Search Results (69)

Background and Objectives: Total femoral replacement (TFR) was originally developed for limb salvage following the resection of malignant tumors. Over time, its indications have expanded, now serving as a reconstructive option for failed endoprosthetic replacements and severe trauma cases. Despite its advantages, TFR is a highly complex surgical procedure associated with significant complication rates. This study aims to analyze the management of complications and propose strategies to mitigate associated risks. Materials and Methods: This is a retrospective study conducted on patients from two independent hospitals who underwent TFR for different reasons. Results: Nineteen patients were included: eight underwent TFR for oncological indications, while 11 had the procedure as a revision following failed endoprosthetic arthroplasty or trauma. Postoperative complications were observed in 10 patients (53%), including hip dislocation (21%), mechanical implant failure (11%), infection (21%), wound healing complications (26%), and metal allergy symptoms (5%). Revision surgery was required in six patients (32%), but no cases necessitated amputation. Conclusions: TFR is associated with a high risk of complications, with infection and wound healing issues being the most prevalent. In our experience effective complication management strategies should include early intervention, considering TFR at an earlier stage in non-oncological patients to minimize multiple revision surgeries; allergy screening, assessing for potential metal hypersensitivity preoperatively; dislocation prevention, implementing dual mobility bearings to reduce instability; infection control, utilizing intraoperative local antibiotic therapy in revision cases; and wound management, applying vacuum-assisted closure (VAC) therapy postoperatively to enhance wound healing. Implementing these strategies may improve patient outcomes and reduce the burden of complications associated with TFR. Full article

Titanium and its alloys are widely used in dental implantology due to their favorable mechanical properties and well-documented long-term clinical performance. Among them, Ti-6Al-4V is particularly common in load-bearing applications. Nevertheless, a growing body of experimental and clinical evidence suggests that Ti-6Al-4V implants cannot be regarded as biologically inert in all patients. Adverse tissue responses, such as impaired healing, chronic peri-implant inflammation, and unexplained implant failure, have been reported even in the absence of classical risk factors, including infection, mechanical overload, or confirmed metal allergy. This critical review challenges the prevailing assumption that these complications are driven primarily by mechanical or immunoallergic mechanisms. Instead, oxidative stress is proposed as a central and unifying factor underlying adverse tissue reactions to Ti-6Al-4V dental implants. Corrosion, tribocorrosion, and mechanical wear lead to the release of titanium-, aluminum-, and vanadium-containing particles and ions, which promote excessive generation of reactive oxygen species at the implant–tissue interface. The resulting redox imbalance disrupts bone remodeling, impairs osteogenic differentiation, and maintains a pro-inflammatory microenvironment. Importantly, pathology arises not merely from increased reactive oxygen species production, but from the failure of local antioxidant defense systems to counteract this burden. Insufficient enzymatic and transcriptional antioxidant responses result in persistent redox imbalance, sustained innate immune activation, and progressive tissue intolerance. Oxidative stress is therefore conceptualized not as a secondary byproduct of inflammation, but as a primary driver of immune dysregulation through chronic macrophage activation and inflammasome signaling. This redox-driven feedback loop amplifies tissue damage and compromises long-term osseointegration independently of classical adaptive immune sensitization. Recognizing oxidative stress as a key determinant of implant–tissue interactions offers a more coherent framework for understanding implant-related complications and underscores the need for redox-aware biomaterial strategies and individualized patient risk assessment. Full article

Background: Dermatitis affecting the earlobe is a highly frequent clinical presentation, predominantly attributed to Allergic Contact Dermatitis (ACD) caused by metallic ions like nickel from earrings. However, a significant subset of patients presents with recurrent eczematous lesions highly suggestive of ACD but with inconclusive or negative patch test results, posing a profound diagnostic and therapeutic dilemma. Objective: This comprehensive review critically evaluates the differential diagnosis of earlobe eczema in the context of negative patch tests. Drawing from a representative case of a 30-year-old female with recurrent earlobe eczema and a strong family history of psoriasis, we explore alternative non-immunological and endogenous mechanisms, specifically Irritant Contact Dermatitis (ICD) and the Koebner Phenomenon on a background of Psoriatic Diathesis. Methods: We performed an extensive review of the current literature focusing on the epidemiology and pathogenesis of metal ACD, non-allergic mechanisms of jewelry-induced dermatitis (ICD), the molecular basis of the Koebner phenomenon, and the clinical overlap between eczema and psoriasis (Eczematous Psoriasis). Results: The localized nature of the inflammation, coupled with the absence of generalized nickel sensitivity, strongly suggests that the mechanical and occlusive trauma from earrings can induce a purely irritant reaction. Crucially, the presence of a familial psoriatic diathesis supports the hypothesis that this local irritation acts as a Koebner phenomenon trigger, leading to an eczematous manifestation of an underlying psoriatic tendency. Conclusions: Not all recurrent eczematous lesions at common contact sites are caused by ACD. Clinicians must adopt an integrated diagnostic approach, factoring in personal and family history alongside patch test results, to differentiate true allergy from ICD and the Koebner phenomenon. This nuanced perspective is vital for providing appropriate counseling (strict jewelry avoidance) and targeted, often steroid-sparing, management (e.g., topical calcineurin inhibitors) for a durable therapeutic outcome. Full article

This work presents a standardized 360-degree, clock-face ultrasonographic protocol for comprehensive static and dynamic assessment of the glenoid labrum. The protocol translates the arthroscopic clock-face orientation into ultrasound scanning windows, providing reproducible steps for each labral quadrant (12 to 12 o’clock) including patient positioning, transducer orientation, and dynamic maneuvers. By leveraging linear transducers with trapezoidal imaging and an optional convex transducer to bypass acoustic shadowing from the acromion and coracoid, all labral segments can be consistently visualized, while dynamic testing reveals subtle clefts, irregular margins, and medial displacement patterns. Clinically, this approach is particularly valuable for patients who cannot undergo MRI or MR arthrography (e.g., due to metallic implants, contrast allergy, claustrophobia or renal dysfunction) and in settings where MR/MRA is unavailable or impractical (sports medicine, urgent care, postoperative follow-up). The pictorial atlas and step-by-step checklists aim to support adoption in routine practice and to facilitate communication with surgeons through shared clock-face terminology. This protocol is not intended to replace MR arthrography for surgical planning; rather, when MRI/MRA cannot be performed or access is limited, it provides actionable, dynamic information that complements clinical decision-making. Full article

Patent foramen ovale (PFO) is implicated in cryptogenic stroke and other clinical syndromes, with transcatheter closure demonstrating superiority over medical therapy in selected patients. Most closure devices are composed of nitinol, a nickel–titanium alloy, raising concerns in individuals with nickel hypersensitivity, one of the most prevalent contact allergies worldwide. Although typically manifesting as localized dermatitis, nickel allergy has been associated with systemic reactions after device implantation, including chest pain, palpitations, migraines, dyspnea, and cutaneous eruptions. Recent evidence indicates that nickel-sensitive patients experience a significantly higher incidence of post-procedural device-related symptoms. Nevertheless, severe reactions remain rare, and the benefits of PFO closure generally outweigh the risks. The predictive value of pre-implantation patch testing remains uncertain, and the lack of nickel-free alternatives constrains device selection. Management strategies are empirical, relying on symptomatic treatment with corticosteroids, antihistamines, or device explantation in refractory cases. Future research should focus on elucidating the pathophysiology of nickel-induced hypersensitivity in cardiovascular implants, improving diagnostic algorithms, and developing biocompatible, nickel-free devices. A multidisciplinary approach involving cardiologists, dermatologists, and allergists is essential to optimize outcomes in this complex subset of patients. Full article

Background/Objectives: Artificial intelligence (AI) has evolved from early diagnostic expert systems to advanced generative models, such as GPT-4, which are increasingly being used in healthcare. Concerns persist regarding inaccuracies and input dependency. This study aimed to deliver initial insights into whether gender influences the interaction of medical professionals with generative AI. Methods: This analysis investigated gender differences in medical students’ and physicians’ interactions with ChatGPT-4 while researching occupational medicine cases in a randomized controlled study. Participants assessed cases involving asbestos-related disease, metal sulfate allergy, and berylliosis using ChatGPT. Inputs and outputs were evaluated for accuracy, confabulations, communication styles, and user satisfaction. Demographic data and self-assessments of occupational medicine knowledge before and after the tasks were also collected. Results: Among 27 participants (63% women, 37% men), women showed greater knowledge improvement after using ChatGPT, particularly in asbestos-related cancer identification. No significant gender differences emerged in diagnostic accuracy, reporting procedures, or satisfaction with ChatGPT. Women exhibited significantly higher self-rated competence after using the ChatGPT application, while men only showed minimal change. Input from the female participants led to more confabulations, although response accuracy remained comparable. Conclusions: This study offers the first real-world insights into the use of generative AI in occupational medicine, highlighting the importance of understanding user-dependent variability in AI-supported clinical practice and decision-making. These findings underscore the need for gender-sensitive AI literacy training in medical education, accommodating diverse interaction styles and strategies to mitigate AI-generated misinformation. Future research with larger and more diverse cohorts could provide deeper insights into the influence of gender, age, and experience on AI utilization in healthcare. Integrating gender-based interaction differences into AI training and applications may improve clinical performance and promote more equitable healthcare practices. Full article

Titanium (Ti) and its alloys have attracted more interest, as they are widely employed as biomaterials due to their great biocompatibility, excellent strength ratio, and lightweight. However, corrosion occurs slowly due to an electrochemical reaction once the Ti material has been placed in the human body, contributing to infection and failure of implants in medical applications. Thus, the corrosion phenomenon has caused great concern in the biomedical field. It is desirable to make the surface modification to provide better corrosion resistance. The fabrication techniques of the coatings fabricated onto Ti and/or Ti alloy surfaces have been reported, including sol–gel, annealing, plasma spraying, plasma immersion ion implantation, physical vapor deposition, chemical vapor deposition, anodization, and micro-arc oxidation. This review first describes the corrosion types, including localized corrosion (both pitting and crevice corrosion), galvanic corrosion, selective leaching, stress corrosion cracking (SCC), corrosion fatigue (CF), and fretting corrosion. In the second part, the effects of corrosion on the human body were discussed, and the primary cause for clinical failure and allergies has been identified as the excessive release of poisonous and dangerous metal ions (Co, Ni, and Ti) from corroded implants into bodily fluids. The inclusion and exclusion criteria during the selection of literature are described in the third section. In the last section, we emphasized the current research progress of Ti alloy (particularly Ti6Al4V alloy) coatings in biomaterials for medical applications involving dental, orthopedic, and cardiovascular implants for anticorrosive applications. However, there are also several problems to explore and address in future studies, such as the release of excessive metal ions, etc. This review will draw attention to both researchers and clinicians, which could help to increase the coatings fabricated onto Ti and/or Ti alloy surfaces for anticorrosive applications in biomaterials for medical applications. Full article

This study investigates the hydrological, ecological, and socio-economic responses of Ugii Lake—a freshwater body in semi-arid Central Mongolia—to climate variability and anthropogenic pressures. Seasonal field surveys conducted during the spring, summer, and fall of 2023–2024 revealed notable spatial and temporal variation in water quality, with pH ranging from 7.54 to 8.87, EC from 316 to 645 µS/cm, and turbidity between 0.36 and 5.76 NTU. Total dissolved solids (TDS) values and ionic compositions indicated increased salinization in some zones, particularly those exposed to high evaporation and shoreline disturbance. Heavy metal analysis identified elevated levels of aluminum, manganese, and zinc at several sampling points; however, concentrations generally remained within national environmental standards. Vegetation surveys showed that disturbed areas—especially those affected by grazing and tourism—exhibited reduced native plant diversity and dominance of invasive species. Socio-economic interviews with local herders and stakeholders indicated that 67.3% of households experienced declining livestock productivity, and 37.1% reported increased allergies or respiratory symptoms linked to deteriorating environmental conditions. Despite some ongoing conservation efforts, respondents expressed dissatisfaction with enforcement and impact. These findings highlight the need for community-driven, integrated lake management strategies that address environmental degradation, climate adaptation, and rural livelihood security. Full article

Hemi-joint implants for treatment of osteoarthritis of the great toe joint have been known to fail at times from a variety of reasons and often requires a return to the operating room for removal and/or conversion. We present an interesting case of a cobalt hemi-implant failure from metal allergy 16 months after implantation. This is an underreported event in podiatric literature. We present an interesting discussion, as we feel a review of metal allergy occurrence with joint implant replacement, whether preoperative screening, patch testing, or lymphocyte transformation testing might be of value. We encourage foot and ankle surgeons to include implant allergy in their differential diagnosis as a possible cause of implant failure. (J Am Podiatr Med Assoc 115(3), 2025; doi:10.7547/23-023) Full article

The widespread adoption of metal implants in orthopaedics and dentistry has revolutionized medical treatments, but concerns remain regarding their biocompatibility, toxicity, and immunogenicity. This study conducts a comprehensive literature review of traditional biomaterials used in orthopaedic surgery and traumatology, with a particular focus on their historical development and biological interactions. Research articles were gathered from PubMed and Web of Science databases using keyword combinations such as “toxicity, irritation, allergy, biomaterials, corrosion, implants, orthopaedic surgery, biocompatible materials, steel, alloys, material properties, applications, implantology, and surface modification”. An initial pool of 400 articles was screened by independent reviewers based on predefined inclusion and exclusion criteria, resulting in 160 relevant articles covering research from 1950 to 2025. This paper explores the electrochemical processes of metals like iron, titanium, aluminium, cobalt, molybdenum, nickel, and chromium post-implantation, which cause ion release and wear debris formation. These metal ions interact with biological molecules, triggering localized irritation, inflammatory responses, and immune-mediated hypersensitivity. Unlike existing reviews, this paper highlights how metal–protein interactions can form antigenic complexes, contributing to delayed hypersensitivity and complications such as peri-implant osteolysis and implant failure. While titanium is traditionally considered bioinert, emerging evidence suggests that under certain conditions, even inert metals can induce adverse biological effects. Furthermore, this review emphasizes the role of oxidative stress, illustrating how metal ion release and systemic toxicity contribute to long-term health risks. It also uncovers the underappreciated genotoxic and cytotoxic effects of metal ions on cellular metabolism, shedding light on potential long-term repercussions. By integrating a rigorous methodological approach with an in-depth exploration of metal-induced biological responses, this paper offers a more nuanced perspective on the complex interplay between metal implants and human biology, advancing the discourse on implant safety and material innovation. Full article

Background/Objectives: Eyelid dermatitis is an inflammatory disease affecting the palpebral skin characterized by itching, edema, and scaling of the periorbital area. This entity can be a manifestation of various underlying dermatological diseases, but allergic contact dermatitis (ACD) is the predominant etiology of eyelid dermatitis among patients, being diagnosed in 43.4% of cases. The thin and highly permeable nature of eyelid skin increases its susceptibility to allergens, making it a distinct clinical entity. This study aimed to identify the primary haptens associated with eyelid ACD and compare these findings with the allergens implicated in non-eyelid ACD over a 25-year period in a large cohort of patients. Methods: We conducted a monocentric, retrospective study on a dataset of 7955 patients patch-tested for ACD at the Outpatient Allergy Dermatology Clinic of the Azienda Ospedaliera Universitaria Senese (AOUS) from 1997 to 2021. Eyelid ACD cases were identified based on clinical features and positive patch test results. Data on demographics, occupation, and personal history of atopy were collected. The statistical analyses assessed the associations between allergens and eyelid ACD. The trends in the sensitization rates for the most prevalent allergens were also evaluated. Results: Eyelid ACD was identified in 4.6% of the study population, predominantly affecting women (88.6%). Patients with eyelid ACD were more likely to exhibit single-hapten positivity (54.6%) and an atopic phenotype (52.3%) compared to non-eyelid ACD cases. Nickel sulfate (54%), cobalt chloride (13.4%), and thimerosal (12.6%) were the most common allergens associated with eyelid ACD. While thimerosal sensitization decreased significantly following its removal from topical products, nickel sensitization increased, likely due to exposure from electronic devices and hand–eye contact. Conclusions: The haptens identified in eyelid ACD largely overlap with those found in other body regions, including metals, fragrances, and preservatives. However, the unique characteristics of eyelid skin and hand–eye contact patterns play a significant role in sensitization. This study highlights the need for further investigation into the pathophysiology of eyelid allergic contact dermatitis, with particular emphasis on elucidating the mechanisms of hapten sensitization. Such insights could contribute to the development of effective strategies aimed at reducing allergen exposure. Full article

This study investigates the release of metal ions from commonly used orthodontic archwires, specifically, stainless steel (SS), nickel–titanium (NiTi), chromium–cobalt (CrCo), and titanium–molybdenum (TMA) alloys. To simulate oral conditions, each type of wire was immersed in artificial saliva at body temperature for a four-week period. Ion release levels were analyzed through ICP-OES mass spectrometry. The findings indicate that NiTi and CrCo wires released significantly higher amounts of nickel (Ni) and chromium (Cr) ions compared to SS wires. These findings underscore the potential risk of allergic reactions, particularly to nickel, and emphasize the need for careful consideration of biocompatibility in orthodontic material selection. This research also provides valuable insights aimed at minimizing adverse reactions in patients, especially those with metal allergies. Full article

A high-noble Au–Pt–Ge porcelain-fused-to-metal (PFM) dental alloy without the known adverse metallic elements and with the addition of germanium (Ge) was produced as a more cost-effective alternative to other precious alloying metals, with investigations for determining the functionality and clinical use of this alloy. The thermomechanical, biocompatibility, durability, workability and economic characteristics of the produced dental alloy were investigated. These properties were investigated with in vitro biocompatibility testing on human gingival fibroblasts (HGFs); static immersion testing for metal ion release; DSC analysis; hardness, tensile testing, density and coefficient of thermal expansion (CTE) measurements; metallographic and SEM/EDX microstructure investigations; and finally with the production of a test PFM dental bridge. The results of the thermomechanical testing showed alloy properties suitable for dental restorations and clinical use, with somewhat lower mechanical properties, making the alloy not suitable for extensive multiunit fixed restorations. The microstructure investigations showed segregations of Ge in the homogeneous alloy matrix, which reduce the alloy’s mechanical properties. The produced PFM dental bridge showed excellent workability of the alloy in a dental laboratory setting, as well as a high standard of the final dental restoration. The ion release was negligible, well below any harmful quantities, while the cell viability examination showed significantly higher viability ratings on polished alloy samples as compared to as-cast samples. The results showed that a dental substructure in direct contact with oral tissue and fluids should be highly polished. The performed investigations showed that the produced PFM dental alloy is suitable for clinical use in producing high-quality dental restorations with high biocompatibility for patients prone to metal allergies. Full article

T cell activation is the final key event (KE4) in the adverse outcome pathway (AOP) of skin sensitization. However, validated new approach methodologies (NAMs) for evaluating this step are missing. Accordingly, chemicals that activate an unusually high frequency of T cells, as does the most prevalent metal allergen nickel, are not yet identified in a regulatory context. T cell reactivity to chemical sensitizers might be especially relevant in real-life scenarios, where skin injury, co-exposure to irritants in chemical mixtures, or infections may trigger the heterologous innate immune stimulation necessary to induce adaptive T cell responses. Additionally, cross-reactivity, which underlies cross-allergies, can only be assessed by T cell tests. To date, several experimental T cell tests are available that use primary naïve and memory CD4+ and CD8+ T cells from human blood. These include priming and lymphocyte proliferation tests and, most recently, activation-induced marker (AIM) assays. All approaches are challenged by chemical-mediated toxicity, inefficient or unknown generation of T cell epitopes, and a low throughput. Here, we summarize solutions and strategies to confirm in vitro T cell signals. Broader application and standardization are necessary to possibly define chemical applicability domains and to strengthen the role of T cell tests in regulatory risk assessment. Full article

Oat-based milk alternatives (OMAs) are an important alternative to bovine milk, with prevalence of lactose intolerance, as well as soy and nut allergies limiting consumers options. However, OMAs are typically lower in protein content than both bovine milk and soy-based alternatives, with protein quality limited by low lysine levels, which can reduce protein digestibility. Addition of alternative plant proteins may increase the quantity of protein, as well as balancing the amino acid profile. However, plant-based proteins have additional sensory qualities and off-flavours, which may lead to undesirable characteristics when introduced to OMAs. This study aimed to assess the effect of pea and potato protein addition on the sensory profile, volatile profile, colour, and particle size in an OMA control product. Results demonstrated that pea protein contributed to a bitter and metallic taste, astringent aftertaste, and a significantly increased overall aroma correlated with higher levels of key volatiles. Whilst potato protein resulted in less flavour changes, it did lead to increased powdery mouthfeel and mouthcoating supported by a substantially increased particle size. Both protein fortifications led to detectable colour changes and a staler flavour. Fortification of OMA product with the pea protein led to significant sensory, volatile and physical changes, whilst the potato protein led to predominantly physical changes. Further investigation into alternative plant-based proteins is necessary to optimise sensory qualities whilst increasing protein content and the amino acid profile. Full article