Search Results (4,825)

Background: Recalcitrant plantar fasciitis (RPF) is a common cause of chronic heel pain, resistant to conservative treatment in up to 10% of cases. A biomechanical association exists between isolated gastrocnemius contracture and increased tension on the plantar fascia. In this context, gastrocnemius recession (GR) has emerged as a surgical intervention aimed at reducing fascial strain and improving functional outcomes. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD420251028862). Randomized controlled trials evaluating the efficacy of GR in patients with RPF were included. Searches were performed in PubMed, Cochrane Library, and Web of Science. Risk of bias was assessed using the RoB 2 tool, and the certainty of evidence was evaluated using the GRADE approach. Primary outcomes included foot function (AOFAS), pain (VAS), and ankle dorsiflexion range (FDTPA). Results: Five studies encompassing 150 patients were included. Meta-analysis revealed statistically significant improvements in foot function (AOFAS, standardized mean difference [SMD] = 0.81; 95% CI: 0.26–1.36), pain reduction (VAS, SMD = −1.17; 95% CI: −1.99 to −0.36), and ankle dorsiflexion (FDTPA, SMD = 0.74; 95% CI: 0.26–1.22). GR demonstrated advantages over plantar fasciotomy in terms of postoperative recovery and preservation of fascial structure. No major complications were reported, and some studies documented sustained benefits up to six years postoperatively. Moderate to high heterogeneity was observed, largely due to variations in surgical technique and follow-up durations. Conclusions: Gastrocnemius recession is a safe and effective surgical option for treating RPF, particularly in patients with isolated gastrocnemius contracture and failure of conservative therapies. It significantly improves foot function, reduces pain, and enhances ankle mobility, with durable long-term outcomes. Trial Registration: This systematic review is registered with PROSPERO (CRD420251028862). Full article

Chronic thromboembolic pulmonary disease (CTEPD) is a severe long-term complication of acute pulmonary thromboembolism (PTE). Its pathogenesis is multifactorial, involving incomplete thrombus resolution, hemodynamic burden, comorbidities, and genetic factors. However, the contribution of inherited thrombophilic mutations to CTEPD development remains controversial. This retrospective cohort study included 204 patients diagnosed with acute PTE at a tertiary referral center between December 2023 and December 2024. Baseline demographic, clinical, laboratory, and echocardiographic data were collected. Genetic analysis assessed Factor II, Factor V Leiden, MTHFR C677T, MTHFR A1298C, Factor XIII V34L, and PAI-1 4G/5G polymorphisms. Patients were followed for at least 12 months for the development of CTEPD, defined according to guideline-based hemodynamic and imaging criteria. During follow-up, 17 patients (8.3%) developed CTEPD. Patients with CTEPD were significantly older and had higher baseline and follow-up systolic pulmonary artery pressure (sPAP) (p < 0.001), elevated NT-proBNP and troponin levels (both p < 0.001), and more frequent comorbidities, including cardiac and renal disease. Multivariate logistic regression identified comorbid diseases (HR: 0.17, 95% CI: 0.039–0.80, p = 0.025) and genetic thrombophilic factors (HR: 0.30, 95% CI: 0.10–0.91, p = 0.034) as independent predictors. Among genetic variants, only the PAI-1 4G/5G polymorphism was significantly associated with CTEPD (p = 0.001). Our study demonstrates that advanced age, comorbid diseases, elevated cardiac biomarkers, and genetic predisposition are associated with the development of CTEPD after acute PTE, while the PAI-1 4G/5G polymorphism may contribute to CTEPD susceptibility within a multifactorial context. Full article

Chronic kidney disease (CKD) accelerates vascular dysfunction and cardiovascular disease, partly through the accumulation of the uraemic toxin indoxyl sulphate (IS). Thrombospondin-1 (TSP1) and its receptor CD47 have been implicated in vascular pathology, but their role in CKD-associated vascular remodelling is unknown. We investigated the contribution of TSP1–CD47 signalling to vascular smooth muscle cell (VSMC) dysfunction in CKD. Human aortic VSMCs (hVSMCs) were exposed to IS, TSP1, or plasma from patients with CKD. CKD was induced in wild-type (WT) and CD47-deficient (CD47KO) mice using 5/6 nephrectomy. Vascular changes were assessed by histology, immunohistochemistry, and molecular analyses. IS, TSP1, and CKD plasma increased TSP1 expression in hVSMCs, reduced proliferation, elevated β-galactosidase activity, and activated phosphorylated ERK1/2 and cytoplasmic aryl hydrocarbon receptor. These effects were attenuated by CD47 blockade. CKD plasma further enhanced IS- and TSP1-induced senescence. In vivo, 5/6 nephrectomy induced aortic wall thickening in WT but not in CD47KO mice. Aortic pERK1/2 was reduced in CD47KO mice despite persistent TSP1 upregulation. IS and TSP1 promote VSMC senescence through CD47-dependent ERK1/2 and AhR signalling. CD47 deletion protects against CKD-induced vascular remodelling, suggesting that CD47 blockade may represent a novel therapeutic strategy to mitigate vascular complications in CKD. Full article

Purpose: Periprosthetic joint infection (PJI) is a devastating complication following limb salvage surgery with tumor megaprosthetic reconstruction, leading to high morbidity and complex management. Despite advancements in prosthesis design and materials, infection rates are notably higher than in conventional arthroplasty. This narrative review synthesizes current evidence on the etiology, diagnosis, and management of PJIs in this unique setting. Methods: We conducted narrative review of literature from PubMed and Embase using keywords related to PJIs and tumor megaprostheses, aiming to summarize risk factors, diagnostic criteria, pathogen profiles, and treatment outcomes. Results: Key findings indicate that the risk of PJI is multifactorial, involving patient-related, disease-related, and treatment-related factors. Diagnosis relies on a combination of clinical presentation, serological markers, imaging, and microbiological studies, though established criteria for conventional PJI may require adaptation for tumor cases. Treatment strategies include irrigation and debridement (I&D), debridement, antibiotics, implant retention with modular component exchange (DAIR), one-stage or two-stage revision, and amputation. Success rates vary, and optimal management requires a multidisciplinary, individualized approach. However, two-stage revision is considered the gold standard for chronic PJIs. Conclusions: PJIs after tumor megaprosthetic reconstruction presents distinct challenges. Management requires a multidisciplinary, individualized approach. Future research should focus on validated diagnostic criteria for this population, novel anti-biofilm strategies, and standardized treatment protocols. Full article

Background: Hyperbaric oxygen therapy (HBOT) is considered a potential adjunctive modality to enhance tissue regeneration in oral and maxillofacial surgery. By increasing tissue oxygen availability, HBOT may support bone and soft-tissue repair under hypoxic and chronically inflamed conditions. Aim: This narrative review evaluates current experimental and clinical evidence regarding HBOT in high-risk dental indications, including osteoradionecrosis (ORN), medication-related osteonecrosis of the jaw (MRONJ), chronic osteomyelitis, poorly healing postoperative wounds, and procedures in patients with systemic comorbidities. Methods: A structured search of PubMed, Web of Science, and the Cochrane Library identified 123 relevant English-language publications (from 1 January 2000–September 2025) addressing HBOT mechanisms and clinical applications in oral and maxillofacial surgery, including clinical trials, observational studies, preclinical models, and systematic reviews. Results: Available evidence suggests that HBOT may improve healing outcomes and reduce complication rates in early-stage ORN and MRONJ when used as an adjunct to surgery and systemic therapy. However, findings in implantology—particularly in irradiated or diabetic patients—and in periodontal therapy remain limited, heterogeneous, and methodologically inconsistent. Conclusions: HBOT may be considered in selected clinical scenarios, particularly where healing is impaired by hypoxia or systemic disease. Nevertheless, current evidence remains insufficient to support routine use. Standardized, high-quality studies with clearly defined endpoints and uniform therapeutic protocols are needed to determine its clinical effectiveness and optimal indications. Full article

Background/Objectives: Recessive dystrophic epidermolysis bullosa (RDEB) is a severe congenital genodermatosis characterized by skin and mucosa fragility, chronic inflammation, recurrent infections and high nutritional demands due to increased metabolism and epithelial barrier-related losses, placing patients at risk of zinc deficiency. We aimed to investigate the clinical relevance and biochemical determinants of zinc deficiency as a potentially modifiable contributor to disease burden in RDEB. Methods: In this cross-sectional study (n = 84), serum zinc levels were analyzed in association with sex, age, disease severity, percentage of body surface area (BSA) affected, inflammatory markers, infection burden, and common clinical complications including anemia and growth impairment. Results: Zinc deficiency, defined as levels below 670 µg/L, was identified in 35% of patients and became more frequent after age 5 and during adulthood, particularly among those with more severe disease. Deficiency was strongly associated with anemia, inflammation, infection burden, growth impairment, and extensive skin involvement. A revised cutoff of 780 µg/L is proposed, showing improved diagnostic performance for identifying patients at risk of systemic complications, and offering a more suitable threshold for starting preventive supplementation. Multivariate logistic modeling confirmed that low serum zinc independently predicted anemia risk, alongside transferrin saturation and C- reactive protein levels. Serum albumin was identified as the strongest determinant of zinc levels, partially mediating the effects of inflammation and skin involvement. Conclusions: These findings identify serum zinc as a clinically relevant marker of nutritional status and complication burden in RDEB. While no causal or therapeutic effects can be inferred from this cross-sectional study, the strong and biologically plausible associations observed suggest a rationale for systematic monitoring and correction of zinc deficiency as part of comprehensive supportive care, and warrant prospective studies to assess clinical benefit. Full article

Background/Objectives: Wound healing represents a pervasive and urgent clinical challenge. Hard-to-heal chronic wounds are frequently complicated by infections, inflammatory responses, and oxidative stress. Currently, wound dressings are broadly categorized into dry and moist types, with moist wound dressings for chronic wounds accounting for approximately 70% of market revenue. Recently, adipose-derived stem cells (ADSCs), which possess self-renewal and multi-lineage differentiation capabilities, have emerged as a promising strategy for promoting tissue regeneration and wound repair. Methods: In this study, we developed a novel luteolin nanoparticle–ADSCs composite hydrogel (GelCA@LUT@ADSCs). This system was constructed by first encapsulating ADSCs within a chitosan/alginate hydrogel (GelCA), followed by coating the hydrogel with luteolin-loaded nanoparticles (LUT@NPs). Results: The sustained release of LUT@NPs from the hydrogel modulates the wound microenvironment, enhancing the pro-healing functions of ADSCs at the wound site. The GelCA hydrogel exhibited excellent biocompatibility. Both in vitro and in vivo results demonstrated that GelCA@LUT@ADSCs treatment effectively reduced inflammation, promoted angiogenesis and collagen deposition, stimulated cell proliferation and migration, and polarized macrophages toward an anti-inflammatory, pro-healing M₂ phenotype, thereby accelerating wound healing. Conclusions: Overall, this innovative therapeutic approach provides a novel strategy for wound management through a synergistic division of labor between pharmaceutical agents and stem cells. Full article

Purpose: Tympanostomy tubes are essential for middle ear ventilation, but conventional long-term tubes carry high perforation rates (12–22%). This study evaluated the Tympanostomy U-Tube (TUT), a novel silicone-based tube designed to minimize perforation risk by redistributing pressure away from the tympanic membrane rim. Methods: This was a retrospective cohort study of 192 ears in children aged 1–4 years who underwent TUT insertion for chronic otitis media with effusion or recurrent acute otitis media. The primary outcomes were tube insertion time and the permanent perforation rate. Mean follow-up was 38.4 months. Results: Mean tube insertion time was 21.6 months. Spontaneous extrusion occurred in 18.2% of ears (mean 24.5 months), while 81.8% underwent elective removal (mean 21.0 months). Permanent perforation developed in only 4 ears (2.08%; 95% CI: 0.6–5.2%), substantially lower than rates reported in the literature for conventional long-term tubes (12–22%), although the retrospective design and reliance on historical controls limit direct comparison. Complications were minimal, with otorrhea (36%) responding to topical therapy. Office-based removal was successful in all cases. Conclusions: The TUT provides intermediate-duration ventilation with a perforation rate comparable to that of short-term tubes, while avoiding the high perforation rates of conventional long-term tubes. Prospective randomized trials are needed to validate these findings. Full article

Chronic rhinitis is induced by endotype-diverse inflammatory processes, which complicates effective therapeutic management. According to the current principles of personalized medicine, which also apply to the management of rhinological disorders, the best therapeutic results can be achieved after targeted treatment preceded by analysis of the patient’s endotype. Analysis of immune and cellular mechanisms allows for the use of biological treatment, and its effects provide new information on inflammatory processes in the nasal mucosa. The effects of biological treatment may be particularly interesting in the case of mixed endotypes, which pose a difficult therapeutic challenge. In eosinophilic asthma co-occurring with allergic rhinitis, as well as in eosinophilic asthma associated with non-allergic rhinitis, eosinophils represent a key effector cell population driving the underlying type 2-mediated inflammatory response. The aim of this study is to analyze the efficacy of anti-IL5 or anti-ILR5 therapy in patients with severe eosinophilic asthma and persistent allergic or non-allergic rhinitis. Methods: In this single-center real-life study, the authors analyzed the effects of biological treatment on rhinological symptoms in patients over the age of 18 with severe uncontrolled eosinophilic bronchial asthma with coexisting persistent allergic or non-allergic rhinitis treated with mepolizumab or benralizumab. In all patients, the otolaryngologist performed anterior rhinoscopy. Evaluation of rhinological symptoms and quality of life in patients treated with anti-IL5 or anti-IL5 therapy before and six months after biological treatment was performed using the TNSS and SNOT-22 scales. Results: In total, 67 patients with eosinophilic severe bronchial asthma were included in the study; among them 39 (58.2%) suffered from persistent allergic rhinitis and 28 (41.8%) suffered from chronic non-allergic rhinitis. After six months of treatment, higher absolute differences for SNOT and TNSS were observed in the persistent allergic rhinitis group. Conclusions: Biological treatment with mepolizumab and benralizumab may reduce the severity of rhinological symptoms in both endotypes of inflammation. However, higher therapeutic benefits were observed in patients with co-existing persistent allergic rhinitis. It was demonstrated that, in addition to IgE-mediated responses, the eosinophil represented an important component of the inflammatory reaction in allergic rhinitis. Full article

Background and Clinical Significance: Cerebral candidiasis (Candida albicans meningoencephalitis) is a rare but severe central nervous system (CNS) infection, usually associated with neurosurgical procedures or indwelling devices. Diagnosis is challenging due to frequent negativity of cerebrospinal fluid (CSF) cultures, and mortality remains high despite antifungal therapy. Case Presentation: We describe a 64-year-old woman who underwent retrosigmoid resection of a left vestibular schwannoma. The early postoperative course was complicated by fever, neurological deterioration, and hydrocephalus requiring external CSF drainage. Multiple lumbar punctures revealed inflammatory CSF profiles but persistently negative cultures. One month post-surgery, intraoperative samples from mastoid repair material grew Candida albicans, prompting antifungal therapy. Despite treatment, the patient experienced fluctuating neurological status and required multiple external ventricular drains. Three months after surgery, she clinically deteriorated and died. Autopsy showed diffuse meningeal thickening and purulent exudates at the brain base and posterior fossa. Histopathology confirmed chronic lympho-histiocytic meningitis with necrotizing foci containing Candida albicans. Conclusions: This case underscores the diagnostic and therapeutic challenges of post-neurosurgical Candida CNS infections. Repeatedly negative CSF cultures delayed diagnosis, emphasizing the value of ancillary tests such as β-d-glucan and molecular assays. Even with antifungal therapy, prognosis is poor. Autopsy remains essential for uncovering fatal healthcare-associated fungal infections and informing clinical vigilance and medico-legal assessment. Full article

Background/Objectives: Ocular graft-versus-host disease (oGVHD) is a chronic, immune-mediated complication of allogeneic hematopoietic stem cell transplantation that can progress to corneal ulceration or perforation. These cases are often refractory to standard therapy and present a high risk of graft failure after keratoplasty. We report a case of oGVHD-related corneal perforation successfully managed with a novel amniotic membrane-assisted “envelope” technique during corneal transplantation. Case Report: A 42-year-old man with chronic oGVHD and a full-thickness corneal perforation underwent urgent repair with a lamellar patch graft completely wrapped in cryopreserved amniotic membrane, followed by penetrating keratoplasty (PKP) using an amniotic membrane envelope surrounding the donor lenticule. Results: The amniotic membrane provided a 360° biological barrier that isolated graft antigens from the inflammatory environment while supporting epithelial healing and stromal remodeling. Despite recurrent inflammatory episodes and multiple procedures—including cataract extraction, pars plana vitrectomy, and multilayer amniotic membrane transplantation—the graft remained clear and stable at 12-month follow-up, achieving a best-corrected visual acuity of 20/40. Conclusions: The amniotic membrane envelope technique may represent a valuable adjunct in managing high-risk corneal perforations secondary to oGVHD. By combining immune modulation and regenerative support, this approach can enhance tectonic stability, reduce rejection risk, and promote durable surface recovery, potentially delaying or avoiding keratoprosthesis in refractory cases. Full article

Background: The main cause of chronic nasal obstruction in ENT practice is represented by the deviated nasal septum. Septoplasty remains the gold standard treatment, performed using either conventional or endoscopic techniques. Methods: A narrative review of the literature was conducted using PubMed and Google Scholar for studies published between May 1999 and October 2024. Eligible studies included adult patients (≥16 years) undergoing conventional or endoscopic septoplasty, with at least one reported outcome measure: NOSE, VAS, or SNOT-22 scores; operative time; or complication rates. Results: Across multiple clinical studies, both conventional and endoscopic septoplasty provided significant improvements in nasal airflow and symptom relief. Endoscopic septoplasty was consistently associated with superior intraoperative visualization, more precise correction of posterior deformities and isolated septal spurs, and lower rates of intraoperative and postoperative complications. Complication rates were low overall for both approaches. Conclusions: Current evidence supports both conventional and endoscopic septoplasty as effective treatments for nasal obstruction due to septal deviation. However, endoscopic septoplasty offers distinct advantages in terms of visualization, operative efficiency, and safety, making it an increasingly preferred technique. Full article

Hyperkalemia is a major complication of chronic kidney disease (CKD). However, owing to the absence of specific symptoms in its early stages, hyperkalemia frequently remains undiagnosed. This study aimed to develop a machine learning model for predicting the risk of early hyperkalemia in patients with CKD. By conducting a comparative analysis of six machine learning methods, CatBoost demonstrated superiority across various evaluation metrics. Further evaluation using confusion matrix and decision curve analysis (DCA) confirmed its high classification accuracy and substantial clinical utility. Meanwhile, through multiple interpretability analyses based on SHAP and Local Interpretable Model-agnostic Explanations (LIME) techniques, we precisely quantify the contributions and positive or negative effects of risk factors for hyperkalemia. Full article

Motor disorders are increasingly recognized as a significant complication of chronic kidney disease (CKD), yet they remain underdiagnosed, undertreated, and often overlooked in clinical practice. Patients with CKD experience a broad spectrum of motor disturbances, including restless legs syndrome, myoclonus, flapping tremor, periodic limb movements in sleep, Parkinsonism, and peripheral neuropathy. These disorders arise from complex and often overlapping mechanisms such as uremic neurotoxicity, vascular injury, electrolyte and hormonal imbalances, or inflammatory processes, reflecting the systemic impact of impaired renal function on the central and peripheral nervous systems. The presence of motor disorders in CKD is associated with substantial clinical consequences for quality of life, contributing to impaired mobility, persistent insomnia, daytime fatigue, higher fall risk, and diminished independence. Moreover, these disturbances have been linked to increased cardiovascular morbidity and mortality, further exacerbating the already high burden of disease in this population. Current management approaches focus on optimizing kidney function through dialysis or transplantation, pharmacological therapies such as dopaminergic agents, gabapentinoids, and iron supplementation, as well as non-pharmacological interventions including structured exercise programs and sleep hygiene measures. Despite these strategies, robust evidence on long-term outcomes, comparative effectiveness, and optimal treatment algorithms remains limited. Greater recognition of the clinical impact of motor disorders in CKD, combined with targeted research efforts, is urgently needed to improve patient-centered outcomes and guide evidence-based care. Full article

Background and Clinical Significance: Superior mesenteric artery syndrome (SMAS) is a rare and often underdiagnosed cause of proximal intestinal obstruction, resulting from compression of the third portion of the duodenum between the SMA and the aorta. It typically occurs in individuals with significant weight loss due to mesenteric fat depletion. CasePresentation: We report the case of a 14.5-year-old female presented with a 6-day history of intractable vomiting and epigastric pain, on a background of intermittent vomiting over the preceding six months associated with a 7 kg unintentional weight loss, culminating in inability to tolerate oral intake. Her clinical course was complicated by a transient episode of blurred vision, numbness, and incoherent speech, initially suspected to be a neurological event. Extensive gastrointestinal and neurological investigations were inconclusive. Elevated fecal calprotectin levels raised suspicion for inflammatory bowel disease, given her family history, though endoscopy and histopathology were unremarkable. Advanced imaging ultimately demonstrated a markedly reduced aortomesenteric angle (6°) and distance (4 mm), confirming the diagnosis of SMAS. The patient was initially managed conservatively with total parenteral nutrition (TPN), achieving partial weight gain of 5 kg after 8 weeks of TPN. Due to persistent duodenal compression, surgical intervention was required. At 7-month follow-up, the patient remained symptom-free with restored nutritional status and a good weight gain. Conclusions: This case highlights the importance of considering SMAS in adolescents with chronic upper gastrointestinal symptoms and significant weight loss. Early recognition and appropriate imaging are essential to diagnosis, and timely surgical management can lead to excellent outcomes when conservative treatment is insufficient. Full article