Search Results (2,297)

Background: Root canal sealers may come into direct contact with periapical tissues, particularly in cases of apical extrusion, potentially influencing periapical healing and treatment outcomes. Cytotoxicity assessment represents a clinically relevant parameter when selecting endodontic sealers. However, evidence derived from in vitro studies remains heterogeneous and challenging to interpret from a clinical perspective. Therefore, the aim of this systematic review was to critically evaluate the in vitro cytotoxicity of all root canal sealers that have been commercially marketed over the years, excluding experimental materials, and to contextualize the findings in relation to clinically relevant experimental conditions. Methods: This systematic review was conducted according to PRISMA guidelines and preregistered on the Open Science Framework. PubMed, Scopus, and the Cochrane Library were searched up to 30 November 2025. In vitro studies evaluating the cytotoxicity of commercially available root canal sealers using validated cell viability or proliferation assays were included. Data extraction focused on sealer composition, setting condition, extraction protocols, exposure parameters, and cytotoxic outcomes. Due to marked methodological heterogeneity, a qualitative synthesis was performed. Results: Ninety-eight in vitro studies were included. All categories of root canal sealers demonstrated some degree of cytotoxicity, particularly when tested in freshly mixed conditions, at higher extract concentrations, or after prolonged exposure. Bioactive and calcium silicate-based sealers generally showed a more favorable cytotoxicity profile compared with conventional materials, especially after complete setting and at diluted concentrations, although cytotoxic effects were reported under specific experimental conditions. Resin-based sealers, including AH Plus, exhibited condition-dependent cytotoxicity, while zinc oxide–eugenol and glass ionomer sealers tended to display higher cytotoxic potential. Conclusions: In vitro cytotoxicity of root canal sealers varies according to material composition and experimental conditions. Bioactive sealers generally exhibit a more favorable biological profile, which may be clinically relevant in situations involving sealer extrusion or prolonged tissue contact. Standardized testing protocols and further translational studies are required to support evidence-based clinical material selection. Full article

This manuscript examines how distinct epistemic attitudes toward singularity and generality have been articulated in medical writing across different historical contexts, offering a conceptual and meta-historical analysis of two enduring genres in biomedical literature: the individualized case report and the systematically aggregated clinical trial. Hippocratic case narratives are considered as a particularly lucid articulation of a mode of inquiry that privileges detailed observation of individual patients, while medieval Aristotelian natural philosophy exemplifies a contrasting emphasis on regularity, intelligibility, and general explanation. Renaissance medical and philosophical traditions are treated as a mediating moment in which attention to anomaly, wonder, and singularity was explicitly re-legitimized within learned medicine. These historically situated articulations are not presented as stages in a progressive narrative, but as recurrent epistemic orientations that are repeatedly reconfigured under different theoretical, institutional, and technological conditions. The paper argues that the tension between attention to exceptional cases and the pursuit of generalizable knowledge continues to structure modern biomedical writing, where case reports remain essential for identifying rare, novel, or anomalous phenomena, while clinical trials formalize strategies for producing reproducible, population-level evidence. Full article

African swine fever (ASF) continues to spread, threatening the global swine industry and endangered swine species. Sri Lanka is a tropical island situated south of India in the Indian Ocean. Here, we report the first detection of ASF in Sri Lanka. In September 2024, increased pig mortality was reported across the country, with initial confirmation of porcine reproductive and respiratory syndrome (PRRS). Despite vaccination for PRRS, the mortalities continued to increase and therefore, tissue samples collected from dead pigs were subjected to ASF real-time PCR. ASFV genomic material was detected in most of the samples. The real-time PCR-positive samples were then subjected to genotyping by partial genome sequencing. All p72 and p54 sequences were found to be aligned with ASFV genotype II viruses, and CD2v sequences were found to be aligned with ASFV serogroup 8 viruses. The real-time PCR-positive samples were inoculated onto primary porcine leukocytes for virus isolation, and a selected number of tissues collected from dead pigs were subjected to histopathology. Histopathological studies revealed widespread loss of lymphocytes together with inflammation and extensive staining of ASFV antigens in tissue samples. Hemadsorption (HAD)-positive isolates were obtained from seven clinical samples, and three of them were subjected to whole-genome sequencing. Phylogeographic analysis of the whole-genome sequences showed that the virus is closely related to ASFV strains circulating in China and Hong Kong. Full article

Background/Objectives: Geographic Information Systems (GIS) offer essential capabilities for identifying spatial concentrations of vulnerability and strengthening context-aware prevention strategies. This manuscript describes a geospatial architecture designed to generate anticipatory, place-based risk identification applicable across diverse community and institutional environments. Interpersonal Violence (IPV), one of several preventable harms that benefit from this spatially informed analysis, remains a critical public health challenge shaped by structural, ecological, and situational factors. Methods: The conceptual framework presented integrates de-identified surveillance data, ecological indicators, environmental and temporal dynamics into a unified spatial epidemiological model. Multilevel data layers are geocoded, spatially matched, and analyzed using clustering (e.g., Getis-Ord Gi*), spatial dependence metrics (e.g., Moran’s I), and contextual modeling to support anticipatory identification of elevated vulnerability. Framework Outputs: The model is designed to identify spatial clustering, mobility-linked risk patterns, and emerging escalation zones using neighborhood disadvantage, built-environment factors, and situational markers. Outputs are intended to support both clinical decision-making (e.g., geocoded trauma screening, and context-aware discharge planning), and community-level prevention (e.g., targeted environmental interventions and cross-sector resource coordination). Conclusions: This framework synthesizes behavioral theory, spatial epidemiology, and prevention science into an integrative architecture for coordinated public health response. As a conceptual foundation for future empirical research, it advances the development of more dynamic, spatially informed, and equity-focused prevention systems. Full article

Background: The Rohingya refugee crisis is one of the largest humanitarian emergencies of the 21st century, with nearly one million Rohingya residing in overcrowded camps in southern Bangladesh. Women and children face the greatest vulnerabilities, including inadequate access to education and healthcare, which exacerbates their risks and limits opportunities for personal and community development. While international organizations continue to provide aid, resources remain insufficient, particularly in maternal and child healthcare, highlighting the urgent need for sustainable interventions. Objectives: The Hope Foundation for Women and Children in Bangladesh launched a pilot project for the Health Assistant Training (HAT) program to address critical gaps in healthcare and education for the Rohingya community. This nine-month training program equips young Rohingya women with essential knowledge and skills to support maternal health services in both clinical and community settings. Design: We conducted a qualitative evaluation of the HAT Program to explore its acceptance and anticipated benefits for both participants and the community. Methods: The research team used semi-structured interviews, focus groups, and field observations to explore the HAT Program’s impact on young Rohingya women and their community. They analyzed data through thematic analysis, developing a coding framework and identifying key themes to uncover patterns and insights. Results: The results were categorized into four themes: (1) community acceptance of the HAT Program, (2) the HAT Program’s impact on the health assistant trainees, (3) the impact of the HAT Program on the community, and (4) the potential ways to expand the HAT Program. Conclusions: This research underscores the program’s impact on improving healthcare access, enhancing women’s empowerment, and promoting community resilience. By situating this initiative within the broader context of refugee health, education, and capacity-building, this research highlights the HAT program’s potential as a replicable model in Bangladesh and in other humanitarian settings. Full article

(−)-Epigallocatechin gallate (EGCG), a major polyphenolic compound in tea leaves, exhibits potent antioxidant, anti-inflammatory, and anticancer properties. Despite its therapeutic potential, poor bioavailability limits clinical efficacy. This review comprehensively examines the sources, and multifunctional bioactivities of EGCG, including its antioxidant, anti-inflammatory, anticancer, cardiovascular protective, metabolic regulatory, neuroprotective, gut microbiota-modulating, and antimicrobial properties. Traditional and emerging applications of EGCG are summarized from different perspectives. Strategies to enhance bioavailability such as nanotechnology, chemical modification, and combination drug regimens are highlighted. Based on existing human clinical trials, recommendations for effective and safe dosage ranges of EGCG intake are provided. By analyzing the current situation, providing reasonable opinions and making outlooks, the clinical value of EGCG will be fully released, which will ultimately promote human health. Full article

Aesthetic Medicine is advanced as an integrated, evidence-based framework for patient-centered care that unites physical, psychological, social, and aesthetic dimensions of health. Drawing on Clinical Health Psychology, the paper introduces Aesthetic Health Psychology as a specialization that embeds psychological theory, assessment, and intervention within aesthetic medicine and surgery, emphasizing interdisciplinary collaboration rather than professional mistrust. The paper argues that integrating Aesthetic Health Psychology into aesthetic medicine can enhance ethical practice, improve patient-reported outcomes, and support equity-focused implementation across diverse procedures and settings. It further suggests a practical framework for implementation. Three interrelated models are proposed: the Aesthetic Biopsychosocial Model, which conceptualizes aesthetics as a distinct health domain alongside biological, psychological, and social factors; the Aesthetic Health Care Process Model, which structures care as a five-stage journey supported by systematic screening for body dysmorphic disorder and the routine use of patient-reported outcome measures; and the Aesthetic Health Systems Model, which situates aesthetic care within institutional, policy, and cultural contexts. Idealized but clinically grounded vignettes from elective cosmetic, reconstructive, and gender-affirming settings illustrate how these models address non-linear trajectories of adaptation, evolving expectations, complications, and stigma. These concepts jointly define both the motivation for Aesthetic Health Psychology and its practical implications, from the use of brief, selective aesthetic screening during primary health care visits to the design of equity-focused implementation strategies across aesthetic procedures and settings. Full article

Amino acid availability is central for the synthesis of macromolecules and numerous bioactive compounds. Amino acids are also involved in ATP production, cell signaling, and the epigenetic regulation of gene expression in human cells. From clinical and experimental studies, it appears that supplementation with specific amino acids may be relevant to correct for amino acid deficiency in the case of insufficient supply from dietary proteins with regards to the amounts needed for optimal metabolism and physiological functions. Clinical and experimental arguments suggest that amino acid supplementation may be indicated in specific situations under a specific nutritional context. However, it is essential not to overdose with excessive quantities of amino acids in supplements beyond the upper levels of safe intake (ULSI). In this narrative review, I recapitulate the protein and amino acid requirements for the general population and for subgroups of the population, and these requirements are compared to the usual consumption. Typical examples of clinical trials showing the benefits from amino acid supplementation in different physiological and pathophysiological contexts are presented together with results obtained from experimental studies. Parameters such as the no-observed-adverse-effect-level (NOAEL) values used to determine the ULSI for amino acid supplementation are defined, and values determined in clinical trials are given and discussed. Finally, prospects for future research in the field are proposed. Full article

Background: Nurses’ clinical reasoning is increasingly being recognized as a core competence that enhances the quality and safety of care across diverse healthcare settings. Nurses with refined clinical reasoning skills contribute significantly to improved health outcomes and broader health gains. In emergency departments, this competence is essential to rapidly assessing complex problems, anticipating complications, and preventing the deterioration of patients’ clinical conditions. Such expertise enables nurses to discern the severity of clinical situations quickly and intervene effectively. Objectives: The aims of this study were to analyze the clinical reasoning process of nurses and develop a theory that explains this process in emergency care settings. Methodology: This qualitative study explored the following research question: “How do nurses enact the clinical reasoning process in emergency departments?” The Grounded Theory methodology was used, with a theoretical sample of 20 nurses. Data collection methods included in-depth interviews, participant observation, and field notes. Results: The theoretical analysis identified clinical reasoning as a substantive theory composed of two subprocesses: Diagnostic Nursing Assessment and Therapeutic Nursing Intervention. Nurses’ clinical reasoning determines two levels of patient severity—Level I, life-threatening situations (immediate risk), and Level II, non-life-threatening situations (expressed problems)—according to which nursing interventions are adjusted. Conclusions: The Nursing Clinical Reasoning Model is a dynamic and continuous process that involves both Diagnostic Nursing Assessment and Nursing Therapeutic Intervention. It is deeply rooted in the nurse–patient–family relationship and is shaped by the specific care context, which influences nurses’ assessments and interventions and patients’ responses and behaviors. Full article

The early diagnosis and treatment of civilizational diseases remain a significant challenge worldwide. Although advances in medical technology have led to the introduction of more screening options over time, these measures are still insufficient to effectively reduce mortality from deadly diseases such as lung cancer (LC), cardiovascular diseases (CVD), diabetes, and chronic obstructive pulmonary disease (COPD). These conditions pose a major public health burden, underlying the urgent need for more comprehensive and efficient prevention strategies. Recently, the concept of ‘multiscreening’ has emerged as a promising approach. Multiscreening involves the simultaneous screening for multiple diseases using integrated diagnostic methods, potentially improving early detection rates and optimizing resource utilization. In 2024, Rzyman W. et al. launched the MULTIPREVENT epidemiological study, which aims to develop and validate a low-dose computed tomography (LDCT)-based screening test for civilizational diseases. This study represents a step forward in the pursuit of more effective, minimally invasive diagnostic tools that could facilitate earlier intervention and improve patient outcomes. To better understand the potential of multiscreening approaches and their clinical utility, it is essential to evaluate the existing predictive models used for identifying individuals at high risk for these diseases. This narrative review focuses primarily on lung cancer risk prediction models used in LDCT screening while situating these approaches within the broader conceptual framework of the MULTIPREVENT project, aimed at future integration of multi-disease prevention strategies. With this analysis, we aim to provide insights that will guide the development of more accurate, integrative screening tools that could reduce the global burden of these diseases. Full article

Objective—Partial do-not-resuscitate (DNR) orders, directives specifying limited resuscitative efforts, are intended to align medical interventions with patient preferences. However, their complexity may introduce ambiguity, inconsistent care, and ethical challenges. Design—A retrospective review was conducted of inpatient partial code order entries over a three-year period at a single institution with a pediatric oncology and immunology cohort. Partial DNR orders were identified and categorized based on included or excluded interventions (chest compressions, defibrillation, intubation, mechanical ventilation, medications). Data was analyzed to assess the frequency, variation, and internal consistency of documented preferences as well as alignment with institutional definitions and clinical feasibility. Results—Partial DNR orders represented a small (n = 15, 7%) but notable proportion of total code status entries. Wide variability was observed in the combinations of permitted and withheld interventions, with orders containing internally conflicting instructions. Documentation of inconsistencies and unclear terminology were common, raising concerns about interpretability during emergent situations. Conclusions—Partial DNR orders demonstrate heterogeneity and potential for miscommunication. These findings suggest that while partial codes may reflect nuanced patient preferences, they pose operational and ethical risks that could compromise care clarity. Clinical implications are reviewed. These findings will guide institutional deliberations regarding whether to refine, restrict, or eliminate partial code order options to enhance patient safety and decision-making transparency. Full article

Background: Traumatic injuries of the duodenum are generally rare but when they occur, they can result in serious complications. Inaccurate injury classification, delayed diagnosis, or late treatment can significantly raise morbidity and mortality. A multidisciplinary approach is often necessary. Mechanisms of injury: Isolated duodenal injuries are relatively uncommon due to the duodenum’s proximity to pancreas and major vascular structures. Duodenal injuries can result from blunt or penetrating trauma. Classification: The 2019 World Society of Emergency Surgery (WSES)-American Association for the Surgery of Trauma (AAST) guidelines recommend incorporating both the AAST-OIS grading and the patient’s hemodynamic status to stratify duodenal injuries into four categories: Minor injuries WSES class I, Moderate injuries WSES class II, Severe injuries WSES class III, and WSES class IV. Diagnosis: The diagnostic approach involves a combination of clinical assessment, laboratory investigations, radiological imaging and, in particular situations, surgery. Prompt diagnosis is critical because delays exceeding 24 h are associated with a higher incidence of postoperative complications and a significant rise in mortality. Contrast-enhanced abdominal computed tomography (CT) represents the gold standard for diagnosis in patients who are hemodynamically stable. Management: Duodenal trauma requires a multimodal approach that considers hemodynamic stability, the severity of the injury and the presence of associated lesions. Non-operative management (NOM) is reserved for hemodynamically stable patients with minor duodenal injuries without perforation (AAST I/WSES I), as well as all duodenal hematomas (WSES I–II/AAST I–II) in the absence of associated abdominal organ injuries requiring surgical intervention. All hemodynamically unstable patients, those with peritonitis, or with CT findings consistent with duodenal perforations or AAST grade III or higher injuries are candidates for emergency surgery. If intervention is required, primary repair should be the preferred option whenever feasible, while damage control surgery is the best choice in cases of hemodynamic instability, severe associated injuries, or complex duodenal lesions. Definitive reconstructive surgery should be postponed until the patient has been adequately resuscitated. The role of endoscopic techniques in the treatment of duodenal injuries and their complications is expanding. Conclusions: Duodenal trauma is burdened by potentially high mortality. Among the possible complications, duodenal fistula is the most common, followed by duodenal obstruction, bile duct fistula, abscess, and pancreatitis. The overall mortality rate for duodenal trauma persists to be significant with an average rate of 17%. Future prospective research needed to reduce the risk of complications following duodenal trauma. Full article

Background: Self-harm is a growing public health concern and the strongest predictor of suicide in young people (YP). The “Supporting Adolescents with Self-Harm” (SASH) intervention was developed with YP with lived experience and expert clinicians. It involves rapid follow-up after ED attendance and up to six intervention sessions. The intervention has three components: Therapeutic Assessment (TA) of self-harm; an enhanced safety plan (SP); and Solution-Focused Brief Therapy (SFBT). Depending on the YP’s preference, carers can join sessions. Carers can also receive two individual sessions. The clinical and cost-effectiveness of SASH is being evaluated in a randomised controlled trial across nine emergency departments in three NHS Trusts in London, England. A total of 154 YP were recruited between May 2023 and March 2025 and randomised on a 1:1 ratio to SASH alongside Treatment As Usual (TAU) or TAU. A logic model describes the SASH inputs, activities, mechanisms, outcomes and longer-term impacts. The aim of this paper is to (1) illustrate how TA, SP, and SFBT were implemented in practice by presenting intervention materials and session recordings for four YP cases and one carer case and (2) explore how the case study materials/recordings reflect the intervention mechanisms in the SASH logic model. Methods: Each case focused on a different component of the intervention. Intervention materials (TA self-harm diagram and completed SP) and recorded SFBT sessions with four YP and one carer were analysed using a descriptive case study approach. The TA diagram and SP were extracted from medical records. Audio/video recordings of intervention sessions were identified. Recordings of intervention sessions and qualitative interviews were transcribed. Quotes from qualitative interviews with the same participants were included where relevant. Results: Across the four YP cases, some core themes emerged. The role of friendships for young people, particularly at school, was important in both negative and positive ways. Experiencing difficulties with friends at school led to feelings of sadness and stress, which could become overwhelming, leading to thoughts of self-harm (“I just need to hurt myself”), triggering self-harm behaviour. YP described mood changes and signs that they were becoming stressed, which improved their self-awareness and understanding of the link between their feelings and self-harm behaviour. They reflected on what kept them feeling calm and overcoming their fear of burdening others by sharing how they were feeling, as this helped them not to self-harm. They also described difficult feelings stemming from a need to please everyone or needing validation from others. Overcoming these feelings led to less social anxiety and more confidence. This made it easier to go to school and to be more social with friends/student peers, which in turn improved their mood. Conclusions: These case studies demonstrate how YP improved their self-awareness and understanding of the link between feelings and self-harm behaviour and identified personal strategies for managing difficult feelings and situations. The carer case study demonstrates how sessions with carers can facilitate carers better supporting their YP’s mental health. Supporting YP and carers in this way has the potential to reduce the risk of future self-harm. Full article

For decades, cervical insufficiency (CI) has been framed predominantly as a mechanical failure of the cervix resulting in painless mid-trimester dilatation. This disease-centered paradigm, reinforced by clinical teaching and administrative coding, does not fully capture the dynamic and biologically integrated nature of cervical remodeling. Accumulating evidence suggests that cervical change is governed by coordinated mechanical, inflammatory, and immunologic interactions rather than by a purely anatomic defect. To outline a process-oriented conceptual framework that situates CI within the broader preterm-birth continuum, this perspective aims to integrate biomechanical, inflammatory, and immunologic dimensions of cervical remodeling and to emphasize that infection- and inflammation-related changes represent dynamic, potentially modifiable elements that may inform more individualized, biology-guided clinical decision-making. This Perspective traces the evolution from a traditional “disease entity” interpretation of CI toward a more integrated view of cervical remodeling as a dynamic, biology-responsive process. Emerging data suggest that when intra-amniotic infection or inflammation is appropriately managed, cervical competence may be partially restored, and mechanical support can be applied more safely in selected patients. Clinical observations indicate that infection-controlled cerclage is associated with meaningful prolongation of gestation. Earlier reports describing double-level mechanical reinforcement techniques conceptually align with contemporary interpretations of infection-controlled emergent cerclage by linking surgical timing with the underlying biology of cervical change. Rather than proposing a prescriptive management pathway, this framework highlights how mechanical, inflammatory, and immunologic factors may interact across heterogeneous CI etiologies and how individualized intervention may be guided by biologic context. Understanding CI as a dynamic rather than a fixed condition provides a framework that integrates its mechanical, inflammatory, and immunologic dimensions within the preterm birth continuum. Such a perspective encourages individualized, biology-informed interpretation of cervical change and supports more context-specific use of established interventions such as cerclage. By emphasizing developmental processes rather than a static defect, this approach seeks to bridge classical clinical practice with contemporary insights into cervical remodeling. Full article

Pulsoximeters are widely used in the medical care of preclinical patients to evaluate the cardiorespiratory status and monitor basic vital signs, such as pulse rate (PR) and oxygen saturation (SpO₂). In many preclinical situations, air transport of the patient by helicopter is necessary. Conventional pulse oximeters, mostly used on the patient’s finger, are prone to motion artifacts during transportation. Therefore, this study aims to determine whether simulated helicopter vibration has an impact on the photoplethysmogram (PPG) derived from an in-ear sensor at the external ear canal and whether the vibration influences the calculation of vital signs PR and SpO₂. The in-ear PPG signals of 17 participants were measured at rest and under exposure to vibration generated by a helicopter simulator. Several signal quality indicators (SQI), including perfusion index, skewness, entropy, kurtosis, omega, quality index, and valid pulse detection, were extracted from the in-ear PPG recordings during rest and vibration. An intra-subject comparison was performed to evaluate signal quality changes under exposure to vibration. The analysis revealed no significant difference in any SQI between vibration and rest (all p > 0.05). Furthermore, the vital signs PR and SpO₂ calculated using the in-ear PPG signal were compared to reference measurements by a clinical monitoring system (ECG and SpO₂ finger sensor). The results for the PR showed substantial agreement (${\mathrm{CCC}}_{rest}$ = 0.96; ${\mathrm{CCC}}_{vibration}$ = 0.96) and poor agreement for SpO₂ (${\mathrm{CCC}}_{rest}$ = 0.41; ${\mathrm{CCC}}_{vibration}$ = 0.19). The results of our study indicate that simulated helicopter vibration had no significant impact on the calculation of the SQIs, and the calculation of vital signs PR and SpO₂ did not differ between rest and vibration conditions. Full article