Search Results (2,316)

Background/Objectives: Retroperitoneal lymph node dissection (RPLND) plays a crucial role in the staging and treatment of testicular cancer and is often mandatory. RPLND is associated with a high risk of morbidity. The use of minimally invasive techniques has significantly increased the number of robotic procedures performed over the last few years. This study aimed to analyze the perioperative and postoperative outcomes and trends of an increasing number of surgeries performed. Materials and Methods: We retrospectively analyzed 30 robotic RPLNDs (R-RPLNDs) performed at our testicular cancer center between 2020 and 2024. Logistic regression analyses were used to analyze the independent variables of operative time (OT), hospital stay (HS), estimated blood loss, lymph node yield, and complications according to the Clavien–Dindo classification system. The independent predictors included case number, clinical stage, post-chemotherapy status, preoperative retroperitoneal tumor mass, and body mass index. Furthermore, the patients were categorized into three groups: group A (cases 1–10), group B (cases 11–20), and group C (cases 21–30). A Kruskal–Wallis test was performed to assess differences among the groups concerning OT, HS, and lymph node yield. Results: OT significantly decreased with an increasing number of cases (p < 0.001), and HS was significantly affected by overall complications (p = 0.0006). There were two major perioperative complications (6.6%). No factors predicted overall complications or Clavien–Dindo grades I-II or III–V. The Kruskal–Wallis test showed a significant difference (p < 0.05) in OT and HS for group C. Conclusions: R-RPLND for GCTs demonstrates a clear learning curve, with significant improvements in OT, HS, and complication rates as surgeons gain experience. Overall, the low complication rates for R-RPLND did not indicate predictive factors for perioperative or postoperative complications. RPLND presents promising potential as a safe and effective treatment for GCTs, especially when performed by experienced surgeons in specialized centers. Full article

Background: The role of CDK4/6 inhibitors (CDK4/6i) has expanded from the treatment of advanced breast cancer to early-stage disease, as recent studies have demonstrated their therapeutic benefits. However, evidence regarding the safety of combining CDK4/6i with adjuvant radiation therapy (RT) in a curative setting remains limited. This study aims to present clinical experiences of pulmonary toxicity following the combined use of adjuvant RT and CDK4/6i. Case presentation: We report a case of an Asian female with left breast cancer who underwent a modified radical mastectomy followed by adjuvant chemotherapy, RT, endocrine therapy, and CDK4/6i (abemaciclib) treatment. Cancer therapy-induced grade 2 pneumonitis was impressed by clinical signs and image findings. A 57-year-old postmenopausal woman was diagnosed with left breast invasive lobular carcinoma, hormone receptor–positive, human epidermal growth factor receptor 2–negative (HR+/HER2−), K67 index of 5–10%, and classified as pT3N3aM0 (stage IIIC). She received adjuvant chemotherapy with FEC followed by docetaxel, endocrine therapy with letrozole, and adjuvant RT of 50.4 Gy in 28 fractions to the left chest wall and regional nodal irradiation. Abemaciclib was initiated after completing RT. Treatment-related pneumonitis developed five months after RT and abemaciclib use. Conclusions: In breast cancer patients receiving a combination of RT and CDK4/6i as curative adjuvant treatment, pulmonary toxicity is a concern and requires careful monitoring, particularly in Asian populations. Full article

Hypoxic preconditioning (HP) is a promising approach to enhance the therapeutic efficacy of mesenchymal stem cells (MSCs) by modulating their oxidative stress response, metabolic activity, and secretome composition. Conditioned media (CM) obtained from MSCs cultured under hypoxia contains bioactive molecules and extracellular vesicles (EVs) that support regenerative processes. However, the effects of varying oxygen levels on the redox status and physicochemical characteristics of MSC-derived CM remain incompletely understood. This study aimed to investigate how two physiologically relevant oxygen concentrations (1% and 5%) influence oxidative stress parameters and nanoparticle features in Wharton’s jelly-derived MSC (WJ-MSC)-conditioned media. Cells were cultured under 1% or 5% O₂ and subjected to serum starvation for 48 or 72 h. CM samples were analyzed for total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI). Nanoparticle size and zeta potential were evaluated using dynamic light scattering (DLS), and HIF-1α levels were quantified via ELISA. Results showed that CM from 1% O₂ cultures exhibited significantly higher oxidative stress, with elevated TOS and OSI values and reduced TAS levels, particularly after 72 h. Nanoparticle size was initially larger under 1% O₂ but decreased with time, whereas 5% O₂ supported more stable size profiles. Zeta potential measurements revealed more negative values under 5% O₂, indicating greater colloidal stability. HIF-1α expression markedly increased under 1% O₂, confirming hypoxia-induced cellular adaptation. In conclusion, this study demonstrates that graded hypoxia distinctly modulates oxidative stress and nanoparticle characteristics in MSC-derived CM. These findings provide a basis for optimizing hypoxic preconditioning protocols to improve the quality and therapeutic potential of acellular MSC-based therapies. Full article

Background: The global increase in the population older than 80 years has led to a paradigm shift centered in the hospital environment, with the inclusion of domiciliary oral health actions improving quality of life. This review evaluates the effects of domiciliary dental care and oral health promotion in nursing homes of older adults. Methods: Seven databases were searched without date restrictions from 15 September to 21 November 2024. A manual search was also performed in the reference lists of the included articles. This research included studies evaluating older adults aged ≥80 years, regardless of sex, who received domiciliary dental care associated or not with oral health promotion, evaluating periodontal condition, dental caries, and the dental and denture plaque index. Regarding data collection and analysis, a risk of bias assessment was performed using RoB 2.0 and RoB 1.0, according to the study design. The level of evidence was assessed using the GRADE tool. Results: Of the 2415 studies found, 5 met the eligibility criteria. After quality assessment, one randomized clinical trial presented a moderate risk of bias, and one presented a low risk. Also, two non-randomized studies presented a high risk and one a low risk. The certainty of evidence was classified as low for all outcomes assessed. One study demonstrated a reduction in the caries level of participants. Regarding periodontal and gingival conditions, although the occurrence of deep pockets (greater than 3.5 mm) decreased over time, there was no significant difference between the control and intervention groups. The level of dental and denture plaque showed a slight reduction. Conclusion: There is limited evidence that domiciliary dental care in nursing homes for older adults can lead to a reduction in caries levels and that oral health programs can reduce dental and denture plaque in evaluations conducted over periods of up to two years. Although the results show a limited magnitude, this does not diminish the importance of promoting domiciliary oral health care. Full article

Osteoarthritis (OA) is the most prevalent rheumatologic disease and a leading cause of years lived with disability worldwide. There are no disease-modifying drugs available to treat it. This study aimed to evaluate the effect of a single dose of 100U botulinum neurotoxin-A (BoNT-A) in patients with early knee OA. We designed a single-arm preliminary clinical trial in patients diagnosed with knee OA (KOA) grades I and II. 45 Patients received a single dose of 100U IncobotulinumtoxinA in the retro-patellar bursa and received nutritional and physical rehabilitation indications. Patients were evaluated at baseline and at days 5, 30, 60, and 90 after injection. The primary outcome was the reduction in pain using the visual analog scale (VAS). Knee function was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We assessed secondary adverse effects and measured muscular strength in every consultation. Descriptive endpoint summaries and a generalized linear random-effect model were used to evaluate changes in each follow-up time compared to baseline. IncobotulinumtoxinA treatment significantly (p < 0.001) reduced pain in all treated patients at day 90 compared to day 0. Patients showed a significant reduction in total WOMAC score (p < 0.001), from a mean baseline of 44.6 (95% CI; 41.4, 47.8) to 4.4 at day 90 (95% CI; 0.2, 0.3). Our results show that IncobotulinumtoxinA applied in the retro-patellar bursa is a safe and effective treatment for pain in patients with early-stage KOA, offering a potential alternative for symptomatic control in KOA. Full article

Background/Objectives: Utilizing a significative sample, this study aimed to analyze body composition components in different age groups and to develop age-specific normative tables for individuals in southern Brazil. Methods: This observational, descriptive, and cross-sectional study evaluated 8556 individuals of both sexes (54% females) aged 18–49. The hypotheses of the present study are related to declining fat-free mass (FFM), lean mass (LM), and skeletal muscle mass (SMM) and increasing fat mass (FM) and body fat percentage (BFP) during the aging process. Data were collected through bioelectrical impedance analysis (BIA) and stratified by age (18–29, 30–39, and 40–49 years), sex, and body mass index (BMI) classifications (normal weight, overweight, grade I, and grade II obesity). Following the comparison, body composition components were presented in the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles. Results: This study’s main findings indicated that FM and BFP increased with age in both sexes. Among overweight and obese individuals, elevated BFP was particularly high in obese females aged 40–49 years and in normal and overweight males. FFM, LM, and SMM were generally lower in the 40–49-year-old group, although obese females over 40 presented higher FFM and LM values. In contrast, males presented lower FFM and LM values but higher values among individuals with higher BMI. SMM was lower in overweight individuals over 40, likely reflecting muscle mass loss associated with aging. Conclusions: Based on these results, lifestyle interventions that combine nutrition and physical exercise may be recommended to mitigate these effects of aging. Full article

This work develops a unified size-dependent shear deformation theory (SDSDT) to analyze the free vibration behavior of a functionally graded (FG) magneto-electro-elastic (MEE) microplate under fully simply supported conditions, open- or closed-circuit surface conditions, biaxial compression, magnetic and electric potentials, and uniform temperature changes based on consistent couple stress theory (CCST). The FG-MEE microplate is composed of BaTiO₃ (a piezoelectric material) and CoFe₂O₄ (a magnetostrictive material). Various CCST-based SDSDTs, considering couple stress and thickness stretching effects, can be reproduced by employing a generalized shape function that characterizes shear deformation distributions along the thickness direction within the unified SDSDT. These CCST-based SDSDTs encompass the size-dependent classical plate theory (CPT), first-order shear deformation theory (SDT), Reddy’s refined SDT, exponential SDT, sinusoidal SDT, and hyperbolic SDT. The unified SDSDT is validated by comparing its solutions with relevant three-dimensional solutions available in the literature. After validation and comparison studies, we conduct a parametric study, whose results indicate that the effects of thickness stretching, material length-scale parameter, inhomogeneity index, and length-to-thickness ratio, as well as the magnitude of biaxial compressive forces, electric potential, magnetic potential, and uniform temperature changes significantly impact the microplate’s natural frequency. Full article

Background/Objectives: The association between sexual dysfunctions and diabetes is largely known, but few studies investigated its prevalence in Type 1 Diabetes (T1D). The aim of this study was to evaluate the prevalence of sexual dysfunction in a group of men with T1D regardless of their age and to compare the prevalence in men treated with different intensive insulin regimens. Methods: The study population included 68 men affected by T1D, of whom 17 were on Multiple Daily Injections (MDI) and 51 were on Continuous Subcutaneous Insulin Infusion (41 on Advanced Hybrid Closed Loop System with catheters and 10 on patch pumps). All participants completed the International Index of Erectile Function (IIEF-15), which evaluates several domains of sexual function. Another questionnaire that evaluated general features, diabetes-specific features, and sexual-specific features was proposed to every participant. Results: The overall prevalence of erectile dysfunction was 48.5%, and the overall prevalence of a severe grade of erectile dysfunction was 26.5%. Correlations were demonstrated between the prevalence of erectile dysfunction and age and between the prevalence of erectile dysfunction and dyadic status. Age and dyadic status were also correlated with lower scores in several other domains of the IIEF-15 questionnaire. Conclusions: Men with Type 1 Diabetes present a high prevalence of erectile dysfunction, independent of glycometabolic control of the disease and insulin regimens; on the contrary, a great correlation is demonstrated with age and dyadic status. Full article

Background: Metabolic age (met-age), a risk marker, may vary within the same chronological age group. Its association with chronological age, waist/height ratio, obesity degree, body mass index (BMI), and physical rating score (PRS)—risk factors for type 2 diabetes—remains unexplored. Methods: A total of 122 type 2 diabetes patients (50 males, 72 females) were analyzed. Bioimpedance measurements were taken using the Tanita MC-780MA, alongside anthropometric data. Variables were compared, and correlations with met-age were assessed. Results: The met-age–chronological age difference was higher in females with type 2 diabetes (p < 0.001). Females also had higher BMI, obesity degree, fat mass, and waist/height ratio (p < 0.05), but lower waist/hip ratio (p < 0.001). Males showed higher PRS, muscle mass, and fat-free mass (p < 0.001). Met-age positively correlated with chronological age and negatively with PRS in both sexes (p < 0.05). According to the linear regression model, in females, the met-age was influenced positively by chronological age and waist/height ratio and negatively by PRS (R² = 0.983). In males, it was positively influenced by chronological age, obesity grade, and BMI, but negatively by PRS (R² = 0.974). Conclusions: Met-age correlates with chronological age and PRS in type 2 diabetes patients. It increases with advancing age and lower PRS, with waist/height ratio impacting females and BMI/obesity degree affecting males. Full article

Background/Objectives: Extra-gastrointestinal stromal tumors (EGISTs) are rare mesenchymal tumors arising outside the gastrointestinal tract, making up <5% of all GISTs. Rectovaginal EGISTs are particularly uncommon, with limited available data. This study systematically reviews the clinicopathological features, management, and outcomes of rectovaginal EGISTs. Methods: A systematic review of the English-language literature was conducted for studies on rectovaginal EGISTs (search date: 15 January 2025). Results: Thirty-one studies, including 40 female patients (mean age: 55.2 ± 15.4 years), met the inclusion criteria. Presenting symptoms included vaginal bleeding (24.3%), palpable mass (13.5%), constipation (10.8%), and abdominal pain (8.1%); however, the majority of patients (45.9%) were asymptomatic. Surgical excision was undertaken in 95% of patients, more often via local resection (61.1%). A high-grade mitotic index (>5/50 HPF) was noted in 63.2%. CD117, DOG-1, and vimentin was expressed in all cases, while CD34 was positive in 97.1%. Adjuvant therapy with tyrosine kinase inhibitors (TKIs) was administered in 57.5%, and neoadjuvant therapy was rare (8.6%). Recurrence occurred in 39.4% over a median follow-up of 40 ± 61.5 months, with a median disease-free survival (DFS) of 48 months. One death occurred 13 months postoperatively. Conclusions: Rectovaginal EGISTs are exceedingly rare and often asymptomatic, complicating preoperative diagnosis. Surgical resection remains the cornerstone of treatment, complemented by stage-specific neoadjuvant or adjuvant TKI therapy. The challenging location predisposes to recurrence, underscoring the need for further studies to optimize management and improve outcomes. Full article

In light of current global challenges of climate change, the over-exploitation of natural resources, and increasing demand for livestock products, the exploration of excellent forage crop resources holds great potential for development. Therefore, selecting forage crops that are high-yield, high-quality, and have excellent resistance to pests and diseases can greatly promote the development of the livestock industry. Oat (Avena sativa L.), a dual-purpose crop for grain and forage, plays a vital role in the development of animal husbandry. Autumn-sown oats have a significantly longer growth cycle than spring-sown oats, ensuring a year-round forage supply and achieving higher yields. The agropastoral transitional zone in southwest China is a key region for autumn-sown oats, but the systematic evaluation of oat germplasm there is still limited. Therefore, we conducted a two-growing-season (2022–2024) field experiment across four locations to evaluate nine oat genotypes for growth phenotypes, forage productivity, and nutritional quality through 11 agronomic traits and nutritional parameters during the filling stage (Zadok’s 75). The results revealed the following: (1) agronomic performance: dry matter yield (DMY) ranged from 10.72 to 14.58 t/ha, with line ‘WC109’ achieving the highest DMY (14.58 t/ha) and crude protein (CP, 9.66%); (2) nutritional quality: CP exhibited a significant negative correlation with fiber content (NDF: r = −0.72, p < 0.01; ADF: r = −0.68, p < 0.01), highlighting a yield–quality trade-off; ‘WC109’ demonstrated superior forage value, with the highest relative forage quality (RFQ: 115.45) and grading index (GI: 19.30); (3) environmental adaptation: location-specific climatic conditions significantly influenced productivity, with Wenjiang (WJ) showing optimal performance due to favorable temperature and precipitation. These results position ‘WC109’ as a promising candidate for autumn-sown cultivation in southwest China, addressing winter forage shortages while enhancing livestock nutrition. Our findings further elucidate the mechanisms linking yield and feeding value to growth performance indicators, providing references for trait-based measures to enhance forage oat productivity and quality. Full article

Background: Knee osteoarthritis (OA) is a progressive joint disorder characterized by pain, stiffness, and functional impairment. Platelet-rich plasma (PRP) has been widely studied as a biological treatment for OA, with autologous PRP (A-PRP) being the most commonly used formulation. Recently, umbilical cord-derived PRP (C-PRP) has emerged as a potential alternative due to its hypothesized higher regenerative potential. However, evidence supporting its superiority over A-PRP remains limited. This study aims to compare the efficacy and safety of C-PRP and A-PRP in terms of pain relief and functional improvement over a 12-month follow-up period. Methods: This prospective cohort study included 84 patients with mild-to-moderate knee OA (Kellgren–Lawrence grades I–III), into two groups: 44 patients received a single intra-articular injection of C-PRP, and 40 received A-PRP. Pain and functional outcomes were assessed at baseline, 3, 6, 9, and 12 months using the Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Score (KOOS). Statistical analysis was performed using the Mann–Whitney U, Exact Fisher test, repeated measures general linear model (GLM) and multivariate logistic regression. Results: Both C-PRP and A-PRP led to significant pain reduction and functional improvement over 12 months (p < 0.01 for both groups). Short-term analysis (3–6 months) showed slightly greater pain relief in the C-PRP group (VAS, p = 0.03 at 3 months), but this difference diminished at later time points. By 9 and 12 months, no significant differences were observed between the two groups in any clinical outcome measures (VAS, WOMAC, KOOS; p > 0.05). No serious adverse events were reported, and both treatments were well tolerated. Conclusions: This study found no long-term superiority of C-PRP over A-PRP in terms of pain relief or functional improvement in knee OA. While C-PRP showed a transient advantage in early pain relief, both treatments demonstrated similar clinical outcomes at 12 months. Given the limited scientific evidence supporting C-PRP and its higher logistical costs, A-PRP should remain the preferred PRP therapy for knee OA. Further randomized controlled trials with longer follow-up periods are needed to confirm these findings. Full article

Background/Objectives: The bidirectional relationship between diabetes mellitus (DM) and periodontal disease (PD) has garnered increasing attention due to shared inflammatory mechanisms and mutual disease exacerbation. In Romania, despite a high prevalence of diabetes and PD, integration of oral health into diabetes care remains limited. This study aimed to investigate the association between glycemic control, salivary inflammatory biomarkers (IL-1β, IL-6, MMP-8), and periodontal status in diabetic patients. Additionally, it evaluated patients’ awareness of oral health risks and their communication with healthcare providers regarding periodontal care. Methods: A cross-sectional, observational study was conducted between May and December 2024, involving 79 adult patients with confirmed type 1 or type 2 DM. Periodontal examinations assessed probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BOP). Salivary samples were collected to quantify IL-1β, IL-6, and MMP-8. Participants also completed a structured questionnaire on oral symptoms, hygiene practices, and awareness of the diabetes–periodontitis link. Correlation and t-test analyses were used to explore associations between clinical, biochemical, and self-reported variables. Results: Most participants had advanced periodontitis (65.8% Stage IV; 72.2% Grade C). IL-1β and IL-6 were positively correlated (r = 0.34, p < 0.01), while MMP-8 correlated with PI (r = 0.28) and BOP (r = 0.26). Inflammatory markers showed weak correlation with HbA1c. Notably, patients with higher oral health knowledge reported worse clinical indices, suggesting increased symptom awareness rather than preventive effectiveness. Conclusions: This study reinforces the inflammatory link between DM and PD and highlights the need for integrated care models. Periodontal screening and education should be embedded within diabetes management, particularly in high-risk populations. Full article

Aims: This phase II study aimed to evaluate the impact of early nutritional intervention on the nutritional status and survival of locally advanced non-small cell lung cancer (LANSCLC) patients undergoing concurrent chemoradiotherapy (CCRT). Methods: LANSCLC patients treated with CCRT were enrolled in the study group and received early nutritional intervention, including individualized nutrition counseling and oral nutritional supplements, from the initiation of CCRT to 2 weeks after its completion. The primary endpoint was the incidence of weight loss ≥5% during the CCRT. For comparison with the study group, a matched control group was retrieved from previous trials by the 1:1 propensity score matching method. Results: Sixty-seven patients were enrolled in the study group with a median follow-up of 52.4 months. Compared with the control group, the study group exhibited a lower incidence of weight loss ≥5% (p = 0.032), higher body mass index (p = 0.034) and prealbumin levels (p = 0.014) at the end of CCRT, as well as lower patient-generated subjective global assessments scores at the end of CCRT (p < 0.001) and 6 months after CCRT (p = 0.007). The study group also had a lower incidence of grade 2+ radiation pneumonitis (p = 0.023) and longer progression-free survival (13.5 vs. 11.3 months, p = 0.032). Patients who responded well to oral nutritional supplements had a higher Firmicutes/Bacteroidetes ratio at baseline (p = 0.036). Conclusions: Early nutritional intervention in LANSCLC patients undergoing CCRT improved nutritional status and reduced radiation pneumonitis. Gut microbiota was associated with the response to oral nutritional supplements. Full article

Background: Oral health is a key indicator of general health, well-being, and quality of life. Sociodemographic factors can affect children’s oral health status. The aim of this study was to analyze the sociodemographic factors that influence the oral health of schoolchildren in Mallorca. Materials and methods: We conducted a cross-sectional observational epidemiological study in Mallorca, analyzing different indicators of oral health, such as the DMFT/dmft index and the Community Periodontal Index (CPI), and sociodemographic variables among 718 schoolchildren aged 5–6, 12 and 15 years. Results: The DMFT (Decayed, Missing, and Filled Permanent Teeth) caries index was higher in public (Pub) schools than in private/charter (P/C) schools for children in the sixth grade of elementary school (Pub, 0.6918 ± 1.272; P/C, 0.323 ± 0.824; p < 0.05) and in the fourth year of secondary school (Pub, 1.178 ± 1.724; P/C, 0.627 ± 1.195; p < 0.05), as determined using a t-test. First-grade elementary students with more highly educated mothers/guardians had a lower rate of DMFT (Decayed, Missing, and Filled Primary Teeth) caries than those whose mothers obtained only elementary-level education (higher, 0.800 ± 1.616; elementary, 3.333 ± 3.393; p < 0.05). Regarding periodontal health, we observed that sixth-grade elementary schoolchildren with more highly educated mothers/guardians had more healthy sextants (higher, 3.987 ± 1.977; elementary, 1.333 ± 2.461; p < 0.001). Conclusions: The sociodemographic and parental factors analyzed, such as the type of school and parents’ education levels, significantly affected the oral health of the schoolchildren in this study. Full article