Search Results (165)

Cellulite, characterised by cutaneous dimpling, surface irregularities, and dermal atrophy skin texture, affects up to 90% of post-pubertal females. It is a multifactorial condition involving anatomical, hormonal, and metabolic components, primarily affecting the thighs and buttocks. Despite numerous available therapies, there remains a high demand for effective, non-invasive, and well-tolerated treatment options. This single-centre, in vivo, prospective study evaluated the efficacy of a non-pharmacological, thermogenic topical cream-gel combined with manual massage in women with symmetrical grade II or III cellulite (Nürnberger–Müller scale). A total of 56 female participants (aged 18–55 years) were enrolled and instructed to apply the product twice daily for eight weeks to the thighs and buttocks. Efficacy was assessed using instrumental skin profilometry (ANTERA^® 3D CS imaging system), dermatological clinical grading, and patient self-assessment questionnaires. Quantitative analysis showed a mean reduction of 23.5% in skin indentation volume (p < 0.01) and a mean decrease of 1.1 points on the cellulite severity scale by week 8. Patient-reported outcomes revealed 85.7% satisfaction with visible results and 91% satisfaction with product texture and ease of application. Dermatological evaluation confirmed no clinically significant adverse reactions, and only 3.5% of participants reported mild and transient skin sensitivity. These findings suggest that this topical cream-gel formulation, when used in conjunction with manual massage, represents a well-tolerated and non-invasive option for the cosmetic improvement of moderate to severe cellulite. Full article

Background/Objectives: Childhood obesity represents a growing public health concern. It is closely associated with obstructive sleep apnoea (OSA), which impairs nocturnal breathing and significantly affects neurocognitive and cardiovascular health. This review aims to analyse differences in fat distribution, anthropometric parameters, and instrumental assessments of paediatric OSA compared to adult OSA to improve the diagnostic characterisation of obese children. Methods: narrative review. Results: While adenotonsillar hypertrophy (ATH) remains a primary cause of paediatric OSA, the increasing prevalence of obesity has introduced distinct pathophysiological mechanisms, including fat accumulation around the pharynx, reduced respiratory muscle tone, and systemic inflammation. Children exhibit different fat distribution patterns compared to adults, with a greater proportion of subcutaneous fat relative to visceral fat. Nevertheless, cervical and abdominal adiposity are crucial in increasing upper airway collapsibility. Recent evidence highlights the predictive value of anthropometric and body composition indicators such as neck circumference (NC), neck-to-height ratio (NHR), neck-to-waist ratio (NWR), fat-to-muscle ratio (FMR), and the neck-to-abdominal-fat percentage ratio (NAF%). In addition, ultrasound assessment of lateral pharyngeal wall (LPW) thickness and abdominal fat distribution provides clinically relevant information regarding anatomical contributions to OSA severity. Among imaging modalities, dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), and air displacement plethysmography (ADP) have proven valuable tools for evaluating body fat distribution. Conclusions: Despite advances in the topic, a validated predictive model that integrates these parameters is still lacking in clinical practice. Polysomnography (PSG) remains the gold standard for diagnosis; however, its limited accessibility underscores the need for complementary tools to prioritise the identification of children at high risk. A multimodal approach integrating clinical, anthropometric, and imaging data could support the early identification and personalised management of paediatric OSA in obesity. Full article

Background: This systematic review and meta-analysis aims to provide a detailed analysis of the current state of knowledge on Progressive Exercise Training (PET), encompassing its diverse modalities, effects on bone mineral density (BMD), quality of life outcomes, and implications for clinical practice. Methods: A structured search strategy was employed to retrieve literature from seven databases (PubMed, Web of Science, Scopus, MEDLINE, Science Direct, EBSCO, CINHAL, and PEDro) yielded twenty-four randomized controlled trials (RCTs) meeting the inclusion criteria. The methodological quality of studies was evaluated using the PEDro scale. Meta-analyses were carried out to comprehensively assess the collective impact of PET on bone mineral density outcomes. Results: PET exhibited favorable effects on BMD across multiple anatomical sites, encompassing the femoral neck, total hip, lumbar spine, and others. This effect was observed across different age groups and genders, highlighting its potential benefits for diverse populations. PET encompasses a range of modalities, including resistance training, aerobic training, impact training, whole-body vibration, and tai chi, with a duration ranging from 4 to 24 months, with weekly sessions varying from two to five times. Some studies combined these modalities, reflecting the adaptability of PET to individual preferences and capabilities. Tailoring exercise prescriptions to individual needs emerged as a feasible approach within PET. A subset of studies assessed quality of life using validated instruments such as the 36-item short form survey (SF-36), shortened osteoporosis quality of life questionnaire (SOQLQ), and menopause quality of life instrument (MENQOL). Conclusions: This study provides strong evidence that PET represents a promising intervention for osteoporosis management, enhancing BMD and, to some extent, quality of life. PET offers a beacon of hope for better skeletal health and well-being in individuals grappling with osteoporosis, emphasizing the need for its incorporation into clinical practice. Full article

Three-dimensional (3D) printing has gained substantial interest among scientists and surgeons over the past decade due to its broad potential in medical applications. Its clinical utility has been increasingly recognized, demonstrating promising outcomes for patient care. Currently, 3D printing technology enables surgeons to enhance operative precision by facilitating the creation of patient-specific anatomical models, customized implants, biological tissues, and even surgical instruments. This personalization contributes to improved surgical outcomes, reduced operative times, and shorter postoperative recovery periods. Furthermore, 3D printing significantly aids in the customization of prostheses to conform closely to individual anatomical structures. Beyond therapeutic applications, 3D printing serves as a valuable educational tool in medical training. It enhances case-specific visualization, elucidates fracture mechanisms, and provides tangible models for simulation-based practice. Although the use of 3D printing might be seen as useful mostly in orthopedics, it has expanded into multiple medical specialties, including plastic surgery, dentistry, and emergency medicine. Presently, 3D-printed constructs are routinely employed for preoperative planning, prosthetic development, fracture management, and the fabrication of patient-specific surgical tools. Futuristically, the integration of 3D printing into clinical practice is expected to play a pivotal role in the advancement of personalized medicine, offering substantial benefits for both healthcare providers and patients. Full article

Despite advancements in multidisciplinary treatment, esophagectomy remains the primary curative treatment for esophageal cancer. Given that lymph node metastases can spread from the cervical to abdominal regions, three-field lymph node dissection has been established as a standard approach. However, this highly invasive procedure involves multiple anatomical regions—thoracic, abdominal, and cervical—leading to significant surgical burden. To reduce surgical invasiveness, minimally invasive esophagectomy (MIE) has become increasingly common worldwide. With its adoption and advancements in multidisciplinary therapy, discussions have emerged regarding the potential omission of lymph node dissection in selected cases. Since the introduction of robot-assisted minimally invasive esophagectomy (RAMIE) in 2004, this technique has progressively replaced conventional MIE. Robotic systems—equipped with a magnified 3D camera, articulated instruments, and tremor filtering—allow surgeons to perform complex procedures with greater precision than manual techniques. One randomized controlled trial (RCT) has demonstrated fewer postoperative complications with RAMIE compared to open esophagectomy. Additionally, RAMIE has been shown to enable more extensive lymph node dissection around the left recurrent laryngeal nerve than conventional MIE. However, the long-term oncological benefits of RAMIE remain unproven, as no RCTs have definitely confirmed its impact on long-term survival in esophageal cancer patients. Ongoing randomized trials are expected to provide further insights into its prognostic benefits. Full article

Introduction: Robotic-assisted (RA) spine surgery enhances pedicle screw placement accuracy through real-time navigation and trajectory guidance. However, the absence of traditional direct haptic feedback by freehand instrumentation remains a concern for some, particularly in minimally invasive (MIS) procedures where direct visual confirmation is limited. During RA spine surgery, navigation systems display three-dimensional data, but factors such as registration errors, intraoperative motion, and anatomical variability may compromise accuracy. This technical note describes a visuohaptic intraoperative phenomenon observed during RA spine surgery, its underlying mechanical principles, and its utility. During pedicle screw insertion with a slow-speed automated drill in RA spine procedures, a subtle and rhythmic variation in resistance has been observed both visually on the navigation interface and haptically through the handheld drill. This intraoperative pattern is referred to in this report as a cyclical insertional torque (CIT) pattern and has been noted across multiple cases. The CIT pattern is hypothesized to result from localized stick–slip dynamics, where alternating phases of resistance and release at the bone–screw interface generate periodic torque fluctuations. The pattern is most pronounced at low insertion speeds and diminishes with increasing drill velocity. CIT is a newly described intraoperative observation that may provide visuohaptic feedback during pedicle screw insertion in RA spine surgery. Through slow-speed automated drilling, CIT offers a cue for bone engagement, which could support intraoperative awareness in scenarios where tactile feedback is reduced or visual confirmation is indirect. While CIT may enhance surgeon confidence during screw advancement, its clinical relevance, reproducibility, and impact on placement accuracy have yet to be validated. Full article

Succenturiate placenta is a rare anatomical variant characterized by one or more accessory lobes connected to the main placental mass by fetal vessels. While frequently asymptomatic, this condition can lead to serious maternal–fetal complications if not diagnosed prenatally. Early detection through advanced ultrasonographic techniques plays a critical role in guiding obstetric management and reducing adverse outcomes. Objective: To describe and analyze the prenatal diagnosis, sonographic characteristics, clinical management, and maternal–fetal outcomes of succenturiate placenta cases diagnosed over a ten-year period at a tertiary care center. Methods: We conducted a retrospective observational study of nine pregnancies diagnosed with succenturiate placenta between 2014 and 2024. Data collected included maternal demographics, ultrasound findings, type of cord insertion, presence of associated anomalies such as velamentous cord insertion or vasa previa, vaginal or cesarean delivery, complications, and neonatal outcomes. Ultrasound evaluation was scored based on a four-point checklist assessing key diagnostic steps. Results: Five of the nine cases (55.6%) presented isolated succenturiate placenta, while four (44.4%) were associated with velamentous cord insertion. No cases of vasa previa were identified. Obstetric outcomes included three vaginal deliveries (33.3%), two instrumental (22.2%), and four cesarean sections (44.4%), one of which was emergent due to fetal distress. Complications occurred in 44.4% of cases, with intrapartum bradycardia being the most common. One neonatal death was reported due to placental abruption. The quality of the ultrasound diagnosis was high in most cases, though transvaginal scanning was inconsistently applied. Conclusions: Prenatal identification of succenturiate placenta via detailed ultrasound, including color Doppler and targeted assessment of cord insertion, is essential to minimize risks associated with this condition. Standardized diagnostic protocols can improve detection rates and enable timely clinical decisions, ultimately improving maternal and neonatal outcomes. Full article

Ankyloglossia causes impairment of normal tongue motility and disrupts the average balance of the muscle forces that form the orofacial complex. Inadequate swallowing from birth can cause long-term anatomical and functional consequences in adult life. Using the video presented herein, we describe the current knowledge about the long-term implications of ankyloglossia. After a literature review of the Medline, Google Scholar, and Embase databases on the relations between ankyloglossia and sleep-disordered breathing, we designed and created a three-dimensional (3D) video using Adobe After Effects based on the anatomical and functional changes produced by repeated deglutition, with and without ankyloglossia, from childhood to adulthood. The animated video (Blender 3D, Amsterdam, The Netherlands, 2024) presented herein was based on the most recent literature review of dentition, breathing, posture, and abnormal swallowing, emphasizing the importance of the potential consequences of sleep-disordered breathing. The resulting animated 3D video includes dynamic sequences of a growing child, demonstrating the anatomy and physiology of deglutition with and without ankyloglossia, and its potential consequences for the surrounding structures during growth due to untreated ankyloglossia. This visual instructional video regarding the impacts of ankyloglossia on deglutition/swallowing may help motivate early childhood diagnosis and treatment of ankyloglossia. This instrument addresses the main myofunctional aspects of normal deglutition based on the importance of free tongue motion and can be used by students or professionals training in myofunctional disorders. Full article

Background/Objectives: Achondroplasia, the most common form of skeletal dysplasia, poses significant challenges for procedural sedation due to distinct anatomical and physiological features. This study evaluated the safety, effectiveness, and imaging quality of a standardized sedation protocol for magnetic resonance imaging (MRI) in children with achondroplasia. Methods: We conducted a single-center, retrospective analysis of 22 MRI procedures in 12 pediatric patients. Intravenous midazolam and propofol were used as primary sedatives, with continuous monitoring and standardized dosing. Sedation parameters were compared between children aged <1 year and children aged ≥1 year. Results: The median sedation duration was 35 (25–65) min, and the median recovery time was 9 (5–14) min. No significant differences were found between age groups in midazolam dose (<1 year: 0.15 ± 0.05 mg/kg vs. ≥1 year: 0.13 ± 0.04 mg/kg; p = 0.238), propofol induction (2.26 ± 1.14 vs. 1.80 ± 0.52 mg/kg; p = 0.375), or infusion rate (3.18 ± 2.74 vs. 5.13 ± 2.65 mg/kg/h; p = 0.203), indicating protocol consistency. High-quality images were obtained in all cases. In one case (4.5%), self-limited desaturation to 92% occurred, with no intervention required. No airway instrumentation or other complications were reported. Conclusions: This protocol provides safe, effective, and reproducible sedation in children with achondroplasia, ensuring high-quality MRI with minimal adverse events. Full article

In recent times, a greater emphasis has been placed on framing patient clinical assessments and QOL as both endpoints and prognostic factors for neuro-oncological care. However, there is currently a lack of consensus on the most effective metrics and instruments for use in patients with primary brain tumors. Due to the heterogeneity in clinical characteristics, histological classification, anatomical location, and available treatment modalities for glioma, quantifying patient clinical condition and QOL within this unique population is particularly challenging. In this paper, we comprehensively review the available literature on the use of clinical assessment tools in glioma patients, highlighting the strengths and limitations of prominent instruments. We demonstrate that clinical outcome assessment (COA) instruments provide valuable and complementary insights into the physical, psychological, and spiritual well-being of glioma patients. Full article

Background/Objectives: Drug shortages are a serious issue affecting health systems worldwide, determined by multiple causes including supply issues, regulatory limitations, and market distortions. The possible repercussions on patients may impair therapeutic efficacy. Despite numerous actions being implemented by regulatory authorities, including market monitoring, export restrictions, and temporary regulation mitigations, few instruments have been made available to help health operators find marketed alternatives to unavailable products. The aim of this work was to create an algorithm to find equivalent or alternative medicinal products available in a certain pharmaceutical market. Algorithm development and validation were performed using the medicinal products marketed in Italy. Methods: First, a newly assembled code, describing the active pharmaceutical ingredient by its Anatomical Therapeutical Chemical (ATC) code, and its dosage form by the European Directorate for the Quality of Medicines & HealthCare (EDQM) Standard Terms, was attributed to each marketed medicinal product. Then, the algorithm was set up to identify its possible equivalents or alternatives by assigning a score quantifying differences in Defined Daily Dose (DDD) per presentation unit and in characterizing Standard Terms. Results: The algorithm was validated on a randomized sample of medicinal products, proving to be able to identify appropriate equivalents or alternatives; moreover, it was tested in real conditions by submitting a survey to health professionals, who found this product to be reliable and useful. Conclusions: The developed algorithm may be employed as a rational tool to help health operators find solutions to drug shortages. This work highlighted some limits of the current ATC attribution that should be addressed by the competent authorities. Full article

Background/Objectives: The aim of this retrospective study was to investigate the supernumerary teeth located in the anterior region of the maxilla of non-syndromic Greek children and adolescents, as well as their possible correlation with demographic characteristics and radiographic findings. Methods: The study sample comprised cone-beam computed tomography (CBCT) scans from 224 children and adolescents aged up to 18 years. The following parameters were studied: location of supernumerary teeth in the anterior maxillary area, their morphology, their relationship to adjacent anatomical structures and adjacent teeth, and potential implications. Results: Out of the 224 cases 26 (11.6%) presented supernumerary teeth. There was higher prevalence in males than females (61.5% versus 38.5%, respectively). Among the 26 participants diagnosed with supernumerary teeth, one supernumerary tooth was found in 80.8% of children/adolescents, while 19.2% had two supernumerary teeth. The vast majority of supernumerary teeth were impacted (92.3%), and their morphology in 57.7% of cases was conical. A total of 38.5% of cases had normal orientation, 26.9% inverted orientation, 19.2% horizontal orientation, and 15.4% other. The localization was palatal in 84.6%, and the area of localization for 50% of cases was the midline. Conclusions: The prevalence of supernumerary teeth in the studied sample of Greek children and adolescents was 11.6% and tended to appear as single, impacted, conical, and with normal orientation. However, these results should be interpreted with caution, due to the limitations in the sampling strategy and the restricted generalizability of this study. The need for further research to enhance broader applicability for different populations is highlighted. These findings are instrumental for a more comprehensive understanding of the prevalence of supernumerary teeth, contributing to more accurate and individualized dental treatment planning in children and adolescents. This will help to avoid future issues in the patient’s dentition. Full article

Accurate femoral tunnel positioning is crucial for successful anterior cruciate ligament reconstruction (ACLR), yet traditional arthroscopic techniques face significant challenges in spatial orientation and precise anatomical localization. This study presents a novel marker-less computer-assisted navigation system that integrates three-dimensional femoral modeling with real-time arthroscopic guidance. The system employs advanced image processing techniques for accurate condyle segmentation and implements the Bernard and Hertel (BH) grid system for standardized positioning. A curvature-based feature extraction approach precisely identifies the capsular line reference (CLR) on the lateral condyle surface, forming the foundation for establishing the BH reference grid. The system’s two-stage registration framework, combining SIFT-ICP algorithms, achieves accurate alignment between preoperative models and arthroscopic views. Validation results from expert surgeons demonstrated high precision, with 71.5% of test groups achieving acceptable or excellent performance standards (mean deviation distances: 1.12–1.86 mm). Unlike existing navigation solutions, our system maintains standard surgical workflow without requiring additional surgical instruments or markers, offering an efficient and minimally invasive approach to enhance ACLR precision. This innovation bridges the gap between preoperative planning and intraoperative execution, potentially improving surgical outcomes through standardized tunnel positioning. Full article

The aim of this pilot study was to investigate the feasibility of markerless tracking to assess upper body movements of children with and without human immunodeficiency virus encephalopathy (HIV-E). Sagittal and frontal video recordings were used to track anatomical landmarks with the DeepLabCut pre-trained human model in five children with HIV-E and five typically developing (TD) children to calculate shoulder flexion/extension, shoulder abduction/adduction, elbow flexion/extension and trunk lateral sway. Differences in joint angle trajectories of the two cohorts were investigated using a one-dimensional statistical parametric mapping method. Children with HIV-E showed a larger range of motion in shoulder abduction and trunk sway than TD children. In addition, they showed more shoulder extension and more lateral trunk sway compared to TD children. Markerless tracking was feasible for 2D movement analysis and sensitive to observe expected differences in upper limb and trunk sway movements between children with and without HIVE. Therefore, it could serve as a useful alternative in settings where expensive gait laboratory instruments are unavailable, for example, in clinical centers in low- to middle-income countries. Future research is needed to explore 3D markerless movement analysis systems and investigate the reliability and validity of these systems against the gold standard 3D marker-based systems that are currently used in clinical practice. Full article

Background: Laparoscopic pancreatic surgery demands high precision and minimal invasiveness, yet conventional robotic systems often face challenges due to complex anatomical environments and uncertainties inherent in surgical procedures. Optimizing key design parameters such as the Remote Center of Motion (RCM) and robotic link lengths is critical for enhancing workspace accessibility and instrument maneuverability. Methods: An integrated optimization framework combining genetic algorithms (GA) with fuzzy logic was developed to determine the optimal RCM position and the ideal lengths of crucial robotic links in a 3-DOF parallel robotic system. The GA explored a large design space based on 6951 tracking points recorded during manual instrument manipulation, while the fuzzy logic system refined fitness evaluations by incorporating expert-defined membership functions and heuristic rules to manage uncertainties and ensure robust performance. Results: Simulation studies demonstrated that the optimized RCM position shifted from an initial [100, 0, 300] to [119.003337, −146.610801, 269.07376], yielding improved workspace coverage and enhanced instrument maneuverability. The GA further determined optimal link lengths of approximately 213.5 mm, 248.5 mm, and 48.6 mm for the primary, tertiary, and minimum secondary links, respectively, which were rounded to practical values of 215 mm, 250 mm, and 50 mm. The optimized design exhibited significant improvements in workspace reachability, precision, and operational stability, as validated by detailed 3D workspace plots and time history diagrams of the instrument tip and joint trajectories. Conclusions: The integrated GA–fuzzy optimization approach effectively enhances the design of a 3-DOF parallel robot for laparoscopic pancreatic surgery by achieving superior kinematic performance. The optimized parameters contribute to improved surgical precision and workspace accessibility, indicating strong potential for clinical application and further experimental validation. Full article