Search Results (1,942)

Tooth structure anomalies, though not frequently described, can be observed in the external appearance not only of humans but also of dogs. The emergence of an oversized set of teeth is not solely an esthetic and health problem, but often also leads to behavioral issues. In the commonly available medical literature, there are many cases describing the occurrence and treatment of double teeth, both in the incisors and in the cheek teeth. In this article, the authors describe a clinical case of a one-year-old female Golden Retriever dog diagnosed with a double tooth in her permanent dentition. The complex morphology of the affected tooth posed a considerable diagnostic and therapeutic challenge. Surgical separation of the tooth was performed, requiring an individualized treatment approach and the adaptation of protocols derived primarily from human dentistry. This case highlights the diagnostic and clinical decision-making difficulties associated with such anomalies. It also emphasizes the importance of tailored therapeutic strategies for managing rare dental developmental abnormalities in dogs. The teeth were successfully surgically separated, and thus the present report contributes to the limited body of literature on double teeth in veterinary patients and provides practical insight into their management. This description of the first case of this type in veterinary dentistry aims to encourage readers to explore the topic of double teeth and demonstrates a non-standard way of thinking and dealing with such a tooth. The presented case is unique from both a diagnostic and therapeutic perspective. Previous publications have focused on these abnormalities as separate entities, failing to consider their simultaneous occurrence within a single tooth. The therapeutic approach employed also deserves particular attention. The most commonly recommended approach involves extraction of the affected teeth; however, in this case, an attempt was made to separate and preserve them, representing a novel clinical approach. Full article

Background: Effective communication improves patient satisfaction and reduces stress for both patients and physicians. Surveys consistently highlight the importance of strong communication skills among physicians, especially in oncologic settings. Yet, communication training is neither ubiquitous nor standardized in medical studies or residency, and physicians report that this task represents a burden for them. Given the limited data addressing the observations and expectations of patients with gynecologic malignancies when receiving bad news, this survey aimed to assess their perspective on this topic. Methods: We examined throughout an anonymous questionnaire how patients with gynecological and breast cancer experienced the delivery of bad news. Data were collected in Germany from July 2024 to September 2025. The questionnaire was available online and in paper form in four languages (German, English, Turkish, Arabic), with the purpose of recording culture-specific data. Results: A total of 249 patients completed the survey. Regarding the overall need for improvement in delivering bad news, 222 women (94.5%) declared that improvement was necessary, with 92 (39.1%) of them indicating that substantial improvement was required. While 67.9% of patients were content with the physician’s professional competence, 30.5% stated a lack of empathy, and 32.9% stated insufficient time for conversation. When comparing satisfied and dissatisfied patients, significant differences were observed across several aspects, such as consultation length, nonverbal communication, calmness of the setting, stress level after the conversation, and the offer to bring a trusted person or arrange a follow-up conversation. Conclusions: This patient survey highlights a persistent gap between patients’ expectations and physicians’ performance when it comes to delivering bad news. The findings underline the urgent need for the implementation of systematic training programs and structured communication protocols in gynecologic oncology. Full article

The Eastern Canadian Gastrointestinal Cancer Consensus Conference convened annually and was held in Fredericton, New Brunswick, from 18 to 20 September 2025. Attendees included experts in medical oncology, radiation oncology, nuclear medicine, and general practitioners in oncology (GPO) from across the eastern Canadian provinces who are engaged in the care and management of patients with gastrointestinal malignancies. The consensus statement resulting from this meeting addresses several key topics, including the management of early-stage gastroesophageal junction cancer, recent developments in molecular biomarkers and colorectal cancer treatments, secondary prevention strategies for colorectal cancer, and treatment of hepatocellular carcinoma. Full article

Providing dietary feedback is important for promoting healthy behaviors in weight management, but the rapid development of obesity and the shortage of medical nutrition human resources have limited this health service. The rise of large language models (LLMs) offers the possibility of using artificial intelligence (AI) to simulate the behavior of human dietitians. However, existing studies have only explored LLM performance when generating answers to common nutrition-related questions; the use of LLMs to generate situation-adapted dietary feedback in practical weight management scenarios still needs further research. In this study, we collected dietary records and dietary feedback from primary dietitians through an mHealth weight management application. We conducted topic modeling to generalize how dietitians deliver nutrition guidance in real-world dietary feedback scenarios. Combining the in-context learning capability of LLMs with real-world data, we proposed a synthetic data generation approach (HDI-SDG) and trained an LLM for dietary feedback with the synthetic data (LLMDF-EXP). Experiments on automatic and manual evaluation of LLMDF-EXP and an LLM trained directly with the real-world data as well as generalized LLMs illustrated that LLMDF-EXP performed most similarly to human experts. Notably, there were no significant differences from human experts in terms of professionalism (p-value = 0.510) and usefulness (p-value = 0.498). The study highlights that integrating LLMs with real-world data in health management processes can enhance the situational adaptability of LLMs in practical health management environment applications. Full article

Background/Objectives: Constipation is a common gastrointestinal problem in older adults and is associated with reduced quality of life, functional decline, frailty, and an increased risk of delirium and cognitive impairment. Its pathogenesis is multifactorial, involving age-related changes in gastrointestinal motility, neural regulation, comorbidities, and polypharmacy. However, this condition has traditionally been regarded as a localized gastrointestinal disorder, which may not fully reflect its systemic clinical significance in older populations. While prior narrative reviews have described multifactorial contributors to constipation, none have formally applied a geriatric syndrome framework to integrate these dimensions. This review proposes a three-criterion operational definition—multifactorial pathogenesis, association with functional decline and frailty, and contribution to adverse systemic outcomes—to characterize constipation in older adults as a “systemic geriatric syndrome,” and evaluates available evidence against each criterion. Methods: A narrative literature search was conducted using PubMed to identify relevant studies published between 1 January 2023, and 31 December 2025. MeSH terms included “Constipation” [Major Topic] and “Aged” [MeSH Terms]. Eligible articles included English-language original studies, systematic reviews, and clinical or epidemiological studies involving individuals aged ≥65 years. Results: Diagnosis in older adults is often complicated by secondary causes, including medications and neurological disorders, as well as atypical symptom presentations in individuals with cognitive impairment. Key pathophysiological mechanisms include reductions in interstitial cells of Cajal, impaired smooth muscle contractility, dysfunction of the enteric and autonomic nervous systems, and gut microbiota dysbiosis, which may promote chronic low-grade inflammation. Major contributing factors include physical inactivity, sarcopenia, dehydration, inappropriate defecation posture, and polypharmacy, particularly opioids and anticholinergic agents. Importantly, these factors interact through the brain–gut–microbiota axis, contributing not only to gastrointestinal dysfunction but also to systemic outcomes such as frailty, cognitive decline, and increased healthcare burden, thereby supporting a multidimensional disease framework. Conclusions: The available evidence collectively supports the plausibility of framing constipation in older adults as a systemic geriatric syndrome, though formal validation of this classification requires further longitudinal and mechanistic research. Comprehensive and individualized management strategies, extending beyond simple laxative use, are essential to reduce complications and preserve functional health in aging populations. Further studies are required to validate this framework. Full article

Background/Objectives: To compare the five-year efficacy and safety of the 63 µm (XEN63) vs. 45 µm (XEN45) XEN^® Gel Stent in patients with open-angle glaucoma (OAG). Methods: This retrospective matched (1:1) cohort study included adults with OAG who underwent standalone ab interno implantation of the XEN63 or the XEN45 between 2014 and 2021 at a tertiary referral center in Belgium. The primary outcome was IOP at five years. The secondary outcomes included surgical success, topical medication use, postoperative hypotony, complications and interventions. Results: Thirty eyes of 30 patients (15 XEN63 and 15 XEN45) were analyzed. The baseline characteristics were comparable. At five years, the mean IOP did not differ between the XEN63 and the XEN45 (11.5 vs. 11.0 mmHg; p = 0.54). The XEN63 demonstrated higher complete success rates than the XEN45 for both the IOP < 18 mmHg (10 vs. four eyes; p = 0.016) and <15 mmHg criteria (10 vs. three eyes; p = 0.003). The topical medication use was low and comparable (0.6 vs. 0.9 medications; p = 0.57). The numerical (13 vs. five eyes; p = 0.008) and symptomatic (six vs. two eyes; p = 0.2) hypotony were more frequent after the XEN63 implantation. The two eyes with XEN63 and none with XEN45 experienced clinically significant hypotony. The needling procedures and secondary glaucoma surgeries were more frequent after the XEN45. Conclusions: The XEN63 implantation was associated with higher long-term success rates and also with a higher incidence of early postoperative hypotony. These findings indicate a trade-off between efficacy and safety and suggest that careful patient selection and postoperative management are essential when considering larger lumen subconjunctival drainage devices. Full article

Background: Most penicillin allergy labels are documented in early childhood and result from events of low risk for allergy. In Germany, evidence-based strategies to evaluate the likelihood of a true penicillin allergy are still lacking. As general practitioner input is indispensable regarding required resources for the implementation of successful delabeling strategies in outpatient care, a mixed-methods study in Baden-Württemberg, Germany explored untapped delabeling potential and conditions for successful initiatives based on their experiences, to support preservation of penicillin as a treatment option and prevent resistance development. Methods: A cross-sectional convergent mixed-methods study was conducted with an online survey and semi-structured interviews. The survey link and invitation to participate in an interview was sent to randomly selected publicly available e-mail addresses. Survey data were analyzed descriptively. Qualitative data were analyzed inductively based on thematic analysis. Results: n = 101 survey questionnaires and n = 15 interviews were analyzed regarding relevance, experiences, framework conditions, and potential approaches to delabeling. All participants with limited recollection of the index reaction. Most participants considered delabeling a highly relevant topic in general practice. Delabeling efforts were discouraged by lack of time, expertise, and remuneration, and uncertainty due to missing guidelines. Taking a sufficient medical history and, if necessary, subsequent testing were seen as one approach to delabeling. For a standardized approach in primary care, patient and care provider education, precise guideline recommendations, and delabeling expert teams were suggested. Conclusions: The findings mirror aspects already identified in international research. A nationwide survey with general practitioners could confirm that addressing necessary resources and systemic adjustments would support effective penicillin allergy delabeling in outpatient care. Full article

Upper airway function has received limited attention as a potentially relevant component of respiratory physiology in aquatic athletes. Repeated exposure to chlorinated indoor environments, combined with high ventilatory demand during training, may contribute to the development of chronic irritant rhinitis characterized by nasal obstruction and mucosal hyperreactivity. Although often perceived as a minor inconvenience, increased nasal resistance may influence breathing comfort, perceived exertion, and recovery stability in swimmers and other aquatic athletes. In addition to environmental exposure, the widespread use of topical nasal decongestants may result in rebound congestion and rhinitis medicamentosa, thereby contributing to a self-reinforcing cycle of airway dysfunction. Performance-related pressure and uncertainty related to anti-doping regulations may further shape medication behavior within athletic environments. This narrative review integrates environmental exposure mechanisms, mucosal pathophysiology, and behavioral medication patterns to provide a unified conceptual framework for understanding upper airway dysfunction in aquatic athletes. Particular emphasis is placed on nasal airflow stability as a potentially relevant factor in breathing comfort, sleep quality, and training consistency. Given that the available evidence is predominantly mechanistic and observational, the proposed relationships should be interpreted as hypothesis-generating and translational rather than as evidence of direct causal effects on athletic performance. Full article

Impaired wound healing is a major cause of morbidity among patients with diabetes. Human α1-antitrypsin (hAAT) promotes the resolution of injured tissues. In hyperglycemic conditions, circulating hAAT is likely to undergo glycation, yet it is unknown whether its reparative properties are preserved. We hypothesized that clinical-grade hAAT treatment, but not deliberately glycated hAAT (gly-hAAT), would promote wound repair under hyperglycemic conditions. Mice were rendered hyperglycemic, excisional wounding was performed, and wounds were treated with topical albumin or hAAT every three days. The wound area was assessed, and samples were collected for histology and gene expression analysis. Gly-hAAT was generated from clinical-grade hAAT, after which in vitro RAW 264.7 macrophage responses and re-epithelialization of A549 cells were assessed. Gap closure was further assessed using sera from a human cohort (prospective samples from 10 patients with poorly controlled diabetes at Soroka University Medical Center, Beer-Sheva, Israel, 2018). Group comparisons were performed using one-way ANOVA with Tukey’s post hoc test. hAAT accelerated in vivo wound closure and in vitro A549 cell gap closure, accompanied by an anti-inflammatory IL-1Ra/IL-1β gene expression profile. In contrast, gly-hAAT inhibited normoglycemic mouse wound closure, evoked an inflammatory response in macrophages, and interfered with A549 cell gap closure; concomitant hAAT treatment improved gap closure. Similarly, patient serum inhibited A549 gap closure, and concomitant hAAT treatment improved gap closure. Importantly, inferential statistical analysis was not performed on this outcome due to the small and heterogeneous human cohort. In conclusion, hAAT accelerated wound closure in hyperglycemic mice and in A549 cells, whereas gly-hAAT promoted inflammatory responses and impaired wound closure, a trend reversed by native hAAT. These findings support the concept that glycation undermines the beneficial functions of circulating hAAT and provides a mechanistic insight into the pathophysiology of diabetic wound healing. Further studies are warranted to evaluate clinical-grade hAAT as a potential therapeutic for hyperglycemia-associated impaired wound healing. Full article

Background/Objectives: To evaluate the relationships between meibomian gland dysfunction (MGD), ocular surface parameters, and matrix metalloproteinase-9 (MMP-9)-mediated inflammation in glaucoma patients, we specifically assessed the impact of prostaglandin analogue use, preservative exposure, and number of medications. Methods: This retrospective cross-sectional study included patients treated with topical antiglaucoma medications for at least six months. Meibomian gland expressibility, meibum quality, and MGD grade were assessed along with tear film break-up time (TBUT), Schirmer I test, and Oxford staining score. Tear MMP-9 levels were measured using a Point-of-Care immunoassay (InflammaDry^®) and graded on a 0 to 4 scale. Results: Elevated MMP-9 grades were significantly correlated with worsening meibum expressibility, meibum quality, and MGD grade (all p < 0.001), whereas no significant associations were found with traditional parameters such as TBUT and Schirmer I test. Prostaglandin analogue use was associated with worse meibomian gland parameters and higher MMP-9 levels compared to non-use. Patients receiving preservative-containing medications exhibited poorer meibomian gland parameters and MMP-9 levels, as well as worse corneal staining scores. An increased number of medications was associated with a stepwise deterioration in meibomian gland function and elevated MMP-9 levels. Conclusions: Prostaglandin analogue use, preservative exposure, and increased number of medications are significant factors associated with the exacerbation of MGD and ocular surface inflammation. Semi-quantitative grading of tear MMP-9 revealed a stepwise association with meibomian gland dysfunction severity that was not detected by conventional dry eye metrics, indicating that MMP-9 may be considered a potential indicator of subclinical ocular surface inflammation in glaucoma patients. Full article

Succinic acid (SA) is a naturally occurring dicarboxylic acid with diverse biological roles, including participation in cellular energy metabolism and signaling. Despite its wide industrial use, clinical and in vivo evidence supporting the application of SA in cosmetics, cosmetology, dermatology, and aesthetic medicine remains limited, although mechanistic and experimental studies describing its biological activity are increasingly available. This review summarizes the chemical properties, natural occurrence, and physiological functions of SA, with a focus on its potential in topical and intradermal applications. The use of SA in cosmetic formulations, including personal care products, moisturizers, and masks, is discussed, alongside its emerging roles in the management of acne vulgaris and rosacea, hyperpigmentation, and as a chemical exfoliant and biostimulatory agent. Available studies suggest that SA can modulate inflammation, enhance microcirculation, support fibroblast proliferation, and stimulate collagen and elastin production, although most clinical evidence derives from small-scale or preliminary studies. Looking forward, the growing market and increasing scientific interest indicate a potential expansion of SA-based products in aesthetic dermatology. Further clinical and mechanistic studies are required to validate its applications and establish standardized protocols for its use in cosmetic and medical settings. The aim of this article is to summarize the existing knowledge on the use of succinic acid in cosmetics and aesthetic dermatology. Despite the growing interest in this compound, no comprehensive review addressing its applications in these fields is currently available. Therefore, this work responds to this gap by integrating and discussing the limited but emerging scientific reports concerning the cosmetic and dermatological potential of succinic acid. Full article

The exponential growth of unstructured medical data, particularly clinical notes and diagnostic reports, presents mounting challenges for healthcare knowledge extraction and utilization. This study introduces the Digital Medical Catalog (DMC), a framework that automates the conversion of clinical narratives into an auditable, semantically structured knowledge base. The framework combines BioClinicalBERT embeddings, c-TF-IDF statistical grounding, and semantic clustering, enabling high-fidelity classification (Macro F1 = 0.877 ± 0.012), traceable topic labeling, and temporal trend analysis. By demonstrating that semantic representation methods, reinforced with statistical grounding, are essential for large-scale medical text processing, this work establishes a foundation for privacy-preserving data governance and real-time intelligence within modern healthcare infrastructures. Full article

Background: While large language models (LLMs) have demonstrated proficiency in medical examinations, their comparative performance on European gastroenterology assessments remains underexplored, particularly regarding architectural differences between reasoning and non-reasoning models. This study benchmarks five state-of-the-art LLMs—DeepSeek-R1, ChatGPT-o1, ChatGPT-4o, Gemini-1.5-Pro, and Llama-3.1-405B (All versions January 2025)—using 203 board-style questions from validated ESEGH preparation materials. Methods: Questions from two commercial ESEGH preparation banks were administered five times per model using standardized prompts. Accuracy, consistency, and domain-specific performance across clinical, diagnostic, and therapeutic questions were analyzed. Four practicing gastroenterologists validated human performance under uniform conditions. Results: ChatGPT-o1 achieved the highest overall accuracy at 84.0% (95% CI: 81.8–86.3), followed closely by ChatGPT-4o (81.7%), DeepSeek-R1 (79.0%), and Llama-3.1-405B (77.2%), while Gemini-1.5-Pro significantly underperformed with 68.5% accuracy (difference vs. ChatGPT-o1: 15.5 percentage points, 95% CI: 11.9 to 19.1, p < 0.01). Although all models exhibited high internal consistency ≥98.4% average agreement across repeated attempts, with 94.6–98.0% of questions answered identically in all five attempts), greater consistency did not necessarily correspond to higher accuracy. Domain-specific analysis revealed that diagnostic questions were answered most accurately, whereas clinical examination questions posed considerable challenges. Topic analysis demonstrated that questions on small intestine disorders were answered with the highest accuracy, in contrast to the lower performance observed in bariatric and pancreatic disorders. Notably, reasoning models, which employed explicit chain-of-thought strategies, outperformed non-reasoning counterparts (81.5% vs. 75.8%, difference: 5.7 percentage points, 95% CI: 3.4 to 8.0, p < 0.001), particularly on therapy questions and complex bait-and-switch formats. Practicing gastroenterologists achieved substantially lower accuracy (mean: 50.9%, range: 37.9–69.0%) compared to all LLMs. All models exceeded the current ESEGH passing threshold of 61.5%, with the top four models surpassing this benchmark by 15.7–22.5 percentage points. Conclusions: This benchmarking study demonstrates that current LLMs, particularly those with reasoning architectures, achieve high accuracy on European gastroenterology board-style questions. However, significant performance gaps in specific domains highlight limitations that must be addressed before clinical application. These findings provide a baseline for evaluating LLM capabilities in European medical contexts. Full article

Background: Despite the general interest in WPV against healthcare workers, there is evidence that this topic has comparatively fewer studies conducted in the context of community settings than in hospital settings. Given the current general transition of care from hospital to community, this study aims to analyze whether community settings present different characteristics in comparison with hospital settings on this topic in Italy. Methods: A retrospective observational study was conducted from 2020 to 2024 on aggressions reported by HCWs in hospitals and community settings belonging to a Local Health Authority of Turin in Piedmont. For physical and non-physical aggressions, a monthly time trend series was constructed. A Mantel–Haenszel fixed-effect meta-analysis was performed to obtain the odds ratio (OR) in two settings. Variables relative to aggressions included the gender of victims, their professional category (medical doctors, nurses, other HCWs), the type and gender of perpetrators (relative, patient, or unknown person), age groups of perpetrators (under 30, 30–49, ≥50), the nature of aggression (physical, non-physical), recidivism, involvement of law enforcement, and time of occurrence (morning, afternoon, or evening/night). Events within hospitals were further classified into emergency department, psychiatric ward, and other wards, while events within community settings were classified as drug addiction service units (serDs), long-term care (including specialist outpatient services, home services, and nursing homes) (LTC), mental health centres, and penitentiary assistance. Results: The results highlighted that fewer WPV incidents were reported in community settings than in hospital settings, even though reported incidents showed a more pronounced increase over time. Differences were observed in a few characteristics of WPV (age classes of aggressors, recidivism, time of aggression, profession of the assaulted worker, and specific location). Only the gender of the assaulted (female workers) (OR = 3.11, 95% CI: 1.27–7.61; p = 0.013; OR = 0.32, 95% CI: 0.13–0.79; p = 0.013 for non-physical and physical violence, respectively, compared to male workers) was identified as a specific risk factor for community settings. Conclusions: Modern health systems are experiencing a transition from hospital-centred to community-centred care settings. This study suggested that WPV is a significant concern, even outside the hospital. Community-based services often involve direct interaction with frail and chronically ill patients and their caregivers, as well as care delivery in diverse and sometimes less controlled environments, which may influence exposure to aggressive behaviours. The identification of setting-specific risk patterns in both hospital and community contexts provides valuable insights into workplace violence and may support the planning and implementation of targeted interventions aimed at mitigating the frequency and burden of WPV. Full article

Background: Chronic diabetic wounds represent substantial issues in healthcare due to their poor healing rate and susceptibility to hyperglycemia, infections, and other serious consequences. Methods: In this work, we developed a Medicated Topical Gel (MTG) that promotes healing of diabetic wounds. The MTG’s distinctive qualities, including biocompatibility, stability, affordability, cost-effectiveness, and non-toxicity, were evaluated in a dermal toxicity assessment as well as a diabetic wound assay from 0 to the 24th day of the study. Results: MTG treatment significantly accelerated wound closure compared with other formulations. In vivo studies revealed that diabetic wounds in the rat model healed more rapidly within the 24-day study period when treated with MTG. Western blot analysis revealed a significant decrease in pro-inflammatory markers, accompanied by enhanced angiogenesis, which was further confirmed by histopathological observations. These findings indicate that MTG effectively promotes faster wound healing by modulating inflammation and stimulating blood vessel formation. Furthermore, clinical cases have demonstrated substantial wound healing, with most cases showing significant recovery on follow-up intervals at 15th and 30th day. Conclusions: Our findings demonstrate a strong evidence-based therapeutic potential of MTG as an effective treatment for chronic diabetic wounds healing. They also provide a promising strategy for wound management in both the experimental and clinical case studies. Full article