Search Results (1,052)

Background and Objectives: There is a global rise of public interest in integrative medicine. The principles of integrative medicine combining conventional medicine with evidence-based complementary therapies have been implemented in many medical areas, including plastic surgery, to improve patient’s outcome. The aim of the present study was to systematically analyze the application and use of additional non-pharmacological interventions (NPIs) of patients of a German department of plastic surgery. Materials and Methods: The present real-world data study utilized data from the Network Oncology registry between 2016 and 2021. Patients included in this study were at the age of 18 or above, stayed at the department of plastic surgery and received at least one plastic surgical procedure. Adjusted multivariable logistic regression analyses were performed to detect associations between the acceptance of NPIs and predicting factors such as age, gender, year of admission, or length of hospital stay. Results: In total, 265 patients were enrolled in the study between January 2016 and December 2021 with a median age of 65 years (IQR: 52–80) and a male/female ratio of 0.77. Most of the patients received reconstructive surgery (90.19%), followed by hand surgery (5.68%) and aesthetic surgery (2.64%). In total, 42.5% of the enrolled patients accepted and applied NPIs. Physiotherapy, rhythmical embrocations, and compresses were the most often administered NPIs. Conclusions: This exploratory analysis provides a descriptive overview of the application and acceptance of NPIs in plastic surgery patients within a German integrative care setting. While NPIs appear to be well accepted by a subset of patients, further prospective studies are needed to evaluate their impact on clinical outcomes such as postoperative recovery, pain management, patient-reported quality of life, and overall satisfaction with care. Full article

Attentional biases seem to play an important role in anorexia nervosa (AN). The objective of this study was to measure visual attention patterns toward female bodies in adolescents and adults with and without AN in order to explore developmental and disease-specific aspects. Female adult and adolescent patients with AN (n = 38) and control participants (n = 39) viewed standardized photographic stimuli showing women’s bodies from five BMI categories. The fixation times on the bodies and specific body parts were analyzed. Differences between participants with and without AN did not emerge: All participants showed increased attention toward the body, while adolescents displayed shorter fixation times on specific areas of the body than adults. Increased visual attention toward areas indicative of weight (e.g., hips, thighs, abdomen, buttocks) and a shorter fixation time on unclothed body parts were observed in all participants. There is evidence for the developmental effect of differential viewing patterns when looking at women’s bodies. The attention behavior of patients with AN seems to be similar to that of the control groups, which is partly consistent with, and partly contradictory to, previous studies. Full article

In this work, the electrospinning technique was used to prepare novel polymeric composite fibers containing Te-doped bioactive glass powders. Bioactive glass powders containing tellurium (STe5 glass) were chosen as fillers for the composites, owing to their bioactive, antibacterial, and antioxidant properties. The biopolymer poly (ϵ-caprolactone) (PCL) and acetic acid (AA) were used as raw materials for the preparation of the polymeric matrix. FESEM analysis confirmed a good incorporation of the glass powders in the polymeric fibers, of up to 20% by weight. Wettability, mechanical, in vitro stability and preliminary antibacterial tests were also performed. The results showed that the treatment in AA did not affect the bioactivity of the glass powders, the presence of STe5 powders in PCL enhanced the wettability of the fibers, and mechanical properties improved by increasing the amount of STe5 powders, as well as the antibacterial effect. Therefore, the obtained materials appear promising for developing multifunctional composite materials for applications in tissue engineering. Full article

The effective suppression of inflammation using disease-modifying therapies is essential in the treatment of multiple sclerosis (MS). Anti-CD20 monoclonal antibodies are commonly used long-term as maintenance therapies, largely due to the lack of reliable biomarkers to guide dosing and evaluate treatment response. However, prolonged use increases the risk of infections and other immune-mediated side effects. The unique ability of brain-derived blood extracellular vesicles (EVs) to cross the blood–brain barrier and reflect the central nervous system (CNS) immune status has sparked interest in their potential as biomarkers. This study aimed to assess whether blood-derived L1CAM⁺ EVs could serve as biomarkers of treatment response to rituximab (RTX) in patients with relapsing-remitting MS (RRMS). Serum samples (n = 25) from the baseline (month 0) and after 6 months were analyzed from the RTX arm of the ongoing randomized clinical trial OVERLORD-MS (comparing anti-CD20 therapies in RRMS patients) and were compared with serum samples from healthy controls (n = 15). Baseline cerebrospinal fluid (CSF) samples from the same study cohort were also included. EVs from both serum and CSF samples were characterized, considering morphology, size, and concentration, using transmission electron microscopy (TEM) and nanoparticle tracking analysis (NTA). The immunophenotyping of EV surface receptors was performed using flow cytometry with the MACSPlex exosome kit, while label-free quantitative proteomics of EV protein cargo was conducted using a proximity extension assay (PEA). TEM confirmed the presence of EVs with the expected round morphology with a diameter of 50–150 nm. NTA showed significantly higher concentrations of L1CAM⁺ EVs (p < 0.0001) in serum total EVs and EBNA1⁺ EVs (p < 0.01) in serum L1CAM⁺ EVs at baseline (untreated) compared to in healthy controls. After six months of RTX therapy, there was a significant reduction in L1CAM⁺ EV concentration (p < 0.0001) and the downregulation of TNFRSF13B (p = 0.0004; FC = −0.49) in serum total EVs. Additionally, non-significant changes were observed in CD79B and CCL2 levels in serum L1CAM⁺ EVs at baseline compared to in controls and after six months of RTX therapy. In conclusion, L1CAM⁺ EVs in serum showed distinct immunological profiles before and after rituximab treatment, underscoring their potential as dynamic biomarkers for individualized anti-CD20 therapy in MS. Full article

Background/Objectives: Enzymatic debridement with NexoBrid^® is an effective alternative to surgical debridement in burn care, but its potential systemic effects remain unclear. In the context of personalized burn care, understanding individual patient responses to topical agents is essential to optimize outcomes and minimize risks. This study aimed to characterize laboratory and clinical parameter changes following NexoBrid^® application in patients with small burn injuries (≤10% TBSA). Methods: We retrospectively analyzed 75 burn patients treated with NexoBrid^® to evaluate changes in systemic inflammatory markers, coagulation parameters, and clinical parameters before and after enzymatic debridement. Results: Statistically significant increases in body temperature (p = 0.018), decreases in hemoglobin (p < 0.001), and increases in C-reactive protein (CRP) levels (p < 0.001) were observed, suggesting mild systemic inflammatory changes. However, leukocyte counts did not change significantly (p = 0.927), and body temperature remained within the normothermic range, indicating that these changes were not clinically significant. A significant decrease in the prothrombin time ratio (% of normal; p = 0.002) was also observed, suggesting potential impacts on coagulation. Importantly, while body temperature was slightly higher in patients with a higher degree of BSA exposure within the ≤10% TBSA cohort (p = 0.036), the extent of NexoBrid^® application did not correlate with other inflammatory markers. Conclusions: These findings suggest that measurable systemic changes can occur following NexoBrid^® application in small burns, particularly affecting inflammatory and coagulation parameters. These observations contribute to the understanding of treatment-related responses and may help inform clinical decision-making. Full article

Background/Objective: Bridging stent optimal choice in fenestrated and branched endovascular aortic repair (f/bEVAR) is under investigation. This systematic review and meta-analysis studied the outcomes of the BeGraft peripheral and peripheral PLUS as bridging stents in f/bEVAR. Methods: The methodology was pre-registered to the PROSPERO (CRD420251007695). Following the PRISMA guidelines and PICO model, the PubMed, Cochrane and Embase databases were searched for observational studies and randomized control trials, in English, from 2015 to 2025, reporting on f/bEVAR patients using the second-generation BeGraft peripheral or the BeGraft peripheral PLUS balloon expandable covered stent (BECS; Bentley InnoMed, Hechingen, Germany) for bridging. The ROBINS-I assessed the risk of bias and GRADE the quality of evidence. Target vessel technical success, occlusion/stenosis, endoleak Ic/IIIc, reintervention and instability during follow-up were primary outcomes, assessed using proportional meta-analysis. Results: Among 1266 studies, eight were included (1986 target vessels; 1791 bridged via BeGraft); all retrospective, except one. The ROBINS-I showed that seven were at serious risk of bias. According to GRADE, the quality of evidence was “very low” for primary outcomes. Target vessel technical success was 99% (95% CI 98–100%; I² = 12%). The mean follow-up was 20.2 months. Target-vessel instability was 3% (95% CI 2–5%; I² = 44%), occlusion/stenosis was 1% (95% CI 1–4%; I² = 8%) and endoleak Ic/IIIc was 1% (95% CI 0–3%; I² = 0%). The estimated target-vessel reintervention was 2% (95% CI 2–4%; I² = 12%). Celiac trunk, superior mesenteric and renal artery instability were 1% (95% CI 0–16%; I² = 0%;), 1% (95% CI 0–5%; I² = 14%) and 4% (95% CI 2–7%; I² = 40%), respectively. Conclusions: The BeGraft peripheral and peripheral PLUS BECS performed with high technical success and low instability when used for bridging in f/bEVAR. Cautious interpretation is required due to the very low quality of evidence. Full article

As digital transformation progresses, schools are increasingly confronted with psychosocial challenges such as technostress, digital overload, and unequal participation in digital (learning) environments. This article investigates the conceptual relevance of digital well-being for school development, particularly in relation to social inequality. Despite growing attention, the term remains theoretically underdefined in educational research—a gap addressed through a theory-driven review. Drawing on a systematic search, 25 key studies were analyzed for their conceptual understanding and refinement of digital well-being, with a focus on educational relevance. Findings suggest that digital well-being constitutes a multidimensional state shaped by individual, media-related, and socio-structural factors. It emerges when individuals are able to successfully manage the demands of digital environments and is closely linked to digital inequality—particularly in terms of access, usage practices, and the resulting opportunities for participation and health promotion. Since the institutional role of schools has thus far received limited attention, this article shifts the focus toward schools as key arenas for negotiating digital norms and practices and calls for an equity-sensitive and health-conscious perspective on school development in the context of digitalization. In doing so, digital well-being is repositioned as a pedagogical cross-cutting issue that requires coordinated efforts across all levels of the education system, highlighting that equitable digital transformation in schools depends on a critical reflection of power asymmetries within society and educational institutions. The article concludes by advocating for the systematic integration of digital well-being into school development processes as a way to support inclusive digital participation and to foster a health-oriented digital school culture. Full article

Material wear significantly impacts the clinical success and longevity of dental ceramic restorations. This in vivo study aimed to assess the wear behavior of IPS Empress^® glass-ceramic inlays and onlays over 14 years, considering the influence of different antagonist materials. Fifty-four indirect restorations of 21 patients were available for comprehensive wear analysis, with complete follow-up data for up to 14 years. Three-dimensional measurements relied on digitized epoxy resin models produced immediately post-insertion (baseline) and subsequently at 2, 4, and 14 years. The occlusal region on the baseline model was delineated for comparative analysis. Three-dimensional superimpositions with models from subsequent time points were executed to assess wear in terms of average linear wear and volumetric loss. Statistical analyses were conducted in R (version 4.4.1), employing Mann–Whitney U tests (material comparisons) and Wilcoxon signed rank tests (time point comparisons), with a significance threshold of p ≤ 0.05. During the entire study period, an increase in wear was observed at each assessment interval, gradually stabilizing over time. Significant differences in substance loss were found between the follow-up time points, both for mean (−0.536 ± 0.249 mm after 14a) and integrated distance (−18,935 ± 11,711 mm³ after 14a). In addition, significantly higher wear was observed after 14 years with gold as antagonist compared to other materials (p ≤ 0.03). The wear behavior of IPS Empress^® ceramics demonstrates clinically acceptable long-term outcomes, with abrasion characteristics exhibiting stabilization over time. Full article

Objectives: The relationship between oral health and general health of geriatric in-hospital patients (GIH) who are poly-morbid and edentulous is currently unclear. This study determined the relationship between oral health and general health, and further implications and recommendations were derived. Methods: This retrospective cohort study included 81 GIH patients with impairment of oral state and masticatory function and need for immediate prosthetic treatment. The number of medical diagnoses, particularly main diagnoses of being hospitalized, comorbid diagnoses and the dental/oral state, were evaluated. Laboratory data of vitamin D3 and albumin concentrations were measured. Intraoral risk factors (IRF) affecting the masticatory function were intraoral inflammation, mucogingival impairment (MGI) and severe bone crest atrophy (SBCA). Masticatory function was evaluated by DMF*-T Index (number of destroyed/diseased, missing teeth and artificial fabrication), Eichner Index and Scores. The clinical relevance was surveyed by significance and effect size calculations. Results: In GIH, the number of medical diagnoses correlated significantly with the occurrence of IRFs. SBCA was the most affecting IRF, as measured by Eichner Index at baseline (p = 0.001). Single main diagnoses CNS and gastro-intestinal disease (GID) correlated with both deficiency of vitamin D3 levels (p = 0.011; p = 0.028) and hypoalbuminemia (p = 0.013; p = 0.023). Single comorbid diagnoses significantly correlated with both vitamin D3 deficiency and hypoalbuminemia (CVD (p = 0.031); DM (p = 0.042). Hypoalbuminemia was further found to be correlated with the sum of comorbid diagnoses (p = 0.033). Conclusions: GIH patients suffered from general and dental poly-morbidity. The prevalence of diseases was higher due to SBCA and impaired masticatory function. Deficiency of vitamin D3 and hypoalbuminemia were possible malnutrition markers. Full article

Pre-eclampsia (PE) is a hypertensive pregnancy complication. Oxidative stress is hypothesized to contribute to the pathophysiology of PE. Both the hydrogen sulfide (H₂S) and oxytocin (OT) systems might play a role in the pathophysiology of PE, like their antioxidant and hypotensive effects. Thus, the role of the interaction of the OT and H₂S systems in the context of PE was further elucidated in the present clinical case–control study “NU-HOPE” (Nürnberg-Ulm: The role of H₂S and Oxytocin Receptor in Pre-Eclampsia; ethical approval by the Landesärztekammer Bayern, file number 19033, 29 August 2019), comparing uncomplicated pregnancies, early onset PE (ePE, onset < 34 weeks gestational age) and late onset PE (lPE, onset > 34 weeks gestational age). Routine clinical data, serum H₂S and homocysteine levels, and tissue protein expression, as well as nitrotyrosine formation, were determined. The main findings were (i) unchanged plasma sulfide levels, (ii) significantly elevated homocysteine levels in ePE, but not lPE, (iii) significantly elevated expression of H₂S enzymes and OT receptor in the placenta in lPE, and (iv) significantly elevated nitrotyrosine formation in the lPE myometrium. Taken together, these findings suggest a role for the interaction of the endogenous H₂S- and OT/OTR systems in the pathophysiology of pre-eclampsia, possibly linked to impaired antioxidant protection. Full article

Background/Objectives: Patients with normal sinus rhythms undergoing cardiac resynchronization therapy defibrillator (CRT-D) implantation may benefit from a novel two-lead CRT-D system (CRT-DX), which features an atrial sensing dipole integrated into the right ventricular lead. This single-arm, international, non-controlled investigation focused on the safety and clinical efficacy of CRT-DX devices in CRT-D candidates who do not require atrial pacing. Methods: Patients indicated for CRT-D implantation (resting heart rates > 40 bpm and ≥100 bpm during exercise, no second or higher-degree AV block, and no history of persistent or permanent atrial fibrillation) were enrolled across 21 sites in four European countries. The primary endpoint was the need for an additional RA lead implantation within 12 months. Secondary endpoints comprised any invasive re-intervention to the CRT-DX system or infection. Results: Among the 110 patients (mean age 62 years, 70% male), 60% had an underlying non-ischemic cardiac disease. During 12 months of follow-up, RA lead implantation was required in two patients for atrial undersensing or chronotropic incompetence (RA lead implantation-free rate: 98.2% (95% CI: 92.7–99.5%)). Atrial sensing amplitudes were stable (mean: 4.7 ± 1.7 mV), AV-synchrony was maintained at >99%, and the median percentage of biventricular pacing exceeded 98%. The left ventricular ejection fraction improved by an absolute 14.7%. Conclusions: Using simple, clinically applicable inclusion criteria, the two-lead CRT-DX system demonstrated a low rate of subsequent RA lead implantations (1.8%) and maintained adequate RA sensing amplitudes throughout the observation period. The two-lead CRT-DX concept appears to be a feasible alternative for patients with preserved chronotropic competence. Full article

Thermal management reveals an increasing importance due to the changing demands in terms of the compactness and the performance of electronic devise. Polymers in general and thermosets specifically depict a low thermal conductivity, where filler systems are needed to improve performance and make polymers suitable for certain applications. So far, different influencing factors in terms of improving the thermal conductivity in thermosets, mainly through the use of single-filler systems, have been investigated in. To some extent, hybrid filler systems have been examined as well; however, the behavior itself in terms of the thermal conductivity as well as the mechanical properties is rather unknown. In terms of the applications, it is essential to understand the correlation between the thermal conductivity and the mechanical properties as this is the fundamental requirement to realize a proper dimensioning of samples in applications. Therefore, this paper investigates hybrid filler systems based on boron nitride (BN) and three different second fillers with varying ratios and in terms of both the improvement of the thermal conductivity and the mechanical properties. Copper (Cu) was shown to reach the best compromise within the hybrid materials. Furthermore, criteria of an improved thermal flow path and sufficient mechanical properties have been stated in general. Full article

Cancer remains one of the leading causes of death worldwide. New treatments like immunotherapy—especially checkpoint inhibitors and CAR-T cell therapy—have improved outcomes for some patients. However, these therapies often struggle to treat solid tumours effectively. Natural killer (NK) cells are part of the immune system and can naturally detect and destroy cancer cells without previous adaption. Scientists are now enhancing these cells by adding special receptors, called CARs (chimeric antigen receptors), to help them better recognize and attack cancer, an approach originally developed for T cells. CAR-NK cell therapy has some advantages over CAR-T therapy. It tends to cause fewer severe side effects, such as strong immune reactions or off-target effects in healthy tissues. Within some limitations, the allogenic use of CAR-NK cells is possible, as these cells exert less graft-versus-host activity. Such CAR-NK cell products can be produced in larger quantities and stored, making treatment more accessible. Still, there are challenges. It can be difficult to create enough modified NK cells, and the tumour microenvironment can block their activity. This review highlights recent progress in CAR-NK therapy, including early lab and clinical research. It also explores ways to improve these treatments and how they might work alongside other cancer therapies to help more patients in the future. Full article

The transition from hospital-based palliative care to home care is a critical phase often marked by logistical, medical, and emotional challenges. Effective discharge planning is essential to ensure continuity of care, yet gaps in communication, interdisciplinary coordination, and access to resources frequently hinder this process. This qualitative study explored key barriers, related support needs, and strategies for optimising palliative care discharge through semi-structured interviews with 28 participants, including healthcare professionals, recently discharged palliative care patients, and primary caregivers. Reflexive thematic analysis revealed five main themes: (1) discharge planning and coordination; (2) symptom management and medication; (3) psychosocial support; (4) communication and information; (5) the role of assistive devices and home care services. Discharge processes were often late or unstructured. Poor interdisciplinary collaboration and a lack of caregiver preparation also contributed to hospital readmissions and emotional distress. By focusing on needs, our analysis identifies not only what was lacking but also what is required to overcome these barriers. Our findings suggest that standardised discharge protocols and checklists, earlier planning, structured communication tools, and improved integration of home care services could enhance patient outcomes and reduce caregiver burden. Addressing psychosocial needs and ensuring timely access to assistive devices are also crucial. Strengthening interdisciplinary collaboration and refining discharge practices can facilitate smoother transitions and improve the quality of palliative care at home. Full article

Context plays a critical role in talent development, yet most national analyses continue to rely on individual-centered talent concepts. This paper highlights the limitations of traditional models for assessing how countries support talent and proposes a resource-oriented, systemic alternative. Building on the Educational and Learning Capital Approach (ELCA), this study argues that national talent development depends on the availability, accessibility, and orchestration of both endogenous and exogenous learning resources across systemic levels. By analyzing the clumping patterns of excellence in STEM, the arts, sports, and innovation, this paper illustrates the unequal global distribution of talent-supportive environments. Seven key principles for effective resource orchestration are outlined, offering a framework for evaluating and strengthening national talent ecosystems. The paper concludes that systematic assessment and strategic enhancement of national resource landscapes are critical for sustainable talent development and for ensuring that human potential can flourish more equitably across countries. Full article