Search Results (2,685)

The use of local anesthetics in dentistry is crucial for pain control. Their efficacy may be related to multiple factors, including gender, the clinical status of the patient, anatomical factors, the type of anesthetic, premedication treatment, and the experience of the professional. Aim: The objective of this study was to analyze whether premedication or the degree of patient anxiety influences the anesthetic efficacy of 4% articaine with epinephrine 1:100,000 and 0.5% bupivacaine with epinephrine 1:100,000 in patients undergoing root canal treatment for symptomatic irreversible pulpitis in the upper and lower molars. The null hypothesis (H0) of this study was that articaine and bupivacaine would have a similar anesthetic efficacy when used during the treatment of symptomatic irreversible pulpitis of the posterior mandibular and maxillary teeth, independent of non-steroidal anti-inflammatory drugs (NSAIDs) premedication or the patient’s anxiety levels. Methods: A total of 140 patients presenting with pulpitis in the upper and lower molars were randomly assigned to one of two anesthetics: articaine or bupivacaine. Before root canal treatment, patients completed the Modified Corah Dental Anxiety Scale (MDAS) and a Visual Analog Scale (VAS) for pain intensity. Inferior alveolar nerve block was performed for the lower molars and buccal infiltration for the upper molars, and the anesthetic efficacy was verified by the Endo Coldspray^® test. During the procedure, the patients’ heart rate and oxygen saturation were monitored using a pulse oximeter. The patients reported their pain levels using a VAS twenty-four hours postoperatively. Results: High levels of dental anxiety were significantly associated with higher pain scores (p = 0.000) for both groups. The hemodynamic changes during treatment remained within normal limits. The need for anesthetic reinforcement was higher in the bupivacaine group (p = 0.004). The patients in both groups reported low-intensity postoperative pain, although the pain level was slightly lower in the bupivacaine group. Conclusions: The anesthetic efficacy of articaine and bupivacaine in patients with irreversible pulpitis did not appear to be influenced by the degree of anxiety or the intake of AINEs as premedication. The intrinsic anesthetic efficacy was higher for articaine, which required less reinforcement than bupivacaine. Comparing the results obtained when performing buccal infiltration and inferior alveolar nerve block further highlighted the differences between the two anesthetics; these differences were more pronounced in the bupivacaine group, leading to rejection of the null hypothesis proposed at the beginning of the study. Full article

Background/Objectives: Magrolimab (Magro) is a humanized naked anti-CD47 monoclonal antibody that blocks the SIRPα CD47 interaction, allowing macrophages to target and destroy cancer cells. To evaluate its preclinical efficacy in vivo, Magro was tested as a single agent and in combination with conventional chemotherapy drugs, Cytarabine (Ara-C) or Azacitidine (Aza), in three pediatric AML (pAML) patient-derived xenograft (PDX) models—AML006 (KMT2A::MLLT1), AML010 (+10, WT1), and AML013 (KMT2A::MLLT4). Methods: After PDX model establishment, mice were assigned to treatment groups hulgG4 (VC, vehicle control for Magro), Magro, Ara-C + VC, Aza + VC, Ara-C + Magro, and Aza + Magro, and then followed for survival. Mice that met humane euthanasia endpoints and at the culmination of experimental timelines had tissues harvested to measure disease burden. Results: Magro alone significantly improved survival in AML006 (p < 0.0001) and AML013 (p = 0.003) and decreased bone marrow (BM) disease burden in AML006 (p = 0.009) and AML013 (p = 0.002). Ara-C + Magro therapy led to significantly improved survival in all three models and significantly decreased BM disease burden in AML006 (p < 0.0001) and AML013 (p = 0.048). Aza + Magro therapy led to significantly improved survival in AML013 (p = 0.047) and AML010 (p = 0.017) and significantly lower BM disease burden in AML010 (p = 0.001). Conclusions: Interestingly, the two models that demonstrated improvement in survival with Magro harbored KMT2A rearrangements, suggesting a subset of patients that may be more responsive to the effects of CD47 blockade. As this drug is being evaluated for use in other malignancies, future studies may focus on investigating the importance of biomarker-based patient selection. Full article

Background: Cervical radiculopathy is one of the frequent musculoskeletal problems prevalent in the general population, characterized by neck pain radiating to the upper limb. This study investigated the effects of the myokinetic stretching technique versus post-isometric relaxation (PIR) exercises with mechanical traction in patients with cervical radiculopathy. Methods: A single-blinded, randomized clinical trial was conducted from March 2023 to June 2023. Sixty-six patients with cervical radiculopathy were randomly assigned to two groups: Group A (n = 33) received myokinetic stretching exercises and Group B (n = 33) received isometric relaxation exercises, while mechanical cervical traction was applied to both groups as the baseline treatment. The treatment frequency was two sessions per week for eight weeks. Outcome measures were pain, range of motion, and neck disability measured through the Numerical Pain Rating Scale, a goniometer, and the Urdu version of the Neck Disability Index. Assessments were performed at the baseline and the 4th and 8th weeks of the treatment. Results: The between-group analysis showed a non-significant difference (p > 0.05). The within-group analysis showed (p < 0.001) significant improvement in both groups. Conclusion: This study concluded that the myokinetic stretching technique and post-isometric relaxation exercises combined with mechanical traction are effective in improving pain, range of motion, and neck disability in patients with cervical radiculopathy. Full article

Background: Remifentanil, an ultra-short-acting µ-receptor agonist, is used with propofol for optimal laryngeal mask airway (LMA) insertion. However, no studies have assessed its effects when combined with thiopental on LMA conditions. The combined use of thiopental and remifentanil may offer advantages, such as enhanced cardiovascular and respiratory stability. This study aims to compare the administration of thiopental with different doses of remifentanil to assess their combined effects on LMA insertion conditions and success in a prospective, randomised double-blind study. Method: A total of 100 ASA I–II patients (18–65 years), including both male and female participants, were randomly assigned to four remifentanil dose groups (0.5–3 µg.kg⁻¹). Induction involved thiopental (5 mg.kg⁻¹) after remifentanil. LMA insertion conditions were evaluated using a six-variable scale. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), and bispectral index monitor (BIS) values, as well as apnoea duration, eyelash reflex loss time, and insertion attempts, were recorded at baseline, before insertion, and at 5 min post-insertion. Results: Time to eyelash reflex loss and LMA insertion were shorter in Groups III and IV than in Groups I and II (p < 0.001). Apnoea duration was longest in Group IV, followed by Group III (p < 0.001). Groups III and IV had significantly better LMA placement, mouth opening, and ease of insertion (p < 0.05). Coughing and gagging were highest in Group I (p < 0.001). SAP, MAP, HR, and DAP were significantly lower in Group IV at various time points (p < 0.05). HR was significantly higher in Group I compared to Groups II and III at multiple time points (p < 0.05). Conclusions: The administration of 5 mg.kg⁻¹ thiopental with 2 μg.kg⁻¹ remifentanil has been found to provide a stable haemodynamic response and 96% excellent or satisfactory laryngeal mask insertion conditions without increasing the duration of apnoea. Full article

Background/Objective: Among the inflammatory bowel illnesses, ulcerative colitis (UC) affects 5 million people worldwide. UC manifests as weight loss, rectal bleeding, persistent diarrhea, and abdominal pain. Experimental research focused into the potential benefits of atorvastatin for colitis, although the literature only has a small amount of clinical evidence. To examine atorvastatin’s protective effect in UC patients by assessing its impact on fecal myeloperoxidase, zonulin, and disease activity index (DAI). Methods: Two groups of patients with mild to moderate UC were randomly assigned. Over a six-month period, the control group (placebo group) received a placebo alongside mesalamine (1 g, three times daily [t.i.d.]). The atorvastatin group received atorvastatin (80 mg once daily) in addition to mesalamine (1 g t.i.d.). Disease severity was assessed by a gastroenterologist using the Disease Activity Index (DAI). Serum zonulin and fecal myeloperoxidase levels were measured before and after treatment to assess the biological efficacy of the interventions. Outcomes: Reduction in DAI and biomarker levels. Results: Both groups showed a significant decrease in DAI, zonulin, and fecal myeloperoxidase levels. However, the atorvastatin group (n = 23) demonstrated a significantly greater decrease in zonulin (p = 0.04), fecal myeloperoxidase (p = 0.03), and DAI (p = 0.001) compared to the placebo group (n = 24). In atorvastatin group, a significant correlation was observed between DAI and zonulin (p = 0.007, r = 0.4) and myeloperoxidase (p = 0.02, r = 0.36). Conclusions: The co-administration of atorvastatin may serve as a potential adjunct therapy for patients with UC. Full article

Background/Objectives: The usefulness of presepsin, which is released from macrophages, in acute exacerbation of interstitial lung diseases (AE-ILDs) is unknown. We aimed to investigate the utility of monitoring presepsin with other AE-ILD markers before and after steroid pulse therapy in AE-ILDs. Methods: This pilot single-center retrospective observational study involved 16 patients with AE-ILDs, including the AE of idiopathic pulmonary fibrosis and idiopathic nonspecific interstitial pneumonia and rapidly progressive connective tissue disease-associated ILD. Patients who survived 90 days were assigned to the survival group (n = 9). The remaining patients were classified in the non-survivor group (n = 7). To evaluate the therapeutic efficacy of steroid pulse therapy, specific serum markers were selected—presepsin, as a novel AE-ILD marker, and surfactant protein D, C-reactive protein, and lactate dehydrogenase (LDH), as classical AE-ILD markers. Results: Thirteen out of sixteen patients with AE-ILDs showed high presepsin levels (presepsin ≥ 470 pg/mL) before steroid pulse therapy. The post-/pre-presepsin ratio and the post-/pre-LDH ratio, calculated by dividing the presepsin and LDH levels after therapy by the levels before therapy, respectively, showed a positive correlation (r = 0.579, p = 0.021). As a result of this correlation, the post-/pre-presepsin–LDH index was created, obtained from the “post-/pre-presepsin ratio” multiplied by the “post-/pre-LDH ratio”. In a receiver operating characteristic curve analysis for non-survival, the post-/pre-presepsin–LDH index showed good discrimination as a prognostic marker for a poor outcome (AUC: 0.873, 95% confidence interval: 0.655–0.999). Conclusions: Tracking presepsin and LDH simultaneously may be useful for determining treatment response to steroid pulse therapy in the clinical management of AE-ILDs. Full article

Background: Oral bronchodilators may serve as an adjunctive therapy in patients with chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the effects of oral doxofylline and oral procaterol on lung function and clinical symptoms in COPD patients. Methods: A crossover randomized controlled trial was conducted in patients with clinically stable COPD. Participants first received either doxofylline or procaterol for 4 weeks, followed by a 1-week washout period. Assessments included the modified Medical Research Council (mMRC) dyspnea scale, COPD assessment test (CAT) scores, and 6-minute walking distance (6MWD). Pulmonary function was evaluated using spirometry with bronchodilator (BD) testing and all adverse events were recorded. Results: Twenty patients were randomly assigned to begin treatment with either doxofylline or procaterol. Their mean age was 71.7 ± 9.4 years. After four weeks of treatment, the doxofylline group showed significantly greater improvement in pulmonary function parameters (post-BD peak expiratory flow and post-BD forced expiratory flow 25–75) compared to the procaterol group. However, there were no significant differences in mMRC scores, CAT scores, or 6MWD between the two groups. More neurological adverse events were observed in the doxofylline group compared to the procaterol group (35% vs. 5%, p = 0.044). Conclusions: Doxofylline improved pulmonary function in COPD patients but did not provide superior functional performance compared to procaterol. Neurological adverse events were more frequently associated with doxofylline. Doxofylline may serve as an adjunctive therapy to enhance pulmonary function in COPD patients, but caution is advised due to its potential side effects. Full article

Background/Objectives: This study evaluated the effects of vascular photobiomodulation (VPBM) on pain intensity, edema, and facial temperature variation in patients undergoing alveolar bone grafting (ABG) surgery. Methods: A total of 42 patients with cleft lip and palate (aged 9–25 years) scheduled for ABG using iliac crest bone were randomly assigned in equal numbers (14 per group) to one of three groups: control (ABG only), test (ABG + VPBM), and placebo (ABG + simulated VPBM). Iliac and facial pain and edema were clinically evaluated 24 h post-surgery, along with thermographic facial analysis. Follow-up was conducted via phone calls for one week. Results: No statistically significant differences were observed among the groups regarding facial pain and edema at 24 h post-surgery. However, iliac pain significantly differed between the placebo and control groups (p = 0.045). A significant time-related effect on both facial and iliac pain outcomes was noted during follow-up, irrespective of the group. The need for rescue medication and self-perception of reduced edema did not differ significantly. Thermographic analysis reveals a significantly lower temperature variation in the test group (2.36 °C) compared to the other groups (p = 0.007). Conclusions: Overall, VPBM therapy influenced postoperative pain in the early recovery phase and temperature in the immediate postoperative period but did not significantly affect edema. Full article

Objective: This study aims to evaluate the application effect of endoscopic thyroidectomy via the gasless unilateral axillary (GUA) approach in thyroid cancer and its impact on the postoperative stress response. Methods: Ninety-four thyroid cancer patients were enrolleod and assigned into the open group (underwent conventional-open-anterior-cervical-approach thyroidectomy) and the endoscopic group (underwent GUA endoscopic thyroidectomy) (n = 47). Perioperative indicators between the two groups were compared. Thyroid function parameters [total triiodothyronine (TT3), total thyroxine (TT4), free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH)] were measured preoperatively and on postoperative day 2. Inflammatory markers [interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α)] and stress-related hormones [norepinephrine (NE) and cortisol (Cor)] were evaluated preoperatively and on postoperative day 1. The aesthetic appearance of the incision was evaluated at 1 and 3 months postoperatively using the Vancouver Scar Scale (VSS). Postoperative complications were also compared between the two groups. Results: The endoscopic group exhibited less intraoperative blood loss, reduced postoperative drainage, a lower pain degree on 1 day postoperatively, a shorter hospitalization time, and a longer surgical time versus the open group (p < 0.05). The serum levels of TT3, TT4, FT3, and FT4 were lower, while the TSH levels were higher in both groups on postoperative day 2 compared to preoperative values. Additionally, the serum levels of IL-6, TNF-α, NE, and Cor increased on day 1 postoperatively, with the endoscopic group showing lower levels of these markers compared to the open group (p < 0.05). The VSS scores at 1 and 3 months after surgery were lower in the endoscopic group compared to the open group, indicating better cosmetic outcomes (p < 0.05). The incidence of postoperative complications was comparable between the endoscopic and open groups (p > 0.05). Conclusions: Endoscopic thyroidectomy by a GUA offers notable advantages over the conventional-open-anterior-cervical-approach thyroidectomy, including reduced intraoperative blood loss, less postoperative drainage, and a lower postoperative stress response. This approach also results in improved cosmetic outcomes, making it a promising alternative for thyroid cancer surgery. Full article

Background and Objectives: Forward head posture (FHP) is associated with reduced stability limits, impaired balance performance, and compromised cervical proprioception. This study investigated the effects of capital flexion exercise (CFE) on the craniovertebral angle (CVA), trunk control, balance, and gait in chronic stroke patients with forward head posture. Materials and Methods: Twenty-six subjects were randomly assigned to the CFE group or the control group (n = 13 each). The CFE group underwent a familiarization process and performed CFE for 9 min per session, 3 times a week for 6 weeks, as well as the existing neurodevelopmental treatment (NDT). The control group received only the existing NDT. Results: The CVA, the Korean version of the Postural Assessment Scale for Stroke (K-PASS), the Berg Balance Scale (BBS), and the Timed Up and Go test (TUG) improved after the intervention in the CFE group (p < 0.05). In the control group, CVA and TUG improved after the intervention (p < 0.05). The CVA (d = 1.34, p = 0.002), K-PASS (d = 1.36, p = 0.000), and BBS (d = 1.68, p = 0.000) values of the CFE group showed statistically significant improvement compared to the control group. Although TUG improved in the CFE group, the between-group difference was not statistically significant (d = −0.28, p = 0.467). Conclusions: This study suggests that capital flexion exercises effectively improve craniovertebral angle, trunk control, and balance in chronic stroke patients with forward head posture. Full article

Background: This randomized controlled study sought to determine the effect of intermittent fasting on anthropometric measurements, fibroblast growth factor (FGF)-21, and autophagy markers, as well as on hepatic steatosis and fibrosis levels in overweight or obese patients with metabolic dysfunction-associated fatty liver disease (MAFLD). Methods: Patients were randomly assigned into two groups: received a dietary treatment involving 22–25 kcal/kg/day of energy for 8 weeks and followed the same dietary intervention and a 16:8 pattern. The extent of hepatic steatosis and fibrosis was determined using transient elastography on a FibroScan^® device. The controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), determined by transient elastography, reflect hepatic steatosis and fibrosis, respectively. In duplicate, serum levels of FGF-21, Beclin-1, and ATG-5 were determined using enzyme-linked immunosorbent assay. Results: The study included 48 patients with a mean age of 48.2 ± 1.4 years (27 female and 21 male). Improvements in anthropometric measurement and CAP and LSM levels and a decrease in serum FGF-21 levels were found in both groups (p < 0.05). Changes in the CAP and FGF-21 levels were higher in the energy + time-restricted diet group (p < 0.05). Autophagy-related protein (ATG)-5 levels increased only in the energy + time-restricted diet group [(0.74 (0.46–1.29) ng/mL vs. 0.95 (0.73–1.32) ng/mL, p = 0.03]. Conclusions: Intermittent fasting was potentially practical in the management of MAFLD. In particular, changes in FGF-21 and ATG-5 levels indicate the potential of intermittent fasting to regulate metabolic processes and autophagy. However, methodological limitations should be taken into consideration when interpreting the study results. Full article

Background: Probiotics alter gut microbiota and have beneficial effects on immune homeostasis. The role of probiotics in diabetes has been shown in some studies. Interleukin (IL)-21 and IL-22 have been implicated in the pathogenesis of type 1 diabetes mellitus (T1DM). Objectives: This study aimed to assess the effect of oral supplementation with probiotics on glycemic control and IL-21 and IL-22 levels in pediatric patients with T1DM. Methods: This randomized controlled trial was registered in ClinicalTrials (NCT04579341) and included 70 children and adolescents with T1DM. They were randomly assigned into two groups to receive either an oral probiotic tablet containing 0.5 mg Lactobacillus acidophilus once daily or a matching placebo. Both groups were followed up for 6 months with assessment of fasting blood glucose (FBG), lipids, hemoglobin A1c (HbA1c), and IL-21 and IL-22 levels. Results: Baseline clinical characteristics and laboratory parameters were similar between both groups (p > 0.05). After six months, probiotic supplementation for the intervention group resulted in significant decreases in FBG, HbA1c, total cholesterol, and IL-21 levels, while IL-22 was increased compared with baseline levels (p < 0.001) and compared with the placebo group (p < 0.001). No adverse reactions were reported. Baseline IL-21 was positively correlated to FBG, HbA1c, and total cholesterol while there were negative correlations between these variables and IL-22 levels. Conclusions: Probiotic supplementation improved glucose homeostasis and glycemic control, possibly through their immunomodulatory effects on cytokines IL-21 and IL-22. Thus, probiotics could be a safe adjuvant therapy to intensive insulin in pediatric patients with T1DM. Full article

Both a shortage and an excess of dopamine (DA) in the prefrontal cortex and striatum result in their decreased functions, and the relationship between the DA levels and their functions exhibits an inverted-U shape. Increased DA transmission via dose reduction in the currently used antipsychotics may improve the activation of DA-related symptoms in schizophrenia; these include delusions and auditory hallucinations caused by increased DA release. In this case, reducing the dose of the antipsychotic may be a treatment option for relapse in patients with schizophrenia who are already on high doses of antipsychotics and find it difficult to further increase the dose. A total of 54 inpatients with schizophrenia receiving high-dose antipsychotic therapy were randomly assigned to either the halved-dose group or the high-dose group (symptomatic treatment). The study compared the time from relapse to improvement between the two groups. In the halved-dose group, the period until relapse improvement ranged from 1 to 3 weeks, while the high-dose group experienced improvement in 4 to 9 weeks, and a significant difference was observed between the two groups using Kaplan–Meier survival analysis (p < 0.001). Full article

Purpose: Patients with advanced glaucoma have visual field defects that impair mobility and quality of life (QoL). We aim to determine the effects of exploratory saccade training (EST) in such patients with bilateral overlapping scotomas that affect at least one visual field quadrant. Patients and Methods: This study was approved by the Ethics Committee of the Medical Faculty of the University of Tuebingen, Germany, and was registered in the German Clinical Trials Register (DRKS DRKS00031082, date of approval: 2 February 2023). We randomly assigned 27 patients to two groups, one of which trained with a computer-based EST (group 1). A control group (group 2) first used reading training (rapid serial visual presentation, RSVP, a single-word presentation to minimize eye movements) as placebo training (PRT) in regard to EST, which trains eye movements and, in a later phase, also used EST. Each training method required 6 weeks of home training. Main outcome variables were reaction time (RT) during the EST training sessions, RT during a natural search task (table test), reading speed (RS) during training on the screen, and during reading printed paragraphs aloud. QoL was assessed by a questionnaire. Results: Reaction times during EST and the table test improved significantly, which indicated transfer of the training effect to daily life. RS and QoL were reduced at baseline. Reading training improved RS significantly and reached normal median values. QoL improved significantly in the sub-categories regarding mobility problems in group 1. Patients with inferior field defects were more impaired and improved more than those without inferior field defects. Conclusions: As a supplement to the necessary treatment for glaucoma, EST is an effective home training method for rehabilitation by improving reaction time in daily living tasks for patients with advanced glaucoma. Reading training improved RS while reading from a screen as well as reading printed text. Full article

Background/Objectives: Otosclerosis causes progressive hearing loss through abnormal bone remodeling within the otic capsule and predominantly affects young individuals. Surgical intervention can markedly enhance a patient’s quality of life and socio-economic status. Anesthetic management may involve either general anesthesia or monitored anesthesia care, with the latter enabling real-time assessment of hearing improvement while providing optimal surgical conditions and patient satisfaction. This study examines the efficacy and safety of continuous dexmedetomidine infusion and target-controlled remifentanil infusion for conscious sedation combined with local anesthesia in otosclerosis surgery. Methods: Seventy-four adult patients undergoing otosclerosis surgery were randomly assigned to either the dexmedetomidine group or the remifentanil group. Primary outcomes included patient satisfaction at 24 h post-surgery and surgeon satisfaction with operative conditions. Secondary outcomes comprised hemodynamic effects, the necessity for adjuncts to the proposed sedation protocols, and intra- and postoperative complications. Results: There was no statistically significant difference between the dexmedetomidine and remifentanil groups regarding patient satisfaction (p = 0.943) and surgeon satisfaction (p = 0.069). A strong correlation was observed between surgeons’ assessments and patients’ satisfaction Composite Scores (η² = 0.185, p = 0.003). Dexmedetomidine was more effective in significantly reducing arterial pressure and heart rate without undesirable clinical effects. Conclusions: No significant difference was found between the groups concerning patient and surgeon satisfaction. Dexmedetomidine infusion led to considerable reductions in arterial pressure and heart rate compared to remifentanil. Full article