Search Results (294)

Introduction: Cystic fibrosis (CF) is a genetic condition affecting several organs and systems, including the pancreas, colon, respiratory system, and reproductive system. The detection of a growing number of CFTR variants and genotypes has contributed to an increase in the CF population which, in turn, has had an impact on the overall statistics regarding the prognosis and outcome of the condition. Given the increase in life expectancy, it is critical to better predict outcomes and prognosticate in CF. Thus, each person’s choice to aggressively treat specific disease components can be more appropriate and tailored, further increasing survival. The objective of our narrative review is to summarize the most recent information concerning the value and significance of clinical parameters in predicting outcomes, such as gender, diabetes, liver and pancreatic status, lung function, radiography, bacteriology, and blood and sputum biomarkers of inflammation and disease, and how variations in these parameters affect prognosis from the prenatal stage to maturity. Materials and methods: A methodological search of the available data was performed with regard to prognostic factors in the evolution of CF in children and young adults. We evaluated articles from the PubMed academic search engine using the following search terms: prognostic factors AND children AND cystic fibrosis OR mucoviscidosis. Results: We found that it is crucial to customize CF patients’ care based on their unique clinical and biological parameters, genetics, and related comorbidities. Conclusions: The predictive significance of more dynamic clinical condition markers provides more realistic future objectives to center treatment and targets for each patient. Over the past ten years, improvements in care, diagnostics, and treatment have impacted the prognosis for CF. Although genotyping offers a way to categorize CF to direct research and treatment, it is crucial to understand that a variety of other factors, such as epigenetics, genetic modifiers, environmental factors, and socioeconomic status, can affect CF outcomes. The long-term management of this complicated multisystem condition has been made easier for patients, their families, and physicians by earlier and more accurate identification techniques, evidence-based research, and centralized expert multidisciplinary care. Full article

Background/Objectives: Severe jawbone atrophy, particularly in elderly or medically compromised patients, presents a significant challenge for conventional implant placement. In cases where bone augmentation is not feasible, alternative techniques—such as short, narrow, tilted, and zygomatic implants—may be indicated for the rehabilitation of the atrophic jaw. Subperiosteal implants have re-emerged as a further viable alternative, especially with recent advancements in digital planning and custom fabrication. This study aims to evaluate the clinical outcomes and complications associated with subperiosteal implants through a literature review and a supporting case series, and to propose clinical preliminary guidelines for their use. Methods: Fourteen studies—including case reports, case series, retrospective studies, and systematic reviews—were analyzed to assess the effectiveness and risk profile of subperiosteal implants. Additionally, we present a case series of nine patients with advanced vertical and horizontal alveolar bone atrophy treated using custom-made, digitally-designed subperiosteal implants. Surgical techniques, prosthetic workflows, and complications were recorded and assessed. Results: Subperiosteal implants were found to be particularly suitable for patients with narrow alveolar crests and severe atrophy where traditional implants are contraindicated. Literature and case series data indicated favorable outcomes, with early complications such as soft tissue inflammation and prosthetic misfit being manageable. A low complication rate was recorded in our series, with digital workflows contributing to improved implant fit and reduced technical errors. Conclusions: Subperiosteal implants could offer an effective solution for complex atrophic cases, provided that patient selection, surgical precision, and prosthetic design are meticulously managed. Based on our findings, clinical recommendations are proposed to guide their application in contemporary practice. Full article

Background and Clinical Significance: The retreatment of failed dental implants remains a challenging clinical scenario, particularly when complicated by peri-implantitis and as sociated bone loss. Successful management requires a comprehensive and predictable approach that addresses both hard and soft tissue deficiencies. Case Presentation: This case report illustrates a fully digital, prosthetically driven workflow for the rehabilitation of a posterior mandibular site following implant failure. A 44-year-old female patient underwent removal of a failing implant and adjacent tooth due to advanced peri-implantitis and periodontitis. After healing, a digital workflow—including intraoral scanning, cone-beam computed tomography (CBCT), and virtual planning—was employed to design and fabricate a customized CAD/CAM titanium mesh for vertical guided bone regeneration. The grafting procedure utilized a composite mixture of autogenous bone and anorganic bovine bone (A-Oss). After nine months of healing, two implants with a hydrophilic surface (SOI) were placed using a fully guided surgical protocol (OneGuide system). Subsequent soft tissue grafting and final prosthetic rehabilitation with monolithic zirconia restorations resulted in stable functional and aesthetic outcomes. Conclusions: This case highlights how the integration of modern digital technologies with advanced regenerative procedures and innovative implant surfaces can enhance the predictability and long-term success of implant retreatment in compromised posterior sites. Full article

Cerebral edema is the abnormal accumulation of fluid in any of the tissue compartments of the cerebral parenchyma. It remains a significant challenge in neurotrauma care because it contributes to secondary brain injury, affecting prognosis. This review analyzes the recent literature, including foundational studies, to describe the mechanisms of distinct types of cerebral edema following traumatic brain injury (TBI). Emerging concepts, such as the role of the glymphatic system and heme-derived inflammasomes, offer new insights into new types of edemas, differentiated by pathogenesis and potential treatments. Recent advancements in understanding these molecular mechanisms can improve therapeutic strategies, facilitating a better approach in the era of precision and personalized medicine. Although there has been notable progress, a proposal to customize treatments for diverse types of edemas is necessary to improve outcomes following traumatic brain injury. In this review, we describe the current subtypes of post-traumatic brain edemas and link them to a specific management approach. Full article

This study explores the use of Large Language Models (LLMs), specifically GPT, for different safety management applications in the construction industry. Many studies have explored the integration of GPT in construction safety for various applications; their primary focus has been on the feasibility of such integration, often using GPT models for specific applications rather than a thorough evaluation of GPT’s limitations and capabilities. In contrast, this study aims to provide a comprehensive assessment of GPT’s performance based on established key criteria. Using structured use cases, this study explores GPT’s strength and weaknesses in four construction safety areas: (1) delivering personalized safety training and educational content tailored to individual learner needs; (2) automatically analyzing post-accident reports to identify root causes and suggest preventive measures; (3) generating customized safety guidelines and checklists to support site compliance; and (4) providing real-time assistance for managing daily safety tasks and decision-making on construction sites. LLMs and NLP have already been employed in each of these four areas for improvement, making them suitable areas for further investigation. GPT demonstrated acceptable performance in delivering evidence-based, regulation-aligned responses, making it valuable for scaling personalized training, automating accident analyses, and developing safety protocols. Additionally, it provided real-time safety support through interactive dialogues. However, the model showed limitations in deeper critical analysis, extrapolating information, and adapting to dynamic environments. The study concludes that while GPT holds significant promise for enhancing construction safety, further refinement is necessary. This includes fine-tuning for more relevant safety-specific outcomes, integrating real-time data for contextual awareness, and developing a nuanced understanding of safety risks. These improvements, coupled with human oversight, could make GPT a robust tool for safety management. Full article

Introduction: Total temporomandibular joint replacement (TMJR) is a well-established surgical solution for patients with severe TMJ disorders. It aims to relieve chronic pain, restore jaw mobility, and significantly enhance quality of life. This systematic review evaluates QoL outcomes following TMJR, analyzes complication profiles, compares custom versus stock prostheses, explores pediatric applications, and highlights technological innovations shaping the future of TMJ reconstruction. Methods: A systematic search of PubMed, Embase, and the Cochrane Library was conducted throughout April 2025 in accordance with PRISMA 2020 guidelines. Sixty-four studies were included, comprising 2387 patients. Results: Primary outcomes assessed were QoL improvement, pain reduction, and functional gains such as maximum interincisal opening (MIO). Secondary outcomes included complication rates and technological integration. TMJR consistently led to significant pain reduction (75–87%), average MIO increases of 26–36 mm, and measurable QoL improvements across physical, social, and psychological domains. Custom prostheses were particularly beneficial in anatomically complex or revision cases, while stock devices generally performed well for standard anatomical conditions. Pediatric TMJR demonstrated functional and airway benefits with no clear evidence of growth inhibition over short- to medium-term follow-up. Complications such as heterotopic ossification (~20%, reduced to <5% with fat grafting), infection (3–4.9%), and chronic postoperative pain (~20–30%) were reported but were largely preventable or manageable. Recent advancements, including CAD/CAM planning, 3D-printed prostheses, augmented-reality-assisted surgery, and biofilm-resistant materials, are enhancing personalization, precision, and implant longevity. Conclusions: TMJR is a safe and transformative treatment that consistently improves QoL in patients with end-stage TMJ disease. Future directions include long-term registry tracking, growth-accommodating prosthesis design, and biologically integrated smart implants. Full article

Background: Klippel–Trenaunay syndrome (KTS) is a congenital vascular malformation syndrome characterized by low-flow vascular anomalies, including venous malformation (VM) and lymphatic involvement. These anomalies may lead to limb asymmetry due to soft tissue and/or bone overgrowth. Compression therapy using elastic garments is considered a conservative and minimally invasive first-line treatment option for KTS. However, the benefits of compression therapy for low-flow vascular malformations, particularly limb VMs, have not been sufficiently evaluated. This prospective, multi-center study assessed the efficacy and safety of compression therapy for KTS with VM. Methods: After measuring the affected limb, a custom-made elastic garment providing 30 mmHg of compression was manufactured (THUASNE, France). A total of 20 patients (7 male, 13 female; mean age: 10.9 years) underwent compression therapy for 26 weeks at four nationwide institutions in Japan. The primary outcome was the change in lower limb circumference. Secondary outcomes included pain, modified Rankin Scale (mRS) score, body water content, vital signs, changes in garment elasticity, and adverse events. Results: All 20 patients completed the study. At the study endpoint, the circumference ratio of the affected to unaffected limbs was significantly reduced at the superior end of the tibial tuberosity (p = 0.02) and the thinnest part of the ankle (p < 0.001). The elastic force of the garment declined by approximately 50% over 26 weeks. No serious adverse events related to the intervention were reported. Conclusions: Compression therapy using a custom-made elastic garment appears to be a safe and effective approach for managing limb overgrowth in patients with KTS and VM. To maintain the therapeutic effect, garment replacement is recommended at least every six months. Full article

The natural history of focal non-infected lesions of the abdominal aorta (fl-AA) remains unclear and largely depends on their aetiology. These lesions often involve a focal “tear” or partial disruption of the arterial wall. Penetrating aortic ulcers (PAUs) and intramural hematomas (IMHs) are examples of focal tears in the aortic wall that can either progress to dilatation (saccular aneurysm) or fail to fully propagate through the medial layers, potentially leading to aortic dissection. These conditions typically exhibit a morphology consistent with eccentric saccular aneurysms. The management of focal non-infected pathologies of the abdominal aorta remains a subject of debate. Unlike fusiform abdominal aortic aneurysms, the inconsistent definitions and limited information regarding the natural history of saccular aneurysms (sa-AAAs) have prevented the establishment of universally accepted practice guidelines for their management. As emphasized in the latest 2024 ESVS guidelines, the focal nature of these diseases makes them ideal candidates for endovascular repair (class of evidence IIa—level C). Moreover, the Society for Vascular Surgery just referred to aneurysm diameter as an indication for treatment suggesting using a smaller diameter compared to fusiform aneurysms. Consequently, the management of saccular aneurysms is likely heterogeneous amongst different centres and different operators. Endovascular repair using tube stent grafts offers benefits like reduced recovery times but carries risks of migration and endoleak due to graft rigidity. These complications can influence long-term success. In this context, the use of endovascular bifurcated grafts may provide a more effective solution for treating these focal aortic pathologies. It is essential to achieve optimal sealing regions through anatomical studies of aortic morphology. Additionally, understanding the anatomical characteristics of focal lesions in challenging necks or para-visceral locations is indeed crucial in device choice. Off-the-shelf devices are favoured for their time and cost efficiency, but new endovascular technologies like fenestrated endovascular aneurysm repair (FEVAR) and custom-made devices enhance treatment success and patient safety. These innovations provide stent grafts in various lengths and diameters, accommodating different aortic anatomies and reducing the risk of type III endoleaks. Although complicated PAUs and focal saccular aneurysms rarely arise in the para-visceral aorta, the consequences of rupture in this segment might be extremely severe. Experience borrowed from complex abdominal and thoracoabdominal aneurysm repair demonstrates that fenestrated and branched devices can be deployed safely when anatomical criteria are respected. Elective patients derive the greatest benefit from a fenestrated graft, while urgent cases can be treated confidently with off-the-shelf multibranch systems, reserving other types of repairs for emergent or bail-out cases. While early outcomes of these interventions are promising, it is crucial to acknowledge that limited aortic coverage can still impede effective symptom relief and lead to complications such as aneurysm expansion or rupture. Therefore, further long-term studies are essential to consolidate the technical results and evaluate the durability of various graft options. Full article

Background: Oral mucositis (OM) is a painful and debilitating stomatitis that often arises following head and neck radiotherapy, chemotherapy, or stem cell transplant, leading to treatment delays and potential patient intervention interruption. The aim of this narrative review was to explore the modalities in the management of OM. When supported by evidence, treatment is customized according to its severity. Method: A literature search was performed using the PubMed database. The search strategy consists of keywords such as “pain management”, “pain control”, and “oral mucositis”. Literature references from 1997 to 2024 were selected by the authors based on relevance to the current practice of oral mucositis pain management. Results: Fourteen studies were included in this review. Interventions were classified into pharmacological and non-pharmacological modalities. In relation to pain measurement, for grade 1 OM, topical treatments are the primary recommendation. For grades 2 to 4, where pain is moderate to severe, systemic analgesia should be administered. Honey and oral care are beneficial for OM with grades 2 to 4. Conclusions: Effective management of OM should be tailored to the severity of the condition, incorporating both pharmacological and non-pharmacological strategies. While various modalities have shown promise in relieving symptoms and enhancing the quality of life, a multifaceted, patient-centered approach remains essential. Advancing high-quality clinical trials, particularly those evaluating non-pharmacological interventions will be crucial to expanding treatment options. Future efforts should focus on personalized therapies, integration of combination treatments, adoption of standardized pain assessment tools, and long-term outcome studies to improve clinical effectiveness and optimize patient care. Full article

Keratoconus is a progressive corneal disorder that causes thinning and irregular astigmatism, often leading to significant visual impairment. In the advanced stages, surgical interventions are necessary to restore corneal shape, improve vision, and enhance contact lens tolerance. Intracorneal ring segments (ICRSs) have emerged as a well-established, minimally invasive option that not only improves vision but also has the potential to delay or prevent the need for corneal transplantation in advanced cases. Recent advancements in the ICRS implantation techniques, patient selection, and femtosecond laser technology have significantly improved the precision and safety of these procedures, reducing complications. The ability to customize the ring parameters—such as thickness, arc length, and positioning—enables a more individualized approach, particularly for patients with irregular astigmatism. Artificial intelligence (AI) is also emerging as a promising tool for optimizing ICRS planning and improving patient outcomes. Although still in the early stages, AI algorithms may refine the treatment strategies by analyzing large datasets, improving the patient selection, and predicting long-term outcomes. Corneal Allogenic Intrastromal Ring Segments (CAIRSs) offer a novel alternative to synthetic ICRSs, with advantages like improved biocompatibility and reduced extrusion risk. However, CAIRSs remain an evolving technique that requires further refinement and long-term evaluation to determine the tissue integration, the durability of the refractive outcomes, and the potential for late-onset complications. In conclusion, ICRSs continue to be a safe and effective option for managing advanced keratoconus. Ongoing refinement of the surgical approaches—combined with advancements such as femtosecond laser technology and the integration of AI—will ensure that both ICRSs and CAIRSs remain key components in the therapeutic arsenal for keratoconus, offering sustained visual improvements and the potential to delay or avoid corneal transplantation. Full article

Background/Objectives: The percutaneous insertion of an external ventricular drain (EVD) is a common neurosurgical procedure that is crucial in managing acute brain injuries because of the drain’s role in monitoring intracranial pressure and draining cerebrospinal fluid. The primary indication is acute hydrocephalus, which often results from subarachnoid hemorrhage, intracranial hemorrhage, traumatic brain injury, stroke, or infection. Standard EVD placement targets the frontal horn of the lateral ventricle. However, complications such as hemorrhage, infection, and catheter occlusion frequently arise, with occlusion rates ranging from 19% to 47%. Occlusion can lead to increased intracranial pressure, necessitating interventions such as saline flushes or fibrinolytic drug administration. The placement of an EVD is a very specific choice that must be tailored to the individual patient, often in scenarios in which multiple interpretations of the data are possible: the question of which patient is eligible for EVD placement may be subjective. Intraventricular fibrinolysis (IVF) with urokinase-type plasminogen activator (uPA) or tissue-type plasminogen activator is used with the aim of lysing intraventricular clots and preventing EVD occlusion. Despite numerous studies, conclusive evidence on their efficacy is lacking. The CLEAR III trial confirmed the safety of IVF but showed uncertain benefits in neurological outcomes. Given the limited literature on uPA, this study evaluates its intrathecal administration for the prevention of EVD occlusion. Not all therapies are appropriate for all patients, and customizing strategies is often the right way to get the best result. Methods: This retrospective study analyzed 20 patients with EVDs receiving intrathecal uPA. The patients had a mean age of 56.4 years, with 95% presenting with hydrocephalus and 80% presenting with intraventricular hemorrhage. uPA dosages varied (25,000–100,000 IU), with an average of 3.9 doses per patient. Results: IVF effectively maintained EVD patency in 95% of cases. One patient experienced asymptomatic bleeding, while four (20%) developed post-treatment infections, the development of which was potentially influenced by the prolonged duration of EVD retention (>21 days). Analysis of Graeb scores showed faster clot resolution with early uPA administration. A higher initial Graeb score correlated with increased total uPA load but not with mortality or discharge outcomes. Although infection rates were slightly higher than in CLEAR III, multiple confounding factors, including duration of EVD retention and bilateral placement, were present. Conclusions: This study supports the feasibility and safety of intrathecal uPA administration for management of EVD occlusion in certain contexts. The appropriate choice in the context of ‘personalized medicine’ must necessarily consider the risk–benefit ratio. Full article

The evaluation of port service quality (PSQ) is critical for enhancing the competitiveness of container terminals. As technological innovation continues to reshape port operations, PSQ has shifted beyond operational efficiency to deliver smart, reliable, and sustainable services. However, few studies have addressed PSQ in the context of smart port evolution, especially with a focus on container terminals. This study employs a five-dimensional framework, comprising resources, outcomes, process, management, image, and social responsibility, to analyze how PSQ influences customer satisfaction and how customer satisfaction, in turn, affects customer loyalty and referral intention. The data was collected through a survey targeting users of container terminals in five major ports in Korea that undergoing smart port transformation, resulting in a final sample of 324 respondents. The findings reveal that resource-related, process-related, and image- & social responsibility-related PSQ dimensions significantly enhance customer satisfaction, which in turn has a positive effect on customer loyalty and referral intention. In contrast, the outcome-related and management-related dimensions did not have a significant impact on customer satisfaction. The analysis results and various implications discussed in this study are expected to provide helpful information and insights for establishing strategies to enhance the competitiveness of smart ports in the future. Full article

Background/Objectives: Infertility in both men and women can be significantly influenced by oxidative stress (OS), which occurs due to an imbalance between reactive oxygen species (ROS) and the body’s antioxidant defenses. In women, OS disrupts oocyte maturation, implantation, and the viability of the embryo; in men, it impairs sperm quality, reduces motility, and damages DNA integrity. This review explores existing research on how dietary and lifestyle interventions can reduce OS and enhance reproductive health outcomes. Methods: We conducted a comprehensive review of clinical, translational, and molecular studies exploring the mechanisms by which OS affects fertility, as well as the efficacy of nutritional and behavioral strategies. The interventions evaluated include weight management, regular exercise, micronutrient supplementation, antioxidant-rich diets, smoking and alcohol cessation, and stress-reduction techniques. Results: Specific dietary components such as zinc, selenium, vitamins C and E, and polyphenols have been found to neutralize reactive oxygen species (ROS) and enhance gamete function. OS is additionally reduced through lifestyle modifications, including minimizing harmful exposures, managing stress, and participating in moderate physical activity. Biomarkers such as ROS levels, total antioxidant capacity, 8-OHdG, and DNA fragmentation index are essential for assessing the effectiveness of interventions. Conclusions: Fertility in both sexes can be improved, and oxidative stress significantly reduced, through a multimodal approach incorporating dietary and lifestyle changes. There are encouraging opportunities to improve reproductive health through customized approaches that are informed by biomarker profiles. To incorporate these treatments into regular fertility care, future studies should concentrate on standardized procedures and long-term results. 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

The pursuit of mergers and acquisitions (M&A) is often an acclaimed strategy for firm growth, resource sharing, and extended reach into new market segments. However, in the healthcare marketplace, there are two very different perspectives related to M&A. On the one hand, the American Hospital Association commends M&A activity as a tool to reduce healthcare costs, drive quality, and serve rural markets. On the other hand, a recent United States’ Presidential executive order suggests that M&A in the healthcare space is harmful to healthcare due to its restrictions on competition and adverse impacts on patients. These conflicting perspectives reflect differing M&A views in mainstream management research, as well. The purpose of the current study is twofold. First, we aim to explore these two seemingly paradoxical perspectives by examining the degree of hospital network geographic dispersion that results from M&A activity. Second, we contribute to the broader M&A literature by drawing attention to the importance of considering geographic influences on M&A performance. Using a spatial analysis of 147 nationwide hospital networks comprising 1713 hospitals, we propose and find support for the notion that the degree of network dispersion, as measured by actual driving distances in healthcare networks, are correlated with patient experiences. Using ordinary least squares (OLS) regression to examine relationships between patient experiences and overall hospital network geographic dispersion, we found support for the hypothesis that more spatially dispersed healthcare networks are associated with lower overall performance outcomes, as measured by customer (patient) satisfaction. The implications of these findings suggest that growth strategies that involve M&A activity should carefully consider the spatial influences on M&A entity selection. Our exploratory findings also provide a foundation for future research to bridge the gap between industry and governmental perspectives on healthcare M&A practices. Full article