Search Results (2,202)

This narrative review addresses the complexities of managing the vertical dimension of occlusion (VDO) in restorative dentistry, focusing on predictability in prosthetic reconstructions. Altering VDO impacts biological, biomechanical, esthetic, and functional aspects, making it a controversial topic. While VDO naturally evolves throughout life, interventions require careful consideration due to potential complications. Various techniques guide VDO determination, including facial proportions, physiological methods, phonetics, and cephalometric analysis. Clinicians must understand these principles and adapt them to individual patient needs. Materials and Methods: A narrative literature review was conducted using PubMed, Scopus, Google Scholar, and the Cochrane Library, searching keywords like “vertical dimension of occlusion”, “dental”, “diagnosis”, “management” and “complications”. In addition to the literature review, two case reports with extensive prosthodontic restorations were included to illustrate the diagnostic challenges and treatment considerations in a clinical setting. Results: Increasing VDO aids restorative treatments, re-establishing morphology, and facilitating additive procedures. Minimally invasive approaches, provisional restorations, and fixed restorations with functional contours are favored. Individualized, patient-centered care is critical, recognizing unique anatomical and functional needs. This approach optimizes stomatognathic system rehabilitation while preventing adverse effects on body posture and airway dimensions. Conclusions: To ensure predictable results and minimize risks, changes in VDO should be kept to a minimum to achieve dentofacial aesthetic harmony and secure adequate space for the planned restorations The two case reports presented, with different clinical approaches, underline the importance of understanding the potential risks and benefits of VDO alteration which is crucial for achieving predictable and successful outcomes in complex restorative cases. Full article

Background and Objectives: Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoscopic procedure that has demonstrated both safety and effectiveness in the treatment of obesity. By reducing the stomach’s volume without the need for surgical incisions, ESG promotes weight loss and can improve obesity-related comorbidities. However, patient responses to ESG can vary significantly. Materials and Methods: A comprehensive search was performed on PubMed, Embase, and Cochrane for studies with endoscopic sleeve gastroplasty; the main outcomes of interest are BMI, weight loss, and postinterventional complications. The search strategy employed a combination of keywords and Medical Subject Heading (MeSH) terms, including “endoscopic sleeve gastroplasty,” “endoscopy,” and “overweight”. To ensure the thoroughness of the review, additional manual searches of key journals and the reference lists of identified studies were performed. Grey literature, such as dissertations and conference abstracts, meta-analysis, and systematic reviews, was excluded to maintain a focus on peer-reviewed evidence. Duplicate records were identified and removed using Rayyan software to streamline the screening process. The I2 test was employed for heterogeneity assessment, while the risk of bias was evaluated utilizing ROBINS-I. Results: Our literature search resulted in the inclusion of 38 studies. Endoscopic sleeve gastroplasty for weight loss is important since it is more effective than pharmacological treatments and lifestyle changes and presents lower adverse event rates compared to bariatric surgery. Long-term weight loss outcomes varied, with total body weight loss ranging from 16% to 20.9% over a period from 2 to 5 years, while excess weight loss ranged from 13% to 79%. Revisional procedures showed higher failure rates, with up to 34.3% of patients experiencing insufficient weight loss. Most interventions led to clinically significant and sustained weight loss, though variability in outcomes highlights the need for further research to optimize long-term weight management strategies. Conclusions: Endoscopic sleeve gastroplasty (ESG) emerges as a promising minimally invasive option for weight loss, offering significant improvements in both weight reduction and obesity-related comorbidities, such as diabetes, hypertension, and dyslipidemia. Full article

Open reduction and internal fixation (ORIF) for mandibular condyle fractures remains a controversial and challenging issue, with the exception of basal and low-neck fractures. Currently, there is a consensus that fractures causing irreparable malocclusion or dislocation, when the fracture line runs through the base or lower neck of the condyle, require ORIF. Due to the different characteristics of fractures, various surgical approaches and their modifications are available. The use of a minimally invasive intraoral approach during endoscope-assisted procedures is considered safer for the facial nerve and provides good esthetic results without facial scarring. This study aimed to compare two surgical approaches—retromandibular and intraoral—to examine post-operative outcomes and to guide surgical decision-making in the treatment of simple fractures of the base and low-neck condylar process of the mandible. Forty-nine patients (thirteen female, thirty-six male) were analyzed: eighteen were treated with the intraoral approach, and thirty-one with the retromandibular approach. There were no statistical differences in the duration of surgery, but intraoperative blood loss was significantly lower in patients treated endoscopically compared with those treated with an extraoral approach. Post-operative facial nerve and TMJ function were comparable in both groups. The endoscope-treated patients were at a higher risk of fracture non-union, but these findings should be considered with connection with the small sample size. The intraoral approach is a valuable option for basal or low-neck fractures but demands significant surgical experience due to its technical complexity. Full article

Background: The treatment of cavitated lesions has evolved with minimally invasive dentistry (MID), whereby we can leave demineralized enamel that could potentially be remineralizable with the use of materials such as resin-modified glass ionomer cements (RMGICs) that allow these lesions to be repaired and remineralized while removing less tooth tissue. The aim of our study was to compare the influence of aging on adhesion to sound enamel, demineralized enamel, and the healthy dentin of five RMGICs (Vitremer^®, ACTIVA BioACTIVE Restorative, Riva LC, Ionolux^®, and GC Fuji II LC) and fluoride release. There are currently no studies on adhesion in demineralized enamel. Method: A total of 1035 bovine incisors were analyzed in 45 groups of 23 teeth each. The groups were established based on three factors: time (24 h, 1 month, and 3 months); substrate (sound enamel, demineralized enamel, and healthy dentin); and type of material. In each group, 20 samples underwent shear bond strength (SBS) and fracture type analysis. Adhesive interfaces were observed in three samples from each group using field emission scanning electron microscopy (FESEM). Daily and cumulative fluoride release rates were calculated. Results: Adhesion improved over time on both demineralized and sound enamel. ACTIVA BioACTIVE Restorative had the highest SBS values (33.63 ± 10.69 MPa), and Vitremer^® had the lowest (4.10 ± 4.63). Most fractures were adhesive. Vitremer^® and Ionolux^® showed the highest daily and cumulative fluoride release rates (Vitremer daily (24 h): 225.30 ± 26.28 ppm/g; Vitremer cumulative (30 days): 635.99 ± 305.38 ppm/g; Ionolux daily (24 h): 207.59 ± 48.43 ppm/g; Ionolux cumulative (30 days): 501.21 ± 138.71 ppm/g) and ACTIVA BioACTIVE Restorative showed the lowest (ACTIVA daily (24 h): 10.50 ± 0.85; ACTIVA cumulative (30 days): 39.10 ± 2.16). Conclusions: ACTIVA BioACTIVE Restorative was the material with the best adhesion values on all substrates and at all times, but it showed the lowest fluoride release rates. Full article

Background/Objectives: Trophoblast cell surface antigen 2 (Trop2), a transmembrane glycoprotein overexpressed in a broad spectrum of epithelial malignancies but minimally expressed in normal tissues, has emerged as a clinically relevant prognostic biomarker and therapeutic target, particularly in breast cancer. This study aims to develop an enhanced way of targeting Trop2 expression in tumors and blocking it using extracellular vesicles (EVs) bioengineered to express a nanobody sequence against Trop2 (NB60 E). Methods: Here, a plasmid construct was designed to express the Trop2 sequence, NB60, flanked with HA tag and myc epitope and a PDGFR transmembrane domain in the C-terminal region, and was transfected into HEK293T cells for EVs isolation. The potency of NB60 E to knock down Trop2 in letrozole-resistant breast cancer cells (LTLT-Ca and MDA-MB-468 cells) was initially investigated. Thereafter, the effects of NB60 E on the cell viability and downstream signaling pathway of Trop2 via MTT assay and Western blotting were determined. Lastly, we also examined whether NB60 E treatment in Jurkat T cells affects IL-6, TNF-α, and IL-2 cytokine production by enzyme-linked immunosorbent assay (ELISA). Results: Results revealed treatment with NB60 E significantly reduced surface Trop2 expression across both cell lines by 23.5 ± 1.5% in MDA-MB-468, and 61.5 ± 1.5% in LTLT-Ca, relative to the HEK293T-derived control EVs (HEK293T E). NB60 E treatment resulted in a marked reduction in LTLT-Ca cell viability by 52.8 ± 0.9% at 48 h post-treatment. This was accompanied by downregulation of key oncogenic signaling molecules: phosphorylated ERK1/2 (p-ERK 1/2) decreased by 30 ± 4%, cyclin D1 by 67 ± 11%, phosphorylated STAT3 (p-STAT3) by 71.8 ± 1.6%, and vimentin by 40.8 ± 1.4%. ELISA analysis revealed significant decreases in IL-6 (−57.5 ± 1.5%, 7.4 ± 0.35 pg/mL) and TNF-α (−32.1 ± 0.3%, 6.1 ± 1.2 pg/mL) levels, coordinated by an increase in IL-2 secretion (22.1 ± 2.7%, 49.2 ± 1.1 pg/mL). Quantitative analysis showed marked reductions in the number of nodes (−45 ± 4.4%), junctions (−55 ± 3.5%), and branch points (−38 ± 1.2%), indicating suppression of angiogenic capacity. In vivo experiment using near-infrared Cy7 imaging demonstrated rapid and tumor-selective accumulation of NB60 E within 4 h post-administration, followed by efficient systemic clearance by 24 h. The in vivo results demonstrate the effectiveness of NB60 E in targeting Trop2-enriched tumors while being efficiently cleared from the system, thus minimizing off-target interactions with normal cells. Lastly, Trop2 expression in LTLT-Ca tumor xenografts revealed a significant reduction of 41.0 ± 4% following NB60 E treatment, confirming efficient targeted delivery. Conclusions: We present a first-in-field NB60 E-grafted EV therapy that precisely homes to Trop2-enriched breast cancers, silences multiple growth-and-invasion pathways, blocks angiogenesis, and rewires cytokine crosstalk, achieving potent antitumor effects with self-clearing, biomimetic carriers. Our results here show promising potential for the use of NB60 E as anti-cancer agents, not only for letrozole-resistant breast cancer but also for other Trop2-expressing cancers. Full article

Arthroscopic treatment of acromioclavicular (AC) joint separations has evolved significantly over the past two decades. Modern anatomical repair methods frequently rely on suspensory fixation devices to reconstruct the coracoclavicular ligaments and, in some cases, to stabilize the AC joint itself. Background/Objectives: Arthroscopy offers a minimally invasive option that ensures excellent visualization of the joint, facilitates management of concomitant intra-articular injuries, and provides direct access to the undersurface of the coracoid process for implant placement. Methods: Over the past seven years, we have managed 30 AC separation cases using this arthroscopic approach. Results: The distinctive feature of our technique is the use of only two portals—one posterior and one anterosuperior—which proved adequate for optimal visualization and accurate implant positioning. Conclusions: In this article, we outline the benefits and limitations of the technique, identify current knowledge gaps, and propose avenues for future clinical research. Full article

Background: Microwave ablation (MWA) is an effective, minimally invasive therapy for benign thyroid nodules; however, the treatment response varies considerably. Identifying imaging biomarkers that can predict volumetric outcomes may optimize patient selection. Diffusion-weighted MRI (DW-MRI) offers a noninvasive assessment of tissue microstructure through apparent diffusion coefficient (ADC) measurements, which may correlate with ablation efficacy. Methods: In this prospective study, 48 patients with 50 cytologically confirmed benign thyroid nodules underwent diffusion-weighted magnetic resonance imaging (DW-MRI) before minimally invasive ablation (MWA). Baseline ADC values were measured, and nodule volumes were assessed by ultrasound at baseline and 1, 3, and 6 months postprocedure. The volume reduction ratio (VRR) was calculated, and associations with baseline variables were analyzed via Pearson correlation and multivariable linear regression. ROC curve analysis was used to evaluate the diagnostic performance of ADC in predicting significant volume reduction (VRR ≥ 50%). Results: Lower baseline ADC values were strongly correlated with greater VRR at 3 months (r = −0.525, p < 0.001) and 6 months (r = −0.564, p < 0.001). Multivariable regression revealed that the baseline ADC was the sole independent predictor of the 6-month VRR (β = −19.52, p = 0.0004). ROC analysis demonstrated excellent discriminative performance (AUC = 0.915; 95% CI: 0.847–0.971), with an ADC cutoff of 2.20 × 10⁻³ mm²/s yielding 90.9% sensitivity and 83.3% specificity for predicting a favorable volumetric response. Conclusions: Baseline ADC values derived from DW-MRI strongly predict volumetric response following microwave ablation of benign thyroid nodules. Incorporating ADC assessment into preprocedural evaluation may enhance patient selection and improve therapeutic outcomes. Full article

Background/Objectives: Patellar instability is a common orthopedic condition affecting pediatric and adolescent populations, particularly during periods of rapid growth and increased sports participation. Recurrent patellar dislocation in skeletally immature patients is frequently associated with underlying anatomical risk factors such as patella alta, trochlear dysplasia, or increased tibial tubercle–trochlear groove distance. Methods: This narrative review summarizes the current evidence on the epidemiology, diagnostic approach, and arthroscopic management of patellar instability in skeletally immature patients. Results: Arthroscopy has become an essential tool in both the diagnosis and treatment of patellar instability, allowing for minimally invasive assessment of patellofemoral alignment, chondral pathology, and ligament integrity. It also enables precise surgical interventions such as physeal-sparing medial patellofemoral ligament reconstruction, which remains the preferred stabilization technique for patients with open physes due to its safety and efficacy. Emerging innovations, including robotic-assisted tunnel placement, bioengineered scaffolds for cartilage repair, and three-dimensional modeling for surgical planning, have the potential to improve outcomes and arthroscopic surgical precision in this population. Despite these advances, major challenges such as a lack of pediatric-specific outcome measures, variability in surgical indications and rehabilitation protocols, and limited long-term follow-up data remain. Conclusions: Optimizing outcomes in pediatric and adolescent patients with patellar instability requires individualized growth-aware strategies and multidisciplinary collaborations. By integrating technological innovation with patient-centered care, clinicians can continue to refine the arthroscopic management of patellofemoral instability in young patients. Full article

Objectives: To optimise surgical treatment of mitral valve disease (MVD), a better understanding of gender-based differences is required. In this study, we analyse the gender-based differences among patients undergoing mitral valve surgery. Methods: Between January 2019 and December 2024, 809 consecutive patients were admitted to our centre for surgery for MVD. We analysed the patient characteristics, surgical details, postoperative and short-term outcomes of these patients. Results: Females (31.8%) undergoing mitral valve (MV) surgery were older (p < 0.001). Females had a higher rate of atrial fibrillation (p < 0.001), Rheumatoid arthritis (RA) (p = 0.002) and malignancy (p = 0.030). Furthermore, females were more often admitted to the intensive care unit (ICU) preoperatively (p = 0.037). Among these patients, 419 patients underwent isolated MV surgery. Furthermore, males underwent minimally invasive MV surgery more often (p = 0.004). Females had higher rates of combined MVD (p < 0.001) and combined MS (p < 0.001). Males had higher rates of severe mitral regurgitation (MR) (p = 0.041) and Left Atrium (LA) dilation (p = 0.004). Females exhibited higher rates of severe Tricuspid Regurgitation (TR) (p = 0.032) and pulmonary hypertension (p < 0.001). males had higher rates of posterior mitral leaflet (PML) prolapse (p < 0.001) and Flail leaflets (p < 0.001). Males underwent mitral valve repair (MVr) more often (p = 0.002). Early MACCE were reported in 5.1% of the patients. Freedom from major adverse cardiac and cerebrovascular events (MACCE) was comparable at 1 year and three years (p = 0.548). Prognosis and freedom from events were comparable between genders. Conclusions: Mitral valve disease presents differently across genders. There exist fundamental differences in the pathophysiological processes and presentation of mitral valve disease. Mitral valve surgery can be carried out with low mortality and morbidity rates irrespective of gender. Full article

Background/Objectives: Trigger finger is a common cause of hand pain and functional limitation. Although open A1 pulley release remains the standard surgical treatment, ultrasound-guided percutaneous needle release (UGPR) has emerged as a minimally invasive alternative. This study aimed to compare the clinical effectiveness and safety of UGPR with open surgery. Methods: In this prospective, randomized controlled trial, 146 patients with Green stage 2–4 trigger finger were randomly assigned to UGPR (n = 75) or open release (n = 71). Pain (VAS), functional status (QuickDASH), and symptom severity (Nirschl Phase Rating) were assessed preoperatively and at postoperative day 3, 1, 6, and 12 months. Grip strength was measured with a digital pinchmeter, and ultrasonographic evaluation of A1 pulley and flexor tendon thickness was performed preoperatively and at 12 months. Subgroup analyses were conducted to address the imbalance in thumb distribution. Results: Both groups showed significant postoperative improvements in VAS, QuickDASH, and Nirschl scores (p < 0.05 for intragroup comparisons), with no significant differences between groups at 12 months (p > 0.05). At the one-year follow-up, grip strength was significantly greater in the UGPR group (p = 0.008). Ultrasonographic evaluation revealed greater MCP tendon thickness in UGPR, without clinical impact. Subgroup analyses confirmed comparable functional outcomes in thumb-only and non-thumb cases. Four revisions occurred in the UGPR group (incomplete release, recurrent tenosynovitis, flexor tendon rupture, and neurovascular injury), while none were observed in the open group. Conclusions: UGPR and open release provide comparable long-term outcomes in the treatment of trigger finger. UGPR offers the advantages of being minimally invasive and preserving grip strength, although it carries a small risk of incomplete release and procedure-related complications. Patient preference, surgeon expertise, and digit type should guide treatment selection. Full article

Purpose: To investigate regional changes in tear film quality associated with orthokeratology (Ortho-K) lens wear using high-resolution spatial mapping and to evaluate the potential of artificial intelligence (AI) models in anticipating these changes. Methods: This study analysed tear film quality in 92 Ortho-K wearers divided into three groups based on lens wear duration (10–29 days, 30–90 days, and ≥91 days). Placido-based topographer measurement was used to generate regional tear film maps before and after treatment. A custom MATLAB pipeline enabled regional comparisons and statistical mapping. A feedforward neural network was trained to forecast local tear film quality using spatial data. Results: Single-value global mean metrics showed minimal changes in tear film quality across groups. However, regional mean mapping revealed significant mid-peripheral and peripheral deterioration over time, particularly in nasal and temporal corneal zones. These changes were often overlooked by global averaging and remained invisible through tear film breakup time (TBUT) measurements. The AI model predicted spatial tear quality with high accuracy (R ≥ 0.9 in testing), capturing nuanced regional variations. Conclusions: The regional analysis uncovers subtle, clinically relevant tear film disruptions caused by Ortho-K lens wear, particularly in peripheral areas. These insights challenge the adequacy of traditional single-value global mean assessments. The AI model demonstrates the potential for non-invasive, predictive evaluation of tear stability, supporting more personalised and effective Ortho-K care. Full article

Breast cancer (BC) is one of the most common malignancies among women worldwide. Despite advances in early detection and treatment, prognosis remains highly variable. Molecular biomarkers, such as microRNAs (miRNAs), have emerged as promising tools to refine prognostic assessment. Among them, miR-21 is consistently overexpressed in solid tumors and implicated in key oncogenic pathways. This systematic review and meta-analysis aimed to clarify the prognostic significance of miR-21 in BC and explore its molecular mechanisms through bioinformatic analyses. A systematic search of PubMed, Scopus, and Web of Science up to April 2025 identified 18 eligible observational studies. Pooled analyses showed that high miR-21 expression was significantly associated with poorer overall survival (OS) (HR = 2.37, 95% CI: 1.42–3.98) and recurrence-related outcomes (DFS/RFS) (HR = 2.10, 95% CI: 1.32–3.34). Subgroup analyses confirmed robust associations across different cut-off definitions and revealed particularly strong effects in triple-negative BC (HR = 5.69) and mixed subtypes (HR = 2.55), but no significant association in HER2-positive BC. Bioinformatic analysis identified target genes such as PTEN, BCL2, STAT3, and MYC, involved in apoptosis regulation, proliferation, NF-κB signaling, and immune modulation. These findings provide consistent evidence that miR-21 is a promising minimally invasive prognostic biomarker in BC, particularly in aggressive subtypes, and support its integration into future multimodal prognostic models. Full article

Iron oxide nanoparticles (IONPs) have emerged as key materials in magnetic hyperthermia (MH), a minimally invasive cancer therapy capable of selectively inducing apoptosis, ferroptosis, and other cell death pathways while sparing surrounding healthy tissue. This review synthesizes advances in the design, functionalization, and biomedical application of magnetic nanoparticles (MNPs) for MH, highlighting strategies to optimize heating efficiency, biocompatibility, and tumor targeting. Key developments include tailoring particle size, shape, and composition; doping with metallic ions; engineering multicore nanostructures; and employing diverse surface coatings to improve colloidal stability, immune evasion, and multifunctionality. We discuss preclinical and clinical evidence for MH, its integration with chemotherapy, radiotherapy, and immunotherapy, and emerging theranostic applications enabling simultaneous imaging and therapy. Special attention is given to the role of MNPs in immunogenic cell death induction and metastasis prevention, as well as novel concepts for circulating tumor cell capture. Despite promising results in vitro and in vivo, clinical translation remains limited by insufficient tumor accumulation after systemic delivery, safety concerns, and a lack of standardized treatment protocols. Future progress will require interdisciplinary innovations in nanomaterial engineering, active targeting technologies, and real-time treatment monitoring to fully integrate MH into multimodal cancer therapy and improve patient outcomes. Full article

Background: Invasive fungal infections (IFIs) remain a major cause of morbidity and mortality among immunocompromised patients, despite advances in antifungal therapy. Conventional diagnostics are limited, highlighting the need for novel biomarkers. Circulating microRNAs (miRNAs) and cell-free DNA (cfDNA) have emerged as promising tools due to their roles in immune regulation, pathogen–host interactions, and disease monitoring. This systematic review and meta-analysis evaluate their diagnostic and prognostic potential in fungal infections. Methods: A systematic search of PubMed, Web of Science, SCOPUS, and EMBASE was conducted up to May 2025 in line with PRISMA guidelines (PROSPERO protocol CRD42021287150). Eligible studies included clinical research on confirmed fungal infections assessing cfDNA or miRNAs. Random-effects meta-analyses were performed for cfDNA, and miRNA findings were synthesized descriptively. Results: In total, 526 studies were included. cfDNA positivity was observed in 12% of all tested samples (95% CI: 0.06–0.22) and in 79% of patients with proven fungal infections (95% CI: 0.62–0.90), supporting its value as a minimally invasive, culture-independent diagnostic marker. Six studies on miRNAs identified disease-specific signatures, including miR-132 and miRNA panels for aspergillosis, with high diagnostic accuracy (AUC ≥ 0.98). miR-146a, miR-223, and miR-545 further correlated with prognosis and mortality. Conclusions: cfDNA and miRNAs show strong potential for early diagnosis, prognosis, and treatment monitoring in IFIs. Standardized methodologies and large-scale validation are essential for clinical translation. Full article

Fertility-sparing treatments (FSTs) have gained importance for young female cancer patients, especially those with early-stage cervical, ovarian, and endometrial cancers. However, concerns about the long-term safety of these procedures, particularly in more advanced cancers, persist. A literature review was conducted using databases such as PubMed, Scopus, and Web of Science. The search terms included “fertility preservation” and “gynaecological cancer”. Articles published between 2014 and 2024 were considered, with 39 articles cited in the paper. The inclusion criteria were female patients undergoing FST. Studies were excluded if prior treatments impacted fertility or if oncological outcomes were inadequately reported. Radical trachelectomy, laparoscopic fertility-sparing surgeries, and cryopreservation techniques, such as ovarian tissue vitrification and oocyte cryopreservation, offer viable options for preserving fertility in early-stage gynecological cancer patients. Radical trachelectomy and cryopreservation showed positive reproductive outcomes, with pregnancy rates of 30–50% in early-stage cases. GnRH analogs during chemotherapy also demonstrated benefits in maintaining fertility. Despite these advances, recurrence in more advanced stages (FIGO IA2 and beyond) remains a concern. Minimally invasive surgeries like robotic-assisted procedures demonstrated comparable fertility outcomes to traditional methods but with fewer complications. FST is a promising option for women with early-stage cancer, offering favorable reproductive and survival outcomes. However, further research is needed to confirm long-term oncological safety in advanced stages. Multidisciplinary approaches and individualized treatment planning are essential for optimizing outcomes. Full article