Search Results (428)

Background: Thromboangiitis obliterans (TAO) is a nonatherosclerotic inflammatory vascular disorder affecting small- and medium-sized vessels, often leading to critical limb ischemia and a high risk of amputation. Conventional medical and surgical treatments remain limited, particularly for advanced diseases. Tibial transverse bone transport (TTT), based on the principles of distraction osteogenesis, has emerged as a novel technique to promote angiogenesis and improve microcirculation. This systematic review evaluated the clinical efficacy and safety of TTT in the management of TAO. Methods: A systematic review was conducted according to the PRISMA guidelines. A comprehensive search of PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar was performed until December 2025. Eligible studies included clinical investigations that evaluated TTT in patients with TAO. Data on patient characteristics, surgical techniques, clinical outcomes, and complications were extracted and analyzed descriptively because of the heterogeneity in study design and reporting. Results: Ten studies involving 368 patients were included in this review. TTT was consistently associated with significant clinical improvement, including pain relief, increased claudication distance, and ulcer healing, which were typically observed within weeks after the procedure. Limb salvage rates were high, with major amputation rates generally ranging from 3.3% to 13.3%. Objective improvements in perfusion parameters have also been reported in several studies. The most common complication was pin-site infection (up to 30%), while fractures, delayed consolidation, and osteomyelitis were less frequent complications. Conclusions: Current evidence suggests that TTT is a promising limb-salvage strategy for TAO and is associated with favorable clinical and functional outcomes, with an acceptable complication profile. However, the available evidence remains limited, partly because of the rarity of TAO and the specialized nature of the TTT procedure. Most available studies are observational, and further high-quality prospective and randomized trials are required to validate the long-term efficacy of this technique. Full article

Grounded in the Cognitive Theory of Multimedia Learning and Cognitive Load Theory, this study examined how cue-based instructional support relates to L2 Chinese vocabulary processing and immediate learning outcomes. Forty intermediate-to-advanced learners studied 24 disyllabic pseudowords under four within-subject conditions: no cueing, verbal cueing (linguistic–semantic support via definitions and collocations), physical cueing (typographical enhancement via bolded targets and underlined contextual words), and full cueing. Eye movements, immediate post-tests, and questionnaires were analyzed. The results revealed selective, measure-dependent effects rather than uniform facilitation. In the Orthographic Choice Task, no cueing outperformed full cueing. In the Semantic Priming Decision Task, verbal cueing yielded a higher accuracy than physical cueing, indicating that linguistic–semantic support benefited initial meaning-related processing more than typographical enhancement. No differences emerged in the Sentence Acceptability Judgment Task. Eye-tracking showed shorter first fixations under physical than verbal cueing, suggesting the limited facilitation of early visual orienting. Full cueing showed no consistent advantage over verbal cueing but elicited larger pupil sizes and longer total fixation durations on targets, indicating additional coordination demands. Learners most often preferred full-cueing materials, yet rated verbal cueing as most helpful. An effective cue-based design should align the cue format and content with the target learning dimension while avoiding unnecessary processing demands. The findings reflect immediate learning under controlled conditions rather than long-term acquisition. Full article

The increasing use of cardiac implantable electronic devices (CIEDs) in pediatric and adolescent populations has led to a growing need for transvenous lead extraction (TLE). However, data on long-term outcomes remain limited. This study aimed to evaluate the efficacy and safety of TLE using mechanical rotational dilator sheaths in a pediatric cohort. This retrospective single-center study included 35 patients who underwent TLE between 2007 and 2025. Outcomes were compared between Evolution^® (Cook Medical, Bloomington, IN, USA) and TightRail™ (Spectranetics/Philips, Colorado Springs, CO, USA) sheath systems. A total of 40 leads were extracted (mean age at extraction: 15.1 ± 4.2 years; 57% male). The most common indication for extraction was lead fracture/dysfunction (22/35–63%). Complete success with the procedure was achieved in 23 (66%) patients, and clinical success in 30 (86%). Major complications requiring surgery occurred in 5 (14%) patients, and minor complications in 2 (6%). Notably, all major complications occurred in patients with implantable cardioverter-defibrillator (ICD) leads (p = 0.013), including innominate vein injury, pericardial effusion, tricuspid entrapment, and cardiac perforation. A comparison of the Evolution^® (n:20) and TightRail™ (n:15) sheath groups showed no statistically significant differences in complete procedural success (p = 0.603), clinical success (p = 0.604), or the incidence of major complications (p = 0.640). No procedure-related mortality was observed. TLE using mechanical rotational dilator sheaths in pediatric patients is feasible and provides acceptable clinical success rates. However, the risk of major complications remains considerable, particularly in patients with ICD leads. These findings highlight the importance of careful procedural planning and performing TLE in experienced centers with immediate surgical backup. Full article

Background: Primary malignant bone tumors of the pelvis account for 10–15% of all primary bone sarcomas, most commonly chondrosarcoma, osteosarcoma, and Ewing’s sarcoma. Although advances have shifted treatment toward internal hemipelvectomy, pelvic resections remain challenging due to the complex anatomy. The need for pelvic reconstruction is controversial, balancing potential stability against higher complication rates. This review evaluates the role of pelvic ring reconstruction, focusing on techniques, outcomes, and complications. Methods: A systematic literature review was performed in June 2025 using PubMed, MEDLINE and Cochrane Library as the primary databases, with the following search string: (hemipelvectomy) AND (orthopedic), acknowledging that this search strategy may be limited in scope. Studies published within the last five years were considered. After performing a full-text assessment of 80 studies, 14 studies were included in this review. Data regarding patients, methods, and outcomes were extracted and summarized. Results: Among the 14 included studies, seven investigated patient-specific three-dimensional (3D) printed pelvic reconstructions, four reported biological reconstruction techniques, two studies focused on non-reconstructive management and one study evaluated alternative stabilization using segmental spinal instrumentation. 3D printed and other reconstructive techniques were associated with improvements in the Musculoskeletal Tumor Society score, reduced pain, and demonstrated osseointegration with few mechanical failures. Although individual case series demonstrated good ambulation and stable fixation, complication rates, particularly wound and infection-related events, remained frequent. Type III reconstructions and personalized implants showed the highest functional gains but occasionally revealed asymptomatic fretting wear. In contrast, the only Level I evidence indicated significantly higher complication and infection rates in reconstructed patients and better functional outcomes in those managed without reconstruction when spinopelvic stability was preserved. Non-reconstructive strategies, including spinal instrumentation, supported early ambulation with low mechanical failure, while pediatric patients treated without reconstruction experienced a high complication rate but acceptable long-term oncologic outcomes. Conclusions: Current evidence suggests that routine pelvic ring reconstruction after internal hemipelvectomy may not be justified based on the currently available evidence. Patient-specific 3D-printed implants appear to provide consistent improvements in function, pain reduction, and mechanical stability, but are associated with a relevant risk of wound-related and infectious complications. In patients with preserved spinopelvic stability, non-reconstructive strategies may achieve comparable functional outcomes with lower morbidity. Therefore, pelvic reconstruction should be performed selectively, and further prospective multicenter studies are needed to better define appropriate patient selection and optimize reconstructive strategies. Full article

Introduction: Alopecia areata (AA) is a chronic immune-mediated disorder characterized by non-scarring hair loss and a significant psychosocial burden. Ritlecitinib, a selective Janus kinase 3 (JAK3) and tyrosine kinase expressed in hepatocellular carcinoma (TEC) family kinase inhibitor, has recently emerged as a targeted systemic therapy for moderate-to-severe AA. While randomized clinical trials have demonstrated its efficacy, real-world evidence remains limited and heterogeneous. Methods: A structured narrative review was conducted to summarize current evidence on ritlecitinib in AA, with a focus on real-world outcomes. A comprehensive search of PubMed/MEDLINE, Scopus, Embase, and Cochrane Library was performed up to March 2026 using predefined keywords. Eligible studies included real-world observational studies, case series, and post hoc analyses of randomized controlled trials reporting clinical outcomes. Two independent reviewers performed study selection. Results: A total of 14 studies were included. Clinical trial analyses suggested sustained efficacy over time, with progressive improvement in Severity of Alopecia Tool (SALT) scores up to 24 months. Real-world studies reported clinically meaningful hair regrowth across diverse populations, including severe, pediatric, and treatment-experienced patients. Response rates increased over time, with a proportion of patients achieving SALT ≤ 20 or ≥80% improvement. Lower baseline severity and shorter disease duration were reported in several studies as potential factors associated with a better response. Safety profiles were favorable, with predominantly mild adverse events. Discussion: Ritlecitinib shows consistent effectiveness and acceptable safety in both clinical trials and real-world settings. Treatment response appears progressive and heterogeneous, supporting the importance of early intervention and adequate treatment duration. Further large-scale and long-term real-world studies are needed to better define predictors of response and optimize patient selection. Full article

Background: Metastatic renal cell carcinoma (mRCC) remains incurable despite advances with immune checkpoint inhibitors and tyrosine kinase inhibitors. Metabolic interventions, such as the ketogenic diet (KD), may modulate tumor biology and systemic inflammation, yet clinical evidence in mRCC is limited. Objective: To evaluate the feasibility, safety, and tolerability of KD combined with systemic therapy in mRCC patients. Design, Setting, and Participants: CETOREIN was a non-randomized, single-center pilot study enrolling 21 adult mRCC patients initiating systemic therapy. KD was initiated concurrently with treatment for up to 12 months, with follow-up at 1, 3, 6, and 12 months. Intervention: Participants followed a 2:1 KD (≈80% fat, 20% protein + carbohydrates) with dietitian-led counseling, medium-chain triglyceride supplementation, food diaries, and ketonuria monitoring. Outcome Measurements and Statistical Analysis: The primary endpoint was feasibility, defined by diet-related adverse events. Secondary endpoints included adherence, metabolic parameters, and exploratory clinical outcomes (response rate, progression-free survival [PFS], overall survival [OS]). All efficacy-related outcomes were descriptive and exploratory only. Results: Eight patients (40%) completed 12 months on KD, with a mean duration of 7 months. Common diet-related toxicities were diarrhea (55%), weight loss (45%), hypercholesterolemia (40%), and dyspepsia (30%), with no severe events. Early weight loss was modest and transient. Ketonuria correlated with dietary records, confirming adherence. Median PFS was 9.5 months, and median OS was 39 months. Among four patients undergoing cytoreductive nephrectomy, exploratory paired PD-L1 analyses showed decreased expression in three cases; however, these observations are hypothesis-generating only and cannot be attributed to the ketogenic diet. Conclusions: KD is feasible and demonstrated an acceptable tolerability profile in selected mRCC patients, though long-term adherence is challenging. No conclusions regarding antitumor efficacy can be drawn from this small non-randomized pilot study. Future studies should evaluate shorter interventions and optimized dietary protocols in larger randomized trials. Full article

Background: Robotic-assisted surgery has increasingly been adopted in pediatric surgical practice; however, data from early implementation stages remain limited. Materials and methods: We conducted a prospective audit of the first 71 pediatric robotic-assisted procedures performed over a 24-month period using the da Vinci Xi platform in a tertiary pediatric center. Patient characteristics, surgical indications, perioperative parameters, and postoperative outcomes were analyzed. Results: A total of 71 procedures were performed in 71 patients (39 girls, 32 boys; mean age 4.46 years). The most frequent procedures were cholecystectomy (n = 19), ovarian tumor excision (n = 14), and pyeloplasty (n = 13). Mean operative time was 90 ± 65.30 min. Intraoperative complications occurred in 9.9% of cases, conversion to open surgery in 2.8%, and postoperative complications in 2.8%. Trocar insertion time and docking time improved significantly during the second year (p < 0.05). No mortality or long-term complications were recorded. Conclusions: Robotic-assisted pediatric surgery is feasible and safe, with acceptable complication rates and favorable early outcomes. Progressive improvement in operative setup parameters reflects a measurable learning curve. Full article

Background: Local recurrence of rectal cancer is a challenging problem for patients and clinicians. Surgical resection is associated with good outcomes if R0 margins are achieved; however, it is often complex, requires suitable patient fitness, and is associated with long term physical and psychological consequences. Meanwhile, continuing technical advances in radiotherapy have enabled the delivery of highly conformal treatment, thereby enabling dose escalation or pelvic reirradiation to be safely considered—either as definitive management or in the neoadjuvant setting—for patients with locally recurrent rectal cancer. Pelvic reirradiation may refer to patients who have received primary rectal radiotherapy with the aim of neoadjuvant downstaging or reducing the risk of locoregional recurrence, versus radiotherapy for a previous unrelated non-rectal pelvic malignancy. Methods: A literature search of pelvic reirradiation for non-metastatic, locally recurrent rectal cancer was conducted for full text articles published over the last 20 years. Additional papers were identified within the references of these papers. Studies focusing on non-rectal cancers, and patients having primary radiotherapy for locally recurrent rectal cancer were excluded. Due to the heterogenicity of the data, no meta-analysis was performed. Results: A total of 15 papers were included, containing a cohort of 840 patients. Several reirradiation modalities were reported, including external beam radiotherapy, brachytherapy, stereotactic ablative radiotherapy and heavy particle therapy (carbon ion). Carbon ion radiotherapy was the most common reirradiation treatment modality utilised with a median cumulative dose of 70.4 Gray (Gy). Treatment response, defined as either complete or partial improvement in tumour size, was only reported in seven studies, and varied from 14 to 88%. Overall 3-year survival was also variable with rates reported between 18 and 85%. These observations may be due to variation in patient selection, treatment intent, and technique. Pelvic reirradiation was associated with acceptable toxicity, low rates of G3+ toxicity, and improved symptom control. Conclusions: Our review describes the multitude of approaches to pelvic reirradiation for locally recurrent rectal cancer. Reviewing the radiobiological and patient outcomes is challenging in view of the degree of heterogeneity in patient selection, treatment approach, and reported outcomes. However, there is consensus that pelvic reirradiation—either for long term control or to downstage prior to definitive surgery—is feasible with potential utility in this setting. Full article

Background/Objectives: Hepatocellular carcinoma (HCC) is a major cause of cancer-related morbidity and mortality, with incidence expected to increase. Liver transplantation is the most definitive curative option for early HCC, but many patients present beyond accepted transplant criteria, including the Milan criteria. Downstaging aims to reduce tumor burden and enable transplantation without compromising long-term outcomes. Methods: We reviewed the literature on liver transplantation, immune checkpoint inhibitors, immunotherapy–locoregional therapy combinations, and immune-related adverse events in HCC. Results: Immunotherapy-based strategies are emerging as downstaging approaches in selected patients. In advanced HCC, immune checkpoint inhibitor combinations have improved objective response rates compared with tyrosine kinase inhibitors, reaching approximately 20–36% in pivotal phase III trials. In the downstaging setting, early data suggest that immune checkpoint inhibitors, particularly with locoregional therapies, can achieve sufficient tumor regression to permit transplantation in patients initially beyond criteria. The ImmunoXXL trial reported successful downstaging and transplantation in all 16 patients treated with atezolizumab–bevacizumab, with 62.5% complete pathological responses, 2-year recurrence-free survival of 90%, and overall survival of 94%. The VITALITY study achieved successful downstaging in 75.6% of patients beyond Milan criteria, with 36.7% undergoing transplantation and 3-year post-transplant survival of 85%. However, pre-transplant immune checkpoint inhibitor exposure carries a clinically relevant risk of acute allograft rejection, reported in approximately 16–28% of transplanted patients. Conclusions: Immunotherapy-based downstaging before liver transplantation is promising but remains non-standard. Its use should be restricted to carefully selected patients within multidisciplinary protocols, as evidence remains limited by small cohorts, heterogeneous regimens, uncertain washout intervals, and rejection risk. Full article

This study develops a ternary Fe-based geopolymer system composed of metakaolin (MK), red mud (RM), and fly ash (FA) for the preparation of sustainable water-retaining subgrade materials for sponge-city roadbed applications. Unlike conventional formulations primarily designed for structural strength or rapid permeability, the proposed MK–FA–RM system was designed to improve water-storage capacity while maintaining adequate mechanical support and environmental compatibility. In this ternary system, MK provides highly reactive aluminosilicate species for geopolymer network formation, RM introduces Fe-bearing phases and enhances industrial solid-waste utilization, and FA contributes to particle packing, workability, and resource efficiency. A constrained ternary mixture design implemented using Design-Expert software was adopted to optimize precursor proportions. Within the investigated compositional range, the fitted first-order mixture model showed acceptable statistical adequacy for preliminary composition screening (R² = 0.86). The optimal blend (60% MK, 30% RM, and 10% FA) achieved a 7-day compressive strength of 8.37 MPa and a water retention rate of 35.3% under ambient curing conditions, satisfying the strength requirement considered for the target subgrade/base-layer application. Microstructural and phase analyses suggest that the synergistic interaction of the three precursors promoted Fe-modified aluminosilicate gel formation together with conventional geopolymer gel products, while improving matrix continuity and preserving interconnected pore space for water storage. This multiscale structural effect helps explain how the material achieved a balance between water retention capacity and mechanical support. Under the tested conditions, the material maintained acceptable residual strength after short-term exposure to water, acid, and sulfate-containing solutions. Life-cycle assessment indicated a 70% reduction in CO₂ emissions compared with ordinary Portland cement, while pilot-scale cost analysis showed a 39% lower production cost than MetaMax-based geopolymer materials. Pilot-scale application further demonstrated the constructability and water-regulation potential of the material in practical environments. Overall, the proposed ternary Fe-based geopolymer demonstrates that Fe-rich industrial wastes can be engineered into low-carbon and economically viable water-retaining subgrade materials that balance hydraulic regulation, structural adequacy, and sustainability. Nevertheless, long-term durability, cyclic loading performance, and direct nanoscale characterization of Fe-bearing gel evolution still require further investigation. Full article

Background/Objectives: Children and young people (CYP) with long-term physical health conditions (LTCs) are at greater risk of psychosocial difficulties. Systematic reviews on adults with LTCs have supported acceptance and commitment therapy (ACT) in improving several psychosocial outcomes. This systematic review aimed to investigate the effectiveness of ACT for CYP-reported psychosocial outcomes among CYP with LTCs. It also examined the factors associated with the effects and the quantitative acceptability of the included ACT interventions. Methods: Eligible studies used a quantitative experimental design to evaluate ACT for CYP-reported psychosocial outcomes in CYP (≤18 years old) with LTCs. Only studies published in English in peer-reviewed journals, from any year, were included. CINAHL (EBSCO), Cochrane Library, Embase (Ovid), MEDLINE (Ovid) and PsycInfo (Ovid) were systematically searched. Google Scholar and Web of Science were also searched, and forward and backward citation searching was completed for included papers. Research quality was appraised using Cochrane risk-of-bias tools. Results were narratively synthesised. Results: Sixteen studies (nine randomised controlled trials (RCTs) and seven non-RCTs) from 19 reports met inclusion criteria, with 777 participants and five LTCs (chronic pain, diabetes, cancer, obesity and visual impairment). Findings provided preliminary support for the effectiveness of ACT on most CYP-reported psychosocial outcomes studied. Seven studies considered factors associated with intervention effects, with mixed findings. Acceptability was supported in the three studies that assessed it quantitatively. However, almost all studies had overall high/serious risk-of-bias ratings. Conclusions: There is preliminary evidence supporting potential benefits of ACT for improving psychosocial outcomes in CYP with LTCs, with limited but supportive findings for its acceptability. However, findings are constrained by high/serious risk of bias and small sample sizes. Larger, high-quality trials with active controls and longer follow-ups are needed to inform future care pathways. Registration: This systematic review was pre-registered (PROSPERO registration number: CRD42023425918). Full article

The available literature provides limited and inadequate data regarding the association between intraoperative knee kinematics, long-term clinical outcomes and survivorship after total knee arthroplasty (TKA). This study aimed to examine the potential relationship between specific intraoperative kinematics laxity assessment, acquired with a computer navigation system, and the long-term clinical outcomes and survivorship in patients undergoing TKA. This study consists of a retrospective cohort analysis of consecutive TKA procedures, in which a surgical navigation system was utilized to intra-operatively assess bone resections, implant positioning and gap balancing. The intraoperative kinematic parameters included varus-valgus laxity at 0° (VV 0) and 30° of flexion (VV 30), anterior–posterior displacement at 90° of flexion (AP 90), and passive range of motion (ROM). Different prosthesis designs were used, with a predominance of the posterior stabilized (PS)-type implant. The Knee Injury and Osteo-arthritis Outcome Score (KOOS) was used to investigate patients’ clinical and functional status. Survival was analyzed with the Kaplan–Meier method. Between-group comparisons were performed using the Mann–Whitney U test. A univariate logistic regression analysis was conducted to identify factors associated with clinical failure. Of 165 eligible patients, 120 were included in the final analysis, with a mean follow-up of 7.7 ± 2.8 years. Revision surgery was required in seven cases, representing surgical failure and an overall survival rate of 94.2%, with survival probabilities of 98.8%, 97.4%, and 93.6% at 6, 8, and 10 years, respectively. Clinical failure (KOOS < 70 in three domains) occurred in 23 patients. No intra-operative surgical parameters, including Hip-Knee-Ankle angle, Preoperative KL grade, prostheses design, VV 0, VV 30, AP 90 and ROM, or demographic variables, were found to be statistically correlated with clinical failure at follow-up. Although, in this navigated TKA cohort, survivorship was acceptable and consistent with previously reported benchmarks, it was not possible to reliably predict survival probability based solely on the intra-operative laxity parameters measured. Nevertheless, the use of surgical navigation can help surgeons accurately assess bone resections and the balance of prosthetic components. Full article

Background/Objectives: Titanium implants remain the gold standard in implant dentistry. However, growing interest in metal-free alternatives has led to increased use of zirconia implants. Despite encouraging short-term outcomes, evidence regarding the medium- to long-term survival of one-piece zirconia implants (O-PZIs) and associated risk factors remains limited. The aim of this retrospective cohort study was to evaluate the survival of O-PZIs over follow-up periods of up to 8 years and to explore variables potentially associated with implant failure. Methods: This retrospective observational cohort study was conducted at a private dental clinic (Madrid, Spain). A total of 307 O-PZIs placed in 196 patients between 2017 and 2021 were analyzed. Implant survival was assessed using Kaplan–Meier analysis, while associations between clinical variables and implant failure were explored using chi-square tests and multivariate Cox regression models (p < 0.05). The mean follow-up period was 61.37 ± 2.25 months. Results: After a mean follow-up of 61.37 ± 2.25 months (range: 39–96 months), 42 failures were recorded, resulting in a cumulative survival rate of 86.32% (CI 95%: 79.28–92.96%). Most failures (64.29%) occurred before prosthetic loading. Kaplan–Meier analysis revealed significantly lower survival for tapered implants (p < 0.001) and among smokers (p < 0.001). Multivariate analysis indicated that only simultaneous guided bone regeneration (GBR) was independently associated with implant failure (Exp(B) = 3.191; 95% CI: 1.299–7.840; p = 0.011). However, this association should be interpreted with caution due to the retrospective design, potential confounding, limited number of events, and lack of adjustment for clustering at the patient level. The discrepancies observed between statistical methods highlight the importance of time-to-event analyses in implant research. Conclusions: Within the limitations of this study, O-PZIs demonstrated acceptable medium- to long-term survival. Simultaneous GBR may be associated with increased risk of failure. However, these findings should be considered exploratory. Further prospective studies are required to confirm these results and to better define risk factors in ceramic implant therapy. Full article

Background: Robotic-assisted surgery (RAS) has progressively expanded in gynecologic practice. Although its technical advantages are recognized, its economic sustainability and equitable accessibility remain debated. Methods: This clinical update provides a critical narrative review of current evidence on RAS in gynecology, integrating data on clinical outcomes, cost-effectiveness, diffusion patterns, and health equity across different healthcare settings. Results: In both benign and oncologic indications, RAS demonstrates consistent perioperative advantages over open surgery, including reduced blood loss, shorter hospital stay, and lower conversion rates. In routine cases, outcomes are largely comparable to conventional laparoscopy. However, robotic approaches appear particularly beneficial in complex scenarios, such as obesity, advanced malignancy, and technically demanding procedures. Economic evidence is heterogeneous. Short-term hospital-based studies report higher direct costs for RAS, especially in benign surgery. Conversely, cost–utility models in oncologic settings suggest that RAS may achieve acceptable cost-effectiveness when long-term outcomes, quality-adjusted life years, and institutional volume are considered. Accessibility remains strongly influenced by reimbursement policies, procedural volume, infrastructure, and workforce training. In the absence of structured reimbursement frameworks, robotic surgery may contribute to socioeconomic and geographic disparities. Conclusions: RAS represents an important component of modern gynecologic surgery, particularly in high-complexity and high-risk cases in which its technical advantages may translate into meaningful perioperative benefit. Its long-term sustainability depends on appropriate patient selection, institutional volume, reimbursement models, and health system organization. Future research incorporating long-term and societal economic perspectives is required to support balanced and equitable implementation. Full article

This study investigated the antimicrobial potential of Coptis chinensis rhizome extract against key oral pathogens and evaluated the safety and clinical efficacy of a CCE-loaded mouthwash. CCE exhibited broad-spectrum bactericidal activity, with low minimum inhibitory concentrations (0.002–0.008%) and minimum bactericidal concentrations (0.004–0.016%) against Streptococcus mutans, Aggregatibacter actinomycetemcomitans, and Porphyromonas gingivalis. Time-kill kinetics revealed that CCE promptly eradicated Porphyromonas gingivalis. To balance antimicrobial potency and sensory acceptability, specifically the extract’s bitterness, we established the CCE concentrations in the mouthwash at 0.01% and 0.02% (w/v). Preclinical safety evaluations in animal models, including oral mucosal irritation and skin sensitization tests, confirmed the biocompatibility of 0.02% CCE, yielding “None” and “Non-sensitizer” ratings, respectively. Furthermore, a four-week, randomized, double-blind clinical trial (n = 73) revealed that 0.02% CCE mouthwash substantially reduced halitosis-inducing volatile sulfur compounds (hydrogen sulfide by 59.5% and methyl mercaptan by 50.0%). Significant improvements were also observed in the Plaque Index (55.2% reduction), Gingival Index (52.0% reduction), and Bleeding on Probing (77.3% reduction), with no adverse effects. These findings provide preliminary evidence that CCE mouthwash improves halitosis-related parameters and gingival indices in adults with self-reported halitosis, though further research is required to evaluate its long-term impact on broader periodontal disease states. Full article