Search Results (92)

Purpose: To present the findings of our preliminary experience using daily image-guided radiotherapy (IGRT) supported by implanted fiducial markers (FMs) in the radiotherapy of the vaginal cuff, in a cohort of post-surgery endometrial cancer patients. Methods: Patients with vaginal cuff cancer requiring adjuvant radiation with external beams were enrolled. Five patients underwent radiation therapy targeting the pelvic disease and positive lymph nodes, with doses of 50.4 Gy in twenty-eight fractions and a subsequent stereotactic boost on the vaginal vault at a dose of 5 Gy in a single fraction. One patient was administered 30 Gy in five fractions to the vaginal vault. These patients underwent external beam RT following the implantation of three 0.40 × 10 mm gold fiducial markers (FMs). Our IGRT strategy involved real-time 2D kV image-based monitoring of the fiducial markers during the treatment delivery as a surrogate of the vaginal cuff. To explore the potential role of FMs throughout the treatment process, we analyzed cine movies of the 2D kV-triggered images during delivery, as well as the image registration between pre- and post-treatment CBCT scans and the planning CT (pCT). Each CBCT used to trigger fraction delivery was segmented to define the rectum, bladder, and vaginal cuff. We calculated a standard metric to assess the similarity among the images (Dice index). Results: All the patients completed radiotherapy and experienced good tolerance without any reported acute or long-term toxicity. We did not observe any loss of FMs during or before treatment. A total of twenty CBCTs were analyzed across ten fractions. The observed trend showed a relatively emptier bladder compared to the simulation phase, with the bladder filling during the delivery. This resulted in a final median Dice similarity coefficient (DSC) of 0.90, indicating strong performance. The rectum reproducibility revealed greater variability, negatively affecting the quality of the delivery. Only in two patients, FMs showed intrafractional shift > 5 mm, probably associated with considerable rectal volume changes. Target coverage was preserved due to a safe CTV-to-PTV margin (10 mm). Conclusions: In our preliminary study, CBCT in combination with the use of fiducial markers to guide the delivery proved to be a feasible method for IGRT both before and during the treatment of post-operative gynecological cancer. In particular, this approach seems to be promising in selected patients to facilitate the use of SBRT instead of BRT (brachytherapy), thanks to margin reduction and adaptive strategies to optimize dose delivery while minimizing toxicity. A larger sample of patients is needed to confirm our results. Full article

Aortic valve diseases affect a significant percentage of the population, and with the extension of survival expectancy, they are expected to increase furthermore. Surgical treatment of aortic valve diseases mainly includes valve replacement and, rarely, its repair. The technology of both surgical and transcatheter valves is evolving, and new prosthetic valves with improved characteristics are available, e.g., longer lifespan, faster implantation, better hemodynamic performance with better effective orifice area, suitable for small aortic annuli, etc. Minimally invasive surgical techniques are constantly evolving and spreading. New access sites are used for transcatheter valve implantation. The Heart Team determines the most appropriate intervention for each patient based on their anatomical and clinical profiles, aiming to optimize long-term outcomes. Full article

Background: The ROSA Knee System (Zimmer Biomet, Warsaw, IN, USA) is a robotic system aiming to increase bone resections and component alignment accuracy during TKA. While much is known about its performance in the coronal plane, its accuracy in the sagittal plane remains debated. The present investigation evaluated the system’s accuracy in achieving planned mechanical axis alignment and specific knee angles in both planes. Methods: A retrospective analysis was performed on 55 consecutive patients who underwent robotic-assisted TKA using the ROSA Knee System. Data on the medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), hip–knee–ankle angle (HKA), tibial slope (TS), and distal femoral flexion (DFF) were collected pre- and post-operatively using the ROSA software. Planned and achieved angles were compared, with deviations greater than 2° and 3° defined as outliers. Results: The mean differences between planned and achieved angles for LDFA and MPTA were 0.5° ± 1.00° and 0.3° ± 1.3°, respectively, with less than 10% outliers. The hip–knee angle recorded only a minimal deviation from planned values. In contrast, the TS angle showed a statistically significant difference between planned and achieved values, while no significant difference was found for the DFF angle. The surgeon’s experience did not impact alignment accuracy. Conclusions: The ROSA Knee System demonstrates high accuracy in achieving planned alignment in the coronal plane during robotic-assisted TKA, with minimal outliers and reliable predictions for both femoral and tibial angles. However, the ROSA Knee System showed less accuracy in the sagittal plane, particularly for the tibial slope, which did not adversely affect the implant’s stability. Full article

Background/Objectives: Peri-implant mucosa plays a key role in both peri-implant health and aesthetics. Differences in contour and color between implants and natural teeth can negatively affect patient satisfaction, while soft tissue deficiency may lead to complications such as peri-implantitis. Peri-implant plastic surgery aims to improve these conditions. The objective of this study is to describe the trouser-shaped connective tissue graft technique designed to enhance vestibular and interproximal peri-implant tissue volume in a single surgical procedure, and to assess its effectiveness and morbidity. Methods: Ten patients requiring soft tissue augmentation in edentulous areas prior to delayed implant placement were selected. Intraoral scanning was performed before and 6 months after treatment to evaluate tissue thickness gain. Results: Significant soft tissue volume gain was observed at both the coronal (mean: 2.74 mm with a 95% confidence interval of 2.21–3.26 mm) and vestibular (mean: 2.79 mm with a 95% confidence interval of 2.24–3.35 mm) levels in all analyzed positions (p < 0.001). The procedure exhibited low morbidity, with minimal complications and discomfort reported by the patients. Conclusions: The trouser-shaped connective tissue graft technique is effective in increasing peri-implant soft tissue. It allows for vestibular and interproximal tissue augmentation in a single procedure, minimizing tissue contraction and morbidity. This technique could be a predictable and minimally invasive alternative for managing volume deficiencies in peri-implant tissues, particularly in aesthetic areas. Full article

Using ultra-short dental implants is a promising alternative to extensive bone grafting procedures for patients with atrophic posterior mandibles and vertical bone loss. However, the amount of insertion torque (IT) applied during implant placement significantly influences stress distribution in the peri-implant bone, which affects implant stability and long-term success. Materials and Methods: This study used finite element analysis (FEA) to examine how different insertion torques (35 N·cm and 75 N·cm) affect stress distribution in cortical and trabecular bone types D2 and D4 surrounding ultra-short implants. Von Mises equivalent stress values were compared with ultimate bone strength thresholds to evaluate the potential for microdamage during insertion. Results: The findings demonstrate that increasing IT from 35 N·cm to 75 N·cm led to a significant increase in peri-implant bone stress. Specifically, cortical bone stress in D4 bone increased from approximately 79 MPa to 142 MPa with higher IT, exceeding physiological limits and elevating the risk of microfractures and bone necrosis. In contrast, lower IT values kept stress within safe limits, ensuring optimal primary stability without damaging the bone. These results underscore the need to strike a balance between achieving sufficient implant stability and avoiding mechanical trauma to the surrounding bone. Conclusions: Accurate control of insertion torque during the placement of ultra-short dental implants is crucial to minimize bone damage and promote optimal osseointegration. Excessive torque, especially in low-density bone, can compromise implant success by inducing excessive stress, thereby increasing the risk of early failure. Full article

Background/Objectives: Infertility in both men and women can be significantly influenced by oxidative stress (OS), which occurs due to an imbalance between reactive oxygen species (ROS) and the body’s antioxidant defenses. In women, OS disrupts oocyte maturation, implantation, and the viability of the embryo; in men, it impairs sperm quality, reduces motility, and damages DNA integrity. This review explores existing research on how dietary and lifestyle interventions can reduce OS and enhance reproductive health outcomes. Methods: We conducted a comprehensive review of clinical, translational, and molecular studies exploring the mechanisms by which OS affects fertility, as well as the efficacy of nutritional and behavioral strategies. The interventions evaluated include weight management, regular exercise, micronutrient supplementation, antioxidant-rich diets, smoking and alcohol cessation, and stress-reduction techniques. Results: Specific dietary components such as zinc, selenium, vitamins C and E, and polyphenols have been found to neutralize reactive oxygen species (ROS) and enhance gamete function. OS is additionally reduced through lifestyle modifications, including minimizing harmful exposures, managing stress, and participating in moderate physical activity. Biomarkers such as ROS levels, total antioxidant capacity, 8-OHdG, and DNA fragmentation index are essential for assessing the effectiveness of interventions. Conclusions: Fertility in both sexes can be improved, and oxidative stress significantly reduced, through a multimodal approach incorporating dietary and lifestyle changes. There are encouraging opportunities to improve reproductive health through customized approaches that are informed by biomarker profiles. To incorporate these treatments into regular fertility care, future studies should concentrate on standardized procedures and long-term results. Full article

Objectives: This study aims to investigate the underlying causes of dental implant failure, focusing on implant-related complications and associated risk factors. Understanding these factors will help improve treatment planning and enhance implant success rates. Methods: A retrospective case-control study was conducted using clinical, medical, surgical, and radiographic records of patients who underwent dental implant removal due to complications. Key factors analyzed included patient-related variables (age, gender, medical conditions, periodontal disease), implant-related factors (implant site, implant system, restoration status), and procedural aspects (previous surgical interventions and reasons for implant removal). Results: The findings revealed that implant type (p = 0.004) and type of restoration (p = 0.001) significantly influenced implant survival. Gender (p = 0.001), medical conditions, smoking status (p = 0.004), and restoration status (p = 0.005) were significantly associated with specific failure mechanisms. Lack of osseointegration (36.4%) and absence of primary stability (22.4%) were the predominant causes of implant failure. Prior surgical interventions (p = 0.001) and decisions for re-implantation (p = 0.005) significantly affected implant removal frequency. Conclusions: Implant survival is influenced by multiple factors, with implant type, restoration type, and gender playing key roles in failure outcomes. Patient-specific risk assessment, particularly regarding medical conditions and smoking, meticulous surgical technique, and appropriate prosthetic planning, is vital for improving implant longevity and minimizing failure rates. Full article

Epilepsy is a neurological disorder characterized by recurrent, unprovoked seizures, affecting millions worldwide. While anti-seizure medications serve as first-line treatment, approximately one-third of patients develop drug-resistant epilepsy (DRE), necessitating alternative interventions. Deep brain stimulation (DBS) has emerged as a promising therapy for DRE, particularly for patients who are ineligible for resective surgery. DBS involves stereotactic implantation of electrodes into target brain regions, such as the anterior nucleus of the thalamus (ANT), centromedian nucleus (CMT), and hippocampus (HC), to modulate aberrant neural activity and to reduce seizure frequency. Anesthesia plays a critical role in DBS implantation, influencing both patient safety and procedural success. The choice of anesthetic technique must balance patient comfort with the preservation of neurophysiological signals used for intraoperative electrode localization. A well-chosen anesthetic strategy can enhance the efficacy of electrode placement by minimizing patient movement and preserving critical neurophysiological signals for real-time monitoring. This precise targeting enhances safety via a reduction in perioperative risks and an improvement in long-term seizure control. Anesthetic considerations in epilepsy patients differ from those in movement disorders due to variations in their nuclei targets during DBS. Despite the increasing use of DBS for epilepsy following its FDA approval in 2018, research on anesthetic effects specific to this population remains limited. This narrative review, therefore, examines anesthetic approaches, pharmacological implications, potential complications, and evolving methods for DBS implantation in epilepsy patients, highlighting new insights and unique considerations in this population. Understanding these factors is essential for optimizing surgical outcomes and improving the safety and efficacy of DBS in epilepsy treatment. Full article

Objectives Implant placement errors remain a persistent challenge, leading to complications such as peri-implant bone loss, neurosensory issues, and, in severe cases, implant failure. This study evaluates the prevalence and characteristics of dental implant positioning errors in patients treated at the Dental University Hospital. Methods: A sample of 500 cone-beam computed tomography (CBCT) scans was used to assess implants for positioning errors, including thread exposure, proximity to anatomical structures, and violations of inter-implant and implant–tooth distances. Results: A total of 56.6% of the implants exhibited positioning errors, with the maxillary posterior region being the most commonly affected area (51.6%). The most frequent errors observed were thread exposure (37.7%) and implant proximity to the maxillary sinus (27.7%). Statistical analysis revealed significant correlations between implant positioning errors and anatomical location, underscoring the need for meticulous preoperative planning and advanced imaging. While factors such as patient age, implant length, and diameter were analyzed, no statistically significant differences were found in error prevalence based on sex or demographic variables. Conclusions: This study highlights the importance of combining clinical expertise with advanced imaging modalities like CBCT to minimize implant positioning errors and improve patient outcomes. Future research should focus on refining surgical techniques and evaluating the impact of the implants’ design and patient-specific factors on the accuracy of placements. Full article

Background/Objectives: To objectively evaluate the rotational stability, refractive predictability, and visual outcomes of toric EVO ICL using automated infrared retinal retroillumination imaging. Setting/Venue: The research was conducted in a specialized ophthalmic surgery center. Design: Longitudinal analytical prospective study. Methods: The methodology included preoperative and postoperative assessments of visual acuity, subjective refraction, corneal topography, and anterior segment OCT. The implantation and alignment process utilized advanced digital centration techniques. Postoperative evaluations were conducted at 1 and 3. Results: The study found a mean incision surgically induced astigmatism (SIA) of 0.32 D, and a refractive SIA average of 2.02 D, closely matching the preoperative refractive astigmatism (target-induced astigmatism—TIA) mean of 2.07 D, resulting in a correction index (CI) of 0.96. Rotational stability was high, with 72% of lenses showing less than 5° rotation and 96% under 10° at the 1-month follow-up. No significant correlations were observed between lens rotation and postoperative vault size or horizontal compression, indicating independent factors. The discrepancy between theoretical and observed rotations suggested that the calculation method slightly underestimated actual rotation, which did not significantly affect visual outcomes. Graphical analysis demonstrated minimal impact of lens rotation on uncorrected distance visual acuity (UDVA), confirming the procedure’s efficacy and safety. Conclusions: Toric EVO ICL implants provide high rotational stability, excellent refractive predictability, and satisfactory visual outcomes. The study underscores the importance of precise implantation and the minimal influence of lens rotation on postoperative refractive errors. Full article

Trapeziometacarpal joint osteoarthritis (TMJ OA) is a progressive condition, particularly affecting postmenopausal women. Various surgical techniques have been proposed, but the optimal approach remains debated. This clinical study compares the clinical, functional, and radiological outcomes of two surgical treatments: suspension tenoplasty using the flexor carpi radialis tendon (Altissimi technique, AST) and a dual-mobility prosthesis. The main complications associated with these procedures include postoperative pain, De Quervain’s syndrome, radial nerve injuries, and prosthetic component mobilization. In prosthetic arthroplasty, the most common complication is component mobilization (8%), while in tenoplasty, postoperative pain is the most frequent (15%). A total of 36 patients were randomized into two groups: 18 patients underwent AST (Group A), and 18 received trapeziometacarpal joint arthroplasty (Group B). Functional outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH), Visual Analogue Score (VAS), and Michigan Hand Outcomes Questionnaire (MHQ) at 3, 6, 12, and 24 months. Range of motion (ROM), Kapandji score, pulp pinch strength, hand grip strength (Jamar dynamometer), and radiological maintenance of the trapezial space (step-off measurement) were also evaluated. Both procedures resulted in significant pain reduction (VAS, p < 0.05) and functional improvement (DASH, MHQ, p < 0.05). ROM increased significantly in both groups. The Kapandji scores improved from 4.0 ± 1.1 to 9.2 ± 1.2 (Group A) and 4.3 ± 0.8 to 7.8 ± 1.4 (Group B) (p < 0.05). Group B grip strength results showed a greater increase in hand grip strength than Group A (p = 0.23). The radiographic step-off showed slight proximal migration of the first metacarpal in Group A, whereas Group B maintained joint height. No implant loosening or major complications were reported in either group. Both suspension tenoplasty and dual-mobility arthroplasty are effective in TMJ OA. AST ensures joint stability with minimal radiographic changes, whereas TJA provides superior grip strength and ROM recovery. The absence of major complications suggests that TJA is a safe alternative to AST, but its higher cost and potential for implant-related complications must be considered. Full article

Si₃N₄ ceramics and composites stand out for their exceptional mechanical and thermal properties. Compared with conventional ceramic forming processes, 3D printing via vat photopolymerization not only ensures high geometric precision but also improves the forming efficiency and strength of green body. Nevertheless, the grayish appearance of Si₃N₄ and its relatively high refractive index can adversely affect the photocuring behavior in ceramic slurries. The primary objectives focus on enhancing the curing performance and rheological properties of slurries, minimizing defects during post-processing, and improving the relative density and mechanical properties of Si₃N₄ ceramics. Key advancements include slurry optimization via refractive index matching, biomodal particle gradation and surface modification, while the integration of whisker/fiber additions or polymer-derived ceramic strategies enhances mechanical properties. In addition, controlling the atmosphere and heating rate of the post-processing innovations can achieve a relative density of more than 95%. This paper introduces the mechanisms of vat photopolymerization and then summarizes the strategies for improving Si₃N₄ ceramic slurries as well as controlling the printing and debinding/sintering processes. It further highlights the ways in which different approaches can be used to enhance the properties of Si₃N₄ slurries and ceramic parts. Finally, applications of Si₃N₄ ceramics and composites via vat photopolymerization in various fields such as aviation, aerospace, energy, electronics, chemical processes, and biomedical implants are also presented to point out future opportunities and challenges. Full article

The prosthetic emergence profile is a factor potentially affecting marginal bone level around dental implants. The aim of this review is to provide a comprehensive analysis of the influence of the prosthetic emergence profile on peri-implant marginal bone-level stability. The marginal bone level is an important parameter in implant dentistry, reflecting the stability of dental implants, and it is a critical indicator of long-term implant success. Minimizing marginal bone loss around dental implants is a key factor for maintaining implant function, supporting peri-implant soft tissues, and achieving predictable aesthetic outcomes. The scientific literature presents various examples of evidence on the influence of emergence angle and prosthetic designs on marginal bone loss. Several studies suggest that emergence angles exceeding 30° and convex prosthetic designs may increase the risk of peri-implantitis and bone resorption, while others find no significant correlation. Moreover, several studies demonstrated the positive influence of taper joint connections on marginal bone stability. Although the current literature remains diverse, it is essential to prioritize cleanability and minimize plaque accumulation for a successful implant-prosthetic restoration. Proper maintenance and a continuous follow-up to monitor marginal bone loss are beneficial for obtaining stable and optimal long-term results. Full article

Background/Objectives: Peripheral artery disease (PAD) is a significant global health challenge, affecting millions worldwide. Among its various manifestations, femoropopliteal atherosclerotic disease presents a unique challenge due to the biomechanical stresses on the superficial femoral artery (SFA) and popliteal artery (PA). Despite advancements in endovascular interventions, restenosis and stent fractures remain critical issues, particularly in complex and long lesions. Biomimetic stents, such as the SUPERA interwoven nitinol stent, have been developed to address these challenges by closely replicating the natural mechanical properties of the femoropopliteal arteries. This study evaluates the clinical and procedural outcomes of biomimetic stent implantation in patients with femoropopliteal atherosclerotic disease, focusing on patency rates, procedural success, and major adverse limb events (MALE). Methods: A cohort study was conducted at the University Clinical Center of Serbia, including 294 patients with femoropopliteal stenosis or occlusion treated with the SUPERA stent from January 2017 to December 2024. Patients were stratified by lesion complexity using the GLASS classification and procedural success, patency rates, and MALE incidence were assessed. Kaplan–Meier survival analysis was used to evaluate long-term outcomes, and Cox regression analysis identified predictors of MALE. Results: Primary patency rates at 1, 6, 12, and 24 months were 95.6%, 90.1%, 84.2%, and 77.7%, respectively. Primary-assisted patency and secondary patency rates remained high over time. Patients with GLASS IV lesions exhibited significantly lower patency rates and higher MALE incidence compared to GLASS I-III patients (p = 0.002). Occlusion length (≥16 cm) and lesion complexity (GLASS IV) were independent predictors of MALE (p = 0.015). The stent demonstrated high procedural success and durability, with minimal complications. Conclusions: Biomimetic SUPERA stents provide high patency rates and favorable clinical outcomes in complex femoropopliteal lesions. However, lesion complexity and occlusion length significantly impact long-term success. The findings highlight the importance of careful patient selection and lesion assessment for optimizing endovascular treatment strategies in PAD management. Full article

Optimizing the injection molding process for making biomedical implants is essential to avoid defects that impact patient safety and implant performance. This study examines how different gate positions affect defect rates in injection-molded polyether ether ketone (PEEK) pedicle screws, using numerical modeling to analyze melt flow, cavity pressure, sink mark depth, warpage, and Von Mises stress across four gate configurations. The findings show that gate position significantly influences structural integrity, with strategically placed gates reducing defects by promoting uniform flow. Gate configuration 2 was optimal, yielding minimal sink depth, low warpage, and low stress, while configuration 4 was the least effective as it was associated with higher values of defect rates. Carefully selecting gate positions can enhance the quality and reliability of biomedical implants. Full article