Search Results (14,357)

Background: The lead breakage (LB) during transvenous lead extraction (TLE) increases procedural complexity, increases the risk of complications, and decreases procedural efficiency. This study aimed to identify protective and risk factors for the breakage of cardiac electronic device leads during extraction. Methods: Data were sourced from the EXTRACT prospective registry for TLE procedures conducted between January 2016 and June 2025. A total of 702 consecutive TLE procedures involving 1375 leads were enrolled. Multivariate logistic regression was used to identify independent protective and risk factors and develop a model to predict the occurrence of LB during TLE. Results: In the analysed group, 56 (7.98%) of 702 TLE procedures were disrupted by the breakage of at least one lead. The model showed a lower lead breakage rate in procedures when an atrial lead was simultaneously extracted, a locking stylet was used, and when the procedure was conducted in older patients or those who had undergone prior cardiac surgery. Higher risk of LB was proven in the following cases: the extraction of leads implanted a long time ago; the extraction of VDD-type leads; the extraction of abandoned leads; extraction during a prolonged procedure. Occurrence of lead breakage may lead to pericardial effusion requiring intervention, acute kidney injury, or leaving remnants of the leads. Conclusions: Lead breakage is an underestimated procedural difficulty that can occur during transvenous lead extraction. In this study, several clinical and procedural variables were independently associated with lead breakage. Abandoned leads, VDD leads, and prolonged procedure time were associated with increased risk. In contrast, older age, use of a locking stylet, atrial lead extraction, prior cardiac surgery, and later year of implantation demonstrated independent protective associations. Full article

In contemporary practice, dental implants are widely recognized as a reliable and effective solution for rehabilitating edentulous patients. Nevertheless, implant placement in the atrophied maxilla presents considerable challenges, with treatment planning influenced by various factors such as patient demographics, anatomical constraints, and economic considerations. Advances in imaging technology have positioned cone-beam computed tomography (CBCT) as the preferred modality for enhancing implant placement accuracy. By producing high-resolution three-dimensional radiographic images, CBCT facilitates precise assessment of maxillary anatomy at the proposed implant site—including bone height, width, length, and angulation—thereby optimizing surgical planning and improving the predictability and success rates of implant integration. Moreover, the timing of implant placement must account for the necessity of maxillary augmentation to ensure implant stability and reduce the risk of postoperative complications. This review discusses the clinical utility of CBCT as a diagnostic tool for preoperative assessment, focusing on the identification of critical anatomical landmarks and the determination of indications for bone augmentation, thereby highlighting its crucial role in enabling accurate treatment planning, minimizing surgical risks, and promoting the long-term survival of dental implants. Full article

Pediatric obesity has shown a marked upward trend over the past decade, with a particularly significant impact in certain regions, to the extent that it is increasingly regarded as a global epidemic. The factors involved in its development and progression are highly diverse and complex. From genetic predisposition to the influence of epigenetic mechanisms, environmental exposures, nutritional patterns, psychosomatic factors, and endocrinological status, current evidence highlights multiple interacting pathways contributing to excessive weight gain in children. Although numerous studies have explored specific mechanisms and interventions, there remains a need for a comprehensive synthesis that integrates recent pathophysiological insights with practical clinical implications. This narrative review was undertaken to fill this gap by summarizing and analyzing the current literature on the mechanisms underlying pediatric obesity, emphasizing novel findings and evidence-based approaches. In light of recent advances in the field, this narrative review provides a comprehensive overview of the latest pathophysiological principles associated with childhood obesity, with particular emphasis on clinically relevant aspects. The review focuses on potential strategies to mitigate the impact of modifiable risk factors and highlights current trends in clinical research. The included studies were selected to cover the most relevant evidence on genetic, epigenetic, environmental, and psychosomatic determinants of pediatric obesity, providing a synthesis that informs both research and clinical practice. Its aim is to enhance the dissemination of knowledge regarding the underlying mechanisms involved in the development of pediatric obesity. In parallel, the review addresses evidence-based therapeutic approaches that may contribute to limiting the increasing incidence of the condition and its associated complications. Expanding the scope of scientifically grounded interventions may reduce obesity-related morbidity and substantially improve long-term outcomes in pediatric populations. Full article

Background: Preterm birth is a significant risk factor for neurodevelopmental delays, but the appropriate use and timing of age correction for developmental assessment remain debated. Objective: This study investigated psychomotor development in preterm children at two years of age, with the aim of clarifying whether age correction remains necessary at this stage, particularly across different gestational age groups. Methods: A total of 161 preterm infants were assessed at a mean chronological age of 25.4 months (mean corrected age: 23.3 months) and compared with two control groups of typically developing children matched for gender and either corrected age (Control–Corr, N = 88) or chronological age (Control–Chron, N = 87). The preterm group was further stratified by gestational age: extremely preterm (<28 weeks), very preterm (28–31 weeks), and moderate-to-late preterm (32–36 weeks). Cognitive, Language (Receptive, Expressive), and Motor (fine, gross) scales of Bayley-III were analysed using t-tests and MANOVAs. Results: Using corrected age, preterm children showed a selective profile, with deficits in Receptive Language, borderline mean score in Gross Motor, and preserved performance in Cognitive, Expressive Communication, and Fine Motor. When compared with controls of the same age, significant differences emerged in the Cognitive, Language, and Gross Motor, but not Fine Motor, domains. In contrast, scoring by chronological age produced a generalised delay, with preterm children performing significantly worse than chronological-age controls across all domains. Subgroup analyses further showed that extremely preterm children already displayed marked Language vulnerabilities at corrected age, which became more severe with chronological scoring and extended to other domains. Very preterm children also fell into the deficit range in Cognitive, Language, and Gross Motor scales/subscales when chronological age was applied, whereas moderate-to-late preterm children performed comparatively better. Conclusions: Developmental assessment using corrected age remains essential at least until 24 months, especially for extremely and very preterm children, to avoid substantial overestimation of developmental difficulties. Chronological scoring, while helpful to highlight persistent vulnerabilities, may inflate delay classification if used too early. Tailoring correction strategies by gestational age and developmental domain could provide a more accurate and clinically meaningful representation of preterm children’s developmental trajectories. Full article

Background: Metamizol (dipyrone) is a widely used analgesic and antipyretic drug in several European countries, particularly for postoperative pain management in both adult and pediatric populations. Methods: A narrative literature review was conducted to evaluate the efficacy, safety, and pharmacological mechanisms of metamizol in postoperative pain management. A comprehensive search of PubMed, Scopus, and the Cochrane Library was performed, and included articles published up to 2024. Search terms included metamizol, dipyrone and children. Results: The available evidence indicates that metamizol provides effective postoperative analgesia, with an efficacy comparable to that of other non-steroidal anti-inflammatory drugs and paracetamol. Pediatric studies similarly support its effectiveness in postoperative settings. Regarding safety, short-term use of metamizol appears to be well tolerated, with a low incidence of serious adverse events. Mechanistic studies suggest that metamizol exerts analgesic effects through a multimodal pathway, involving not only cyclo-oxygenase inhibition but also modulation of opioid and endocannabinoid systems. Conclusions: Metamizol represents an effective and generally well-tolerated option for short-term postoperative pain management in both adults and children when used under appropriate clinical monitoring. Current evidence supports a favorable benefit-to-risk balance for short-term use while highlighting the need for caution during prolonged therapy. Further large-scale, prospective studies are warranted to better define rare adverse events, clarify interindividual risk factors, and refine the understanding of their non-classical mechanisms of action. Full article

Placental abruption (PA) without vaginal bleeding is known to be associated with severe outcomes when compared to symptomatic cases; the presence of hypertensive disorders of pregnancy (HDP) is an additional negative prognostic factor. According to guidelines, severe HDP are indications for prompt delivery after maternal–fetal stabilization. Considering gestational age, parity and clinical obstetric examination, the induction of labor should be prioritized to avoid additional risks associated with cesarean section. However, since only a minority of cases of PA may be detected by ultrasonography (US), findings consistent with this suspicion should contribute to the establishment of an appropriate mode of delivery. We present two cases affected by severe HDP, eclampsia and HELLP syndrome, admitted to St. Luke Catholic Hospital, Wolisso, Ethiopia. In both cases, obstetric point-of-care (POC) US revealed a live premature fetus and a solid heterogeneous placental mass, raising the suspicion of concealed placental abruption. To expedite delivery, cesarean section was promptly offered. PA was confirmed in both cases; the first had stillbirth and postpartum hemorrhage, while the second ended up with healthy mother and newborn. In conclusion, POC-US imaging could play a role in optimizing delivery mode and timing for patients with HDP in low-resourced settings. Additional research is warranted to determine the impact of this technique in the management of obstetric emergencies. Full article

Background: Radiation therapy is a critical treatment modality for craniofacial tumors and metastatic lesions, particularly gliomas. While effective, it poses significant risks of neurotoxicity, which adversely affects patient quality of life. This review aims to explore the mechanisms underlying radiation-induced neurodegeneration (RIN) and its clinical implications, focusing on the interplay between radiation exposure, cognitive decline, and potential therapeutic strategies. Methods: A comprehensive literature review was conducted, analyzing studies on radiation effects on the central nervous system (CNS), including mechanisms of injury, clinical outcomes, and emerging therapeutic approaches. Key areas of interest included the role of inflammation, vascular damage, neurogenesis impairment, and genetic predispositions in the context of radiation therapy. Results: The findings indicate that radiation induces a complex cascade of neurobiological changes, including vascular injury, microglial activation, and neurogenesis dysfunction, leading to cognitive impairments. The severity of these effects is influenced by patient age, treatment regimens, and individual genetic factors. Additionally, emerging biomarkers in cerebrospinal fluid may provide insights into individual susceptibility to radiation-induced neurotoxicity. Therapeutic strategies such as neuroprotective agents, anti-inflammatory treatments, and advanced radiation techniques show promise in mitigating cognitive decline. Conclusions: Radiation-induced neurodegeneration is a multifaceted process with significant implications for patients undergoing radiation therapy. The underlying mechanisms include endothelial cell apoptosis leading to blood–brain barrier breakdown, chronic inflammation, and the destruction of neural progenitor cells in the hippocampus, which collectively trigger cognitive decline and progressive degeneration. A better understanding of these mechanisms is crucial for developing effective preventative and therapeutic strategies. Future research should focus on identifying high-risk patients and exploring innovative approaches to minimize cognitive impacts while maximizing the efficacy of radiation treatment. Full article

Background/Objectives: Hepatocellular carcinoma (HCC) shows marked molecular and histopathological heterogeneity. Among the alterations most strongly associated with clinical outcome are mutations in TP53 and CTNNB1, as well as the presence of microvascular invasion (MVI). Although these factors are well established as prognostic indicators, how their molecular effects relate to tumor morphology remains unclear. In this work, we studied transcriptomic changes linked to TP53 and CTNNB1 mutational status and to MVI, and examined whether these changes are reflected in routine histology. Methods: RNA sequencing data from HCC samples annotated for mutations and vascular invasion were analyzed using differential expression analysis combined with machine learning-based feature selection to characterize the underlying transcriptional programs. In parallel, we trained a weakly supervised multitask deep learning model on hematoxylin and eosin-stained whole-slide images using slide-level labels only, without spatial annotations, to assess whether these features could be inferred from global histological patterns. Results: Distinct gene expression profiles were observed for TP53-mutated, CTNNB1-mutated, and MVI-positive tumors, involving pathways related to proliferation, metabolism, and invasion. Image-based models were able to capture morphological patterns associated with these states, achieving above-random discrimination with variable performance across tasks. Conclusions: Taken together, these results support the existence of coherent biological programs underlying key risk determinants in HCC and indicate that their phenotypic effects are, at least in part, detectable in routine histopathology. This provides a rationale for integrative morpho-molecular approaches to risk assessment in HCC. Full article

Background: Visceral fat plays a central role in cardiometabolic risk among people with type 2 diabetes mellitus (T2DM), yet its assessment in routine clinical practice remains largely dependent on imaging techniques or indirect anthropometric measures. Identifying accessible blood-based markers that reflect visceral adiposity may facilitate improved phenotyping in this population. This study aimed to investigate whether circulating coiled-coil domain–containing protein 3 (CCDC3) reflects visceral fat accumulation in adults with T2DM. Methods: Public RNA-sequencing datasets and human adipose tissue samples were analyzed to identify CCDC3 as a visceral fat–enriched secretory gene. In this cross-sectional study of 160 adults with T2DM undergoing dual-energy X-ray absorptiometry, plasma CCDC3 was measured by ELISA. Associations between plasma CCDC3 and visceral fat area (VFA) were examined using multivariable regression. Logistic regression models for abdominal obesity (VFA ≥ 100 cm²), with and without CCDC3, were evaluated using receiver operating characteristic (ROC) analysis, calibration curves, decision curve analysis (DCA), and Shapley additive explanations (SHAP). Results: Circulating CCDC3 levels were positively associated with VFA (β = 3.11, p < 0.001), independent of demographic and metabolic factors. Incorporating CCDC3 into the baseline model significantly improved discrimination of abdominal obesity (AUC 0.820 vs. 0.663; p = 0.009). Calibration curves and DCA supported better model fit and higher net clinical benefit with CCDC3. SHAP analysis showed that CCDC3 contributed the greatest incremental importance beyond waist circumference, sex, and age. Conclusions: Circulating CCDC3 may serve as a blood-based biomarker reflecting visceral adiposity in adults with T2DM and provides complementary information beyond traditional anthropometric measures. Full article

Objective: The primary objective of this study is to investigate the prevalence of unexpected findings requiring treatment after routine histological examinations following tonsillectomy, tonsillotomy, adenotomy, or conchotomy (TTAC) in a retrospective study and to discuss whether routine histological examination is useful in patients without clearly defined risk factors or whether it would be better to reduce unnecessary costs and resource utilisation. Materials and methods: The present retrospective study encompasses 5709 patients who underwent routine histological examinations following TTAC and were treated as inpatients at the University Medical Center Freiburg, Department of Otolaryngology, Head and Neck Surgery, between 2011 and 2021. The data was collected based on patient characteristics, including date of birth, gender, age of patients at the time of surgery, date of surgery, indication for surgery, tissue examined, and histological result. Results: Of a total of 6687 patients who underwent TTAC, 5709 with routine histological examinations were included in the analysis, of whom only four showed abnormal findings, corresponding to an overall prevalence of 0.07%. Three of these four patients were adults. These included two cases of granulomatous inflammation, one instance of Burkitt lymphoma, and one instance of chronic lymphocytic leukaemia/small cell B-lymphoma. Following the exclusion of tuberculosis and sarcoidosis, and the lymphoma board’s decision to adopt a watch-and-wait approach in the case of chronic lymphocytic leukaemia/small cell B-cell lymphoma, only n = 1/0.0175% of patients were found to require treatment. Conclusions: The study demonstrated that only four abnormal histological findings occurred in 5709 inpatient TTACs, of which only one, namely Burkitt lymphoma, ultimately required treatment. Consequently, it can be concluded that routine histological examinations following TTAC are not beneficial in patients without clearly defined risk factors, such as blood in the saliva, history of smoking or alcohol consumption, unexplained pain, previous cancer, mucosal changes, or tissue asymmetries. However, in instances where clinical or anamnestic suspicion of malignancy is present, a histological examination should be conducted. Full article

Maintaining sustainable mental health is an increasing societal challenge in Japan, where psychological distress and sleep problems have become major public health concerns. This study examined how three culturally grounded dimensions of self-construal—Subjective Self (SS), Objective Self (OS), and Autonomous Self (AS)—relate to both positive and negative indicators of psychological adjustment among Japanese adults. This study aimed to examine whether internally guided forms of self-regulation (SS and AS) function as psychological resources, whereas externally guided self-regulation (OS) operates as a potential vulnerability factor in a culturally tight social context. By simultaneously examining multiple indicators of adjustment, this research clarifies how culturally shared self-regulatory patterns are linked to distress and sleep difficulties that affect large segments of the population. From a public health perspective, the findings highlight socially reinforced risk and protective patterns that can inform population-level prevention and mental health promotion in settings such as schools, workplaces, and communities, rather than relying solely on individual clinical intervention. These results underscore the importance of integrating cultural psychology into public health frameworks aimed at promoting sustainable mental health in contemporary and increasingly diverse social environments. Full article

Background: Cardiac rehabilitation (CR) is a key component of secondary prevention after acute coronary events, coronary and valve interventions, and device implantation, yet participation and long-term adherence remain suboptimal. Digital technologies offer the potential to extend CR beyond the centre-based model and to support more flexible, patient-centred care. Methods: This narrative “review on a systematic backbone” synthesizes original clinical studies published between 2005 and 2025 that evaluated the use of digital technologies as an integral part of CR in adults after myocardial infarction, revascularization, valve procedures or implantation of cardiac devices. Interventions were grouped into four categories: mobile health (mHealth) and tele-rehabilitation, virtual reality (VR) and exergaming, virtual education platforms, and other multi-component digital CR solutions. Only original studies with clinical, functional, or patient-reported outcomes were included. Results: Twenty-one studies on the categories mentioned above met the eligibility criteria. mHealth-enabled home-based or hybrid CR programs consistently achieved improvements in functional capacity and physical activity that were broadly comparable to centre-based CR, with generally high adherence. VR and exergaming interventions were feasible and safe, produced at least similar functional gains, and showed more consistent benefits as far as anxiety levels and engagement levels. Virtual education platforms delivered knowledge and produced behaviour change similar to traditional education and, in some studies, supported better control of blood pressure and lipids. Comprehensive digital CR platforms improved risk-factor profiles and quality of life to a degree comparable with face-to-face CR. Conclusions: Digital technologies can credibly support core objectives of CR in high-risk patients and expand access, but must be implemented as a complement to, rather than a replacement for, multidisciplinary, patient-centred rehabilitation. Full article

Objectives: This study aimed to evaluate phenotypic associations between preoperative alkaline phosphatase (ALP) levels and clinical characteristics, and explore clinical factors associated for postoperative regrowth in craniofacial fibrous dysplasia. Methods: In this retrospective cohort (2003–2024), 71 surgically treated fibrous dysplasia patients were analyzed. Relationships between preoperative ALP (using age-stratified reference ranges) and key phenotypes (age at surgery, onset age, laterality, lesion type) were assessed via nonparametric tests. Associations with postoperative regrowth were assessed using Mann–Whitney U or Kruskal–Wallis tests for non-normally distributed continuous variables and χ² or Fisher’s exact tests for categorical variables. Results: Preoperative ALP levels significantly correlated with younger surgical age (16–19 vs. ≥19 years: 244.0 vs. 107.0 U/L, p < 0.001), earlier onset (0–16 vs. >16 years: 114.0 vs. 83.0 U/L, p = 0.030), bilateral lesions (176.0 vs. 106.2 U/L, p = 0.006), and polyostotic subtype (polyostotic fibrous dysplasia vs. monostotic fibrous dysplasia: 162.0 vs. 87.5 U/L, p < 0.001). However, neither ALP levels (p = 0.061) nor abnormal ALP rates (p = 0.090) predicted regrowth. Crucially, bilateral lesions were significantly associated with regrowth (83.3% (5/6) vs. 21.5% (14/65); p = 0.005). The overall regrowth rate was 8.5% (6/71). Conclusions: Bilateral lesions demonstrate significant association with postoperative regrowth risk, potentially guiding surveillance intensity. ALP correlates with phenotypic burden but shows limited prognostic utility. These findings, interpreted considering retrospective constraints, warrant validation in larger cohorts. Full article

Background: Traumatic brain injury (TBI) imposes a substantial public health burden through long-term physical, cognitive, and psychiatric effects. This includes substance use disorders (SUDs) for which TBI is a demonstrated risk factor; however, prior studies have not comprehensively compared relative incidences of SUD subtypes post-TBI or differences between intracranial hemorrhage (ICH) and non-ICH TBI in patients without prior SUD history. This global retrospective analysis using the TriNetX database aims to quantify new-onset SUD incidence post-TBI in the largest cohort of patients evaluated to date, with cohorts stratified by SUD subtype and ICH versus non-ICH TBI, to highlight opportunities for post-injury care models to mitigate SUD risk. Methods: De-identified data from the TriNetX Research Network were used to select patients with TBI (n = 1,889,112) and define distinct cohorts based upon the presence (n = 420,868) or absence (n = 1,471,592) of ICH. Patients with previously diagnosed SUD before the date of TBI were excluded. Patient demographics and medical comorbidities were calculated for each group. The incidence of new SUD diagnosis over the lifetime and at 1-, 3-, and 5-years post-TBI were calculated and compared. Subtypes of SUD were defined and calculated based on the specific substance used. Propensity scores were calculated to create balanced matched ICH and non-ICH cohorts (n = 331,812 each) were used for comparisons of 5-year SUD incidence. Results: In the full TBI cohort, 5-year new SUD incidence was 4.2% overall, with nicotine (2.4%) and alcohol (1.1%) predominating, followed by cannabis (0.9%) and opioids (0.4%). Rates of SUDs increased over time, but attenuated beyond 5 years, with approximately 50% of those who would ultimately be diagnosed with SUD manifesting (lifetime) by 3 years post-TBI. After propensity matching, non-ICH TBI showed higher 5-year risk for any SUD (4.2% vs. 3.6%; risk difference −0.65%, p < 0.0001) and all subtypes (p < 0.05) except inhalants (p = 0.53). Conclusions: This largest-to-date analysis of new-onset SUD post-TBI demonstrates significantly higher rates of SUD in TBI patients; rates of nicotine, alcohol, cannabis, and opioid use disorders were most common. Non-ICH TBI patients demonstrated greater rates of SUD after injury than patients with ICH-associated TBI. Of patients suffering from TBI without ICH who would eventually be diagnosed with SUD, approximately 50% had obtained that diagnosis within 3 years of the injury. Taken together, these findings demonstrate the clinical need for routine SUD screening in post-TBI care, especially for 3 years post-injury. Such an intervention has the potential to significantly alleviate the public health burden and associated cost of care for TBI-associated substance use disorder patients. Full article

The OHI demonstrated moderate internal consistency and consistent associations with oral health-related quality of life and cardiovascular risk indicators. Objective: The primary objective was to propose and internally assess an Oral Health Index (OHI) which integrates multiple clinically assessed oral health variables. The secondary objective was to investigate its association with oral health-related quality of life (OHRQoL) and common clinical cardiovascular risk (CVR) factors. Material and Methods: This observational study included 191 participants. Seven parameters (tooth loss, periodontal disease, endodontic involvement, residual roots, extractions due to periodontitis, inflammatory oral mucosal diseases, and dental maintenance and rehabilitation status) were combined using Z-scores to compute the OHI, with higher scores indicating poorer oral health. CVR factors included age/sex thresholds, education level, BMI, smoking status, diabetes, hypertension, pulse pressure, and lung function. OHRQoL was assessed using the Oral Health Impact Profile. Results: Higher OHI scores were associated with poor oral health-related quality of life. Participants with cardiovascular risk factors had significantly higher OHI scores. The analysis demonstrated that the OHI was directly associated with worse oral health-related quality of life and a greater cardiovascular risk burden, independent of age, sex, and comorbidities. Conclusions: This study proposed and internally assessed the Oral Health Index, designed to integrate multiple clinical parameters into a single standardized measure of oral health. The OHI demonstrated moderate internal consistency and showed consistent associations with poorer oral health conditions, reduced oral health-related quality of life, and a greater cardiovascular risk burden. Full article