Search Results (2,679)

Background: Locally advanced rectal cancer is traditionally managed with neoadjuvant chemoradiotherapy followed by total mesorectal excision, but radical surgery entails substantial morbidity, including bowel, urinary, and sexual dysfunction as well as permanent stomas. Organ-preserving strategies such as total neoadjuvant therapy (TNT) followed by a watch-and-wait (WW) approach aim to reduce morbidity while maintaining oncologic safety. A recent study from the FOREST cohort confirmed favorable survival outcomes with WW but did not assess the patient-centered impact. Methods: This retrospective observational study included locally advanced rectal cancer patients treated at a tertiary hospital. Following TNT, patients who achieved a complete clinical response entered WW, while others underwent radical surgery (RS). Patient-reported outcomes were assessed using an 18-item questionnaire grouped into domains and transformed to a 0–100 scale according to EORTC scoring methodology. All patients underwent a shared decision-making process. Comparisons between groups used Pearson chi-square tests for clinical and demographics associations and Mann–Whitney U tests for ordinal outcomes. The protocol was integrated into Quirónsalud’s value-based healthcare framework. Results: Clinical and demographics characteristics did not differ between WW and RS groups. PROMs favored WW in multiple domains: Symptoms/Complications (87 vs. 66; p < 0.001), Psychosocial adaptation (90 vs. 66; p < 0.001), Mental health (90 vs. 78; p = 0.006), and Global quality of life (80 vs. 67; p = 0.011). Bowel and sexual functions were similar between groups, and Care satisfaction was very high for both. Conclusions: TNT plus WW appears to be oncologically safe and confers significant quality-of-life benefits across several domains. These findings support the theory that WW is a value-based, patient-centered strategy for rectal cancer, and this warrants validation in larger, randomized cohorts. Full article

Background and Objectives: Long COVID-19 (LC) is a multifaceted condition characterized by persistent fatigue and impaired health-related quality of life (HRQoL). Exercise intolerance and post-exertional symptom exacerbation (PESE) pose challenges for rehabilitation. This study aimed to evaluate the effects of a 12-week core-focused plank exercise program on fatigue and HRQoL in women with LC, using validated patient-reported measures. Materials and Methods: A pilot quasi-experimental design was implemented, with non-randomized group allocation. Thirty-nine women with LC were recruited from the Madrid Long COVID Association. Participants were assigned to either an intervention group (n = 20), which completed a supervised plank-based motor control program, or a control group (n = 19), which maintained usual activity. Fatigue was assessed using the Modified Fatigue Impact Scale (MFIS), and HRQoL was measured using the EQ-5D-5L and EQ Visual Analog Scale (EQ-VAS). Body composition was evaluated via bioelectrical impedance analysis. Results: The intervention group showed significant reductions after intervention in the MFIS total scores compared to the control group, particularly in the physical (21.26 ± 6.76 vs. 25.21 ± 6.06; p < 0.001) and psychosocial domains (4.51 ± 0.41 vs. 5.21 ± 0.38; p < 0.001), without triggering PESE. EQ-VAS scores improved significantly (63.94 ± 15.33 vs. 46.31 ± 14.74; p = 0.034). No significant changes were found in body composition parameters, suggesting that benefits were driven by neuromuscular adaptations rather than morphological changes. Conclusions: A core-focused, non-aerobic exercise program effectively reduced fatigue and improved perceived health status in women with LC. These findings support the use of motor control-based interventions as a safe and feasible strategy for LC rehabilitation, particularly in populations vulnerable to PESE, suggesting clinical applicability for the rehabilitation of women with LC. Further randomized trials are warranted to confirm these results and explore long-term outcomes. Full article

Healthcare-associated infections remain an ongoing concern across medical and dental practice, prompting continuous evaluation of infection prevention measures. In dental extractions, the necessity of sterile gloves is debated, as the oral cavity represents an inherently contaminated environment. This systematic review and meta-analysis evaluated whether the use of sterile gloves reduces postoperative socket infections compared with non-sterile gloves. A search of MEDLINE, Embase, Web of Science, Cochrane CENTRAL, and Google Scholar identified randomized controlled trials, clinically controlled trials, and observational trials directly comparing sterile versus non-sterile glove use during dental extractions. The primary outcome of this study was extraction socket infection at day 7 post-surgery. A meta-analysis using relative risk (RR) was performed for dichotomous data. Of the initial 7170 publications found, seven articles met inclusion criteria. Infection rates ranged from 0% to 3.9%, with an overall infection rate of 0.3% in the sterile glove group (672 patients) and 1.3% in the non-sterile glove group (758 patients). Three studies qualified for meta-analysis, resulting in an RR of 0.30 (95% CI 0.07–1.24), indicating no significant difference in postoperative infections between sterile and non-sterile glove usage. Given the limitations of small sample sizes, low event rates, incomplete reporting, and lack of subgroup data for surgical versus non-surgical extractions, no difference in postoperative infection was found between sterile and non-sterile glove use. Additional research is needed to determine whether glove sterility influences infection risk, particularly in surgical procedures. Full article

Background: Radiotherapy is a common treatment for gynecological malignancies, often accompanied by significant side effects that impact patient nutritional status. The ketogenic diet has been proposed as a complementary nutritional strategy to enhance treatment efficacy, manage side effects, and preserve body composition. However, its safety and feasibility in the oncological setting remain under-investigated. Methods: The KOMPARC study is a prospective, randomized controlled trial evaluating the adherence, safety, and clinical tolerability of a ketogenic diet versus a standard Mediterranean diet in patients with cervical and endometrial cancer undergoing radiotherapy. Before the start of the treatment, patients were randomized to either the ketogenic diet or the standard diet groups. Anthropometric measures, Hand Grip Test, and body composition parameters from bioimpedance analysis were taken before the start of treatment and at the end. Adherence, adverse events, and patient-reported outcomes were monitored throughout the treatment period. Results: A total of 33 patients were enrolled. Adherence rates were comparable between the KD and standard diet groups (46.1% vs. 25.0% interruption rate, p = 0.21). No significant differences were observed in the incidence of gastrointestinal toxicities (p = 0.56), diarrhea (p = 0.81), nausea (p = 0.94), or weight loss (p = 0.24). Both groups experienced significant weight reduction during therapy without differential loss of body cell mass or other body composition parameters. Quality of life assessments indicated varied symptom profiles, with the KD group reporting increased appetite loss and worry about weight. Conclusions: Preliminary findings suggest that the ketogenic diet is a safe and feasible nutritional intervention during radiotherapy for pelvic tumors. These results support further investigation into ketogenic dietary strategies as adjuncts in oncologic care. Full article

Aesthetic Medicine is advanced as an integrated, evidence-based framework for patient-centered care that unites physical, psychological, social, and aesthetic dimensions of health. Drawing on Clinical Health Psychology, the paper introduces Aesthetic Health Psychology as a specialization that embeds psychological theory, assessment, and intervention within aesthetic medicine and surgery, emphasizing interdisciplinary collaboration rather than professional mistrust. The paper argues that integrating Aesthetic Health Psychology into aesthetic medicine can enhance ethical practice, improve patient-reported outcomes, and support equity-focused implementation across diverse procedures and settings. It further suggests a practical framework for implementation. Three interrelated models are proposed: the Aesthetic Biopsychosocial Model, which conceptualizes aesthetics as a distinct health domain alongside biological, psychological, and social factors; the Aesthetic Health Care Process Model, which structures care as a five-stage journey supported by systematic screening for body dysmorphic disorder and the routine use of patient-reported outcome measures; and the Aesthetic Health Systems Model, which situates aesthetic care within institutional, policy, and cultural contexts. Idealized but clinically grounded vignettes from elective cosmetic, reconstructive, and gender-affirming settings illustrate how these models address non-linear trajectories of adaptation, evolving expectations, complications, and stigma. These concepts jointly define both the motivation for Aesthetic Health Psychology and its practical implications, from the use of brief, selective aesthetic screening during primary health care visits to the design of equity-focused implementation strategies across aesthetic procedures and settings. Full article

Background: Three-dimensional (3D) facial scanning is an objective, non-invasive method for quantifying facial soft-tissue changes following complete denture (CD) rehabilitation. Reliable quantification of these changes in completely edentulous patients can support more predictable aesthetic and functional outcomes. Methods: This prospective before–after observational study included 30 completely edentulous patients (12 men, 18 women; age 48–87 years; mean ± SD: 67.8 ± 9.2 years) who received new maxillary and mandibular CDs. Structured-light 3D facial scans were obtained at baseline (edentulous, without dentures) and post-rehabilitation with dentures in place, in relaxed posture (RP) and maximal intercuspation (MI). Sixty-five validated anthropometric landmarks were analyzed. Primary outcomes were lower facial height (Sn-Gn), nasolabial angle (Cm-Sn-Ls), lower facial convexity (Ls-Li-Pg), mouth width (Ch-Ch), and upper vermilion height (Ls-Sto). Pre–post changes were assessed using paired-sample tests (p < 0.05). Results: Thirty-four of 65 parameters (52.3%) demonstrated significant post-treatment changes (p < 0.05), mainly in the perioral and lower facial regions. The reported parameters were selected due to their clinical relevance in evaluating perioral support and facial profile changes after complete denture treatment. In RP, upper lip thickness increased from 3.69 ± 0.97 mm to 4.96 ± 1.11 mm (Δ = +1.27 mm; p < 0.0001) and lower lip thickness from 6.18 ± 2.69 mm to 7.36 ± 1.52 mm (Δ = +1.18 mm; p = 0.0408). The nasolabial angle decreased from 116.08 ± 9.17° to 108.06 ± 9.56° (Δ = −8.02°; p = 0.0016). In MI, mouth width increased from 55.72 ± 3.43 mm to 57.97 ± 3.13 mm (Δ = +2.25 mm; p = 0.0102). Conclusions: Complete denture rehabilitation produces measurable, clinically relevant improvements in facial soft-tissue morphology in completely edentulous patients, particularly affecting lip support, mouth width, and the nasolabial profile. Structured-light 3D facial scanning provides a reproducible approach to objective outcome assessment and may support individualized denture design. Full article

Background/Objectives: Intracranial arachnoid cysts (Acs) are congenital, usually benign lesions that are frequently regarded as clinically silent in adulthood. Nonetheless, growing evidence indicates that Acs may be associated with subtle but measurable cognitive dysfunction. This systematic review synthesizes neuropsychological and functional neuroimaging findings in adults with intracranial Acs, with a focus on cognitive profiles, functional interactions with the adjacent cortex, and postoperative reversibility. Methods: In accordance with PRISMA 2020 guidelines, MEDLINE/PubMed and Scopus were searched for English-language studies published up to 2023 that reported neuropsychological assessments and/or functional neuroimaging in adult patients with Acs, including single-case reports, case series, and group studies with pre- and post-operative data. Results: Sixty studies met the inclusion criteria. Across anatomical locations, Acs were most consistently associated with impairments in verbal and visual memory and learning, attention, and executive functions, as well as reduced processing or psychomotor speed, whereas language deficits were less consistently observed. Several studies reported postoperative improvement in one or more cognitive domains, suggesting partial reversibility in selected patients. Functional neuroimaging findings revealed altered cortical function in regions adjacent to the cyst, including reduced regional metabolism or cerebral blood flow and task-related activation changes, supporting a functional interaction between Acs and the neighboring cortex. Conclusions: Overall, adults with Acs may exhibit subtle cognitive alterations that vary according to cyst location and appear to be moderated by compensatory mechanisms. These findings underscore the clinical relevance of systematic neuropsychological evaluation and highlight the need for prospective, standardized studies integrating cognitive and neuroimaging outcomes. Full article

Background/Objectives: Limb salvage surgery is the preferred treatment for bone and soft tissue tumors. The Toronto Extremity Salvage Score (TESS) is a validated patient-reported outcome measure (PROM). However, its upper extremity section is outdated, lacking assessment of modern technology use. This study adapted TESS (creating TESS 2.0) by adding a question on touchscreen/keyboard use, based on an existing Italian version. Methods: Two independent translations of the new item were synthesized. Linguistic feedback was obtained from two German speakers from Germany and Switzerland. Pretesting with eight individuals refined the wording. Fourteen patients who underwent upper extremity surgery completed the TESS 2.0 twice (once in person, once at home) and the DASH questionnaire once. Reliability was assessed using Cronbach’s alpha and ICC, and validity was assessed using Spearman’s correlation between TESS 2.0 and DASH. Results: TESS 2.0 demonstrated excellent internal consistency (Cronbach’s alpha ≥ 0.98 at both time points). A strong, statistically significant inverse correlation existed between TESS 2.0 and DASH (r = −0.867, p < 0.001). Test–retest reliability was high (ICC = 0.98). Conclusions: German TESS 2.0 is a reliable and valid instrument for assessing upper extremity function in patients treated for bone and soft tissue tumors. Further research is needed to validate its use in postoperative follow-up and a larger, more diverse patient population. Full article

Background/Objectives: Pilates is a form of exercise that benefits people with bodily pain and movement limitations. The Clinical Pilates method assesses a patient through history taking and exercise testing to identify the patient’s problem side and directional preference. This study is a technical report of two case studies to evaluate the feasibility of the Clinical Pilates conceptual framework for the management of neck and shoulder musculoskeletal conditions. Methods: A conceptual framework on the use of the diagnostic bullseye for neck and shoulder movements are presented. To illustrate the application of the framework, two independent case studies with neck and shoulder pain were interpreted. These cases were assessed for upper and lower quadrant movement preferences using the Clinical Pilates method. Patient self-reported outcome measures included the pain numeric rating scale (/10), patient-specific functional scale (/10), and shoulder pain and disability index (%). Results: In both case studies, the clinical outcomes improved by more than 50% from the baseline. These improvements showed that the conceptualized framework is feasible for use among individuals with neck and musculoskeletal conditions. Conclusions: The neck and shoulder diagnostic bullseyes developed provide an extension from existing lower quadrant diagnostic bullseye. The feasibility of the Clinical Pilates method for neck and shoulder conditions was illustrated in the two case studies. Full article

Background/objective: To evaluate the effectiveness of resin infiltration in managing anterior molar incisor hypomineralization (MIH) defects, focusing on color improvement, lesion size reduction, sensitivity outcomes and patient aesthetic perception. Enamel defects in MIH result from a combination of environmental, systemic, and genetic factors, indicating a multifactorial etiology. These defects, particularly in anterior teeth, pose significant aesthetic and emotional challenges due to their high visibility. This study provides one of the few prospective clinical evaluations of resin infiltration for anterior MIH lesions, assessing not only objective clinical outcomes but also patients’ aesthetic perception. It further introduces a patient-centered approach by comparing aesthetic evaluations made by children and dental professionals over time. Methods: A total of 109 MIH-affected anterior teeth were treated using Icon^® resin infiltration (DMG, Hamburg, Germany) in this registered prospective clinical study (ClinicalTrials.gov: NCT05597956). Participants were classified as children (6–12 years) and adolescents (13–17 years) according to standard pediatric age definitions. Of these, 101 teeth were available for evaluation at the 6-month follow-up due to patient loss to follow-up. The evaluation included photographic follow-up, measurement of lesion size and color, and assessment of sensitivity. During follow-up visits, patients rated the appearance of their lesions using the FDI scale. Results: Before treatment, spectrophotometric analysis showed that lesions exhibited a reddish hue (mean a* = 2.12), were distinctly yellowish (mean b* = 23.20), and clearly differed from surrounding enamel (ΔE = 8.62). The brightness level (L* = 69.81) indicated medium-high luminosity. Lesion size was reduced by an average of 4.5 percentage points. Significant increases in L values and reductions in a* and b* components were observed, with clinically perceptible ΔE changes. Sensitivity improved in 36.6% of patients, who reported a 1–2 point decrease on the SCASS. Moreover, patients’ aesthetic perception significantly improved after Icon^® infiltration resin. Conclusions: Resin infiltration produced noticeable improvements in color, reduced lesion size and sensitivity, and enhanced aesthetic perception, making it a valuable treatment option for managing MIH-affected anterior teeth in children. Full article

Background: In recent years, electronic patient-reported outcome (ePRO) systems on electronic devices, such as smartphones, have been employed to collect patients’ self-assessments and symptom reports. However, these studies were limited to younger populations and patients with severe diseases. Objective: This study aimed to evaluate the ease of use and response continuity of an ePRO system used by healthy middle-aged and older adults. Methods: This prospective observational study included participants aged 40–74 years undergoing specific health checkups. The System Usability Scale (SUS) was used to assess ePRO usability. Response continuity was evaluated by assessing EuroQol 5-Dimensional 5-Level responses once a month for up to 3 months after the health checkup date. Results: Eleven participants, aged 47–73 years, participated in the study. The mean SUS on the screening date was 59.1 (95% CI: 50.0–68.1; a cut-off of 70 indicated “useful”). However, only one participant failed to complete the ePRO at one and two months post-examination, and responses were obtained from all participants at three months. Conclusions: Due to the small sample size, usability as measured by the SUS should be interpreted descriptively. While initial onboarding appeared to be a major implementation barrier, sustained monthly ePRO reporting over 3 months was achievable among participants who completed registration with support, suggesting the conditional feasibility of response continuity in this preventive health checkup setting. Full article

Background/Objectives: Cleft lip and/or palate are common craniofacial anomalies whose surgical repair is classified as clean-contaminated and may be complicated by surgical site infection or palatal fistula. Despite widespread perioperative antibiotic use, there are no standardized, evidence-based recommendations, and rising antimicrobial resistance underlines the need for rational prescribing. This systematic scoping review aimed to map current evidence on prophylactic antibiotic therapy and related perioperative measures in cleft surgery. Methods: A scoping review was conducted using the Arksey and O’Malley framework and reported in line with PRISMA 2020. PubMed, Mendeley and Google Scholar were searched (January 2015–10 February 2025) for English-language retrospective studies, clinical trials, survey studies and systematic reviews concerning prophylactic antibiotics, bone grafting procedures, mouthwash use or oral microbiota in patients undergoing cleft lip and/or palate surgery. Six reviewers independently screened records; two experienced clinicians extracted data on study characteristics, antimicrobial regimens and infectious or microbiological outcomes. Given heterogeneity and the scoping aim, no formal risk-of-bias assessment or meta-analysis was performed. Results: A total of 40 studies met the inclusion criteria, including 21 original research articles. Considerable variation in antibiotic choice, timing and duration was observed, with no clear superiority of any regimen. Single-dose perioperative prophylaxis appeared non-inferior to prolonged courses in several settings. Oral microbiota studies highlighted colonization by resistant and opportunistic pathogens in cleft patients. Conclusions: Current evidence supports individualized, often short-course perioperative antibiotic strategies rather than routine prolonged therapy. High-quality randomized and microbiological studies are required to develop standardized, resistance-conscious guidelines. Full article

Background: Patient-reported outcome measures (PROMs) provide important insights into recovery after anterior cruciate ligament reconstruction (ACLR). Previous research suggests that males and females recover differently after ACLR, with females reporting greater pain, slower functional gains, and lower psychological readiness at later stages of rehabilitation. However, it is unknown if patient-reported outcomes differ by sex early after ACLR. To address this gap, we conducted a cross-sectional analysis comparing patient-reported outcome measures between sexes three months after ACLR. We hypothesized that females would report worse PROMs compared to males. Methods: This cross-sectional analysis used data from a prospectively maintained ACL reconstruction cohort. Fifty-six individuals (female: 23 and male: 33) with primary, unilateral ACLR completed PROMs three months after surgery. These PROMs included the Knee Injury and Osteoarthritis Outcome Score (KOOS; Symptoms, Pain, Activities of Daily Living, Sport and Recreation, Quality of Life), International Knee Documentation Committee (IKDC) subjective score, Knee Outcome Survey–Activities of Daily Living Scale (KOS-ADLS), Anterior Cruciate Ligament–Return to Sport After Injury (ACL-RSI), and the Tampa Scale of Kinesiophobia (TSK). All outcomes were expressed on a 0 to 100 percent scale, with higher scores indicating better outcomes, except for TSK, where lower scores indicated better outcomes. Normality was assessed within sex, using the Shapiro–Wilk test. Two-tailed independent-samples t-tests with Welch correction were used for approximately normal variables; otherwise, Mann–Whitney U tests were utilized (α = 0.05). Several outcomes had limited statistical power to detect MCID-sized differences, and findings for these measures should be interpreted cautiously. Results: No significant differences between sexes were found for any of the PROMs. Males trended towards having better KOOS Sport and Recreation and IKDC, but these were not statistically significant, and the effect sizes were small-to-moderate. Conclusions: No statistically significant sex-based differences were detected in PROMs at approximately 3 months after ACLR, indicating that any sex-related divergences between these measures may not occur until later in recovery. Full article

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and fibromyalgia (FM) are debilitating disorders with overlapping symptoms such as chronic pain and fatigue. Dysregulation of the endogenous opioid system, particularly µ-opioid receptor function, may contribute to their pathophysiology. This study examined whether epigenetic modifications, specifically µ-opioid receptor 1 gene (OPRM1) promoter methylation, play a role in this dysfunction. Using a repeated-measures design, 28 ME/CFS/FM patients and 26 matched healthy controls visited the hospital twice within four days. Assessments included blood sampling for epigenetic analysis, a clinical questionnaire battery, and quantitative sensory testing (QST). Global DNA (hydroxy)methylation was quantified via liquid chromatography–tandem mass spectrometry, and targeted pyrosequencing was performed on promoter regions of OPRM1, COMT, and BDNF. ME/CFS/FM patients reported significantly worse symptom outcomes. No differences in global (hydroxy)methylation were found. Patients showed significantly higher OPRM1 promoter methylation, which remained after adjusting for symptom severity and QST findings. Across timepoints, OPRM1 methylation consistently correlated with BDNF Promoter I and Exon III methylation. This is, to the best of our knowledge, the first study examining OPRM1 methylation in ME/CFS/FM. Increased OPRM1 methylation in patients, independent of symptoms or pain sensitivity measures, supports the hypothesis of dysregulated opioidergic signaling in these conditions. Full article

Background: Advanced endometrial cancer is associated with poor survival. With the advent of molecular classification and novel systemic therapies—including immunotherapy and targeted agents—treatment regimens have become increasingly complex. While these approaches aim to improve survival, they also potentially introduce long-term toxicities and treatment burden, reinforcing the importance of incorporating health-related quality of life (HRQoL) and patient-reported outcomes (PROs) into clinical trials. Methods: A systematic review was conducted of phase III randomized controlled trials (RCTs) in advanced, recurrent, or metastatic endometrial cancer evaluating systemic treatment registered on ClinicalTrials.gov and published up to 30 November 2025. Extracted data included study characteristics, HRQoL instruments, reporting formats, adherence to CONSORT-PRO, and timing of HRQoL dissemination (relative to primary efficacy reports). Results: Eight phase III RCTs published between 2020 and 2024 were included. Although HRQoL was consistently designated as a secondary endpoint, reporting within pivotal efficacy publications was limited. Most reports presented mean changes from baseline using the EORTC QLQ-C30, QLQ-EN24, and EQ-5D-5L. None of the primary reports reported time-to-deterioration analyses or the proportions of patients improving/deteriorating. Adherence to CONSORT-PRO was low, with only a minority of items addressed. Dedicated QoL publications were delayed by up to 25 months after primary efficacy reports and typically appeared in journals with lower impact factors. Conclusions: Despite routine inclusion of HRQoL measures in trial protocols, reporting remains inconsistent, limited in scope, and often delayed. Strengthening adherence to established frameworks is essential to ensure that HRQoL endpoints are predefined, analytically robust, and disseminated alongside efficacy data—particularly in a rapidly evolving therapeutic landscape. Full article