Search Results (731)

Background: Auricular defects resulting from congenital anomalies, trauma, or oncologic resection pose significant functional and psychosocial challenges. When autologous reconstruction is not feasible or not desired, implant-retained auricular prostheses represent a reliable alternative with high patient satisfaction. This study aimed to systematically evaluate the clinical performance of craniofacial implants used for auricular prosthetic rehabilitation, focusing on implant survival, prosthetic outcomes, workflow typologies, and complications. A secondary objective was to illustrate the long-term validity of a minimally invasive navigation technique through a clinical case with 6-year follow-up. Methods: A systematic review was conducted according to PRISMA guidelines. Clinical studies published between 2005 and 2025 reporting outcomes of implant-retained auricular prostheses were searched in PubMed and Scopus databases. Data were extracted on implant type, survival rates, prosthetic performance, workflow, and complications. Risk of bias was assessed using appropriate tools based on each study design. Results: A total of thirty-two studies were included, comprising fifteen case reports, fifteen case series, one cohort study, and one prospective observational study. Implant survival was consistently high across all workflow categories, with failures predominantly associated with irradiated or anatomically compromised bone. Prosthetic outcomes were favorable, showing excellent esthetics, stable retention, and high patient satisfaction irrespective of manufacturing method, although digital and navigation-assisted workflows improved reproducibility, symmetry, and planning precision. Complication rates were low and generally limited to mild peri-abutment inflammation manageable with conservative care. The clinical case confirmed these findings, showing stable osseointegration, healthy soft tissues, and uncompromised prosthetic function at 6-year follow-up. Conclusions: Implant-retained auricular prostheses show predictable long-term success, independent of whether traditional, hybrid, or fully digital workflows are employed. Digital technologies enhance surgical accuracy, minimize morbidity, and streamline prosthetic fabrication, although high-quality comparative studies remain limited. Full article

Background: The success of in vitro fertilization (IVF) is influenced by multiple patient- and laboratory-related factors, including maternal age, body mass index (BMI), ovarian stimulation, and embryo quality. Laboratory illumination may induce photo-oxidative stress, potentially impairing embryo development and implantation. This study evaluated the clinical impact of introducing a light-protection protocol in an IVF laboratory. Methods: We retrospectively analyzed 2125 IVF cycles with fresh embryo transfer performed at the Assisted Reproduction Centre of the University of Pécs between 1 March 2016 and 30 November 2020. A light-protection protocol was implemented on 1 March 2017, while all other laboratory and clinical parameters remained unchanged. Pregnancy outcomes before and after implementation were compared, with additional subgroup analyses focusing on cycles with low blastocyst-formation rates. Results: After implementation of light protection, overall pregnancy rates increased by approximately 5%; however, this difference was not statistically significant. In contrast, subgroup analyses demonstrated a markedly greater improvement in pregnancy outcomes—up to 37%—in cycles characterized by low blastocyst-formation rates. Conclusions: Although light protection did not significantly improve overall pregnancy rates, the findings suggest a clinically relevant benefit in selected cases with reduced embryonic developmental competence. Minimizing photo-oxidative stress may therefore represent a targeted laboratory intervention to improve IVF outcomes in vulnerable embryo populations. Full article

Pancreatic ductal adenocarcinoma (PDAC) remains one of the most lethal malignancies, with limited treatment options for patients with locally advanced or metastatic disease. Endoscopic ultrasound (EUS)-guided intra-tumoral radioactive implantation has emerged as a minimally invasive approach to enhance local tumor control while minimizing systemic toxicity. Among the available isotopes, phosphorus-32 (³²P) microparticle brachytherapy has demonstrated promising outcomes, including significant tumor regression, reductions in CA 19-9, and higher rates of tumor downstaging and surgical conversion when combined with systemic chemotherapy. Compared with stereotactic body radiotherapy (SBRT), ³²P delivers higher intratumoral radiation doses, spares adjacent healthy tissues, and can be administered during ongoing chemotherapy without treatment interruption. Additionally, preliminary evidence suggests that ³²P may modulate the tumor microenvironment, improving vascularity and enhancing chemotherapy efficacy. The procedure shows high technical success and a favorable safety profile, with minimal serious adverse events. Future directions include prospective randomized trials to validate its impact on survival, optimize dosing, and establish treatment protocols. EUS-guided intra-tumoral ³²P brachytherapy holds potential as a key component of multimodal therapy, bridging local tumor control and systemic disease management in PDAC. Full article

Background and Objectives: Transcatheter aortic valve implantation (TAVI) has become the mainstay of treatment for symptomatic aortic stenosis (AS) in patients over 70 years of age. It is also indicated for younger patients with significant comorbidities, for valve-in-valve interventions, and in selected patients with severe aortic insufficiency. We aimed to evaluate procedural and clinical outcomes of transfemoral TAVI performed over the course of 12 years by the same operators using different bioprosthetic valves. Materials and Methods: Between 2012 and 2023, 375 patients underwent TAVI in our clinic, with six types of bioprosthetic valves (Edwards Sapien XT, Medtronic Valves [CoreValve and Evolut R], Portico, Myval, Acurate Neo, and Direct Flow Medical). A transfemoral approach was used in all patients. The procedural and clinical outcomes were defined according to Valve Academic Research Consortium-3 (VARC-3) criteria. Results: The mean age of the patients was 78.4 ± 7.3, and their median STS score was 4.2 (2.9–5.9). Of the 375 patients, 361 had severe AS, 4 had severe aortic insufficiency, 5 were valve-in-valve, and 5 were valve-in-TAVI. Seven patients required a second valve implantation: four due to embolization of the prosthetic valve and three due to deep implantation of the prosthetic valve. Based on the VARC-3 criteria, the rates of technical success and device success were 90.4% and 85.3%, respectively. Major vascular complications were observed in 18 (4.8%) patients. Also, 42 (11.2%) patients required permanent pacemaker implantation. The incidence of moderate or worse paravalvular leak was 2.9%. The peri-procedural, 30-day, 1-year, and 5-year mortality rates were 5.1%, 4.3%, 15.2%, and 45.6%, respectively. STS scores (HR:1.129, 95%CI: 1.068–1.192, p < 0.001) and post-TAVI acute kidney injury (HR:3.993, 95%CI:1.629–9.785, p = 0.002) were detected as independent predictors of mortality in Cox regression analysis. Conclusions: This registry demonstrated the evolution of TAVI procedures at a single center over 12 years. A high level of collaboration between experienced operators and innovations in devices seem to be the key features for achieving high procedural success and low complication rates. Full article

Objective: To evaluate the clinical success outcomes and risk factors associated with dental implants placed with simultaneous bone augmentation in a large-scale, real-world cohort. Methods: A retrospective analysis was conducted on 158,824 implants, including 45,715 Dental Bone Grafts, placed between 2014 and 2022 within a national healthcare network. Multivariate Generalized Estimating Equations were utilized to assess the impact of demographic, anatomical, and procedural variables on implant failure. Results: The augmented cohort demonstrated a high clinical success rate of 97.83% (2.17% failure), statistically comparable to the general implant population. Failures were predominantly early (<1 year), accounting for 70% of losses. Significant independent risk factors included immediate implant placement (3.08% failure vs. 2.07% for delayed), male gender, and maxillary location. Notably, low socioeconomic status (SES) emerged as a significant predictor, with a failure rate of 3.07% compared to 2.06% in high-SES groups. Conclusions: Simultaneous bone augmentation is a predictable modality that does not inherently increase implant failure risk, supporting the stabilization hypothesis. However, failure is modulated by specific variables. The identification of lower SES, male gender, and immediate placement as significant risk indicators highlights the necessity for personalized risk assessment and targeted protocols to optimize outcomes in augmented sites. Full article

Background: Intentional occlusion of the internal iliac artery (IIA) during endovascular repair of aorto-iliac aneurysms may predispose patients to pelvic ischemic complications such as gluteal claudication, erectile dysfunction, and bowel ischemia. Iliac branch devices (IBDs) have been developed to preserve hypogastric perfusion. E-Liac (Artivion/Jotec) is one of the latest modular IBDs yet reports on mid-term performance are limited to small single-center cohorts with short follow-up. The CAMpania PugliA bRanch IliaC (CAMPARI) study is a multicenter investigation of E-Liac outcomes. Methods: A retrospective observational cohort study was conducted across five Italian vascular centers. All consecutive patients undergoing E-Liac implantation for aorto-iliac or isolated iliac aneurysms between January 2015 and December 2024 were identified from prospectively maintained registries. Inclusion criteria comprised elective or urgent endovascular repair of aorto-iliac aneurysms in which an adequate distal sealing zone was not available without covering the IIA and suitability for the E-Liac device according to its instructions for use (IFU). Patients with a life expectancy < 1 year or hostile anatomy incompatible with the IFU were excluded. The primary end point was freedom from branch instability (occlusion/stenosis, kinking, or detachment of the bridging stent). Secondary end points included freedom from any endoleak, freedom from device-related reintervention, freedom from gluteal claudication, aneurysm-related and all-cause mortality, acute renal failure, and sac regression > 5 mm. Results: A total of 69 consecutive patients (68 male, 1 female, median age 72.0 years) received 74 E-Liac devices, including 5 bilateral implantations. The mean infrarenal aortic diameter was 45 mm and the mean CIA diameter 34 mm; 14 patients (20.0%) had a concomitant IIA aneurysm (>20 mm). Concomitant fenestrated or branched aortic repair was performed in 23% of procedures. Two patients received a standalone IBD without implantation of a proximal aortic endograft. Technical success was achieved in 71/74 cases (96.0%); three failures occurred due to inability to catheterize the IIA. Distal landing was in the main IIA trunk in 58 cases and in the posterior branch in 13 cases. Over a median follow-up of 18 (6; 36) months, there were four branch instability events (5.4%): three occlusions and one bridging stent detachment. Seven patients (9.5%) developed endoleaks (one type Ib, two type II, two type IIIa, and two type IIIc). Five patients (6.8%) required reintervention, and five (6.8%) reported gluteal claudication. There were seven all-cause deaths (10%), none within 30 days or related to aneurysm rupture; causes included COVID-19 pneumonia, acute coronary syndrome, melanoma, gastric cancer, and stroke. No acute renal or respiratory failure occurred. Kaplan–Meier analysis showed 92% (95% CI 77–100) freedom from branch instability in the main-trunk group and 89% (60–100) in the posterior-branch group (log-rank p = 0.69). Freedom from any endoleak at 48 months was 87% (95% CI 75–95), and freedom from reintervention was 93% (95% CI 83–98). Conclusions: In this multicenter cohort, the E-Liac branched endograft demonstrated high technical success and favorable early–mid-term outcomes. Preservation of hypogastric perfusion using E-Liac was associated with low rates of branch instability, endoleak, and reintervention, with no 30-day mortality or aneurysm-related deaths. These findings support the safety and efficacy of E-Liac for aorto-iliac aneurysm management, although larger prospective studies with longer follow-up are needed. Full article

Reactive oxygen species (ROS) are essential regulators of fertilization and early embryo development in mammals, including humans and various animal models, but they exert detrimental effects when produced in excess. In assisted reproductive technologies (ART), particularly in vitro fertilization (IVF), exposure to non-physiological conditions increases oxidative stress (OS), impairing gamete quality, embryo viability, and clinical outcomes. This review synthesizes experimental and clinical studies describing the endogenous and exogenous sources of ROS relevant to embryo development in IVF. Endogenous ROS arise from intrinsic metabolic pathways such as oxidative phosphorylation, NADPH oxidase, and xanthine oxidase. Exogenous sources include suboptimal laboratory conditions characterized by factors such as high oxygen tension, temperature shifts, pH instability, light exposure, media composition, osmolarity, and cryopreservation procedures. Elevated ROS disrupt oocyte fertilization, embryonic cleavage, compaction, blastocyst formation, and implantation by inducing DNA fragmentation, lipid peroxidation, mitochondrial dysfunction, and apoptosis. In addition, the review highlights how parental health factors establish the initial redox status of gametes, which influences subsequent embryo development in vitro. While antioxidant supplementation and optimized culture conditions can mitigate oxidative injury, the precise optimal redox environment remains a subject of ongoing research. This review emphasizes that future research should focus on defining specific redox thresholds and developing reliable, non-invasive indicators of embryo oxidative status to improve the success rates of ART. Full article

Background/Objectives: Dental implant placement protocols including immediate (IIP) and delayed implant placement (DIP) are likely to affect bone tissue repair and regeneration after the surgery. Despite many benefits of IIP, it has remained unclear whether IIP demonstrates comparable healing processes and outcomes to those observed in DIP. This review aims to summarize and compare biological and clinical outcomes of IIP and DIP, focusing on success and survival rates, periodontal status, esthetics and radiographic outcomes, and biochemical markers. Methods: A literature search of electronic databases was conducted using PubMed/MEDLINE, Embase, and the Scopus databases (January 1983–February 2025). 109 articles published in English, consisting of in vitro, in vivo, and clinical studies met the inclusion criteria. Results: This review shows that both IIP and DIP show similar implant survival rates, but IIP may lead to a higher risk of mid-facial recession in esthetic areas. DIP, on the other hand, can result in better soft tissue and bone healing. Histological and radiographic evidence shows comparable bone to implant contact (BIC) between the two methods, although peri-implant bone loss tends to be higher with IIP. Lastly, although specific molecular markers are well-established in all phases of osseointegration following DIP, there is no available literature comparing differences in biomarkers during healing periods between IIP and DIP. Conclusions: This review highlights the similarities and differences in the outcomes of IIP and DIP, as well as the knowledge gaps that require further investigation, providing valuable insights for predicting treatment outcomes and managing complications associated with dental implant placement. Full article

Background and Objectives: Coronal plane deformities of the knee, particularly genu valgum and varum, represent common indications for guided growth in pediatric orthopedics. This study evaluates the clinical and radiographic outcomes of temporary hemiepiphysiodesis using tension-band plates in skeletally immature patients and identifies factors associated with successful correction. Materials and Methods: A retrospective review was conducted on patients treated with tension-band plate hemiepiphysiodesis for knee valgus or varus deformities between 2012 and 2023. Inclusion required open physes, pre- and postoperative full-length radiographs, and follow-up until implant removal or skeletal maturity. Mechanical axis parameters (mLDFA, mMPTA) were compared pre- and postoperatively, and correction rates were calculated. Idiopathic cases were analyzed separately from those with neurological or osteological disorders. Results: Sixty-six limbs were included (51 valgus, 15 varus). In the idiopathic subgroup, significant correction was achieved, with mLDFA improving by +5.19° and mMPTA by −1.88°, corresponding to annual correction rates of 4.75°/year and −1.74°/year, respectively (p < 0.001). Regression analysis showed no significant predictive value of age or treatment duration for total correction. Patients with pathological physes demonstrated inconsistent outcomes, often requiring additional procedures. No major complications occurred. Conclusions: Temporary hemiepiphysiodesis using tension-band plates is a safe, minimally invasive, and highly effective method for correcting idiopathic valgus deformities in growing children, with correction rates comparable to the existing literature. Outcomes in patients with neurological or osteological comorbidities remain less predictable, underscoring the need for individualized planning and close follow-up. Full article

Purpose: Periprosthetic joint infection (PJI) is a devastating complication following limb salvage surgery with tumor megaprosthetic reconstruction, leading to high morbidity and complex management. Despite advancements in prosthesis design and materials, infection rates are notably higher than in conventional arthroplasty. This narrative review synthesizes current evidence on the etiology, diagnosis, and management of PJIs in this unique setting. Methods: We conducted narrative review of literature from PubMed and Embase using keywords related to PJIs and tumor megaprostheses, aiming to summarize risk factors, diagnostic criteria, pathogen profiles, and treatment outcomes. Results: Key findings indicate that the risk of PJI is multifactorial, involving patient-related, disease-related, and treatment-related factors. Diagnosis relies on a combination of clinical presentation, serological markers, imaging, and microbiological studies, though established criteria for conventional PJI may require adaptation for tumor cases. Treatment strategies include irrigation and debridement (I&D), debridement, antibiotics, implant retention with modular component exchange (DAIR), one-stage or two-stage revision, and amputation. Success rates vary, and optimal management requires a multidisciplinary, individualized approach. However, two-stage revision is considered the gold standard for chronic PJIs. Conclusions: PJIs after tumor megaprosthetic reconstruction presents distinct challenges. Management requires a multidisciplinary, individualized approach. Future research should focus on validated diagnostic criteria for this population, novel anti-biofilm strategies, and standardized treatment protocols. Full article

Background and Objectives: Klotho (KL) is a multifunctional protein involved in reproductive physiology; however, its precise role in ovarian reserve and in vitro fertilization (IVF) outcomes remains unclear. This study aimed to evaluate the relationship between follicular fluid KL levels, ovarian reserve markers, and key IVF success parameters. Materials and Methods: This prospective study included a total of 150 women undergoing IVF, of whom 82 had diminished ovarian reserve (DOR) and 68 had normal ovarian reserve (NOR). All participants underwent controlled ovarian stimulation using a standard antagonist protocol. During oocyte pick-up (OPU), the first aspirated follicular fluid sample was collected, processed, and analyzed for KL concentrations using a Human Klotho ELISA kit. Hormonal profiles, ovarian reserve markers, and IVF outcomes were compared between groups. Results: Follicular fluid KL levels were significantly lower in the DOR group compared with the NOR group (117.07 ± 28.88 pg/mL vs. 266.13 ± 58.29 pg/mL; p < 0.001). Anti-Müllerian hormone (AMH) levels were reduced, whereas follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) levels were significantly higher in the DOR group (all p < 0.001). Implantation and clinical pregnancy rates were also significantly lower in the DOR group compared with the NOR group (p < 0.001 and p = 0.003, respectively). KL levels showed a strong positive correlation with the number of fertilized oocytes in both groups (DOR: r = 0.690; NOR: r = 0.552). Each one-unit increase in KL was associated with a 3.7% increase in implantation probability and a 3.2% increase in clinical pregnancy probability in the DOR group, and with corresponding increases of 4.4% and 1.2% in the NOR group (all p < 0.05). Conclusions: This study demonstrates significant associations between follicular fluid KL levels and fertilization, implantation, and clinical pregnancy outcomes. These associations appear to be more pronounced than those observed with traditional ovarian reserve markers such as AMH and antral follicle count. Reduced KL levels are associated with fewer fertilized oocytes, whereas higher KL concentrations correspond to increased implantation and clinical pregnancy probabilities. Nevertheless, similar to other non-invasive biomarkers, current evidence is insufficient to support routine clinical use of KL. Large-scale, well-designed, multicenter studies are therefore required to validate its clinical relevance and to determine whether KL can serve as a reliable and practical predictor of IVF success. Full article

This study evaluated the efficiency and potential risks associated with three clinical tools for removing cement-retained implant-supported prostheses: Magnetic Mallet, sliding hammer, and Coronaflex. The tests consisted of: cementation of three-unit bridge models onto titanium abutments with different geometries using Zinc Oxide non-eugenol or Zinc Phosphate cement. Seven different geometries of three-unit bridges were tested; therefore, a total of 7 bridges × 2 luting agents × 3 tools were combined in a full factorial analysis. Five test replicates were performed for each combination, resulting in a total of 5 × 7 × 2 × 3 = 210 retrieval tests. The 70 tests regarding the Coronaflex were taken from a previously conducted experiment on the topic, using the same dental bridge models and the same experimental conditions. Efficiency was assessed by the percentage of successful removals and the maximum force recorded with a piezoelectric load cell. For temporary cementations, the sliding hammer achieved the highest retrieval rate, while the Magnetic Mallet demonstrated comparable efficiency with lower forces. Coronaflex showed lower success rates and higher forces than Magnetic Mallet. For permanent cementations, most bridges were not removable, and attempts with the sliding hammer occasionally resulted in abutment screw damage. Within the limitations of this study, the Magnetic Mallet appears to be an effective option for removing bridges cemented with temporary cement, potentially in combination with a sliding hammer for highly retentive geometries. Zinc phosphate cement should be avoided when retrievability is desired, except for abutments with very low retention capability. Full article

Background/Objectives: Edentulism represents a major public health challenge, causing disorders of social, psychological and biological origin. Full-arch implant-supported restorations represent a viable alternative to mitigate this problem. This study aimed to evaluate immediate implant-supported restorations for the rehabilitation of the edentulous maxilla using four implants and distal implant tilting between 15 and 20 years. Methods: A total of 740 patients were included (women: 440; men: 300; average age: 55.3 years) rehabilitated with 740 prostheses, supported by 2960 dental implants. The primary outcome measure was prosthetic/implant cumulative survival and success (CSurR;CSucR). Secondary outcome measures included marginal bone loss (MBL), and the incidence of complications was evaluated as a secondary outcome measure. The outcomes were evaluated at 15 and 20 years. Results: In total, 287 patients (38.8%) with 1148 implants (38.8%) were lost to follow-up. A total of 170 implants (5.7%) in 101 patients (13.6%) failed, resulting in an implant CSurR and CSucR of 90.7% and 84.6%, respectively, after up to 20 years of follow-up. The prosthetic success rate was 98.1%. The average MBL was 1.07 mm ± 1.38 mm and 1.46 mm ± 1.56 mm at 15- and 20-years, respectively. Mechanical complication incidence was 78.5%, occurring in 581 patients (provisional prostheses: n = 448, 60.5%; definitive prostheses: n = 374, 50.5%). Biological complications occurred in 449 implants (15.2%) in 260 patients (35.1%). Biological complications and smoking habits were major risk indicators. Conclusions: Considering the study limitations, it can be concluded that the current rehabilitation concept is a viable treatment option in the long term, with mechanical and biological maintenance being necessary throughout the patients’ lives. Full article

The success of embryo implantation and pregnancy depends on a complex interaction between the trophoblast and the endometrial environment, where endometrial receptivity plays a crucial role in this process. Assisted reproductive technologies (ARTs) are essential in overcoming biological barriers and enabling implantation in women with fertility issues. However, one of the main challenges in ART is ensuring that the endometrium is receptive at the time of implantation. Therefore, identifying endometrial receptivity biomarkers is essential to optimize ART treatments, improving success rates. A comprehensive literature review was conducted by searching peer-reviewed articles published in PubMed, Scopus, and Web of Science databases. The search included studies focusing on molecular and cellular mechanisms underlying endometrial receptivity in both natural and stimulated cycles. Various experimental methods, including proteomic and microRNA studies, have identified key biomarkers involved in endometrial receptivity, such as adhesion molecules, growth factors, and others. However, ovarian stimulation in fertility treatments can alter endometrial receptivity, making approaches like frozen embryo transfer necessary. Despite advancements, many questions persist regarding the endometrial receptivity and implantation mechanisms in both natural and stimulated cycles. This article reviews the main molecules involved in endometrial receptivity in natural and stimulated cycles, highlighting their potential role as biomarkers for embryo implantation. Full article

Over the past three decades, cardiac surgery has undergone a deep transformation, shifting from full median sternotomy to minimally invasive (MICS) and micro-invasive techniques. These approaches aim to achieve equivalent therapeutic outcomes while reducing surgical trauma, postoperative pain, hospitalization time, and healthcare costs. Minimally invasive strategies are now widely applied to aortic and mitral valve surgery, coronary artery bypass grafting, atrial fibrillation ablation, and combined procedures. Key advancements such as sutureless prostheses, video- and robotic-assisted systems, and enhanced imaging technologies have improved surgical precision and clinical outcomes while promoting faster recovery and superior cosmetic results. Evidence from randomized trials and observational studies demonstrates that MICS provides mortality and morbidity rates comparable to conventional surgery, with additional benefits in high-risk, elderly, and frail patients. Micro-invasive transcatheter interventions, particularly transcatheter aortic valve implantation (TAVI) and transcatheter mitral repair or replacement, have further expanded therapeutic options for patients unsuitable for open-heart surgery. Their success has fostered debate not between conventional and minimally invasive surgery, but between minimally invasive and micro-invasive approaches. Hybrid procedures—combining surgical and percutaneous techniques—exemplify a multidisciplinary evolution aimed at tailoring treatment to patient-specific anatomy, comorbidities, and risk profiles. Despite clear advantages, these techniques present challenges, including a steep learning curve, increased procedural costs, and the requirement for specialized equipment and institutional expertise. Optimal patient selection based on clinical risk assessment and advanced imaging remains essential. Future directions include refinement of robotic platforms, artificial intelligence-based decision support, miniaturization of instruments, and broader validation of emerging technologies in younger and low-risk populations. Minimally and micro-invasive cardiac surgery represent a paradigm shift toward patient-centered care, offering reduced physiological burden, improved functional recovery, and long-term outcomes comparable to conventional techniques. As innovation continues, these approaches are poised to become integral to modern cardiac surgical practice. Full article