Search Results (5,127)

Background/Objectives: Sarcoidosis is a granulomatous disorder of unknown etiology that can affect multiple organs, including the oral cavity. This study aimed to compare the clinical and demographic characteristics of sarcoidosis cases with and without bone involvement in the jaw. Methods: A systematic review of the case reports and case series of sarcoidosis in the oral cavity between 1943 to 2024 were analyzed. Variables assessed included age, sex, presenting symptoms, duration of symptoms, diagnosis methodology, treatment approaches, and outcomes. Results: A total of 59 studies reporting 77 patients were included, with a mean age of 43.3 yrs. Female predominance was noted in both, bone-involved (61.5%) and non-bone-involvement cases (72.5%). Patients with bone involvement often presented with localized symptoms such as loose teeth (34.6%), bone loss (69.2%), and nasal obstruction (15.4%), whereas non-bone-involvement cases frequently exhibited soft tissue manifestations, like swelling (38%) and bleeding (14%). Treatment typically involved surgical intervention and steroid therapy in both groups, with favorable outcomes achieved in most cases. Conclusions: This systematic review presents the most extensive analysis of oral sarcoidosis. Oral sarcoidosis presents as two distinct clinical entities based on bone involvement. Soft tissue lesions often serve as an early diagnostic clue for systemic disease, while bony manifestations suggest a later, more destructive complication. Recognizing this dichotomy is crucial for dentists and clinicians to ensure timely diagnosis and appropriate referral, and this underscores the oral cavity’s critical role as an indicator of systemic illness and mandates a multidisciplinary management strategy. Full article

Background: Lumbar disk herniation is a common cause of low back pain and radiculopathy, significantly impacting patients’ life quality and functional capacity. Magnetic Resonance Imaging (MRI) remains the gold standard for its assessment due to its superior soft tissue contrast and multiplanar imaging capabilities. However, recent advances in spectral computed tomography (CT), particularly dual-energy CT (DECT), have introduced new diagnostic opportunities, offering improved soft tissue characterization. Objective: To evaluate the diagnostic performance of DECT in detecting and grading lumbar disk herniations using dedicated color-coded fat maps. Materials and Methods: A total of 205 intervertebral levels from 41 consecutive patients with lumbar symptoms were prospectively analyzed. All patients underwent both DECT and MRI within 3 days. Three radiologists with varying years of experience independently assessed DECT images using color-coded reconstructions. A five-point grading score was attributed to each lumbar level: 1 = normal disk, 2 = bulging/protrusion, 3 = focal herniation, 4 = extruded herniation, and 5 = migrated fragment. The statistical analysis included Pearson’s correlation for score consistency, Cohen’s Kappa for interobserver agreement, generalized estimating equations for a cluster-robust analysis, and an ROC curve analysis. The DECT diagnostic accuracy was assessed in a dichotomized model (grades 1–2 = no herniation; 3–5 = herniation), using MRI as reference. Results: A strong correlation was observed between DECT and MRI scores across all readers (mean Pearson’s r = 0.826, p < 0.001). The average exact agreement between DECT and MRI was 79.4%, with the highest concordance at L1–L2 (86.7%) and L5–S1 (80.4%). The interobserver agreement was substantial (mean Cohen’s κ = 0.765), with a near-perfect agreement between the two most experienced readers (κ = 0.822). The intraclass correlation coefficient was 0.906 (95% CI: 0.893–0.918). The ROC analysis showed excellent performance (AUC range: 0.953–0.986). In the dichotomous model, DECT demonstrated a markedly higher sensitivity than conventional CT (95.1% vs. 57.2%), with a comparable specificity (DECT: 99.0%; CT: 96.5%) and improved overall accuracy (98.4% vs. 90.0%). Subgroup analyses by age and disk location revealed no statistically significant differences. Conclusions: The use of DECT dedicated color-coded fat map reconstructions showed high diagnostic performance in the assessment of lumbar disk herniations compared to MRI. These findings support the development of dedicated post-processing tools, facilitating the broader clinical adoption of spectral CT, especially in cases where MRI is contraindicated or less accessible. Full article

Hydrogels are hydrophilic, soft polymer networks with high water content and mechanical properties that are tunable; they are also biocompatible. Therefore, as biomaterials, they are of interest to modern medicine. In this review, the main applications of hydrogels in essential clinical applications are discussed. Chemical, physical, or hybrid crosslinking of either synthetic or natural polymers allow for the precise control of hydrogels’ physicochemical properties and their specific characteristics for certain applications, such as stimuli-responsiveness, drug retention and release, and biodegradability. Hydrogels are employed in gynecology to regenerate the endometrium, treat infections, and prevent pregnancy. They show promise in cardiology in myocardial infarction therapy through injectable scaffolds, patches in the heart, and medication delivery. In rheumatoid arthritis, hydrogels act as drug delivery systems, lubricants, scaffolds, and immunomodulators, ensuring effective local treatment. They are being developed, among other applications, as antimicrobial coatings for stents and radiotherapy barriers for urology. Ophthalmology benefits from the use of hydrogels in contact lenses, corneal bandages, and vitreous implants. They are used as materials for chemoembolization, tumor models, and drug delivery devices in cancer therapy, with wafers of Gliadel presently used in clinics. Applications in abdominal surgery include hydrogel-coated meshes for hernia repair or Janus-type hydrogels to prevent adhesions and aid tissue repair. Results from clinical and preclinical studies illustrate hydrogels’ diversity, though problems remain with mechanical stability, long-term safety, and mass production. Hydrogels are, in general, next-generation biomaterials for regenerative medicine, individualized treatment, and new treatment protocols. Full article

To address the issue of insufficient contrast in conventional X-ray absorption imaging for biological soft tissues and weakly absorbing materials, this paper proposes a beam tracking X-ray phase-contrast imaging system using a conventional X-ray source. A periodic pinhole array mask is placed between the X-ray source and the sample to spatially modulate the X-ray beam, dividing it into multiple independent sub-beams. Each sub-beam is deflected due to the modulation effect of the sample, resulting in slight positional shifts in the intensity patterns formed on the detector. The experiments employ an X-ray source with a 400 μm focal spot and use a two-dimensional step-scanning approach to acquire image sequences of various samples. The experimental results show that this method can extract the edge profile and structural changes in the samples to some extent, and it demonstrates good contrast and detail recovery under weak absorption conditions. These results suggest that this method has certain application potential in material inspection, non-destructive testing, and related fields. Full article

β-Hydroxy-β-methylbutyrate (HMB), a natural metabolite derived from the essential amino acid leucine, is primarily recognised for its anabolic and anti-catabolic effects on skeletal muscle tissue. Recent studies indicate that HMB may also play a role in influencing the structural organisation of extracellular matrix (ECM) components, particularly collagen, which is crucial for maintaining the mechanical integrity of connective tissues. In this investigation, bovine type I collagen was polymerised in the presence of two concentrations of HMB (0.025 M and 0.25 M) to explore its potential function as a molecular modulator of fibrillogenesis. The morphology of the resulting collagen fibres and their molecular architecture were examined using atomic force microscopy (AFM) and Fourier-transform infrared (FTIR) spectroscopy. The findings demonstrated that lower levels of HMB facilitated the formation of more regular and well-organised fibrillar structures, exhibiting increased D-band periodicity and enhanced stabilisation of the native collagen triple helix, as indicated by Amide I and III band profiles. Conversely, higher concentrations of HMB led to significant disruption of fibril morphology and alterations in secondary structure, suggesting that HMB interferes with the self-assembly of collagen monomers. These structural changes are consistent with a non-covalent influence on interchain interactions and fibril organisation, to which hydrogen bonding and short-range electrostatics may contribute. Collectively, the results highlight the potential of HMB as a small-molecule regulator for soft-tissue matrix engineering, extending its consideration beyond metabolic supplementation towards controllable, materials-oriented modulation of ECM structure. Full article

Phyllodes tumors are rare fibroepithelial neoplasms of the breast, and their malignant forms present significant diagnostic and therapeutic challenges. This review summarizes current knowledge across the benign-to-malignant spectrum, focusing on diagnostic approaches, histopathological classification, molecular alterations, and treatment strategies. While recent molecular studies have revealed recurrent genetic mutations, their clinical implications remain under investigation. Surgical excision remains the cornerstone of treatment, and systemic therapies are generally adapted from soft tissue sarcoma protocols. Future efforts should focus on improving diagnostic accuracy, identifying molecular targets for therapy, and fostering international collaboration to advance clinical research in this rare tumor type. Full article

Background: Pilon fractures are severe distal tibia injuries from high-energy trauma, often involving joint and soft tissue damage. Despite surgical advances, long-term outcomes remain poor. This study compared quality of life and functional limitations after surgical treatment of pilon versus tibial shaft fractures using validated PROMs. Methods: This case–control study was conducted at a Level I Trauma Center. Between 2016 and 2019, 84 patients with lower leg fractures were included: 38 pilon and 46 tibial shaft fractures. Inclusion criteria were AO type 42 or 43 fractures and follow-up of ≥24 months; exclusion criteria were polytrauma (ISS > 15), ASA ≥ 3, and incomplete consent. Outcomes were assessed with SF-12, EQ-5D-5L, and VAS-FA. Data were collected 36–48 months postoperatively. Analyses included t-tests, chi-square tests, linear regression. Results: Patients with pilon fractures had significantly poorer physical quality of life than tibial shaft fractures (SF-12 physical: 39 vs. 42, p < 0.05). Mental quality of life showed no significant difference. EQ-5D-5L scores were lower in the pilon group (70% vs. 79%). VAS-FA indicated higher pain and reduced function (total: 64 vs. 76, p = 0.009). Rehabilitation duration correlated with improved VAS outcomes in pilon fractures (p = 0.008), while physiotherapy reduced pain in tibial shaft fractures (p = 0.030). Conclusions: Pilon fractures substantially impair physical quality of life and long-term function, while mental well-being remains unaffected. PROMs provide insights beyond radiological findings and should be integrated into follow-up. Further multicenter studies are required to validate these results and optimize rehabilitation strategies. Full article

Background/Objectives: Soft tissue sarcomas (STS) of the hand are rare, representing only 2% of all STS. The small size and benign appearance of these tumors often lead to unplanned excisions and diagnostic delay. This systematic review sought to characterize the clinical presentation, histology, treatment modalities, and oncological outcomes of hand STS. Methods: A systematic review of PubMed and Embase was conducted following PRISMA guidelines. The protocol was registered on PROSPERO. We included studies with ≥10 patients with STS that provided data on treatment options and oncologic outcomes. Data was extracted regarding demographics, tumor features, treatment modalities, and survival metrics. Results: Eighteen studies comprising 570 patients were included. Most tumors were <5 cm, and 56.8% were deep (subfascial). Epithelioid and synovial sarcomas were the most common histologies, accounting for 27% and 17% of cases, respectively. UEs were seen in 57% of cases, and 26% of patients required amputation. Positive surgical margins were reported in 16% of patients. Radiation therapy and chemotherapy were used in 40% and 17% of patients, respectively. Twelve and 15% of patients developed regional lymph node and distant metastases, respectively. Local recurrence occurred in 20% of cases. Five- and ten-year overall survival were 80% and 77%, respectively. Disease-free survival at those time points were 77% and 74%, respectively. Conclusions: Hand STSs are challenging due to their rarity, small size, and high rates of UEs. Despite favorable survival rates, local recurrence and metastases remain a concern. Early referral to specialized centers and individualized treatment strategies are essential for improving outcomes. Full article

Background: The aim of this bibliometric study was to evaluate publication trends in the most frequently cited clinical trials on the treatment of gingival recession, taking into account the augmentation materials used. Methods: A Web of Science search was performed among articles published by 30 September 2024. Two independent reviewers evaluated year of publication, journal, authorship country of authors, collaborative relationship, keywords, and the main domains. Results: The top one hundred most-cited clinical trials were published in the span of 26 years from 1993 to 2019, and the total citation counts varied from 44 to 284 (83.69 citations per paper). There was correlation between the time of publication and the number of citations. The articles were authored by 333 researchers representing twenty-two countries. Italy contributed the highest number of articles (n = 36), followed by the USA (n = 28) and Brazil (n = 17). International collaborations were predominantly observed between Italy, the USA, and Switzerland. The type of graft was the most cited field of research (34), followed by guided tissue regeneration (17) and enamel matrix derivative (13). Conclusions: The country that produced the highest number publications among the 100 most-cited clinical trials on gingival recession treatment was Italy. The use of connective tissue graft (CTG) and coronally advanced flap (CAF) was the most prominent trend. Future work should combine bibliometric mapping with critical quality appraisal and explore whether citation trends align with best available evidence. Full article

Background/Objectives: Skeletal Class III malocclusion in growing patients presents therapeutic challenges. While traditional tooth-anchored facemask (FM) therapy is widely used, it may induce undesired dental effects. Bone-anchored maxillary protraction (BAMP), using either miniscrews (MSs) or miniplates (MPs), has been proposed to enhance skeletal outcomes and minimize dental compensation. The objective is to compare the efficacy of MS and MP as skeletal anchorage in the orthopedic treatment of the Class III growing patients. Methods: This systematic review and meta-analysis followed PRISMA guidelines. Five databases and manual searches were conducted without restrictions. Inclusion criteria encompassed randomized and non-randomized controlled trials assessing cephalometric outcomes in growing patients treated with MS or MP. Risk of bias was assessed with RoB 2 and ROBINS-I tools, and evidence certainty was evaluated using GRADE. A meta-analysis was performed, collecting all the statistically significant results that emerged in the 11 articles between skeletal anchorage and controls, comparing the values of the MP group with the MS group. Results: Eleven studies (seven MP, four MS) met the inclusion criteria. Both MS and MP groups showed significant maxillary advancement and improved maxillo–mandibular relationships compared to controls. Regarding vertical values, studies have reported contrasting outcomes. Soft tissue improvements were consistent in both MS and MP devices. Statistical analysis has highlighted how MP devices demonstrated more pronounced skeletal effects, while MS systems were associated with more dental effects. Conclusions: MP may be preferable when the aim is to maximize skeletal correction with fewer dental side effects, while MS can be considered in cases favoring less invasive approaches; long-term follow-up and high-quality clinical studies are needed to confirm these clinical assessments. Full article

Background: There are no comparative trials between the two most common schemes in HER2-positive early breast cancer treatment; BERENICE (with anthracyclines) and TRAIN-2 (without anthracyclines). In this study, we investigated the pathological complete response (pCR) and safety events achieved with each. Methods: This analytical retrospective observational study included 111 patients with early and locally advanced HER-2-positive breast cancer who initiated neoadjuvant treatment with an anthracycline-based scheme (four cycles of doxorubicin and cyclophosphamide, followed by four cycles of taxane, trastuzumab, and pertuzumab = AC-THP) and a non-anthracycline scheme (carboplatin, weekly paclitaxel, trastuzumab, and pertuzumab for six–nine cycles = TCbHP) at the National Cancer Institute in Colombia, between April 2020 and December 2024. The primary endpoint was the pCR. Safety was analyzed in patients who received at least one treatment cycle. Results: A total of 51 patients received AC-THP and 60 TCbHP (89.6% of which received six cycles). The pCR was 58.3% in ACHTP and 60.4% in TCbHP (p = 0.84). As a descriptive analysis, with the anthracycline-based scheme, there was a trend toward a higher pCR in patients with T3-T4, positive nodal involvement (N+), and positive hormone receptor (HR+). Cardiac toxicity events during the neoadjuvant phase were 9.8% in ACTHP and 3.3% in TCbHP. Grade 2 neuropathy events were higher in patients with the TCbHP scheme, at 23.3%, versus 9.8% in ACTHP. Conclusions: We found similar pCR rates between the schemes with anthracyclines and without anthracyclines. It is still pertinent to discuss the risk–benefit of using anthracycline-based regimens in patients with HR+, T3-T4, and N+. The cardiac adverse events reported in our patients were similar to those reported in the BERENICE trial. Full article

Background and Objectives: Immediate implant placement in the esthetic zone presents challenges in maintaining peri-implant tissues due to post-extraction remodeling. Bone grafting has been proposed to support tissue preservation and improve esthetic outcomes. This article reviews the role of grafting in clinical studies and case reports. Materials and Methods: A literature search on PubMed and Google Scholar identified studies focusing on immediate implant placement with grafting. The search strategy included articles from 2012 to 2025, in English, from peer-reviewed journals. Results: Implant survival is possible without grafting in ideal cases, but grafting is often essential in patients with thin biotypes or esthetic demands. Technique and material selection are critical. The socket shield technique shows promise in preserving buccal tissues despite its complexity. Case reports demonstrated stable soft tissues and favorable esthetic outcomes. Conclusions: Grafting should be tailored to the clinical situation. While not always necessary, it is often crucial in compromised sites to ensure long-term esthetic success. Current literature supports predictable outcomes with appropriate grafting protocols. Full article

Background/Objectives: The maintenance of peri-implant soft tissue health is critical for the long-term success of implant therapy, particularly in edentulous patients rehabilitated with mandibular overdentures. Leukocyte- and platelet-rich fibrin (L-PRF) has been proposed as an autologous biomaterial to enhance peri-implant tissue quality. This randomized controlled clinical trial evaluated the effect of L-PRF on peri-implant mucosal thickness in edentulous patients treated with mandibular implant-retained overdentures. Methods: Edentulous patients received two interforaminal implants to retain a mandibular overdenture and were randomly assigned to a test group (L-PRF applied during surgery) or a control group (standard protocol without L-PRF). Clinical measurements of keratinized mucosal thickness and width were recorded at baseline, 12 weeks, and 24 weeks. Volumetric analyses of soft and hard tissue changes were performed using digital superimposition of STL models. The trial was conducted in accordance with the Declaration of Helsinki and approved by the Scientific Ethics Committee of the Aconcagua Health Service. All participants provided written informed consent. Results: A significant increase in keratinized mucosal thickness was observed in the L-PRF group at 12 and 24 weeks compared with baseline (p < 0.01). No significant differences were detected between the groups in soft tissue volume (p = 0.12) or bone volume (p = 0.45). Mucosal width remained stable in both groups throughout follow-up. Conclusions: The application of L-PRF at implant placement resulted in a significant gain in peri-implant mucosal thickness, suggesting a soft tissue modulating effect. Enhancing keratinized mucosal thickness during implant surgery may improve peri-implant tissue quality and support long-term stability of mandibular overdentures. Full article

Background/Objectives: Synovial sarcoma (SS) is an aggressive soft-tissue tumor characterized by the chromosomal translocation t(X;18) (p11.2;q11.2), most commonly involving the fusion of the SYT gene on chromosome 18 with the SSX1 or SSX2 genes on chromosome X. This study aims to explore the clinicopathological and molecular characteristics of synovial sarcoma in a cohort of Moroccan patients. Methods: We analyzed 48 cases of synovial sarcoma using formalin-fixed, paraffin-embedded (FFPE) tissue samples. Histological grading was performed according to the FNCLCC system. Immunohistochemical staining was employed to detect cytokeratin (CK) and epithelial membrane antigen (EMA). Molecular analysis included fluorescence in situ hybridization (FISH) to identify SS18 gene rearrangements and reverse transcription–polymerase chain reaction (RT-PCR) to detect SYT-SSX fusion transcripts. Results: Among the cohort, 56% of cases showed SS18 gene rearrangements via FISH, while RT-PCR confirmed the presence of SS18-SSX1 and SS18-SSX2 transcripts in 60% and 32% of cases, respectively. The remainder was classified as undifferentiated sarcoma. Notably, no significant associations were observed between SYT-SSX fusion type and clinicopathological features. Conclusions: These findings underscore the importance of integrating molecular techniques for precise diagnosis in synovial sarcoma. The results align with global patterns, emphasizing the necessity for molecular testing to enhance diagnostic accuracy and informing potential therapeutic advancements. Full article

Introduction: Tumors of the lateral skull base, particularly those arising from the external auditory canal and peri-retroauricular regions, present considerable surgical and reconstructive difficulties due to their intricate anatomy and aggressive nature. The anterolateral thigh (ALT) free flap offers a viable reconstruction option, enhancing oncological radicality while minimizing morbidity. Materials and Methods: A retrospective analysis was conducted on five cases of malignant tumors involving the external auditory canal and adjacent soft tissues, treated at a tertiary center from March 2023 to March 2025. All patients underwent radical resection, which included lateral or subtotal temporal bone resection, along with parotidectomy and neck dissection when necessary. Reconstruction was performed using myocutaneous anterolateral thigh free flaps. The study evaluated clinical outcomes, complications, and esthetic results. Results: The ALT flap was used in all cases without major postoperative complications. Two patients received adjuvant radiotherapy; one did not start treatment due to early recurrence. At follow-up, three patients were disease-free, while two had died from unrelated causes. Esthetic and functional outcomes were satisfactory in all patients. Conclusions: The ALT free flap is a universal and reliable option for the reconstruction of complex lateral skull base defects, especially in patients following the radical removal of tumors of the external auditory canal and peri-retroauricular areas. It offers excellent tissue coverage, facilitates adjuvant treatment, and has a low complication rate. While our experience supports its use in aggressive oncological resection, larger studies are needed to confirm these findings. Level of evidence: 4. Full article