Search Results (3,581)

Background: Proximal humerus fractures (PHFs) constitute a significant orthopedic challenge, particularly among the elderly, due to osteoporosis and comorbidities. While surgical intervention is often considered for complex fractures, non-surgical treatment (NST) has gained attention, especially during the COVID-19 pandemic, when surgical resources were limited. This study evaluates the functional outcomes of patients over 65 years old who underwent NST for PHFs during the pandemic. Methods: A retrospective analysis was conducted on patients presenting with 3- or 4-part PHFs at the Hospital Marino di Alghero (Italy) between 9 March 2020 and 18 May 2020. Inclusion criteria included age over 65, conservative management, and a minimum 30-month follow-up. Seven patients were evaluated through radiographic imaging and clinical assessments, including the Constant Shoulder Score (CSS), Oxford Shoulder Score (OSS), and Disabilities of the Arm, Shoulder, and Hand Score (DASH). Functional recovery was analyzed over a 48-month period. Results: The average CSS was 69.4 (SD: 22.3), OSS was 34 (SD: 14.6), and DASH was 27.9 (SD: 30.3), indicating moderate functional recovery. One patient required surgical fixation due to excessive displacement. Tuberosity union was observed in 85.7% of cases, and complications were minimal. NST allowed patients to recover shoulder function while avoiding surgical risks, particularly during the pandemic. Conclusions: NST proved to be a viable treatment for elderly patients with PHFs, yielding satisfactory functional outcomes with minimal complications. The pandemic highlighted the importance of conservative approaches in orthopedic management, emphasizing the need for individualized treatment decisions based on patient comorbidities and fracture characteristics. Full article

Background: Elective surgery soon after SARS-CoV-2 infection is linked to high morbidity, but the risk > 7 weeks post-infection is uncertain. Methods: A PROSPERO-registered systematic review (CRD42023416842) following PRISMA 2020 searched PubMed, Web of Science, WHO COVID Database, Wiley, Google Scholar, and Scopus (Jane 2020–July 2025) for studies reporting postoperative outcomes in patients with confirmed COVID-19 ≥ 7 weeks before elective surgery. Primary endpoints were cardiopulmonary, neurological, renal and thrombotic complications, ICU/hospital stay and 30-day mortality. Results: Thirteen observational studies (38,055 patients) met inclusion criteria. In patients operated ≥7 weeks after mild or asymptomatic infection, overall mortality rate was 2.27% (607/26,688), with no significant excess versus uninfected controls. Pneumonia (1.66%), pulmonary embolism (1.47%), arrhythmias (2.57%) and myocardial injury (1.06%)—did not exceed baseline surgical rates. Thrombosis occurred in 2.8% but lacked a clear association with prior infection. Conversely, individuals with previous moderate-to-severe disease or recent COVID-19-related hospitalization showed higher complication rates, especially in complex procedures such as coronary bypass. Conclusions: Evidence to date indicates that COVID-19 history beyond seven weeks does not independently raise perioperative morbidity or mortality for most elective procedures. Full article

Intestinal disorders such as inflammatory bowel diseases (IBDs), Crohn’s disease, malabsorption syndromes, and gastrointestinal fistulae (GIFs) are often characterized by chronic inflammation, epithelial barrier disruption, impaired stromal remodeling, and defective angiogenesis. These multifactorial alterations hinder tissue repair and contribute to poor clinical outcomes, with limited efficacy from current therapeutic options. Despite recent advances in surgical and endoscopic techniques, current treatment options remain limited and are frequently accompanied by high morbidity and costs. In this context, regenerative medicine offers a promising avenue to support tissue repair and improve patient care Regenerative medicine offers a promising avenue to restore intestinal homeostasis using advanced biomaterials and cell-based therapies. In this study, we developed a 3D-bioprinted model based on patient-derived stromal vascular fraction (SVF) embedded in a GelMA hydrogel, designed to promote intestinal tissue regeneration. To identify the most suitable hydrogel for bioprinting, we initially evaluated the mechanical properties and biocompatibility of four distinct matrices using bone marrow-derived mesenchymal stromal cells (BM-MSCs). Among the tested formulations, GelMA demonstrated optimal support for cell viability, low oxidative stress, and structural stability in physiologically relevant conditions. Based on these results, GelMA was selected for subsequent bioprinting of freshly isolated SVF. The resulting bioprinted constructs enhanced key regenerative processes across multiple compartments. The SVF-laden constructs significantly enhanced intestinal epithelial cell viability and tight junction formation, as shown by increased trans-epithelial electrical resistance (TEER). Co-culture with fibroblasts accelerated wound closure, while endothelial cells exhibited increased tube formation in the presence of SVF. Together with VEGF secretion, indicating strong paracrine and angiogenic effects. By supporting epithelial, stromal, and vascular regeneration, this approach provides a versatile and translational platform for treating a broad spectrum of intestinal pathologies. Full article

Introduction: The number of older adults living with frailty undergoing gastrointestinal cancer surgery is increasing. To address the unique needs of the population, a whole pathway perioperative geriatrics strategy—PRIME—was developed to integrate geriatric principles into surgical care. The objective of this study was to evaluate the implementation of PRIME using validated structural, process, and outcome quality indicators. Materials and Methods: This retrospective cohort study included 106 consecutive patients aged 70 years and older who underwent gastrointestinal surgery for cancer or pre-cancerous lesions at a single institution between 1 July 2020 and 5 October 2023. The whole pathway perioperative geriatrics strategy, PRIME, includes preoperative comprehensive geriatric assessment (CGA), collaborative care between surgery, geriatrics, and anesthesia, and post-operative co-management. Implementation was evaluated using validated structural, process, and outcome quality indicators. Results: Most structural indicators (five of eight) were implemented. In terms of process indicators, 96.2% (n = 102) received CGA prior to or within 24 h of admission. Adherence to screening was high: 97.2% for dementia, 96.2% for functional status, and 95.3% for frailty. The median number interventions resulting from CGA was 17 (IQR 14–20). Serious complication, delirium, and functional decline occurred in 19.8%, 27.1%, and 19.8%, respectively. Conclusions: Implementation of a perioperative geriatrics strategy for older adults undergoing gastrointestinal cancer/pre-cancer lesion surgery is feasible, with high adherence to structural and process quality indicators. Full article

Background/Objectives: Recurrences of squamous cell carcinoma (SCC) at the base of the tongue (BoT) after primary radiochemotherapy (RT-CHT) are associated with low survival rates, poor functional outcomes, and high morbidity following salvage surgery. Transoral robotic surgery (TORS) has emerged as a less invasive alternative to open surgical approaches. This study aims to describe our clinical experience with TORS in patients with BoT SCC recurrence after RT-CHT, focusing on oncological outcomes—relapse-free survival (RFS) and disease-specific survival (DSS)—as well as functional outcomes, particularly swallowing function. Methods: We conducted a retrospective review of four patients who underwent salvage TORS for BoT recurrence between September 2013 and September 2014 at a single tertiary referral center. All patients had been previously treated with primary RT-CHT for oropharyngeal squamous cell carcinomas. Oncological events (recurrence, death) and functional endpoints (dietary limitations, MD Anderson Dysphagia Inventory [MDADI] scores) were retrieved from medical records. Results: Four patients were included. All achieved unrestricted oral intake by one month post-TORS, showing functional improvement compared to their preoperative status. Three of the four patients remained free of locoregional recurrence during follow-up. No major perioperative complications were reported. Conclusions: In selected patients with BoT SCC recurrence after primary RT-CHT, TORS may offer a viable and less morbid salvage treatment option with favorable early functional outcomes and acceptable oncologic control. Based on both our institutional experience and the supporting literature, we propose selection criteria to guide TORS indication in this clinical setting. Full article

The gut microbiome is essential for gut health, immune regulation, and metabolism, but pathogenic bacteria like Enterococcus and Streptococcus can disrupt these processes, increasing infection risk after colorectal surgery. Prior studies show that intravenous antibiotics and surgical bowel preparation (SBP, including mechanical preparation with oral antibiotics) significantly disrupt the gut microbiota, potentially delaying postoperative recovery. However, the effects of surgical indication (e.g., diagnosis) and operation type on gut microbiome composition and function remain unclear. This study examines how SBP, resectional and non-resectional surgery, and underlying diagnoses shape the postoperative gut microbiome and microbial recovery. Methods: Fecal samples were collected from patients undergoing colonoscopy (n = 30), non-resectional (ventral mesh rectopexy, transanal surgery; n = 25), or resectional surgery with primary anastomosis (n = 26) at baseline, intraoperatively, and on postoperative days (POD) 10, 30, and 180. Microbial diversity was assessed through 16S rRNA sequencing, and short-chain fatty acid (SCFA) levels were measured to evaluate functional changes. Results: Alpha diversity (Shannon indices) decreased across all groups, recovering by POD10 in colonoscopy patients and by POD180 in non-resectional and resectional cohorts. Beta diversity (community composition) also returned to baseline by POD10 in colonoscopy patients and POD180 in non-resectional patients, but the resectional cohort did not fully recover (p < 0.001). Both surgical cohorts showed substantial losses of commensal bacteria through POD30, with notable increases in Streptococcus in resectional patients (p < 0.0001) and Enterococcus in both surgical cohorts (p < 0.0001). Functionally, only the resectional cohort experienced significant reductions in SCFA levels (p < 0.015) relative to baseline levels. Diagnosis minimally influenced long-term microbiota recovery, although cancer patients tended to have more stable microbiomes compared to patients with diverticulitis. Conclusions: These findings indicate that perioperative factors, especially surgical resection and SBP, significantly impact gut microbial recovery, with pathogenic bacteria persisting up to 6 months post-surgery. Full article

Hyperammonaemia in dogs is most frequently associated with hepatic encephalopathy caused by portosystemic shunting. This retrospective multicentre study aimed to investigate the prevalence of hyperammonaemia and hepatic encephalopathy in dogs with recent or ongoing epileptic seizures. Furthermore, we sought to evaluate if transient post-ictal hyperammonaemia as a sequela to seizure activity occurs, as reported in humans and recently in cats. The medical records of all dogs presented between 2014 and 2024 to ten AniCura Veterinary Hospitals in Sweden were retrospectively reviewed to obtain those with recent or ongoing epileptic seizures with concurrent analysis of ammonia. The records of 267 dogs were extracted for further review. Inclusion criteria included information regarding the description and characterisation of the seizures and the analysis of ammonia within 24 h after last reported seizure activity. Additionally, hepatic function tests were required in dogs with elevated ammonia. In total, 58 dogs fulfilled the inclusion criteria, and 10 of those dogs (17%) had hyperammonaemia. Three dogs had documented hepatopathy, and two of them had surgically corrected portosystemic shunts. In seven dogs, no definitive cause of hyperammonaemia could be established. Three of the seven dogs had no evidence of portosystemic shunts, and six had no laboratory evidence supporting acute liver failure. According to the findings in this retrospective study, hyperammonaemia in the absence of evident acute hepatic failure or portosystemic shunting can occur in dogs with epileptic seizures, indicating that other differentials than hepatic encephalopathy should be considered. This study could not confirm the hypothesis of hyperammonaemia being a transient consequence of seizures. Full article

Alcohol Use Disorder (AUD) is common among patients with maxillofacial trauma. Conventional perioperative care recommends complete abstinence. However, abrupt cessation can lead to Alcohol Withdrawal Syndrome (AWS), negatively impacting psychological well-being and compliance. This randomized controlled pilot study evaluated the effectiveness of Monitored Therapeutic Alcohol Administration (MTAA) in reducing perioperative stress and enhancing quality of life without impairing fracture healing. Twenty-four adult male patients with AUD and isolated facial fractures requiring surgery were enrolled. They were assigned to either an intervention group (n = 12) receiving MTAA—oral alcohol at 0.5 g/kg/day for two weeks—or a control group (n = 12) undergoing complete abstinence. Outcomes were assessed over six weeks, including stress (Zung Self-Rating Depression Scale), quality of life (Oral Health Impact Profile-14), soft tissue healing (Landry’s Index), and hard tissue healing (Moed’s Scale, serum osteocalcin). The MTAA group showed significantly reduced stress and improved quality of life (p < 0.001). Healing outcomes were comparable between groups, with no significant differences in soft tissue indices, osteocalcin levels, or radiographic scores. MTAA appears to be a safe and effective strategy to manage AWS-related distress and improve postoperative recovery, offering a practical alternative to strict abstinence in the surgical management of patients with AUD. Full article

In elective hernia surgery, the primary aim is to improve quality of life, rather than to save life. Therefore, outcome measures should emphasize domains such as pain, function, and overall satisfaction. While some principles also apply to other benign procedures, this perspective article centers on hernia repair as a paradigm for redefining surgical success. We perform hernia surgeries primarily due to quality-of-life concerns, and, consequently, it makes sense that outcome measures should emphasize quality-of-life indicators such as pain, other complaints impacting daily life, and most importantly, overall patient satisfaction with the procedure. Nonetheless, many interventional studies related to hernia disease tend to focus on tangible surgical outcomes like recurrence, infections, hospital stays, and readmissions. Therefore, we advocate for a shift in the evaluation of surgeries to prioritize more relevant patient-reported outcomes when assessing the effects of surgical procedures for benign conditions. These considerations not only apply to hernia surgery but also to other surgical interventions where the indication for surgery is based on quality-of-life issues. We urge the systematic incorporation of patient-reported outcomes into surgical practices and outcomes research to promote a more patient-centered approach, aligning surgical success with the outcomes that matter most to patients. Full article

Background: Craniofacial clefts represent the most common congenital malformation in the head and neck region. Although most patients undergo primary cleft repair in childhood, many still present midfacial growth deficiencies in adulthood. This study aimed to evaluate and compare the incidence and indications for orthognathic surgery in adult patients with cleft lip (CL), cleft lip and alveolus (CLA), cleft lip and palate (CLP), and isolated cleft palate (CP). Materials and Methods: Sixty adult cleft patients (36 males and 24 females) born with a cleft and with a mean age of 19.51 ± 1.83 years were retrospectively enrolled in this study. All patients had undergone primary lip and palate repair during childhood at the Oral and Maxillofacial Surgery Service of “Mother Teresa” University Hospital Centre in Tirana. Clinical records, orthodontic documentation, and cephalometric data were reviewed to determine the indication for orthognathic surgery. Results: The statistical analysis showed that orthognathic surgery was deemed necessary in 30% patients, including ten males (56%) and eight females (44%). The most prevalent type of cleft was CLP, accounting for 35% of all patients, and it showed the highest surgical indication rate (83.3%). Cleft patients and the need for orthognathic surgery were evaluated according to the skeletal malocclusion in three planes. The need for surgery was more prevalent in patients with skeletal class III malocclusion with maxillary hypoplasia (83.3% of surgical cases), those with anterior and posterior crossbite (21.7% of all patients), and in deep bite patients (16.7% of all patients). Additionally, all patients with facial asymmetry (15%) required orthognathic surgery, highlighting the strong association between asymmetry and surgical indication. Conclusions: Patients with craniofacial cleft, especially those with CLP and combined maxillary deficiencies, demonstrate a significantly higher need for orthognathic surgery. Quantitative assessment supports the necessity of a multidisciplinary treatment approach to address persistent skeletal discrepancies and optimize functional and aesthetic outcomes in adult cleft patients. Full article

Background and objectives: Patient-specific components (PSC) represent an innovative option for total knee arthroplasty (TKA) in advanced osteoarthritis. Their effectiveness, however, closely relies on accurate positioning. Our study investigates the accuracy achieved by means of an inertial-based extramedullary cutting guide and the postoperative clinical and radiographic outcomes. Methods and materials: This was a prospective, single-arm, pilot study involving patients undergoing primary TKA with YourKnee^TM PSC. Femoral and tibial bone resections were performed using the Perseus inertial-based extramedullary cutting guide. Postoperative mechanical alignment and component positioning were assessed by computed tomography. Clinical outcomes were evaluated preoperatively and at 1, 3, 6, and 12 months postoperatively by main knee function and clinical outcome measures. Results: The study population included a small cohort (n= 12, four females/eight males, mean age 69 ± 5.65 years, mean BMI 25.7 ± 3.8 kg/m², KL grade > 3) with no control group. The mean absolute error between the planned and obtained Hip–Knee–Ankle angle was 1.36° ± 1.06 and within ±3° of all cases. Mean coronal alignment error was 1.87° ± 0.87 and 1.67° ± 0.75 for the femoral and tibial components, respectively. The mean sagittal alignment error was 1.89° ± 1.24 and 2.45° ± 0.87 for the femoral and the tibial components, respectively. Patients showed significant improvement in clinical and functional scores within the first 6 months: OKS increased from 20.64 ± 2.77 at the preoperative screening to 42.27 ± 4.34 (p < 0.0001), total KSS rose from 90.64 ± 17.25 to 169.36 ± 23.57 (p < 0.0001), and FJS reached 85.09 ± 17.14 at 6 months (p = 0.0031), indicating excellent functional recovery and forgotten joint effect. Knee ROM improved from 90.91° ± 11.14 to 110.36° ± 8.44 (p < 0.0001). After 6 months, outcome scores plateaued, suggesting an early stabilization of clinical benefits. No signs of radiolucency were detected on X-rays at 3- and 12-month follow-ups. Conclusions: The Perseus inertial-based extramedullary cutting guide used in combination with the YourKnee^TM PSCs resulted in accurate intraoperative prosthesis positioning and significant improvements in clinical and functional outcomes at 6 months after surgery. Despite the small sample size and absence of a control group, the results suggest that such combination represents a viable option to conventional surgical instrumentation and current off-the-shelf prosthetic designs. Full article

Background/Objectives: Chiari 1 malformation (CM-1) is a structural abnormality characterised by cerebellar tonsillar descent of 5 mm or more through the foramen magnum. Despite improved imaging, surgical criteria remain inconsistent. This study evaluates the correlation between classical symptoms, imaging findings, and need for surgical intervention, as well as introducing a novel Chiari 1 scoring system aimed at refining the criteria for management options. Methods: A retrospective study was conducted on adult patients who were evaluated for CM-1 at a tertiary neurosurgical department with a specialised Chiari and Syringomyelia service over 12 months. Data included demographics, symptoms, imaging characteristics, and surgical intervention. Statistical analysis was performed using SPSS Version 30. Results: Sixty-nine (69) patients met the inclusion criteria (mean age, 36.26 years; male-to-female ratio, 1:3.1). Thirty patients (43.5%) had classic symptoms, of whom 26 had a tonsillar descent of >10 mm. A significant association was noted between surgery and classic symptoms (p < 0.01), tonsillar descent of >10 mm (p < 0.01), and syrinx presence (p = 0.02). Our novel scoring system had an AUC of 0.974 (95% CI 0.94–1.00; p < 0.001), with an optimum cut of the value of ≥3 points leading to a sensitivity of 100%, specificity of 89.5%, positive predictive value of 66.7% and negative predictive value of 100%. Conclusions: Surgical intervention remains an effective option for symptomatic patients. Our novel scoring system could provide a simplified, practical, and more accurate method for identifying patients who may benefit from surgical intervention. Full article

This in vivo animal study aimed to evaluate the effects of two different implant placement micromotor systems on implant stability and removal torque. In a within-animal crossover design, twenty titanium implants (AnyOne fixture; internal type; diameter, 3.5 mm; length, 7.0 mm; Megagen, Daegu, Republic of Korea) were placed in the tibiae of five rabbits using a conventional micromotor system (NSK group: SurgicPro+; NSK, Kanuma, Japan) and a diode laser-integrated micromotor system (SAESHIN group: BLP 10; Saeshin, Daegu, Republic of Korea). Resonance frequency analysis provided the implant stability quotient (ISQ) immediately after placement and at four weeks. Micro-computed tomography quantified the bone–implant interface gap (BIG). Removal torque was measured at sacrifice. Linear mixed-effects models with a random intercept for rabbit generated adjusted means with 95% confidence intervals (CIs) (α = 0.05). Equivalence for the four-week ISQ used two one-sided tests with a margin of ±5 ISQ. The SAESHIN group achieved a higher immediate ISQ than the NSK group (difference =+6.9 ISQ; 95% CI +1.3–+12.5; p = 0.018). At four weeks, the ISQ did not differ (difference = −1.2 ISQ; 95% CI −4.3–+1.9; p = 0.42), and equivalence was supported (TOST p_lower = 0.024; p_upper = 0.019). Removal torque was comparable (difference = +4.3 N·cm; 95% CI −5.2–+13.8; p = 0.36). BIG metrics showed no between-system differences across regions. ICC indicated clustering for ISQ and torque (0.36 and 0.31). The diode laser-integrated micromotor system yielded a higher immediate ISQ under a standardized 35 N·cm seating torque, whereas the ISQ, removal torque, and BIG at four weeks were comparable to those of the conventional system. The immediate ISQ should be interpreted as stiffness under fixed torque rather than superior device-dependent interlocking. These findings support the clinical interchangeability of the two systems for early osseointegration endpoints in preclinical settings. Full article

Rectal cancer remains a significant clinical challenge due to its complex anatomy and the critical need to balance oncological radicality with functional preservation. Multimodal treatment strategies, including neoadjuvant therapy, advanced endoscopic techniques, and precise surgical approaches, have evolved to optimize patient outcomes. Neoadjuvant chemoradiotherapy improves resectability and local control in locally advanced tumors, while endoscopic treatment offers organ-preserving options for carefully selected early-stage cancers. Surgical resection, primarily through total mesorectal excision (TME), remains the cornerstone of curative therapy, with minimally invasive and transanal approaches enhancing precision and recovery. In advanced and recurrent cases, extended procedures such as pelvic exenteration provide potential for cure despite substantial morbidity. This review summarizes current evidence on the indications, techniques, and outcomes of neoadjuvant, endoscopic, and surgical treatments for rectal cancer, emphasizing individualized treatment planning to achieve optimal oncological and functional results. Full article

Growth arrest-specific protein 6 (GAS6) has an important role in regulating the immune system. Recent studies have revealed its association with the pathophysiology of endometriosis and identified GAS6 as one of the hub genes and a biomarker candidate. Endometriosis is a common chronic inflammatory gynaecological disease of women of childbearing age. Due to surgical diagnosis, non-invasive biomarkers are urgently needed. We investigated GAS6 as a candidate biomarker for the diagnosis of endometriosis. Our case–control study included 284 patients and showed that plasma levels of GAS6 are significantly higher in patients with endometriosis compared to control patients. We calculated logistic regression models using GAS6, CA-125, and GAS6 together with CA-125, and added a series of clinical and lifestyle data collected before surgical diagnosis. A CA-125 model and a model including GAS6 and CA-125 showed the highest AUC values of 0.745 ± 0.04, while the model including CA-125, data on sport/recreation before surgery, and dysmenorrhea score reached an AUC of 0.767 ± 0.04. Our results indicate that GAS6 is increased in patients with endometriosis, but it cannot serve as a biomarker candidate. Full article