Search Results (304)

Thirteen mandarin and hybrid cultivars grafted onto the commercial rootstocks Rangpur Lime and Swingle Citrumelo were comparatively assessed for vegetative growth, fruit physicochemical attributes, and field incidence and severity of Altenaria Brown Spot (ABS) and Huanglongbing (HLB). The experiment was conducted from January 2015 to December 2018 under a randomized block design, with ten replicates per scion–rootstock combination. Plant height, canopy volume, fruit mass, juice yield, acidity, soluble solids, and disease assessments were performed. RL induced greater vegetative growth but was associated with higher HLB severity, particularly in the Dekopon IAC 2009 and TM × LP 358 varieties. SC resulted in less vigorous trees but improved fruit quality, with higher acidity and soluble solids. Regarding ABS, the Loose Jacket IAC 515 and Muscia varieties showed high susceptibility, while Ortanique IAC 554 and Rainha BRS exhibited tolerance to both ABS and HLB. These findings suggest that although RL promotes vigorous growth, it may increase disease susceptibility, whereas SC is associated with reduced disease severity and improved fruit quality. Ortanique IAC 554 and Rainha BRS showed consistently low severity of ABS and HLB, combined with stable vegetative development and fruit quality, underscoring the importance of rootstock choice for guiding cultivar deployment in orchards under high disease pressure. Full article

Background: Renal cell carcinoma (RCC) accounts for nearly 90% of kidney cancers. Transplantation is the best treatment for kidney failure, associated with improved survival, quality of life, and lower societal costs compared with remaining on dialysis. Thanks to modern immunosuppression, rejection rates have decreased. Cancer is the second most common cause of morbidity and mortality in kidney transplant recipients (KTRs) after cardiovascular disease. KTRs are at increased cancer risk due to chronic immunosuppression. Case report: We report a 54-year-old kidney transplant recipient without prior history of malignancy who developed metachronous bilateral RCC early posttransplant (first RCC within 3 months after kidney transplantation and second RCC after one year later). Both tumours were treated with nephrectomy. Conclusions: Early diagnosis enabled appropriate oncologic management while preserving graft function. It should also be stressed that beside graft assessment, abdominal sonography should not be forgotten in kidney allograft recipients, in particular, in certain high-risk patients (i.e., elderly, male, with longer dialysis vintage, smokers, obese, with high burden of immunosuppression including pretransplant immunosuppressive therapy, induction at transplantation, etc.). Full article

Ovarian tissue cryopreservation (OTC) has emerged as the only viable fertility preservation strategy for prepubertal girls and adolescent cancer patients facing gonadotoxic treatments. While OTC has transitioned from an experimental procedure to an established clinical practice, the functional longevity of transplanted grafts remains limited by massive follicle depletion. This review synthesizes recent technological advances in OTC for female children, with a particular focus on the underlying molecular mechanisms and innovative protective strategies. We systematically evaluate pre-cryopreservation assessments, surgical harvesting techniques such as medulla-sparing biopsies, and the comparative efficacy of slow freezing versus vitrification in preserving stromal and follicular integrity. Central to this discussion are the molecular drivers of post-transplantation injury, including ischemia–reperfusion-induced oxidative stress and the iatrogenic over-activation of the PI3K/Akt/mTOR signaling pathway, which leads to follicular “burnout.” Furthermore, we explore targeted pharmacological interventions, such as the dual-drug application of VEGFA and rapamycin, alongside emerging bioengineering frontiers including decellularized extracellular matrix scaffolds and 3D-printed bioprosthetic ovaries. Clinical outcomes are also summarized, highlighting high rates of endocrine recovery (~95%) and promising live birth rates (~28%), predominantly through natural conception. By integrating deep molecular insights with advanced tissue engineering, this review provides a comprehensive framework for optimizing long-term fertility restoration and improving the quality of survivorship for young female cancer survivors. Full article

Background: Axillary hidradenitis suppurativa (HS) often requires wide surgical excision and reconstruction. Thoracodorsal artery perforator (TDAP) flaps and split-thickness skin grafts (STSGs) are common options, but comparative long-term data are insufficient. Methods: In this single-center retrospective study, patients aged ≥ 17 years with Hurley stage II–III axillary HS underwent wide excision followed by TDAP flap or STSG reconstruction. Demographic variables, surgical characteristics, complications, recurrence, shoulder mobility, and dermatology-specific quality-of-life outcomes assessed using the Dermatology Life Quality Index (DLQI) were analyzed. Results: In total, 35 reconstructions were reviewed: TDAP (n = 15, 42.9%) and STSG (n = 20, 57.1%). Follow-up was longer for TDAP (28.53 ± 16.38 vs. 19.65 ± 28.06 months; p = 0.014). Mean defect size was 105.47 ± 26.29 cm² (TDAP) vs. 164.65 ± 77.99 cm² (STSG; p = 0.116). Both groups showed significant improvement in DLQI from preoperative to postoperative assessments (TDAP: +20.87; Graft: +18.50; both p < 0.0001), with no significant postoperative difference (p = 0.9608). Smokers had higher preoperative DLQI scores than non-smokers (+5.72; p = 0.0051), but postoperative outcomes were similar (p = 0.5908). Conclusions: Both reconstructions after wide axillary excision provided durable coverage, low complication rates, and significant improvement in quality of life. Incorporating patient-reported and functional outcomes into reconstructive planning may optimize surgical decision-making for axillary HS. Full article

Background: The socket preservation technique involves filling the bone defect that occurs after a tooth is extracted with bone substitute material. This procedure helps to minimize bone resorption of the alveolar ridge following extraction. Various bone substitute biomaterials can be used for augmentation, including autogenous, allogeneic, and xenogeneic options. This study aimed to assess changes in alveolar ridge dimensions and variations in radiographic bone density in sockets grafted with two distinct biomaterials. Furthermore, bone biopsies collected from the grafted sites were subjected to histological analysis. Methods: Forty generally healthy patients were enrolled in the study and split into four equal groups. The first and third groups underwent first or second maxillary premolar extraction and received treatment with an allogeneic material (BIOBank®, Biobank, Paris, France), while the second and fourth groups underwent first or second mandibular molar extraction and were treated with a xenogeneic material (Geistlich Bio-Oss®, Geistlich Pharma AG, Wolhusen, Switzerland). Following tooth extraction, the appropriate biomaterial was inserted into the socket. It was covered with a collagen membrane (Geistlich Bio-Gide®, Geistlich Pharma AG, Wolhusen, Switzerland) and stabilized with sutures, which were removed seven to ten days after the procedure. Micro-CBCT scans were conducted to evaluate the dimensions of the alveolar ridge and the radiographic density of the grafted socket at 7–10 days and 6 months after the procedure. A bone trepanobiopsy was performed concurrently with implant placement six months after socket preservation. The obtained biopsy was analyzed histologically using hematoxylin and eosin (H&E) and Masson’s trichrome staining. Results: There was no statistically significant difference in alveolar ridge height or width preservation between allogeneic and xenogeneic biomaterials. After six months of healing, sockets grafted with both materials exhibited greater radiographic bone density, with significantly greater density observed in the xenograft group. Conclusions: The findings of this study suggest that the two biomaterials are comparable in their effectiveness at maintaining the dimensions of the alveolar ridge. However, the quality of the newly formed bone may differ depending on the type of biomaterial used. Full article

Anterior cervical discectomy and fusion (ACDF) is one of the most commonly performed surgical procedures for the treatment of cervical degenerative disease, myelopathy, radiculopathy, and segmental instability. Although clinical outcomes are generally favorable, pseudarthrosis remains a relevant complication, with a reported incidence ranging from 5% to 20%. In a field with no yet clear main directions, this narrative review aims at giving the reader a broad picture and a wide analysis of the recent advances in cervical spinal fusion, with particular focus on biomaterials, intervertebral cage technologies, cervical spine biomechanics and imaging methods used for fusion assessment. The literature regarding quantitative imaging parameters and emerging applications of artificial intelligence (AI) is also reviewed. Current bone grafts include autologous grafts, allografts, xenografts and polymeric grafts, while the materials for the intervertebral cages comprehend titanium, polyetheretherketone and silicon nitride, with reported fusion rates distributed in a very large range. Computed tomography (CT) remains the standard imaging modality to assess whether fusion has occurred, due to its high spatial resolution. However, the lack of shared diagnostic criteria and the significant interobserver variability continue to limit its reliability. Quantitative parameters, such as Hounsfield Unit measurements and MRI-derived bone quality scores, may contribute to a more objective evaluation, although current evidence remains heterogeneous. In parallel, AI-based imaging analysis is showing promising results for quantitative assessment and longitudinal monitoring of bone fusion; however, large prospective clinical studies are still needed to confirm its clinical applicability. In conclusion, despite advances in surgical technologies and biomaterials, radiological assessment of cervical fusion still lacks universally accepted diagnostic standards. Future AI applications may improve diagnostic accuracy and reproducibility, promoting a more standardized approach in clinical practice. Full article

Background: Although survival rates for patients with malignant bone tumors have improved significantly, complications following tumor resection and limb-sparing reconstruction remain a major clinical challenge, particularly in young individuals. Intercalary resection often results in large bone defects, necessitating complex reconstructions. Fibula grafts offer biological advantages; however, their long-term outcomes, especially regarding mechanical complications and comprehensive patient-reported well-being, require further detailed exploration, particularly in cohorts utilizing non-vascularized grafts. Objective: This retrospective study evaluated the complication rates, bone hypertrophy, limb function, and quality of life following non-vascularized fibular graft reconstruction for malignant bone tumors in a single-center cohort. This study offers insights into long-term success and patient well-being, with a particular focus on correlations with systemic therapy and defect size, factors that remain insufficiently explored in the current literature. Methods: In this single-center retrospective study, twenty-four non-vascularized fibular grafts were used to reconstruct intercalary bone defects following malignant tumor resection. Complications were categorized using the Clavien–Dindo classification. Graft hypertrophy was evaluated according to the method described by Weiland and de Boer. Functional outcomes were assessed using the MSTSs and TESSs, while quality of life was measured using the SF-36 questionnaire. Notably, the cohort analyzed represents a relatively large single-center series focusing exclusively on the outcomes of non-vascularized fibular grafts. Results: Our findings revealed significant rates of mechanical complications, with osteosynthesis material failure occurring in 50.0% of cases, pseudarthrosis in 47.6%, and fractures of the fibular grafts in 38.1% of cases. Importantly, there were significant correlations between mechanical complications and systemic therapy (p = 0.017), as well as between defect size and fractures (p = 0.013), identifying critical risk factors. Despite these considerable complication rates, patients achieved satisfactory limb function (MSTS: 74 ± 17; TESS: 83 ± 15) and quality of life scores comparable to national norms, with notably higher mental health indices, highlighting their psychological resilience. Conclusions: Non-vascularized fibular graft reconstruction, despite high mechanical complication rates, significantly facilitates long-term functional recovery and psychological well-being. These findings emphasize the necessity of risk-adapted surgical strategies and long-term follow-up protocols to mitigate complications, optimize long-term function, and ultimately advance patient-centered care. Full article

Background: Among the superficial flexor muscles of the upper limb, the Palmaris longus muscle is the most susceptible to anatomical variation. The most common anatomical variant is complete bilateral absence, followed by unilateral absence. Although considerable study has been conducted on the frequency of Palmaris longus muscle absences in Africa, much of it has been conducted at the national level. The pooled prevalence of Palmaris longus absence in Africa has not been established. Objectives: To assess the absence of Palmaris longus muscle and its clinical significance in Africa cadaveric and clinical studies: systematic review and meta-analysis. Methods: We thoroughly examined Google Scholar, PubMed/med line, Science Direct, Hinari, African online journals, Web of Sciences, Central, Embase, Scopus, Cochrane, and institutional repositories. The studies’ quality were assessed using the Newcastle–Ottawa Scale. The pooled prevalence of Palmaris longus muscle absences was estimated using a random-effects meta-analysis model. Data analysis was conducted using STATA 17; heterogeneity, funnel plots, and meta-regression were examined. Sensitivity analyses, publication bias, and subgroup analysis by study time code, location code, and sample size code were also carried out. Result: A total of 23 studies were included in the meta-analysis. The pooled prevalence of Palmaris longus absence in Africa was 14.0% (95% CI: 10.0–18.0). However, there was significant variation in reported prevalence rates, as seen by the significant heterogeneity found across studies (I² = 99.13%). The results were not significantly changed by sensitivity analysis. Conclusions and recommendation: This study found that the Palmaris longus muscle is absent in 14% of African populations. Comparison with international studies revealed both similarities and differences, influenced by methodology and genetic factors. Clinicians should consider this prevalence when advising patients requiring tendon grafts. Further long-term studies using imaging techniques (MRI; ultrasound) are recommended to improve understanding in African populations and globally. Full article

Objectives: To evaluate the effectiveness and durability of matrix-associated autologous chondrocyte implantation with periosteal flap (pMACI) in treating knee cartilage defects using clinical scores and MRI evaluations. Methods: Data were collected from 37 knees of 17 patients, with a mean follow-up of 5 years (range: 0.1–20 years). Clinical outcomes were assessed using the Lysholm Knee Scoring Scale (LKS) and Knee Injury and Osteoarthritis Outcome Score (KOOS). Tissue quality was quantitatively evaluated using MRI T1ρ and T2 mapping (biochemical) and MR observation of cartilage repair tissue: MOCART 2.0 (morphological). A linear mixed model was used to identify factors affecting outcomes, including etiology (trauma, OCD, OA), graft site, and defect size. Results: At the 20-year follow-up, clinical scores remained significantly improved from baseline (mean LKS: 55.6 to 86.5; KOOS: 37.8 to 70.8). The biochemical MRI parameters (T1ρ and T2 values) stabilized at levels comparable to native cartilage across all etiologies and sites (p = 0.326 and 0.412, respectively), indicating stable long-term tissue quality. In contrast, the MOCART 2.0 scores significantly declined over time (annual rate: −1.14 points; p < 0.001). Etiology was a significant factor; the OA group showed significantly lower clinical and MOCART scores compared to the trauma/OCD groups (p < 0.05). However, no significant differences were found in LKS and KOOS based on graft site (p = 0.489) or defect size (p > 0.05). Conclusions: pMACI may be a highly durable treatment capable of maintaining biological tissue quality and providing clinical benefits for two decades. The observed morphological deterioration after 20 years likely reflects joint-wide aging—especially in OA cases—rather than graft failure, highlighting the importance of long-term MRI monitoring. Full article

Sarcopenia, defined as the progressive loss of skeletal muscle mass and strength, is increasingly recognized as a significant concern in patients with chronic kidney disease (CKD) and particularly in kidney transplant recipients (KTx-ps). This review explores the complex interplay of pathophysiological mechanisms, prevalence, and management strategies of sarcopenia in the context of kidney transplantation. CKD contributes to sarcopenia through systemic inflammation, malnutrition, uremic toxin accumulation, and metabolic imbalances, all of which persist or are exacerbated after transplantation due to immunosuppressive therapies especially corticosteroids. Notably, the post-transplant period may introduce additional risks, such as altered body composition and reduced physical activity, further aggravating muscle wasting. Sarcopenia affects approximately 26% of KTx-ps, leading to adverse outcomes including decreased quality of life, increased risk of infection, frailty, delayed recovery, and graft loss. The diagnosis remains challenging due to variability in assessment tools and a lack of standardized criteria. Management strategies must be multifactorial, including personalized nutritional support, targeted physical activity, and, where appropriate, pharmacological interventions. Early identification through imaging and functional testing is critical, especially in older patients and those with prolonged dialysis vintage. Emerging therapies, such as myostatin inhibitors, offer promise but require further validation. Additionally, early steroid withdrawal may mitigate muscle loss without compromising graft survival in selected patients. This review underscores the need for heightened awareness and standardized protocols to identify and manage sarcopenia in kidney transplantation, ultimately improving long-term outcomes and patient-centered care. Full article

Purpose: To critically evaluate the role or effect of platelet-rich plasma (PRP) in anterior cruciate ligament (ACL) reconstruction in terms of clinical and radiological outcomes. Method: We conducted a systematic search of PubMed, Embase, the Cochrane Library, and Web of Science to identify relevant studies. Clinical outcomes included the Visual Analogue Scale (VAS), International Knee Documentation Committee (IKDC) subjective and objective evaluations, Lysholm score, Tegner score, anterior knee laxity, Knee Injury and Osteoarthritis Outcome Score (KOOS), Kujala score, Victorian Institute of Sport Assessment (VISA) scale, proprioception, isokinetic strength, and physical examination tests (anterior drawer, Lachman, and pivot-shift tests). Radiological outcomes encompassed measures obtained via magnetic resonance imaging (MRI), computed tomography (CT), X-ray, and ultrasound. Statistical significance was defined as a p value < 0.05, and all analyses were performed using R software (version 4.1.3). Results: A total of 23 studies, including 19 randomized controlled trials, met the inclusion criteria, encompassing 1072 patients overall. The meta-analysis showed significant differences between PRP group and non-PRP group with regard to VAS score at 6- and 12-month follow-up, Lysholm score at 6-month follow-up, and Tegner score at 6-month follow-up. Meta-regression showed that the two group differences in VAS score changed significantly with follow-up time (p < 0.01). In terms of radiological findings, about half of the assessments favored PRP to facilitate the graft maturation and integration at 6-month follow-up. Conclusions: PRP application in ACL reconstruction compared with non-PRP, may produce short-term but not long-term clinical outcomes such as VAS score, Lysholm score and Tegner score. While some short-term statistical differences exist, their magnitude and durability do not yet justify routine clinical adoption of PRP in ACL reconstruction. Larger samples and higher-quality studies are needed to support our results and further explore the advantages of PRP in other aspects. Level of evidence: Level II. Full article

Background: Cardiovascular diseases are the main cause of mortality and morbidity in Portugal, with coronary artery bypass grafting (CABG) being one of the most performed surgeries in cardiothoracic centers. After cardiac surgery, patients often experience a decrease in physical capacity, which results in an increased risk of mortality or hospitalization expenditures. The objective of this systematic review was to characterize changes in respiratory function in patients undergoing CABG. Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Web of Science, Pubmed, SCOPUS, and Sport Discus were searched using a predefined research strategy to identify relevant original studies published until August 2025. To be included, studies must have assessed adult patients submitted to CABG who evaluated the respiratory function before and after cardiac surgery. Studies that reported other types of cardiac surgery were excluded. The Risk of Bias in Non-randomized Studies-of-Exposure and the Cochrane risk-of-bias tool for randomized trials were used to analyze the risk of bias of the selected studies. Results: After screening 1184 potential articles, six studies met the inclusion criteria. The studies included participants who underwent CABG (n = 324), with a mean age ranging from 54.05 ± 13.6 to 67 ± 10 years. Conclusions: All included studies reported significant postoperative reductions in respiratory function following CABG, including forced vital capacity, forced expiratory volume in one second, maximal inspiratory pressure, and maximal expiratory pressure. Although these findings consistently indicate a decline in pulmonary function, the limited number of available studies limits the strength of the conclusions. This systematic review suggests that monitoring respiratory impairments after CABG may be clinically relevant to improve health-related quality of life. Full article

Background/Objectives: Radiotherapy following mastectomy induces persistent structural alterations in the chest wall, including fibrosis, extracellular matrix disorganization, and vascular changes that compromise reconstructive outcomes. Although autologous fat grafting is widely used to improve tissue quality in irradiated breasts, direct human histological evidence remains limited. The aim of this prospective pilot study was to evaluate intra-patient histological remodeling in irradiated postmastectomy breast tissue before and 4 months after autologous fat grafting using paired core needle biopsies. This study should be considered a hypothesis-generating histological pilot study. Methods: Five female patients with prior mastectomy and adjuvant radiotherapy underwent Tru-Cut core needle biopsy of irradiated chest wall tissue before lipofilling and at approximately four months (range between 3 and 12 months) post-procedure. Specimens were processed using formalin fixation, paraffin embedding, and hematoxylin and eosin staining. Histological assessment focused on collagen density, stromal organization, vascular structures, inflammatory infiltrate, and adipocyte integration. Comparative intra-patient analysis was performed descriptively. Results: Baseline biopsies demonstrated consistent post-radiation alterations, including collagen compaction, stromal disorganization, perivascular fibrosis, and variable inflammatory infiltrate. Post-lipofilling specimens showed heterogeneous remodeling characterized by focal collagen fiber insertion between adipocytes, areas of immature connective tissue formation, and variable preservation of adipose architecture. The extent and pattern of remodeling differed among patients. Inflammatory activity decreased or remained mild in most cases. Conclusions: Autologous fat grafting in irradiated postmastectomy tissue is associated with measurable histological remodeling. Structural adaptation appears heterogeneous and patient-specific, suggesting a dynamic multi-stage process rather than uniform regeneration. Further studies incorporating quantitative and molecular analyses are required to clarify the mechanisms underlying these changes. Full article

Background: Autologous fat grafting is widely used in reconstructive, aesthetic and regenerative surgery and often requires repeated applications. Cryopreservation of lipoaspirate enables autologous fat banking and off-the-shelf availability; however, its clinical implementation is limited by freezing-induced tissue injury, regulatory requirements and uncertainties regarding the optimal preservation protocol. Glycerol is a biocompatible cryoprotective agent with promising preliminary data. Nevertheless, the optimal concentration for lipoaspirate cryopreservation remains unknown. The aim of this study was to determine the optimal glycerol concentration for preservation of adipose tissue processed according to the Cell-Enriched Lipotransfer (CELT) protocol in clinically relevant volumes under GMP-compatible conditions. Methods: Lipoaspirates from 10 patients were processed by centrifugation according to the CELT protocol and allocated into experimental groups: fresh unfrozen control, frozen samples without cryoprotectant, frozen samples with PBS, and frozen samples supplemented with glycerol in concentrations ranging from 10% to 60%. Samples were cryopreserved using a controlled freezing rate at a temperature of −80 °C for 24 h. Large-volume cryopreservation was additionally performed with the best concentration of glycerol. Post-thaw tissue quality was assessed by resazurin assay of whole tissue, stromal vascular fraction (SVF) cell live/dead counting, and resazurin assay after short-term cell culture. Results: Glycerol supplementation improved post-thaw tissue viability compared with cryopreservation without cryoprotectant or with PBS alone. An optimal concentration range between 10% and 30% glycerol was identified, with highest preservation of metabolic activity and surviving cell yield observed at 20%. Higher glycerol concentrations resulted in a marked decline in tissue quality. Cryopreservation in large volume was feasible and did not impair post-thaw viability compared with small-volume samples. Conclusions: Glycerol-based cryopreservation allows effective and GMP-compatible preservation of human lipoaspirate. An optimal glycerol concentration range was identified, enabling large-volume fat banking without compromising tissue quality. This protocol provides a clinically applicable strategy for autologous fat storage and may facilitate repeated reconstructive and regenerative treatments. Full article

Objective: The aim of this systematic review was to evaluate the skeletal stability, predictability, and safety of using autogenous iliac crest bone grafts (ICBG) during large maxillary advancement performed with Le Fort I osteotomy. Methods: A systematic literature search was performed in November 2025 using PubMed, Scopus, Embase, Web of Science, and WorldCat databases. Clinical studies reporting large maxillary advancement performed with Le Fort I osteotomy and incorporating ICBG were included. Study selection followed PRISMA guidelines. Data extraction focused on the magnitude of maxillary advancement, surgical protocols, stabilization methods, skeletal stability, relapse patterns, graft integration, implant-related outcomes, and complications. Methodological quality was assessed using the Mixed-Methods Appraisal Tool (MMAT). Results: The review included clinical studies predominantly consisting of case reports, case series, and retrospective cohort studies. ICBG were consistently used in complex clinical scenarios, such as severe maxillary atrophy, hypoplasia, and congenital craniofacial deformities. Large maxillary advancements were generally associated with favorable postoperative skeletal stability, with most relapse occurring during the early healing phase and minimal changes observed during long-term follow-up when rigid fixation and adequate graft integration were achieved. Interpositional grafting facilitated predictable advancement by bridging extensive osteotomy gaps. Donor-site morbidity related to iliac crest harvesting was typically mild and transient. Implant-related outcomes, reported as secondary findings, were generally favorable when implants were placed after an adequate healing period. Conclusions: Despite predominantly observational evidence, ICBG during large maxillary advancement with Le Fort I osteotomy appears to offer predictable advancement, acceptable skeletal stability, and a favorable safety profile, warranting further prospective investigation. Full article