Search Results (157)

Background/Objectives: Spinal cord stimulation (SCS) is an established therapy for chronic refractory pain, but its clinical value depends on whether benefit persists beyond the early post-implant period. Although short-term SCS studies are abundant, reports with follow-up of 24 months or longer are dispersed, methodologically heterogeneous, and difficult to interpret across indications and stimulation platforms. This scoping review aimed to map the clinical literature reporting SCS outcomes at ≥24 months, characterize the represented populations and modalities, summarize the long-term outcome domains assessed, and identify major methodological and clinical gaps in the evidence base. Methods: This PRISMA-ScR-informed scoping review applied a Population–Concept–Context framework. PubMed/MEDLINE and Scopus were searched through April 2026, yielding 6866 records before deduplication. Following staged title/abstract screening, iterative full-text retrieval, and the reconciliation of overlapping publications, 292 unique full-text reports were assessed for eligibility. Studies reporting original clinical SCS data with extractable outcomes at ≥24 months were included. No meta-analysis or formal GRADE assessment was undertaken, as the objective was evidence mapping rather than pooled effect estimation. Results: The final evidence map comprised 65 unique reports representing a cumulative report-level population of 11,518 participants across non-overlapping cohorts. The literature was dominated by non-randomized evidence (55 observational reports; 10 randomized or randomized-derived). The most frequent indication was mixed chronic pain (30/65; 46.2%), followed by failed back surgery syndrome/persistent spinal pain syndrome (FBSS/PSPS; 16/65; 24.6%), chronic back and/or leg pain (6/65; 9.2%), complex regional pain syndrome (CRPS; 5/65; 7.7%), and painful diabetic neuropathy (PDN; 4/65; 6.2%). Most reports involved conventional or unspecified SCS (47/65; 72.3%), with smaller contemporary clusters for 10 kHz high-frequency SCS and ECAP-controlled closed-loop SCS. The most frequently reported outcome domains were pain durability, function and quality of life, device-related outcomes, and opioid use. At a descriptive level, the literature more often supported persistence of benefit than complete erosion of effect, particularly in spinal pain populations and in contemporary PDN and closed-loop SCS cohorts. Interpretation was constrained by outcome heterogeneity, cohort overlap, mixed indication categories, and inconsistent opioid and device-maintenance reporting. Conclusions: The long-term SCS literature supports the view that durable benefit is achievable in a substantial patient subset, particularly in FBSS/PSPS populations, and in more recent evidence, in PDN, nonsurgical refractory back pain, and closed-loop SCS cohorts. The evidence base remains heterogeneous and does not support a uniform certainty-ranked estimate across indications and technologies. Future studies should prioritize indication-specific cohorts, standardized multidomain outcome reporting, and transparent separation of unique cohorts from secondary analyses of the same clinical populations. Full article

Objective: This study aimed to investigate intraoperative and long-term impedance changes in cochlear implant recipients and to evaluate the prevalence and course of electrode circuit malfunctions. Methods: A retrospective longitudinal observational study was conducted on 358 ears that underwent cochlear implantation between October 2023 and June 2024. Intraoperative and postoperative impedance telemetry measurements were obtained at 1, 2, 6, and 12 months. Electrode arrays were analyzed according to their positions (basal, medial, apical), and electrode malfunctions were classified as open circuit (OC) or short circuit (SC). Results: Impedance values significantly increased from intraoperative to first activation measurements, reached their peak at the 1st postoperative month, and gradually decreased, stabilizing after the 6th month (p < 0.05). Electrode malfunctions were detected in 26 of 358 devices (7.2%), with 22 OCs (84.7%) and 4 SCs (15.3%). While 4 of the 22 OC cases improved within the first month after surgery, no improvement was observed in SC cases during the 12-month follow-up period. Conclusions: Impedance telemetry is useful for assessing electrode integrity intraoperatively and for monitoring changes over time during follow-up. These findings highlight the dynamic nature of impedance changes, particularly during the first 6 months, and underscore the value of regular follow-up measurements and individualized programming. Full article

Background and Objectives: Functional neurosurgery encompasses surgical interventions aimed at modulating the function of the central and peripheral nervous systems. Spinal cord stimulation (SCS), as a form of neuromodulation, is an established treatment for chronic pain and is increasingly utilized by both anesthesiologists and neurosurgeons. The aim of this study was to evaluate the effectiveness of SCS in patients with chronic neuropathic spinal pain. Materials and Methods: This prospective study included 42 patients who demonstrated a positive response to trial stimulation. Only patients achieving a clinically meaningful response (≥50% pain reduction) during the trial phase were included in the final analysis. Pain intensity and functional disability were assessed using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). All patients underwent a two-stage percutaneous implantation procedure using burst stimulation. A follow-up assessment was performed 3–6 months after implantation. Results: A statistically significant reduction in pain intensity was observed (p < 0.0001), with median VAS scores decreasing from 8 to 3, corresponding to a 62.5% reduction in pain intensity and exceeding the minimal clinically important difference (MCID) for VAS. Functional status improved significantly, with ODI scores decreasing from 74% to 38%, markedly surpassing the established MCID threshold. A clinically meaningful reduction in pain (≥50%) was achieved in the majority of patients. All patients requiring opioid analgesics at baseline discontinued their use following SCS implantation, and a reduction in overall analgesic consumption was observed across the cohort. Conclusions: These findings suggest that burst SCS may be an effective treatment option for carefully selected patients with chronic neuropathic spinal pain who are not candidates for conventional spine surgery. However, the results should be interpreted with caution due to the enriched study design and limited follow-up period. Full article

Titanium dental implants are widely regarded as the gold standard for the rehabilitation of missing teeth due to their high survival rates and favorable mechanical properties. However, in the oral environment, implant materials are continuously exposed to complex chemical, mechanical, and biological factors that may lead to surface degradation, including corrosion, tribocorrosion, and mechanical wear. These processes can alter implant surface characteristics and influence biological responses in peri-implant tissues. Zirconia implants have been introduced as alternative material due to their favorable aesthetics and biocompatibility. Nevertheless, zirconia ceramics are also susceptible to degradation phenomena, including hydrothermal aging, phase transformation, and surface wear under specific conditions, although their clinical relevance remains unclear. In addition, emerging hybrid titanium–zirconia implant systems introduce new considerations regarding surface stability. This scoping review, conducted in accordance with PRISMA-ScR guidelines, summarizes the current evidence on degradation mechanisms affecting titanium, zirconia, and hybrid dental implants, with particular focus on processes occurring in the oral environment and their biological and clinical implications. The available evidence differs substantially between the two materials. While titanium degradation is well documented and supported by both experimental and clinical studies, the evidence for a hybrid implant remains limited and is largely based on in vitro and mechanistic data. Full article

Background: Accurate digital impressions are crucial for the long-term success of implant-supported prostheses, with scan bodies playing a pivotal role in transferring the implant position into the virtual model. Recent work has focused on PEEK (polyether-etherketone) scan bodies because their optical behavior may facilitate intraoral scanning; however, the breadth and quality of supporting evidence remain unclear. Methods: This scoping review followed PRISMA-ScR reporting guidelines and was registered in the Open Science Framework (OSF; Registration DOI 10.17605/OSF.IO/CU3V8). Pub-Med/MEDLINE, Embase, and Scopus were searched through September 2025. Eligible designs included in vitro studies, randomized trials, observational studies, and technical reports evaluating PEEK scan bodies in implant dentistry. Screening and data extraction were performed in duplicate, and findings were synthesized descriptively. Results: The search identified 227 records, and after screening, 31 studies met the inclusion criteria. Most studies were in vitro, with limited clinical evidence, and only one prospective clinical study was identified. Outcomes commonly addressed trueness, precision, scan time, and handling. Comparators varied (e.g., titanium, resin; splinted vs. unsplinted), and the results on accuracy were heterogeneous, with deviations typically within clinically acceptable limits (<100 µm). Conclusions: PEEK scan bodies are applicable for digital implant impressions. Clinical data are sparse, though, and methods vary. Controlled clinical studies are necessary to confirm the accuracy, reliability, and indications of this approach compared to titanium ISBs. Full article

Background: While hydroxyapatite (HA) is considered stable and non-resorbable, other calcium phosphate phases such as Tricalcium Phosphate (TCP), Brushite, and Monetite are characterized by higher solubility and biodegradation rates. This review aims to map the clinical evidence of these resorbable phases. Objective: The aim of this scoping review was to map and synthesize the available clinical evidence on resorbable calcium phosphate phases, focusing on TCP-, brushite-, and monetite-based biomaterials in alveolar bone regeneration. The review evaluates clinical indications, surgical protocols, reported outcomes, and existing knowledge gaps. Methods: This scoping review was conducted in accordance with the PRISMA-ScR guidelines. A comprehensive literature search was performed in PubMed, MEDLINE, Scopus, and SCI Clarivate databases without language or time restrictions (from June 2025 to August 2025) using terms related to brushite, monetite, dicalcium phosphate anhydrous, ridge augmentation, bone regeneration, and dental implants. Clinical studies involving brushite- or monetite-based biomaterials used for alveolar bone regeneration were eligible, including randomized controlled trials, prospective cohort studies, and case series. Data were charted descriptively with respect to study design, patient characteristics, clinical scenario, biomaterials used, surgical approach, healing time, outcome measures, and reported complications. No meta-analysis or formal assessment of comparative clinical effectiveness was undertaken, in line with scoping review methodology. Results: Seven clinical studies were included. The identified evidence encompassed heterogeneous clinical scenarios, including post-extraction alveolar ridge preservation, localized ridge augmentation, and periodontal or intraosseous defects with relevance to future implant placement. Study designs, defect characteristics, biomaterial formulations, and outcome measures varied substantially. Across studies, brushite- and monetite-based materials were associated with new bone formation and progressive graft resorption, as assessed by clinical, radiographic, and histological outcomes. Direct comparisons between studies were not feasible due to methodological and clinical heterogeneity. Conclusions: The available literature on brushite- and monetite-based biomaterials in alveolar bone regeneration is limited and heterogeneous. Current evidence supports their biocompatibility and resorbable nature across different clinical contexts, but does not allow conclusions regarding comparative clinical effectiveness. This scoping review highlights important gaps in the literature, particularly the need for well-designed randomized clinical trials with standardized indications and outcome measures. Full article

The accuracy of digital impressions in fully edentulous cases is limited by the lack of anatomical reference structures, potentially affecting passive fit. The effects of scanner type, impression level, and scan body splinting on accuracy remain insufficiently elucidated. This in vitro study aimed to evaluate the effects of different intraoral scanners, scanning levels, and scan body splinting methods on digital impression accuracy. A fully edentulous mandibular model with four implants (All-on-4) was fabricated, and scan bodies were connected at either the implant or multi-unit abutment level. Five splinting methods (nonsplinted, floss, orthodontic elastomeric, chain attachments, and single attachments) were applied, creating 10 experimental groups. Each group was scanned using three intraoral scanners: iTero Lumina (Align Technology, Tempe, AZ, USA), TRIOS 3 (3Shape A/S, Copenhagen, Denmark), and Medit i700 (Medit Corp, Seoul, Republic of Korea), with four repeated scans per scanner (120 scans total). Trueness and precision were assessed based on linear and angular deviations using Geomagic Control X (3D Systems, Rock Hill, SC, USA). Scanner type and scanning level significantly affected accuracy (p < 0.05), with TRIOS 3 showing higher deviations, while multi-unit abutments reduced deviations. Splinting methods showed no significant effect on accuracy, and precision did not differ among groups. Scanner type and scanning level significantly influenced digital impression accuracy; however, splinting methods yielded no significant effect. Precision remained comparable among groups. Full article

Background/Objectives: Chronic limb-threatening ischemia (CLTI) is a severe form of peripheral artery disease characterized by ischemic rest pain or ulcer necrosis. In Europe, spinal cord stimulation (SCS) can be offered to CLTI patients with chronic pain to improve mobility and prolong limb preservation. We evaluated the long-term, real-world outcomes of SCS therapy in patients with CLTI. Methods: In this observational study, medical chart review data from consecutive CLTI patients treated with SCS were analyzed. Results: Fifty-three patients (56.6% Fontaine Stage III, 39.6% Fontaine Stage IV, 3.8% Fontaine Stage IIb) had a single-stage SCS implant procedure between 2013 and 2022. Two years after SCS therapy activation, claudication pain intensity had significantly improved; the overall numerical rating scale pain score decreased from 9.4 ± 0.9 at baseline to 3.7 ± 3.2 (p < 0.0001). In addition, walking distance increased by more than 350 m (from 70 ± 87 to 429 ± 320 m, p < 0.0001), and pre-existing skin lesions stabilized in ten patients (63%). The probability of limb survival in Fontaine’s stage IIb/III and Fontaine’s stage IV patients at 12 months was 90% and 70%, respectively (log-rank p-value = 0.04). Finally, significant associations were found between the occurrence of an amputation after SCS and Fontaine Stage (p = 0.01), active smoking (p = 0.02), hypertension (p = 0.04), and prior minor amputation (p = 0.02). No major complications were reported. Conclusions: Our real-world experience suggests that SCS for CLTI patients provides significant and durable improvements in ischemic pain and functional outcomes. SCS may also help reduce the natural risk of major amputation, especially when implemented at early CLTI stages. Full article

Is it reasonable to use allogeneic mesenchymal stem cells (MSCs) therapy for thin endometrium and recurrent implantation failure? Thin endometrium (TE) and recurrent implantation failure (RIF) are associated with poor reproductive outcomes. Single-cell RNA sequencing (scRNA-seq) shows that such pathologies involve functional impairment of endometrial stromal, vascular, immune cells rather than reductions in cell numbers. MSCs exert regenerative and immunomodulatory effects and are proposed as candidates for endometrial repair. scRNA-seq studies indicate that TE and RIF are characterized by stromal progenitor dysfunction, impaired angiogenesis, immune dysregulation, and cellular senescence, providing a biological rationale for investigating allogeneic MSC-based therapies. scRNA-seq studies of human endometrium in patients with TE and RIF are reviewed alongside experimental and clinical studies evaluating autologous and allogeneic MSCs, with particular emphasis on umbilical cord-derived MSCs. Transcriptomic analyses consistently demonstrate reduced proliferation and decidualization of endometrial stromal cells, suppression of angiogenesis, immune dysregulation, and activation of senescence-associated genes. Preclinical studies show that MSC administration restores endometrial structure, vascularization, and receptivity markers. Early clinical studies suggest potential benefit, although data remain limited and heterogeneous due to non-randomized studies. Allogeneic MSCs are promising as therapy, but further studies on mechanisms and clinical validation are needed. Full article

Background: Digital implant impressions using intraoral scanners are increasingly adopted; however, their accuracy remains challenging in complete-arch and extended edentulous scenarios due to limited anatomical reference points and cumulative stitching errors. Various splinting techniques, scan-body modifications, and auxiliary geometric devices have been proposed to enhance digital accuracy, yet the available evidence is highly heterogeneous and lacks comprehensive synthesis. Methods: This scoping review was conducted according to PRISMA-ScR guidelines. A systematic search of PubMed/MEDLINE, Embase, Scopus, and Web of Science databases identified studies evaluating materials, designs, or techniques intended to splint, stabilize, or geometrically augment intraoral scan bodies in digital implant workflows. In vitro, clinical, and mixed-design studies were included. Data were extracted descriptively and synthesized narratively. Results: Seventy-three studies met the inclusion criteria, the majority of which were in vitro investigations focused on fully edentulous arches. Splinting strategies included direct resin-based connections, rigid or semi-rigid auxiliary geometric devices, modified scan bodies with extensional geometries, and artificial landmarks. Most studies reported improved trueness, precision, or scanning efficiency when rigid or geometrically enriched devices were used, particularly in long-span or angulated implant configurations. However, flexible or optically interfering splints occasionally reduced accuracy, and outcomes were strongly scanner-dependent. Conclusions: Splinting and auxiliary scanning strategies generally enhance the accuracy of complete-arch digital implant impressions, especially when rigid, well-engineered, or geometrically complex designs are employed. Modified scan bodies and calibrated auxiliary devices appear particularly promising, while flexible splints may be counterproductive. Standardized protocols and further in vivo validation are required to optimize digital implant workflows. Full article

Background: Spasticity is a complex and multifactorial condition resulting from upper motor neuron injury. It manifests through muscle contractions, pain, limited range of motion, and clonus, which significantly impair daily activities and quality of life. High-frequency spinal cord stimulation (HF SCS) has shown optimal results in treating chronic neuropathic pain, but its potential role in spasticity remains underexplored. This study aimed to evaluate the efficacy of HF SCS in patients with spasticity. Methods: From April 2021 to July 2024, six patients with spasticity from various etiologies underwent SCS implantation at our institution. Clinical evaluations including the use of the Visual Analog Scale (VAS), Douleur Neuropathique 4 (DN4), and the Ashworth score, as well as ambulation ability and clonus episodes, were performed preoperatively and at a minimum of six months post-surgery. Subjective assessments of motor function, including coordination, movement efficiency, and postural transitions, were also recorded. Results: The mean age of patients was 50.12 ± 9.41 years, with follow-up averaging 24.32 ± 10.83 months. Statistically significant improvements were observed in VAS (p = 0.0412) and DN4 (p = 0.0422) scores, alongside a reduction in clonus episodes. All patients reported subjective improvements in coordination, movement efficiency, and postural transitions. Ambulation remained stable or improved in all cases. No perioperative complications or sensory/motor side effects were noted. Conclusions: HF SCS offers a promising approach to managing spasticity, with improvements in motor function, ambulation, and postural transitions. These findings support further investigation into HF SCS for spasticity, with multicenter trials needed to optimize treatment protocols and identify the most responsive patient populations. Full article

Background/Objectives: Traumatic spinal cord (SC) injury (SCI) is a debilitating neurological condition. Minimally invasive approaches to monitor in real time the functional state of the neuromotor apparatus in animal models of SCI (at rest and movement) to assess effectiveness of therapy are needed in preclinical studies. We aimed to develop such a bioethically acceptable platform for SCI studies on non-human primates (Rhesus macaques). Methods: Epidural and myographic electrode implantation (EI) (wireless and wired, connected via a head plug) was performed. After EI, motor responses caused by electrical stimulation of the SC at the level of the cervical and lumbar thickening were recorded; electromyography of the limb muscles was recorded during quadrupedal movement of the animal on a treadmill with simultaneous assessment of movements’ kinematic parameters. Five weeks after EI, three animals underwent lateral hemisection of the SC in the C4–C5 segment under the control of a surgical microscope and intraoperative recording of motor- and sensory-evoked potentials. Results: Within 30 days after SCI, during treadmill testing, a decrease in electromyographic activity of the limb muscles and the volume of angular movement in the joints on the side of the injury was detected. Electrical stimulation at the L2–S1 segments of the SC at a frequency of 30 Hz led to the appearance of a locomotor pattern in the muscles of the hind limbs and an increase in the range of motion. Conclusions: Our platform can be used for pathophysiological studies of various neuromodulation modes and as a basis for the development of control neurointerfaces. Full article

Background: Computer-guided static implant surgery (CGSIS) is widely adopted to enhance the precision of dental implant placement. However, significant heterogeneity in reported accuracy values complicates evidence-based clinical decision-making. This variance is likely attributable to a fundamental lack of standardization in the methodologies used to assess dimensional accuracy. Objective: This scoping review aimed to systematically map, synthesize, and analyze the clinical methodologies used to quantify the dimensional accuracy of CGSIS. Methods: The review was conducted in accordance with the PRISMA-ScR guidelines. A systematic search of PubMed/MEDLINE, Scopus, and Embase was performed from inception to October 2025. Clinical studies quantitatively comparing planned versus achieved implant positions in human patients were included. Data were charted on study design, guide support type, data acquisition methods, reference systems for superimposition, measurement software, and accuracy metrics. Results: The analysis of 21 included studies revealed extensive methodological heterogeneity. Key findings included the predominant use of two distinct reference systems: post-operative CBCT (n = 12) and intraoral scanning with scan bodies (n = 6). A variety of proprietary and third-party software packages (e.g., coDiagnostiX, Geomagic, Mimics) were employed for superimposition, utilizing different alignment algorithms. Critically, this heterogeneity in measurement approach directly manifests in widely varying reported values for core accuracy metrics. In addition, the definitions and reporting of core accuracy metrics—specifically global coronal deviation (range of reported means: 0.55–1.70 mm), global apical deviation (0.76–2.50 mm), and angular deviation (2.11–7.14°)—were inconsistent. For example, these metrics were also reported using different statistical summaries (e.g., means with standard deviations or medians with interquartile ranges). Conclusions: The comparability and synthesis of evidence on CGSIS accuracy are significantly limited by non-standardized measurement approaches. The reported ranges of deviation values are a direct consequence of this methodological heterogeneity, not a comparison of implant system performance. Our findings highlight an urgent need for a consensus-based minimum reporting standard for future clinical research in this field to ensure reliable and translatable evidence. Full article

This review integrates molecular, clinical, and translational data to provide an updated understanding of GJB2-related deafness and its emerging treatment landscape. Truncating mutations in GJB2 typically cause severe-profound hearing loss (HL) phenotypes, whereas non-truncating alleles are often associated with milder or progressive phenotypes. Geographic variation in variant prevalence contributes to regional differences in disease burden. Beyond the coding region, deletions and cis-regulatory mutations within the DFNB1 locus, including GJB6 and CRYL1, can influence HL severity when compounded with other pathogenic GJB2 variants. DFNB1 hearing loss generally presents as symmetric, bilateral, and flat to gently sloping across frequencies, with preserved cochlear neurons that support excellent cochlear implant (CI) outcomes. Early implantation CI in GJB2-positive children yields superior speech and language development compared with non-GJB2 etiologies. Emerging therapies include dual-AAV (AAV1 + AAV-ie/ScPro) delivery, achieving cell-specific Cx26 restoration, adenine base-editing for dominant-negative variants, and allele-specific suppression using RNA interference or antisense oligonucleotides. Concurrent progress in human iPSC-derived cochlear organoids provides a physiologic model to advance toward clinical trials. By integrating genotype-phenotype correlations, natural history insights, and advances in molecular therapeutics, this review presents a comprehensive update on GJB2-related HL and highlights how gene-based strategies are poised to change the treatment of this condition. Full article

Background and Objectives: Predicting postoperative refractive development after paediatric intraocular lens (IOL) implantation remains challenging due to continued ocular growth and interindividual variability. This scoping review maps current evidence on demographic, biometric, and surgical factors influencing postoperative myopic shift in children undergoing cataract surgery with IOL implantation. Methods and Materials: A systematic literature search was conducted in PubMed and Scopus from the last ten years through October 2025. Eligible studies included children (≤18 years) with congenital or developmental cataract undergoing primary or secondary IOL implantation that reported postoperative refractive change and its predictors. Titles, abstracts, and full texts were screened according to PRISMA-ScR guidelines. Data were charted on study design, age at surgery, follow-up duration, refractive and biometric outcomes, and associated predictors. Results: Twelve studies met the inclusion criteria. Younger age at surgery, shorter preoperative axial length, and unilateral cataract consistently predicted greater postoperative myopic shift. Reported myopic change ranged from approximately −1.8 D after 2 years to −11.6 D after 15 years of follow-up, correlating with the rate of axial elongation. Optical biometry and modern formulas (e.g., Holladay 1) showed lower absolute prediction error than manual A-scan or SRK-II calculations. Postoperative complications, especially glaucoma and visual axis opacification, were associated with greater refractive change. Conclusions: Postoperative myopic shift is a predictable, age-dependent feature of paediatric pseudophakia driven primarily by ocular growth dynamics. Standardised biometry, age-stratified refractive targeting, and integration of longitudinal growth models into IOL calculation algorithms may improve refractive predictability and visual outcomes in children. Full article