: This study demonstrates that vaginal delivery is associated with increased sacroiliac joint (SIJ) enlargement in both healthy individuals and those with ankylosing spondylitis (AS). Our findings suggest that delivery type independently influences SIJ morphology, and cesarean section (C/S) may serve as a protective procedure for preserving SIJ shape in AS patients. These results underline the importance of individualized obstetric planning for AS patients to mitigate potential risks to SIJ morphology. Full article

(This article belongs to the Special Issue Clinical Anatomy in the 21st Century: Understanding the Possible Basis of Certain Pathologies and Clinical Symptoms)

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22 pages, 541 KiB

Open AccessReview

Retinopathy in Metabolic Dysfunction-Associated Steatotic Liver Disease

by Myrsini Orfanidou and Stergios A. Polyzos

Medicina 2025, 61(1), 38; https://doi.org/10.3390/medicina61010038 - 30 Dec 2024

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a multisystemic disease, i.e., influencing various organ systems beyond the liver and, thus, contributing to comorbidities. Characterized by excessive fat accumulation in the hepatocytes, MASLD is frequently linked to metabolic syndrome components, such as obesity, insulin [...] Read more.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a multisystemic disease, i.e., influencing various organ systems beyond the liver and, thus, contributing to comorbidities. Characterized by excessive fat accumulation in the hepatocytes, MASLD is frequently linked to metabolic syndrome components, such as obesity, insulin resistance, dyslipidemia, and hypertension. Therefore, exploring the intricate connection between MASLD and other organ systems, including the eyes, seems to be essential. In this context, retinopathy has been investigated for its potential association with MASLD, since both conditions share common pathogenetic pathways. Chronic low-grade inflammation, oxidative stress, insulin resistance, and endothelial dysfunction are only some of those mechanisms contributing to disease progression and, possibly, determining the bidirectional interplay between the liver and retinal pathology. This narrative review aims to summarize data concerning the multisystemicity of MASLD, primarily focusing on its potential association with the eyes and, particularly, retinopathy. Identifying this possible association may emphasize the need for early screening and integrated management approaches that address the liver and eyes as interconnected components within the framework of a systemic disease. Further research is necessary to delineate the precise mechanisms and develop targeted interventions to mitigate the bidirectional impact between the liver and eyes, aiming to reduce the overall burden of disease and improve patient outcomes. Full article

(This article belongs to the Special Issue Retinal and Choroidal Vascular Disease)

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10 pages, 4275 KiB

Open AccessArticle

Challenges in the Management of Giant Carcinoma Ex-Pleiomorphic Adenoma of the Parotid Gland in a Single Tertiary Center

by Miruna Bratiloveanu, Mihai Dumitru, Andreea Nicoleta Marinescu, Crenguta Serboiu, Oana Maria Patrascu, Adrian Costache and Daniela Vrinceanu

Medicina 2025, 61(1), 37; https://doi.org/10.3390/medicina61010037 - 29 Dec 2024

Abstract

Background and Objectives: Carcinoma ex-pleiomorphic adenoma (CXPA) is a carcinoma derived from a primary or recurrent pleiomorphic adenoma. Microscopically, non-invasive CXPA (intracapsular and carcinoma in situ), minimally invasive CXPA (extracapsular invasion less than 1.5 mm), and invasive CXPA (extracapsular invasion more than [...] Read more.

Background and Objectives: Carcinoma ex-pleiomorphic adenoma (CXPA) is a carcinoma derived from a primary or recurrent pleiomorphic adenoma. Microscopically, non-invasive CXPA (intracapsular and carcinoma in situ), minimally invasive CXPA (extracapsular invasion less than 1.5 mm), and invasive CXPA (extracapsular invasion more than 1.5 mm) are described. Materials and Methods: We performed a retrospective clinical study over the period of 2009–2023 in patients admitted to the ENT Department of the Bucharest University Emergency Hospital. Results: In the studied group, there was a net male predominance of 2.5:1. The tumor evolution until presentation was 6.64 years on average, with values between 2 and 20 years. The reasons for presenting to our department included a sudden increase in size in eleven cases (78.57%), pain in nine cases (64.29%), peripheral facial paralysis in eight cases (57.14%), skin invasion/ulceration in five cases (35.71%), and massive tumor hemorrhage in one case (7.14%). There were histopathological results on paraffin of myoepithelial CXPA in four cases (28.57%), of high-grade CXPA (salivary duct, secretory) in eight cases (57.14%), and of squamous CXPA in two cases (14.29%). The patients with unfavorable evolution showed the following characteristics: a tumor diameter over 11 cm (four cases), integument invasion (four cases), perivascular invasion at HP exam (six cases), perineural invasion at HP exam (six cases), and invasion of the ganglion (three N3b cases and two N1 cases). Conclusions: CXPA is a neoplasia that, when associated with large tumor volumes or peripheral facial paralysis in particular, is a challenge for both the doctor and patient. Full article

(This article belongs to the Special Issue Optimizing Outcomes in Head and Neck Surgery)

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10 pages, 4804 KiB

Open AccessCase Report

A Case of Acquired Reactive Perforating Dermatosis with Complete Resolution of Eruptions on Upper and Lower Limbs During the Treatment of Diabetes Mellitus and Peripheral Artery Disease

by Yoshihito Mima, Tsutomu Ohtsuka, Ippei Ebato, Ryosuke Nishie, Satoshi Uesugi, Makoto Sumi, Yoshimasa Nakazato and Yuta Norimatsu

Medicina 2025, 61(1), 36; https://doi.org/10.3390/medicina61010036 - 29 Dec 2024

Abstract

Acquired reactive perforating dermatosis (ARPD) is characterized by its onset after the age of 18 years, umbilicated papules or nodules with a central keratotic plug, and the presence of necrotic collagen tissue within an epithelial crater. ARPD is strongly associated with systemic diseases [...] Read more.

Acquired reactive perforating dermatosis (ARPD) is characterized by its onset after the age of 18 years, umbilicated papules or nodules with a central keratotic plug, and the presence of necrotic collagen tissue within an epithelial crater. ARPD is strongly associated with systemic diseases such as diabetes mellitus (DM) and chronic renal failure, which may contribute to ARPD through factors including microcirculatory disturbances and the deposition of metabolic byproducts, including advanced glycation end-products and calcium. Here, we report a case of ARPD that improved following DM treatment and catheter-based interventions for peripheral artery disease (PAD). The eruptions on the upper limbs significantly improved with DM management. On the other hand, lesions on the lower limbs showed marked improvement after the enhancement in arterial blood flow due to catheter surgeries, along with DM treatment. Although a few reports of ARPD improving with DM management exist, our case underscores the importance of adequate DM control in ARPD management. The inability to perform the biopsy of the lesions on the lower limbs is our limitation; however, these lesions, similar to those on the upper limbs, presented with a central keratotic plug and re-epithelialized without forming ulcers or erosions, suggesting they were also related to ARPD. To date, there has been little discussion on the relationship between blood flow impairment in major vessels and ARPD. However, hypertension and venous circulatory dysfunctions are considered to lead to ARPD, raising the possibility that PAD-induced microvascular disturbances might have facilitated lesion formation in the present case. Further accumulation of cases and research is needed to clarify the relationship between blood flow impairment in major vessels and ARPD. Full article

(This article belongs to the Section Dermatology)

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22 pages, 2195 KiB

Open AccessArticle

Improvement of Presbyopia, Dry Eye, Intraocular Pressure, and Near Vision Through Cassiae Tea Consumption

by Mei Fan, Jen-Lin Hung, Shao-Huan Hung, Li-Chai Chen and Chi-Ting Horng

Medicina 2025, 61(1), 35; https://doi.org/10.3390/medicina61010035 - 29 Dec 2024

Abstract

Background and Objectives: This study aimed to illustrate a novel method for improving presbyopia by drinking cassiae tea. Materials and Methods: A total of 425 eyes from 425 participants (aged 52.5 ± 9.5 years) were recruited and divided into several experimental [...] Read more.

Background and Objectives: This study aimed to illustrate a novel method for improving presbyopia by drinking cassiae tea. Materials and Methods: A total of 425 eyes from 425 participants (aged 52.5 ± 9.5 years) were recruited and divided into several experimental groups over a 6-month period. Participants consumed cassiae tea daily (10 g of cassiae semen brewed in 500 cc of water). Meanwhile, control group participants consumed 500 cc of plain water along with 1000 mg of vitamin C each day. Experiments 1 and 2: Participants with severe dry eye and intraocular pressure (IOP) > 30 mmHg were enrolled, and outcomes were assessed for these conditions, respectively. Experiments 3, 4, and 7: These experiments evaluated pupil size, near vision, and serum superoxide dismutase (SOD) levels in two groups of volunteers. Experiment 5: Different quantities of cassiae tea were prescribed to various groups, and near vision was measured. Experiment 6: Three questionnaires assessed presbyopic symptoms after cassiae tea consumption. Experiment 8: The antioxidant activity of cassiae tea compared with other bioactive compounds and Chinese herbs was evaluated using the DPPH test. Results: By the fourth month of the study, participants experienced increased tear volume and reduced IOP. Pupil size constricted, near vision improved, and serum SOD levels increased. Furthermore, greater consumption of cassiae tea was correlated with better near vision. The antioxidant activity of cassiae tea was found to surpass that of anthocyanins, wolfberry, and vitamin C. Conclusions: Drinking cassiae tea improves dry eye symptoms, reduces IOP, regulates pupil size, and enhances near vision due to its excellent antioxidant and pharmacological properties. These benefits may particularly aid individuals with presbyopia and those engaged in near-distance activities, such as smartphone use. Full article

(This article belongs to the Section Ophthalmology)

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10 pages, 308 KiB

Open AccessSystematic Review

Postoperative Outcomes After Robotic Liver Resection of Caudate Lobe: A Systematic Review

by Gabriela Del Angel Millan, Gianluca Cassese, Fabio Giannone, Celeste Del Basso, Mariantonietta Alagia, Marco Lodin, Igor Monsellato, Marco Palucci, Federico Sangiuolo and Fabrizio Panaro

Medicina 2025, 61(1), 34; https://doi.org/10.3390/medicina61010034 - 29 Dec 2024

Abstract

Background and Objectives: Resection of the caudate lobe of the liver is considered a highly challenging surgical procedure due to the deep anatomic location of this segment and the relationships with major vessels. There is no clear evidence about the safety and [...] Read more.

Background and Objectives: Resection of the caudate lobe of the liver is considered a highly challenging surgical procedure due to the deep anatomic location of this segment and the relationships with major vessels. There is no clear evidence about the safety and effectiveness of robotic resection of the caudate lobe. The aim of this systematic review was to report data about the safety, technical feasibility, and postoperative outcomes of robotic caudate lobectomy. Materials and Methods: A systematic review of the MEDLINE and SCOPUS databases was undertaken, including studies published until 19 December 2024. Results: A total of 5 studies including 110 patients were selected. Of these surgeries, 56.3% were performed for malignant tumors. Tumor size varied significantly between 0.9 and 7.7 cm in the largest diameter. The mean operative time was 184.5 min (range 70–522 min), and the estimated blood loss was 95.5 mL (range 10–1500 mL). The median hospital length of stay was 4.2 days (range 2–19 days) and no cases of conversion to open were reported. All the patients underwent R0 resection. In total, 24 out of 110 patients (21.8%) developed postoperative complications, with 1.8% of all patients developing a major complication (Clavien–Dindo classification ≥ III). No perioperative deaths were reported by the included studies. Conclusions: Few retrospective studies investigating the outcomes of robotic resection of the caudate lobe are currently available in the literature. From published data, it may be a safe and feasible alternative to open and laparoscopic caudate lobectomy in selected patients in referral HPB centers. Further studies with larger sample sizes are needed to confirm such preliminary findings. Full article

(This article belongs to the Special Issue Advances in Liver Surgery)

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9 pages, 433 KiB

Open AccessArticle

Abnormal Uterine Bleeding Among Rural Adolescent Schoolgirls: A Cross-Sectional Study

by Yasir Salih, Ghaday S. Almutairi, Norah H. Alhumaidi, Nadiah Alhabardi and Ishag Adam

Medicina 2025, 61(1), 33; https://doi.org/10.3390/medicina61010033 - 28 Dec 2024

Abstract

Background and Objectives: The International Federation of Gynecology and Obstetrics (FIGO) and the American College of Obstetricians and Gynecologists (ACOG) define abnormal uterine bleeding (AUB) as “bleeding from the uterus that is abnormal in regularity, volume, frequency, or duration and occurs in [...] Read more.

Background and Objectives: The International Federation of Gynecology and Obstetrics (FIGO) and the American College of Obstetricians and Gynecologists (ACOG) define abnormal uterine bleeding (AUB) as “bleeding from the uterus that is abnormal in regularity, volume, frequency, or duration and occurs in the absence of pregnancy”. The impact of AUB on the physical and psychosocial well-being of adolescent girls can be significant. In this study, we aim to investigate the menstrual cycle characteristics in adolescent Sudanese schoolgirls and the prevalence of abnormal uterine bleeding (AUB) and its associated factors. Materials and Methods: A school-based cross-sectional study was conducted in Almatamah locality, Sudan. A questionnaire was used to collect sociodemographic data and menstrual cycle parameters. Weight and height were measured, body mass index (BMI) was calculated, and hemoglobin levels were determined. Logistic regression was also performed. Results: Of the 162 girls in the study, 27.2% had frequent cycles, 3.7% had infrequent cycles, 2.5% had prolonged menses duration, 44.4% had irregular cycles, and 21.0% had heavy menstrual bleeding. The overall prevalence of AUB in the study was 64.8%. None of the investigated factors (chronological age, maternal education or occupation, gynecological age, BMI, and hemoglobin level) were associated with AUB. Conclusions: In conclusion, the prevalence of AUB was high among the study participants, with irregular cycles, frequent cycles, and heavy menstrual bleeding being the most common types. Full article

(This article belongs to the Section Obstetrics and Gynecology)

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12 pages, 691 KiB

Open AccessCase Report

Left Ventricular Hypertrabeculation (LVHT) in Athletes: A Negligible Finding?

by Rokas Jagminas, Rokas Šerpytis, Pranas Šerpytis and Sigita Glaveckaitė

Medicina 2025, 61(1), 32; https://doi.org/10.3390/medicina61010032 - 28 Dec 2024

Abstract

Left ventricular hypertrabeculation (LVHT) used to be a rare phenotypic trait. With advances in diagnostic imaging techniques, LVHT is being recognised in an increasing number of people. The scientific data show the possibility of the overdiagnosis of this cardiomyopathy in a population of [...] Read more.

Left ventricular hypertrabeculation (LVHT) used to be a rare phenotypic trait. With advances in diagnostic imaging techniques, LVHT is being recognised in an increasing number of people. The scientific data show the possibility of the overdiagnosis of this cardiomyopathy in a population of people who have very high levels of physical activity. We describe the case of a young athlete with no medical history, who presented with syncope during a marathon running race. Initial evaluation showed elevated troponin I; transthoracic echocardiography showed a trabeculated ventricle and subsequent cardiac magnetic resonance (CMR) revealed left ventricular hypertrabeculation (LVHT). During subsequent evaluation by tilt table testing, vasovagal syncope was identified as the likely aetiology of the syncope. The patient was advised to cease sports and stimulants like caffeine use. At the 29-month follow-up, CMR showed the normalisation of the non-compacted to compacted myocardial ratio and an improvement in left ventricular function, with no further syncopal episodes reported. This is an example of the physiological hypertrabeculation of the LV apex in a recreational endurance athlete, with the normalisation of the non-compacted to compacted myocardial layer ratio after detraining. Physiological hypertrabeculation, a benign component of exercise-induced cardiac remodelling, must be differentiated from non-compaction cardiomyopathy and other pathologies causing syncope. This case underscores the importance of distinguishing physiological hypertrabeculation from pathological LVHT in athletes, highlighting that exercise-induced cardiac remodelling can normalise with detraining. Full article

(This article belongs to the Section Cardiology)

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16 pages, 320 KiB

Open AccessArticle

Life Satisfaction Among Individuals with Physical Disabilities in Saudi Arabia: The Impact of Physical Activity, Self-Perceived Health and Fitness, and Sociodemographic Features

by Majed M. Alhumaid, Mohamed A. Said and Selina Khoo

Medicina 2025, 61(1), 31; https://doi.org/10.3390/medicina61010031 - 28 Dec 2024

Abstract

Background and Objectives: Life satisfaction (LS) is a key aspect of mental well-being, particularly for individuals with physical disabilities (IWPDs).This study examined LS levels among IWPDs in Saudi Arabia, focusing on the effects of three independent variables: (i) sociodemographic factors, (ii) self-reported [...] Read more.

Background and Objectives: Life satisfaction (LS) is a key aspect of mental well-being, particularly for individuals with physical disabilities (IWPDs).This study examined LS levels among IWPDs in Saudi Arabia, focusing on the effects of three independent variables: (i) sociodemographic factors, (ii) self-reported health and fitness, and (iii) self-assessed physical activity (PA). Materials and Methods: Data was collected from 271 participants using validated questionnaires. Two models analyzed the effects of the independent variables on LS: the first model included the overall level of PA, while the second examined its individual components. Results: The results indicated that females reported a higher LS than males (p = 0.011). Participants with a university degree demonstrated a significantly greater LS compared to those who did not disclose their educational status (Exp(β) = 1.104). Poor health and inactivity were linked to a lower LS, while age correlated positively with LS (odds ratio = 1.012). Additional factors, including marital status, income, education level, and mobility assistance usage, significantly impacted LS. Interestingly, PA exhibited no direct statistical effect on LS. Conclusions: These findings highlight the importance of equitable access to education, regular PA, support for married couples, and preventive healthcare. Special attention to young people, particularly boys, is recommended to improve LS outcomes among IWPDs in Saudi Arabia. Full article

(This article belongs to the Special Issue Impact of Exercise on Neuropsychiatric and Cognitive Symptoms)

8 pages, 10700 KiB

Open AccessCase Report

Embedded Ileal Fish Bone Removed via Deep Enteroscopy in a Patient with Abdominal Pain and Hematochezia: A Case Report

by Hsin-Yang Chen, Chao-Feng Chang, Tien-Yu Huang and I-Hsuan Huang

Medicina 2025, 61(1), 30; https://doi.org/10.3390/medicina61010030 - 28 Dec 2024

Abstract

Ingestion of foreign bodies is a prevalent issue in clinical practice, with fish bones being the predominant cause. While the upper gastrointestinal tract is commonly affected, small intestine impactions pose significant diagnostic challenges due to nonspecific symptoms and lack of awareness of foreign [...] Read more.

Ingestion of foreign bodies is a prevalent issue in clinical practice, with fish bones being the predominant cause. While the upper gastrointestinal tract is commonly affected, small intestine impactions pose significant diagnostic challenges due to nonspecific symptoms and lack of awareness of foreign body ingestion. Herein, we describe a case presenting with recurrent, unexplained abdominal pain and hematochezia. Multiple diagnostic investigations, including esophagogastroduodenoscopy and colonoscopy, conducted over several months failed to identify the underlying cause until a retrograde single-balloon enteroscopy for obscure gastrointestinal bleeding revealed a 2.3 cm fish bone embedded in the distal ileum. The successful removal of the fish bone led to the resolution of the patient’s symptoms. This case highlights that foreign bodies in the small intestine can be a cause of hematochezia and emphasizes the growing importance of deep enteroscopy techniques in detecting and retrieving these foreign objects, thereby reducing the need for surgery. Full article

(This article belongs to the Section Gastroenterology & Hepatology)

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