Search Results (14,628)

Background: Mechanical circulatory support (MCS) has revolutionized advanced heart failure and cardiogenic shock management, yet randomized controlled trials have failed to demonstrate consistent mortality benefits with temporary devices, and outcomes remain highly variable across institutions. Methods: This narrative review examines contemporary MCS devices, analyzing their hemodynamic principles, clinical outcomes, complications, and selection strategies. The published literature addressing MCS clinical applications and outcomes was reviewed, with reference lists examined to identify additional sources. Results: Temporary MCS devices demonstrate a persistent hemodynamic-survival paradox where improved hemodynamics fail to translate into mortality benefits in randomized trials. This disconnect reflects delayed intervention after irreversible organ damage, device complications offsetting hemodynamic gains, heterogeneous patient selection without phenotyping, timing challenges, and inadequate statistical power. Landmark trials provide definitive evidence against routine early VA-ECMO use, showing no survival advantage while significantly increasing complications. Optimal device selection requires integrating hemodynamic phenotyping with shock stage to match devices to pathophysiology, while biventricular failure presents the greatest challenge with substantially lower survival. For durable devices, third-generation systems demonstrate superior outcomes with dramatically reduced pump thrombosis and improved survival. Critically, multidisciplinary shock teams employing standardized protocols significantly reduce mortality beyond what devices alone achieve, with structured programs showing substantially improved survival compared to trials using similar devices without organized care systems. Conclusions: Mechanical circulatory support has transformed heart failure management, but optimal outcomes require integrating devices within structured care delivery systems. Success depends on comprehensive hemodynamic assessment, multidisciplinary team activation, protocolized device selection, standardized escalation and weaning strategies, and regionalized networks. The future lies in shifting focus from device innovation to implementation science, establishing quality metrics, developing precision medicine approaches, and conducting trials in phenotype-selected populations with protocolized care. This systems-of-care paradigm offers the most promising path toward translating technological advances into sustained mortality reduction. Full article

Introduction: Conservative or upfront radical management for high- and very high-risk non-muscle-invasive bladder cancer continues to be debated, particularly for cases with adverse pathological features. We aimed to compare survival outcomes among NMIBC patients treated with transurethral resection of bladder tumour (TURBT) followed by either Bacillus Calmette–Guérin (BCG), sequential BCG plus electromotive administration of mitomycin C (EMDA-MMC), or upfront radical cystectomy (RC). Materials and Methods: High- and- very high-risk NMIBC cases undergoing TURBT followed by BCG, BCG plus EMDA-MMC, or RC at two international tertiary referral centres between 2009 and 2024 were retrospectively reviewed. Recurrence-free survival (RFS), progression-free survival (PFS), and overall survival (OS) were estimated using Kaplan–Meier methods. Multivariable Cox regression models were applied to identify factors independently associated with survival outcomes. Results: A total of 1178 patients were included: 852 received BCG, 249 received BCG/EMDA-MMC, and 77 underwent upfront RC. Kaplan–Meier analysis revealed no significant differences in RFS or PFS between the BCG and BCG/EMDA-MMC groups, nor in OS between the three treatment strategies. According to multivariable analysis, concomitant carcinoma in situ (CIS) and increasing T stage at TURBT were independently associated with poorer RFS (HR 1.39; 95% CI 1.05–1.85), PFS (HR 1.95; 95% CI 1.36–2.82), and OS (HR 2.28; 95% CI 1.60–3.25). A second resection conferred a protective effect on PFS (HR 0.72; 95% CI 0.54–0.95). Treatment modality (BCG, BCG/EMDA-MMC, or upfront RC) was not significantly associated with any survival endpoint. Conclusions: In this large multicentre series of patients with high- and very high-risk NMIBC undergoing TURBT, survival outcomes were primarily influenced by clinical–pathological characteristics rather than the adjuvant treatment of choice. Full article

Gram-negative (GN) periprosthetic joint infections (PJIs) are being increasingly reported. However, the role of Klebsiella species in PJIs remains unclear. Therefore, we aimed to analyze the prevalence, clinical presentation, microbial spectrum, antibiogram, treatment strategies and outcomes of Klebsiella-associated PJIs. A total of 1925 culture-positive total joint revision arthroplasties (rTJA) were retrospectively reviewed at a single center. Patient data were extracted from our institutional arthroplasty and PJI database. We identified 20 Klebsiella-positive PJIs (hip/knee, 11/9), representing 1.0% of all culture-positive rTJAs. The cases were predominantly polymicrobial (80%) and chronic (50%). Notably, Klebsiella spp. was rarely detected as an initial infectious event but was predominantly identified in the context of revision or re-revision procedures, frequently in patients with prior or persistent PJIs. Klebsiella pneumoniae was the most frequent species, with 44% showing multi-drug resistance. The antimicrobial susceptibility of Klebsiella isolates showed high resistance to cephalosporines and penicillin, in contrast little to no resistance to meropenem, gentamicin and levofloxacin. The most common initial surgical intervention was a two-stage revision (65%). Infection control (Tier 1) was observed in 11%, while further intervention was needed in 56% (Tier 3). All patients who had already died were classified as Tier 4 (33%). Klebsiella spp. was detected in 10.0% of GN rTJAs and was mainly associated with complex revision settings rather than primary infections. It is often associated with chronic polymicrobial infections and high antimicrobial resistance. The outcomes were generally poor, highlighting the need for pathogen-specific treatment strategies and improved diagnostics. Full article

Background: The precise segmentation and classification of dermoscopic images remain prominent obstacles in automated skin cancer evaluation due, in part, to variability in lesions, low-contrast borders, and additional artifacts in the background. There have been recent developments in foundation models, with a particular emphasis on the Segment Anything Model (SAM)—these models exhibit strong generalization potential but require domain-specific adaptation to function effectively in medical imaging. The advent of new architectures, particularly Vision Transformers (ViTs), expands the means of implementing robust lesion identification; however, their strengths are limited without spatial priors. Methods: The proposed study lays out an integrated foundation-model-based framework that utilizes SAM-Adapter-fine-tuning for lesion segmentation and a ViT-based classifier that incorporates lesion-specific cropping derived from segmentation and cross-attention fusion. The SAM encoder is kept frozen while lightweight adapters are fine-tuned only, to introduce skin surface-specific capacity. Segmentation priors are incorporated during the classification stage through fusion with patch-embeddings from the images, creating lesion-centric reasoning. The entire pipeline is trained using a joint multi-task approach using data from the ISIC 2018, HAM10000, and PH2 datasets. Results: From extensive experimentation, the proposed method outperforms the state-of-the-art segmentation and classification across the dataset. On the ISIC 2018 dataset, it achieves a Dice score of 94.27% for segmentation and an accuracy of 95.88% for classification performance. On PH2, a Dice score of 95.62% is achieved, and for HAM10000, an accuracy of 96.37% is achieved. Several ablation analyses confirm that both the SAM-Adapters and lesion-specific cropping and cross-attention fusion contribute substantially to performance. Paired t-tests are used to confirm statistical significance for all the previously stated measures where improvements over strong baselines indicate a $p<0.01$ for most comparisons and with large effect sizes. Conclusions: The results indicate that the combination of prior segmentation from foundation models, plus transformer-based classification, consistently and reliably improves the quality of lesion boundaries and diagnosis accuracy. Thus, the proposed SAM-ViT framework demonstrates a robust, generalizable, and lesion-centric automated dermoscopic analysis, and represents a promising initial step towards clinically deployable skin cancer decision-support system. Next steps will include model compression, improved pseudo-mask refinement and evaluation on real-world multi-center clinical cohorts. Full article

Age-related macular degeneration (AMD) is an increasingly prevalent source of permanent visual impairment in the aging population and is widely accepted as a multi-factorial neurodegenerative disorder of the retina. While there has been significant progress in treating neovascular AMD, there are currently no effective disease-sparing treatments for dry AMD and geographic atrophy. To date, research has begun to reveal the complex relationship between the environment and genetic predisposition in AMD pathogenesis. Various environmental factors responsible for AMD include oxidative stress, mitochondrial dysfunction, inflammation, abnormal complement activation, and epigenetic regulation, which interact dynamically to drive disease progression. This review summarizes recent data and provides a comprehensive model for understanding how these interacting factors lead to the progression of AMD from an early stage to advanced stages with complications associated with the disease. We highlight the central role of retinal pigment epithelial mitochondrial failure and impaired stress resilience as upstream drivers that amplify inflammation and complement-mediated injuries. We also discuss how dysregulated miRNAs and proteomic network remodeling contribute to disease heterogeneity. Emerging therapeutic strategies are reviewed in the context of molecular endotyping and personalized intervention. Finally, we outline future directions toward precision medicine in AMD, emphasizing early disease modification, rational combination therapies, and the need to bridge the translational gaps between molecular discovery and clinical trial design. Full article

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, primarily driven by chronic inflammation from viral hepatitis, metabolic dysfunction, alcohol-induced liver disease, and cirrhosis. Conventional therapies often fail in advanced stages, highlighting the need for mechanism-based, precision-guided interventions. Plant-derived secondary metabolites represent a promising class of bioactive compounds with structural diversity, multitarget activity, anti-inflammatory effects, and favorable toxicity profiles. This review follows a semi-systematic narrative that synthesizes preclinical and experimental evidence on the anti-inflammatory and anticancer properties of key phytochemicals, including epigallocatechin-3-gallate, galangin, resveratrol, quercetin, curcumin, berberine, genistein, and thymoquinone. These compounds consistently modulate critical inflammation-driven signaling pathways, PI3K/AKT/mTOR, NF-κB, JAK/STAT, Wnt/β-catenin, and MAPK, resulting in apoptosis induction, cell cycle arrest, inhibition of angiogenesis, and reduced invasion and metastasis in multiple HCC models. Despite strong preclinical evidence, clinical translation remains limited by variable bioavailability, incomplete safety data, and insufficient human studies. A staged development strategy is recommended: standardized formulations, Good Laboratory Practice-compliant pharmacokinetic/toxicology studies, validation in patient-derived models, and early-phase, biomarker-guided clinical trials with combination therapy arms. Addressing regulatory, manufacturing, and quality control considerations will be essential for advancing these compounds as adjuvant or complementary agents in precision HCC therapy. Full article

Background/Objectives: Otitis media (OM), including acute otitis media (AOM) and chronic otitis media (COM), is a common middle ear disease that can lead to significant morbidity if not accurately diagnosed. Otoscopic interpretation remains subjective and operator-dependent, underscoring the need for objective and reproducible diagnostic support. Recent advances in artificial intelligence (AI) offer promising solutions for automated otoscopic image analysis. Methods: We developed an AI-based diagnostic framework consisting of three sequential steps: (1) semi-supervised learning for automatic recognition and semantic segmentation of tympanic membrane structures, (2) region-based feature extraction, and (3) disease classification. A total of 607 clinical otoscopic images were retrospectively collected, including normal ears (n = 220), AOM (n = 157), and COM with tympanic membrane perforation (n = 230). Among these, 485 images were used for training and 122 for independent testing. Semantic segmentation of five anatomically relevant regions was performed using multiple convolutional neural network architectures, including U-Net, PSPNet, HRNet, and DeepLabV3+. Following segmentation, color and texture features were extracted from each region and used to train a neural network-based classifier to differentiate disease states. Results: Among the evaluated segmentation models, U-Net demonstrated superior performance, achieving an overall pixel accuracy of 96.76% and a mean Dice similarity coefficient of 71.68%. The segmented regions enabled reliable extraction of discriminative chromatic and texture features. In the final classification stage, the proposed framework achieved diagnostic accuracies of 100% for normal ears, 100% for AOM, and 91.3% for COM on the independent test set, with an overall accuracy of 96.72%. Conclusions: This study demonstrates that a semi-supervised, segmentation-driven AI pipeline integrating feature extraction and classification can achieve high diagnostic accuracy for otitis media. The proposed framework offers a clinically interpretable and fully automated approach that may enhance diagnostic consistency, support clinical decision-making, and facilitate scalable otoscopic assessment in diverse healthcare screening settings for disease prevention and health education. Full article

Background and Objectives: Diabetic retinopathy (DR) is a leading microvascular complication of type 2 diabetes (T2D). Fractalkine (CX3CL1), a chemokine involved in inflammation, angiogenesis, and microglial activation, may play a role in DR pathogenesis. This study investigated the association between serum fractalkine levels, the presence of DR, and disease severity. Materials and Methods: In this cross-sectional study, 140 adults with T2D were classified as non-DR (n = 32) or DR (n = 108) according to ICDR and ETDRS criteria; DR cases were further categorized into NPDR (n = 76) and PDR (n = 32), with NPDR staged as mild, moderate, or severe. Serum fractalkine concentrations were measured using ELISA. Results: Serum fractalkine levels were significantly higher in patients with DR than in those without retinopathy (0.7 vs. 0.4 ng/mL, p < 0.001). Within NPDR stages, fractalkine levels were highest in severe NPDR (p = 0.004). No significant fractalkine difference was found between NPDR and PDR groups. In multivariable analysis, serum fractalkine (OR 10.2; 95% CI 1.2–89.6; p = 0.036) remained independently associated with the presence of DR. For identifying DR, fractalkine yielded an AUC of 0.736; the optimal cut-off of 0.455 ng/mL provided 81.5% sensitivity and 56.3% specificity. In distinguishing severe NPDR, fractalkine demonstrated strong diagnostic performance (AUC = 0.784), with a cut-off of 0.720 ng/mL yielding 100% sensitivity and 61.9% specificity. Conclusions: Serum fractalkine is significantly associated with both the presence and severity of DR and remains independently associated with retinopathy after adjustment for traditional risk markers. Serum fractalkine may offer complementary systemic information in automated and AI-based retinal screening. These findings are exploratory and hypothesis-generating, and prospective studies are required to determine the clinical relevance of serum fractalkine in DR. Full article

Background: and objective: Globally, breast cancer (BC) raises global health concerns, being the most common cancer. Women with BC experience a significant increase in perception of stress. Therefore, this study aims to evaluate the stress levels and associated sociodemographic and clinical factors among BC women in Saudi Arabia. Methods: A cross-sectional study was conducted between January and May 2025. Women diagnosed with BC, who were at least 18 years old, were recruited conveniently from outpatient and inpatient departments in King Fahad Specialist Hospital, Dammam, Saudi Arabia. Data were collected in the Arabic language through self-reported questionnaires, including sociodemographic/clinical characteristics and the Cohen’s Perceived Stress Scale. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 27. Results: A total of 200 participants were included in the study. The mean stress perception score was 26.52 ± 7.34. A high proportion (71.5%) of the sample reported elevated stress. A significant association was observed between age and stress levels. Most women aged 20–40 and 41–60 reported high stress, compared to women in the 61–80 age group (p = 0.003). Among all predictors, age was the only variable significantly associated with stress scores. Increasing age was associated with lower stress levels (B = −0.179, p = 0.013), indicating that younger participants tended to report higher stress. This corresponds to an adjusted decrease of approximately 1.8 points in the PSS-10 score per 10-year increase in age. Although participants with Stage IV cancer showed higher stress scores compared to those with Stage I cancer, this association approached but did not reach statistical significance (p = 0.054). Conclusions: This study highlights the substantial psychological burden experienced by women living with BC in Saudi Arabia. The majority of participants reported high levels of perceived stress. Younger women were particularly vulnerable to elevated stress. These findings highlight the need for targeted psychosocial support within oncology care to improve emotional well-being and quality of life. Full article

Effective drug delivery in oncology is challenged by a hierarchy of biological barriers—from abnormal vasculature and dense stroma to cellular immunosuppression and specialized interfaces like the blood–brain barrier. This review provides a contemporary analysis of smart nanoformulations through the lens of a rational, stage-gated design pipeline. We first deconstruct the solid tumor microenvironment as a multi-tiered obstacle (systemic, stromal, cellular), establishing a barrier-specific foundation for nanocarrier design. The core of the review articulates an architectural toolkit, detailing how intrinsic nanoparticle properties precondition in vivo identity via the protein corona, which in turn informs the selection of advanced ligands for cellular targeting and programmed intracellular trafficking. This integrated framework sets the stage for exploring sophisticated applications, including endogenous and externally triggered responsive systems, bio-orthogonal activation, immuno-nanoformulations, and combination strategies aimed at overcoming multidrug resistance. By synthesizing these components into a cohesive design philosophy, this review moves beyond a catalog of advances to offer a blueprint for engineering next-generation nanotherapeutics. We critically assess the translational landscape and contend that this hierarchical design approach is essential for developing more effective, personalized, and clinically viable cancer treatments. Full article

Background/Objectives: Although tissue inhibitors of metalloproteinases (TIMPs) are key regulators in breast cancer, their differential expression, clinical relevance, and molecular roles remain unclear. This study aimed to compare the expression patterns of the four TIMPs in breast cancer and evaluate their molecular interactions and associated pathways through an integrated bioinformatic analysis. Methods: The expression of TIMPs and their correlations with MMPs were analyzed using the TCGA PanCancer, cBioPortal, and GEO datasets. Associations between TIMP expression and overall survival were assessed in the TCGA Breast Invasive Carcinoma PanCancer cohort. Pathway enrichment analysis was performed using GO, KEGG, and DAVID. The relationships between immune cell infiltration, stromal cells, and TIMP expression were assessed using the EPIC algorithm. Statistical analyses were performed using R. Results: TIMP1 was the only inhibitor overexpressed in breast tumors and showed significant associations with the Luminal B, HER2, TNBC, and normal-like subtypes, along with a modest increase across stages. TIMP2, TIMP3, and TIMP4 were downregulated in tumors. High expression of TIMP1 and TIMP4 correlated with better overall survival. TIMP1-associated genes were enriched in NF-kappa and PI3K–Akt signaling and actin cytoskeleton components. TIMP2 was linked to Hedgehog and MAPK pathways and actin-related elements. TIMP3 correlated with Hedgehog and PI3K–Akt signaling, DNA damage response, and membrane components. TIMP4 was associated with VEGF, MAPK, PI3K–Akt, DNA damage pathways, and actin organization. TIMP2 showed strong positive correlations with MMP2 and MMP14, while TIMP4 showed negative correlations with MMP1 and MMP9. Interestingly, we found a strong positive correlation between TIMP2 and TIMP3 with ADAM12, as well as between TIMP2 and TIMP3 with ADAM10, and negative correlations with ADAM15. The differential expression of TIMPs favors greater infiltration of immune cells related to tumor progression and poor prognosis in breast cancer patients. Conclusions: TIMPs display contrasting expression profiles and distinct pathway associations in breast cancer. TIMP1 emerges as the only consistently overexpressed inhibitor, while TIMP4 appears as a promising prognostic marker with unique MMP correlations that may influence tumor behaviors. Full article

Background and Objectives: Medication adherence is a key determinant of treatment effectiveness in early-stage breast cancer, particularly during long-term systemic therapies. As breast cancer is increasingly diagnosed at younger ages, a growing number of women continue to carry active parenting responsibilities during treatment. However, the associations between parenting-related psychosocial factors and medication adherence remain insufficiently explored. This study aimed to examine the associations between parenting stress, spiritual well-being, and medication adherence in women with early-stage breast cancer who maintain active parenting roles. Materials and Methods: This multicenter, cross-sectional study included 432 women with early-stage (I–III) breast cancer receiving active systemic therapy across nine oncology centers. Parenting stress was assessed using the Parenting Stress Scale (PSS), spiritual well-being using the Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being Scale (FACIT-Sp-12), and medication adherence using the 6-item Modified Morisky Adherence Scale (MMAS-6). Spearman correlation analyses and multivariable linear regression models were used to evaluate associations between variables. Mediation analysis was performed using Hayes’ PROCESS macro (Model 4) with 5000 bootstrap samples to assess statistical mediation. Results: Parenting stress was positively associated with poorer medication adherence (ρ = 0.248, p < 0.01), whereas spiritual well-being was negatively associated with non-adherence (ρ = −0.225, p < 0.01). Parenting stress showed a strong inverse association with spiritual well-being (ρ = −0.597, p < 0.01). In multivariable regression analyses, both parenting stress and spiritual well-being were independently associated with medication adherence (β = 0.180, p = 0.002 and β = −0.199, p = 0.001, respectively). Mediation analysis demonstrated a significant indirect statistical association between parenting stress and medication adherence through spiritual well-being (indirect effect = 0.0155), consistent with partial statistical mediation. Conclusions: Medication adherence among women with early-stage breast cancer and active parenting responsibilities is associated with psychosocial context in addition to clinical factors. Parenting stress is associated with poorer adherence, whereas greater spiritual well-being is associated with better adherence within a statistical mediation framework. These findings generate hypotheses for future longitudinal and interventional studies. Full article

Background: Gingivitis and periodontitis are progressive inflammatory diseases affecting the tissues surrounding the teeth; gingivitis involves reversible gingival inflammation, whereas periodontitis is a more advanced condition characterized by irreversible tissue destruction, including clinical attachment and alveolar bone loss. Salusin-α and salusin-β are inflammation-related polypeptides that may reflect periodontal inflammatory burden; however, salivary data in periodontal diseases are lacking. This study aimed to evaluate the salivary salusin-α and salusin-β levels in individuals with gingivitis and periodontitis. Methods: Saliva samples were collected from a total of 80 systemically healthy non-smoker individuals classified into three groups: gingivitis (n = 27), stage III grade B periodontitis (n = 27), and healthy participant (n = 26) based on the 2017 Periodontal Classification criteria. Salusin-α and salusin-β levels in saliva were quantified using enzyme-linked immunosorbent assays (ELISA). Statistical analysis utilized one-way ANOVA, Student’s t-test, and Receiver Operating Characteristic (ROC) curve analysis. Results: Compared to the healthy group, salivary levels of salusin-α and salusin-β were found to be significantly elevated in periodontitis groups (p < 0.05), not gingivitis (p > 0.05); moreover, the increase in both markers was significantly greater in the periodontitis group than in the gingivitis group (p < 0.05). Conclusions: Our finding suggests that salusins play a role in the inflammatory processes of periodontal diseases. The increase in salusin-α and salusin-β levels in the periodontitis suggests that these parameters may serve as biomarkers. Full article

Chronic kidney disease (CKD) has emerged as a pervasive global health concern, for which there are no known curative treatments. Consequently, there is an imperative for the implementation of preventive and kidney-protective strategies. The renal kallikrein–kinin system (KKS) is a vasodilator, anti-inflammatory, and antifibrotic pathway located in the distal nephron, whose decline contributes to hypertension and CKD progression. In this narrative, non-systematic review, a thorough evaluation of both experimental and clinical data was undertaken to ascertain the interactions between dietary potassium, renal KKS activity, and kidney protection. A particular emphasis was placed on animal models of proteinuria, tubulointerstitial damage, and salt-sensitive hypertension, in conjunction with human studies on potassium intake and renal outcomes. A body of experimental evidence suggests a relationship between potassium-rich diets and renal kallikrein synthesis, urinary kallikrein activity, and up-regulated kinin B2 receptor expression. Collectively, these factors have been shown to result in reduced blood pressure, oxidative stress, apoptosis, inflammation, and fibrosis, and these effects are counteracted by B2 receptor blockade. In humans, higher potassium intake has been shown to enhance kallikrein excretion and lower cardiovascular and renal risk, independently of aldosterone. Conversely, low potassium intake has the potential to exacerbate CKD progression. Notwithstanding the concerns that have been raised regarding the potential necessity of increasing potassium intake in cases of advanced CKD, extant evidence would appear to indicate that potassium excretion persists until late disease stages. The activation and preservation of the renal KKS through a potassium-rich diet is a rational, cost-effective strategy for renoprotection. When combined with sodium reduction and nutritional education, this approach has the potential to halt the progression of CKD and enhance cardiovascular health on a population scale. Full article

Background: The progressive aging of the population has led to an increased prevalence of chronic diseases and polypharmacy, with arterial hypertension representing one of the most frequent conditions. Consequently, the management of vital signs during dental interventions, such as tooth extractions, has acquired particular clinical relevance. The present study aimed to analyze the hemodynamic impact of vasoconstrictors (VAs) used in local anesthesia (LA) at different procedural stages in patients with pharmacologically controlled hypertension, as well as to compare these effects with those observed in normotensive individuals. Additionally, the study evaluated the influence of antihypertensive medication on hemodynamic responses during dental extraction. Methods: A case–control study was conducted at Dr. Peset University Hospital (Valencia, Spain), including 254 patients—148 hypertensive (controlled with type 1 and 2 antihypertensive therapy) and 106 normotensive controls. Hemodynamic parameters—systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and oxygen saturation (SO₂)—were recorded at four time points: baseline (T1), five minutes post anesthesia with 4% articaine and epinephrine (T2), upon completion of extraction (T3), and one week postoperatively (T4). Results: The SBP remained more stable in normotensive patients, while both groups exhibited a slight DBP decrease at T2, with recovery by T3. In hypertensive patients treated with angiotensin receptor blockers (ARBs), DBP decreased further. Tooth extraction under controlled hypertension conditions caused a mild, clinically insignificant increase in HR. Conclusions: Significant fluctuations in SBP, DBP, and SO₂ occurred during dental extraction, underscoring the necessity for vigilant intraoperative monitoring and individualized management of hypertensive patients. Full article