Search Results (1,451)

Background/Objectives: Diabetic neuropathy (DN) is a prevalent complication of diabetes mellitus, affecting up to 50% of long-term patients and causing significant pain, reduced quality of life, and healthcare burden. Conventional treatments, including anticonvulsants, antidepressants, and opioids, offer limited efficacy and are associated with adverse effects. Emerging evidence suggests that cannabis, acting via the endocannabinoid system, may provide analgesic and neuroprotective benefits. This study evaluates the long-term effects of inhaled cannabis as adjunctive therapy for refractory painful DN. Inhaled cannabis exhibits rapid onset pharmacokinetics (within minutes, lasting 2–4 h) due to pulmonary absorption, targeting CB1 and CB2 receptors to modulate pain and inflammation. Methods: In this prospective, observational study, 52 patients with confirmed painful DN, unresponsive to at least three prior analgesics plus non-pharmacological interventions, were recruited from a single clinic. Following a 1-month washout, patients initiated inhaled medical-grade cannabis (20% THC, <1% CBD), titrated individually. Assessments occurred at baseline and annually for 5 years, including the Brief Pain Inventory (BPI) for pain severity and interference; the degree of pain relief; Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) score; HbA1c; and medication usage. Statistical analyses used repeated-measures ANOVA, Kruskal–Wallis tests, Welch’s t-tests, and Pearson’s correlations via Analyze-it for Excel. Results: Of 52 patients (mean age 45.3 ± 17.8 years; 71.2% male; diabetes duration 23.3 ± 17.8 years), 50 completed follow-up visits. Significant reductions occurred in BPI pain severity (9.0 ± 0.8 to 2.0 ± 0.7, p < 0.001), interference (7.5 ± 1.7 to 2.2 ± 0.9, p < 0.001), LANSS score (19.4 ± 3.8 to 10.2 ± 6.4, p < 0.001), and HbA1c (9.77% ± 1.50 to 7.79% ± 1.51, p < 0.001). Analgesic use decreased markedly (e.g., morphine equivalents: 66.8 ± 49.2 mg to 4.5 ± 9.6 mg). Cannabis dose correlated positively with pain relief (r = 0.74, p < 0.001) and negatively with narcotic use (r = −0.43, p < 0.001) and pain interference (r = −0.43, p < 0.001). No serious adverse events were reported; mild side effects (e.g., dry mouth or euphoria) occurred in 15.4% of patients. Conclusions: Inhaled cannabis showed sustained pain relief, improved glycemic control, and opioid-sparing effects in refractory DN over 5 years, with a favorable safety profile. These findings are associative due to the observational design, and randomized controlled trials (RCTs) are needed to confirm efficacy and determine optimal usage, addressing limitations such as single-center bias and small sample size (n = 52). Future studies incorporating biomarker analysis (e.g., endocannabinoid levels) could elucidate mechanisms and enhance precision in cannabis therapy. Full article

Background and Objectives: Plantar fasciitis is one of the most common foot pathologies, and its diagnosis and clinical follow-up increasingly rely on the use of ultrasound. The aim of this study is to compare the reliability of ultrasound measurements of plantar fascia thickness between an expert technician, with more than 5 years of ultrasound experience, and a novice technician, with no prior ultrasound experience—both of whom are podiatrists. This allows us to assess whether operator experience significantly influences the results. Methods: An observational, descriptive, and cross-sectional study was designed with a sample of 60 healthy patients aged between 20 and 32 years. The thickness of the plantar fascia in both feet was measured using ultrasound. Each patient was evaluated by two observers (one expert and one novice) using a Vinno E35 ultrasound machine. Results: The results of the analysis indicated that there were no statistically significant differences in the measurements obtained either between the two technicians or between the left and right feet of the same individual, as the calculated p-value in both cases was greater than the conventional threshold of 0.05. This suggests that the measurements were consistent regardless of the operator or the side being evaluated. Nevertheless, when examining the differences in the time required to measure the plantar fascia between the two technicians, the situation was different. In this case, the data distribution did not meet the assumption of normality, as evidenced (p-value of less than 0.001). Furthermore, it was observed that the experienced technician not only completed the measurements in a shorter amount of time but also demonstrated less variability in those times, indicating a more efficient and standardized approach to the procedure. In contrast, the novice technician initially took longer and exhibited greater inconsistency; however, as the study progressed, a noticeable and progressive learning effect became apparent. Specifically, from approximately the midpoint of the study onward, the novice technician showed a significant improvement, achieving faster and more consistent measurement times compared to the earlier stages of the research. Conclusions: The study demonstrates that ultrasound measurements of the plantar fascia are consistent between technicians. However, the expert technician performs the measurements with greater speed and precision, and a learning effect is evident in the novice technician. Full article

Background: Hand function is critical for daily living, occupational performance, and sports. Optimal training approaches for healthy adults remain unclear. Objective: To evaluate the effects of hand-focused strength and proprioceptive training on grip strength, pinch strength, manual dexterity, maximum voluntary contraction, joint position sense, and force sense in healthy younger and older adults. Methods: PubMed, Google Scholar, Semantic Scholar, Web of Science, Cochrane CENTRAL and registers were searched until July 2025 for randomized controlled trials (RCTs) involving adults (≥18 years) without upper limb dysfunction. Studies with clinical populations, single-session interventions, or lacking pre–post outcome data were excluded. Risk of bias was assessed using the Cochrane RoB 2 tool. Random-effects meta-analyses (Hedges’ g) pooled pre–post change score differences for each outcome; subgroup analyses examined age, training type, and comparator. Results: Twenty-two RCTs (n = 1017 participants; 19–78 years) met the inclusion criteria. Strength and proprioceptive training produced a small-to-moderate improvement in grip strength (g = 0.44, 95% CI [0.23–0.64], 95%PI [–0.09, 0.96]) and a large improvement in manual dexterity (g = 1.11, 95% CI [0.52–1.71], 95%PI [–0.01, 2.23]). Effects on pinch strength were positive but non-significant (g = 0.63, 95% CI [–0.09–1.35], 95%PI [–1.38, 2.63]) and showed substantial heterogeneity. Moderator analyses indicated greater effects in older adults (g = 0.97) compared to younger adults (g = 0.18). Strength-only protocols showed significant effects, while combined protocols yielded smaller, non-significant effects; however, the difference between them was not statistically significant. Effects were also larger when compared with passive controls than with untrained hands. Limitations: Evidence quality was limited by high risk of bias, measurement variability, and small study numbers for some outcomes. Conclusions: Strength-focused hand training, particularly in older adults, yields meaningful improvements in grip strength and dexterity. Further high-quality RCTs are needed for under-studied outcomes. Full article

Background/Objectives: This study is part of an exploratory mixed-methods project investigating how companies and their employees in Germany dealt with adapted working conditions during the COVID-19 pandemic. Here, we identify predictive factors for employees’ attitudes towards the suitability of work-related technical, organisational, and personal SARS-CoV-2 infection control measures. Methods: In July 2021, when there was little evidence to suggest that the risk of work-related exposure to SARS-CoV-2 differed between occupations and workplaces, a standardised online and an optional paper-and-pencil survey were distributed across seven companies in southern Germany. Multivariate linear regression was used for analysis. Results: A total of 821 employees participated (average response rate: 24.5%). Most of the respondents (93%) worked in large companies, in the production industry (82%), with most of them having office jobs (82%). Around 29% reported doing most of their office work remotely during the pandemic. The perceived suitability of workplace infection control measures was rated quite high, with an overall mean score of 4.11 (SD 0.60) out of a possible 5. Workplace characteristics related to the COVID-19 pandemic as well as individual perception of SARS-CoV2 and COVID-19 in general were the most prominent predictors of attitudes towards the suitability of work-related SARS-CoV-2 infection control. For example, a higher COVID-19-specific reactance was negatively associated with attitudes towards technical (ß = −0.16), organisational (ß = −0.14), and personal (ß = −0.17) infection control measures (all p-values < 0.001). Furthermore, a higher rating of the employer’s commitment to occupational safety and health related to SARS-CoV-2, a higher individual disease perception, and a higher individual COVID-19-specific resilience had a positive association with attitudes towards the suitability of infection control measures. Finally, professional activity as well as company affiliation had statistically significant associations with employees’ attitudes towards the suitability of infection control measures. Conclusions: The results provide insight into factors relevant to pandemic prevention and control. In particular, our findings highlight the potential to implement organisational measures alongside compulsory technical occupational health measures. This could inform the development of pandemic preparedness strategies that prioritise adherence to established occupational infection control measures. Full article

Background/Objectives: The execution of clinical trials is increasingly constrained by operational complexity, regulatory requirements, and variability in site performance. These challenges have direct implications for the reliability of trial outcomes. However, standardized methods to evaluate site-level performance remain underdeveloped. This study introduces the Clinical Trial Site Performance Measure (CT-SPM), a novel framework designed to systematically capture site-level operational quality and to provide a scalable short form for routine monitoring. Methods: We conducted a multicenter study across six Italian academic hospitals (January–June 2025). Candidate performance indicators were identified through a systematic review and expert consultation, followed by validation and reduction using advanced statistical approaches, including factor modeling, ROC curve analysis, and nonparametric scaling methods. The CT-SPM was assessed for structural validity, discriminative capacity, and feasibility for use in real-world settings. Results: From 126 potential indicators, 18 were retained and organized into four domains: Participant Retention and Consent, Data Completeness and Timeliness, Adverse Event Reporting, and Protocol Compliance. A bifactor model revealed two higher-order dimensions (participant-facing and data-facing performance), highlighting the multidimensional nature of site operations. A short form comprising four items demonstrated good scalability and sufficient accuracy to identify underperforming sites. Conclusions: The CT-SPM represents an innovative, evidence-based instrument for monitoring trial execution at the site level. By linking methodological rigor with real-world applicability, it offers a practical solution for benchmarking, resource allocation, and regulatory compliance. This approach contributes to advancing clinical research by providing a standardized, data-driven method to evaluate and improve performance across networks. Full article

Background and Objectives: This study aimed to compare gait patterns between young adults and physically active older adults. Additionally, the relation between these parameters and age was explored. Materials and Methods: Transversal case and control study, recruiting 81 participants divided into two groups: young adults (18–45 years) and physically active older adults (60+ years). Participants were assessed using the PodoSmart Insole^® system, which recorded spatiotemporal and kinematic gait data. Gait parameters were measured during a self-selected walking test. Data analysis included descriptive statistics, t-tests for group comparisons, and Pearson’s correlation to explore relationships between age and gait parameters. Results: Significant differences in gait parameters were found between young and older adults, particularly in stride length (right foot: p = 0.009, left foot: p = 0.001), cadence (p < 0.001), contact time (p < 0.001), swing time (p < 0.001), and support phase duration (p < 0.001), with moderate to large effect sizes. Sex differences were also observed within each group for several gait variables. Correlation analysis evidenced worsened parameters with increasing age, with moderate to strong associations in terms of cadence (r = −0.590), contact time (r = −0.504, r = −0.462), swing time (r = −0.662), and support phase duration (r = −0.524, r = −0.439). Conclusions: Evident differences in gait parameters are observed between young adults and active older adults. Although these results follow the trend of previous studies that employed more sophisticated lab-based protocols for gait analysis, slight differences between our study and these others could be attributed to the regular physical activity performed by these participants, which should be explored in more detail in future studies. Full article

Framed within the lens of systems theory and sociotechnical systems thinking, this systematic review examines telehealth as a complex adaptive system and dynamic health system shaped by the interactions between interconnected technological, social, and institutional components. Recognizing telehealth as part of a complex adaptive system, the review identifies how interdependent factors, such as digital literacy, connectivity, and policy, evolve and influence access to and the emergent properties of care. A systematic review was conducted following the PRISMA 2020 guidelines and PROSPERO registration (CRD420251103608), analyzing 42 peer-reviewed articles published between January 2020 and June 2025, identified through the MEDLINE, Web of Science, EBSCOhost, ACM Digital Library, PsycINFO, and Scopus databases. Key findings include sustained but reduced telehealth use after the pandemic peak, as well as a small yet statistically significant positive effect of telehealth interventions on cognitive emergent properties, defined here as measurable outcomes like memory, attention, executive function, and processing speed (SMD = 0.29; 95% CI [0.04, 0.54]) with very low heterogeneity (I² = 0%). Significant system components such as digital illiteracy, poor internet connectivity, and complex technology interfaces disproportionately affected economically disadvantaged, minority, and rural older adults. Practical strategies rooted in systems thinking include digital literacy programs, simplified interfaces, caregiver support, improved broadband infrastructure, hybrid healthcare models, and supportive policies. Future research should focus on evidence-based, system-level interventions across diverse settings to bridge the digital divide and promote equitable access to telehealth for older adults. Full article

The applications of electromagnetic (EM) field treatment on water in agriculture have garnered increasing attention as a sustainable method to enhance plant growth, water-use efficiency, and metabolic performance. A growing body of evidence suggests that exposure to EM fields can affect water molecules, possibly by influencing hydrogen bonding dynamics, the structuring of water clusters, and electrokinetic properties of the water molecules. These alterations are thought to correlate with plant physiological performance. The methodology of the study was divided into two parts. The first part focused on the preparation of electromagnetically treated water. The second part involved applying this treated water to spinach plants. The present study investigates the physiological responses of Spinacia oleracea L. to irrigation with electromagnetically treated water (EMTW), focusing on elucidating the potential mechanisms that may underlie the observed effects. EMTW was generated using a solenoid-based system operating in dual-frequency ranges (100–1000 Hz and 10–100 kHz), which has been previously shown to influence both the microbiological and electrokinetic properties of aqueous systems. To evaluate the structural and functional implications of EMTW, a combined methodological approach was employed, integrating proton nuclear magnetic resonance (¹H-NMR) spectroscopy, density functional theory (DFT) modeling of water hydrogen bonds and clusters, and comprehensive plant physiological assessments. Plants were cultivated under both controlled and field conditions to assess consistency across environmental settings. Physiological measurements demonstrated that EMTW irrigation increased photosynthetic rate by ~80%, transpiration by 49–67%, stomatal conductance by 78–129%, intercellular CO₂ concentration by 42–80%, and chlorophyll content by 9.3–9.5% compared to control samples. Additionally, phenoloc and flavonoid contents were elevated by 7.4% and 7.6%, respectively, in field-grown plants. These enhancements were statistically significant (p < 0.001 or p < 0.01) under both laboratory and field conditions, confirming the robustness of the observed effects. Full article

This study evaluates the economic dimension of sustainable supply chain efficiency among Korean automotive suppliers using an SCOR-aligned two-stage Network Range-Adjusted Measure (NRAM) Data Envelopment Analysis (DEA) model. The framework separates performance into Stage 1 (internal operations: Plan/Source/Make/Deliver) and Stage 2 (external outcomes: sales and profitability), enabling stage-specific assessment of operational versus market-facing efficiency. Firm-level financial data for about 1200 suppliers annually from 2021 to 2024, spanning five sectors, were analyzed with descriptive statistics, visualizations, and non-parametric tests. Results show that Stage 1 efficiency was consistently high and stable, while Stage 2 efficiency was lower, more variable, and declined in 2022 and 2024, revealing vulnerability to systemic market disruptions. Overall efficiency mirrored Stage 2, underscoring the fact that downstream financial outcomes drive total performance. Rather than introducing a new methodology, the contribution of this study lies in applying an established two-stage NRAM DEA within an SCOR-aligned framework to a large-scale longitudinal dataset. This application provides sectoral and temporal benchmarks on a national scale, offering evidence-based insights into how structural interdependence and systemic shocks influence supply chain efficiency. While the scope is limited to the economic pillar of sustainability, the findings contribute contextualized benchmarks that can inform managerial practice and future research integrating environmental and social performance dimensions. Full article

Background: Depression is a significant public health concern, with working mothers at greater risk due to combined biological and psychosocial stressors. Recent evidence suggests that inner strength may play a mediating role in the link between biological risks and depression. Objectives: The primary objective was to determine whether inner strength mediates the relationship between biological risk factors (hormonal fluctuations, smoking, alcohol use, family psychiatric history, and physical diseases) and depressive symptoms among Chinese working mothers. A secondary objective was to assess the prevalence of depressive symptoms in this population, measured with the OI-Depression subscale (Outcome Inventory-21). Methods: A cross-sectional online survey was conducted with 330 Chinese working mothers aged 30–45 years, using validated instruments to measure depression, inner strength, and parental stress. Mediation analysis evaluated the indirect effect of inner strength, while covariate-adjusted regression analyses explored associated factors. Results: Biological risk factors showed a significant direct effect (β = 0.584, p < 0.001) and an indirect effect through inner strength (indirect effect = 0.623, 95% CI [0.294, 0.962]. The Sobel test indicated that the indirect effect of biological risk factors on depressive symptoms through inner strength was statistically significant (z = 3.67, p < 0.001). The prevalence of clinically significant depressive symptoms was 38.2%. Conclusions: Biological factors significantly contribute to depressive symptoms, but inner strength partially mediates this relationship, suggesting that interventions to enhance inner strength may help reduce depression risk in working mothers. Further research should investigate strategies to build inner resilience in this population. Full article

Cover crops provide soil cover benefits but can impose allelopathic risks on cotton. We evaluated the functional trade-offs of rye and wheat residues versus purified 2-benzoxazolinone (BOA) under greenhouse conditions. Four experiments applied graded residue or BOA inputs in Pullman clay loam; cotton germination, height, chlorophyll (SPAD), and biomass were measured, and soil BOA, DIBOA, and DIMBOA were quantified by HPLC at designated sampling dates. Responses were dose dependent: BOA reduced germination linearly (−16.5% at 1000 nmol g⁻¹ versus control) and shortened plants, and biomass and SPAD were directionally lower, most evident at 500 nmol g⁻¹, but not statistically significant. Rye showed hormesis at 6400 kg ha⁻¹ (+7.3% germination) and strong inhibition at 12,800 kg ha⁻¹ (−31% germination; biomass up to −45%). Wheat produced intermediate inhibition (biomass −23.7%) and did not affect germination. In soil, benzoxazinoids exhibited significant rate effects at specific sampling dates followed by rapid decline. After storage, BOA showed no residual effects, whereas prior rye still reduced height, SPAD, and biomass. Framed at the agroecosystem scale, maintaining residue biomass below inhibitory thresholds and adjusting termination-to-planting intervals to avoid the early post-termination period, together with species or cultivar choice, can reconcile soil cover services with reliable cotton establishment. Full article

Background: Degenerative lumbar spine disease is a prevalent cause of chronic low back pain that significantly impairs daily function and quality of life. While conservative management is the first line of treatment, many patients ultimately require instrumented lumbar spine surgery. However, postoperative outcomes vary considerably, with emerging evidence suggesting that preoperative psychological factors such as anxiety, depression, and pain catastrophizing may influence recovery. The SAP-LD (Scale for Anxiety and Pain in Lumbar Degeneration) study was designed to assess the prognostic role of these psychological and physical parameters in surgical outcomes. Methods: This prospective observational study enrolled 70 adult patients with degenerative lumbar spine pathology scheduled for instrumented surgical treatment at the University of Brescia and ASST Spedali Civili di Brescia between March and December 2024. Preoperative assessments included demographic, clinical, and radiologic data along with validated scales: the Oswestry Disability Index (ODI), 36-Item Short Form Health Survey (SF-36), Visual Analogue Scale (VAS), Pain Catastrophizing Scale (PCS), and Hospital Anxiety and Depression Scale (HADS). Follow-up evaluations were performed at 45 days and at 6 months, and statistical analyses were conducted using correlation tests, ANOVA, and regression modeling. Results: The demographic analysis of the 70 enrolled patients shows a balanced gender distribution (38 females, 34 males) with a mean age of 61 years (range 23–81). The educational level distribution indicates that the majority of patients (44.29%) have a secondary education level, while 35.71% have a tertiary education level. Regarding employment status, 50% of the patients are retired or not working. Patients with clinically significant anxiety and/or depression showed higher levels of perceived pain, pain catastrophizing, and disability at baseline. These patients reported significantly worse scores on the Visual Analogue Scale (VAS), Pain Catastrophizing Scale (PCS), and Oswestry Disability Index (ODI). The Oswestry Disability Index (ODI) demonstrates a clinically significant improvement (reduction) in disability between the preoperative period (t0) and the 45-day follow-up (t2), with the median decreasing from 39.00 to 13.00. However, there is a partial regression at the 6-month follow-up (t3), with the median increasing to 27.00. For the SF-36 Health Survey, the General Health subscale shows an improvement between t0 and t2 (median increasing from 55.00 to 60.00), followed by a slight decrease at t3 (median 55.00). Similar patterns are observed in most other subscales, with initial improvement followed by partial regression. The Pain Catastrophizing Scale (PCS) shows a substantial reduction in catastrophizing between t0 and t2 (median decreasing from 16.00 to 3.00), followed by an increase at t3 (median 11.00), though still below baseline levels. Pain intensity as measured by the Visual Analogue Scale (VAS) shows a significant reduction at t2 (median decreasing from 5.00 to 3.00), but increases again at t3 (median 6.00), even exceeding the preoperative level. For the Hospital Anxiety and Depression Scale (HADS), no significant differences were observed across time points, with values indicating mild symptoms throughout the study period. Correlation analyses confirmed that higher preoperative anxiety and depression scores were predictive of poorer postoperative outcomes. Specifically, higher HADS scores at baseline are associated with higher ODI scores (increased disability) at all time points (p = 0.002), higher VAS scores (increased pain) at all time points (p = 0.015), and lower scores on SF-36 subscales, particularly Emotional Well-being (p = 0.00023) and Social Functioning (p = 0.002). Higher PCS scores at baseline are associated with higher ODI scores at all time points (p = 0.001), higher VAS scores at all time points (p = 0.008), and lower scores on SF-36 subscales, particularly Pain (p = 0.00023) and Physical Functioning (p = 0.04254). The mixed linear models analysis confirms these findings, showing that the ODI score decreases significantly between t0 and t2 (p = 0.00023) and increases between t2 and t3, though this increase is not statistically significant (p = 0.079). For VAS scores, there is a significant decrease between t0 and t2 (p = 0.00023) and a significant increase between t2 and t3 (p = 0.04254). Patients with elevated preoperative HADS scores tended to have slower recovery trajectories and reported lower satisfaction levels. These findings reinforce the prognostic value of psychological assessments in spine surgery and suggest that targeted psychological interventions could improve patient outcomes. Conclusions: By identifying psychological predictors of postoperative recovery, this study underscores the importance of integrating preoperative psychological screening into routine clinical practice. The results suggest that a multidisciplinary approach, including both surgical and psychological care, could enhance long-term functional outcomes and quality of life for patients undergoing instrumented lumbar spine surgery. Full article

Educational reforms increasingly require teachers to implement innovations, yet these efforts often remain unsustainable. Effective implementation is closely tied to continuous professional development and learning (CPDL). This study explores how a CPDL path supports the transition from current teaching practices to enhanced instructional methods that integrate a STEM innovation focused on improving students’ spatial ability—a critical cognitive skill linked to STEM success, especially in early education. While professional development (PD) can foster practices that support spatial thinking, few studies have examined how teacher learning translates into measurable student gains. This study evaluates the impact of a CPDL program that combined expert-led workshops with Lesson Study (LS), a collaborative and reflective approach. The program was tailored to 24 female STEM teachers whose profiles showed limited cognitively active learning opportunities for students. Pre- and post-intervention assessments measured changes in student performance across three spatial components: visualization, mental transformation, and orientation. Students in Grades 1–3 showed statistically significant gains (p < 0.00001), with the strongest improvement in spatial visualization. Grade 3 students made the largest relative gains, indicating developmental readiness. Findings highlight the value of stepwise preparation and leadership support in innovation implementation, offering strong empirical evidence that LS-based CPDL improves both teaching and student cognitive outcomes. Full article

Introduction (Objectives): This study aimed to evaluate the serological response to a fourth dose of mRNA COVID-19 vaccine in patients with conditions that confer a high risk of severe disease, particularly those with high-level immunosuppression. Methods: An observational study was conducted at the Ramón y Cajal University Hospital between February and August 2022. Adults (≥18 years) with high-risk conditions who had received four doses of either BNT162b2 or mRNA-1273 were included. Anti-spike IgG levels were measured ≥14 days post-vaccination. An adequate response was defined as an antibody concentration ≥260 BAU/mL. Results: A total of 943 patients were analyzed; 846 (89.7%) achieved an adequate response. In the bivariate analysis, patients aged 60–74 years had a higher risk of inadequate response compared to those aged 18–39 years (OR 1.824 vs. OR 0.257). Female sex was associated with a higher risk of inadequate response (OR 1.522; 95% CI: 0.974–2.371). In multivariable logistic regression, patients with high immunosuppression had a higher, though not statistically significant, risk of inadequate response compared with those without. Discussion: Our findings are consistent with international evidence suggesting that age and certain clinical factors reduce vaccine immunogenicity. The observed paradoxical effect of sex could reflect the higher prevalence of aggressive immunosuppressive therapies among women in the study cohort. Conclusions: Most immunosuppressed patients achieved seroconversion after the fourth dose. These results underscore the need for tailored vaccination strategies and additional measures in highly immunosuppressed subgroups. Full article

Background/Objectives: Osseointegration of titanium dental implants is essential for the long-term success of prosthetic treatments. Cold atmospheric pressure plasma (CAP) has recently emerged as a promising surface modification technique aimed at enhancing early osseointegration by improving implant surface properties and exerting antimicrobial effects. This systematic review aims to critically evaluate the in vivo preclinical evidence on the effects of CAP or similar cold plasma treatments on titanium dental implant surfaces with regard to osseointegration outcomes. Methods: A systematic literature search was conducted in PubMed and Scopus databases for preclinical in vivo studies published between 2005 and 2025 investigating the effects of cold plasma on titanium dental implant surfaces. The primary outcome assessed was the bone-to-implant contact (BIC), followed by secondary outcomes including implant stability quotient (ISQ), removal torque, bone area fraction occupancy (BAFO), peri-implant bone density (PIBD), interfacial bone density (IBD), bone-implant direct weight (BDWT) and bone loss measurements via histology and micro-CT. Risk of bias was evaluated using the SYRCLE Risk of Bias tool. Results: Nine eligible studies involving 310 titanium implants in 71 animal models (dogs, pigs and mice) were included. CAP-treated implants consistently demonstrated significant improvements in early osseointegration parameters compared to controls, with statistically significant increases in BIC (up to +20%), BAFO and biomechanical fixation metrics (removal torque and ISQ). Micro-CT analyses revealed enhanced peri-implant bone density and architecture. No adverse biological events or implant failures related to plasma treatment were reported. However, heterogeneity in plasma protocols, animal species and short follow-up durations (2–12 weeks) limited comparability and long-term interpretation. Conclusions: Preclinical evidence seems to support CAP as a safe and potentially effective surface treatment for enhancing early osseointegration of titanium dental implants. Further standardized long-term studies involving functional loading and clinical trials in humans are needed to confirm clinical efficacy and optimize treatment protocols. Full article