Search Results (1,314)

Background: This retrospective study assessed long-term survival outcomes of severely periodontally compromised mandibular incisors (≥50% bone loss) following initial periodontal treatment and a structured recall protocol. Methods: Ninety-three patients with ≥50% bone loss in all mandibular incisors were treated in a private practice over a 32-year period by the same periodontist. Following initial treatment, patients were assigned 6- or 12-month recall intervals based on response and motivation. The baseline was set after subgingival debridement (visit 3). Last follow-up visit (LFV) in this study was defined as follows: the last control visit of the patients done by the periodontist. ‘Survival’ was divided into 3 groups: complete survival (CS), all incisors were still present, and partial survival (PS), one or two incisor(s) were lost. Total failure (TF) involved instances in which all incisors were lost. Effective survival was monitored when an extracted tooth was repositioned and stabilized with a splint, ensuring preservation of function. Only 9.7% of patients needed a mandibular incisal splint. For reasons of consistency the CPITN was used. Statistical analysis was performed in R. The significance level was set at α = 0.05. Event-free patients can be considered as uninformative censoring, all with the same probability of risk, as they all were still in follow-up at the time of informed consent approval. Results: A total of 93 patients were included in the study. The mean follow-up was 17.7 years. At the last visit, 79.6% of patients retained all incisors, with an effective survival rate of 89.2%. Regarding the survival probability over time, after 15 years, it is 91% (95% CI: 0.86–0.98), and after 20 years, it is 78% (95% CI: 0.69–0.90). The effective survival probability over time after 15 years was 95% (95% CI: 0.91–1.0), and after 20 years, it was 89% (95% CI: 0.81–0.98). Compliance significantly influenced survival (p = 0.007), whereas the number of occluding units did not (p = 0.226). The total amount of teeth lost during the entire follow-up period showed a statistically significant difference compared to survival (p < 0.001). The general periodontal health of the patient population presented a shift from CPITN 3 to the 0–2 group. Conclusions: Severely compromised mandibular incisors demonstrate high long-term survival rates with appropriate therapy. After 20 years the survival probability was 78%, and the effective survival probability, 89%, underscoring the critical role of lifelong periodontal care. Mandibular incisor preservation over long-term follow-up is highly achievable. Full article

Background: Drug-induced sleep endoscopy (DISE) with a jaw-thrust maneuver is used to simulate mandibular advancement in obstructive sleep apnea (OSA), yet determinants of functional airway improvement remain incompletely defined. Objective: To identify clinical, polysomnographic, and baseline DISE anatomic factors associated with jaw-thrust responsiveness. Methods: We conducted a single-center retrospective observational study of adults with polysomnography-confirmed OSA who underwent DISE with paired baseline and jaw-thrust VOTE assessments between 1 January 2015 and 31 December 2025 (n = 355). Jaw-thrust responsiveness was defined a priori as a within-subject reduction in the number of obstructed VOTE sites (grade ≥ 1). Multivariable logistic regression was used to identify independent correlates within a prespecified explanatory modeling framework. The study was approved by the Institutional Review Board of Taipei Tzu Chi Hospital (protocol 14-IRB079), with the need for informed consent being waived. Results: Jaw thrust reduced overall obstruction burden from two (two to three) to one (one to two) sites (Wilcoxon p < 0.001). Hypopharyngeal levels demonstrated the greatest improvement, particularly at the tongue base (39.2% to 7.6%) and epiglottis (23.9% to 5.4%) (both p < 0.001). Overall, 62.8% met responder criteria and 18.9% achieved complete normalization. In multivariable analysis (n = 272), baseline tongue-base collapse (adjusted odds ratio [aOR] 2.46, 95% CI 1.20–5.04) and greater baseline multilevel obstruction burden (aOR 1.85 per SD, 95% CI 1.19–2.85) were independently associated with responsiveness, whereas conventional PSG severity metrics were not. Conclusions: In adults with OSA, jaw-thrust responsiveness during DISE is more strongly associated with baseline anatomic phenotype than with global PSG severity. Standardized DISE functional assessment may provide complementary information to support phenotype-informed selection of non-CPAP therapies, pending prospective validation. Full article

Background and Objectives: Effective postoperative analgesia is essential for enhanced recovery after bariatric surgery. The erector spinae plane block (ESPB) has emerged as a promising regional anesthesia technique, but its impact on postoperative pain control, opioid requirement, patient and surgeon satisfaction, and stress response in obese patients undergoing sleeve gastrectomy remains unclear. This study aimed to evaluate the effects of bilateral ESPB on postoperative analgesia requirements, pain scores, patient and surgeon satisfaction, hemodynamic stability, postoperative stress response, and perioperative hematologic and biochemical parameters in ASA II–III patients with a body mass index (BMI) > 30 undergoing sleeve gastrectomy. Study design was a prospective, randomized, single-blind clinical trial. Materials and Methods: After obtaining ethics committee approval (Şanlıurfa Harran University Hospital, date: 23 January 2023; decision no: HRÜ/23.02.09) and written/verbal informed consent, 60 patients aged 18–65 years, BMI > 30, ASA II–III scheduled for elective sleeve gastrectomy were included. Patients were randomized into two groups: those receiving bilateral ESPB (Group E, n = 30) and those without ESPB (Group C, n = 30). Demographic characteristics, ASA scores, comorbidities, and surgical duration were recorded. Preoperative venous samples were collected into hemogram (WBC, lymphocyte, neutrophil) and biochemistry tubes (CRP, cortisol, glucose). Standard monitoring (ECG, SpO₂, NIBP) was applied intraoperatively, and vital parameters (HR, MAP) were recorded throughout. Postoperatively, HR, MAP, Numerical Rating Scale (NRS) scores at 0, 2, 4, 8, and 24 h, opioid requirement, patient and surgeon satisfaction (Likert scale), postoperative hemogram and biochemistry values, and side effects or complications were documented. All patients received dexketoprofen as baseline analgesia, with tramadol HCl administered as rescue analgesic. Results: All 60 patients completed the study. There were no statistically significant differences between the groups regarding age, BMI, or surgery duration. Comorbidities were similar between groups. Intraoperative and postoperative HR and MAP values showed no significant differences. Postoperative NRS scores at the 0, 2, 8, and 24 hours were significantly lower in Group E compared with Group C. Both patient and surgeon satisfaction scores were higher in Group E. Rescue analgesic (tramadol HCl) consumption in the postoperative ward was significantly reduced in Group E. Cortisol levels, particularly at the 24th postoperative hour, showed a significantly smaller increase in Group E, suggesting a reduced surgical stress response. No significant differences were found between the groups regarding postoperative side effects or complications. Conclusions: Preoperative bilateral ESPB is an effective component of multimodal analgesia in sleeve gastrectomy. The block significantly reduces postoperative pain intensity, lowers NRS scores, improves patient and surgeon satisfaction, and decreases opioid requirements. Additionally, ESPB appears to attenuate the postoperative stress response, as reflected by smaller increases in cortisol levels. These findings support the routine incorporation of ESPB in perioperative pain management strategies for gastric sleeve surgery. Full article

Background: Immersive technologies are increasingly used to support interprofessional education and team training in healthcare. Holographic display technology (HDT) offers a novel approach for delivering distributed, simulation-based TeamSTEPPS training; however, evidence regarding its short-term feasibility remains limited. Methods: This mixed-methods pilot feasibility study examined the acceptability and limited efficacy (defined as learning satisfaction and self-reported gains) of HDT for interprofessional TeamSTEPPS-based team training across two geographically distributed campuses. Quantitative measures assessed changes in UTAUT-informed constructs, including attitude toward technology use (ATU) and behavioral intention (BI), while qualitative focus groups explored learner experiences and perceptions. Results: Of 64 participants, 47 consented to analysis. Quantitative analyses demonstrated post-training improvements in key technology-acceptance constructs, including significant gains in ATU and strengthened alignment between BI and UTAUT predictors. Qualitative findings reflected high learner engagement and perceived educational value, alongside practical considerations related to technical and instructional coordination. Conclusions: HDT was feasible for assessment of short-term foci of acceptability and perceived limited efficacy through the delivery of interprofessional TeamSTEPPS training, with observed gains in ATU and BI. These findings inform future assessment of long-term feasibility foci, including implementation studies examining the role of holographic simulation in advancing interprofessional education, healthcare workforce development, and the quality of healthcare delivery. Full article

The adoption of the Anishinabek Nation Child Well-Being Law (ANCWBL) has given birth to a framework for Indigenous communities in Ontario, Canada, to exercise self-determination in governing child and family services, including service delivery and authority over policy and funding. This means an end to child and family services agencies that serve First Nations on reserves and are bound by provincial standards and legislation following a protection-based model. Instead, it begins a system of customary care that genuinely respects and supports the primary role of parent/guardian, family, and community in prevention-focused child welfare in accordance with standards based on Anishinabek cultures and the practice of consent. This conceptual essay highlights an Indigenous feminist perspective on the ANCWBL’s significance and its ability to address the historical suffering stemming from colonial child welfare practices and to institute child and family services by reinstating the rights of Indigenous children and women’s leadership in care as a communal responsibility. Full article

Intranasal drug delivery represents a transformative “backdoor” to the brain, bypassing the blood–brain barrier (BBB) that bars 98% of small molecules and nearly all large biopharmaceuticals. By harnessing the unique anatomy of the olfactory and trigeminal nerves, therapeutics can travel directly from the nasal cavity to the central nervous system, achieving therapeutic concentrations without the systemic toxicity of traditional routes. Clinical and preclinical evidence highlight the efficacy of intranasal insulin (INI) in treating Alzheimer’s disease (AD) and delirium, with studies showing significant improvements in cognitive scores and reduced hospital stays (7.9 vs. 12.9 days; p = 0.014). Additionally, other peptides can be administered intranasally like oxytocin, neuropeptide Y, and novel metabolic modulators for neuroprotection and affective disorders (AD, autism, Down syndrome). Despite these promises, critical translational gaps remain, including anatomical differences between macrosmatic rodents and microsmatic humans, and significant sex-based dosing dimorphism. The ease of intranasal administration introduces profound bioethical dilemmas regarding neuroenhancement, authenticity, and informed consent in vulnerable populations. The current literature concludes that realizing the full potential of nose-to-brain (N2B) therapy requires a commitment to precision medicine, utilizing specialized delivery devices and objective biomarkers to ensure safe and equitable clinical application. Full article

Background: Chronic kidney disease (CKD) continues to place immense strain on health systems globally, with nurses at the centre of care delivery physically, emotionally, and relationally. In dialysis units, nurses form long-term therapeutic relationships with patients who depend on life-sustaining treatment several times a week. Objective: This study explored the lived experiences of professional nurses caring for patients with CKD in a dialysis unit, using Watson’s Theory of Human Caring as a guiding framework. Methods: A qualitative, exploratory, descriptive design was employed. Data were collected through in-depth face-to-face interviews with twelve professional nurses and analyzed using thematic analysis. Trustworthiness was ensured through credibility, dependability, confirmability, transferability, and authenticity. Ethical approval and informed consent were obtained. Results: Three themes emerged: (1) emotional and professional experiences, (2) systemic resource constraints, and (3) recommendations for practice improvement. These findings highlight the tension between caring ideals and systemic limitations. Conclusions: The study concludes that dialysis nursing is profoundly meaningful yet emotionally demanding. Strengthened emotional support, improved leadership visibility, consistent resource allocation, and enhanced nephrology nursing education are critical to sustaining compassionate care. The findings offer important insights for policy, workforce development, and quality improvement efforts in CKD care. Full article

Surgically created native arteriovenous fistulas (AVFs) remain the preferred vascular access for chronic hemodialysis, yet they are limited by substantial early failure and progressive consumption of venous capital. Endovascular arteriovenous fistulas (endoAVFs, also referred to as percutaneous AVFs) have become a catheter-based alternative to surgical AVF (sAVF). We conduct an updated narrative, practice-oriented review of the literature on endoAVF creation, and we qualitatively synthesize evidence. Two devices are currently available in contemporary clinical practice: a dual 4 Fr-catheter, fluoroscopy-guided radiofrequency system (WavelinQ) and a single 6 Fr-catheter, ultrasound-guided thermal resistance system (Ellipsys). Across prospective studies and real-world series, endoAVF creation is consistently reported to have high technical success, with low major complication and infection rates. Clinical usability can often be achieved within weeks when ultrasound-based surveillance and protocol-driven maturation assistance are implemented; however, adjunctive procedures are frequently required and should be anticipated in program planning and informed consent. Observational comparisons and pooled analyses indicate broadly comparable functional outcomes versus surgery in selected cohorts, while estimates of primary patency and maintenance burden vary substantially across studies. Overall, endoAVFs represent a feasible, minimally invasive, vessel-sparing option that can be integrated into multidisciplinary access pathways in anatomically suitable candidates and experienced centers, complementing rather than replacing surgical strategies within a distal-first plan. Recent society practice guidance further emphasizes standardized mapping, expectation setting, troubleshooting algorithms for non-maturation, and dialysis-unit cannulation training to support consistent implementation. Pragmatic comparative studies and long-term registries using standardized endpoints, paired with healthcare-system-specific economic analyses, are needed to better define durability, resource use, and patient-centered outcomes over the full-access life cycle. Full article

Introduction: End-of-life (EOL) HIV cure-related research offers a unique opportunity to advance scientific discovery while honoring the values, dignity, and legacy of people with HIV. However, participation remains demographically skewed, mirroring long-standing inequities in who is informed, invited, and supported to take part. Synthesizing eight years of experience, published literature reviews, and community engagement from the University of California San Diego’s Last Gift program, we propose strategies to embed justice, equity, diversity, inclusion, and accessibility (JEDIA) throughout the design and implementation of EOL HIV cure-related studies. Discussion: Using intersectionality as a structural analytic framework, we examine how interlocking systems and social determinants shape access, consent, and participant experience, and we translate ethics into action across three themes and eight domains. As examples, we facilitate equitable access by implementing solutions that address gaps limiting awareness and feasibility of participation. We establish ongoing consent through multi-session consent processes with teach-back methods, clear healthcare proxy pathways, and explicit separation of research activities from clinical care. We center lived experiences by partnering with people with HIV and community groups, customizing participation, and honoring cultural and spiritual needs. We enable real-time course correction by using a dashboard that monitors enrollment patterns and representation. Conclusions: An intersectionality-informed, participant-centered approach is both feasible and essential to ensure HIV cure-related research advances with fairness, trust, and global relevance. Programs such as the Last Gift show that scientific rigor, integrity, and participant dignity can coexist, establishing a model for equitable HIV cure discovery. Full article

Background: Deep vein thrombosis (DVT) is one of the most common cardiovascular diseases and is especially prevalent in areas with environmental pollution. Bioaccumulation of toxic heavy metals may lead to deterioration of homeostasis with cellular change, endothelial dysfunction, DNA impairment and cellular signaling. The reason for this is usually the accumulation of thrombogenic toxins in the body as a result of long-term exposure or a lack of regulatory gene expression. In this study, we aimed to measure the minerals that potentially accumulate in the nail. The measurement method was laser-induced breakdown spectroscopy (LIBS), which is a form of atomic emission spectroscopy. It uses a highly energetic laser source to form a plasma of excited atoms emitting light of characteristic wavelengths. It provides accurate quantification and reveals the relationship between tissue accumulation of toxic heavy metals and DVT formation. Methods: Between January 2020 and December 2021, 100 patients diagnosed with lower-extremity deep vein thrombosis were screened in a single tertiary healthcare center. Among them, 50 patients who met the eligibility criteria and consented to participate were included in the study. An additional 50 age-matched healthy volunteers were enrolled as controls. Demographic and clinical characteristics were recorded. Nail samples were obtained from each participant, and elemental emission intensities were quantitatively analyzed using laser-induced breakdown spectroscopy (LIBS). Results: No difference in clinical characteristics was detected between the groups. While iron, calcium and silicon were found to be high in DVT patients, magnesium was found to be low. Regarding the magnesium emission, ROC analysis showed 76–90% specificity and 69–82% sensitivity, respectively. Conclusions: LIBS is a useful method because it is easy to use and can be used with a small sample. According to the results of our study, information about the pathogenesis of DVT was obtained through nail analysis. Therefore, we believe that LIBS analysis is a method that may be useful in determining the causes and predisposing factors for DVT. Full article

Background/Objectives: Greece has been a major host country for refugee populations, operating under conditions of limited resources and strained healthcare services. Refugee women residing in accommodation facilities face barriers to accessing primary prevention and health promotion services, including limited health literacy and cultural and linguistic challenges. This study aimed to assess the level of primary prevention and health promotion among refugee women living in accommodation facilities in Greece and to identify their health needs and barriers to accessing healthcare services. Methods: A quantitative cross-sectional study was conducted among 150 adult refugee women residing in the Malakasa accommodation facility in Greece. Participants voluntarily agreed to take part in the study. Data were collected between December 2024 and March 2025 using a structured questionnaire assessing sociodemographic characteristics, primary prevention, health promotion, and barriers to healthcare access. Descriptive statistical analysis was performed. The study was approved by the relevant ethics committee, and informed consent was obtained from all participants. Results: The study included 150 refugee women, primarily young adults with low educational attainment. Familiarity with primary prevention was reported as moderate or lower by the majority of participants, with only 24% indicating high or excellent familiarity, while familiarity with health promotion was even lower (8%). Participation in preventive practices varied, with 42.7% reporting frequent health check-ups; however, uptake of key preventive behaviors remained limited, including vaccination (30%) and adoption of a healthy diet (32.7%). During their stay in Greece, 97.3% participated in regular health check-ups, 32.7% adopted a healthy diet and 30% were vaccinated. Cardiovascular and gynecological conditions were the most frequently reported health problems (76.7% and 73.3%, respectively). The most prominent barrier to healthcare access was long distance from health facilities (97.3%), followed by lack of information or health education (24.7%). Conclusions: The study identified low levels of preventive health knowledge and limited uptake of key preventive practices among refugee women, alongside persistent barriers to healthcare access, underscoring the need for targeted and culturally sensitive health promotion interventions. Full article

Background: Treating depression and anxiety in adolescents can be challenging due to interindividual variability in medication response. With current trial-and-error prescribing practices, adolescents may undergo multiple medication changes over months or years before an effective and tolerated drug and dose are identified. Pharmacogenomic (PGx) testing can identify interindividual differences in drug metabolism, and evidence supporting PGx-guided prescribing in adults with mental disorders is growing. However, its impact on pediatric psychotropic prescribing remains underexplored. Methods: This is a protocol for a parallel-arm, multicentre, randomized controlled trial. Canadian adolescents aged 12–17 years who are initiating or switching a selective serotonin reuptake inhibitor (SSRI) for depression and/or an anxiety disorder under physician care are eligible. A total of 452 participants will be randomized 1:1 to PGx-guided SSRI prescribing (experimental) or SSRI prescribing based on current practice guidelines (control). Participants, caregivers, prescribing clinicians, outcome assessors, and investigators will be blinded to treatment allocation. Dual primary outcomes are symptom remission at 12 weeks, measured with the Quick Inventory of Depressive Symptomatology–Adolescent (QIDS-A17-SR) and the Screen for Child Anxiety Related Disorders (SCARED). Secondary outcomes, assessed at 4, 8, and 12 weeks, include participant- and physician-rated changes in depressive and anxiety symptoms, role functioning, health-related quality of life, health care utilization, cost-effectiveness, side-effect burden, medication burden, and adherence. Multiple testing will be addressed using the Hochberg method, and a parallel gated analysis will account for non-actionable genotypes. Secondary analysis will estimate minimal clinically important differences for symptom and role-functioning change with PGx-guided therapy. Discussion: At the time of writing, 36 participants have consented and been randomized to an intervention. This trial will evaluate whether PGx-guided prescribing improves symptom remission in adolescents treated with SSRIs. If efficacious, results should be interpreted with existing pediatric pharmacokinetic, observational, and adult trial data to inform PGx use in managing pediatric anxiety and depressive disorders. Full article

The rapid expansion of commercial human spaceflight is forcing a re-examination of how we decide who is “fit to fly” in space. For more than six decades, astronaut selection has been dominated by government programmes employing stringent medical and psychological criteria designed to minimise risk for small cohorts undertaking long-duration, high-consequence missions. Contemporary standards such as NASA-STD-3001 reflect this paradigm, treating astronauts as highly trained national assets expected to perform reliably under extreme physiological and psychological stress. In contrast, commercial operators aim to fly large numbers of spaceflight participants with highly heterogeneous medical and psychological profiles, within regulatory frameworks that emphasise informed consent and currently impose very limited prescriptive health requirements on passengers. This review examines the evolution and structure of traditional astronaut selection, outlines emerging approaches to screening and certifying commercial spaceflight customers, and explores the conceptual and practical gap between “selection” and “screening”. Particular attention is given to the increasing relevance of behavioural and psychological risk in short-duration but high-stress commercial missions, where acute responses, passenger–crew interaction, and behavioural variability can influence safety, especially in mixed-capability crews. Drawing on agency standards, psychological selection research, and recent proposals for commercial medical guidelines, this paper proposes a risk-informed, mission- and role-specific framework that adapts lessons from government astronaut corps to the needs of commercial spaceflight. We argue that future practice must balance safety, inclusion, and commercial viability through proportionate, evidence-based risk management, supported by systematic data collection across government and commercial flights. Full article

Background: The development of facial scanning technology has introduced new methods for facial morphology analysis, progressively shifting from conventional methodology such as direct anthropometry and two-dimensional photography toward three-dimensional digital acquisition. These technologies aim to reduce operator subjectivity, enhance measurement reproducibility, and enable comprehensive facial analysis within digital workflows. Methods: Thirty adult volunteers were recruited and provided informed consent. In each participant, twenty-five predefined facial landmarks were identified and nineteen linear interlandmark distances were recorded using three methods: direct anthropometric measurement with a digital caliper (Mitutoyo^®, USA), a low-cost portable facial scanner (Revopoint^®), and a professional static facial scanner (RAYFace^®). Manual anthropometry was used as a clinical refence standard. All measurements were performed by a single trained operator. Trueness was defined as the absolute difference between the reference measurements and the mean of digital measurements, while precision was defined as the standard deviation of repeated digital measurements. Results were expressed as mean values and 95% confidence intervals. Results: Overall precision was 0.58 (0.53; 0.62) mm for Revopoint^® and 0.43 (0.39; 0.47) mm for RAYFace^®, corresponding to precision percentages of 1.19 (1.06; 1.33) % and 0.88 (0.78; 0.97) %, respectively. Mean trueness values were 2.16 (2.01; 2.31) mm and 1.92 (1.80; 2.05) mm for conventional-Revopoint^® and conventional-RAYFace^®, corresponding to a trueness impact value of 4.30 (3.87; 4.74) % and 4.08 (3.61; 4.55) %, respectively. Statistically significant differences between scanners were observed for specific landmark locations. Conclusions: Within the methodological limitations of this in vivo study—including the use of manual anthropometry as a reference standard, a single-operator design and a predominantly female sample—both facial scanners demonstrated reproducible linear measurements within clinically acceptable thresholds for prosthodontic and esthetic planning applications. The professional static scanner showed superior accuracy, suggesting greater suitability for complex cases requiring higher precision. Full article