Search Results (3,571)

Background: Unilateral progressive condylar growth (UPCG) represents a complex clinical condition characterized by abnormal enlargement of the mandibular condyle, leading to progressive facial asymmetry and functional impairment. Objectives: The aim of this review is to analyze the biological, clinical, and therapeutic factors guiding condylectomy, assess the current role and scope of proportional condylectomy, and propose an algorithm to guide its indication in patients with UPCG. Methods: A narrative review was conducted to analyze the biological, clinical, and therapeutic factors involved in the indication for condylectomy in patients with progressive unilateral condylar growth. Studies including patients diagnosed with unilateral condylar hyperplasia or condylar osteochondroma who underwent surgical treatment were considered to evaluate clinical indications, timing of intervention, and outcomes. Special attention was given to the concept of proportional condylectomy. Results: Current evidence indicates that early intervention may control disease progression, reduce the severity of residual deformity, and minimize the need for secondary orthognathic surgery. The integration of clinical findings, three-dimensional imaging, and patient-specific factors is essential for appropriate treatment planning. Conclusions: Based on these considerations, a structured clinical algorithm is proposed to guide decision-making in patients with unilateral progressive condylar growth. This approach supports individualized treatment strategies aimed at optimizing functional and esthetic outcomes. Full article

Background/Objectives: Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive intervention for overactive bladder (OAB) typically utilized in patients for whom behavioural and pharmacological therapies do not work. The aim of this study is to identify predictors of progression to alternate minimally invasive treatment options following PTNS in patients with OAB refractory to medical and behavioural therapy. In addition, the aim of this study is to determine predictors of maintenance therapy after completing PTNS induction. Methods: This study is a retrospective cohort analysis of patients that underwent PTNS between March 2018 and June 2023 for management of overactive bladder. The primary outcome of this study is progression to alternate minimally invasive treatment options following PTNS, such as sacral neuromodulation or intradetrusor onabotulinum toxin injections. The secondary outcome of this study is the continuation of maintenance therapy following the initial 12-week PTNS treatment course. Results: A total of 49 patients were included for analysis. Overall, 33% (16/49) of patients had further alternate minimally invasive treatment. Multivariate logistic regression analysis identified only age (OR = 1.06; p = 0.05) as a significant predictor of progression to alternate minimally invasive OAB treatment following PTNS. Overall, 27 (55%) patients continued with ongoing monthly maintenance PTNS after completing initial weekly treatment for OAB. Multivariate logistic regression only identified sex as a predictor of ongoing maintenance PTNS (OR = 13.2; p = 0.017). Conclusions: The present study identifies younger age as a significant predictor of progression to further minimally invasive OAB treatments after PTNS. Furthermore, female sex was found to be a significant predictor of ongoing maintenance PTNS. Full article

Artificial intelligence (AI) is increasingly integrated into emergency general surgery (EGS), where rapid diagnosis, accurate decision-making, and timely intervention are essential for improving patient outcomes. Recent advances in machine learning, deep learning, computer vision, and predictive analytics have enabled AI-assisted systems to support clinicians throughout the perioperative workflow. Current applications include radiologic image interpretation, diagnosis of acute abdominal conditions, surgical workflow recognition, intraoperative anatomical guidance, postoperative complication prediction, and intensive care monitoring. AI technologies may improve diagnostic accuracy, optimize operative planning, enhance surgical safety, and facilitate personalized perioperative management. In minimally invasive surgery, computer vision and real-time data analysis have shown promising results for intraoperative decision support and surgical education. However, important limitations remain, including concerns regarding data quality, algorithm transparency, ethical governance, regulatory approval, and implementation disparities between healthcare systems. In addition, much of the current evidence is derived from retrospective or highly specialized datasets, limiting broad clinical applicability. This narrative review summarizes the current clinical applications of AI in emergency general surgery and discusses emerging technologies, existing challenges, and future perspectives regarding the integration of AI into acute surgical care. Full article

The rapid integration of artificial intelligence (AI) technologies into educational contexts has introduced innovative instructional approaches, particularly within Science, Technology, Engineering, and Mathematics (STEM) education. Although an increasing number of empirical studies have examined AI-supported instruction, existing findings remain heterogeneous, making it difficult to draw firm conclusions about its overall effectiveness. This study aims to systematically synthesize experimental and quasi-experimental research on AI-supported instructional interventions in STEM education, quantify their overall effects on student learning outcomes, and examine potential moderating factors, including educational level, STEM discipline, and intervention duration. A comprehensive systematic literature search was conducted across Web of Science, Scopus, ERIC, ScienceDirect, and Google Scholar, covering studies published between 2005 and 2025. A total of 35 studies meeting predefined inclusion criteria were included in the meta-analysis. Effect sizes were calculated using Hedges’ g, and a Random Effects Model (REM) was employed to account for heterogeneity among studies. Moderator analyses were conducted for educational level, STEM discipline, and intervention duration. Publication bias was assessed using multiple diagnostic methods. The meta-analysis revealed a statistically significant overall positive effect of AI-supported instruction on student learning outcomes in STEM education (g = 0.67, 95% CI [0.49, 0.85], p < 0.001). Moderator analyses indicated that AI interventions were most effective at the high school level. Although Science and Mathematics disciplines showed slightly higher effect sizes, the between-group difference was not statistically significant (Q = 4.85, df = 2, p = 0.088). Regarding intervention duration, the highest effect size was observed in interventions lasting more than one month and up to two months, though no consistent pattern of increasing effectiveness with longer durations was found. Publication bias analyses suggested minimal influence on the overall findings. AI-supported instructional interventions demonstrate a moderately to highly positive impact on student learning outcomes in STEM education. The effectiveness of these interventions varies according to educational level, disciplinary context, and intervention duration. These findings provide robust empirical evidence supporting the pedagogical value of AI in STEM education and offer guidance for educators and policymakers regarding effective implementation. Full article

Background: Endoscopic spine surgery (ESS) is an established minimally invasive approach for degenerative spinal conditions. Advances in instrumentation and visualization have expanded its application to spinal tumor resection. This review synthesizes reported clinical outcomes and technical considerations of ESS for primary spinal tumors. Methods: PubMed was queried from 2000 to 2025 for studies reporting endoscopic resection of primary spinal tumors. Studies involving metastatic disease or non-resective interventions were excluded. Data were descriptively analyzed given heterogeneity and limited sample size. Results: Eleven patients across seven studies were included (mean age = 50.3 years). Pathologies comprised schwannoma (n = 5), meningioma (n = 3), osteoid osteoma (n = 2), and Ewing sarcoma (n = 1). Seven tumors were intradural extramedullary (63.6%) and four were extradural (36.4%); no intramedullary lesions were included. Of the seven intradural cases, one was performed via uniportal full-endoscopic technique, one via biportal endoscopy, and five via tubular retractor-assisted endoscopy. Across all eleven patients, gross total resection was achieved in 90.9% of cases. Gross total resection was achieved in 100% of cases in which it was the operative intent (10/10); the remaining case was a planned biopsy of recurrent Ewing sarcoma. One transient postoperative lower extremity weakness was reported; no cerebrospinal fluid leaks, reoperations, or perioperative deaths occurred. No recurrences were observed across a mean follow-up of 21.9 months (range 4–48 months), though this duration may be insufficient to assess long-term recurrence for slow-growing tumors such as meningioma and schwannoma. Conclusions: ESS of primary spinal tumors appears feasible and safe in carefully selected cases, particularly for small, well-circumscribed lesions in favorable anatomical locations. Intradural resection introduced distinct technical challenges, including irrigation management and dural closure, which influence platform selection. These findings are limited by small sample size, short follow-up, and likely publication bias. ESS should be considered an emerging minimally invasive option rather than a replacement for established microsurgical approaches. Prospective comparative studies are needed to better define its role in spinal oncology. Full article

Background: Enterocutaneous fistulas (ECFs) and enteroatmospheric fistulas (EAFs) are rare but highly morbid complications that most commonly arise after abdominal surgery. Outcomes have improved with advances in multidisciplinary care and with increasing research on how to best manage them; however, they remain associated with significant morbidity, high mortality, and prolonged hospitalization. Optimal timing of definitive repair is unknown, with many high-volume centers waiting 6–12 months, though emerging data suggest that earlier intervention may be feasible in carefully selected patients. Given their complexity and variability in management, a comprehensive review of current evidence is needed. Methods: A narrative review of the literature was conducted with emphasis on the classification, pathophysiology, and multidisciplinary management of ECFs and EAFs. Relevant studies addressing fluid and sepsis control, nutritional optimization, wound care, pharmacologic therapies, and interventional strategies were reviewed. Results: The management of ECFs requires a staged approach focused on fluid resuscitation, sepsis control, wound management, and nutritional optimization. Spontaneous closure can occur, and is most commonly within the first two months. Nutritional optimization through enteral and/or parenteral nutrition or fistuloclysis plays a vital role in improving outcomes. Therapies such as negative pressure wound therapy, biologics, and pharmacologic agents may support spontaneous closure and fistula control. In non-healing fistulas, surgical repair remains necessary, with optimal time for surgery at least 6–12 months from fistula development. Conclusions: ECFs and EAFs remain complex surgical challenges. Outcomes have improved due to advances in nutritional support and wound management, and the emergence of minimally invasive techniques. Standardization of treatment protocols and further research into novel therapy may further enhance outcomes and limit variability in management. Full article

Epileptic seizure prediction using an Electroencephalogram (EEG) can improve patient safety by enabling early intervention, yet most existing approaches focus on short prediction horizons with limited personalization or computational efficiency. This study presents a unified deep learning framework evaluated across ten pre-ictal prediction windows up to 300 min before seizure onset, using recordings from 161 patients and 1023 seizure events. At the 5 min horizon, the generalized model achieved 96.30% accuracy and 91.62% sensitivity. Two complementary personalization strategies are introduced: incremental transfer learning, which progressively fine-tunes the generalized model using patient-specific data, and Dynamic Time Warping (DTW)-based similarity personalization, which constructs a morphology-aware training cohort from a single reference seizure. Personalized models consistently outperform generalized baselines, particularly at longer horizons, with the DTW-based approach achieving 89.68% accuracy using only 70 similar patients. Reliable prediction is demonstrated up to 60 min prior to onset, while model optimization reduces computational complexity with minimal performance loss, supporting deployment in resource-constrained clinical environments. Full article

Background: The management of white spot caries lesions (WSCLs) presents a clinical challenge due to a lack of standardized protocols. This study aimed to evaluate the knowledge, attitudes, and practices of dental practitioners in Russia regarding the diagnosis and treatment of WSCLs. Methods: A cross-sectional online survey was conducted from October 2024 to July 2025 among 397 dental professionals in Russia. A validated questionnaire assessed four domains: demographics, knowledge, attitudes, and clinical practices concerning WSCL management. Data were analyzed using descriptive statistics, Kruskal–Wallis tests, and Spearman’s correlation. Results: The majority of respondents were females (83%), with over half having less than five years of experience (55%). A majority of the practitioners (62.5%) demonstrated a good level of knowledge (mean score 12.8 ± 2.2). Knowledge was significantly better among female practitioners (p < 0.001) and inversely correlated with years of clinical experience (p < 0.001). Attitudes towards minimally invasive treatment were mainly positive (mean score 13.5 ± 2.6), with 86% of respondents showing a positive score (>10 points). While awareness of minimally invasive techniques like resin infiltration (84%) and remineralization (79.1%) was high, clinical practice varied. Remineralization was the most frequently used treatment (68% used casein phosphopeptide–amorphous calcium phosphate and 62% used fluoride), whereas resin infiltration was used by 46% and microabrasion by only 5% of the respondents. A majority of dentists (52%) preferred monitoring lesions rather than immediate intervention. Conclusions: Russian dental practitioners possess good theoretical knowledge and positive attitudes toward contemporary, minimally invasive management of WSCLs. However, a significant gap exists between knowledge and clinical practice, particularly concerning the use of resin infiltration and microabrasion. These findings underscore the need for continuous education on the topic. Full article

The ability to take another person’s perspective is a valuable skill in today’s society, fostering a better understanding of complex issues involving differing viewpoints. Although this competency is also central in geography education, there has been little analysis of students’ perspective-taking, and no method has been proposed to teach it effectively in geography classes. Therefore, the objective of this study was to analyse and systematically foster students’ competency in perspective-taking using a developed competency model. The study was situated within a pre- and post-test control group design (14 secondary students in the experimental group; 15 in the control group). Quantitative pre- and post-test data showed minimal changes in students’ perspective-taking competency, which underlines the complexity of the competency and supports the article´s focus on the intervention itself to gain deeper insights into how competent secondary students are in this regard, as well as how they engaged with and reflected on the guided perspective-taking tasks. Overall, the intervention results showed that the students demonstrated a high level of perspective-taking competency when guided by respective tasks. Furthermore, the students self-reported that they were able to cope with the given tasks. The operationalised model could therefore help students to understand perspective-taking and can support them to develop perspective-taking competency. Full article

Alzheimer’s disease (AD) and metabolic syndrome often occur together, sharing characteristics such as insulin resistance, dyslipidemia, and chronic inflammation. Metabolic dysfunction frequently precedes cognitive decline, indicating that early intervention might alter the disease’s progression. We investigated whether the GLP-1 receptor agonist semaglutide (SMGL) influences metabolic impairment and AD pathology in an AD mouse model. Male and female 5xFAD and wild-type (WT) mice on regular (RD) or high-fat diets (HFD) were administered SMGL for 13 weeks. SMGL-treated groups exhibited significant, context-dependent effects. In metabolically challenged 5xFAD HFD mice, treatment led to reduced body weight, improved glucose tolerance, normalized cholesterol levels, and a restored balance of adiponectin and leptin. These improvements were associated with reduced Aβ40 and Aβ42 levels, restored GLP-1 receptor expression, increased synaptophysin and βIII-tubulin levels, and enhanced spatial memory. SMGL also decreased Iba1 and CD68 immunoreactivity in the hippocampus and cortex, reduced macrophage infiltration, and lowered CD36 expression in visceral adipose tissue (VAT), indicating coordinated anti-inflammatory effects. WT RD mice showed minimal metabolic responses and a modest decline in Y-maze performance, suggesting that excessive GLP-1 receptor activation may disrupt neuronal homeostasis when metabolic status is normal. SMGL acts as a context-specific metabolic and neuroprotective agent, offering the greatest benefits under conditions of metabolic dysfunction. These findings in a preclinical model suggest that targeting early metabolic disturbances provides a testable hypothesis for attenuating AD-related neurodegeneration, though further translational studies are required. Full article

Background and Clinical Significance: “Hikikomori”—a state of prolonged social withdrawal affecting an estimated 2% of Japan’s working-age population—is frequently associated with underlying anxiety disorders, such as gaze phobia, and contributes to the socio-economic burden known as the “8050 problem,” in which aging parents support their socially isolated adult children. While Morita therapy is effective for such conditions, nursing support has historically lacked a systematic theoretical framework. This case report presents a novel nursing model analyzing the transformation process from toraware (mental preoccupation) toward mokuteki-hon-i (purpose-driven action). It proposes the ‘side-by-side’ nursing approach as a potentially important element in supporting patient autonomy in similar clinical settings. Case Presentation: A man in his 20s, diagnosed with gaze phobia and experiencing long-term withdrawal following traumatic bullying, was referred to our specialized short-care program. After initial preparation through structured psychoeducation regarding Morita therapy principles (toraware, sei-no-yokubo, mokuteki-hon-i), he participated in a 14-month Morita therapy-based short-care program combining individual and group interventions. Initially, the patient exhibited severe social avoidance and was trapped in a cycle of seishin-kogo-sayo (psychic interaction). Nurses applied ‘Strategic Inattention to Symptoms’ (shojo-fumon) and provided specific role suggestions, such as serving as a secretary in group discussions, to elicit his sei-no-yokubo (desire for life). Through the reframing of his anxiety as a constructive drive, the patient shifted to a purpose-driven stance. Outcomes showed improved self-adjustment skills in public spaces and successful social reintegration through sustained part-time employment. Conclusions: Nursing care characterized by ‘intentional non-intervention’—which involves waiting in a ‘side-by-side’ manner within a minimally structured environment—may contribute to fostering patient autonomy in similar clinical contexts. This ‘experience-oriented’ approach appeared to elicit inner strengths and support self-regulation in this case, warranting further investigation in multi-case designs. The relative contributions of individual nursing support and group therapeutic milieu cannot be disentangled in a single-case design. Full article

Social anxiety, peer victimisation, and social support are key issues during mid-childhood that provide important influence in the later adolescent years. While extensive research has evaluated these constructs in isolation and during adolescence, almost no longitudinal studies have evaluated relationships between them during mid-childhood. The current study obtained self-report measures of social anxiety, peer victimisation, and social support from a close friend, from 7846 students from grades three and four (M age = 9.01 yr), on three occasions over two years. Path analyses examined mediating and moderating relationships, as well as moderation by binary gender. There was minimal moderation by gender on any of the relationships between variables. Over time, there was a stronger positive prediction from social anxiety to later victimisation (β’s = 0.09–0.12) than from victimisation to later social anxiety (β’s = 0.04–0.07). Social anxiety negatively predicted later social support (β’s = −0.05 to −0.09), but social support did not consistently predict later social anxiety (β’s = −0.01 to −0.02). Interestingly, the results did not support a buffering effect of social support on peer victimisation; however, these longitudinal data did support several indirect paths. The results highlight the cyclical relationship between social anxiety and peer victimisation but point to social anxiety as a unidirectional predictor of social support from a close friend during the middle to late childhood years. Early intervention for social anxiety may produce positive downstream effects on both peer victimisation and social support. Full article

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with obesity, insulin resistance, and altered body composition. Although dietary intervention is a cornerstone of treatment, complex or calorie-restricted regimens may reduce long-term adherence. This study evaluated the effects of a pragmatic, short-term intervention that involved replacing one daily carbohydrate serving with cruciferous vegetables on body composition and metabolic parameters in individuals with obesity and MASLD. Associations between changes in fat mass and vitamin D and follistatin levels were also explored. Methods: In this prospective pilot study, 44 adults with obesity and MASLD followed a two-month intervention, substituting one daily serving of carbohydrate-rich foods with 200 g of cruciferous vegetables, without prescribed caloric restriction. Anthropometric, bioimpedance, biochemical, and FibroScan assessments were performed at baseline and post-intervention. Changes were analyzed using the Wilcoxon signed-rank test, Spearman’s correlation analysis, and generalized estimating equation (GEE) models adjusted for confounding factors. Results: The intervention was associated with a significant reduction in fat mass (−4.86 kg, p < 0.001), corresponding to an average relative decrease of approximately 12% along with improvements in metabolic and hepatic parameters. Changes in fat mass were inversely correlated with changes in vitamin D (rho = −0.33, p = 0.035), fat-free mass (rho = −0.37, p = 0.018), and follistatin (rho = −0.24, p = 0.143). In multivariate GEE models, the intervention remained independently associated with fat mass reduction (β = −5.190, p < 0.001). Conclusions: A simple carbohydrate-to-vegetable substitution without prescribed caloric restriction was associated with improvements in body composition and metabolic health. These exploratory findings suggest that pragmatic dietary modifications may provide clinically meaningful metabolic benefits and support the feasibility of minimal dietary substitution strategies in this population. However, causal inferences remain limited by a single-arm pilot design and require confirmation in larger randomized controlled trials. Full article

Hypoxic–ischemic brain injury remains the leading cause of death and neurological disability after cardiac arrest. Although targeted temperature management (TTM) and other neuroprotective strategies have demonstrated promising results in preclinical studies, large randomized controlled trials have largely failed to show consistent clinical benefit. This review examines two major limitations that may contribute to these translational failures: delayed initiation of therapy beyond a time-limited therapeutic window and the lack of baseline injury severity stratification. Evidence from both experimental and clinical studies suggests that the opportunity to modify neurological injury may be confined to the first few hours after return of spontaneous circulation (ROSC). Delayed intervention may occur after irreversible neuronal injury, microvascular dysfunction, and impaired cerebrovascular autoregulation have already become established. In addition, cardiac arrest survivors represent a heterogeneous population. Patients with minimal injury may recover with standard supportive care, whereas those with severe irreversible injury are unlikely to benefit from neuroprotective interventions. Patients with moderate-severity brain injury may represent the subgroup most likely to respond to targeted therapies. Ultra-early stratification using neuroimaging, electroencephalography, circulating biomarkers, and clinical risk scores may help identify patients with therapeutic potential. This review proposes that future post-cardiac arrest research should integrate both time-sensitive intervention strategies and early injury severity stratification. Large prospective studies and randomized controlled trials are needed to determine not only whether interventions are effective, but also when they should be initiated and which patients are most likely to benefit. Full article

The COVID-19 pandemic exposed critical limitations in conventional screening protocols, particularly in high-traffic environments where rapid, accurate, and contactless health assessment became essential to mitigate transmission risks. In response, this study presents the development of an Artificial Intelligence-Enhanced Contactless Screening Kiosk (AICS-K) that integrates multimodal sensing, embedded systems engineering, and machine learning into a unified workflow. Utilizing a Raspberry Pi platform with computer vision, thermal sensing, QR-based contact tracing, and intelligent control logic, the system enables efficient real-time screening while minimizing human intervention. The proposed architecture demonstrates the potential of extensible, affordable AI-driven solutions for early signs detection and institutional health resilience. Full article