Search Results (21,039)

Necrotizing fasciitis (NF) is a rare but aggressive soft tissue infection with high rates of mortality and amputation, making early identification of key prognostic biomarkers essential for clinical management. However, the rarity and heterogeneity of NF mean clinical datasets are often small and non-normally distributed, limiting the effectiveness of standard parametric statistical approaches. To address this, we retrospectively analyzed 66 NF patients using a robust, distribution-free framework that combines the Nonparametric Combination (NPC) methodology and bootstrap resampling. We specifically assessed glycated hemoglobin (HBA1C) and serum albumin (ALBUMINA) as potential predictors of two outcomes: mortality (MORTO) and major amputation (AMPUTAZIONE). NPC enabled exact multivariate hypothesis testing while rigorously controlling the family-wise error rate (FWER), and bootstrap resampling generated 95% confidence intervals (CI) for critical biomarkers. HBA1C was an exceptionally significant predictor compared to the 7.0% clinical threshold (p = 1.04 × 10⁻¹⁵⁴, CI: 0.0830–0.0957), while ALBUMINA showed greater biological variability but no significant association with outcomes (2.8 g/dL; p = 0.267, CI: 2.551–2.866). We also developed a global severity ranking, integrating multiple variables to improve clinical risk stratification. Our results demonstrate that permutation-based and resampling methods provide reliable, actionable insights from challenging small-sample clinical datasets. Based on a small-sample dataset from necrotizing fasciitis patients, this framework provides a replicable model for robust, nonparametric statistical analysis in similarly rare and high-risk medical conditions. This study introduces a Nonparametric Combination (NPC) framework for risk scoring in necrotizing fasciitis using bootstrap resampling and permutation tests. Key predictors like HBA1C and Albumin were assessed, achieving an AUC of 0.89 and a Youden Index of 0.71. The model offers a robust, interpretable tool for clinical risk stratification in small-sample rare disease settings. Full article

Background/Objectives: To compare patient-reported outcome measures (PROMs) between digital and conventional impression techniques for implant-supported fixed dental prostheses (iFDPs). Methods: A systematic literature search was conducted in PubMed, Embase, Scopus, and the Cochrane Library databases up to June 2025, following PRISMA guidelines. Human clinical studies reporting PROMs between digital and conventional impression techniques for iFDPs were included. Studies using structured, but not necessarily validated, questionnaires were eligible. Two reviewers independently performed study selection, data extraction, and risk of bias assessment. Where possible, meta-analyses were conducted using a random-effects model to pool comparable outcomes across studies using mean differences (MD) or standardized mean differences (SMD) with 95% confidence intervals (CIs). Results: Out of 1784 records screened, eighteen studies were included. Most studies showed that digital impressions were associated with higher patient satisfaction, compared to conventional impressions. Ten studies contributed data to at least one outcome; pooled analyses included the following: overall satisfaction (k = 5), comfort (k = 7), gagging/nausea (k = 5), esthetic satisfaction (k = 2), unpleasant taste (k = 5), anxiety (k = 5), discomfort (k = 2), pain (k = 5), and overall discomfort (k = 5). Digital impressions were significantly favored (p < 0.05) for anxiety (MD = 13.3, 95% CI: −22 to −4.5), nausea (MD = −26.4, 95% CI −46.8 to −6.0), bad taste (MD = −34.8, 95% CI −58.3 to −11.3), discomfort (SMD = −2.24, 95% CI −3.51 to −0.98), comfort (SMD = 1.77, 95% CI: 0.60 to 2.94), perceived procedure time (SMD = 0.96; 95% CI 0.29 to 1.62), and overall satisfaction (SMD = 0.55; 95% CI 0.01 to 1.09). No statistically significant differences were found for pain or esthetic evaluation. Substantial between-study heterogeneity was observed among the included studies. Conclusions: Current evidence indicates that digital impression workflows enhance the overall patient experience for implant-supported fixed restorations, especially in domains linked to comfort and procedural efficiency. These findings support PROM-informed personalization of impression workflows: screening for gagging, anxiety, or intolerance to impression materials could guide patient-tailored use of intraoral scanning while acknowledging no consistent advantage for pain or esthetic perception. Full article

Background/Objectives: A subset of children with monosymptomatic nocturnal enuresis (MNE) remains unresponsive to standard treatments such as desmopressin and alarm therapy. This study aimed to identify clinical predictors of response to biofeedback therapy in treatment-resistant MNE and to evaluate the role of bladder capacity as a stratification parameter. Methods: In this prospective study, 89 children with treatment-resistant MNE underwent six weekly sessions of biofeedback therapy involving visual pelvic floor feedback. Based on treatment outcomes, patients were classified as complete responders or partial/non-responders. Clinical characteristics including age-adjusted maximal voided volume (MVV), nocturnal polyuria, and wetting frequency were compared. Results: Patients with a complete response had significantly lower baseline MVV and age-adjusted MVV (p < 0.001). Nocturnal overactivity was more common among responders (60.6% vs. 33.9%, p = 0.017), whereas nocturnal polyuria was more frequent in non-responders (p = 0.027). Age-adjusted MVV emerged as the only independent predictor of treatment success in multivariate analysis (p = 0.045), with ROC analysis confirming its predictive value (AUC = 0.767, 95% CI: 0.667–0.866). Conclusions: These findings suggest that reduced bladder capacity and frequent night-time wetting may help identify patients who are more likely to benefit from biofeedback therapy. Bladder capacity assessment may thus serve as a useful tool in tailoring management strategies for refractory MNE. Full article

Background and Objectives: Perioperative enteral and parenteral nutrition have been increasingly used to treat malnutrition in patients with gastric cancer. Immunonutrients have been suggested to reduce postoperative inflammatory responses and enhance immune function compared to conventional nutritional formulas. However, the insufficiency of evidence and unclear specific mechanism limit the recommendation level of immunonutrients in clinical guidelines. This study aimed to investigate the effects of immunonutrients on intestinal barrier function and to explore potential mechanisms through gut microbiota modulation. Methods: A total of 58 patients who underwent gastric cancer surgery participated in this randomized controlled trial. The immunonutrients group (n = 29) was additionally supplemented with 282 mg of omega-3 fatty acids, 1.2 g of arginine, and 128 mg of nucleotides per 100 kilocalories compared to the standard nutrients group (n = 29). Perioperative serum immune, nutritional parameters, and intestinal barrier markers (diamine oxidase, D-lactate, endotoxin) were evaluated. Fecal microbiota structure and functional pathways were analyzed via metagenomic sequencing. Results: Postoperative immune and nutritional parameters showed no statistically significant intergroup differences, though mean value curves suggested a protective trend in the immunonutrients group. The immunonutrients group exhibited significantly lower postoperative diamine oxidase (p = 0.043) and endotoxin levels (p = 0.043), alongside a substantial increase in microbiota α-diversity (p = 0.0005). Probiotic genera such as Akkermansia (3.26%) and Bifidobacterium longum (2.31%) were enriched in the immunonutrients group. Functional pathway analysis suggested that immunonutrients enhanced intestinal barrier protection. Conclusions: Immunonutrients may attenuate surgery-induced intestinal barrier damage in gastric cancer patients by modulating gut microbiota diversity, enriching beneficial taxa, and suppressing pathogenic bacteria. Full article

Background/Objectives: Nutritional status affects postoperative outcomes, but the effect of standardized preoperative nutritional preparation on morbidity in malnourished patients undergoing pancreatoduodenectomy (PD) remains unclear. This study evaluated preoperative nutritional parameters following the standardization of nutritional screening and intervention in patients undergoing PD. The influence of nutritional parameters on postoperative morbidity was also assessed. Methods: This prospective cohort study was conducted from 2019 to 2021 at the Department of Surgery, University Hospital, Olomouc. A total of 133 patients were categorized nutritionally as “high risk” (weight loss or reduced appetite with restricted intake) or “low risk” (no weight or appetite loss). High-risk patients received enteral supplementation of 600 kcal/day. A multivariate logistic regression model was used to evaluate the association between major postoperative complications and risk factors, including sex, age, ASA score, BMI, weight and appetite loss, malignancy, duct diameter, pancreatic texture, serum albumin, prealbumin, MUST, and NRS2002 scores. Results: Eighty patients (60.2%) were “high risk,” and 53 (39.8%) were “low risk.” Major morbidity and 90-day mortality occurred in 24 (18.0%) and 4 (3.0%) patients, respectively. No significant differences were observed between high- and low-risk groups in CD morbidity grade, 90-day mortality, POPF, PPH, DGE, or hospital stay. Major morbidity was associated with prealbumin < 0.2 g/L, duct diameter ≤ 3 mm, soft texture, and male sex, with respective odds ratios of 3.307, 3.288, 4.814, and 2.374. Conclusions: High-risk patients receiving preoperative nutrition had comparable rates of major complications and POPF as low-risk patients. Low serum prealbumin predicts major postoperative complications after PD. Full article

Perianal fistulising Crohn’s disease (pfCD) affects 1 in 5 Crohn’s patients and requires frequent MRI monitoring. Standard radiology reports are written for clinicians using technical language often inaccessible to patients, which can cause anxiety and hinder engagement. This study evaluates the feasibility and safety of AI-generated patient-friendly MRI fistula summaries to improve patient understanding and shared decision-making. MRI fistula reports spanning healed to complex disease were identified and used to generate AI patient-friendly summaries via ChatGPT-4. Six de-identified MRI reports and corresponding AI summaries were assessed by clinicians for hallucinations and readability (Flesch-Kincaid score). Sixteen patients with perianal fistulas were randomized to review either AI summaries or original reports and rated them on readability, comprehensibility, utility, quality, follow-up questions, and trustworthiness using Likert scales. Patients rated AI summaries significantly higher in readability (median 5 vs. 2, p = 0.011), comprehensibility (5 vs. 2, p = 0.007), utility (5 vs. 3, p = 0.014), and overall quality (4.5 vs. 4, p = 0.013), with fewer follow-up questions (3 vs. 4, p = 0.018). Clinicians found AI summaries more readable (mean Flesch-Kincaid 54.6 vs. 32.2, p = 0.005) and free of hallucinations. No clinically significant inaccuracies were identified. AI-generated patient-friendly MRI summaries have potential to enhance patient communication and clinical workflow in pfCD. Larger studies are needed to validate clinical utility, hallucination rates, and acceptability. Full article

Primary central nervous system lymphoma (PCNSL) is a rare extra-nodal non-Hodgkin lymphoma confined to the central nervous system. The cancer biology of PCNSL remains incomplete and is often associated with genetic aberrations with abnormal signaling pathways, cell differentiation, regulation of epigenetic modification, and the tumor microenvironment. Stereotactic brain biopsy remains the gold standard for the diagnosis of PCNSL. For patients ill-suited for biopsy, MYD88 and IL-10 may be important biomarkers to diagnose PCNSL. High-dose methotrexate-based polychemotherapy is currently the standard induction treatment for PCNSL, followed by consolidation treatments including autologous stem cell transplant and whole-brain radiotherapy. Some studies suggest that low-dose lenalidomide is recommended as a maintenance therapy for PCNSL. Currently, relapse rates of PCNSL range from 25 to 50% with poor prognosis. Insight research is necessary to identify novel targeted treatments to improve outcomes in relapsed/refractory disease, such as immunomodulatory drugs, immune checkpoint inhibitors, signaling pathway inhibitors, and chimeric antigen receptor T-cell therapy. Full article

Background and Objectives: This systematic review and meta-analysis aimed to evaluate the efficacy of xenogeneic collagen matrix (XCM) in combination with a coronally advanced flap (CAF) in the management of multiple gingival recessions and to compare its outcomes with those achieved using the conventional connective tissue graft (CTG) + CAF approach. Materials and Methods: After searching and reviewing the literature in the electronic databases PubMed/PMC, Google Scholar, ScienceDirect, Cochrane Library, and LILACS, 601 publications were found. The titles and abstracts of 543 publications were screened. After evaluating the full text of 290 publications, based on the inclusion criteria, four randomized controlled clinical trials were included in the systematic review and meta-analysis. In all the studies, the test group was treated with XCM + CAF, whereas in the control group, CTG + CAF was used. Results: Clinical attachment level (CAL), gingival recession depth (GR), keratinized tissue width (KTW), and complete root coverage (CRC) statistically significantly (p < 0.05) improved in both groups in all of the studies. Inter-group comparison showed better results in the control group in individual studies. All clinical trials reported a statistically significant (p < 0.05) decrease in surgery time and less postoperative pain in the test group. The meta-analysis of KTW (−0.438 [95% CI, −0.714 to −0.163], p < 0.002) and GR (0.35 [95% CI, 0.098 to 0.602], p < 0.001) showed a significant difference between the test and the control groups in all of the studies. CAL (0.78 [95% CI, −0.305 to 0.461], p > 0.05) showed no statistically significant difference between test and control groups. Conclusions: CTG + CAF remains the gold standard in root coverage procedures. However, XCM offers a less invasive alternative with improved patient comfort, less postoperative pain, shorter surgical time, and acceptable clinical outcomes. Full article

Background/Objectives: Rhodiola rosea L. (Crassulaceae), a perennial adaptogenic herb native to Northern Europe, Asia, and North America, is renowned for its therapeutic properties attributed to phenolic compounds including flavonoids, phenylethanoids, phenylpropanoids, and cinnamyl alcohol glycosides. The plant’s antioxidant and anti-inflammatory activities align with its traditional use in boosting physical and cognitive performance, reducing fatigue, and improving stress resilience. However, conventional dosage forms present compliance challenges, particularly for vulnerable populations with swallowing difficulties. This study aimed to develop and optimize orally disintegrating tablets (ODTs) containing standardized Rhodiola rosea root and rhizome (RR) dry extract to ensure rapid disintegration and acceptable taste, thereby improving patient compliance. Methods: Dried Rhodiola rosea root and rhizome (particle size 2–3 mm) were extracted using 70% m/m ethanol using the fractionated maceration methodology. The resulting dry RR extract was standardized to 3.0% m/m rosavin content by blending batches of the extract and analyzed using validated chromatographic methods. The standardized dry extract was formulated into ODTs via direct compression technology. Various excipients were evaluated to achieve rapid disintegration while masking the characteristic bitter taste of RR extract. Results: The optimized ODT formulation (500 mg, 11 mm ø, 20% standardized RR dry extract) disintegrated within 3 min and effectively masking the characteristic bitterness of the RR extract. The formulation maintained content uniformity and did not exhibit loss of active compounds during processing, meeting European Pharmacopoeia requirements for ODTs. Conclusions: The developed ODTs containing standardized Rhodiola rosea extract offer a patient-friendly alternative for oro-mucosal administration, supporting improved compliance in populations with swallowing difficulties while retaining the extract’s phytochemical integrity and sensory acceptability. Full article

Background: Orthognathic surgery using the Surgery-First approach (SFA) has gained increasing attention not only for its functional and aesthetic benefits but also for its potential psychological impact. Aim: This study aimed to evaluate the effects of SFA on the psychological well-being of patients with dentofacial anomalies and temporomandibular disorders (TMD), using validated tools for assessing anxiety (GAD-7), depression (PHQ-9), and pain catastrophizing (PCS). Materials and methods: A longitudinal observational study was conducted on 27 patients treated between 2022 and 2025. TMD was assessed using the DC/TMD clinical criteria. Psychological status was evaluated preoperatively and 6 months postoperatively using the GAD-7, PHQ-9, and PCS standardized questionnaires. Results: Significant reductions were observed in all three domains: GAD-7 scores dropped from 13.8 to 4.1 (p < 0.001), PHQ-9 from 15.5 to 5.3 (p < 0.001), and PCS from 26.2 to 12.7 (p < 0.001). These are raw total scores; corresponding normalized mean scores (per item) decreased from 2.78 to 1.08 for GAD-7, from 3.00 to 0.36 for PHQ-9, and from 1.22 to 1.06 for PCS. The greatest improvements were seen in Class III patients with TMD. Psychological scores did not significantly predict persistent TMD. Conclusions: These findings support the psychological benefits of SFA and underline the importance of integrating psychological screening into orthognathic treatment planning. Full article

Background: Rare diseases affect fewer than 1 in 2000 people, but collectively, they impact millions. Their diagnosis and management present challenges due to low prevalence, clinical heterogeneity, and a lack of standardized protocols. Nurses play a key role in assisting and caring for these patients by providing direct care, emotional support, and health education. Objective: The objective of this systematic review is to update the existing knowledge on nurses’ level of understanding regarding rare diseases, as a decline in their training can compromise the quality of care and access to early detection. Methodology: A bibliographic search was conducted in Scopus, PubMed, CINAHL, SciELO, and Cochrane Library, selecting studies published between 2014 and 2024 on rare disease knowledge. The PRISMA model was followed, and the review was registered with PROSPERO under code CRD42024580656. Result: Ultimately, 24 studies were included. The main results showed a significant gap in nursing education concerning rare diseases. Conclusions: Continuous education, telemedicine, and the integration of health technologies were highlighted as improving competencies in rare diseases. Therefore, it is a priority to increase nursing training in rare diseases at all levels. Full article

Background/Objectives: The objective of this study is to compare the optical and visual quality provided by the advanced monofocal intraocular lens (IOL) ISOPure and the standard monofocal IOL MicroPure in cataract patients, using objective and subjective assessments. Methods: This prospective, single-blind clinical study includes 28 patients with cataracts, bilaterally implanted with either the ISOPure or MicroPure IOL. Eligible eyes had no ocular comorbidities and regular corneal astigmatism ≤ 1.00 D. Three months postoperatively, uncorrected distance and intermediate (UDVA, UIVA) and corrected distance and intermediate (CDVA, DCIVA) visual acuities were measured at 4 m, 80 cm, and 66 cm under photopic (85 cd/m²) and mesopic (3.5 cd/m²) conditions. Photic phenomena, including halo and glare, were evaluated. Objective optical quality was assessed using Objective Scattering Index (OSI), Modulation Transfer Function (MTF), Strehl Ratio (SR), and ocular aberrations. Subjective patient satisfaction was evaluated using Quality of Vision (QoV) and Catquest-9SF questionnaires. Results: Under photopic conditions, logMAR DCIVA at 80 cm, UIVA at 66 cm, and DCIVA at 66 cm were 0.18 ± 0.06, 0.25 ± 0.12, and 0.20 ± 0.13, respectively, for ISOPure, and 0.22 ± 0.06, 0.30 ± 0.09, and 0.25 ± 0.09 for MicroPure (p = 0.05, 0.02, and 0.05, respectively). No significant differences were observed in halo/glare size or intensity, OSI, MTF, or SR. However, statistically significant differences were found in higher-order total aberrations for pupil sizes of 3.0, 4.0 mm, and 5.0 mm. Questionnaires indicated greater satisfaction and functional intermediate vision with ISOPure. Conclusions: The ISOPure IOL offers superior intermediate vision without compromising distance vision, delivering a balanced combination of optical quality, functional performance, and patient satisfaction. Full article

Pharmacy technicians (PT) are vital to the efficient and safe operation of hospital pharmacy services, fulfilling a range of technical and clinical responsibilities that directly impact patient care. However, increasing healthcare demands have underscored the importance of adequate staffing levels to sustain service quality and safeguard patient outcomes. This perspective paper explores how appropriate staffing levels for PT in hospital settings are essential and important to support safe, efficient care and a sustainable workforce. It compares evidence-informed staffing models, highlights real-world benchmarks, and proposes governance recommendations to guide policies that strengthen pharmacy services. Recommendations are made to inform clinical governance, suggesting that staffing policies, continuous training, and professional development programs are essential to supporting PT effectiveness and retention. The findings advocate for regulated staffing ratios and governance measures to foster an environment where PTs can deliver high-quality care and uphold safety standards within hospital pharmacies. Full article

Background/Objectives: Chronic ulcers represent a major public health concern, being associated with substantial morbidity, impaired quality of life, and significant costs to healthcare systems. Against the backdrop of an aging population and increasing prevalence of chronic comorbid conditions, this study aimed to profile hospitalized patients with chronic ulcers in Romania and to examine their differential patterns of healthcare resource utilization. Methods: We conducted a retrospective analysis of the national administrative hospitalization database between 2017 and 2022, including adult patients with at least two admissions coded with a primary diagnosis of chronic ulcer. Sociodemographic, clinical, and healthcare utilization indicators were extracted, standardized, and analyzed using the K-means clustering algorithm to derive utilization-based phenotypes. Results: Two distinct patient clusters were identified: the first comprised predominantly elderly patients with multiple comorbidities, prolonged hospitalizations, and frequent readmissions, representing a high-burden profile; the second included relatively younger patients with fewer comorbidities, shorter hospital stays, and lower readmission rates, reflecting a more stable clinical profile. The high-burden cluster accounted for a disproportionate share of inpatient resource consumption, underscoring its impact on the healthcare system. Conclusions: These findings highlight the importance of early identification of potential high-burden patients, enabling the implementation of personalized care strategies and more efficient allocation of hospital resources, with the potential to improve health outcomes and support healthcare system sustainability. Full article

Transplant ureteral stricture (TUS) reconstruction remains a significant challenge in renal transplantation, particularly when conventional access to the transplant ureter and renal pelvis is not feasible. This report presents two rare and complex surgical reconstructions: a combined calico-vesicostomy and uretero-calycostomy in one patient, and an ileo-calycostomy in another. Both cases involved patients with prior failed minimally invasive interventions and complex anatomy that precluded standard repairs. A hybrid surgical approach incorporating open reconstruction with fluoroscopic and endoscopic guidance was used to access the renal calyces directly, enabling successful re-establishment of urinary tract continuity. The first patient underwent dual reconstruction with native ureteral reimplantation to the middle calyx and a simultaneous calycovesicostomy, bladder to the It lower pole calyx. The second patient, with prior ileal conduit urinary diversion, underwent ileocalycostomy—anastomosing the ileal conduit to the middle calyx. Both reconstructions were performed using modified partial nephrectomies to preserve nephron mass. Long-term follow-up (34 and 40 months) demonstrated excellent graft function and minimal complications. These cases represent the first reported long-term outcomes of calycovesicostomy and ileocalycostomy in transplant ureteral reconstruction and reinforce the utility of calyceal access in complex TUSs. These cases highlight rare but viable surgical options in complex scenarios of transplant ureteral strictures. Hence, a multidisciplinary approach and meticulous preoperative planning are essential to optimize outcomes in these challenging scenarios. Full article