Search Results (48,420)

Background: Rehabilitation of the severely atrophic maxilla remains a major challenge in implant dentistry, particularly when conventional endosseous implants and regenerative procedures are contraindicated due to extensive bone loss, sinus pathology, or patient-related factors. Advances in digital planning and additive manufacturing have enabled the reintroduction of juxta-osseous subperiosteal implants as a graftless, patient-specific treatment option. This case report aimed to describe the complete digital workflow, surgical placement, and immediate prosthetic rehabilitation of a customized juxta-osseous subperiosteal implant in a patient with severe posterior maxillary atrophy and a history of failed sinus augmentation procedures. Case Presentation: A 75-year-old male patient presenting with left severe posterior maxillary atrophy and previous unsuccessful sinus lift surgeries was rehabilitated using a digitally designed, additively manufactured titanium subperiosteal implant. Cone-beam computed tomography–based planning and CAD–CAM technology were used to design a patient-specific framework, which was rigidly fixed to stable maxillofacial support and immediately loaded with a screw-retained provisional prosthesis. Results: Clinical and radiographic follow-up demonstrated stable implant fixation, soft tissue healing, absence of biological or mechanical complications, and satisfactory functional and aesthetic outcomes. The patient reported high levels of comfort and satisfaction throughout the treatment period. Conclusions: Digitally manufactured juxta-osseous subperiosteal implants may represent a predictable and minimally invasive graftless alternative for selected patients with severe maxillary atrophy, particularly when conventional implant placement or extensive bone augmentation is not feasible. Accurate digital planning, rigid fixation, and appropriate patient selection appear to be key factors for clinical success. Full article

Glass fiber reinforced polymers (GFRPs) have drawn significant attention given their lightweight, mechanical resistance and tunable properties through constituent selection. Due to environmental concerns, research efforts have focused on incorporating sustainable materials, such as bio-epoxy resins, to reduce the ecological impact of GFRPs. This study characterizes a GFRP containing a bio-epoxy resin matrix, various loadings of titanium dioxide (TiO₂) nanoparticles, and a stabilized arrangement of glass fiber. The unreinforced composite exhibited a tensile strength and modulus of 214 MPa, and 13 GPa, respectively, and a flexural strength and modulus of 375 MPa and 14.5 GPa, respectively. The addition of TiO₂ produced an improvement in mechanical response for all the composites. The formulation with 1 wt.% TiO₂ showed the best tensile response with an improvement of 13% and 14% for its tensile strength, and modulus, respectively; meanwhile, the composites with 2 wt.% TiO₂ attained an improvement of 19% and 40% for the flexural strength and modulus, respectively. Scanning electron microscopy (SEM) revealed significant changes in the fracture mechanism of the composites, while energy-dispersive spectroscopy (EDS) confirmed an even nanoparticle distribution. Additionally, machine learning (ML) models were developed to predict the mechanical response as a function of the TiO₂ content. Full article

This second part of this expert panel review explores the broader impact of vaccines across the lifespan, emphasizing their role beyond immediate infection control. Vaccines not only extend life expectancy but also influence long-term health trajectories, particularly during the critical first 1000 days of life, where they prevent severe infections, disability, and mortality. They contribute to cancer prevention through vaccination against human papillomavirus and hepatitis B, reduce cardiovascular events and complications in individuals with chronic diseases, and protect against late-life functional decline. Furthermore, vaccines exert lasting effects on healthy aging by modulating inflammation and preserving independence, while proposed vaccination schemes illustrate the need for a comprehensive, life-course approach. Together with Part 1, which focused on immunosenescence and immune modulation, this closing installment underscores vaccination as a cornerstone of sustainable health policy, reinforcing its pivotal role in extending both lifespan and healthspan for future generations. Full article

Physical and competitive environments play an important role in shaping athletes’ psychological development, motivation, and long-term engagement in sport. Guided by the Personal Assets Framework, this study examined basketball athletes’ perceptions of the quality of facilities and material resources across developmental stages and explored how these environments influenced developmental experiences and continuity in youth sport. A mixed-methods sequential explanatory design was employed. Quantitative data were collected from Brazilian basketball athletes aged 18–19 years (n = 141), followed by semi-structured interviews with 24 athletes. Distributional differences were explored using Kruskal–Wallis tests and associations using chi-square tests, while qualitative data were analysed through thematic analysis. Results indicated that both public and private gyms were commonly used practice settings; however, private facilities were consistently perceived as offering superior structural conditions and material resources, particularly from early adolescence onward. Although physical environments were largely perceived as non-limiting during childhood, their influence on psychological development, motivation, and perceived developmental opportunities became progressively more salient with age. Overall, the findings highlight the importance of adequate physical and competitive environments as key contextual components of athlete development, suggesting that long-term participation in youth sport is strongly influenced by the contexts in which athletes are embedded. Full article

Multiple sclerosis (MS) is characterized by progressive mitochondrial dysfunction affecting complexes I, III, and IV of the electron transport chain, contributing to axonal energy failure and neurodegeneration. This review examines the potential of combining β-hydroxybutyrate (βHB), epigallocatechin-3-gallate (EGCG), and ellagic acid (EA) as a multi-target therapeutic strategy to restore mitochondrial function in patients with MS. Experimental and clinical studies demonstrate that each compound exerts complementary mechanisms. Ketone bodies provide an alternative energy substrate and restore complex I activity via sirtuin-dependent pathways. EGCG acts predominantly at the peripheral level by reducing systemic inflammation and oxidative stress. EA-derived urolithins effectively cross the blood–brain barrier to directly enhance mitochondrial biogenesis and respiratory chain function in the central nervous system. Clinical trials have reported improvements in fatigue, cognition, mood, and muscle function following supplementation with these compounds. The convergence of their actions on energy restoration, reactive oxygen species reduction, and epigenetic modulation of protective pathways suggests their synergistic potential. Optimized delivery strategies, including exogenous ketone salts, liposomal EGCG, and microencapsulated EA, may overcome bioavailability limitations and interindividual variability in the gut microbiota metabolism. Full article

Objectives: The general objective of the study was to analyze the influence of sociodemographic factors and care and hygiene practices on the appearance of Incontinence-Associated Dermatitis (IAD). The specific objectives were to identify the relationship between sociodemographic variables (age, sex, comorbidities) and the incidence of IAD, and to evaluate hygiene protocols (cleaning products and absorbent use and practices) and compare time to IAD onset according to the hygiene practices used. Methods: A multicenter, prospective cohort study was conducted across 10 social health centers. The study population consisted of older institutionalized patients with urinary and/or mixed incontinence who used absorbents continuously. The variables included risk assessment using validated scales, such as the Braden scale and the Perianal Assessment Tool (PAT), as well as ad hoc questionnaires. Survival analysis of time-to-event onset was assessed using the Kaplan–Meier curve and the Log-Rank test. Results: A statistically significant association was found between the occurrence of IAD and the Braden scale (p = 0.004) and the PAT scale (p = 0.02). However, no statistically significant association was found with age, sex, or the Barthel Index. Regarding hygiene, soapy wipes were associated with the highest incidence of IAD. In contrast, dry wipes were the most effective, with the lowest cumulative risk and the longest time-to-event (p = 0.001). The brand of the absorbent used had a significant influence (p = 0.024), suggesting that the “B” brand prevented one IAD per six patients compared with the “A” brand. The frequency of absorbent changes did not show a statistically significant association. Conclusions: The risk of developing IAD was strongly linked to the scores of the Braden and PAT scales, the brand of the absorbent (“B” being more effective), and the cleaning product used, with dry wipes being the most protective compared to soapy wipes. On the other hand, factors such as age, sex, degree of dependence (Barthel), or frequency of absorbent change did not show a significant influence on the appearance of IAD. Full article

Background: The role of transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) management has evolved over recent years. Although it appears that the overall number of procedures is declining, international guidelines now endorse TACE beyond the Barcelona Clinic Liver Cancer (BCLC) intermediate stage, and multiple TACE platforms allow patient-tailored treatments. In this context, degradable starch microspheres TACE (DSM-TACE) may be valuable when the goal is to preserve liver function and spare healthy parenchyma. This study reports multicenter retrospective Italian data to assess the efficacy and safety of DSM-TACE with EmboCept^® in patients with early-to advanced-stage HCC, and to evaluate whether procedural selectivity (superselective vs. lobar) influences outcomes. Methods: This retrospective multicenter study included 201 patients initially; after applying exclusion criteria, 187 patients (334 HCC nodules) treated across eight centers (2014–2024) were analyzed. Treatment indications were discussed in multidisciplinary tumor boards in all centers. Superselective DSM-TACE was performed in 48 patients (66 nodules, 19.8%), while 139 patients (268 nodules, 80.2%) underwent a lobar approach. Repeated sessions were performed on demand and recorded for lobar treatments. Tumor response was assessed using mRECIST criteria at 1, 3–6, 6–9, and 9–12 months; adverse events were classified according to the Common Terminology Criteria for Adverse Events (CTCAE). efficacy and safety outcomes were compared according to the DSM-TACE approach. Results: In terms of safety, analysis confirmed the overall good tolerability of DSM-TACE, with no grade ≥ 3 adverse events and no major complications or procedure-related deaths. No significant differences were observed in post-embolization syndrome (PES) rates between groups. With regard to efficacy, for the entire cohort, the overall response rate (ORR) was 70% at 1 month, 31.6% at 3–6 months, 20.5% at 6–9 months, and 13.5% at 9–12 months, while the disease control rate (DCR) was 91.4% at 1 month, 69% at 3–6 months, 38.6% at 6–9 months, and 27% at 9–12 months. At intermediate follow-up, superselective DSM-TACE achieved higher ORR than lobar treatment at 3–6 months (53.8% vs. 26.4%; p = 0.009) and 6–9 months (43.8% vs. 15.3%; p = 0.009). Per-nodule analysis confirmed this advantage at 3–6 months (ORR = 66.7% vs. 31.3%; p = 0.0008). Conclusions: DSM-TACE with EmboCept^® provides favorable tumor control and a good safety profile in routine clinical practice. A superselective approach is associated with improved response at intermediate follow-up compared with lobar strategy, supporting DSM-TACE as a flexible therapeutic option for localized HCC. Full article

Background/Objectives: The labial frenum is a variable oral structure with potential impacts on infant feeding, speech development, periodontal health, and aesthetics. Several classification systems have been established, but the age-related natural history and its relationship with midline diastema remain incompletely defined. This study aimed to systematically evaluate age-related changes in maxillary and mandibular labial frenum morphology and tension, and their association with midline diastema across pediatric age groups. Methods: A cross-sectional study was conducted on 1068 patients (ages 1 day–47 years) presenting for routine dental examinations at two pediatric dental clinics. Frenum morphology was classified as mucosal, gingival, papillary, or papillary-penetrating. Palpable tension was assessed by manual lip pulling and recorded as present or absent. Midline diastema was defined as ≥1 mm spacing between the maxillary central incisors, measured at the incisal midline with a periodontal probe. Data were analyzed using Pearson’s chi-square tests with Bonferroni correction for multiple comparisons, and logistic regression was applied to evaluate independent predictors. Inter-examiner agreement was assessed using Cohen’s κ. Results: Among 1068 participants, maxillary frenum morphology varied significantly by age. In children < 3 years, papillary and papillary-penetrating insertions predominated (65.7%), while gingival and mucosal insertions were more frequent in older children and adults (72.8%). Palpable tension declined sharply with age, from 92.5% in infants to <10% in adults. Midline diastema was significantly associated with papillary-penetrating frena (RR = 3.47, 95% CI 2.45–4.91) and with the presence of tension (RR = 1.68, 95% CI 1.34–2.11). Logistic regression confirmed both phenotype (OR = 6.2, 95% CI 3.8–10.1) and tension (OR = 2.1, 95% CI 1.5–2.9) as independent predictors of diastema. In contrast, mandibular frena showed minimal variation by age and limited functional impact. Conclusions: The maxillary labial frenum demonstrates predictable developmental change, migrating apically and losing tension most prominently between 3 and 6 years of age, while the mandibular frenum remains largely stable. Papillary and papillary-penetrating phenotypes with palpable tension carry the greatest risk of midline diastema. These findings emphasize that management should prioritize functional symptoms and growth trajectory rather than appearance alone, with frenectomy reserved for cases of demonstrable impairment. Full article

Background: Di(2-ethylhexyl) phthalate (DEHP) is a high-production-volume plasticizer and ubiquitous environ-mental contaminant with established endocrine-disrupting potential. While zebrafish transcriptomic studies have typically used high concentrations and long exposure windows, less is known about genome-wide responses during late embryogenesis/early larval maturation under environmentally relevant exposures. Here we profiled whole-organism transcriptomic responses to a short DEHP exposure during a developmentally sensitive transition (96–120) hours post-fertilization, hpf) and interpreted responses using differential expression, enrichment analyses, and endocrine-focused protein–protein interaction (PPI) network modeling. Methods: Wild-type AB zebrafish lar-vae (96 hpf) were exposed to DEHP at [10⁻⁹ M] or solvent control for 24 h. Larvae were pooled per replicate (25 lar-vae/pool) and processed for poly(A)-selected RNA-seq. Reads were quality-controlled, aligned to the Danio rerio reference genome, and quantified at gene- level. Differential expression was performed using DESeq2. Functional enrichment used KEGG over-representation analysis (ORA) and gene set enrichment analysis (GSEA). Zebrafish genes were mapped to human orthologs for GO/KEGG and STRING-based endocrine subnetworks, which were visualized and interrogated using STRINGdb and visNetwork. Results: Low-dose, short-term exposure does not produce large gene-level effects but induces coordinated, pathway-level transcriptional remodeling. KEGG ORA showed significant enrichment of MAPK signaling and regulation of actin cytoskeleton with additional enrichment of axon guidance and neuroactive ligand–receptor interaction. GSEA detected coordinated downregulation of KEGG neurodegeneration collections with negative normalized enrichment scores reflecting shared gene sets re-lated to mitochondrial function, proteostasis, cytoskeletal organization, and stress-response pathways. Endo-crine-focused STRING subnetworks indicated consistent downregulation of CYP19A1 within estrogen metabo-lism/biosynthesis modules and downregulation of upstream androgen biosynthetic enzymes HSD3B2 and CYP17A1, alongside upregulation of HSD17B3 and proteostasis-associated factors including DNAJA1. Endocrine network to-pology highlighted regulatory and cofactor nodes affecting receptor-linked transcription, consistent with indirect endocrine modulation rather than large receptor-transcript changes. Conclusions: In summary, this study demon-strates that exposure to low-dose DEHP during a critical period of zebrafish embryonic development is associated with modest but coordinated transcriptomic changes across multiple biological pathways. Pathway enrichment and network-based analyses highlight estrogen- and androgen-associated processes, along with broader signaling, met-abolic, and structural pathways, as transcriptionally responsive during this window. Importantly, these findings reflect molecular-level associations rather than direct evidence of functional or physiological endocrine disruption. Instead, they identify candidate pathways and regulatory networks that may be sensitive to low-level environmen-tal exposure and warrant further investigation. Collectively, this work underscores the value of systems-level tran-scriptomic approaches for detecting subtle, pathway-wide responses to environmentally relevant exposures during development. Full article

Background: Speckle-tracking echocardiography (STE) has been increasingly used to uncover subtle cardiac dysfunction in patients with extracardiac sarcoidosis (ECS) who show no clinical evidence of heart disease. However, prior investigations were mostly retrospective, methodologically heterogeneous, and focused primarily on left ventricular (LV) function. We conducted a prospective study to provide a broader evaluation of myocardial deformation across both ventricles and atria in ECS without fibrotic pulmonary involvement. Methods: Forty-one patients with ECS (mean age 57.4 ± 10.2 years; 58.5% male) and 30 age- and sex-matched controls without ECS and without known structural heart disease (58.5 ± 11.1 years; 53.3% male) were enrolled. All participants underwent conventional transthoracic echocardiography (TTE) supplemented by comprehensive STE analysis of ventricular and atrial function. Subclinical myocardial dysfunction was defined as LV global longitudinal strain (GLS) less negative than −20%, and potential predictors were analyzed. Results: Standard TTE did not show echocardiographic features suggestive of overt infiltrative cardiomyopathy but revealed higher E/average e′ ratios in the ECS group, suggesting subtle diastolic dysfunction. While traditional indices of biventricular systolic function remained preserved, STE demonstrated significant reductions in LV-GLS, LV global circumferential strain, right ventricular-GLS, and both left and right atrial reservoir strain. Multivariate analysis identified disease duration as the sole independent determinant of LV-GLS impairment (OR 2.26, 95%CI 1.10–4.65; p = 0.03). A disease duration of ≥4.5 years predicted abnormal GLS with 88% sensitivity and 75% specificity (AUC 0.89; 95%CI 0.76–1.00). Conclusions: ECS without fibrotic pulmonary involvement is associated with early impairment of biventricular and biatrial strain despite preserved conventional function. The extent of dysfunction correlates strongly with disease duration, underscoring the value of STE for early detection and monitoring. Full article

A systematic review of the scientific literature focused on the analysis of the main strategies related to the management of Eichhornia crassipes [water hyacinth] in Mexico is presented. The review was classified according to the levels of the biomass valorization pyramid, using specific inclusion and exclusion criteria: (i) eradication; (ii) physical control of the plant; and (iii) exploitation of its biomass. It focused on research conducted in Mexico from 1971 to 2023, which allowed for the analysis of a total of 147 studies. The results indicated that 73.4% of the research in Mexico is oriented towards the exploitation and valorization of water hyacinth biomass through the transformation of the plant into mid-value products, such as chemicals and materials (70.7%), energy (12.2%), food (7.3%) and health and lifestyle products (9.8%); however the sectors considered high-added-value, such as pharmaceuticals, fine chemicals and food, continue to be areas of opportunity. The remaining 26.6% focuses on control and eradication strategies, through the insertion of biological enemies, and physical control, by means of cutting and crushing the plant in situ. This situation underscores the importance of promoting integrated management approaches that incorporate biomass recovery, contributing to environmental sustainability and the responsible use of this invasive resource. Full article

An up-to-date catalog of residents space objects orbiting Earth requires a critical balance between computational efficiency and orbital prediction precision. This work presents HSGP4, a hybrid orbit propagator specifically tailored for Galileo-type orbits that enhances the classical SGP4 analytical model using Artificial Neural Networks. The methodology centers on a non-invasive hybridization process that utilizes high-fidelity pseudo-observations to forecast SGP4 error residuals. A core contribution is the introduction of the Hybrid Two-Line Element format, which encapsulates neural model parameters alongside traditional orbital elements, ensuring seamless integration with existing catalog infrastructure. The development process involved comprehensive Exploratory Data Analysis and sensitivity analysis, which identified the argument of latitude as the most influential variable for correcting SGP4 errors in the MEO region. To ensure statistical robustness, a hierarchical selection strategy was implemented. This reduced an exhaustive search space of 32,256 candidate architectures to a final subset of optimized configurations. Validated against a decade of TLE data, the results confirm that HSGP4 effectively captures missing dynamic patterns and significantly improves ephemeris accuracy. By forecasting SGP4 error residuals, this hybrid approach provides a high-fidelity correction layer. It compensates for the limitations of analytical theories without requiring complex numerical integration. Full article

To support latency-sensitive Internet of Vehicles (IoV) applications amidst dynamic environments and intermittent links, this paper proposes a Reconfigurable Intelligent Surface (RIS)-aided semantic-aware Vehicle Edge Computing (VEC) framework. This approach integrates RIS to optimize wireless connectivity and semantic communication to minimize latency by transmitting semantic features. We formulate a comprehensive joint optimization problem by optimizing offloading ratios, the number of semantic symbols, and RIS phase shifts. Considering the problem’s high dimensionality and non-convexity, we propose a two-tier hybrid scheme that employs Proximal Policy Optimization (PPO) for discrete decision-making and Linear Programming (LP) for offloading optimization. The simulation results have validated the proposed framework’s superiority over existing methods. Specifically, the proposed PPO-based hybrid optimization scheme reduces the average end-to-end latency by approximately 40% to 50% compared to Genetic Algorithm (GA) and Quantum-behaved Particle Swarm Optimization (QPSO). Moreover, the system demonstrates strong scalability by maintaining low latency even in congested scenarios with up to 30 vehicles. Full article

The growing environmental impact of petroleum-based plastics has intensified research into sustainable, biodegradable alternatives for food packaging. Among bio-derived polymers, carboxymethyl cellulose (CMC) has attracted increasing attention due to its abundance, non-toxicity, biodegradability, and excellent film-forming ability. Nevertheless, the intrinsic hydrophilicity and limited mechanical strength of neat CMC restrict its direct application in packaging systems. This review provides a comprehensive and critical overview of recent strategies developed between 2015 and 2025 to enhance the performance of CMC-based films for food packaging applications. Emphasis is placed on physical and chemical modification routes, including polymer blending, polyelectrolyte complex formation, incorporation of functional fillers and nanomaterials, and ionic or covalent crosslinking approaches. The influence of these strategies on key functional properties, such as mechanical behavior, water barrier performance, antimicrobial and antioxidant activity, is systematically discussed. Particular attention is given to CMC-rich systems, enabling meaningful comparison across studies. By highlighting structure–property relationships and identifying current limitations, this review aims to provide guidance for the rational design of advanced CMC-based materials as viable, eco-friendly alternatives to conventional plastic packaging. Full article

Background: Inflammatory bowel disease (IBD) is associated with numerous extraintestinal manifestations and systemic comorbidities; however, the certainty of prevalence estimates across multiple organ systems has not been systematically evaluated. Objective: To synthesize evidence from systematic reviews on the prevalence of comorbidities in patients with inflammatory bowel disease (IBD) and to assess the certainty of estimates through an umbrella review. Methods: In this umbrella review, we included systematic reviews reporting the prevalence of comorbidities in adults with IBD and their confidence intervals. Methodological quality was assessed using AMSTAR-2 and ROBIS, while statistical heterogeneity and certainty of evidence were evaluated using GRADE adapted for prevalence studies. Results: Eighteen systematic reviews published between January 2014 and September 2025 were included. The highest prevalences were sexual dysfunction 50.6% (95% CI 40.8–60.5), fecal incontinence in Crohn’s disease 34.8% (27.9–41.9), non-alcoholic fatty liver disease 32% (24–40), anemia 24% (18–31), and ≥1 extraintestinal manifestation 24% (19–31). Only four comorbidities achieved moderate certainty: primary sclerosing cholangitis 2.16% (1.76–2.60), uveitis 2.38% (1.60–3.17), hepatitis B 3.3% (2.5–4.0), and hepatitis C 1.8% (1.2–2.4). Prevalence rates varied significantly by IBD subtype, geographic region, and diagnostic method. Heterogeneity was consistently high (I² > 90%), and certainty was predominantly low or very low. Conclusions: Comorbidities in IBD are frequent, with prevalences ranging from 1.8% to 50.6%, highlighting the importance of comorbidity awareness in clinical practice. However, the certainty of evidence is predominantly low or very low due to extreme methodological heterogeneity. These findings underscore the urgent need for studies with standardized diagnostic methods and robust statistical approaches to strengthen the evidence base and establish evidence-based surveillance protocols. Full article