Medical sciences (Basel, Switzerland)最新文献

{"title":"Combining Immune Checkpoint Inhibitors and Anti-Angiogenesis Approaches: Treatment of Advanced Non-Small Cell Lung Cancer.","authors":"Tate Barney, Anita Thyagarajan, Ravi P Sahu","doi":"10.3390/medsci13030143","DOIUrl":"https://doi.org/10.3390/medsci13030143","url":null,"abstract":"<p><p>Combining immune checkpoint inhibitors (ICIs) and anti-angiogenic pharmacologic agents is an encouraging therapeutic approach in the treatment of non-small cell lung cancer (NSCLC). Currently, the only FDA-approved therapy combining an immune checkpoint inhibitor and a vascular endothelial growth factor (VEGF) inhibitor is atezolizumab, bevacizumab, and chemotherapy in first-line metastatic NSCLC patients. However, the combination of nivolumab, a programmed death-1 (PD-1) inhibitor, and bevacizumab has also shown encouraging results in patients with NSCLC with minimal adverse effects, respectively. This communication aims to highlight the efficacy of nivolumab and bevacizumab in NSCLC patients without sensitizing mutations in epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), or ROS proto-oncogene 1 (ROS1). In addition, the combination of nivolumab/atezolizumab and bevacizumab with other therapeutic agents is also discussed. We also underscore the adverse effects and limitations of such combinations in NSCLC patients. Future studies should focus on large-scale trials and biomarker identification to establish the benefits of these combination therapies in NSCLC patients.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12371936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health-Related Quality-of-Life Measures in Patients with Heart Failure Cardiogenic Shock Following Axillary Mechanical Circulatory Support.","authors":"Hans Mautong, Aarti Desai, Shriya Sharma, Jose Ruiz, Juan Leoni, Rohan Goswami","doi":"10.3390/medsci13030146","DOIUrl":"https://doi.org/10.3390/medsci13030146","url":null,"abstract":"<p><p><b>Background:</b> Patients with end-stage heart failure-related cardiogenic shock (HF-CS) are conclusively associated with a poor health-related quality of life (HRQL). Axillary mechanical circulatory support (aMCS), such as the Impella 5.5, is increasingly used in this population and may improve HRQL during hospitalization by providing enhanced left ventricular unloading. We aimed to assess changes in HRQL between admission and two weeks after Impella 5.5 placement in patients with HF-CS, using the Kansas City Cardiomyopathy Questionnaire (KCCQ). <b>Methods:</b> We conducted a prospective longitudinal analysis on patients with the Impella 5.5 between May 2023 and July 2023. Participants completed the condensed KCCQ-12 at admission and again two weeks post-implantation. Changes in the scores were evaluated using the Wilcoxon signed-rank test. <b>Results:</b> Fifteen patients were enrolled. The median age was 59 years (50-63), and the median ejection fraction at implantation was 20% (15-30). On admission, most patients reported an overall HRQL of poor-to-fair (46.7%) according to the summary KCCQ-12 score. The median overall summary score increased significantly after Impella 5.5 support (50.52 vs. 28.13, <i>p</i> = 0.005). Symptom frequency (70.83 vs. 43.75, <i>p</i> = 0.009) and quality-of-life (50.00 vs. 12.50, <i>p</i> = 0.023) domains improved significantly, while physical limitation showed a positive trend and social limitation remained unchanged. These HRQL improvements occurred alongside a significant shift toward lower SCAI shock stages, marked increases in cardiac output and cardiac index, and no escalation in vasoactive-inotropic requirements. <b>Conclusions:</b> Impella 5.5 support in HF-CS patients was associated with early and clinically meaningful improvements in HRQL, particularly in symptom frequency and quality of life, during the critical pre-transplant or recovery period. These findings suggest that the Impella 5.5 may provide both physiological and patient-perceived benefits in this high-risk population.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12371966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping Healthcare Needs: A Systematic Review of Population Stratification Tools.","authors":"Giovanni Genovese, Caterina Elisabetta Rizzo, Antonio Nirta, Linda Bartucciotto, Roberto Venuto, Francesco Fedele, Raffaele Squeri, Cristina Genovese","doi":"10.3390/medsci13030145","DOIUrl":"https://doi.org/10.3390/medsci13030145","url":null,"abstract":"<p><p><b>Background and Aim</b>: In 2021, healthcare expenditure in Italy represented 7.3% of the national gross domestic product, with approximately 80% attributed to the management of chronic diseases-an increasing burden associated with population aging. Population stratification tools have emerged as critical instruments for the efficient allocation of healthcare resources, particularly for high-need, high-cost individuals. This systematic review aimed to identify, classify, and evaluate existing population stratification tools based on their characteristics, validation status, and practical applications. <b>Methods</b>: A systematic literature review was conducted in accordance with the PRISMA 2020 guidelines to examine adult population stratification models grounded in healthcare needs. The review encompassed studies retrieved from major scientific databases and included both national and international implementations. <b>Results</b>: The initial search yielded 140,111 records, from which 17 distinct stratification tools were identified. Of these, nine had undergone validation through peer-reviewed studies. Within the Italian context, only six tools were in active use-three of which were developed as region-specific algorithms, while the remaining three employed internationally established software platforms. <b>Conclusions</b>: Population stratification tools provide a robust framework for assessing both clinical complexity and resource utilization, thereby facilitating the design of integrated care pathways and evidence-based policy decisions. In the context of proactive and personalized healthcare delivery, such tools play a pivotal role in enhancing system efficiency, informing strategic planning, and promoting equitable access to care.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12372013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current and Emerging Therapeutic Strategies for Limited- and Extensive-Stage Small-Cell Lung Cancer.","authors":"Walid Shalata, Rashad Naamneh, Wenad Najjar, Mohnnad Asla, Adam Abu Gameh, Mahmoud Abu Amna, Leonard Saiegh, Abed Agbarya","doi":"10.3390/medsci13030142","DOIUrl":"https://doi.org/10.3390/medsci13030142","url":null,"abstract":"<p><strong>Background: </strong>Small-cell lung cancer (SCLC) is a highly aggressive neuroendocrine malignancy characterized by rapid growth, early metastatic dissemination, and a dismal prognosis. For decades, treatment paradigms remained largely stagnant, particularly for extensive-stage disease (ES-SCLC). However, the last five years have witnessed a significant evolution in the therapeutic landscape.</p><p><strong>Methods: </strong>The information for this article was gathered by synthesizing data from several key sources. This article synthesizes the evidence supporting current standards of care for both limited-stage (LS-SCLC) and ES-SCLC, incorporating data from pivotal clinical trials, a network meta-analysis of first-line chemoimmunotherapy regimens, and a critical appraisal of international treatment guidelines, and a critical analysis of international treatment guidelines from prominent organizations like the National Comprehensive Cancer Network (NCCN) and the European Society for Medical Oncology (ESMO). This comprehensive approach allows for a robust and well-supported summary of the current therapeutic landscape.</p><p><strong>Results: </strong>For limited-stage SCLC (LS-SCLC), concurrent chemoradiotherapy (cCRT) remains the curative-intent standard, but its efficacy is now being augmented by consolidative immunotherapy, as demonstrated by the landmark ADRIATIC trial. The role of prophylactic cranial irradiation (PCI) in LS-SCLC is being re-evaluated in the era of high-sensitivity brain imaging and concerns over neurotoxicity. For ES-SCLC, the treatment paradigm has been fundamentally transformed by the integration of immune checkpoint inhibitors (ICIs) with platinum-etoposide chemotherapy, establishing a new standard of care that offers a modest but consistent survival benefit.</p><p><strong>Conclusions: </strong>The treatment of SCLC has been significantly advanced by the integration of immunotherapy, particularly for extensive-stage disease, which has established a new standard of care and improved patient outcomes. Looking to the future, the quest for predictive biomarkers and the development of novel therapeutic classes, such as Bi-specific T-cell Engagers (BiTEs) and antibody-drug conjugates, promise to build upon recent progress and offer new hope for improving the dismal prognosis associated with this disease.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12371899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Use of Vitamin D and DPP-4 Inhibitors as a Potential Adjuvant Treatment Strategy to Enhance the Efficacy of Novel Beta-Cell Replacement Therapies for Type 1 Diabetes.","authors":"Marcelo Maia Pinheiro, Felipe Moura Maia Pinheiro, Bruna Fioravante Di Serio, Nathalia Padilla, Benjamin Udoka Nwosu, David Della-Morte, Camillo Ricordi, Marco Infante","doi":"10.3390/medsci13030141","DOIUrl":"https://doi.org/10.3390/medsci13030141","url":null,"abstract":"<p><p>Emerging evidence suggests that vitamin D and dipeptidyl peptidase-4 (DPP-4) inhibitors exert synergistic immunomodulatory, anti-inflammatory and antioxidant actions. Moreover, intervention studies showed that combination therapy based on the concomitant use of vitamin D and DPP-4 inhibitors (VIDPP-4i) may preserve beta-cell function in patients with type 1 diabetes mellitus (T1D) and latent autoimmune diabetes in adults (LADA). These effects are particularly relevant in the context of beta-cell replacement strategies, whose long-term efficacy can be hampered by various factors, such as immune-mediated graft rejection, inadequate vascularization, hypoxia, trauma-induced cell apoptosis, fibrosis, host immune response, and recurrence of autoimmunity. Based on preclinical and clinical studies conducted in the fields of autoimmune diabetes and solid organ/cell transplantation, the present narrative review aims to describe the rationale behind the investigation of VIDPP-4i combination therapy as an adjuvant treatment strategy to enhance the efficacy of novel beta-cell replacement therapies for T1D. In this regard, we discuss the potential immune and metabolic mechanisms through which vitamin D and DPP-4 inhibitors can promote the long-term function and survival of transplanted islets in patients with T1D receiving various types of beta-cell replacement therapies, including therapeutic approaches using encapsulated stem cell-derived beta cells.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12371964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PROX1 Expression in Resected Non-Small Cell Lung Cancer: Immunohistochemical Profile and Clinicopathological Correlates.","authors":"Evangelia Ntikoudi, Thomas Karagkounis, Konstantinos S Mylonas, Stylianos Kykalos, Dimitrios Schizas, Ioannis N Vamvakaris, Ekaterini Politi, Michail V Karamouzis, Stamatios Theocharis","doi":"10.3390/medsci13030140","DOIUrl":"https://doi.org/10.3390/medsci13030140","url":null,"abstract":"<p><p><b>Background/Objectives:</b> PROX1 (prospero homeobox 1) is a transcription factor involved in lymphangiogenesis and cellular differentiation. Its role in cancer biology appears to be highly context-dependent, with it exhibiting both tumor-promoting and -suppressive functions across various malignancies. Nonetheless, the clinical significance of PROX1 expression in non-small cell lung cancer (NSCLC) remains poorly elucidated. The objective of this study is to evaluate the immunohistochemical expression of PROX1 in NSCLC, specifically in the adenocarcinoma and squamous cell carcinoma subtypes, and to assess its correlation with clinicopathologic features and overall survival (OS). <b>Methods:</b> This retrospective study included surgically resected specimens from 121 patients with histologically confirmed NSCLC. PROX1 expression was assessed via immunohistochemistry on formalin-fixed, paraffin-embedded specimens. Staining intensity (graded 0- National and Kapodistrian University of Athens 3) and the percentage of positive tumor cells were recorded. Correlations with histological subtype, tumor characteristics, and OS were analyzed using chi-square tests, one-way ANOVA, and Kaplan-Meier survival analysis with log-rank testing. <b>Results:</b> Low PROX1 intensity (level 1) was significantly associated with P63 positivity (<i>p</i> = 0.028), while high PROX1 intensity (level 3) correlated with nodal metastasis to station 3 (S3+) (<i>p</i> = 0.025). Additionally, alveolar-pattern adenocarcinomas exhibited intermediate PROX1 expression (26-50%) (<i>p</i> = 0.010). Although PROX1 positivity did not differ among mucinous and non-mucinous adenocarcinomas (<i>p</i> = 0.152), its distribution across defined expression subgroups was statistically significant (<i>p</i> = 0.002). Tumors with low PROX1 expression (0-24%) were associated with a larger maximum tumor diameter (<i>p</i> = 0.026). PROX1 expression was not independently associated with OS (<i>p</i> > 0.05). Factors significantly associated with improved survival included an age < 50 years, female sex, the absence of necrosis, fewer than 10 positive lymph nodes, a lymph node ratio < 0.5, and the absence of extensive nodal involvement in stations 5, 10, 11, and 12. <b>Conclusions:</b> Although PROX1 expression is variably associated with specific histologic subtypes and nodal metastases in NSCLC, it does not independently predict overall survival. Its expression patterns suggest a potential role in tumor differentiation and lymphatic spread. Further mechanistic and immunologic studies are warranted to elucidate the functional significance of PROX1 in lung cancer biology.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12372085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Interventional Study Exploring the Effects of Nutritional Psychoeducation on Emotional Eating After 3 Months.","authors":"Maria Mentzelou, Gavriela Voulgaridou, Konstantinos Papadimitriou, Olga Alexatou, Eirini-Georgia Deligiannidou, Aspasia Serdari, Sousana K Papadopoulou, Evmorfia Psara, Gerasimos Tsourouflis, Constantinos Giaginis","doi":"10.3390/medsci13030138","DOIUrl":"https://doi.org/10.3390/medsci13030138","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Emotional eating may be a consequence of acquired cue reactivity, a lack of control, or an inaccurate link between episodic overeating and negative affect, according to a new analysis of its standard measurement. This study was a controlled trial, which was designed to investigate the effect of personalized nutritional psychoeducation on emotional eating behavior. <b>Methods:</b> This study enrolled 95 participants (62 control group and 33 intervention group) who were randomized to treatment and assessed at 3-month follow-up. Over a period of 3 months, six thematic individual sessions were conducted with a frequency of every 15 days for the participants in the intervention group. The Three-Factor Eating Questionnaire (TFEQ) was used to assess feeding patterns and the manifestation of emotional food consumption in response to emotion. <b>Results:</b> At baseline, it appears that gender is positively related to TFEQ Emotional Score (β: 1.77 (random error: 0.57, <i>p</i>-value: 0.003). BMI (β: -0.11 (random error: 0.04, <i>p</i>-value: 0.003) and waist circumference are negatively related to the TFEQ Emotional Score. <b>Conclusions:</b> Although this study confirmed significant associations of emotional eating and gender, BMI, and waist circumference, the nutritional psychoeducation-based intervention did not exert the expected effects on emotional eating. More high-quality clinical trials need to further be designed to improve emotional eating behavior by applying relevant nutritional psychoeducation-based interventions.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12371952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival Patterns and Mortality Causes in Patients with Invasive Ependymoma: A Retrospective Cohort Analysis from 2000 to 2019.","authors":"Anas Elgenidy, Khaled Saad, Amir Aboelgheet, Eman F Gad, Usama El-Shokhaiby, Thamer A M Alruwaili, Abdelrahman N Abdelal, Kawashty R Mohamed, Mohammad Bazzazeh, Mohamed Hesn, Abdelrahman H Elshimy, Aya Sayed, Sara Magdy, Doaa Ali Gamal, Amira A Elhoufey, Shymaa Adel Ismael, Ahmed M Afifi, Mohamed Fahmy M Ibrahim, Amany Ragab","doi":"10.3390/medsci13030139","DOIUrl":"https://doi.org/10.3390/medsci13030139","url":null,"abstract":"<p><strong>Background: </strong>Ependymomas are primary CNS neoplasms that arise from the ependymal cells of the brain and spinal cord, accounting for 3-6% of all CNS tumors.</p><p><strong>Aims: </strong>This study provides a comprehensive analysis of ependymoma survival patterns and examines non-cancer causes of death in the US.</p><p><strong>Methods: </strong>This retrospective study used data from SEER 17 registries between 2000 and 2019 to evaluate the incidence of ependymoma, as well as the survival and mortality trends in the US.</p><p><strong>Results: </strong>A total of 3821 patients were included, with 842 (22%) deaths. The highest mortality was observed in younger patients (<18 years) within one year of diagnosis (SMR, 54.77; 95% CI, 38.95-74.88). Brain and other nervous system cancers were the leading causes of death, followed by non-cancer causes, particularly cerebrovascular diseases, pneumonia, influenza, and septicemia. The survival rates observed at one, three, and five years were 94% (95% CI: 0.94-0.95), 88% (95% CI: 0.87-0.89), and 84% (95% CI: 0.82-0.85), respectively. Conditional survival improved over time, with a three-year conditional relative survival rate of 92% after one year of diagnosis and 96% for those who survived five years.</p><p><strong>Conclusion: </strong>The death rate was highest among pediatric patients under 18 years of age. Cerebrovascular disorders were the leading non-cancer cause of death across all time intervals. The probability of surviving for three years increases for patients who have already survived one, three, or five years post-diagnosis.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12371993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smoking Behavior, Exposure to Second-Hand Smoke, and Attitudes Among Bulgarian and Foreign Medical Students.","authors":"Dolina Gencheva Gencheva, Fedya Petrov Nikolov","doi":"10.3390/medsci13030134","DOIUrl":"https://doi.org/10.3390/medsci13030134","url":null,"abstract":"<p><p><b>Background:</b> Cardiovascular morbidity and mortality are alarmingly high in Bulgaria, partly due to behavioral risk factors such as smoking. <b>Purpose:</b> This study aimed to assess and compare smoking habits, second-hand smoke exposure, and attitudes of Bulgarian and foreign medical students to better understand smoking behavior in this population. <b>Methods:</b> A cross-sectional survey was conducted among 1063 medical students at the Medical University of Plovdiv (60.8% women; 53% Bulgarian). <b>Results:</b> More Bulgarian students were active smokers and ever-smokers than foreign students (24.7% vs. 14% and 29.3% vs. 18.8%, <i>p</i> < 0.001). Bulgarian women smoked nearly as much as Bulgarian men (24.1% vs. 25.6% for active smokers, <i>p</i> > 0.05), whereas foreign women smoked less than foreign men (15.7% vs. 23.7%, <i>p</i> = 0.034). Women more often replaced classic cigarettes with tobacco heating systems (THSs) than men (40.7% vs. 25.3%, <i>p</i> = 0.020). Nearly 85% of the respondents started smoking by the age of 19. Exposure to second-hand smoke among friends, among colleagues, and in the family was associated with a higher risk of being an ever-smoker (ORs ~8.9; 3.4 and 3.7, respectively). About 20% of students were unsure or disagreed that smoking fewer cigarettes, THSs, or e-cigarettes posed health risks. The majority (61.3%) of active smokers acknowledged negative health effects. <b>Conclusions:</b> These findings highlight a concerning smoking prevalence among Bulgarian medical students and emphasize the need to strengthen medical education and health policies with updated tobacco risk information and targeted prevention programs to reduce smoking and improve future physicians' cessation counseling skills. Smoking likely contributes significantly to Bulgaria's high cardiovascular morbidity.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12372101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanisms of GLP-1 in Modulating Craving and Addiction: Neurobiological and Translational Insights.","authors":"Gabriel Amorim Moreira Alves, Masatoki Teranishi, Ana Claudia Teixeira de Castro Gonçalves Ortega, Frank James, Arosh S Perera Molligoda Arachchige","doi":"10.3390/medsci13030136","DOIUrl":"https://doi.org/10.3390/medsci13030136","url":null,"abstract":"<p><p>Substance use disorders (SUDs) remain a major public health challenge, with existing pharmacotherapies offering limited long-term efficacy. Traditional treatments focus on dopaminergic systems but often overlook the complex interplay between metabolic signals, neuroplasticity, and conditioned behaviors that perpetuate addiction. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), originally developed for type 2 diabetes and obesity, have recently emerged as promising modulators of reward-related brain circuits. This review synthesizes current evidence on the role of glucagon-like peptide-1 (GLP-1) and its receptor in modulating craving and substance-seeking behaviors. We highlight how GLP-1 receptors are expressed in addiction-relevant brain regions, including the ventral tegmental area (VTA), nucleus accumbens (NAc), and prefrontal cortex (PFC), where their activation influences dopaminergic, glutamatergic, and GABAergic neurotransmission. In addition, we explore how GLP-1 signaling affects reward processing through gut-brain vagal pathways, hormonal crosstalk, and neuroinflammatory mechanisms. Preclinical studies demonstrate that GLP-1RAs attenuate intake and relapse-like behavior across a range of substances, including alcohol, nicotine, and cocaine. Early-phase clinical trials support their safety and suggest potential efficacy in reducing craving. By integrating findings from molecular signaling, neurocircuitry, and behavioral models, this review provides a translational perspective on GLP-1RAs as an emerging treatment strategy in addiction medicine. We propose that targeting gut-brain metabolic signaling could provide a novel framework for understanding and treating SUDs.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12372146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}