Search Results (4,535)

Implant-supported partial dentures with cantilever extensions (ISPDCs) present significant biomechanical challenges when rehabilitating partially edentulous patients, especially in the posterior region, where higher complication rates are often reported. This systematic review aimed to evaluate the complications, survival rates, and marginal bone loss associated with ISPDCs in posterior areas. The review protocol was registered with the PROSPERO database (CRD42024606201) and was conducted in accordance with PRISMA-P guidelines. A comprehensive search was performed across 10 databases for studies published up until 28 January 2025. Out of an initial 2142 records, 11 clinical studies met the inclusion criteria. The analysis showed a low failure rate for both prostheses and implants, at 1% (95% confidence interval: 0–3%) across the studies evaluated. However, noteworthy complications arose from biological factors as well as technical issues. Complications related to the prosthesis and abutment occurred in 14% of cases (95% CI: 5–26%), while loss of retention was noted in 13% of cases (95% CI: 7–21%). These technical issues were particularly more frequent in extensions greater than 7 mm. A significant difference was observed in marginal bone loss when comparing the final and initial measurements to the cantilever (p < 0.0001), which was influenced by the study design. Factors such as the type of occlusal veneering material, study design related to biological complications, the number of implants, marginal bone loss (between adjacent and distant sites), and the retention system did not significantly affect the complication rate (p > 0.05). The certainty of evidence for all primary outcomes was rated as low due to study limitations, heterogeneity, and risk of bias. In conclusion, ISPDCs show favorable survival outcomes when supported by adequate planning and clinical monitoring, although longer extensions require more cautious case selection and prosthetic design. Full article

Background: Fractures of the distal humerus (DHFs) represent challenging intra-articular injuries that are often followed by postoperative complications, most notably ulnar neuropathy. There is still debate regarding the best method of handling the ulnar nerve during open reduction and internal fixation (ORIF). Objective: The primary objective was to evaluate the incidence of postoperative ulnar neuropathy (UN) in patients who underwent open reduction and internal fixation (ORIF) for DHFs, comparing anterior transposition (AT) with in situ decompression (ISD) of the ulnar nerve. Additionally, we investigated the influence of AT on individuals presenting with preoperative UN. Methods: A retrospective review was conducted on 68 patients (26 females and 42 males; mean age: 46.3 years) who underwent ORIF for intra-articular DHF between 2018 and 2022. Patients were divided into two groups: anterior transposition (n = 14) and in situ decompression (n = 54). Ulnar neuropathy was evaluated using the modified McGowan classification, and radiographic outcomes were assessed with AO/OTA fracture classification. Results: Sixty-eight patients (26F/42M) were included. The mean age was 46.3 years (20–77 years) and the mean follow-up time was 53 months (36–76 months). The postoperative UN incidence was 30.8% (21/68). Neuropathy was significantly higher in the transposition group compared to in situ decompression (57.1% vs. 24%; p = 0.012). Olecranon osteotomy (36.3% vs. 20%; p = 0.042) and parallel plate configuration (33.3% vs. 12.5%; p = 0.037) were also associated with increased neuropathy risk. Among patients with preoperative ulnar neuropathy (n = 12), functional recovery was more favorable with transposition, where 71% experienced full resolution compared to 60% in the in situ group. Conclusions: Routine anterior transposition of the ulnar nerve during ORIF for DHF is associated with an increased risk of postoperative neuropathy and should be avoided in patients without preoperative symptoms. However, transposition appears beneficial in patients with pre-existing ulnar neuropathy. Surgeons should individualize ulnar nerve management to balance surgical risks and neurological outcomes. Full article

Background/Objectives: This study aimed at evaluating the association between maternal pre-pregnancy glycemic status and growth delay in offspring using nationwide health screening data. Methods: A retrospective cohort of 258,367 mother–child dyads born between 2014 and 2021 was analyzed. Maternal glycemic status was categorized as normal (<100 mg/dL), impaired fasting glucose (IFG, 100–125 mg/dL), or diabetes mellitus (DM, ≥126 mg/dL). Growth delay was defined as measurements below the 10th percentile of height, weight, and head circumference at 18–24 and 30–36 months. Visual and auditory development were assessed using caregiver questionnaires. Inverse probability of treatment weighting was applied, and weighted relative risks (RRs) were estimated. Results: The prevalence of growth delay was 3.5% for height, 3.8% for weight, and 4.3% for head circumference; visual and auditory problems were reported in 1.2% and 8.2% of children, respectively. Both the DM (1.2%) and IFG (9.3%) groups showed increased risks of growth delay across both age periods. Maternal hyperglycemia was also associated with offspring’s visual and auditory development, with age- and period-specific differences observed. Conclusions: Maternal pre-pregnancy glycemic status was significantly associated with delayed growth in Korean children aged 18–36 months. These findings highlight the importance of optimizing maternal glycemic control prior to pregnancy for favorable child developmental outcomes. Full article

Background: Triple-negative breast cancer (TNBC) is an aggressive breast cancer subtype characterized by poor prognosis and limited therapeutic options. Chemotherapy regimens are associated with significant adverse effects negatively impacting patients’ quality of life (QoL). This systematic review aims to evaluate and compare QoL outcomes of patients with TNBC receiving novel therapies—including immunotherapy, antibody–drug conjugates, and targeted therapies—versus standard chemotherapy. Methods: We systematically reviewed randomized controlled trials (RCTs) published within the past 15 years, identified through comprehensive searches in PubMed, Google Scholar, Research4Life, and Elicit. Included studies involved FDA-approved novel therapies (pembrolizumab, atezolizumab, sacituzumab-govitecan, olaparib, and talazoparib) administered to TNBC patients, and assessed QoL using validated tools such as EORTC QLQ-C30. Observational studies, case reports, and non-standardized assessments were excluded. Results: Eight RCTs comprising 3929 patients met the inclusion criteria. Sacituzumab govitecan and PARP inhibitors (olaparib and talazoparib) significantly improved QoL, notably delaying deterioration across physical, emotional, and functional domains compared to standard chemotherapy. Conversely, immunotherapies (pembrolizumab, atezolizumab) showed non-significant trends toward QoL improvement, with effects varying by patient subgroup and disease stage. Interpretation was limited by study design differences, inconsistent compliance, and incomplete data reporting. Conclusions: Immunotherapy showed a neutral effect on quality of life, providing neither significant improvement nor additional decline. Olaparib was associated with a delayed deterioration in quality of life, showing a more favorable tolerability profile compared to chemotherapy. Talazoparib leads to clinically meaningful enhancements in quality of life, while sacituzumab govitecan effectively improves patient-reported outcomes relative to standard chemotherapy. Full article

Proximal humerus fractures are frequent injuries that often require internal fixation. Conventional metallic plates, however, present significant drawbacks such as corrosion, secondary removal surgeries, and adverse reactions in patients with metal hypersensitivity. This study evaluates biocomposite plates fabricated from polylactic acid (PLA) and polyvinyl alcohol (PVA), reinforced with hydroxyapatite (HA) derived from sugar industry by-products (BCF) at 10% and 20% concentrations. These composites are compatible with both injection molding and 3D printing, enabling the design of patient-specific implants. Characterization by SEM, FTIR, XRD, and DSC confirmed that BCF incorporation enhances strength, stiffness, osteoconductivity, and biocompatibility. Mechanical testing showed that PVA/BCF exhibited greater tensile strength and stiffness, suggesting suitability for load-bearing applications, though their water solubility restricts use in humid environments and prevents filament-based 3D printing. PLA/BCF composites demonstrated better processability, favorable mechanical performance, and compatibility with both manufacturing routes. Finite element analysis highlighted the importance of plate–humerus contact in stress distribution and fixation stability. Compared with non-biodegradable thermoplastics such as PEI and PEEK, PLA/BCF and PVA/BCF offer the additional advantage of controlled biodegradation, reducing the need for secondary surgeries. Cell viability assays confirmed cytocompatibility, with optimal outcomes at 10% BCF in PVA and 20% in PLA. These results position PLA/BCF and PVA/BCF as sustainable, patient-tailored alternatives to metallic implants, combining adequate mechanical support with bone regeneration potential. Full article

Costa Rica has experienced 45 tsunamis at both its Pacific and Caribbean coasts, with none to moderated impact. However, the coastal population has increased exponentially in the past few decades, which might lead to higher impact in future tsunamis. In 2018 and 2019, IOC/UNESCO organized Experts Meetings of Tsunami Sources, Hazards, Risks and Uncertainties associated with the Tonga–Kermadec and Colombia–Ecuador subduction zones, where experts defined maximum credible scenarios. Here we modeled the propagation of those tsunami scenarios to Costa Rica and their inundation for selected sites. We found that the Tonga–Kermadec scenarios provoked more inundation than previous modeled sources from that region. However, the large travel time for those scenarios, about 14 h, would allow for a timely evacuation. In the Colombia–Ecuador scenarios, they provoked less inundation than previously modeled sources from that region, a good outcome as their arrival time is between 75 and 150 min. These new results required the update of tsunami evacuation maps and/or plans for many communities but provided more favorable conditions for tsunami preparedness. Yet, the short arrival times of the Colombia–Ecuador scenarios still require a prompt response from the population and authorities. For this, additional to updated tsunami evacuation maps and plans, it is recommended to have tsunami exercises on a regular basis. Full article

Background/Objectives: This study evaluated the effects of virtual reality (VR) on functionality, quality of life, and motivation in children with cerebral palsy (CP). Methods: The systematic review was registered in PROSPERO (CRD42022321170) and conducted using the keywords physical therapy OR physiotherapy AND “Virtual Reality”. Studies were screened based on title, abstract, and full-text review. The PEDro scale was used to assess methodological quality, and the GRADE system was applied to determine the level of certainty of the evidence. Results: A total of 10 studies showed improvements in balance, 6 in gross motor function, and 8 in upper limb coordination. Additional gains were found in daily functioning (6), gait (4), motivation (3), and spasticity (1–2). Overall, virtual reality enhanced motor abilities and engagement compared with conventional therapy, underscoring its value as a playful and motivating tool in rehabilitation. All outcome measures showed positive changes, particularly in functionality and quality of life. The primary outcomes with the most favorable responses to intervention were gross motor function and balance, followed by motivation and adherence. However, the generalities of the findings are limited due to variabilities in outcome reporting and measurement tools. Conclusions: The findings indicated clinical improvements in key outcome measures following VR interventions. Nonetheless, there were significant variabilities in the evaluation instruments used across studies. Despite this, the clinical evidence supported the integration of VR into neurorehabilitation processes for children with CP. Full article

This narrative review addresses the complexities of managing the vertical dimension of occlusion (VDO) in restorative dentistry, focusing on predictability in prosthetic reconstructions. Altering VDO impacts biological, biomechanical, esthetic, and functional aspects, making it a controversial topic. While VDO naturally evolves throughout life, interventions require careful consideration due to potential complications. Various techniques guide VDO determination, including facial proportions, physiological methods, phonetics, and cephalometric analysis. Clinicians must understand these principles and adapt them to individual patient needs. Materials and Methods: A narrative literature review was conducted using PubMed, Scopus, Google Scholar, and the Cochrane Library, searching keywords like “vertical dimension of occlusion”, “dental”, “diagnosis”, “management” and “complications”. In addition to the literature review, two case reports with extensive prosthodontic restorations were included to illustrate the diagnostic challenges and treatment considerations in a clinical setting. Results: Increasing VDO aids restorative treatments, re-establishing morphology, and facilitating additive procedures. Minimally invasive approaches, provisional restorations, and fixed restorations with functional contours are favored. Individualized, patient-centered care is critical, recognizing unique anatomical and functional needs. This approach optimizes stomatognathic system rehabilitation while preventing adverse effects on body posture and airway dimensions. Conclusions: To ensure predictable results and minimize risks, changes in VDO should be kept to a minimum to achieve dentofacial aesthetic harmony and secure adequate space for the planned restorations The two case reports presented, with different clinical approaches, underline the importance of understanding the potential risks and benefits of VDO alteration which is crucial for achieving predictable and successful outcomes in complex restorative cases. Full article

Background: Diabetes-related foot diseases represent a global health problem because of the associated complications, the risk of amputation, and the economic burden on health systems. Negative pressure wound therapy (NPWT) is a technique that uses sub-atmospheric pressure to help promote wound healing by reducing the inflammatory exudate while keeping the wound moist, inhibiting bacterial growth, and promoting the formation of granulation tissue. Objective: This study aimed to assess the effectiveness of NPWT in preventing major amputation in diabetic patients with complicated foot or lower limb infections and to contextualize the results through a review of the existing literature. Materials and methods: We conducted a retrospective study at the First Surgical Department of “Dr. I. Cantacuzino” Clinical Hospital in Bucharest, Romania, over a 15-year period, including 30 consecutive adult patients with diabetes and soft tissue foot or lower limb infections treated with NPWT. Patients with non-diabetic ulcers, incomplete medical data, or aged under 18 were excluded. All patients underwent initial surgical debridement, minor amputation, or drainage procedures, followed by the application of NPWT using a standard protocol. Dressings were changed every 2–4 days for a total of 7–10 days. Antibiotic therapy was adapted according to the culture results. The primary outcome was limb preservation, defined as avoidance of major amputation. Secondary outcomes included in-hospital mortality and wound status at discharge. Results: NPWT was associated with a favorable outcome in 24 patients (80%), defined by wound granulation or healing without the need for major amputation. Five patients (16.6%) underwent major amputation because of failure of the primary lesion treatment, and one patient died. No statistically significant association was observed between the outcomes and standard classification scores (WIFI, IWGDF, and TPI). A comprehensive literature review helped to integrate these findings into the existing pool of knowledge. Conclusions: NPWT may support limb preservation in selected diabetic foot cases. While the retrospective design and the small sample size of the study limit generalizability, these results reinforce the need for further controlled studies to evaluate NPWT in real-life clinical settings. The correct use of NPWT combined with etiological treatment may offer a maximum chance to avoid major amputation in patients with diabetes-related foot diseases. Full article

Cushing’s syndrome is one of the most common endocrine disorders in dogs and is typically managed with long-term medical treatment. Several pharmacological agents are available: trilostane, mitotane, ketoconazole, cabergoline, selegiline, and aminoglutethimide, but their comparative effects on survival remain unclear. This systematic review and meta-analysis compared the impact of these agents on survival outcomes in dogs with naturally occurring diseases. A comprehensive search of MEDLINE, Embase, Web of Science, Academic Search Complete, and the Cochrane Library was conducted between 1 September 2024 to 3 January 2025. Eligible studies included dogs diagnosed with Cushing’s syndrome that reported survival outcomes for at least one of the specified treatments. Five studies (n = 295 dogs) met the inclusion criteria, with trilostane and mitotane providing sufficient data for meta-analysis. Pooled mean difference in survival time across four studies was 85.1 days (95% CI: −255.9 to 85.7, p = 0.21) with substantial heterogeneity (I² = 89%), indicating no statistically significant difference between the drugs. In contrast, pooled survival rates at fixed intervals favored trilostane, with an 11% higher survival at 36 months (p = 0.005) and no heterogeneity observed (I² = 0%). These findings suggest trilostane may offer long-term survival benefits over mitotane. Full article

Background/Objectives: The COVID-19 pandemic has significantly intensified global concerns surrounding antimicrobial resistance (AMR), particularly in relation to tuberculosis (TB). In the European Union (EU), the reallocation of healthcare resources towards managing COVID-19 led to a de-prioritization of TB surveillance and control. This shift contributed to delays in TB diagnosis and treatment, creating conditions favorable for the emergence and spread of drug-resistant TB strains. This meta-analysis aims to assess epidemiological trends of drug-resistant TB across EU countries before, during, and after the pandemic and quantify the impact of COVID-19 on Mycobacterium tuberculosis resistance patterns. Methods: Data were obtained from the European Centre for Disease Prevention and Control (ECDC) covering 2015 to 2022. Following the TB incidence, the multidrug-resistant TB (MDR-TB) and rifampicin-resistant/MDR-TB (RR/MDR-TB) cases, as well as treatment success rates over 12- and 24-month periods, were analyzed. The analysis included 31 EU countries across three-time frames: pre-pandemic (2015–2019), pandemic onset (2020), and post-pandemic transition (2020–2022). Results: The pandemic was associated with a decrease in reported TB cases but a simultaneous increase in the proportion of MDR and RR/MDR cases. Treatment success rates showed a modest rise for 24-month regimens, while outcomes declined for 12-month therapies. Conclusions: These findings underscore the pandemic’s disruptive impact on TB control and highlight the need for renewed investment in diagnostic capacity, treatment access, and antimicrobial stewardship, in order to reduce antimicrobial resistance occurrence. Continued monitoring beyond 2022 is essential to fully understand long-term effects and inform future public health strategies. Full article

Background/Objectives: Sweet’s syndrome (SS), also known as acute febrile neutrophilic dermatosis, is a rare inflammatory skin disorder that may also present with extracutaneous manifestations. Liver involvement is thought to result from sterile neutrophilic infiltration, mirroring the skin pathology and highlighting the syndrome’s systemic inflammatory nature. Timely recognition, exclusion of infectious or autoimmune etiologies, and prompt corticosteroid therapy are critical for favorable outcomes. Methods: Herein, we present the case of a 73-year-old man with hyperuricemia who developed both cutaneous and systemic manifestations of SS seven days after initiating allopurinol treatment. His symptoms included fever, conjunctivitis in the right eye, and painful, non-pruritic erythematous plaques, some with pustules, on the lower limbs, palms, and face. Results: Initial laboratory investigations revealed neutrophilic leukocytosis, elevated inflammatory markers, and renal and hepatic dysfunction. Empirical treatment with antibiotics and antivirals failed to improve his condition. The patient discontinued allopurinol and initiated a high-dose corticosteroid regimen, leading to rapid resolution of fever and improvement in skin lesions. Laboratory parameters gradually normalized, except for persistent high liver enzymes. A comprehensive diagnostic workup ruled out infectious, autoimmune, and malignant causes. Imaging studies, including CT, MRI, and MRCP, showed no structural liver abnormalities. Skin biopsy findings were consistent with SS, demonstrating dense neutrophilic infiltrates in the reticular dermis and papillary dermal edema. After his discharge, he was followed up by the Hepatology unit. The patients’ liver enzyme levels normalized within three months with no recurrence or late complications one year later. Conclusions: In the context of drug-induced SS, persistent hepatic abnormalities, although rare, may occur in patients without underlying liver disease. Full article

Background/Objectives: Early-onset scoliosis (EOS) is often treated with growing rods, which use distraction-based correction to control deformity while allowing spinal growth. Although effective in the coronal plane, this technique may adversely affect sagittal alignment, particularly thoracic kyphosis and lumbar lordosis. Whether final fusion surgery is necessary after the growing rod treatment remains controversial. This study compared radiographic outcomes, including coronal and sagittal parameters, between patients with and without final fusion to clarify the value of final fusion. Methods: We retrospectively reviewed 19 EOS patients treated with growing rods between 2015 and 2019. Patients undergoing posterior spinal fusion after lengthening were classified as the final fusion group (n = 9), while those with more than 12 months of follow-up without fusion formed the graduated group (n = 10). Demographics, surgical variables, and radiographic parameters (Cobb angle, correction rate, coronal balance, clavicular angle, thoracic kyphosis, lumbar lordosis, sagittal vertical axis) were compared. Results: Baseline characteristics were similar. At final follow-up, the final fusion group had significantly better outcomes in Cobb angle (24.2° vs. 34.9°, p = 0.002), correction rate (66.6% vs. 40.1%, p = 0.001), and coronal balance (−1.5 mm vs. 19.7 mm, p = 0.004). Sagittal alignment did not differ significantly, but preservation of thoracic kyphosis tended to favor the fusion group. Conclusions: Final fusion surgery after growing rod treatment achieved superior coronal correction and balance compared with observation alone. Although sagittal alignment was not statistically different, a trend toward better thoracic kyphosis preservation was observed. Final fusion should be considered for larger residual curves or coronal imbalance, while observation may suffice in well-corrected cases. Full article

Lymphocyte-activation gene 3 (LAG3) is an immune checkpoint receptor and inhibitory regulator of T-cells. Here, we analyzed the prevalence of LAG3 rs870849 in B-cell lymphoma patients and the treatment outcomes according to the LAG3 genetic background and discovered that LAG3 germline variants may affect the risk of developing lymphoma and also affect the treatment outcome of DLBCL patients in the current CD19 CAR-T cell therapies. The LAG3 rs870849 was prevalent at high frequency in DLBCL patients. Significant differences in treatment outcomes to CAR-T cell therapy emerged in LAG3 I455hom versus I455Thet and T455hom carriers. The overall and complete response rates to CAR-T cell therapy were lower in the I455hom genetic subgroup with median PFS in the I455hom of 2 versus 20 months in the T455hom and I455Thet subgroups (p = 0.025). Median OS was 6 months in the LAG3 I455hom versus 41 months in the T455hom and I455Thet subgroups (p = 0.007). LAG3 rs870849 may affect treatment outcome in CAR-T cell therapy, with favorable outcomes in T455 carriers. Specific combinations of CTLA4 and LAG3 germline variants may cooperate to affect the response to CAR-T cell therapy. Full article

Ginsenosides, the primary bioactive components of Panax ginseng, have demonstrated significant immunomodulatory potential. While major ginsenosides have been extensively studied, rare ginsenosides produced through deglycosylation, heating, and steaming show enhanced biological activities with improved bioavailability. This review aimed to comprehensively analyze the immunomodulatory mechanisms, structure-activity relationships (SARs), therapeutic applications, and clinical translation strategies of five emerging rare ginsenosides: F1, Rg5, Rk1, Rh1, and Rg2. We conducted a comprehensive literature review examining the production methods, immunological effects, molecular mechanisms, pharmacokinetics, safety profiles, and clinical applications of these five compounds. Analysis focused on chemical structures, immune cell modulation, signaling pathways, disease model efficacy, and bioavailability enhancement strategies. Ginsenoside F1 uniquely demonstrated immunostimulatory effects, enhancing natural killer (NK) cell cytotoxicity and macrophage phagocytosis through mitogen-activated protein kinase (MAPK)/nuclear factor-κB (NF-κB) activation. Conversely, Rg5, Rk1, Rh1, and Rg2 exhibited anti-inflammatory properties via distinct mechanisms: Rg5 through Toll-like receptor 4 (TLR4)/NF-κB inhibition, Rk1 via triple pathway modulation (NF-κB, p38 MAPK, signal transducer and activator of transcription (STAT)), Rh1 by selective p38 MAPK and STAT1 inhibition, and Rg2 through modulation of both central nervous system (neuroinflammation) and peripheral organ systems. Structure-activity analysis revealed that sugar moiety positions critically determine immunological outcomes. Crucially, advanced delivery systems including nanostructured lipid carriers, self-microemulsifying systems, and specialized liposomes have overcome the major translational barrier of poor bioavailability, achieving up to 2.6-fold improvements and enabling clinical development. Safety assessments demonstrated favorable tolerability profiles across preclinical and clinical studies. These five rare ginsenosides represent promising immunomodulatory agents with distinct therapeutic applications. F1’s unique immunostimulatory properties position it for cancer immunotherapy, while the complementary anti-inflammatory mechanisms of Rg5, Rk1, Rh1, and Rg2 offer opportunities for precision medicine in inflammatory diseases. Advanced formulation technologies and optimized production methods now enable their significant clinical translation potential, providing promising therapeutic options for immune-related disorders pending further development. Full article