Search Results (30,990)

Background/Objectives: The main purpose of the present scoping review was to map and explore the efficacy of computer-controlled intraosseous anesthesia (CCIA) in comparison with conventional dental anesthesia in pediatric dental patients. Secondarily, this study aimed to compare the acceptance and preference factors between CCIA and conventional dental anesthesia in children. Given the limited and heterogeneous nature of the available literature, this review aimed to identify gaps and scope the extent of research conducted in this area, providing a foundation for future, more targeted studies. Methods: The search was conducted in 19 electronic databases, and the appropriate studies were identified according to PRISMA-ScR guidelines. Only split-mouth randomized controlled clinical trials that reported on the clinical outcomes of CCIA in children were included. Two reviewers worked independently on the screening and selection of the studies. The same two reviewers carried out the data extraction and the risk of bias assessment, using the Cochrane risk of bias tool. Due to the exploratory nature, this review focused on mapping the characteristics, outcomes, and research trends rather than synthesizing effect sizes. Results: Out of 841 papers, 2 randomized clinical trials were ultimately included in the scoping review. The outcomes were categorized as primary (including results that answered the focus question) and secondary (relating to additional quality characteristics). Regarding the primary outcomes, in both studies, intraosseous anesthesia was efficacious in achieving the adequate level of anesthesia. One of the secondary outcomes was the acceptance and preference of CCIA in comparison with conventional dental anesthesia in children. The limited number and the high risk of bias in existing studies highlight the necessity for more comprehensive and high-quality research. Conclusions: The selected studies support the assertion that CCIA is a promising technique since it results in less pain perception and is preferred by patients compared to conventional local anesthesia. However, the existing literature is limited and at high risk of bias. Thus, further targeted investigations are needed to evaluate and yield more definitive results regarding the superiority of CCIA. Full article

The continuous need for simplified, minimally invasive restorative procedures with a high precision has led to the advancement of highly filled flowable resin-based materials. These materials present excellent initial outcomes in various clinical applications, including the injection molding technique. Given that several clinical reports present signs of wear and staining, this systematic review aims to investigate the mechanical and optical properties of highly filled flowable composite resins. A comprehensive literature research was conducted to identify relevant studies from the PubMed, the Cochrane Library, and Scopus databases. Data extraction and screening was performed by two independent evaluators. Both in vitro studies and clinical trials were included. A total of thirty-one studies were included in this review. A total of 27 in vitro studies investigated highly filled flowable composite resins independently, or in comparison with conventional composite resins, traditional flowable composites, bulk-fill flowable composites, glass ionomer cements, and compomers. Additionally, four randomized controlled clinical trials (RCTs) compared highly filled flowable composite resins with their conventional counterparts. Highly filled flowable composite resins exhibit adequate optical properties. Despite their significant improvements, their mechanical properties remain inferior to those of medium-viscosity composite resins. These materials demonstrate a favorable initial performance in the injection molding technique. Based on a limited number of RCTs, these materials demonstrate an adequate performance in class I and II restorations; however these findings should be interpreted with caution. The reported drawbacks in laboratory studies may contraindicate their clinical application in extensive cavities, load-bearing areas, and in cases of excessive tooth wear and parafunctional activity. A careful clinical case selection is strongly recommended. Full article

Background/Objectives: Major depressive disorder (MDD), including late-onset forms, is a prevalent and disabling condition. Despite multiple pharmacological treatment options, over half of patients fail to achieve full remission. This systematic review aims to assess current evidence on the influence of pharmacogenetic factors on antidepressant response and safety, with a focus on patients with major and late-life depression. Methods: We conducted a systematic review following PRISMA guidelines (PROSPERO: CRD42020212345). Studies published in the past five years involving adult patients with MDD or late-onset depression and pharmacogenetic data were included. Results: From 793 abstracts screened, 29 studies with 39,975 participants were included. CYP2C19 and CYP2D6 were the most frequently analyzed genes (41% and 17% of studies, respectively). Poor metabolizers for CYP2C19 showed higher plasma levels of SSRIs, leading to increased adverse effects. In contrast, ultrarapid metabolizers had significantly lower response rates. Variants in SLC6A4 and other genes (e.g., HTR2A, ABCB1) were also associated with treatment outcomes. Combinatorial pharmacogenetic testing showed superior predictive value compared to single-gene approaches. Conclusions: Genetic variants in CYP2C19, CYP2D6, and SLC6A4 may affect the efficacy and tolerability of antidepressant therapy. Integrating this information into clinical practice may allow more personalized prescribing and improved outcomes. Full article

Background/Objectives: This study evaluates the performance of a large language model (lLm) in providing geographically tailored colorectal cancer screening and surveillance recommendations to gastrointestinal surgeons. Methods: Fifty-four patient cases, varying by age and family history, were developed based on colorectal cancer guidelines. Standardized prompts with predefined query terms were used to query ChatGPT-4.5 on 18 April 2025, from four locations: Canada, Italy, Romania, and the United Kingdom. Responses were classified as “Correct,” “Partially Correct,” or “Incorrect” based on clinical guidelines and expert recommendations for each country. Outcomes were analyzed using descriptive statistics. Results: ChatGPT provided recommendations on screening eligibility, test interpretation, the management of positive results, and surveillance intervals. Correct recommendations were given for 50.0% (27/54) of cases in Canada, 63.0% (34/54) of cases in Italy, 40.7% (22/54) of cases in Romania, and 55.6% (30/54) of cases in the United Kingdom. Queries in Italian yielded correct guidance for 64.8% (35/54) of cases, while Romanian queries were accurate for 40.7% (22/54) of cases. Notably, Romania and Italy lacked detailed guidelines for polyp management and post-test surveillance. A key finding was the inconsistency between ChatGPT-generated titles and corresponding recommendations, which may impact its reliability in clinical decision-making. Conclusions: ChatGPT-4.5’s performance varies by country and language, highlighting inconsistencies in geographically tailored recommendations. This study highlights limitations associated with the training data cutoff and the potential biases introduced by model-generated responses. Healthcare professionals should recognize these limitations and the possible gaps in guideline availability, particularly for high-risk screening, polyp management, and surveillance in certain European countries. Full article

The physiological and biomechanical characteristics of inline speed skating have not been systematically mapped nor research evidence synthesized. The aim was to identify and synthesize novel elements across studies, including participant characteristics, outcomes measures, experimental protocol, main outcomes and other relevant information, to inform evidence-based guidelines and recommendations. Following the PRISMA 2020 guidelines, a systematic search of databases was conducted to identify relevant studies. The extracted data were charted and synthesized to summarize the physiological and biomechanical aspects of inline speed skating. From 272 records, 22 studies met the defined criteria. Studies related to inline speed skating focused primarily on physiological variables (n = 14) and lower limb muscles function, with limited evidence on biomechanics of inline speed skating (n = 5) and the combination of biomechanics and physiology (n = 3). An overall unclear risk of bias was observed (59% of studies). Although studies have examined physiological and biomechanical variables, continuous physiological and biomechanical assessments of skaters performing different skills on both straight and curved tracks have not been conducted. Therefore, well-planned physiological and biomechanics studies are required to uncover underexplored areas in research and support the development of sport-specific studies. Full article

Background/Objectives: Out-of-hospital cardiac arrest (OHCA) is associated with high mortality, and outcomes may be influenced by underlying conditions such as cancer, hypertension (HTN), and diabetes mellitus (DM). This study aimed to evaluate whether HTN and DM modify the effects of post-resuscitation treatments—specifically targeted temperature management (TTM) and percutaneous coronary intervention (PCI)—on survival and neurological recovery in OHCA patients with a history of cancer. Methods: This retrospective cohort study analyzed data from the Korean national OHCA registry between January 2018 and December 2021. Adults aged ≥18 years with presumed cardiac-origin OHCA and a documented history of cancer—defined as any prior cancer diagnosis recorded in medical records regardless of remission status—were included. Multivariable logistic regression was used to examine associations between treatment and outcomes, and interaction effects were assessed using adjusted p-values to account for multiple testing. Results: Among the 124,916 EMS-assessed OHCA cases, 4115 patients met the inclusion criteria. TTM and PCI were both statistically associated with good neurological recovery (TTM: adjusted odds ratio [aOR], 1.69; 95% confidence interval [CI], 1.12–2.55; p < 0.05; PCI: aOR, 11.35; 95% CI, 7.98–16.14; p < 0.05). In interaction analyses, the benefit of TTM and PCI for achieving good neurological recovery was attenuated in patients with diabetes mellitus (DM; TTM: aOR, 0.59; 95% CI, 0.23–1.49; PCI: aOR, 4.94; 95% CI, 2.69–9.06) and hypertension (HTN; TTM: aOR, 0.94; 95% CI, 0.49–1.82; PCI: aOR, 7.47; 95% CI, 4.48–12.44), with adjusted p-values < 0.05 for all interactions. Conclusions: In OHCA patients with a history of cancer, TTM and PCI are associated with improved survival and neurological outcomes. However, the presence of comorbidities such as HTN and DM may attenuate these benefits. These findings support the need for individualized post-resuscitation care strategies that account for comorbid conditions. Full article

Background and Objectives: Epithelial ovarian cancer (EOC) remains the deadliest gynecologic malignancy, yet the psychosocial dynamics of early survivorship are inadequately described. We prospectively quantified six-month trajectories in the quality of life in a consecutive cohort of 88 women newly diagnosed with EOC and explored clinical moderators of change. Methods: Eighty-eight consecutive patients (mean age 59.1 ± 10.7 years) completed the SF-36, WHOQOL-BREF, EORTC QLQ-C30, and 10-item Perceived Stress Scale (PSS-10) at baseline (pre-therapy) and six months after cytoreductive surgery ± platinum-based chemotherapy. Stage (FIGO I–II vs. III–IV) and treatment pathway (primary debulking surgery, neoadjuvant chemotherapy plus interval debulking, chemotherapy only) data were recorded. Results: Global QoL improved significantly (EORTC Global Health +5.9 ± 7.7 points; p < 0.001) while perceived stress declined (ΔPSS −3.6 ± 5.1; p < 0.001). SF-36 Physical Functioning rose 4.7 ± 7.9 points (p < 0.001) and Mental Health 4.4 ± 7.9 points (p = 0.004). The WHOQOL Physical and Psychological domains gained 4.7 ± 7.1 and 4.3 ± 7.4 points, respectively (both p < 0.01). Advanced-stage patients experienced larger stress reductions than early-stage patients (−4.1 ± 2.7 vs. −2.9 ± 2.2; p = 0.028) but comparable QoL gains. Greater stress relief correlated with greater mental-health improvement (r = −0.51) and global-health gains (r = −0.45) (all p < 0.001). Treatment pathway did not significantly influence trajectories. Conclusions: Early survivorship after first-line ovarian-cancer therapy was characterized by the clinically meaningful recovery of physical and emotional functioning together with the moderate alleviation of perceived stress. Improvements were observed irrespective of stage and treatment strategy, suggesting that contemporary multimodal regimens do not inevitably compromise patient-reported outcomes. Our estimates provide preliminary effect sizes that should be validated in multi-center cohorts with longer follow-up. Full article

Aims: To systematically review and synthesize qualitative research exploring the Breast Cancer Survivors (BCSs)’ perception of health promotion interventions and informing strategies to mitigate recurrence risk within five years post-treatment and improve clinical outcomes. Specifically, this study addresses the question: “How do women diagnosed with breast cancer perceive health promotion interventions for recurrence prevention?” Design: A systematic review and qualitative meta-synthesis were performed. Data Sources: A systematic search of scientific databases (CINAHL, MEDLINE, and Scopus) was undertaken in November 2024. The reference list was cross-referenced and hand-searched to identify additional articles. Review Methods: Studies were included if they met the following criteria: they were primary qualitative studies focusing on BCSs within five years post-treatment, involving participants who had completed surgery, radiotherapy, or chemotherapy in the same time frame, as this period is critical for monitoring recurrence and implementing health promotion interventions. Only studies published in peer-reviewed journals and written in Italian, English, French, or Spanish were considered, provided that an abstract and the full text were available. Moreover, eligible studies had to be conducted in high-income or middle-income countries. Studies were excluded if they focused exclusively on advanced or metastatic breast cancer, if they involved mixed cancer populations without reporting separate data for BCSs, or if they were non-qualitative studies or gray literature. The review study protocol was registered in the PROSPERO database (CRD42024626033). Results: The literature search identified 490 records, 13 articles from databases, and 3 articles identified via other methods (web and citation searching) that met inclusion criteria. A narrative synthesis approach allowed the emerging five themes: (I) Challenges, (II) Self-motivation and empowerment, (III) The relationships as a facilitator, (IV) Barriers to change, and (V) Proactive support strategies. Conclusions: Addressing internal and external factors that influence health behaviors is essential to improve adherence, reduce recurrence risk, and enhance quality of life. Tailored interventions, social support, and healthcare engagement are crucial in this effort. Impact: Our meta-synthesis highlighted significant challenges as well as valuable resources for health promotion among BCSs, suggesting practical and tailored approaches to improving the adoption of healthy behaviors, supported by relationships and targeted support strategies. Full article

Background and Objectives: Acute respiratory failure (ARF) represents an increasingly relevant clinical challenge in older subjects due to population aging and the high prevalence of cardiopulmonary comorbidities. Non-invasive ventilation (NIV), developed as continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP), has become a first-line treatment in various forms of ARF, including acute cardiogenic pulmonary oedema (ACPE) and acute exacerbations of COPD (AECOPD), offering several clinical advantages. In this context, the limited evidence on the efficacy of NIV in older patients leaves considerable uncertainty as to whether it constitutes a valid therapeutic option or represents medical futility in these patients. Materials and Methods: This narrative review explores the use of NIV and its outcomes in four key clinical scenarios in the elderly: ARF due to ACPE, AECOPD, community-acquired pneumonia (CAP), and palliative/end-of-life care. Results: Strong evidence supports NIV use with improved outcomes in ACPE and AECOPD, even in older populations. Conversely, data on its use in pneumonia are inconclusive, with potential harm if applied inappropriately. In palliative care, NIV can help relieve symptoms, but if not used appropriately, it may extend suffering. Conclusions: Age alone does not appear to be a sufficient factor to determine whether or not to use NIV; it becomes relevant only when considered in conjunction with the purpose of its use and the patient’s clinical history and condition. Data remain limited and often conflicting, particularly when investigating the elderly population and patients with a “do not intubate” (DNI) order. There is a need for additional research on these patients, focusing on long-term outcomes and quality of life. Full article

The increasing prevalence of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) has led to a growing demand for kidney transplantation (KTx). Identifying risk factors that enable improved allograft survival through novel therapeutic agents, advanced biomarkers, and artificial intelligence (AI)-driven data integration are critical to addressing this challenge. Drugs, such as SGLT2 inhibitors and finerenone, have demonstrated improved outcomes in patients but lack comprehensive long-term evidence in KTx patients. The use of biomarkers, including circulating cytokines and transcriptomics, coupled with AI, could enhance early detection and personalized treatment strategies. Addressing patient self-management and addressing health access disparities may be more achievable using technologies used at home rather than traditional models of healthcare and thus lead to increased transplant success, both in terms of transplantation rates and allograft longevity. Full article

Environmental persistent free radicals (EPFRs) represent a class of long-lived, redox-active species with half lives spanning minutes to months. Emerging as critical environmental pollutants, EPFRs pose significant risks due to their persistence, potential for bioaccumulation, and adverse effects on ecosystems and human health. This review critically synthesizes recent advancements in understanding EPFR formation mechanisms, analytical detection methodologies, environmental distribution patterns, and toxicological impacts. While progress has been made in characterization techniques, challenges persist—particularly in overcoming limitations of electron paramagnetic resonance (EPR) spectroscopy and spin-trapping methods in complex environmental matrices. Key knowledge gaps remain, including molecular-level dynamics of EPFR formation, long-term environmental fate under varying geochemical conditions, and quantitative relationships between chronic EPFR exposure and health outcomes. Future research priorities could focus on: (1) atomic-scale mechanistic investigations using advanced computational modeling to resolve formation pathways; (2) development of next-generation detection tools to improve sensitivity and spatial resolution; and (3) integration of EPFR data into region-specific air-quality indices to enhance risk assessment and inform mitigation strategies. Addressing these gaps will advance our capacity to mitigate EPFR persistence and safeguard environmental and public health. Full article

Objectives: This study aimed to evaluate the effects of photomodulation therapy (PMT) on delayed onset muscle soreness (DOMS). Methods: Controlled studies investigating PMT for DOMS were identified through systematic searches of PubMed and EMBASE databases. Selected articles were reviewed for the effects of PMT, and the outcome data were extracted according to specific assessments and time points for meta-analysis. Results: A total of 14 studies met the inclusion criteria, all of which evaluated the effects of PMT following the induction of DOMS. The wavelength of PMT ranged from 660 to 950 nm and was applied to one to six points on the affected muscles. Four studies provided sufficient data for quantitative synthesis, comparing PMT with the placebo in terms of visual analog scale (VAS) scores and muscle strength at 24, 48, 72, and 96 h after the induction of DOMS. The results demonstrated a statistically significant reduction in VAS scores at 72 h (pooled SMD = −0.55) and 96 h (pooled SMD = −0.56), indicating a moderate effect. Muscle strength showed significant improvement at 24 h (pooled SMD = 0.97) and 48 h (pooled SMD = 0.99), reflecting a large effect size. Conclusions: These findings suggested that PMT may be an effective intervention for managing DOMS, with potential effects on reducing pain, enhancing muscle strength, and decreasing biochemical markers of muscle damage. Full article

Background/Objectives: Diabetic foot (DF) is among the leading causes of diabetes-related disability. It is important to maintain regular follow-up and patient education in the prevention and treatment of DF ulcers. In extraordinary situations such as a pandemic, there are disruptions in regular clinical follow-up and patient education, and the effects of this disruption need to be investigated. The aim of this study was to investigate the impact of the pandemic on the clinical condition of patients hospitalised for DF. Methods: Patients were divided into two groups according to the date of admission to the clinic: the pre-pandemic (1 January 2019–11 March 2020) and the pandemic period (12 March 2020–1 June 2021). Comparisons were made between the two groups in terms of DF data and clinical parameters. Data were analysed with SPSS using chi-square, Student’s t-test and Mann–Whitney U analysis. Results: As a result of the screening, data from 125 DF patients (45 pre-pandemic and 80 pandemic) were collected. The DF stage, according to the Wagner classification, was significantly more advanced in patients during the pandemic period (p = 0.015). However, the time between the onset of symptoms and hospitalisation was longer for patients during the pandemic period (p = 0.035). When analysing treatment outcomes, the rate of wound healing was found to be lower (62.2% vs. 30%), and the rate of transtibial amputation was higher (11.2% vs. 20%) during the pandemic period (p = 0.002). Conclusions: This study found that the number of patients hospitalised for DF increased during the pandemic period, as did the severity of the wound, length of admission and radical treatment interventions. Full article

Background/Objectives: Initial cardiac rhythm is a known prognostic indicator in out-of-hospital cardiac arrest (OHCA). However, the impact of rhythm conversion during cardiopulmonary resuscitation (CPR) on outcomes in patients undergoing extracorporeal CPR (ECPR) remains unclear. This study evaluated the association between initial and converted cardiac rhythms and outcomes in patients with refractory OHCA treated with ECPR. Methods: This nationwide retrospective observational study analyzed data from the Out-of-Hospital Cardiac Arrest Surveillance registry in South Korea (2008–2022). Patients were categorized into three groups: initial shockable rhythm (SR), non-shockable rhythm (NSR) converted to SR, and refractory NSR. The primary outcome was survival to hospital discharge; the secondary outcome was favorable neurological status (CPC 1–2). Results: Among 681 patients, 161 had initial SR, 345 had converted SR, and 175 had refractory NSR. Before matching, survival and CPC 1–2 rates were highest in the initial SR group (21.1% and 15.5%), followed by the converted SR group (19.4% and 11.6%), and lowest in the refractory NSR group (9.7% and 4.0%) (p < 0.01). After matching, CPC 1–2 remained significantly higher in the initial SR group (14.4%) and in the converted SR group (9.3%) vs. the refractory NSR group (5.1%, p = 0.016; 3.7%, p = 0.042). Persistent NSR was independently associated with poor neurological outcomes compared to both initial SR (AOR 0.337, p = 0.037) and converted SR (AOR 0.283, p = 0.020). Conclusions: Rhythm conversion from NSR to SR before ECPR was associated with significantly improved neurological outcomes. Rhythm conversion may serve as a prognostic marker and resuscitation target to guide ECPR decisions. Full article

Background and objectives: Delirium is a prevalent disorder that is associated with morbidity and mortality in hospitalized older adults. Recent evidence highlights sarcopenia, defined by low muscle mass, as a prognostic factor of importance. This study aims to investigate the association between sarcopenia, assessed by L3-level computed tomography (CT) and clinical outcomes, particularly mortality, in inpatients with delirium managed by a liaison psychiatry team (LPT). Methods: This single-center, retrospective observational study included 57 consecutive patients diagnosed with delirium and referred to the LPT at a tertiary care hospital between 2021 and 2023. Patients with available abdominal CT scans were included. Sarcopenia was defined based on the presence of low muscle mass observed at the L3 level on CT imaging, following established diagnostic criteria. The analysis included demographic data, clinical history, laboratory parameters, and treatment-related variables. Cox proportional hazards models and Kaplan–Meier survival curves were utilized to evaluate the association between sarcopenia and mortality during follow-up. Results: Of the 57 patients included, 52.6% (n = 30) were sarcopenic. Sarcopenia was associated with lower albumin levels (p = 0.038) and higher mortality rates (56.7% vs. 33.3%). Kaplan–Meier analysis showed reduced survival in sarcopenic patients (p = 0.038). Cox regression identified sarcopenia as an independent predictor of mortality (HR = 2.95; 95% CI: 1.03–8.46; p = 0.04), alongside the Charlson comorbidity index. Conclusions: Sarcopenia represents a robust and independent predictor of mortality in patients with delirium. Early nutritional assessment and targeted interventions addressing sarcopenia hold the potential to improve clinical outcomes. Further prospective studies with larger sample sizes are needed to validate these findings. Full article