Search Results (481)

Background/Objectives: Multi-strain Limosilactobacillus fermentum supplementation has been reported to promote weight loss outcomes in free-living conditions, but limited evidence exists on these probiotic strains added to an energy-restricted diet and walking program in overweight adults. Methods: In a double-blind, placebo-controlled, parallel-arm randomized trial, overweight adults (35.2 ± 13.2 years old, 167.6 ± 8.6 cm, 79.9 ± 11.8 kg, 28.4 ± 2.7 kg/m² body mass index, 36.1 ± 6.6% body fat) completed a 12-week weight loss program that included a 500 kcal/day energy deficit and walking 10 k steps/d. Participants ingested one daily capsule containing a three-strain probiotic blend (L. fermentum K7-Lb1, L. fermentum K8-Lb1, L. fermentum K11-Lb3; 6 billion CFU/day) (PRO) or maltodextrin placebo (PLA). Assessments were performed at baseline, week 6, and week 12 and included body composition, resting energy expenditure, substrate utilization, peak oxygen uptake, dietary intake, step counts, blood biomarkers, quality of life, and side effects. Data were analyzed using multivariate and univariate repeated-measures general linear models (GLM), with mean changes from baseline presented alongside 95% confidence intervals. Results: All participants significantly reduced body weight, fat mass, body fat percentage, and waist circumference. At 12 weeks, PRO reduced fat mass more than PL (−2680.7 ± 1276.7 g; p = 0.039). In PRO, android and gynoid fat percentage decreased at 6 weeks (p < 0.001; p = 0.008) and 12 weeks (p = 0.004; p < 0.001), respectively. Visceral adipose tissue mass, volume, and area were lower at 6 weeks and trended lower at 12 weeks. In PRO, bone mineral content and bone mineral area decreased at 12 weeks, while bone mineral density paradoxically increased (0.007 ± 0.003 g/cm²; p = 0.024). Conclusions: During a 12-week weight loss program, supplementation of a multi-strain L. fermentum probiotic significantly reduced body fat and central adiposity. Full article

Background/Objectives: Horizontal alveolar ridge resorption following tooth loss often compromises implant placement and requires augmentation procedures to restore adequate bone volume. This pilot case series descriptively evaluated the clinical, radiographic, and histological outcomes of lateral ridge augmentation (LRA) using a collagenated porcine-derived xenograft combined with autogenous bone. Methods: Three consecutive partially edentulous patients presenting with severe horizontal ridge deficiency (residual bone width ≤ 4 mm) underwent LRA using a mixture of porcine-derived xenograft and autogenous bone covered with a resorbable collagen membrane. After a healing period of 3–5 months, core biopsies were harvested at implant placement and subjected to histological and histomorphometric analysis, including TRAP staining. Results: All sites healed uneventfully without intraoperative or postoperative complications. Radiographic evaluation demonstrated substantial horizontal bone gain, allowing placement of standard-diameter implants. Histological analysis revealed newly formed trabecular bone, residual graft material, and well-vascularized connective tissue, indicating active bone regeneration and biomaterial integration. TRAP-positive multinucleated giant cells (MNGCs) were observed at the biomaterial interface, suggesting ongoing remodeling. Long-term follow-up (mean 54.2 months) showed stable implant function without biological or mechanical complications. Conclusions: Within the limitations of this pilot case series, LRA using a collagenated porcine-derived xenograft combined with autogenous bone demonstrated preliminary favorable clinical, radiographic, and histological outcomes. Full article

Background: Total knee arthroplasty in patients with hemophilia remains the most effective surgical intervention for end-stage hemophilic arthropathy, yet it poses unique surgical and perioperative challenges that are rarely encountered in standard osteoarthritis cases. This article synthesizes technical, anatomical, and perioperative considerations specific to hemophilic patients and integrates prospective clinical data derived exclusively from the hemophilic cohort of our long-term study (twenty patients, twenty knees; 2015–2024). Emphasis is placed on deformity correction, bone loss management, implant selection, hemostatic strategies, transfusion patterns, and perioperative pitfalls. The objective is to provide a comprehensive narrative reference for surgeons managing complex hemophilic knees, consolidating both evidence-based recommendations and practical perioperative “tips and tricks” accumulated across more than a decade of clinical experience. Methods: This prospective observational study evaluated twenty consecutive male patients with hemophilia who underwent primary total knee arthroplasty for advanced hemophilic arthropathy between 2015 and 2024 at our institution. The following variables were collected: operative time measured from skin incision to skin closure, postoperative transfusion requirement, length of hospitalization measured in days, early postoperative complications, and functional recovery as assessed by the Knee Society Score. Early complications included postoperative bleeding or hematoma, superficial or deep infection, and stiffness requiring intensive physiotherapy or manipulation under anesthesia. Results: The mean age at the time of surgery was 44.8 years with a standard deviation of 7.2 years, ranging from 31 to 59 years. The mean operative time in the hemophilic cohort was 154.54 min with a standard deviation of 18.36 min. The range of operative time was from 120 to 180 min. Nine of the twenty patients, representing 45 percent, required postoperative blood transfusion. The mean length of hospital stay in the hemophilic cohort was 12.3 days with a standard deviation of 2.38 days, ranging from 9 to 17 days. The mean Knee Society Score improved from 38 points preoperatively to 82 points at final follow-up, representing a mean increase of 44 points. Conclusions: Total knee arthroplasty in hemophilic patients is safe and effective when specialized surgical techniques, comprehensive synovectomy, precise deformity correction, optimized hemostasis, and structured postoperative coagulation factor replacement are implemented. Functional outcomes and prosthetic survival are excellent in experienced centers. Full article

Background/Objectives: Immediate provisionalization in the esthetic zone is a well-documented but technique-sensitive procedure, and the choice of provisional connection geometry, with or without an antirotational index, remains debated. The aim of this retrospective single-arm cohort clinical study was to evaluate the clinical performance of a digitally planned, guide-delivered provisionalization protocol using prefabricated provisional crowns connected to 5-degree Morse taper implants without an antirotational index, with emphasis on emergence profile shaping and peri-implant tissue stability at one year; Methods: Twenty consecutive single-implant cases treated according to the standardized protocol from January 2024 onward and completing at least one year of follow-up after definitive crown delivery by the February 2026 data-lock date were included (19 female, 1 male; mean age 38.1 ± 12.7 years; 18 anterior and 2 premolar sites). All implants were placed with primary insertion torque ≥ 30 N·cm (mean 34.75 ± 2.55 N·cm) and immediately restored with a digitally designed, non-antirotational provisional crown. Primary outcome was provisional retention without major intervention; secondary outcomes included biologic complications, papilla score, marginal bone change at T0–T3 and T3–T4, and buccal contour change (T0 vs. T2 intraoral scan superimposition). Wilson 95% confidence intervals, Fisher’s exact test, and Mann–Whitney U test were used (α = 0.05); Results: Provisional retention without major intervention was 75.0% (15/20; 95% CI 53.1–88.8). Biologic complications were uncommon (bleeding on probing, suppuration, midfacial recession, and chairside adjustment, each 5.0%). Mean total marginal bone loss at one year was 0.37 ± 0.20 mm; mean buccal contour gain was 1.41 ± 0.48 mm. A complete papilla was preserved in 70.0% of cases. Conclusions: Digitally planned, guide-delivered provisionalization on a non-antirotational 5-degree Morse taper interface appears clinically feasible for emergence profile shaping in the esthetic zone, with favorable peri-implant tissue outcomes at one year. Full article

Background: Cage subsidence (CS) is among the main complications after oblique lumbar interbody fusion (OLIF) and may lead to the failure of indirect decompression. Accurate preoperative bone quality assessment is critical for risk stratification, yet the optimal imaging modality and diagnostic threshold remain unclear. Objectives: This study aimed to determine a quantitative computed tomography (QCT)-derived volumetric bone mineral density (vBMD) threshold for predicting CS after OLIF with posterior fixation. Methods: Patients undergoing OLIF with posterior fixation between July 2017 and March 2020 were retrospectively enrolled. Preoperative vBMD was measured using QCT as the average L2–L4 trabecular volumetric BMD. CS was defined as a loss of more than 2 mm of disk height on sagittal midline CT views between 3 days postoperatively and the last follow-up. Clinical and radiographic parameters including gender, age, body mass index, vBMD, number of operative levels, cage dimensions, disk height, segmental lordosis, intraoperative endplate injury, and fusion status were analyzed. Results: 86 patients (107 operative levels) with a mean follow-up of 20.6 months were included; 25 levels (23.4%) developed CS. Multivariate logistic regression identified vBMD (p < 0.001; OR 0.947; 95% CI 0.923–0.972) and intraoperative endplate injury (p = 0.031; OR 3.640; 95% CI 1.125–11.776) as independent risk factors. The area under the receiver operating characteristic curve (AUC) for vBMD was 0.847 (95% CI, 0.762–0.932), with an optimal threshold of 83.0 mg/cm³ (sensitivity 84.0%, specificity 76.8%). This threshold closely aligns with the American College of Radiology QCT criterion for osteoporosis (80 mg/cm³); however, given that it was derived from a single-center retrospective cohort, external validation in multi-center studies is warranted before broad clinical adoption. Fusion rates differed significantly between CS and non-CS groups (84.0% vs. 96.3%, p = 0.029). Conclusions: QCT-derived vBMD provides a phantom-calibrated, protocol-standardized metric for preoperative risk stratification of cage subsidence after OLIF. Full article

Background: There are still insufficient studies based on large patient cohorts that evaluate both functional and surgical outcomes after internal hemipelvectomy and 3D-printed endoprosthesis implantation. This study aimed to determine how the method of pelvic bone defect reconstruction determines early functional, surgical, and radiographic outcomes. Methods: The aims of the study were achieved based on retrospective observations of 49 patients who underwent surgical treatment at several centres in Poland. All patients underwent internal hemipelvectomy and implantation of 3D-printed prostheses. Surgical parameters were assessed, including operative time, blood loss, and surgical complications (infections, implant loosening, dislocations), as well as bone osseointegration. Functional outcomes were assessed using the HHS and MSTS-93 scales, and pain intensity was measured using the VAS. Outcomes were stratified according to implant design and fixation method based on the West China Classification. Results: The most commonly performed procedures were internal hemipelvectomies of Enneking Type I + II and II + III, with reconstructions most frequently classified as WChC-Aa (15%) and WChC-Bb (44%). Functional assessments revealed significant improvement across all patients. Both the HHS and MSTS-93 values demonstrated marked progress from preoperative averages of 44 (HHS) and 12 (MSTS-93) to 64, 70.2, and 76 (HHS) and 19, 20, and 20.2 (MSTS-93) after 6 weeks, 3 months, and 6 months, respectively. Correspondingly, pain intensity decreased from a mean preoperative VAS score of 8.5 to 4.4, 3.4, and 3.2 after surgery. Osseointegration occurred in 53%, 75%, and 83% of patients after 6 weeks, 3 months, and 6 months, respectively. Wound-healing complications were observed in 6 patients, while deep infection developed in 4 cases. In 3 patients, the implant was removed. Implant loosening was noted in imaging studies in 7 patients (14%) and 8 patients (16%) at 3 and 6 months postoperatively, respectively. Local tumour recurrence was observed in 6 cases. Conclusions: The extent of pelvic tumour resection and the reconstruction method appear to influence surgical parameters, the risk of complications, and operative time. Functional outcomes measured using VAS, HHS, and MSTS-93 scales showed improvement following surgical treatment and tended to improve over time; however, these findings should be interpreted with caution given the relatively short follow-up period and the lack of assessment of minimal clinically important difference (MCID). The use of 3D-printed implants may facilitate precise pelvic reconstruction and enable early mobilization and rehabilitation. Full article

This prospective, single-arm post-market study aimed to evaluate the clinical safety and performance of a synthetic calcium phosphate ceramic used in alveolar bone regeneration procedures. Eighty adult patients requiring bone augmentation were treated with β-tricalcium phosphate (β-TCP) under routine clinical indications. Surgical approaches were adapted to defect morphology. Safety outcomes included adverse events (AEs) and device deficiencies (DDs), while performance outcomes focused on two-dimensional radiographic bone assessment. Radiographic bone consolidation was defined as continuous trabecular radiopacity without radiolucent defects or clinical signs of infection. Patients were followed for six months post-surgery, with clinical and radiographic evaluations, as well as assessment of oral health-related quality of life (OHIP-14). All 80 patients (mean age: 47.2 ± 18.9 years; 51% male) completed the immediate postoperative assessment. Eleven DDs (granule loss) were observed postoperatively (13.8%) and no AEs. At six months, 71 patients (88.8%) completed follow-up. Radiographic bone repair was confirmed in all cases clinically observed and with follow-up X-ray (100%). No AEs or DDs reported (AE-free rate: 100%) at this follow-up. The median OHIP-14 score improved significantly at six months (p = 0.037), indicating better self-reported oral health. Given the observational design, absence of a control group, and partial reliance on non-radiographic follow-up, these findings should be interpreted with caution. Within these limitations, the synthetic calcium phosphate ceramic demonstrated a favorable short-term safety profile and apparent bidimensional radiographic signs of clinical performance under real-world conditions, rather than definitive evidence of effectiveness. Further controlled studies incorporating histological and volumetric analyses are warranted to confirm its regenerative potential. Full article

Background/Objectives: Extraforaminal lumbar interbody fusion provides indirect decompression without entering the spinal canal, but its uptake has been limited by poor visualization and risk of exiting nerve root injury. We describe a minimally invasive exoscopic extraforaminal lumbar interbody fusion (exELIF) technique and evaluate its clinical and radiological outcomes. This study aims to describe the exELIF technique and report its early clinical and radiological outcomes. Methods: Twenty-six patients with lumbar degenerative diseases underwent exELIF using a 3D exoscope (ORBEYE). The procedure was performed through bilateral 30–40 mm posterior incisions. Clinical outcomes were assessed using the Japanese Orthopedic Association score preoperatively and at 1-year follow-up. Postoperative computed tomography evaluated interbody fusion. Operative time, blood loss, and complications were recorded. Results: Mean operative time was 131 ± 51 min, and mean estimated blood loss was 82 ± 99 mL. The mean JOA score improved from 15.2 ± 2.2 to 24.3 ± 2.6, with a mean recovery rate of 66% at 1 year. Interbody fusion was achieved in 96%. In an exploratory CUSUM analysis of 18 single-level fluoroscopy-guided cases, a transition in operative time was observed at approximately the 10th case; operative time and estimated blood loss decreased from 141.5 ± 39.2 min and 89.0 ± 77.8 mL in cases 1–10 to 80.1 ± 6.7 min and 21.2 ± 18.1 mL in cases 11–18 (p < 0.001 and p = 0.035, respectively), indicating a reduction of operative time with accumulated experience rather than a formally established learning curve. Three patients developed transient exiting nerve root symptoms that resolved spontaneously during follow-up. One patient at the L5/S level required revision surgery due to left L5 nerve root palsy caused by posterior migration of the bone graft; this complication led to a modification of the technique, with posterior bone grafting no longer performed at L5/S. Partial screw loosening was observed in 5 patients (19%), all of which were asymptomatic and required no additional intervention. Conclusions: ExELIF provides excellent visualization in deep surgical fields, allowing the use of conventional surgical instruments through minimally invasive incisions. This is an early feasibility report of a single-institution retrospective case series with a heterogeneous cohort and no control group; the present data therefore do not establish superiority over conventional or endoscopic ELIF. Within these limits, exELIF was associated with acceptable early clinical improvement and a high interbody fusion rate, and progressive reduction in operative time with experience suggests that it may be a technically feasible minimally invasive option for selected patients with lumbar degenerative disease and for revision surgery after lumbar decompression. Full article

As life expectancy for people living with human immunodeficiency virus (HIV) (PLWH) increases, long-term comorbidities, such as bone mineral density (BMD) loss, have emerged as significant clinical challenges. This study evaluated the prevalence and determinants of skeletal demineralization in a contemporary Romanian HIV cohort. A cross-sectional study was conducted among 180 PLWH (mean age 41.86 ± 12.69 years) undergoing stable antiretroviral therapy. Bone health was assessed via dual-energy X-ray absorptiometry (DXA), while body composition and metabolic status were evaluated using bioelectrical impedance analysis (BIA) and serum lipid profiling. A high prevalence of reduced skeletal mass (58.3%) was observed, with 10% of the cohort diagnosed with osteoporosis at a mean age of only 45.7 years. Significant correlations were identified between osteoporosis and a history of AIDS, active smoking, and hypertriglyceridemia. Notably, women with osteoporosis exhibited significantly lower current CD4+ T-cell counts (268.4 ± 180.5 cells/μL) compared to those with normal BMD. While the body mass index was an inconsistent predictor of bone health, BIA-derived bone mass effectively identified subclinical depletion. Our findings underscore a phenotype of premature skeletal aging in PLWH, driven by an interplay of immunological history, metabolic disturbances, and lifestyle factors. Early screening via DXA and BIA, alongside aggressive management of modifiable risks, is essential for mitigating fragility fractures in this aging population. Full article

Background/Objectives: Mandibular reconstruction following ablative oral surgery is particularly challenging in elderly patients due to comorbidities and reduced physiological healing potential. While vascularized bone flaps represent the gold standard, the combination of an anterolateral thigh (ALT) flap and a bone reconstruction metallic plate may be considered as a less invasive alternative. This systematic review aimed to evaluate the effectiveness of such reconstructive techniques, in terms of success rate and complication rate, in patients aged over 55. Methods: Studies were included if the sample size consisted of at least 20 patients undergoing mandibular reconstruction with an ALT flap and plate following oral cavity resection for benign or malignant conditions. Studies were excluded if relevant outcomes were not reported and the mean age was <55 years. An electronic search was conducted in PubMed, Scopus, Web of Science and Embase. The last search was made on 26 February 2026. Data extracted included patient demographics, clinical outcomes and postoperative plate-related and overall complications. Risk of bias assessment was undertaken using the Joanna Briggs Institute tool for cohort studies and case series. Proportional meta-analysis was conducted to estimate the overall clinical success and the complication rate. Results: Of the 525 studies initially screened, four studies including a total of 329 patients (292 males, 37 females) with an overall mean age > 55 years were included. Mean hospital stay ranged from 10 to 24 days. The overall clinical success rate of the ALT flap procedure was 97% (95% confidence intervals (CIs): 92%, 99%). Flap-related complications were rare, with flap loss reported in only one patient and partial necrosis or failure affecting up to 6.6% of cases. Conversely, the overall plate-related complications rate was 28% (95% CI: 15%, 41%), with plate exposure rates ranging from 10% to 38.7% in the included studies. Wound complications, including infection and fistula formation, ranged from 20% to 38.7% of patients. Conclusions: In patients over 55, despite the not negligible rate of complications, the use of ALT flaps and reconstruction plate represents a viable alternative to vascularized bone flaps for mandibular reconstruction, particularly when comorbidities or frailty preclude more complex procedures. Further studies with a large sample size are needed to validate these findings and guide clinical decision-making. Full article

Background/Objectives: Sarcopenia and impaired bone quality are increasingly recognized as important determinants of outcomes after liver transplantation (LT). However, longitudinal data describing early post-transplant musculoskeletal changes in patients with chronic hepatitis B virus (HBV) infection, particularly according to hepatocellular carcinoma (HCC) status, remain limited. Aim: To evaluate longitudinal changes in skeletal muscle mass and vertebral bone attenuation after LT in patients with chronic HBV infection and to assess the impact of concomitant HCC and clinical subgroups on these patterns. Methods: This retrospective, single-center study included 99 adult patients who underwent LT for chronic HBV infection (HBV alone, n = 59; HBV + HCC, n = 40) between January 2018 and December 2024. Contrast-enhanced abdominal computed tomography examinations obtained before transplantation and at approximately 6 (POD180) and 12 months (POD365) after transplantation were analyzed. Skeletal muscle was assessed using psoas muscle area (PMA) and psoas muscle index (PMI), while bone quality was evaluated using mean vertebral trabecular attenuation averaged across L1–4. Longitudinal changes were examined according to HCC status, sex, Child–Pugh class, and survival status. Results: Repeated-measures analyses of longitudinal changes demonstrated a significant decline in both PMA and PMI at POD180 and POD365 compared with pre-transplant values (PMA: p = 0.006; PMI: p = 0.009). These patterns were comparable between patients with HBV alone and those with HBV-related HCC, with no significant differences between groups (all p > 0.05). Male patients consistently exhibited higher PMA and PMI values than female patients across all assessed time points (both p < 0.001). In contrast, neither Child–Pugh class nor mortality status was associated with differences in PMA or PMI levels (all p > 0.05). L1–4 attenuation declined markedly by POD180 and remained below baseline at POD365 (p < 0.001). Although overall L1–4 values did not differ between disease groups (p = 0.109), the temporal pattern of L1–4 change differed according to survival status (p = 0.026), with a greater decline observed in non-survivors. Conclusions: In patients with chronic HBV undergoing LT, early post-transplant loss of skeletal muscle and vertebral bone attenuation is common and persists throughout the first year of follow-up. These changes occur similarly in patients with and without HCC. CT-based assessment of muscle and bone parameters, particularly L1–4 attenuation, may therefore support early post-transplant risk stratification. Full article

Background/Objectives: Chronic otitis media with effusion (OME) is the primary cause of conductive hearing loss in children. High recurrence rates following conventional surgery are often linked to incomplete nasopharyngeal clearance or persistent adenotonsillar biofilms. This study evaluates the long-term impact of endoscopic coblation adenotonsillotomy on middle ear clearance and disease recurrence compared to conventional curettage adenoidectomy. Methods: We conducted a prospective comparative study on 142 pediatric patients with persistent OME. Participants were allocated into Group A (Endoscopic Coblation Adenotonsillotomy, n = 72) and Group B (Conventional Curettage Adenoidectomy, n = 70). Groups were homogeneous regarding age, gender, and baseline audiological parameters (p > 0.05), all presenting with moderate conductive hearing loss and Type B/C tympanograms. Primary outcomes included tympanometric normalization (Type A conversion), auditory gain (Air–Bone Gap closure), and the rate of secondary ventilation tube (VT) insertion, monitored at 1, 3, 6, and 12 months. Results: At the 1-month follow-up, Group A showed a higher normalization rate than Group B (75.0% vs. 60.0%), though this was near the threshold of statistical significance (p = 0.058). However, at 3, 6, and 12 months, the coblation group demonstrated significantly higher recovery rates (p < 0.05). By 12 months, 94.4% of Group A maintained a Type A tympanogram compared to 78.5% in Group B. Group A achieved a significantly lower mean ABG at 12 months (8.2 ± 3.1 dB vs. 12.6 ± 5.4 dB, p < 0.001), reflecting a superior auditory gain (20.2 dB vs. 15.3 dB). Furthermore, the recurrence rate was significantly lower in Group A (4.1% vs. 15.7%, p = 0.021), resulting in a substantially lower requirement for secondary VT insertion compared to the conventional group (2.7% vs. 12.8%, p = 0.018). Conclusions: Endoscopic coblation adenotonsillotomy provides significant long-term clinical advantages over conventional curettage. By ensuring precise, atraumatic clearance of the Fossa of Rosenmüller and addressing the tonsillar biofilm reservoir, this technique achieves more stable middle ear aeration and superior auditory recovery, significantly reducing the necessity for secondary surgical interventions at one year. Full article

Objectives: The aim of this retrospective study was to evaluate the long-term clinical and radiographic performance of zirconia dental implants with one-piece and two-piece configurations supporting single-tooth restorations. The primary outcome was implant survival, while the secondary outcome was the assessment of interproximal marginal bone loss (MBL) over time. Materials and methods: A total of 67 implants placed in 55 patients were included, with a mean follow-up of 60.6 months. Forty-five implants were one-piece systems and twenty-two were two-piece systems. All surgical and prosthetic procedures were performed by the same operator, following the manufacturer’s recommendations. Final restorations were delivered three months after implant placement. Marginal bone levels were assessed radiographically at the time of definitive prosthesis delivery (T0) and at the last follow-up examination (T1). Statistical significance level was set at 5% (α = 0.05). Results: The overall implant survival rate was 100% in both groups. One-piece implants showed higher initial MBL values than two-piece implants; however, bone level changes over time were limited in both configurations, with no significant intra-group differences between T0 and T1. Conclusions: Both implant configurations showed excellent clinical and radiographic outcomes, with a 100% survival rate and limited marginal bone loss during long-term follow-up. Marginal bone levels appeared to be influenced more by implant neck design than by implant configuration, suggesting that zirconia implants with a smooth transmucosal design may represent a reliable metal-free option for single-tooth rehabilitation in properly selected patients. Full article

Alveolar osteitis (AO) and postoperative pain are common complications after dental extractions. Excessive fibrinolysis leading to premature clot loss contributes to AO. Tranexamic acid (TXA), an antifibrinolytic agent, may stabilize post-extraction blood clots and reduce AO, although evidence from randomized controlled trials (RCTs) remains inconsistent. This systematic review and meta-analysis evaluated the effectiveness of topical TXA in preventing AO and reducing postoperative pain following dental extractions. PubMed, Embase, Scopus, and CENTRAL were searched from inception to June 2025 using terms related to “dental extraction” and “tranexamic acid”. Only English-language human studies were included. Eligible studies were RCTs assessing topical TXA versus placebo, saline, or plain gauze, reporting AO and/or pain outcomes. Non-RCTs, in vitro or animal studies, and trials lacking relevant outcomes or controls were excluded. Two reviewers independently screened and selected studies. Following PRISMA guidelines, two reviewers extracted data and assessed risk of bias with the Cochrane RoB-2 tool. Pooled analyses used random-effects models, with risk ratios (RRs) for AO and standardized mean differences (SMDs) for pain. AO was defined as exposed bone, foul odor, or persistent pain after day 3. Pain was measured on the Visual Analogue Scale (VAS) on days 3 and 7. Five RCTs (378 patients) were included. TXA significantly reduced AO incidence compared with controls (RR = 0.49; 95% CI: 0.32–0.76; p = 0.001; I² = 0%), indicating a ~50% risk reduction. Pain outcomes showed no significant differences on day 3 (SMD = −0.36; 95% CI: −0.95 to 0.24; p = 0.24; I² = 84%) or day 7 (SMD = −0.43; 95% CI: −1.34 to 0.48; p = 0.36; I² = 93%). Topical TXA significantly reduces the risk of AO after dental extraction, while its effect on postoperative pain remains inconsistent. Its safety, accessibility, and low cost support its use as a preventive adjunct in dental extractions. Further standardized, high-quality RCTs are needed to clarify its role in pain management. Full article

This study introduces a novel approach for optimizing models that reconstruct high-quality full-dose bone scintigraphy images from their 40% low-dose counterparts using optimized attention-based U-Net architectures. We utilized Genetic and Epigenetic Algorithms (epiGA) hyperparameter optimization of two distinct models: a standard Attention U-Net and an Attention U-Net modified with ResNet blocks. Models were trained using a hybrid Mean Squared Error and Structural Similarity (MSE/SSIM) loss function. Obtained results demonstrated superior performance, achieving an average SSIM of 0.9197 and an average Peak Signal-to-Noise ratio (PSNR) of 34.1516 dB, significantly surpassing the baseline low-dose image quality, by gaining ΔSSIM = 0.0333 and ΔPSNR = 3.0729 dB, due to hyperparameter optimization. Comparative benchmarks against Bayesian optimization revealed that epiGA offers superior search efficiency—exploring twice the architecture space in comparable wall-clock time—while consistently identifying more compact, hardware-efficient solutions. These results highlight the effectiveness of integrating epigenetic mechanisms for robust, scalable hyperparameter tuning in medical image reconstruction. Full article