Search Results (4,625)

Background/Objectives: Intravenous patient-controlled analgesia (IV-PCA) is commonly used for pain control following arthroscopic rotator cuff repair (ARCR), but its use is limited by adverse effects such as nausea and vomiting. The suprascapular nerve block (SSNB) has emerged as an effective regional analgesic alternative. This retrospective cohort study aimed to compare the analgesic efficacy and safety of continuous intra-operative suprascapular nerve block (CI-SSNB) alone versus CI-SSNB combined with fentanyl-based IV-PCA (CI-SSNB + IV-PCA). Methods: A total of 40 patients undergoing ARCR under general anesthesia with a single-shot interscalene block (ISB) were allocated to either CI-SSNB alone (n = 20) or CI-SSNB + IV-PCA (n = 20). Pain scores were assessed using a 0–10 visual analog scale from 0 to 72 h postoperatively at predetermined intervals, along with opioid consumption and adverse events. Results: At post-operative day 0 (POD 0, 10 p.m.), mean pain scores were 5.75 ± 2.59 in the CI-SSNB + IV-PCA group vs. 3.95 ± 3.00 in the CI-SSNB group (p = 0.050). The total number of rescue pethidine doses up to post-operative day 3 was 1.80 ± 2.02 vs. 0.95 ± 1.10, respectively (p = 0.108). However, adverse effects such as nausea and vomiting occurred only in the CI-SSNB + IV-PCA group. Conclusions: CI-SSNB provides comparable analgesia to CI-SSNB + IV-PCA, while avoiding IV-PCA-related side effects, suggesting that IV-PCA may not be necessary when CI-SSNB is employed for post-operative analgesia following ARCR. Full article

Long COVID is characterized by persistent symptoms affecting one or more organ systems for at least 3 months following a SARS-CoV-2 infection. Our study aimed to examine the characteristics of frailty seen in patients with Long COVID compared to the frailty seen in aging patients with multimorbidity. This is a retrospective cohort study conducted in the Miami Veterans Affairs Medical Center (VAMC). The data used to calculate the Fried phenotype through the Johns Hopkins frailty calculator was collected from two separate clinics, a Long COVID clinic and a geriatric frailty clinic. We obtained the VA Frailty Index from VA CDW (Corporate Data Warehouse). We included 106 patients from the Long COVID clinic and 97 from the frailty clinic. Patients from the Long COVID clinic were significantly younger than those from the frailty clinic (60 ± 12.6 vs. 79.8 ± 5.8, p < 0.01). Patients with frailty in the Long COVID group experienced exhaustion (96.4% vs. 53.3%) and low activity (78.6% vs. 63.3%) at a higher rate than those in the geriatric frailty clinic. Long COVID may predispose patients to develop frailty that presents with a higher frequency of exhaustion and low activity. Full article

Metabolic syndrome (MetS) is defined by a combination of metabolic abnormalities, such as central obesity, insulin resistance, hypertension, and dyslipidemia, and significantly increases the risk of cardiovascular diseases and type 2 diabetes. The high prevalence of MetS is a public health concern, necessitating rapid identification and intervention strategies to prevent this emerging epidemic. Diagnosing MetS requires the presence of three or more of these abnormalities, underscoring the need for effective management approaches. Despite a growing body of literature, limited reviews have critically evaluated the complex interplay between metabolic dysfunction, inflammation, and coagulation, particularly in the context of dietary interventions. Therefore, this article reviews the relationship between metabolic syndrome, inflammation, and thrombotic diseases, with an emphasis on their impacts on hematological health. Furthermore, this review explores the potential role of vegetarian and vegan dietary patterns in controlling these processes and improving hematological outcomes. This narrative review aims to critically evaluate current research on the inflammatory and thrombotic implications of MetS and assess the potential modulating role of vegan and plant-based diets within this context. Full article

This paper uses survival analysis as a tool to assess credit risk in loan portfolios within the framework of the Basel Internal Ratings-Based (IRB) approach. By modeling the time to default using survival functions, the methodology allows for the estimation of default probabilities and the dynamic evaluation of portfolio performance. The model explicitly accounts for right censoring and demonstrates strong predictive accuracy. Furthermore, by incorporating additional information about the portfolio’s loss process, we show how to empirically estimate key risk measures—such as Value at Risk (VaR) and Expected Shortfall (ES)—that are sensitive to the age of the loans. Through simulations, we illustrate how loss distributions and the corresponding risk measures evolve over the loans’ life cycles. Our approach emphasizes the significant dependence of risk metrics on loan age, illustrating that risk profiles are inherently dynamic rather than static. Using a real-world dataset of 10,479 loans issued by Angolan commercial banks, combined with assumptions regarding loss processes, we demonstrate the practical applicability of the proposed methodology. This approach is particularly relevant for emerging markets with limited access to advanced credit risk modeling infrastructure. Full article

Background and Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) and eosinophilic otitis media (EOM) are frequently co-existing eosinophilic disorders related to type 2 inflammation, which significantly impair the quality of life of patients. Dupilumab, a monoclonal antibody targeting the IL-4 receptor alpha and anti-IL-13, has demonstrated a promising profile of efficacy and safety in the treatment of CRSwNP; however, evidence on its role in concomitant EOM and CRSwNP remains limited in the literature. This study aims to evaluate the clinical efficacy of dupilumab in patients with concomitant CRSwNP and EOM over a six-month observational period. Materials and Methods: A retrospective observational cohort study was conducted on twenty-two patients (aged 18–75 years) over six months with severe uncontrolled CRSwNP and confirmed refractory EOM who were treated with dupilumab (300 mg every two weeks). Demographic data are collected, and outcome measures included Nasal Polyp Score (NPS), Sino-Nasal Outcome Test (SNOT-22), Visual Analog Scale for nasal congestion (VAS), tympanogram classification, and Chronic Otitis Media Outcome Test (COMOT-15), evaluated at baseline and 6 months. Results: Over the six-month treatment period, patients with coexisting CRSwNP and eosinophilic otitis media experienced significant improvements across the multiple validated clinical and patient-reported outcome measures. The Nasal Polyp Score (NPS) significantly decreased from a median of 5.7 (IQR: 1.2) at baseline to 1.5 (IQR: 1.3) at six months (p < 0.0001). The SNOT-22 showed a substantial decline from a median of 77.6 (IQR: 19.0) to 21.5 (IQR: 13.4), p < 0.0001. Visual Analog Scale (VAS) scores for nasal congestion improved significantly from 8.4 (IQR: 1.1) to 1.7 (IQR: 1.2), p < 0.0001. Tympanogram scores improved from Tympanogram type “B” to Tympanogram type “A” (p = 0.018). COMOT-15 scale decreased from a median of 51.3 (IQR: 8.4) to 19.2 (IQR: 5.0) (p < 0.0001). Peripheral eosinophil counts remained unchanged or increased (baseline 0.80 vs. 0.84 cells/μL at six months, (p = 0.834)). Conclusions: Dupilumab treatment in patients with CRSwNP and EOM led to significant clinical improvements in sinonasal symptoms, middle ear function, and quality of life over six months, with no significant change in peripheral eosinophilia. Full article

Background: Osteoporosis is the most prevalent metabolic bone disease, characterized by decreased bone mineral density (, which leads to increased bone fragility, back pain, impaired postural stability, and a heightened risk of fractures. Proprioceptive exercises have been identified as an effective approach for reducing the risk of falls and adverse events. Objective: Our aim was to conduct a pilot exploratory study evaluating the effectiveness of proprioceptive training in improving coordination and balance, and in reducing chronic thoracolumbar back pain in older women diagnosed with osteoporosis. Methods: Quantitative ultrasound bone densitometry was performed on 144 women over the age of 60, followed by the implementation of a proprioceptive training program. The One-Leg Stance balance test and the Visual Analog Scale for pain intensity were administered before and after a six-month training intervention. Results: ANOVA revealed significant improvements in balance, with the OLS duration increasing from 2.49 s at baseline to 7.31 s following the intervention. Participants aged over 70 years demonstrated a positive, though comparatively lower increase in stability and balance. Chi-squared (χ²) analysis indicated that 83.9% of the variance in OLS performance was attributable to proprioceptive training (Cramer’s V = 0.839, p = 0.001). A significant reduction in VAS pain scores was observed, with 48.1% of the variance explained by the moderate effect of proprioceptive training (Cramer’s V = 0.481, p = 0.001). Conclusions: Proprioceptive training has the potential to improve postural stability, balance, and coordination and stimulate pain intensity in the thoracolumbar region. Despite promising results, the absence of a control group limits our ability to draw definitive causal conclusions. Full article

Background/Objectives: This study evaluates the effectiveness of a toothpaste containing Java Tea and Little Ironweed in alleviating tooth sensitivity compared to a conventional potassium nitrate toothpaste. Methods: A total of 90 healthy patients aged 18–70 with up to two teeth exhibiting gingival recession were recruited into this study. All selected teeth had a visual analog scale (VAS) score ≥ 4 in response to tactile or air blast stimuli. Excluded teeth included those requiring restoration or participants undergoing treatments affecting sensitivity or taking pain medication/anti-sensitivity agents. Participants were randomly divided into three groups and instructed to brush twice daily with different toothpastes. The S1 group was prescribed toothpaste containing Java Tea and Little Ironweed extract, the S2 group was prescribed toothpaste containing Java Tea and Little Ironweed extract with 0.7% potassium nitrate, and the S3 group was prescribed toothpaste containing potassium nitrate. VAS scores were recorded at baseline, 2 weeks, and 4 weeks. Data were then compared and statistically analyzed between the groups. Results: For the tactile test, the final number of included teeth was 47 in the S1 group, 46 in the S2 group, and 22 in the S3 group. For the air blast test, the number of teeth included was 38 in the S1 group, 30 in the S2 group, and 27 in the S3 group. At baseline, mean VAS scores were comparable across groups for both tactile (S1: 6.89 ± 0.98; S2: 6.65 ± 1.52; S3: 6.82 ± 1.99) and air blast tests (S1: 7.39 ± 1.15; S2: 7.53 ± 1.31; S3: 6.89 ± 2.12). All groups showed significant reductions in VAS scores from baseline at both 2 and 4 weeks. A Kruskal–Wallis test indicated significant between-group differences in VAS scores at 2 and 4 weeks (p = 0.001). Post hoc analysis (Dunn’s test with Bonferroni correction) at 2 weeks revealed that the S1 group had significantly higher VAS scores than those of S2 (tactile p = 0.001, air blast p = 0.001) and S3 (tactile p = 0.002, air blast p = 0.018). By 4 weeks, the S2 group demonstrated superior efficacy, with significantly lower VAS scores compared to those of S1 (tactile p < 0.001, air blast p = 0.030) and S3 (tactile p = 0.035, air blast p = 0.001). Conclusions: All tested toothpastes effectively reduced dentin hypersensitivity over the study period. Potassium nitrate toothpaste provided more rapid initial relief, when compared to the herbal formulation alone; however, both achieved similar outcomes by 4 weeks. The herbal toothpaste supplemented with potassium nitrate demonstrated superior efficacy and may offer a promising natural alternative for managing dentin hypersensitivity. Full article

Background/Objectives: Tinnitus has been increasingly recognized not only as an auditory disturbance but also as a condition that is potentially linked to cognitive decline, particularly in older adults. However, the relationship between tinnitus characteristics and cognitive impairment remains underexplored in clinical settings. This study aimed to (1) evaluate the association between chronic tinnitus and cognitive function in adults aged 60 years and above using standardized tools, and (2) determine whether tinnitus severity and duration are associated with increased risk of cognitive impairment. Methods: A cross-sectional study was conducted among 240 older adults, divided into tinnitus (n = 120) and non-tinnitus (n = 120) groups. Cognitive function was assessed using the Mini-Cog (0–5) and SPMSQ (0–10) tools. Tinnitus severity and duration were evaluated using the Tinnitus Handicap Inventory (THI), Visual Analogue Scale (VAS), and duration categories. Results: Participants with tinnitus were significantly older and had higher rates of hearing loss (58.33% vs. 33.33%, p = 0.001), depression (37.50% vs. 18.33%, p = 0.002), and poor sleep quality (51.67% vs. 31.67%, p = 0.003). Mini-Cog and SPMSQ scores were significantly lower in the tinnitus group (2.87 ± 1.14 vs. 3.52 ± 1.06; 6.95 ± 1.42 vs. 8.02 ± 1.18; both p < 0.001). Tinnitus presence, longer duration, and higher severity were independently associated with cognitive impairment. Each 10-point increase in THI score increased the odds of impairment by 45% (OR = 1.45, p < 0.001). Conclusions: Tinnitus burden, particularly when severe and prolonged, is significantly associated with cognitive impairment in older adults. These findings highlight the need for cognitive screening and integrated management in this population. Full article

The WRKY gene family is a widely distributed and highly conserved transcription factor (TF) family in plants, with its members playing key roles in plant growth and development, stress response, and metabolism. Although WRKY TFs have been extensively studied in many plant species, research on the WRKY gene family in Vaccinium bracteatum Thunb. remains limited. Therefore, integrating molecular biology and bioinformatics approaches to further explore the WRKY gene family in V. bracteatum is of considerable scientific importance. In this study, we employed various online tools to obtain genomic and expression data, which were subsequently analyzed to determine the composition, evolutionary relationships, and functions of WRKY family genes in V. bracteatum. A total of 66 WRKY genes (VaWRKY) were identified, named based on homology alignment. Phylogenetic analysis classified the 66 VaWRKYs into three major clades and seven subclades. Sequence and structural analyses of VaWRKY genes provided insights into their evolutionary and functional characteristics. Expression profile analysis revealed significant differences in the expression of 12 VaWRKY genes at various stages of fruit development. Protein interaction analysis further indicated that VaWRKY genes are functionally diverse, playing important roles in stress response, seed germination regulation, and plant growth and development. In summary, we have a deeper understanding of VaWRKY genes, and systematic analysis of structure, evolutionary characteristics, and expression patterns plays an important role in analyzing its biological functions, molecular breeding, and enhancing economic value. Full article

The citrus processing industry is an economically important agro-industrial sector worldwide; however, it produces significant amounts of waste annually. The biorefinery concept and the recovery of bio-based materials from agro-industrial residues, including citrus processing waste, are emphasized in the European Green Deal, reflecting the EU’s commitment to fostering circularity. Biotreatment of citrus processing waste, including bioconversion into biomethane, biohydrogen, bioethanol and biodiesel, has been applied to valorize biomass for energy recovery. It can also be composted into a valuable soil conditioners and fertilizers, while raw and fermented citrus residues may exhibit phytoprotective activity. Citrus-derived residues can be converted into materials such as nanoparticles with adsorptive capacity for heavy metals and recalcitrant organic pollutants, and materials with antimicrobial properties against various microbial pathogens, or the potential to remove antibiotic-resistance genes (ARGs) from wastewater. Indeed, citrus residues are an ideal source of industrial biomolecules, like pectin, and the recovery of bioactive compounds with added value in food processing industry. Citrus processing waste can also serve as a source for isolating specialized microbial starter cultures or as a substrate for the growth of bioplastic-producing microorganisms. Solid-state fermentation of citrus residues can enhance the production of hydrolytic enzymes, with applications in food and environmental technology, as well as in animal feed. Certain fermented products also exhibit antioxidant properties. Citrus processing waste may be used as alternative feedstuff that potentially improves the oxidative stability and quality of animal products. Full article

Background: Abdominal wall endometriosis (AWE) is a rare but debilitating condition, often occurring in surgical scars after Caesarean sections. It is characterized by cyclic pain and a palpable mass, significantly impacting patients’ quality of life. Traditional treatments, including hormonal therapy and surgery, have limitations, prompting interest in minimally invasive techniques such as cryoablation. This study evaluates the efficacy and safety of percutaneous image-guided single-probe cryoablation using liquid nitrogen for symptomatic AWE. Purpose: To evaluate the effectiveness and safety of percutaneous image-guided single-probe cryoablation using liquid nitrogen in treating symptomatic AWE lesions, with a primary objective to assess pain relief using the Visual Analog Scale (VAS). Materials and Methods: This retrospective, single-center study included 14 patients (23 lesions) treated with percutaneous cryoablation between September 2022 and April 2025. Clinical, imaging (MRI and ultrasound), and procedural data were analyzed. Pain scores (VAS scale) were assessed before treatment and at 3-month follow-up. Hydro- and/or carbo-dissection were used to protect adjacent structures. Response to treatment was evaluated with MRI and clinical follow-up. Statistical analysis was performed using median, range, and percentage calculations, with comparisons made using the Mann–Whitney test. Results: A total of 23 AWE lesions were treated in 14 patients (mean age: 39.6 years). The median lesion volume was 3546 mm³, with a range from 331 mm³ (8 × 4.6 × 9 mm) to 45,448 mm³ (46 × 26 × 38 mm). Most of the lesions were located in the muscle (69.6%, n = 16), while 17.4% (n = 4) involved both muscle and subcutaneous tissue, and 13.0% (n = 3) were purely subcutaneous. Among the 23 treated lesions, 8.7% (n = 2) appeared as purely hemorrhagic, 13.0% (n = 3) as fibrotic, and 78.3% (n = 18) were classified as mixed, based on imaging characteristics. Procedures were performed under general anesthesia in 65% of cases and under sedation in 35%. Hydrodissection was used in 48% of lesions, carbo-dissection in 4%, and combined hydro–carbo-dissection in 26%. A single 13G cryoprobe was used in 83% of cases, and a 10G probe in 17%. The median ablation time was 15 min (range: 6–28 min), and the median total procedure time was 93 min (range: 22–240 min). Pain scores significantly decreased from a median of 8/10 (range: 6–10) before treatment to 0/10 (range: 0–2) at follow-up (p < 0.0001). MRI follow-up confirmed complete coverage of the ablation zone and disappearance of hemorrhagic inclusions in all cases. Two patients (14%) required re-treatment, both with satisfactory outcomes. No peri- or post-procedural complications were observed, and no visible scars were noted. Conclusions: Percutaneous cryoablation using a single probe with liquid nitrogen is a safe and effective treatment for AWE, offering significant pain relief, minimal morbidity, and excellent cosmetic outcomes. It should be considered as part of multidisciplinary care. Further prospective studies with longer follow-up are warranted to confirm these findings. Full article

Background/Objectives: Maintaining proper posture and preventing musculoskeletal pain are essential for the healthy development of young football players. Contemporary concepts of postural control emphasize the importance of the lumbopelvic-hip complex and the activation of deep trunk muscles. This study aimed to evaluate the effects of a structured core stabilization training program on postural parameters and pain reduction in young football players. Methods: A total of 182 male football players, aged 9–15 years, were enrolled and allocated to either the intervention or control group. The 12-week intervention consisted of exercises targeting both local and global trunk stabilizers. Assessments included measurements of spinal curvatures, trunk rotation angles, lower limb loading symmetry, and postural stability using the TMX-127 digital inclinometer (Saunders Group Inc., Chaska, MN, USA) and the Baseline scoliometer (Fabrication Enterprises, Inc. New York, USA). Pain intensity was measured using the Visual Analogue Scale (VAS). Repeated-measures statistical analyses were performed with a significance level set at p ≤ 0.05. Results: The intervention group showed significant improvements in trunk rotational parameters, with reductions in ATR values at C7/Th1 (−0.54°) and L5/S1 (−0.49°). SATR values decreased by −0.28° between the second and third assessments. Symmetry of lower limb loading under eyes-open conditions improved significantly (p < 0.00195). No significant changes were observed in dynamic balance, as assessed by the Y-Balance Test (p > 0.05). Pain intensity decreased from 3.33 to 2.55 on the VAS, reflecting a reduction of 0.78 points. Conclusions: Systematic core stabilization training enhances postural quality and reduces the occurrence and severity of musculoskeletal pain in young football players, with lasting effects—except for postural control under conditions of reduced visual input. This type of training represents an effective physioprophylactic strategy, supporting postural control and lowering the risk of injuries. To maintain these benefits, continued training that incorporates balance and proprioceptive exercises is recommended. Full article

Temporomandibular joint disorders (TMDs), particularly disc displacement with reduction (DDwR), are prevalent musculoskeletal conditions characterized by symptoms such as joint clicking, pain, and sometimes limited jaw movements. Accurate diagnosis requires a multidisciplinary approach, including clinical examination, imaging (MRI), and functional analysis. Among conservative treatment modalities, anterior repositioning splints (ARSs) are widely used to recapture the displaced discs and reposition the mandibular condyles. Determining the optimal therapeutic position (Th.P) for anterior repositioning splint fabrication remains challenging due to individual anatomical variability and a lack of standardized guidelines. This study introduces the controlled mandibular repositioning (CMR) method, which integrates clinical examination, imaging (MRI), computerized cephalometry, computerized condylography, neuromuscular palpation, and the Condylar Position Variator (CPV) to define an individualized Th.P. After treatment with CMR stabilizers (splints), the control MRI confirmed that in 36 out of 37 joints, the discs were repositioned to their normal position. There was a reduction in pain, as shown by VAS scores at the 6-month follow-up. This study demonstrated the effectiveness of the CMR method to find a precise therapeutic position, resulting in a 97.3% joint luxation reduction in DDwR. This study underscores the importance of precise, individualized Th.P determination for effective anterior repositioning. Full article

Background and Objectives: The surgical approach for Haglund’s triad remains a topic of ongoing debate. This study presents pioneering data on Achilles tendon reattachment using the SpeedBridge technique following partial detachment, retrocalcaneal bursa excision, and Haglund prominence resection in patients with Haglund’s triad. Materials and Methods: A retrospective analysis was conducted on patients operated on between March 2019 and March 2022, encompassing demographic data and preoperative and 6-month and 12-month postoperative assessments of the VAS (Visual Analog Scale), AOFAS (American Orthopedic Foot & Ankle Society) score, and SF-36. Results: Nine patients (three females and six males) with a mean age of 53.8 years underwent surgery, with a mean follow-up of 34 months. The results indicated a significant improvement (p < 0.0001) in the VAS, AOFAS, and SF-36 at the 12-month follow-up. Conclusions: Taking into account the limitations of the study, including its retrospective design and the small sample size, the use of SpeedBridge for Achilles tendon reattachment, alongside the aforementioned procedures, demonstrated promising outcomes. These findings warrant further investigation in future randomized studies with larger sample sizes to confirm their efficacy. Full article

Purpose: Thoracolumbar burst fractures represent a significant proportion of spinal injuries, with management strategies remaining a subject of debate. While four-screw (4S) short-segment posterior fixation is commonly used, recent biomechanical studies suggest that adding pedicle screws at the fractured level (six-screw, 6S, construct) may improve stability and clinical outcomes. However, the clinical relevance of these findings remains uncertain. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Three databases (Scopus, PubMed/MEDLINE, Cochrane Library) were searched for studies comparing 4S and 6S constructs in thoracolumbar fractures. Inclusion criteria encompassed comparative clinical studies reporting perioperative, functional, and radiological outcomes. Data were extracted and analyzed using Review Manager 5.4.1, applying fixed- or random-effects models based on heterogeneity. Results: Twenty-two studies involving 1595 patients were included. The 6S group showed significantly improved postoperative pain scores (VAS), better short- and long-term sagittal alignment, and a lower implant failure rate. However, this technique was associated with longer operative times, increased intraoperative blood loss, and extended hospital stays. No significant differences in long-term functional disability (ODI) or infection rates were found. Conclusions: The addition of intermediate screws improves radiological outcomes and reduces implant failure but increases surgical burden. Further high-quality studies focusing on patient-reported outcomes and specific fracture subtypes are needed to refine clinical indications. Full article