Search Results (1,335)

Objectives: Type-D personality, characterized by negative affectivity (NA) and social inhibition (SI), has been associated with adverse outcomes in chronic pain and cardiovascular populations. Evidence in spine outpatient settings remains limited. We aimed to assess the prevalence of Type-D personality and its association with pain, disability, and psychological distress in patients presenting to a university spine outpatient clinic. Methods: This exploratory cross-sectional study included 300 consecutive patients (18–85 years) presenting to a university spine outpatient clinic between 2023 and 2025. Patients completed the Type-D Scale-14 (DS14; Type-D defined as NA ≥10 and SI ≥10), the Hospital Anxiety and Depression Scale (HADS), the Visual Analog Scale for pain (VAS, 0–10), and the Oswestry Disability Index (ODI, 0–100). Demographic and clinical characteristics were recorded. Comparisons between Type-D and non-Type-D patients were performed. Results: The prevalence of Type-D personality was 32.3% (95% CI: 27.0–37.6%). Compared with non-Type-D patients, Type-D patients reported higher pain intensity (VAS: 5.23 vs. 3.88), disability (ODI: 38.6 vs. 31.3), anxiety (HADS-A: 10.0 vs. 6.5), and depression (HADS-D: 8.4 vs. 6.4); all p < 0.01. Between-group differences were clinically relevant, with large effect sizes for pain intensity (VAS; Cohen’s d ≈ 1.10) and moderate-to-large effect sizes for functional disability (ODI; Cohen’s d ≈ 0.75). Correlation analyses showed moderate to strong associations between Type-D personality traits (negative affectivity and social inhibition) and psychological distress. In stratified analyses, longer pain duration was descriptively associated with greater disability, particularly among patients with Type-D personality. Conclusions: Type-D personality is common in spine outpatient populations and is associated with greater pain, disability, and psychological distress. These findings underscore the relevance of psychosocial factors in spine outpatient care and highlight the need for further longitudinal research to clarify prognostic implications and potential targets for intervention. Full article

Introduction: Ceramic-on-ceramic (CoC) articulation in total hip arthroplasty (THA) offers excellent wear characteristics but carries risks such as liner malseating and ceramic fracture. To solve these problems, monoblock acetabular cups with preassembled ceramic liners were developed to minimize technical errors and allow the use of larger femoral heads. This study aimed to evaluate the mid-term clinical and radiological outcomes of a ceramic monoblock acetabular cup system. Methods: A retrospective analysis was performed on 106 primary THAs in South Korean patients using the Maxera monoblock cup (Zimmer Biomet) between 2015 and 2018, with a minimum follow-up of 5 years. Clinical outcomes were assessed using the Harris Hip Score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Visual Analog Scale (VAS). Radiologic evaluation included osteolysis and radiolucent lines. Normality of clinical variables was confirmed, and pre-to-postoperative comparisons were performed using paired t-tests. Results: The mean follow-up was 6.8 ± 1.4 years. The most common preoperative diagnosis was avascular necrosis (66.0%). Cups sized ≤52 mm were used in 80.2% of hips, allowing the frequent use of large femoral heads (32–40 mm). Clinical scores improved significantly: HHS from 37.0 ± 13.4 to 90.8 ± 6.2, WOMAC from 66.6 ± 11.5 to 7.6 ± 6.7, and VAS from 6.45 ± 1.1 to 1.1 ± 0.8 (p < 0.001). No osteolysis was observed. Radiolucent lines was appeared in four hips (3.7%) without evidence of migration or loosening. One cup fixation failure (0.9%) required revision. No cases of ceramic fracture, squeaking, or dislocation occurred. Conclusions: The ceramic monoblock acetabular cup demonstrated excellent mid-term clinical and radiological outcomes with a very low complication rate. The ability to reliably use large femoral heads likely contributed to enhanced joint stability. However, the absence of screw fixation and inability to directly visualize cup insertion require careful attention during cup impaction. Long-term studies with comparative cohorts are warranted. Full article

Background and Objectives: Intra-articular injection of adipose-derived stromal vascular fraction (SVF) has emerged as a promising regenerative treatment for knee osteoarthritis (OA) because of its heterogeneous cellular composition and potent anti-inflammatory paracrine effects. Although SVF therapy has demonstrated clinical efficacy, the timing of pain relief and the influence of SVF cell dose on early clinical outcomes remain incompletely defined. Materials and Methods: This retrospective study included 146 patients (217 knees) with Kellgren–Lawrence (K–L) grade II–IV knee OA who underwent intra-articular injection of autologous adipose-derived SVF and completed a minimum follow-up of 1 year. Pain was assessed using the visual analog scale (VAS), and patients reported the time to perceived pain improvement after treatment. Radiographic severity was evaluated using the K–L grading system. Correlation analyses were performed to assess associations between pain-related outcomes, SVF cell number, and radiographic severity. Results: VAS scores improved significantly from baseline to the final follow-up (p < 0.01). Patients reported perceived pain improvement at a mean of 18.9 ± 14.5 days after SVF injection. The mean injected dose was 7.4 × 10⁷ total SVF cells per knee, including approximately 7.0 × 10⁶ stromal cells. Higher SVF cell numbers were significantly associated with greater pain improvement and lower VAS scores at final follow-up (p < 0.001 for both). Radiographic severity was not significantly correlated with pain at final follow-up, the magnitude of pain improvement, or the time to symptom relief. No clinically relevant adverse events were observed. Conclusions: Intra-articular injection of high-dose autologous SVF was associated with rapid and clinically meaningful pain relief, with symptom improvement occurring within approximately 3 weeks after treatment. The dose-dependent association and the lack of correlation with radiographic severity suggest that early pain relief is primarily mediated by the anti-inflammatory and paracrine effects of SVF rather than immediate structural cartilage regeneration. Full article

Objectives: While Pilates exercise is commonly prescribed for chronic low back pain (CLBP), its effect on normalizing the lumbar flexion–relaxation ratio (FRR) remains unclear. This trial examined whether an 8-week Pilates exercise program (PEP) modifies FRR magnitude and side-to-side asymmetry in women with CLBP and explored associations with trunk kinematics, pain, and functional capacity. Methods: In a randomized controlled pre-test–post-test training design, ninety-six women with CLBP (55.8 ± 5.4 y) were allocated to a PEP group (n = 49) or a usual-care control group (n = 47). The PEP included two supervised 60-minute mat sessions per week over eight weeks. Surface electromyography of the right and left erector spinae and trunk flexion range of motion (TFRoM), measured via inertial sensors, were recorded during the standardized flexion–extension task pre- and post-intervention. Pain intensity (Visual Analog Scale) and functional capacity (Low Back Outcome Score, LBOS) were assessed concurrently. Results: Two-way repeated-measures ANOVA revealed no group × time interaction for global FRR (p = 0.454) or TFRoM (p = 0.745). FRR asymmetry increased by 11% in the PEP group (p = 0.033), with no change observed in the controls (p = 0.143). Compared to the controls, the PEP group exhibited a 30% reduction in pain (p = 0.003) and a 13.4% improvement in LBOS (p < 0.001) compared to the control group (all ps > 0.228). Conclusions: An 8-week Pilates intervention reduces pain and improves functional capacity in women with CLBP but does not restore lumbar extensor relaxation. The observed increase in FRR asymmetry may reflect compensatory or maladaptive redistribution. Full article

Heel pain is a very common foot condition. Mechanical factors are the most common cause of heel pain. The main causes of heel pain include plantar fasciitis, heel spurs, Achilles tendinopathy, heel neuritis, and heel bursitis. This case study aimed to manage pain in a patient with heel pain accompanied by pronounced pes planus. A 42-year-old woman presented with heel pain and pes planus. The pain was present in the normal standing position and at rest. After examination, a spur, plantar fasciitis, and Morton’s neuroma were diagnosed. The patient, who had not responded to medical and rehabilitative treatments, was evaluated using the visual analog scale and the 36-Item Short Form Survey quality of life questionnaire to assess pain during rest and walking using a newly developed combined exercise method. Significant improvements were observed in the final measurements. This study contributes significantly to our knowledge of the best physiotherapy treatments for patients with heel pain associated with spurs and plantar fasciitis. Full article

Background: Nociplastic-like pain features are increasingly recognized as significant contributors to chronic pain and reduced quality of life in patients with rheumatoid arthritis (RA). However, their clinical correlates and relationship with disease activity remain incompletely understood. Objective: To evaluate the prevalence of nociplastic-like pain features in patients with RA and to investigate their associations with disease activity, pain intensity, fatigue, sleep quality, and health-related quality of life. Methods: In this cross-sectional study, 160 patients with RA were enrolled. Nociplastic-like pain features were assessed using the PainDETECT questionnaire. Disease activity was evaluated using the Disease Activity Score in 28 joints (DAS28). Pain intensity, fatigue, sleep quality, and health-related quality of life were assessed using the visual analog scale (VAS), Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F), Pittsburgh Sleep Quality Index (PSQI), and Short Form-36 (SF-36), respectively. Continuous variables were compared using t-tests or Mann–Whitney U tests according to data distribution. Stepwise multivariate linear regression analysis was performed to identify independent factors associated with PainDETECT scores. Results: Pain patterns suggestive of nociplastic-like features were identified in 22.5% of patients. These patients had significantly higher pain intensity, greater fatigue (lower FACIT-F scores), poorer sleep quality (higher PSQI scores), and lower SF-36 scores across all domains compared with patients without these features (all p < 0.001). PainDETECT scores showed a strong positive correlation with VAS pain intensity (r = 0.679, p < 0.001) and a moderate correlation with DAS28 (r = 0.536, p < 0.001). PainDETECT scores were negatively correlated with FACIT-F (r = −0.512, p < 0.001) and several SF-36 domains. In stepwise multivariate regression analysis, pain intensity, tender joint count, and education level emerged as independent predictors of nociplastic-like pain features, whereas inflammatory markers (CRP, ESR) and DAS28 were excluded from the model. Conclusions: Nociplastic-like pain features are common in RA and are independently associated with pain intensity, joint tenderness, and psychosocial factors rather than inflammatory activity alone. Routine assessment of these features is essential for personalized pain management and underscores the importance of considering potential central sensitization mechanisms in addition to traditional anti-inflammatory therapies. Full article

Objective: Cervical facet joints are prominent sources of chronic neck pain. This single-center retrospective cohort study compared ultrasound (US)-guided and fluoroscopy (FL)-guided cervical medial branch procedures at the C3–C6 levels in terms of technical success and tested for non-inferiority (NI). Methods: Between March 2022 and July 2025, 224 procedures performed at the Adana City Training and Research Hospital, Department of Algology (US, n = 104; FL, n = 120), were analyzed. The primary endpoint was technical success. Secondary endpoints included procedure duration; complications; pain intensity, measured using the Visual Analog Scale (VAS); functional outcomes, assessed with the Neck Disability Index (NDI) at 1, 3, 6, and 12 months; and radiation exposure in the FL group. Propensity score weighting was applied to reduce confounding. The NI margin for technical success was set at −5 percentage points, with α = 0.025. Results: The technical success rates were similar (US: 90.4%, FL: 90.8%; difference: −0.4%, 95% CI: −8.1 to 7.2), but non-inferiority was not statistically achieved (power ≈ 72%). Procedure time was significantly shorter in the ultrasound-guided group compared with the fluoroscopy-guided group (mean difference −5.2 min; 95% CI: −7.5 to −2.9; p < 0.001). No major complications occurred. Both groups demonstrated sustained improvement over 12 months, with VAS scores decreasing from 7.4 at baseline to 4.0 at 12 months and NDI scores decreasing from 41.3 to 29.2. No statistically significant between-group differences were observed for pain intensity (VAS) at any follow-up time point (all p > 0.05). Similarly, functional outcomes (NDI) did not differ significantly between the ultrasound- and fluoroscopy-guided groups throughout follow-up (all p > 0.05). Exploratory analyses using minimum clinically important difference (MCID) thresholds supported the clinical non-inferiority of US. In the FL group, the mean fluoroscopy time was 2.28 min with low radiation doses. Conclusions: Although NI was not statistically confirmed for technical success, US achieved comparable outcomes to FL with shorter procedure times and without radiation exposure. Both modalities provided similar long-term pain relief and functional improvement. US can be considered a safe and effective alternative in experienced hands, but larger multicenter prospective NI trials are needed to confirm these findings. Full article

Background: Alcohol Use Disorder (AUD) is a major contributor to global morbidity, mortality, and socioeconomic burden. Cravings, defined as intense urges to consume alcohol, play a central role in relapse and are recognized as a diagnostic criterion in DSM-5. Pharmacological strategies targeting cravings may offer immediate or short-term relief, complementing existing long-term approaches. However, evidence on short-term (up to approximately three months) anti-craving interventions remains fragmented. Objective: To systematically review randomized, double-blind, placebo-controlled trials (RCTs) assessing the short-term effects of pharmacological treatments on cue-induced alcohol cravings. Methods: A systematic search was conducted in PubMed and PsycINFO using terms related to alcohol, craving, and randomized controlled designs. Eligibility included clinical trials on alcohol-dependent participants that evaluated craving as an outcome. Exclusion criteria encompassed non-clinical studies, non-pharmacological interventions, animal studies, single-blind trials, and studies with psychiatric comorbidities. Study quality was appraised using Cochrane and Joanna Briggs Institute tools. Results: From 442 studies screened, 26 RCTs fulfilled the inclusion criteria. In total, 1097 participants were enrolled across the trials (range = 16–125 per study; mean = 44), predominantly male outpatients aged 15–65 years. Craving was assessed primarily with the Visual Analog Scale and Alcohol Urge Questionnaire. Intervention duration ranged from 1 to 98 days. Naltrexone consistently reduced cue-induced craving across four trials, with additional benefit observed when combined with ondansetron. Varenicline and acamprosate also demonstrated reductions in craving and drinking. Memantine showed efficacy in craving reduction but was not assessed for abstinence. Topiramate was effective, whereas gabapentin showed limited short-term benefit. Other agents (e.g., citalopram, oxytocin, ondansetron, quetiapine) yielded mixed findings, often limited to single studies. Overall, 58% of trials reported positive anti-craving effects, 23% no difference, and 8% increased craving versus placebo. However, these findings should be interpreted in light of important methodological limitations, including small sample sizes and heterogeneous experimental paradigms. Conclusions: This review suggests that naltrexone and varenicline appear to be the most consistently supported short-term pharmacotherapies for alcohol craving within the available evidence, with promising but less consistent findings for memantine, acamprosate, and topiramate. These results highlight potential candidates for immediate craving management in AUD, while underscoring the need for larger and longer-term trials to confirm their efficacy and safety. Full article

Background: The extent to which bone marrow aspiration technique affects the biological quality of bone marrow aspirate and its clinical relevance in knee osteoarthritis remains uncertain. This study compares the efficacy of the traditional aspiration method and the Snap Back technique at two anatomical harvest sites, the posterior iliac crest and the proximal tibia. Methods: This ancillary post hoc analysis was conducted within a randomized trial comparing posterior iliac crest and proximal tibia harvest sites in 60 patients with unicompartmental knee OA. Aspiration technique (traditional vs. Snap Back) was selected intraoperatively and not randomized. BMA samples were analyzed for MSCs, mononuclear cells (MNCs), platelet concentration, and marrow purity. Clinical outcomes were assessed at baseline and six months using the Visual Analog Scale and the Western Ontario and McMaster Universities Osteoarthritis Index. Results: The posterior iliac crest yielded significantly higher MSC and MNC concentrations compared to the tibia, with superior purity and PLT counts observed using the Snap Back technique. Within each anatomical site, Snap Back aspiration provided improved cellular recovery over the traditional method. However, differences in clinical outcomes between groups were modest and did not consistently reach statistical significance. Conclusions: Both harvest site and aspiration technique were associated with substantial differences in the cellular composition of BMA. The withdrawal from posterior iliac crest combined with the Snap Back technique optimizes MSC yield and marrow purity, though clinical improvements appear independent of cellular concentration in the short term. These findings suggest that standardized aspiration protocols may be relevant for the biological efficacy of orthobiologic therapies in knee OA. Full article

Background: Poor sleep quality is common among university students and may contribute to adverse reproductive health outcomes, including dysmenorrhea. However, limited evidence exists on whether chronic sleep disturbance independently predicts dysmenorrhea severity or menstrual-related functional impairment after accounting for key confounders. Objectives: We aimed to determine the prevalence of poor sleep quality among female university students and to examine its association with (1) severe dysmenorrhea and (2) menstrual-related functional impairment. Methods: A cross-sectional study was conducted among female undergraduate students at Ras Al Khaimah Medical and Health Sciences University (United Arab Emirates). Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), and perceived stress was assessed using the Perceived Stress Scale (PSS-10). Dysmenorrhea severity was assessed using a 0–10 visual analog scale; functional impairment was defined as moderate/severe disruption in ≥1 life domain. Multivariable logistic regression models estimated adjusted odds ratios (aORs) for the association between sleep quality and menstrual outcomes after controlling for age, BMI, socioeconomic status, and stress. A component-level analysis examined independent effects of PSQI dimensions. Results: Of the 254 participants, 68.9% reported poor sleep quality and 48.8% reported severe dysmenorrhea. In adjusted models, moderate sleep problems (aOR = 2.00, 95% CI: 1.09–3.67, p = 0.024) and severe sleep problems (aOR = 3.63, 95% CI: 1.45–9.06, p = 0.006) were significantly associated with severe dysmenorrhea. Severe dysmenorrhea strongly predicted menstrual-related functional impairment (aOR = 4.81, 95% CI: 2.63–8.77, p < 0.001). Poor sleep quality remained independently associated with functional impairment (aOR = 1.96, 95% CI: 1.05–3.65, p = 0.035). In component analysis, sleep disturbance (PSQI Component 5) was the only independent predictor of severe dysmenorrhea (aOR = 2.11, 95% CI: 1.31–3.41, p = 0.002). Conclusions: Poor sleep quality, particularly sleep disturbance, is associated with increased odds of severe dysmenorrhea and menstrual-related functional impairment in female university students. Sleep fragmentation may represent a key mechanistic and modifiable contributor to menstrual pain severity. Integrating sleep assessment into dysmenorrhea management and evaluating sleep-focused interventions in longitudinal and interventional studies are warranted. Full article

Background: Targeted muscle reinnervation (TMR) is increasingly used to enhance prosthetic control and to reduce post-amputation pain. Its implementation across new centers raises questions about the reproducibility of outcomes and the impact of surgical experience. Methods: We compared the first three TMR patients treated in a newly established center in Nantes, France, with three patients treated in a high-volume center in Göttingen, Germany. Functional outcomes were measured using the Box and Block test (BBT), and operative time was recorded. Two French cases were performed with the assistance of a Göttingen-based surgeon. Conclusions: The functional outcomes showed a similar trend in both groups. The mean BBT scores were equivalent, suggesting reliable reinnervation and prosthetic integration even in early cases. Operative times were longer in Nantes, but did not impact outcomes. TMR appears not to have a pronounced learning curve, particularly regarding functional success in early cases under guided protocols. Factors such as assistance from experienced surgeons and favorable donor-to-recipient nerve ratios likely contribute to consistent outcomes. These findings support the reproducibility of TMR across institutions. Results: Within the first two years of rehabilitation we observed improvements in both functional performance and patient-reported quality of life. All six patients across both centers in-creased in BBT scores. All the patients reported an increase in social relationships and psychological health, and two of three patients reported an increase in physical health. Importantly, all six patients discontinued the use of pain medication at 2 years fol-lowing TMR. Furthermore, the French patients reported a decrease from 65–82 mm to 0–31 mm across the patients’ Visual Analog Scale (VAS) pain scores. Full article

Background/Objectives: Genitourinary syndrome of menopause (GSM) is a common and under-diagnosed condition that significantly affects the quality of life of post-menopausal women. Conventional treatments, especially those based on estrogens, have limitations, which has prompted the search for alternative therapies in the field of regenerative medicine. In this context, intradermal injectable collagen, with regenerative and analgesic properties, could represent an innovative option. This study aims to evaluate the efficacy and safety of multipoint intradermal injections of collagen (MD-Tissue) in the treatment of GSM refractory to conventional first-line therapy. Methods: A retrospective study was conducted in 20 patients diagnosed with GSM. Intradermal injections of collagen were administered in the vulvovaginal region. Clinical outcome was assessed using the Visual Analog Scale (VAS) for baseline pain and dyspareunia, the Vaginal Health Index (VHI), the Vulvar Health Index (vHI), the Vulvovaginal Symptoms Questionnaire (VSQ) and the Clinical Global Impression scale (CGI). Results: Three months after end of injections, baseline pain measured using the VAS was significantly reduced from a mean of 5.9 to 0.8 (p < 0.001), and pain during intercourse decreased from 8.7 to 2.0 (p < 0.001). Significant improvements were also observed in the tissue parameters of VHI and vHI. In the VSQ, 100% of patients reported improvement in at least one domain, including itching, dryness, burning, and social and sexual impact. According to the CGI scale, 80% reported feeling ‘much better’ and 20% ‘moderately better’. No relevant adverse effects were reported. Conclusions: Intradermal vulvovaginal collagen injections appear to be a safe and potentially effective intervention in improving pain and other symptoms of GSM, within the regenerative medicine approach. These preliminary results justify prospective studies, with larger sample sizes and long-term follow-up, to confirm and consolidate clinical utility. Full article

Objective: The aim of the study was to compare postoperative pain, functional recovery, knee stability and complication profiles between the all-inside technique and the conventional full tibial tunnel technique for anterior cruciate ligament (ACL) reconstruction. Methods: This retrospective comparative cohort study included 104 patients who underwent primary ACL reconstruction between 2018 and 2020. Surgical technique allocation was non-randomized. Patients were divided into two groups based on the surgical technique employed; the conventional full tibial tunnel group (n = 58) and all-inside group (n = 46). Hamstring tendon autografts were used in all cases, and the procedures were performed by the same surgical team to ensure consistency. Clinical outcomes were evaluated using the Visual Analog Scale (VAS) for pain, Lysholm knee score and International Knee Documentation Committee (IKDC) score. Knee stability was assessed with the Lachman and pivot-shift test. Additionally, postoperative complications and revision rates were recorded. Results: The study included 104 patients, with 58 treated using the conventional technique and 46 using the all-inside technique. Baseline characteristics, trauma mechanisms, and follow-up duration were comparable between groups (p > 0.05). Four patients in each group underwent revision surgery and excluded from the final analysis. Revision rates were comparable between groups (6.9% vs. 8.6%) and were considered descriptively when interpreting outcomes. The preoperative VAS, Lysholm and IKDC scores were comparable between groups. At 3 months, the all-inside group demonstrated significantly lower VAS pain scores and higher Lysholm and IKDC scores (with moderate-to-large effect sizes) (all p < 0.01). No significant differences were observed at the 12-month or final follow-up. Postoperative knee stability was comparable between groups, whereas anterior knee pain was significantly less frequent in the all-inside group (p < 0.001). Moreover, patients treated with the all-inside technique returned to sports significantly earlier than those treated with the conventional technique (13.25 ± 2.70 vs. 16.40 ± 5.85 months, p < 0.001; Cohen’s d = 0.66). However, the proportion of patients who returned to their preinjury sports level was comparable between the two groups (81.0% vs. 83.3%, p = 0.78). Conclusions: The all-inside ACL reconstruction technique was associated with superior early pain relief and short-term functional outcomes compared with the conventional technique, while achieving comparable knee stability and mid-term clinical results. These advantages occur without increasing complications or revision rates. These findings support the all-inside technique as patient-centered, optimizing early recovery without sacrificing mid-term clinical durability. These findings should be interpreted in the context of the non-randomized retrospective study design. Full article

Facial profile esthetics play a pivotal role in orthodontic diagnoses, treatment planning, and patient satisfaction; however, the perception of facial attractiveness is inherently subjective and varies according to professional expertise and sociocultural background. This study aimed to compare the perceived attractiveness of standardized sagittal facial profiles across skeletal Class I, II, and III patterns and to investigate the influence of professional training and sociodemographic variables on facial profile evaluations. It was hypothesized that straight facial profiles would be perceived as the most attractive across all observer groups, while deviations from the orthognathic profile would be rated as less attractive, with significant differences based on professional training and sociodemographic variables. This cross-sectional descriptive study included 509 participants, comprising orthodontists, orthodontic Ph.D. students, general dentists, specialist dentists, first- and fifth-year dental students, and laypersons. Seven standardized sagittal facial profile silhouettes (S1–S7) were digitally generated from a standardized lateral facial photograph and evaluated using a seven-point visual analog scale. Participants were also asked to identify the sagittal facial profile range (S8) they ideally preferred to possess. Intergroup comparisons were performed using non-parametric statistical tests (Mann–Whitney U and Kruskal–Wallis). The straight profile (S3) emerged as the most attractive and most frequently preferred across all participant groups, confirming its role as the dominant esthetic reference. Retrusive profiles, particularly bimaxillary retrusion (S2), mandibular retrognathism (S5), and maxillary retrusion (S6), were consistently rated as the least attractive. Significant differences in esthetic perceptions were observed according to the professional expertise, educational level, age, and nationality, whereas gender had no clinically meaningful effect. Orthodontic training was associated with increasingly critical evaluations, especially for protrusive and convex profiles, while laypersons demonstrated greater esthetic tolerance. Both anatomical characteristics and sociocultural experience shape the perception of facial profile esthetics. While the straight profile represents a widely shared aesthetic ideal, increasing orthodontic expertise accentuates discrepancies between professional standards and public preferences. These findings underscore the necessity of integrating patient-centered and culturally sensitive considerations into contemporary orthodontic treatment planning. Full article

Objectives: Nasal obstruction is a common presenting symptom in otolaryngology practice. Frequent etiologies include allergic and non-allergic rhinitis, inferior turbinate hypertrophy (HIT), and nasal septal deviation (DNS). This study aimed to evaluate the relationship between major causes of nasal obstruction and their effect on patient-reported quality of life (QoL). Methods: We conducted a retrospective analysis of patients presenting with nasal obstruction who completed the 22-item Sino-Nasal Outcome Test (SNOT-22), the Nasal Obstruction Symptom Evaluation (NOSE) scale, and a visual analog scale (VAS). Patients were categorized into three groups based on etiology: rhinitis, anatomical obstruction, or combined pathology. Results: The study included 170 patients (62% male), with a mean age of 38.4 years. Mean SNOT-22, NOSE, and VAS scores were 38, 61, and 6.5, respectively, with no statistically significant differences observed among the three etiologic groups. QoL outcomes were also comparable across anatomical subgroups, including isolated DNS, HIT, or combined findings. Among SNOT-22 domains, rhinologic symptoms demonstrated the highest burden. Patients with rhinitis exhibited significantly higher rhinologic and ear/facial symptom scores compared with patients with isolated anatomical obstruction (p = 0.04 and p = 0.005, respectively). Strong correlations were observed between SNOT-22, NOSE, and VAS scores across the entire cohort. Conclusions: Nasal obstruction is associated with substantial impairment in multiple domains of quality of life, independent of the underlying etiology. These findings highlight the broad impact of nasal obstruction on patient well-being. Larger prospective studies are warranted to further assess changes in quality of life following medical and surgical interventions. Full article