Search Results (29,747)

Background: Composite restorations are the standard of care for posterior teeth due to their aesthetic properties and conservative nature. However, the choice between direct and semi-direct techniques can influence clinical longevity and performance. Objectives: This study aimed to compare the clinical performance of two restorative approaches: a direct technique and the semi-direct onlay technique in terms of aesthetic quality, surface finish, wear resistance, marginal integrity, and overall clinical efficiency over a two-year period. Methods: A total of 348 composite restorations were placed in 192 patients. Each restoration was evaluated at four timepoints: baseline (T0), 6 months (T1), 1 year (T2), and 2 years (T3). Clinical performance was assessed using standardised 5-point rating scales across the five dimensions. Repeated-measures ANOVA assessed changes over time, while Wilcoxon signed-rank and Mann–Whitney U tests were used for intra- and inter-group comparisons. Results: Significant time effects were observed across all clinical parameters (p < 0.0001). The direct technique exhibited superior initial results in aesthetics and surface finish at T0 and T1 (p < 0.001), but differences diminished by T3. In contrast, the semi-direct technique demonstrated improved performance in wear resistance and marginal integrity at T2 and T3. Both techniques showed progressive deterioration, particularly in marginal adaptation. Conclusions: The direct technique offers enhanced short-term aesthetics and procedural efficiency, while the semi-direct approach provides superior long-term durability and marginal adaptation. Full article

Background/Objectives: Modifiable lifestyle factors, particularly diet, are important for preventing type 2 diabetes (T2D); however, the evidence regarding this from prospective studies is limited in the Asian population. We therefore evaluated whether a diet-inclusive healthy lifestyle score (HLS) predicts incident T2D in a community-based cohort. Methods: We analyzed 7185 T2D-free adults from the KoGES Ansan–Ansung cohort, constructing the HLS (range: 0–5) based on five lifestyle factors: non-smoking, ≥30 min/day of moderate-to-vigorous physical activity, low-risk alcohol consumption (≤40 g/day for men; ≤20 g/day for women), BMI of 18.5–24.9 kg/m², and a healthy diet, defined as a healthy plant-based diet index within the top 40th percentile. Cox proportional hazards regression models were employed to examine the association between HLS and incident T2D risk. Results: During a median follow-up of 17.5 years, 1223 cases of T2D were identified. Compared to individuals with a score of 0 or 1, those with a score of 5 had a 56% lower risk of T2D after adjustment for potential confounders (HR: 0.44, 95% CI: 0.32–0.62), and these associations remained consistent across subgroups stratified by age, sex, family history of T2D, hypertension, and residential area. However, the association was stronger among non-users of anti-diabetic medication than among users. Conclusions: Adherence to a healthier lifestyle, as indicated by a higher HLS, was significantly associated with a reduced risk of developing T2D among Korean adults. These findings underscore the importance of promoting integrated healthy lifestyle behaviors to prevent T2D. Full article

Background/Objectives: Low back pain (LBP) is one of the most prevalent musculoskeletal disorders globally, significantly impacting quality of life across diverse populations. Despite its association with middle-aged and older populations, evidence indicates that LBP is increasingly prevalent among younger age groups. Health science students are considered a potential risk factor for LBP; however, longitudinal studies are scarce. This study aims to determine the risk factors for LBP among health science students over a 2-year follow-up. Methods: One hundred ninety-seven of the third-class health science students (Nursing, Physiotherapy, Medical laboratory science, and Emergency Medical services) were contacted in June 2024. A self-administered modified version of the Standardized Nordic Questionnaire, and data about sedentary and physical activity behavior, as well as 1-month LBP (lasting at least 12 h and numeric rating scale > 5) and stress scores, were recorded. Results: A total of 172/197 (87.3%) respondents completed the questionnaire at the end of the 2-year follow-up. The mean age was 25 ± 3.5 (years) and body mass index (BMI) value 23.5 ± 4.3 (kg/m²). About 49% (n = 84) and 20% (n = 34) of the participants had 1-month LBP and functional disability, respectively. No significant association was found between health science programs and the presence of 1-month LBP (χ² = 0.55, p > 0.05). The logistic regression analyses found that males (OR = 0.269, p = 0.005) and a history of pain frequency (OR = 3.377, p = 0.001) had a significant association with LBP over time. Conclusions: This prospective study shows a high prevalence of 1-month LBP (48.8%) among health science students at Zefat Academic College. LBP was significantly related to sex (female) and pain frequency, but not to health science students. We believe that implementing ergonomic and educational strategies is recommended for this population. Full article

Background/Objectives: Patients with deep brain stimulation (DBS) require regular follow-up. When a sudden loss of therapeutic effect occurs, impedance abnormalities are often the underlying cause. If reprogramming cannot restore clinical benefit, revision surgery may be necessary to replace defective hardware. Since all three major manufacturers are used at our center, we analyzed our patient cohort to determine the incidence and causes of impedance abnormalities. Methods: All 601 patients who underwent de novo DBS implantation in Hamm between 2009 and 2025 were evaluated for impedance abnormalities. In cases requiring revision surgery, the specific cause was identified. The manufacturer, electrodes, and contacts involved were systematically analyzed. Results: A total of 25 of 601 patients required revision surgery. Revision rates were 2.67% in patients with Parkinson’s disease, 6.19% in those with a tremor, and 5.71% in those with dystonia. Across manufacturers, 7.6% of patients with a Medtronic system required revision surgery, compared with 3.4% of patients with an Abbott system and no patients with a Boston Scientific system. The primary causes of revision were electrode-related problems (19/25), followed by extension defects (6/25), connector issues (4/25), and, in one case, a generator defect (1/25). Conclusions: Only 4.16% of patients required revision surgery due to impedance abnormalities. Patients with a tremor and non-segmented electrodes showed a higher incidence than those with Parkinson’s disease or dystonia. Predominantly older Medtronic systems had the highest revision rate, whereas no Boston Scientific systems required revision. In most cases, the electrodes were the primary source of impedance abnormalities. A total of 52% of revisions were performed within two years and 92% were performed within six years of implantation. Full article

This follow-up study investigates the long-term environmental sustainability and remediation outcomes of the UPPER (‘Urban Productive Parks for Sustainable Urban Regeneration’-UIA04-252) project in Latina, Italy, focusing on Nature-Based Solutions (NbS) applied to urban green infrastructure. By integrating proximal and satellite-based remote sensing methodologies, the research evaluates persistent improvements in vegetation health, soil moisture dynamics, and overall environmental quality over multiple years. Building upon the initial monitoring framework, this case study incorporates updated data and refined techniques to quantify temporal changes and assess the ecological performance of NbS interventions. In more detail, ground-based data from meteo-climatic, air quality stations and remote satellite data from the Sentinel-2 mission are adopted. Ground-based measurements such as temperature, humidity, radiation, rainfall intensity, PM10 and PM2.5 are carried out to monitor the overall environmental quality. Updated satellite imagery from Sentinel-2 is analyzed using advanced band ratio indices, including the Normalized Difference Vegetation Index (NDVI), the Normalized Difference Water Index (NDWI) and the Normalized Difference Moisture Index (NDMI). Comparative temporal analysis revealed consistent enhancements in vegetation health, with NDVI values significantly exceeding baseline levels (NDVI 2022–2024: +0.096, p = 0.024), demonstrating successful vegetation establishment with larger gains in green areas (+27.0%) than parking retrofits (+11.4%, p = 0.041). However, concurrent NDWI decline (−0.066, p = 0.063) indicates increased vegetation water stress despite irrigation infrastructure. NDMI improvements (+0.098, p = 0.016) suggest physiological adaptation through stomatal regulation. Principal Component Analysis (PCA) of meteo-climatic variables reveals temperature as the dominant environmental driver (PC2 loadings > 0.8), with municipality-wide NDVI-temperature correlations of r = −0.87. These multi-scale findings validate sustained NbS effectiveness in enhancing vegetation density and ecosystem services, yet simultaneously expose critical water-limitation trade-offs in Mediterranean semi-arid contexts, necessitating adaptive irrigation management and continued monitoring for long-term urban climate resilience. The integrated monitoring approach underscores the critical role of continuous, multi-scale assessment in ensuring long-term success and adaptive management of NbS-based interventions. Full article

Background and Objectives: Corpus atrophic gastritis (CAG) is associated with vitamin B₁₂ deficiency due to impaired gastric acid and intrinsic factor secretion. Untreated vitamin B₁₂ deficiency can lead to pernicious anemia, severe neurological consequences, and acute cardiocerebral-vascular events. Timely vitamin B₁₂ supplementation is relevant; however, the dosage of intramuscular (IM) vitamin B₁₂ supplementation has not been standardized to date. The objective was to assess the efficacy of a 1st and 2nd treatment schedule of IM-cyanocobalamin treatment in CAG patients with vitamin B₁₂ deficiency at long-term follow-up and to identify the predictors of increased cyanocobalamin requirement. Methods: This monocentric real-life cohort study included 213 CAG patients with vitamin B₁₂ deficiency. Inclusion criteria were adult age, histological diagnosis of CAG with vitamin B₁₂ deficiency (<220 pg/mL), and follow-up of more than 12 months. The 1st-treatment-schedule (TxA) was 5000 µg IM cyanocobalamin every 5 days for 3 times, followed by 5000 µg IM cyanocobalamin every 3 mos (20,000 µg/yr); the 2nd-treatment-schedule (TxB) was 5000 µg IM cyanocobalamin every 5 days for 3 times, followed by 5000 µg IM cyanocobalamin every 2 mos (30,000 µg/yr). The treatment endpoint was serum vitamin B₁₂ normalization. Clinical-biochemical follow-up was scheduled every 12 ± 6 mos: patients who satisfied the endpoint maintained the TxA, otherwise, TxB was prescribed. Results: Of the 213 CAG patients with vitamin B₁₂ deficiency, 48.3% had anemia, and 26.3% macrocytosis without anemia. TxA efficaciously corrected vitamin B₁₂ deficiency in 146 (68.5%) patients, maintaining efficacy until the longest available follow-up (42.2 ± 2.6 months). The remaining 67 patients (31.5%) were switched to TxB due to persistent vitamin B₁₂ deficiency observed at 12 (6–36) months and were maintained until the longest available follow-up (50.2 ± 4.1 months). At the longest available follow-up, a significant increase in Hb (TxA: 11.9 ± 0.2 to 13.1 ± 0.1 g/dL, p < 0.001; TxB: 12.2 ± 0.3 to 13.6 ± 0.2 g/dL, p = 0.003) and serum vitamin B₁₂ (TxA: 168 ± 7 to 402 ± 19 pg/mL, p < 0.0001; TxB: 157 ± 12 to 340 ± 24 pg/mL, p < 0.0001) was shown in both schedules. A significant decrease in MCV was shown in TxB only (p = 0.0003). In logistic regression, switching to TxB was significantly associated with severe corpus intestinal metaplasia (OR 11.0, 95% CI 2.8–43.7), macrocytosis at CAG diagnosis (OR 2.7, 95% CI 1.2–6.3), and male sex (OR 2.4, 95% CI 1.1–5.2). Conclusions: In this real-world setting, at long-term follow-up, nearly 70% of CAG patients with vitamin B₁₂ deficiency restored their vitamin B₁₂ levels with 20,000 µg/yr of cyanocobalamin, while the remaining 30% required 30,000 µg/yr. Male vitamin B₁₂-deficient CAG patients with advanced gastric damage and severe macrocytosis required higher dosages of cyanocobalamin. They should be carefully monitored to avoid suboptimal supplementation and potentially dangerous consequences of vitamin B₁₂ deficiency. Full article

Background/Objectives: Evidence-based recommendations are vital in healthcare to standardize care, reduce variability, and improve patient outcomes. In children, anaphylaxis, allergy to antibiotics, and hymenoptera venom allergy are among the commonest reasons for allergological evaluation. This work was intended to optimize the prescriptions for allergological evaluation and for the related diagnostic tests with the aim of improving the management of children with allergic diseases and promoting resource efficiency. Methods: A systematic literature review of the literature was performed to formulate recommendations on the diagnostic management of children with anaphylaxis, drug allergy, and hymenoptera venom allergy. Results: Effective management of anaphylaxis involves rapid assessment and specialist follow-up to identify triggers, prevent recurrence, and ensure patients and caregivers are educated and equipped with an adrenaline auto-injector. Integrating skin testing, specific serological assays, and oral provocation tests into the diagnostic process for children with suspected beta-lactam allergy enhances diagnostic accuracy and minimizes unnecessary avoidance of first-line antibiotics. Children and adolescents with systemic reactions to hymenopteran stings should be referred to an allergy specialist for diagnosis, risk assessment, management education, and adrenaline prescription. Conclusions: These recommendations may enhance care quality, minimize inappropriate prescriptions, and support standardized methods of diagnosis of allergological diseases in children. Full article

Background: Acute respiratory distress syndrome (ARDS), recognized as an inflammatory and life-threatening lung injury, is typified by severe hypoxaemia, lack of heart-related pulmonary edema, and bilateral lung infiltrates. Glucocorticoids are anti-inflammatory and immunoregulatory agents that are considered a viable treatment for ARDS. This study sought to contrast the effects of methylprednisolone, hydrocortisone, and dexamethasone at equivalent doses in ARDS. Methods: About 195 ARDS patients were allocated at random to take methylprednisolone (1 mg/kg/day), hydrocortisone (350 mg/day), or dexamethasone (13 mg/day). The primary and secondary outcomes over 28 days following the initiation of glucocorticoid therapy involved mortality, ventilator-free days, duration of hospitalization, duration of intensive care unit (ICU), total number of patients requiring invasive mechanical ventilation, and changes in the means of arterial oxygen partial pressure to inspired oxygen fraction (PaO₂/FiO₂) and oxygen saturation percentage to inspired oxygen fraction (SpO₂/FiO₂) ratios. Results: Over the 28-day follow-up, regarding mortality, there was a significant difference between dexamethasone and hydrocortisone, as well as between methylprednisolone and hydrocortisone. However, methylprednisolone exhibited the lowest mortality. There were no significant differences among study groups in ventilator-free days, hospitalization duration, ICU duration, and requirement for invasive mechanical ventilation. On the other hand, methylprednisolone had the lowest means of both durations of hospitalization and ICU, and the lowest requirement for invasive mechanical ventilation. Each study group exhibited a significant increase in both PaO₂/FiO₂ and SpO₂/FiO₂ ratios at follow-up time. However, dexamethasone showed the highest means of both PaO₂/FiO₂ and SpO₂/FiO₂ ratios at follow-up time. There was a significant difference in PaO₂/FiO₂ and SpO₂/FiO₂ ratios at follow-up assessment between dexamethasone and hydrocortisone. Conclusions: At equivalent doses, treating ARDS with methylprednisolone may be more successful than using dexamethasone and hydrocortisone. Full article

Background: Renal and cardiac dysfunction are major determinants of adverse outcomes following transcatheter aortic valve replacement (TAVR). The ratio of blood urea nitrogen to left ventricular ejection fraction (BUN/EF) integrates renal and cardiac status into a single physiological index. This study aimed to evaluate the prognostic value of both baseline and temporal (48–72 h) BUN/EF ratios for predicting mortality after TAVR. Methods: A total of 429 patients (mean age 76 ± 8 years; 51% female) who underwent TAVR for severe aortic stenosis between 2017 and 2025 were retrospectively analyzed. The primary endpoint was long-term all-cause mortality; in-hospital mortality was secondary. Receiver operating characteristic (ROC) curves, Cox regression, and reclassification metrics (NRI, IDI) assessed prognostic performance. Restricted cubic spline (RCS) analysis explored non-linear associations. Results: During a median follow-up of 733 days, overall and in-hospital mortality rates were 37.8% and 7.9%, respectively. Both baseline and 48–72 h BUN/EF ratios were independently associated with mortality (HR = 3.46 and 3.79 per 1 SD increase; both p < 0.001). The temporal ratio showed superior discrimination for in-hospital mortality (AUC = 0.826 vs. 0.743, p = 0.007). Adding baseline BUN/EF to EuroSCORE II significantly improved model performance (AUC 0.712 vs. 0.668, p = 0.031; NRI = 0.33; IDI = 0.067). RCS analysis revealed a linear relationship for baseline and a steep, non-linear association for temporal ratios with mortality risk. Conclusions: The 48–72 h BUN/EF ratio is a robust dynamic biomarker that predicts early mortality after TAVR, while baseline BUN/EF identifies patients at long-term risk. Integrating this simple bedside index into risk algorithms may refine postoperative monitoring and improve outcome prediction in TAVR populations. Full article

Background/Objectives: Endoscopic submucosal dissection (ESD) is a state-of-the-art en bloc resection for early gastro-intestinal cancers and precursors developed and validated in Japan. Western expertise with this complex technique remains limited. Tutored training might be optimal for patients and ESD learning. We established ESD tutoring courses led by experienced Japanese experts to provide (i) optimal long-term curative outcomes and low complication rates for patients and (ii) hands-on training on difficult lesions for European endoscopists under direct expert supervision. Methods: Prospective data from 2011 to 2015 (follow-up to 12/2024) were analyzed. A total of 118 neoplasms (50% HGIEN and cancer) in 101 patients (median age 68 [37–91] years; 38% with significant comorbidities) were treated with expert or tutored ESD. Japanese experts performed 28 ESDs, while 22 trained beginners conducted 90 supervised procedures on difficult lesions during 5 live and 20 tutoring events (1–4 days each). Results: Analysis of the complete data showed curative and en bloc resection rates of 88% and 95%, respectively, with no recurrence after R0 resections during a median follow-up of 9.8 [1.5–14.9] years. Long-term survival remained recurrence-free after endoscopic resection of 3 recurrent adenomas (at R1/Rx) and curative surgery/2nd ESD for 5 non-curative ESDs. Adverse events occurred in 9.3% without emergency surgery or 30-day mortality. Comparing expert-only vs. tutored ESD procedures, beginners correctly applied curative ESD indications in 94% of 118 neoplasms. Experts resected larger lesions (22 cm²) at a rate of 9.3 cm²/h in 121 min. Tutored beginners achieved a 75% [25–100] self-completion rate on 33% smaller lesions in 112 min. Conclusions: ESD tutoring courses led by Japanese experts ensure excellent patient outcomes and standardized procedural training. This model may foster professional ESD performance across European referral centers. Full article

Ceramic-on-ceramic (CoC) bearings are widely used in total hip arthroplasty due to their extremely low wear rate, excellent chemical stability, and good biocompatibility. They are considered one of the most reliable long-term friction bearing systems. Although frictional instability, lubrication regime transitions, and microstructural damage mechanisms have been widely reported at the experimental and retrieval-analysis levels, current clinical evidence, limited by follow-up duration and event incidence, has not demonstrated a definitive negative impact on the clinical performance of fourth-generation ceramic components, including BIOLOX® delta. Data from national arthroplasty registries consistently demonstrate excellent survivorship and low complication rates for 4th-generation ceramics in both hard-on-soft and hard-on-hard configurations. The most reported causes for revision, such as infection, dislocation, aseptic loosening, and periprosthetic fracture, are not primarily associated with ceramic-related complications, such as ceramic fracture, excessive wear, squeaking, and revision, related to bearing failure; however, these mechanisms remain highly relevant for the design and evaluation of emerging ceramic materials and next-generation implant systems, where inadequate control may potentially impact long-term clinical performance. This review summarizes recent advances in the tribological research of CoC artificial joints, focusing on clinical tribological challenges, material composition and surface characteristics, lubrication mechanisms, wear and microdamage evolution, and third-body effects. Recent progress in ceramic toughening strategies, surface engineering, biomimetic lubrication simulation, and structural optimization is also discussed. Finally, future research directions are outlined to support the performance optimization and long-term reliability assessment of CoC artificial joint systems. Full article

Background: Glaucoma is an age-related optic neuropathy frequently accompanied by systemic comorbidities. Vitamin D deficiency (VDD) has been associated with cardiovascular and renal diseases in the general population, yet its relationship with long-term systemic outcomes in glaucoma remains unclear. This study evaluated the association between baseline vitamin D status and subsequent mortality and cardiorenal events in patients with primary glaucoma. Methods: We conducted a retrospective cohort study using deidentified electronic health records from the TriNetX U.S. Collaborative Network, a federated network of participating healthcare organizations. Adults (≥18 years) with incident primary glaucoma (2005–2020) and a serum 25-hydroxyvitamin D (25(OH)D) test within 12 months prior to diagnosis were categorized as VDD (<30 ng/mL) or vitamin D adequacy (VDA; ≥30 ng/mL). After 1:1 propensity score matching across 47 demographic, clinical, medication, and laboratory variables, 11,855 patients per group were followed for up to 5 years. Outcomes included all-cause mortality, major adverse cardiovascular events (MACE), acute kidney injury (AKI), and renal function decline (eGFR < 60 mL/min/1.73 m²). Analyses incorporated Kaplan–Meier curves, Cox models, landmark tests, sensitivity analyses, and competing risk methods. Results: Among the 35,100 eligible patients, the matched cohorts demonstrated higher 5-year risks associated with VDD for all-cause mortality (HR 1.104; 95% CI 1.001–1.217), MACE (HR 1.151; 95% CI 1.078–1.229), and AKI (HR 1.154; 95% CI 1.056–1.261), whereas the risks of renal function decline did not differ (HR 0.972; 95% CI 0.907–1.042). Risk divergence emerged within the first year of follow-up and persisted through the 5-year observation period. Conclusions: In patients with primary glaucoma, vitamin D deficiency was associated with higher long-term risks of mortality and cardiorenal complications, but not renal function decline. Taken together, the results are consistent with vitamin D status serving as a marker of broader systemic vulnerability in glaucoma and highlight the need for prospective studies to further clarify its prognostic significance. Full article

Background/Objectives: Chronic Obstructive Pulmonary Disease (COPD) is frequently associated with dyspnea, impaired health-related quality of life (HRQoL), and cognitive dysfunction. Although pulmonary rehabilitation (PR) is considered a core therapeutic strategy, its specific effects on cognitive function, dyspnea, and dysphonia remain unclear. This systematic review aimed to evaluate the impact of PR and respiratory or cognitive-focused rehabilitative interventions on dyspnea, quality of life, cognitive performance, and voice outcomes in adults with COPD. Methods: This review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251131325). A systematic search of PubMed, Scopus and Web of Science identified studies published between 2010 and 21 August 2025. Eligible designs included randomized and non-randomized controlled studies, cohort, and mixed-method studies involving adults with COPD undergoing rehabilitative interventions targeting dyspnea, cognition, dysphonia, or swallowing. Outcomes included cognitive measures, dyspnea scales, voice parameters, and HRQoL indices. Results: Twelve studies (n ≈ 810 participants) met inclusion criteria. Most PR and exercise-based programs showed improvements in global cognition and executive functions, particularly when combined with cognitive training or high-intensity exercise modalities. Dyspnea improved consistently following short- to medium-term PR or respiratory muscle training, whereas low-frequency long-term programs yielded limited benefit. HRQoL improved across structured PR programs, especially in multidimensional interventions. Only one study assessed dysphonia, reporting transient improvements in maximum phonation time following inspiratory muscle training. No included study evaluated dysphagia-related outcomes. Conclusions: PR and respiratory muscle training can enhance cognition, dyspnea, and HRQoL in COPD, although evidence for dysphonia remains scarce and dysphagia is entirely unaddressed. Future high-quality trials should adopt standardized outcome measures, include long-term follow-up, and integrate voice and swallowing assessments within PR pathways. Full article

Background/Objectives: The aim of this study was to assess the short-term and long-term effectiveness of group voice therapy in changing vocal behaviour and improving voice quality (VQ) among teachers with hyperfunctional voice disorders (HFVD), using both subjective and objective measures. Methods: Thirty-one teachers participated in a structured group voice therapy programme. Participants underwent videoendostroboscopic evaluation of laryngeal morphology and function, perceptual assessment of voice, acoustic analysis of voice samples, and aerodynamic measurements of phonation. Patients’ self-assessment of VQ and its impact on quality of life were measured using a Visual Analogue Scale (VAS) and the Voice Handicap Index-30 (VHI-30). Evaluations were conducted at four time points: pre-therapy (T0), immediately post-therapy (T1), and at 3-month (T3) and 12-month (T12) follow-up visits. Results: Significant improvement was observed between T0 and T1 in perceptual voice evaluations: grade, roughness, asthenia, strain, loudness, fast speaking rate, as well as in neck muscle tension, shimmer, patients’ most harmful vocal behaviours, VHI-30 scores, patients VQ evaluation, and its impact on quality of life (all p < 0.05). Almost all parameters of subjective and objective voice assessment improved over the 12-month observation period, with the greatest improvement between T0 and T12 (all p < 0.05), indicating lasting reduced laryngeal tension and improved phonatory efficiency. Conclusions: Group voice therapy has been shown to be an effective treatment for teachers with HFVD, leading to significant and long-lasting improvements in perceptual, acoustic, and self-assessment outcomes. Therapy also promoted healthier vocal and lifestyle behaviours, supporting its role as a successful and cost-effective rehabilitation and prevention method for occupational voice disorders. Full article

Objectives: To compare the therapeutic efficacy and safety of balloon-assisted transarterial chemoembolization (B-TACE) versus conventional TACE (C-TACE) in hepatocellular carcinoma (HCC) and to evaluate the potential predictive value of intraoperative balloon-occluded arterial stump pressure (Boasp). Methods: In this prospective, single-centre, randomized controlled study, 60 patients with hepatocellular carcinoma were allocated to either the B-TACE group (n = 30) or the C-TACE group (n = 30). One patient in the B-TACE group was lost to follow-up after allocation. The primary analyses were conducted according to the intention-to-treat (ITT) principle, including all randomized patients, with conservative handling of missing data. Sensitivity analyses were performed to assess the robustness of the results. Tumor response and survival outcomes were evaluated using the modified Response Evaluation Criteria in Solid Tumors (mRECIST) and Cox proportional hazards regression models. Intraoperative balloon-occluded arterial stump pressure (BOASP) was measured as an exploratory parameter to quantify embolization adequacy. Adverse events (AEs) were systematically assessed and graded according to the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. Results: TACE achieved a higher 3-month ORR (63.3% vs. 10.0%, p < 0.001) and 6-month disease control rates (80.0% vs. 36.7%, p < 0.001), with PFS (HR = 0.30, 95% CI 0.148–0.608) and procedures within 6 months (1 vs. 3, p < 0.001). The 6-month surgical conversion rate was higher (34.5% vs. 6.7%, p = 0.009). Changes in Boasp correlated with efficacy (AUC = 0.825, p = 0.0398). Severe infections were lower in B-TACE (17.2% vs. 76.7%, p < 0.001). Conclusions: B-TACE offers superior efficacy, survival, and surgical conversion versus C-TACE with favorable safety. Boasp provides a quantitative biomarker for predicting treatment response. Full article