Search Results (2,535)

Background/Objectives: Blunt abdominal trauma is a frequent challenge in emergency medicine, but its diagnosis and treatment become significantly more complex when rare anatomical anomalies are present. Atypical anatomy may mask symptoms or mimic other acute abdominal conditions, causing delays in treatment. The aim of this paper is to review the literature on six rare anatomical anomalies and their impact on the consequences of blunt abdominal trauma. Methods: A Narrative literature review was undertaken, covering PubMed, Scopus, Web of Science and Google Scholar databases, analysing publications from 1960 to 2025. Case reports and case series (91 patients in total) with confirmed organ damage following blunt trauma in the course of: duodenal diverticulum, Meckel’s diverticulum, splenic torsion, rupture or torsion of the accessory spleen, visceral inversion (situs inversus) and horseshoe kidney. Results: Demographic analysis revealed a predominance of perforations of the duodenal diverticulum in older women (mean age 62 years), while younger men predominated in all other groups. The clinical picture was often non-specific or misleading, especially in situs inversus, where the location of pain did not correlate with the typical topography of organs. Contrast-enhanced computed tomography (CECT) has proved to be a key diagnostic tool, surpassing ultrasound/FAST scans due to its ability to provide precise anatomical imaging. Surgical treatment was predominant (100% in Meckel’s diverticulum, 95% in duodenal diverticulum), while conservative treatment was effective in horseshoe kidney injuries (94.8%). Mortality was highest in situs inversus (29%) and duodenal diverticulum perforation (20%). The vast majority of these fatal cases occurred in the era of modern computed tomography, suggesting that the therapeutic challenges stem directly from the specific nature of these anomalies, rather than from past diagnostic limitations. Conclusions: Anatomical anomalies significantly modulate the clinical manifestations of blunt abdominal trauma, increasing the risk of diagnostic errors. Early contrast-enhanced computed tomography and awareness of these rare pathologies are crucial for appropriate management and improved prognosis. Full article

Median overall survival remains a central endpoint in oncology, but it can obscure a clinically meaningful long tail of patients with advanced solid tumors who survive well beyond the median. One biological context in which this pattern may be relevant is tumor microenvironment (TME) acidosis. Driven by aerobic glycolysis, hypoxia, impaired perfusion, and proton-export programs, acidic TME is increasingly implicated in invasion, therapeutic resistance, and immune suppression. This narrative review examines TME acidosis as the primary biological framework and considers long-tail survival as a clinical lens through which its implications may be interpreted. We summarize the biological basis and heterogeneity of acidic TME, review current approaches to clinical and translational assessment of tumor acidity, including acidoCEST magnetic resonance imaging (MRI) and positron emission tomography (PET)-based approaches, and discuss the potential and limitations of alkalization-oriented interventions such as buffering and diet-based strategies. Particular attention is given to the distinction between direct measurements of tumor acidity and clinically feasible but indirect markers such as urinary pH, which should not be interpreted as a direct surrogate for local tumor extracellular pH. From a science-based medicine perspective, long-tail survival is treated here as a hypothesis-generating clinical signal rather than proof of causality. Overall, alkalization-oriented interventions appear biologically plausible and clinically testable, but current clinical evidence remains limited and context-dependent. Future progress will require mechanistically informed biomarkers, careful safety evaluation, and trial designs capable of detecting delayed separation of survival curves and tail-oriented patterns of benefit. Full article

Background: Glioblastoma remains the most aggressive and treatment-resistant primary brain tumor, with patient outcomes strongly associated with the extent of surgical resection. Tumor recurrence is largely driven by infiltrating glioma cells that extend beyond the contrast-enhancing margin, which has traditionally served as the boundary for surgical resection. Advances in pre- and intraoperative imaging, functional mapping, and fluorescence guidance have challenged the conventional definition of “maximal safe resection” and given rise to the concept of supramaximal resection (SMR). This technique, where surgical resection extends beyond the contrast-enhancing border, has garnered significant interest in recent years and shown promising preliminary survival outcomes. However, the lack of standardized definitions and methodological consistency has limited reproducibility and clinical adoption. Methods: A systematic literature search of PubMed/MEDLINE, Embase, and Web of Science was performed from database inception through March 2026 in accordance with PRISMA guidelines. Studies investigating resection beyond the contrast-enhancing tumor margin in adult glioblastoma patients were evaluated for inclusion. Results: A total of 1045 records were identified, with 37 studies meeting inclusion criteria. Across studies, SMR was frequently associated with improved progression-free and overall survival in selected patients, particularly following complete contrast-enhancing tumor resection. However, substantial heterogeneity exists in SMR definitions, and the current body of evidence is largely retrospective and derived from high-volume centers. Conclusions: SMR represents a promising extension of maximal safe resection targeting infiltrative tumor beyond conventional imaging boundaries. While emerging evidence suggests survival benefits, variability in methodology and patient-specific factors require cautious interpretation. Future standardization and prospective validation are needed to better define the role of SMR within multimodal glioblastoma treatment. Full article

Background: Musculoskeletal disorders (MSDs) are a major contributor to global disability. Exercise-based rehabilitation is widely recommended as first-line management; however, in clinical practice, it is frequently combined with adjunct therapeutic modalities, and the incremental effectiveness of these approaches remains unclear. The present review addressed the research question: Do adjunct modalities provide additional benefits beyond exercise-based rehabilitation alone in individuals with musculoskeletal disorders? Methods: This systematic review was conducted according to PRISMA 2020 guidelines and prospectively registered in the PROSPERO database (registration number CRD420261309183). Electronic searches were performed in PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials to identify controlled clinical trials evaluating exercise-based rehabilitation delivered alone or combined with adjunct modalities. Outcomes included pain, functional disability, physical performance, strength, structural or imaging-based measures, biomechanical variables, injury risk, and work-related outcomes. Due to methodological heterogeneity across studies, a structured narrative and tabular synthesis were performed. Results: Twenty-one controlled clinical trials were included, encompassing tendinopathies (n = 7), knee osteoarthritis (n = 5), post-ACL reconstruction (n = 2), chronic spinal pain (n = 3), sarcopenia (n = 2), low bone mass (n = 2), and occupational musculoskeletal conditions (n = 1), with sample sizes ranging from 22 to 823 participants. Pain outcomes were reported in 18 studies (86%) and functional outcomes in 16 studies (76%). Exercise-based rehabilitation consistently produced clinically meaningful improvements across studies, whereas adjunct modalities demonstrated short-term advantages in a limited number of trials but rarely showed sustained long-term superiority. Conclusions: Evidence from controlled clinical trials indicates that exercise-based rehabilitation is an effective primary intervention for improving pain, functional capacity, and physical performance across diverse musculoskeletal conditions. Adjunct modalities may provide condition-specific or short-term benefits but do not consistently enhance long-term outcomes beyond structured exercise programs. Full article

This systematic review aimed to assess whether the initial apical position of impacted maxillary canines, evaluated using cone-beam computed tomography [CBCT], influences three-dimensional root displacement during orthodontic traction. An extensive literature search was conducted in PubMed/MEDLINE, Web of Science, Embase, Scopus, and the Cochrane Library up to November 2025. Prospective and retrospective clinical studies including pre-treatment CBCT assessment and reporting either direct apical displacement or CBCT-derived three-dimensional position parameters were considered eligible. Study selection, data extraction, and quality appraisal were carried out independently by two reviewers. Seven studies met the inclusion criteria. Substantial heterogeneity was observed in imaging protocols, reference systems, traction mechanics, and outcome measures, precluding quantitative synthesis. Only two studies directly quantified three-dimensional apical displacement using CBCT–CBCT or CBCT–STL superimposition methods, predominantly suggesting bodily movement patterns; although, this is based on limited direct evidence, with velocities ranging from 0.29 to 0.84 mm/month. The remaining studies provided indirect evidence based on angular changes, positional parameters, or traction duration. Taken together, the available evidence suggests that unfavorable initial apical positions, including palatal or bicortical impactions and increased root angulation, may be associated with greater biomechanical complexity and longer traction duration. Although CBCT-based three-dimensional evaluation provides clinically relevant diagnostic information, standardized measurement protocols are required to improve comparability and reproducibility across studies. Full article

Egyptian papyri are commonly documented using high-resolution two-dimensional imaging, which enhances legibility but does not adequately capture the micrometric surface morphology required for material and conservation studies. To address this limitation, we developed and validated an integrated, fully non-contact imaging workflow combining Ultra-Close-Range Multiband Photogrammetry with Reflectance Transformation Imaging (RTI) and normal map integration. The protocol was tested on six papyrus fragments from the Museo Egizio di Torino (XXI Dynasty–Byzantine period) exhibiting different conservation conditions. Multiband photogrammetry in the visible and visible-induced infrared luminescence bands achieved a Ground Sample Distance of 17 µm/px and a point cloud density of approximately 170 points/mm², enabling detailed analysis of fiber morphology, surface deformation, and the spatial distribution of Egyptian blue. RTI-based normal map integration provided complementary high-frequency surface information with reduced acquisition and processing times. To overcome RTI low-frequency distortions, a revised normal integration strategy was implemented using surface planarization and frequency-domain fusion with photogrammetric data based on Power Spectral Density analysis. The resulting hybrid models combine metric reliability with enhanced surface detail, providing a scalable and non-invasive approach for papyrological documentation and conservation research. Full article

Background and objectives: Movement disorders are an underrecognized phenomenon in Myelin Oligodendrocyte Glycoprotein-Associated Disease (MOGAD). The aim of this paper was to summarize all movement disorders previously described in MOGAD. Materials and Methods: We conducted a systematic literature search in PubMed, Web of Science, and Scopus in English, focusing on patients with MOGAD exhibiting a movement disorder, i.e., ataxia, tremor, dystonia, parkinsonism, chorea, athetosis, myoclonus, ballism, tics, stereotypies, dyskinesia. Results: We included 58 studies, with a total of 91 patients with MOGAD and a movement disorder (45.6% male, 54.4% female). Movement disorders had a mean latency of 2.1 years (±6.9, 0–42) after MOGAD onset; however, they could be the presenting feature (in approximately 70% of cases), especially in pediatric patients. Cerebellar ataxia was the most common movement disorder, occurring in 77 patients (84.6%). Tremor, postural and/or kinetic, was the second most common movement disorder (15%). Dystonia was reported in 8.8%, presenting as cervical, or limb dystonia or stereotyped dystonic episodes. Myoclonus and hypokinetic movement disorders were rare. Subcortical (in 60%), brainstem and cerebellar lesions (in 50% respectively) were the most common imaging findings. The most common accompanying symptoms were encephalopathy, fever and headache. Approximately half of the patients made a full recovery, and the other half showed a significant improvement in the movement disorder after immunomodulatory treatment, most commonly steroids. Conclusions: The new onset of a movement disorder, especially ataxia, in a young patient should prompt the search for MOGAD or can indicate a relapse in patients with an established diagnosis. Full article

Background: Unanticipated difficult airways remain a leading cause of anesthesia-related morbidity and mortality, with traditional bedside predictors demonstrating limited sensitivity. Point-of-Care Ultrasound (POCUS) has emerged as a non-invasive adjunct offering real-time visualization and quantitative measurement of airway anatomy. This narrative review, structured according to the Scale for the Assessment of Narrative Review Articles (SANRA), synthesizes current evidence on POCUS as an adjunct for airway evaluation. We explore the sonoanatomy of the upper airway, the utility of ultrasound in predicting difficult laryngoscopy and intubation, its critical role in emergency front-of-neck access, and the verification of endotracheal tube placement. Furthermore, we discuss the integration of Artificial Intelligence (AI) in image interpretation and the necessity of standardized training curricula. Methods: We systematically searched PubMed/MEDLINE, Scopus, and Web of Science for English-language peer-reviewed studies addressing sonographic airway assessment, including sonoanatomy, prediction of difficult laryngoscopy/intubation, guidance for emergency FONA and endotracheal tube confirmation. Results: POCUS enhances visualization of critical anatomical structures, may improve anatomical assessment and risk stratification when combined with clinical assessment, and it may provide real-time guidance during emergency procedures. Integration of AI has shown promising diagnostic performance, primarily based on surrogate outcomes. Conclusions: Airway ultrasound may represent a shift toward personalized, safer airway management. However, standardized training protocols and validation in diverse clinical settings remain essential. Future research should focus on developing evidence-based algorithms integrating POCUS into airway management guidelines. Full article

Background/Objectives: Ultrasound shear-wave elastography (SWE) enables quantitative assessment of tissue stiffness and may provide a non-invasive biomarker of carotid plaque vulnerability. This study aimed to evaluate the ability of SWE to differentiate symptomatic from asymptomatic carotid plaques and to assess its reproducibility. Methods: A systematic search of PubMed, Web of Science, EMBASE, and the Cochrane Library was conducted in the last ten years until January 2026 for publications evaluating carotid plaques using ultrasound SWE. Inclusion criteria required original publications that used quantitative ultrasound SWE parameters for the evaluation of carotid plaque in symptomatic and asymptomatic patients and/or investigated the reproducibility of SWE parameters for carotid plaques; non-carotid studies, non-original articles, and studies not comparing symptomatic versus asymptomatic plaques or not reporting reproducibility were excluded. Fourteen studies comprising 1781 carotid plaques were included. Quantitative SWE measurements were meta-analyzed using random effects. Differences between symptomatic and asymptomatic plaques were assessed using standardized mean differences (SMDs). The reproducibility of SWE measurements was evaluated using pooled correlation coefficients. Publication bias was evaluated using funnel plots and Egger’s regression test. Results: Ten studies including 1246 plaques compared SWE stiffness between symptomatic (n = 472) and asymptomatic plaques (n = 774). The meta-analysis demonstrated significantly lower stiffness values in symptomatic plaques compared with asymptomatic plaques (SMD −1.10, p < 0.001). Reproducibility analysis of correlation coefficients extracted from seven studies demonstrated excellent agreement for SWE measurements (r = 0.92, n = 602). Heterogeneity was observed across the included studies. No statistically significant evidence of publication bias was detected. Conclusions: Ultrasound SWE is a promising approach for assessing carotid plaque vulnerability, with lower SWE stiffness observed in symptomatic plaques compared to asymptomatic plaques. This finding should be interpreted with consideration of methodological heterogeneity and the cross-sectional nature of the available assessed evidence. Further prospective studies with standardized imaging protocols and longitudinal follow-up are needed to determine clinically applicable stiffness thresholds and evaluate the prognostic value of ultrasound SWE in cerebrovascular risk stratification. Full article

Background: Contemporary dentistry increasingly relies on tools and methods derived from the exact sciences, particularly mathematics and physics, to better understand the complexity of biological processes. One such tool is fractal analysis (FA), which enables the characterization and quantification of irregular, complex, self-similar structures commonly observed in nature in the form of the fractal dimension (FD). In oral radiology, it has been found useful for describing structural changes in bone tissue. Objective: The aim of this review is to present the current state of knowledge regarding the application of fractal analysis in the management of patients with, or at risk for, medication-related osteonecrosis of the jaw (MRONJ), with particular emphasis on its diagnostic and prognostic potential. This paper summarizes key research findings, and discusses the principal challenges and limitations associated with the use of this method of analysis in MRONJ cases. Materials and Methods: The inclusion criteria were as follows: original papers, the presence of MRONJ, and fractal analysis. In order to find relevant studies, international databases, including PubMed and Google Scholar, were searched. The last search was performed on 29 November 2025. Six articles were included in the systematic review. Results: The majority of the review studies show lower FD values for MRONJ patients and healthy control groups. The values are the lowest for necrotic lesions and highest for perinecrotic bone tissue. Conclusions: FD values calculated from radiological images of the jaws can be used to differentiate healthy and MRONJ-affected patients and to describe necrotic lesions. Fractal analysis has potential to be used in the diagnosis and monitoring of MRONJ after further studies and standardization of methodology. Full article

Background and Objectives: Tooth impaction is a common developmental dental anomaly characterized by the failure of eruption within the expected physiological timeframe. Permanent canines represent the second most frequently impacted teeth after third molars and may lead to functional, esthetic, and orthodontic complications. This systematic review aimed to synthesize current evidence regarding the incidence, anatomical distribution, etiological determinants, and diagnostic evaluation of permanent canine impaction. Materials and Methods: A systematic literature search was conducted in PubMed, PubMed Central, and ScienceDirect for studies published between December 2009 and December 2025. Studies reporting prevalence data, anatomical positioning, etiological factors, or imaging characteristics of permanent canine impaction were included. Study selection followed PRISMA 2020 guidelines, and 31 studies were included in the qualitative synthesis. Two independent reviewers screened titles, abstracts, and full texts. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Tools. Results: Thirty-one studies met the inclusion criteria and were included in the qualitative synthesis. The reported prevalence of maxillary canine impaction ranged from 0.97% to 7.10%, while mandibular impaction occurred less frequently. Palatal displacement represented the most common positional pattern. Major etiological factors included retained deciduous canines, dental arch constriction, supernumerary teeth, odontomas, and genetic anomalies such as lateral incisor agenesis. Cone-Beam Computed Tomography (CBCT) demonstrated superior diagnostic accuracy compared with panoramic radiography. Conclusions: Permanent canine impaction is a multifactorial condition predominantly influenced by local anatomical and environmental factors, with genetic predisposition acting as a secondary contributor. Early diagnosis and appropriate imaging assessment are essential to prevent complications such as root resorption and to optimize treatment outcomes. Full article

Background: Total joint arthroplasty (TJA) is one of the most successful surgical procedures for patients to improve the quality of life. In recent years, the use of machine learning (ML) in the setting of arthroplasty decision-making has grown. Methods: This article reviewed studies published between 2020 and 2025 that applied ML to TJA, with a focus on the limitations reported by these studies. A search in ScienceDirect identified 220 articles. After screening and full-text assessment, 17 studies met the inclusion criteria, excluding imaging-based research, to focus on predictive models trained on non-image clinical data. Results: The reviewed studies revealed several common limitations, categorised into four groups, including observations and follow-up (30.3% of the studies), dataset quality and design (27.3%), model transferability and generalisation (27.3%), and outcome measurement and interpretation (15.2%). These limitations impact the reliability and real-world relevance of ML models in the context of arthroplasty. This article also provides suggestions to help researchers address these limitations in future studies. Conclusions: This review provides an overview of the potential limitations associated with the development of ML models within the TJA community in order to identify the gaps and challenges to improve the quality of research and possibly decision-making support systems using joint arthroplasty clinical datasets. Full article

Radiogenomics examines associations between imaging phenotypes and underlying biological characteristics across cancer types. This structured narrative review focuses on oropharyngeal squamous cell carcinoma (OPSCC) and evaluates how genomic programs characteristic of HPV-positive and HPV-negative tumors have been investigated across computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) as variations in heterogeneity, diffusion patterns, perfusion and metabolic activity. A structured literature search was conducted in PubMed/MEDLINE, Scopus and Web of Science to identify studies on radiomics and radiogenomics in OPSCC and related head and neck cancers. After screening and eligibility assessment, 81 studies were included in the narrative synthesis. The reviewed literature indicates that imaging-derived features have been associated with HPV status, hypoxia-related signatures, extranodal extension and treatment outcomes. However, the current evidence base remains heterogeneous and is largely composed of retrospective, single-institution studies with relatively small cohorts. Methodological challenges, including variability in imaging acquisition, segmentation and feature harmonization, limit reproducibility and generalizability. Although cone-beam computed tomography (CBCT) is not used for primary OPSCC staging and no CBCT-based radiogenomic studies in OPSCC have been reported, existing radiomics research in dentomaxillofacial imaging suggests its potential as a hypothesis-generating modality for future investigation. Overall, current evidence supports the biological plausibility of radiogenomic imaging signatures in OPSCC, while emphasizing the need for larger multicenter datasets, standardized imaging protocols and prospective validation before clinical implementation. Full article

Background: Kartagener syndrome (KS) is a rare subset of primary ciliary dyskinesia characterized by the triad of situs viscerum inversus (SVI), chronic sinusitis, and bronchiectasis. Laparoscopic cholecystectomy (LC) in patients with SVI is technically demanding because of mirror-image anatomy, while evidence supporting the use of indocyanine green (ICG) fluorescence in this setting is scarce. Case Presentation: We report the case of a 25-year-old woman with KS and SVI totalis who underwent elective LC for symptomatic cholelithiasis. The procedure was performed using a mirror American approach with four trocars and near-infrared ICG fluorescence cholangiography. ICG enabled real-time visualization of biliary anatomy and facilitated intraoperative orientation. The procedure was completed laparoscopically without intraoperative or postoperative complications, and the postoperative course was uneventful. Methods: A non-systematic narrative review of the literature was conducted to identify reported cases of LC in patients with SVI, including cases associated with KS. Studies published between 1991 and 2025 were retrieved from PubMed, Web of Science, Scopus, and Embase. Data were descriptively summarized, focusing on surgical technique, trocar placement, and reported use of ICG fluorescence. Results: A total of 143 articles were included. Most cases involved isolated SVI, while KS was reported only in a minority of patients. The mirror American technique and four-trocar configuration were the most frequently adopted approaches. Only three cases, including the present report, described the use of ICG fluorescence during LC in patients with SVI or KS. Conclusions: LC in patients with SVI is feasible but technically demanding. ICG fluorescence may assist intraoperative biliary orientation in complex anatomical settings; however, current evidence is extremely limited and should be considered hypothesis-generating only. Full article

The management of multiple sclerosis (MS) is shifting from a phenotype-based framework toward a biologically driven precision medicine model, as conventional magnetic resonance imaging (MRI) inadequately captures smoldering inflammation and progression independent of relapse activity (PIRA). This systematic review aimed to synthesize current evidence on the diagnostic and prognostic utility of fluid biomarkers in distinguishing acute inflammatory injury from chronic neurodegeneration. A comprehensive search of Web of Science, PubMed, and Scopus (January 2020–September 2025) identified 28 eligible studies including 7775 participants (6365 MS patients and 1410 controls). Biomarkers derived from serum, plasma, cerebrospinal fluid (CSF), and stool were evaluated in relation to clinical disability measured using the Expanded Disability Status Scale (EDSS) and magnetic resonance imaging (MRI) outcomes. Neurofilament light chain (NfL) consistently predicted acute inflammatory activity, gadolinium-enhancing lesions, and relapse-associated worsening, but levels were reduced by high-efficacy therapies and did not reliably predict PIRA. In contrast, glial fibrillary acidic protein (GFAP) was associated with astrogliosis, disability progression, and retinal thinning, even in patients with low inflammatory activity. Additional CSF, metabolic, and immunologic markers correlated with neurodegeneration and disease severity. Nevertheless, broader clinical use will require greater assay standardization, improved consistency across cohorts, and validation in prospective longitudinal studies. These findings compel a shift toward a multi-biomarker model to guide personalized therapeutic strategies and develop targeted neuroprotective treatments for progressive multiple sclerosis. Full article