Search Results (3,362)

Background: Therapeutic exercise (TE) is recommended as the first line of treatment for low back pain (LBP), but questions remain about the true efficacy of TE in the acute phase. This study aimed to evaluate the effectiveness of isolated TE in reducing pain intensity and disability in patients with acute or subacute LBP. Methods: A systematic review with meta-analysis was conducted following the PRISMA guidelines. Randomized controlled trials (RCTs) that analyzed therapeutic exercise alone in one of the intervention groups and assessed pain intensity and disability were included; both outcomes were considered primary in this review. The quality of evidence was assessed using the GRADE tool. Results: Five RCTs were included. Meta-analyses were performed in subgroups according to the comparators: usual care, education, manual therapy, and bed rest. Statistically significant differences in favor of TE were found only when compared to usual care (SMD = −0.23; 95% CI [−0.45, −0.01]; p = 0.04). Conclusions: TE, when prescribed as an isolated intervention, appears to be more effective than usual care in improving short-term disability outcomes in patients with acute LBP. However, the limited quality and number of available studies, together with the typically favorable natural course of acute LBP, suggest that these findings should be interpreted with caution. Current evidence supports the integration of exercise within a comprehensive, multimodal management plan that addresses the physical, psychological, and social dimensions of pain. Full article

Aim: Hostile aortic neck anatomy—characterized by short neck length, severe angulation, conical shape, and mural thrombus or calcifications—represents a major limitation to the durability and applicability of standard endovascular aneurysm repair (EVAR). In response to these challenges, newer endografts with improved conformability have been developed. This study aimed to evaluate the mid-term outcomes of EVAR using the GORE EXCLUDER Conformable AAA Endoprosthesis (CEXC) (W.L. Gore & Associates Inc., Flagstaff, AZ, USA) in patients with hostile neck anatomy, with specific attention to type III endoleak occurrence, aortic sac remodeling, and maintenance of distal sealing. Methods: A retrospective observational analysis was conducted on 50 consecutive patients treated with the CEXC endograft between October 2019 and September 2023. Patients included had either elective or urgent indications for EVAR and were evaluated preoperatively using CT angiography. Hostile neck criteria were defined according to the 2019 Delphi Consensus. Procedural variables, imaging follow-up, and clinical outcomes were collected. The primary endpoints were technical and clinical success, while secondary outcomes included endoleak rates, aneurysm sac evolution, and reintervention-free survival. Results: Technical success was achieved in 100% of cases, with a clinical success rate of 98%. No type Ia, Ib, or III endoleaks were observed at a median follow-up of 23 months. Sac shrinkage (>5 mm reduction) occurred in 70% of patients, and distal sealing was preserved in 100% of cases. One perioperative death occurred in an emergency setting, and no late reinterventions or aneurysm-related mortalities were reported. The use of intravascular ultrasound (IVUS) and floppy guidewires contributed to precise deployment and sealing in angulated anatomies. Conclusions: The CEXC endograft proved to be a safe and effective option for EVAR in patients with hostile aortic anatomy, ensuring durable proximal and distal sealing, promoting favorable sac remodeling, and preventing type III endoleaks. These findings support the use of CEXC in anatomically complex settings, as long as procedures are meticulously planned and guided by appropriate intraoperative imaging and deployment techniques. Full article

Background. Food resilience is the ability of the food system to adapt to external and internal disturbances and maintain the outcome of food security. This paper focuses on shaping the concept of urban food resilience regarding the operation of urban food infrastructure and its capacity to provide food security. Methods. To achieve this, a methodology based on the pillars defined by the Food and Agriculture Organization (FAO) for food security, i.e., availability, accessibility, and stability, is used, operationalized from a spatial approach, and evaluated in terms of urban food resilience. Three simple indexes are built, i.e., diversity, redundancy, and short-term stability, and combined into a composite index: the Urban Food Resilience Index (UFRI). Results. The results are analysed from a spatial and quantitative perspective, linking scores with urban surface area, population, and density. The study examines the reality of Chilean intermediate cities distributed throughout the country, using the La Serena–Coquimbo Conurbation as a case study. Conclusions. The ultimate goal is to provide a straightforward methodology for assessing urban food resilience in countries with limited data access, thereby providing a foundation for informed urban planning decision-making. Full article

Background/Objectives: Preventive oral health education plays a key role in preparing future healthcare professionals to promote and maintain good oral hygiene. Individually Trained Oral Prophylaxis (iTOP) is a structured, personalized educational program that emphasizes correct brushing techniques and interdental cleaning. This study aimed to evaluate the long-term effectiveness of a single-session iTOP intervention on clinical oral health outcomes among medical and dental students. Methods: A 2-year prospective cohort study included 82 first- and fourth-year medical and dental students at the University of Mostar, Bosnia and Herzegovina. The researchers randomly assigned participants to an iTOP intervention group or a control group. The primary analysis used multivariable linear mixed-effects models for repeated measures, adjusted for study program, academic year, smoking status, and baseline oral-hygiene habits, with effect sizes reported alongside 95% confidence intervals. Clinical periodontal parameters—plaque index, bleeding on probing, and probing depth—were assessed at baseline, three months, and two years. All participants received professional cleaning and oral hygiene kits. Only the intervention group received personalized iTOP training, consisting of a single session with brief reinforcement at the 3-month follow-up. This study was registered at ClinicalTrials.gov (NCT07085013). Results: Seventy-six students completed the follow-up. The iTOP group had significantly lower plaque index and bleeding scores at both follow-up points (p < 0.001) compared to the control group. Baseline differences were observed between subgroups (medical vs. dental; younger vs. older students), but these diminished over time. At the 2-year follow-up, only the plaque index remained significantly improved, while other clinical parameters returned to values comparable to baseline. Conclusions: The iTOP program resulted in significant short-term improvements in oral health among medical and dental students. For sustained long-term outcomes, iTOP or similar structured oral health education programs should be integrated into medical and dental curricula. Enhancing oral health awareness among healthcare providers may ultimately contribute to improved public oral health outcomes. Given the single-center design and the single-session nature of the intervention, the results should be interpreted with caution. Full article

Objectives: Patients with chronic limb-threatening ischemia (CLTI) represent a high-risk cohort for cardiac surgery due to the systemic atherosclerotic burden and frailty. This study aimed to evaluate the short- and mid-term prognoses of CLTI patients undergoing open cardiac surgery and to assess the prognostic utility of four risk scoring systems: Japan SCORE, SPINACH SCORE, Clinical Frailty Scale (CFS), and Geriatric Nutritional Risk Index (GNRI). Methods: We retrospectively analyzed 44 patients with CLTI who underwent open cardiac surgery between 2014 and 2023. Thirty-day and 1-year mortality were assessed. Patients were stratified using ROC-derived cutoffs for each scoring system. Kaplan–Meier survival curves and time-dependent ROC analyses were used to evaluate predictive performance over time. Results: Thirty-day mortality was significantly associated with a higher Japan SCORE; survivors had significantly lower scores than non-survivors (5.5% vs. 25.8%, p < 0.05). One-year mortality was significantly associated with nutritional status, as survivors showed a significantly higher GNRI than non-survivors (92.0 vs. 86.0, p < 0.05). Time-dependent ROC analysis revealed that the GNRI and SPINACH SCORE’s sustained prognostic accuracy beyond 1 year. Calibration plots showed good agreement between predicted and observed probabilities for the SPINACH SCORE and GNRI, while decision curve analysis (DCA) demonstrated that these two models provided greater net clinical benefit across a range of thresholds, particularly in the 5–20% range. Conclusions: Japan SCORE is effective for short-term risk prediction, while SPINACH SCORE and GNRI offer superior prognostic value for mid-term outcomes. These scoring systems may support preoperative risk stratification and decision-making in CLTI patients undergoing cardiac surgery. Full article

Background/Objectives: The prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is significantly affected by inflammatory state and immune dysregulation. The systemic inflammatory response index (SIRI), which reflects neutrophil, monocyte, and lymphocyte dynamics, has emerged as a potential marker of immune-inflammatory status. However, its role in predicting HBV-ACLF outcomes remains unclear. This research aims to elucidate the prognostic value of SIRI and its dynamic changes combined with disease severity scores in predicting the outcomes of HBV-ACLF. Methods: The study included HBV-ACLF patients enrolled in a multicenter clinical study between July 2019 and April 2024. Based on 90-day outcomes, the participants were categorized into survival and death groups. Clinical data and SIRI values were collected on days 0 (baseline), 3, 7, and 14. Independent prognostic factors were identified using Cox regression and least absolute shrinkage and selection operator (LASSO) analysis. The predictive value of dynamic SIRI changes combined with disease severity scores was evaluated using receiver operating characteristic (ROC) curves. Results: A total of 153 patients with HBV-ACLF were analyzed, including 104 in the survival group and 49 in the death group. SIRI values were significantly lower in the survival group than in the death group across all time points. Multivariate Cox regression analysis identified that an increased ΔSIRI at day 3 (ΔSIRI3), a higher MELD score, and a lower albumin level were independently associated with increased 90-day mortality. The combination of SIRI on day three (SIRI3) and MELD-Na score on day three (MELD-Na3) demonstrated the highest predictive performance, with an AUC of 0.817 (95% CI: 0.750–0.883). Conclusions: The combination of the SIRI and MELD-Na score on day three provides a strong predictive value for the short-term prognosis of HBV-ACLF, highlighting its potential utility in early prognostic evaluation. Full article

Background: The potential impact of maternal SARS-CoV-2 infection during pregnancy on the neurodevelopment of offspring has raised considerable concern. Emerging studies have evaluated various developmental domains in exposed infants, yet findings remain inconsistent. Objective: To synthesize current evidence regarding neurodevelopmental outcomes in infants born to mothers with confirmed SARS-CoV-2 infection during pregnancy. Methods: We conducted a narrative review following PRISMA guidelines. A literature search was performed in PubMed, Cochrane, and ScienceDirect using keywords including “COVID-19”, “pregnancy”, “neurodevelopment”, and “SARS-CoV-2”. Nineteen studies were included. Data were extracted regarding study design, sample size, timing of exposure, age at assessment, developmental tools used, and key findings. Study quality was assessed using the Newcastle–Ottawa Scale. Results: Among 19 included studies, 12 reported at least some neurodevelopmental delays, particularly in motor and language domains. However, these delays were generally mild, domain-specific, and often not statistically significant. Seven studies, most of which were high-quality and low-risk, reported no significant differences between exposed and unexposed groups. Assessment tools and follow-up durations varied widely, limiting comparability. Conclusions: Current evidence does not support a consistent association between in utero SARS-CoV-2 exposure and an unfavorable neurodevelopmental outcome up to 24 months. However, heterogeneity in methods and short-term follow-up warrant further high-quality longitudinal research. Full article

Background/Objectives: Total ankle replacement (TAR) is considered an effective solution for end-stage ankle arthritis. New-generation implants have shown promising intermediate clinical outcomes and are available in two main designs: fixed-bearing and mobile-bearing prostheses. The aims of this study are to compare both prosthetic systems, focusing on (i) the revision rate for major complications, including conversion to arthrodesis, revision of components, and below-knee amputation; (ii) minor complications requiring additional surgery; and (iii) providing a comprehensive overview of total ankle replacement. Methods: A systematic review of the literature was conducted using the main databases. The inclusion criteria were patients aged 18 years or older and individuals who had undergone total ankle arthroplasty. Case reports, case series, original articles, and systematic reviews were excluded from the final selection. The pooled incidence of events was reported using odds ratios (ORs) with corresponding 95% confidence intervals (CIs). Results: A total of 33 studies, pooling data from 3652 observations and identifying 635 events, met the inclusion criteria. Relevant demographic and surgical data were systematically extracted and analyzed. A meta-analysis of comparable data revealed revision and failure risks for both prosthesis types. No statistically significant differences in complication rates were observed between fixed-bearing and mobile-bearing prostheses. Conclusions: Both fixed-bearing and mobile-bearing prostheses are viable options for treating ankle arthritis, demonstrating an intermediate risk of complications over short, medium, and long-term follow-ups. Full article

Herpes Simplex Virus (HSV) infections, caused primarily by HSV-1 and HSV-2, are among the most prevalent viral diseases worldwide, with recurrent manifestations that significantly affect quality of life. Therapeutic strategies include both topical and systemic interventions, each with distinct goals. This systematic review was conducted according to PRISMA guidelines. A comprehensive search of PubMed, Scopus, and Web of Science (2005–2025) identified studies evaluating topical or systemic treatments for HSV. Eligible studies included randomized controlled trials and observational studies reporting validated clinical outcomes. Topical treatments, including acyclovir cream, docosanol, and newer formulations, primarily reduce lesion duration and alleviate local symptoms when applied early. These interventions have limited systemic absorption and generally do not influence recurrence frequency. Novel delivery methods and combination strategies, such as acyclovir–hydrocortisone formulations or photodynamic therapy, may enhance local efficacy and symptom control. Systemic Therapies: Systemic antivirals, such as acyclovir, valacyclovir, and famciclovir, target both lesion resolution and recurrence prevention. Evidence from randomized trials supports their use for episodic and suppressive therapy, including short-course, high-dose regimens that improve adherence while controlling symptoms. Systemic therapy is particularly indicated for recurrent, disseminated, or high-risk infections. Topical and systemic therapies serve complementary roles in HSV management. Topical agents are useful for localized or initial episodes, while systemic therapy addresses broader clinical objectives, including recurrence reduction. Future research should focus on mechanism-based therapies, novel delivery systems, and standardized outcome measures to guide personalized treatment strategies. Emerging therapies targeting viral latency, immune modulation, and gene-editing technologies hold promise for long-term suppression and personalized management of HSV infections. Full article

Radical prostatectomy is the standard of care for the treatment of early, clinically localized prostate cancer (PC). In addition to known clinical prognosticators, perioperative conditions and the type of anesthesia may affect clinical outcomes through several mechanisms that favor a tumor-propagating state, including activation of the sympathetic system, increased opioid requirements, and inflammation. In this review, we provide an overview of the impact of the perioperative period on PC prognosis and patient outcomes. A non-systematic literature review was conducted to investigate the possible association between neuraxial anesthesia and outcomes after radical prostatectomy (RP) for prostate cancer. The following keywords were used: “cancer recurrence” OR “cancer prognosis” OR “metastasis” AND “neuraxial anesthesia” AND “prostate cancer”. Eligible studies were summarized in the form of a narrative review. In the era of limited use of ERAS protocols, the implementation of neuraxial anesthesia was found to reduce mortality after RP for primary prostate cancer when compared to general anesthesia. Although there was no significant association between anesthetic technique and radiological or biochemical-free survival, regional anesthesia may have an impact on short-term survival in patients with severe comorbidities, involving pulmonary complications and thrombosis. The effect of anesthetic technique on PC patient outcomes remains elusive, although preliminary retrospective evidence suggests a possible positive effect of neuraxial anesthesia on patient outcomes. As the perioperative period is considered a vulnerable timeframe for these patients, the role of the leadership dyad of surgeon and onco-anesthesiologist is crucial. Full article

Background: While mechanical alignment total knee arthroplasty (TKA) has long been the conventional surgical technique in patients with advanced osteoarthritis, kinematic alignment TKA has emerged as a promising alternative, designed to restore the knee’s native pre-arthritic anatomy. Since superiority of either technique remains inconclusive, we aimed to compare immediate and short-term postoperative outcomes of kinematic versus mechanical alignment TKA. Methods: This prospective cohort study was conducted at a tertiary care centre between January 2020 and August 2022, enrolling kinematic and mechanical alignment TKA patients. Outcomes were assessed during hospitalization and at 14 days postoperatively. Data collected included patient-reported outcome measures (PROMs), functional performance evaluations, pain scores, discharge disposition and hospital length of stay. Both univariate and multivariate regression analyses were conducted, adjusting for potential confounders. Results: The study included 103 patients, with 77 who underwent kinematic alignment and 26 mechanical alignment TKA. Patients in the kinematic alignment group demonstrated statistically significant better postoperative outcomes compared to those in the mechanical alignment group. Kinematic alignment TKA patients demonstrated superior functional performance on the Timed Up and Go test immediately postoperatively and were more frequently discharged home rather than to a rehabilitation facility. Hospital stay length and short-term PROMs also favoured the Kinematic alignment TKA group, showing statistically significant higher scores in the Oxford Knee Score, short form-12 Mental Component Summary, and the Knee Injury and Osteoarthritis Outcome Score Symptoms subscale. Conclusions: Kinematic alignment TKA offers superior immediate and short-term outcomes compared to mechanical alignment TKA, with benefits in functional recovery, hospitalization duration, and discharge disposition. This evidence supports kinematic alignment TKA as a viable alternative, aiding in patient and surgeon decision-making. Full article

Background/Objective: The global acceleration of population aging presents profound challenges to the physical, psychological, and social well-being of older adults. As traditional exercise programs face limitations in accessibility, personalization, and sustained social support, there is a critical need for innovative, inclusive, and community-integrated digital movement solutions. This study aimed to develop and evaluate Movement Poomasi, a hybrid digital healthcare application designed to promote physical activity, improve digital accessibility, and strengthen social connectedness among older adults. Methods: From March 2023 to November 2023, Movement Poomasi was developed through an iterative user-centered design process involving domain experts in physical therapy and sports psychology. In this study, the term UI/UX—short for user interface and user experience—refers to the overall design and interaction framework of the application, encompassing visual layout, navigation flow, accessibility features, and user engagement optimization tailored to older adults’ sensory, cognitive, and motor characteristics. The application integrates adaptive exercise modules, senior-optimized UI/UX, voice-assisted navigation, and peer-interaction features to enable both home-based and in-person movement engagement. A two-phase usability validation was conducted. A 4-week pilot test with 15 older adults assessed the prototype, followed by a formal 6-week study with 50 participants (≥65 years), stratified by digital literacy and activity background. Quantitative metrics—movement completion rates, session duration, and engagement with social features—were analyzed alongside semi-structured interviews. Statistical analysis included ANOVA and regression to examine usability and engagement outcomes. The application has continued iterative testing and refinement until May 2025, and it is scheduled for re-launch under the name Wello! in August 2025. Results: Post-implementation UI refinements significantly increased navigation success rates (from 68% to 87%, p = 0.042). ANOVA revealed that movement selection and peer-interaction tasks posed greater cognitive load (p < 0.01). A strong positive correlation was found between digital literacy and task performance (r = 0.68, p < 0.05). Weekly participation increased by 38%, with 81% of participants reporting enhanced social connectedness through group challenges and hybrid peer-led meetups. Despite high satisfaction scores (mean 4.6 ± 0.4), usability challenges remained among low-literacy users, indicating the need for further interface simplification. Conclusions: The findings underscore the potential of hybrid digital platforms tailored to older adults’ physical, cognitive, and social needs. Movement Poomasi demonstrates scalable feasibility and contributes to reducing the digital divide while fostering active aging. Future directions include AI-assisted onboarding, adaptive tutorials, and expanded integration with community care ecosystems to enhance long-term engagement and inclusivity. Full article

Instrument fracture during endodontic treatment significantly compromises treatment outcomes, with sodium hypochlorite (NaOCl) and other irrigants potentially affecting the cyclic fatigue resistance of nickel–titanium (NiTi) rotary files. This systematic review evaluated the impact of endodontic irrigants on NiTi instrument durability. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, Embase, Cochrane Library, and WorldCat databases through June 2025, following PRISMA guidelines. Studies investigating cyclic fatigue resistance of NiTi rotary instruments exposed to various irrigants were included. Twenty-seven in vitro studies met the inclusion criteria, involving instruments across multiple file systems and irrigant solutions. The review revealed that NaOCl, particularly at concentrations ≥5% and elevated temperatures, significantly reduced cyclic fatigue resistance in most studies, with scanning electron microscopy confirming surface corrosion and microcrack formation. Heat-treated NiTi alloys demonstrated superior fatigue resistance compared to conventional austenitic alloys. Short-term NaOCl exposure (1–5 min) showed minimal impact, while prolonged exposure combined with autoclave sterilization produced cumulative weakening effects. Alternative irrigants such as EDTA and chlorhexidine showed more neutral effects on instrument integrity. These findings suggest that irrigant selection and exposure protocols significantly influence NiTi instrument longevity, with implications for clinical endodontic practice and instrument safety protocols. Full article

Background: Deferred cord clamping (DCC) is beneficial for preterm infants, but there are concerns about the safety of DCC during Cesarean deliveries (CD) under general anesthesia (GA). We evaluated maternal and neonatal outcomes in preterm CD under GA vs. regional anesthesia (RA) after implementing 180 s of DCC. Methods: This retrospective single-center observational study included CD at <33 weeks gestation, delivered between January 2018 and December 2023. The cord was clamped before 180 s for concerns of maternal bleeding or infant apnea after 30–45 s stimulation. Data was collected from reports from electronic medical records, neonatal intensive care unit database, and manually from the medical records of the patient. Multivariable regression analysis was used to assess the effect of anesthesia type and DCC on outcomes, adjusting for confounders. Results: This study included 170 mothers and 194 infants, and 84.9% of the infants received DCC ≥ 60 s. The GA group had a higher percentage of emergency CD and a lower median duration of DCC (105 s vs. 180 s, p ≤ 0.001) compared to RA. In multivariate regression analysis, GA was associated with lower odds (95% CI) of umbilical artery pH < 7 [0.1, (0.0, 0.6)], base deficit ≥ 16 [0.0, (0.0, 0.5)], and higher odds of necrotizing enterocolitis [28.2, (1.4, 560.0)]. GA was not associated with maternal hemorrhage, delivery room (DR) resuscitation, or other major neonatal morbidities or mortality. DCC ≥ 60 s was associated with lower maternal blood loss [Regression coefficient −698, (−1193, −202)], lower odds of transfusion [0.4, (0.1, 1.0)], DR resuscitation [0.4, (0.2, 0.8)], and chronic lung disease [0.4, (0.2, 0.9)], and higher survival without major morbidities [2.8, (1.2, 6.8)]. Conclusions: DCC was performed in a majority of CD under GA by adhering to protocols to shorten DCC in cases where maternal or fetal safety was threatened. GA with DCC was not associated with increased neonatal resuscitation or major neonatal morbidities and was associated with lower maternal hemorrhage and transfusion. Full article

This is a single-center study about upward facing in branched endovascular aortic repair. Background: The evolution of branched endovascular aortic repair (BEVAR) has introduced upward-facing branches as a novel approach to facilitate exclusive transfemoral access in complex aortic aneurysm repair. This study evaluates the feasibility, safety, and early outcomes of custom-made BEVAR devices incorporating upward-facing branches in patients with cranially oriented renal arteries. The investigation further aims to analyze the technical success and mid-term outcomes related to these novel devices, as well as to identify any challenges or complications specific to the use of upward-facing branches in clinical practice. Methods: We retrospectively analyzed 17 patients treated at a single center between January 2020 and December 2024 using custom-made Cook Medical branched stent grafts with at least one upward-facing branch. Demographics, comorbidities, target vessel details, bridging stent graft (BSG) configurations, and procedure-related complications were collected. The primary endpoints were technical success and branch patency. Secondary endpoints included short- and mid-term branch-related complications. Results: The cohort had a mean age of 70 years, with hypertension (88%) and coronary artery disease (47%) being common comorbidities. Technical success was achieved in 100% of cases. The left renal artery was the most frequently targeted vessel (63.2%). Most upward-facing branches were bridged using a combination of balloon-expandable and self-expandable stents. One patient (5.9%) experienced a renal bleeding complication requiring embolization. There were no cases of primary stent occlusion or dislocation. At a mean follow-up of 14 months, one asymptomatic occlusion of an upward-facing branch was detected in computed tomography angiography. No further upward-facing branch-related complications occurred, and 1-year follow-up was available in 41.2% of patients. Conclusions: In our single-center study including 17 patients, upward-facing branches in BEVAR demonstrate high technical success and a low complication rate, offering a promising alternative to traditional access strategies. These findings support broader adoption in select anatomical scenarios, pending larger comparative studies and longer-term data collection. Full article