Search Results (950)

Background: The integration of additive manufacturing (AM) into digital dentistry has extended 3D printing beyond auxiliary applications toward the fabrication of definitive restorations, yet the evidence remains dispersed across diverse materials and technologies. This scoping review aimed to map the available evidence on 3D-printed resin- and ceramic-based materials for definitive tooth-supported restorations, including crowns, fixed dental prostheses, endocrowns, veneers, overlays, and onlays. Methods: The review followed the JBI framework and reported according to PRISMA-ScR. MEDLINE, Embase, and Scopus were searched from inception to April 2026. Two reviewers screened records independently against predefined eligibility criteria, and data were extracted using a piloted charting form capturing study design, materials, additive manufacturing technology, restoration type, and evaluated outcomes. Given the anticipated heterogeneity, extracted data were synthesised descriptively and mapped narratively rather than pooled statistically; 111 studies met the inclusion criteria. Results: The evidence was predominantly in vitro (105 studies), with only six clinical studies, including one randomised controlled trial. Research concentrated on single crowns, zirconia and ceramic-filled/methacrylate-based resins, and vat-photopolymerization technologies. Additively manufactured restorations were frequently reported as comparable to milled controls in dimensional accuracy, marginal and internal fit, and fracture resistance, with values generally falling within the clinically accepted thresholds defined by the primary studies; reported outcomes were most consistent for printed zirconia, whereas printed resins were more often limited by lower strength and colour instability. Outcomes were strongly influenced by processing parameters, underscoring the need for workflow standardisation. Conclusions: The current evidence supports the technical feasibility of 3D-printed definitive restorations more strongly than their long-term clinical durability, highlighting a need for long-term clinical trials. Full article

Dietary polyphenols are studied as potential adjuncts for type 2 diabetes (T2D), although many reviews still rely on an antioxidant framework that does not adequately reflect human exposure. This review organises the evidence around two metabolite waves, namely early postprandial phase-II conjugates produced by host enzymes within 0 to 4 h of a polyphenol-rich meal, and microbiome-derived catabolites including urolithins and γ-valerolactones that peak at 6 to 24 h. This biphasic interpretation is advanced as a hypothesis-generating framework rather than as an established explanation, and it offers a testable account of why polyphenol effects may be meal-contingent, metabotype-dependent and heterogeneous across clinical trials. Using randomised controlled trials and meta-analyses published between 2015 and 2025, we review the human evidence for anthocyanins, catechins, stilbenes, cocoa flavanols and olive phenolics, with briefer coverage of isoflavones, curcuminoids and ellagitannins. Anthocyanins show the most consistent glycaemic signal, with a best available pooled estimate of about 0.3% for HbA1c (−0.31%, median exposure eight weeks) derived from trials that did not verify metabolite exposure, an effect that is modest and lies at the lower bound of what is generally regarded as clinically meaningful. Green tea catechins and high-phenolic extra-virgin olive oil are associated with comparable postprandial gains, whereas cocoa flavanols and resveratrol more reliably improve vascular and inflammatory intermediates than glycaemia itself. Most interventions were well tolerated at the nutritional doses tested. Polyphenols are better regarded as meal-timed dietary adjuncts to standard T2D care than as primary glycaemic agents. Full article

Background/Objectives: Radial artery spasm (RAS) is the most common periprocedural complication of transradial coronary angiography (TRA) and is identified clinically, from patient-reported forearm pain and operator-perceived catheter resistance, rather than by imaging. This study compared two sedation strategies used in routine clinical practice, namely fentanyl-midazolam moderate sedation (MS) and a propofol-integrated monitored anaesthesia care (MAC) regimen, with respect to procedure-related pain and the incidence of clinically detected radial artery spasm (cRAS). Methods: This single-centre, prospective, non-randomised, observational study enrolled 394 consecutive patients undergoing elective TRA (MS, n = 231; MAC, n = 163). cRAS was defined as at least two of five established criteria: three patient-reported pain items and two operator-perceived resistance items. No angiographic, ultrasonographic or physiological assessment of radial vasomotor tone was performed, and operators were not blinded. Co-primary endpoints were cRAS and post-procedural pain scores; the secondary endpoint was a composite of periprocedural complications. Factors associated with cRAS were analysed using multivariable logistic regression, including sensitivity analyses with decreasing dependence on patient-reported pain. Results: cRAS occurred in 59 patients (15%), 20.3% with MS and 7.4% with MAC (p = 0.001). VAS pain scores were lower with MAC (p < 0.001); complications did not differ (13.4% vs. 7.3%; p = 0.083). Female sex (odds ratio [OR] 3.60; 95% confidence interval [CI] 1.91–6.78), procedural duration (OR 1.04 per minute; CI 1.02–1.06) and MS rather than MAC (OR 3.69; CI 1.80–7.58) were independently associated with cRAS (all p < 0.001). The association persisted when the outcome was restricted to operator-assessed criteria (21.6% vs. 9.2%; OR 2.95; CI 1.55–5.59). Conclusions: The propofol-integrated regimen was associated with less procedural pain and less clinically detected spasm. These hypothesis-generating findings describe clinically apparent spasm and cannot establish prevention of true vasospasm. Within that limit, they support testing this strategy in a randomised trial with objective, blinded endpoints, particularly in women. Full article

Objective: Modern high-intensity warfare, such as the Russo-Ukrainian conflict, generates a high incidence of multisystem polytrauma, blast-induced traumatic brain injury, and limb amputations often complicated by post-traumatic stress disorder and chronic pain. Traditional specialised rehabilitation protocols are structurally inadequate for these co-occurring symptoms and rely heavily on medical treatments, increasing the risk of opioid dependency. The primary aim of this review is to conceptualise a multidimensional integrative framework for war-related polytrauma; a secondary aim is to evaluate and summarise the evidence underpinning its key rehabilitation strategies for limited-resource, post-conflict environments. Methods: This narrative review synthesises evidence identified through targeted database searches and purposive selection guided by clinical relevance, methodological quality, and applicability to war-related polytrauma across physical, technological, and non-pharmacological rehabilitation domains. Evidence was evaluated using a four-tier (A–D) hierarchy, comprising Tier A (systematic reviews and RCTs), Tier B (prospective cohort studies and non-randomised controlled trials), Tier C (descriptive, case-series, and retrospective studies), and Tier D (exploratory, mechanism-based, or expert opinion evidence). No systematic inclusion/exclusion protocol was applied, and no claims of comprehensive search coverage are made. Results: Concurrent physical and trauma-focused psychological rehabilitation, evidenced by reduced pain and psychological symptom burden alongside improved functional independence, is supported by high-quality evidence (Tier A) for managing comorbid polytrauma. Robotic exoskeletons and AI-supported tele-rehabilitation demonstrate dose-dependent motor benefits in selected rehabilitation populations (Tier A–B), but their scalability in wartime settings is contingent on electricity supply, connectivity, equipment maintenance, and trained personnel. Acupuncture shows Tier A evidence for neuropathic pain and Tier B cost-effectiveness; evidence for phantom limb pain and PTSD is preliminary (Tier C–D) and requires dedicated RCTs in veteran populations. Ayurvedic herbal interventions are exploratory (Tier C–D) with no war-specific clinical trials; mechanistic plausibility is discussed as hypothesis-generating only. Conclusions: Addressing the war-related rehabilitation gap requires integration of biomedical care, technology-assisted rehabilitation, and evidence-graded non-pharmacological adjuncts within a structured biopsychosocial framework. Future priorities include pragmatic, adapted trial designs (e.g., stepped-wedge or cohort-embedded designs, which are more feasible than classical RCTs under wartime conditions) for acupuncture in phantom limb pain, feasibility trials for robotic rehabilitation in frontline-adjacent facilities, and health-economic modelling adapted to the Ukrainian context. Full article

Background/Objectives: C-reactive protein point-of-care tests (CRP POCTs) have become a useful tool in reducing inappropriate prescribing of antibiotics in the management of respiratory tract infections (RTIs). This review examined the barriers and enablers of CRP POCT implementation in primary care using the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Methods: A search was conducted in six electronic databases (PubMed, Scopus, CINAHL (EBSCOhost), Medline (EBSCOhost), ProQuest and CENTRAL) for studies up to December 2025 on CRP POCT implementation for RTIs in primary care. Eligible studies included quantitative randomised controlled trials (RCTs), qualitative studies, cost-effectiveness studies, mixed-methods and observational studies. Only English-language studies were included. Results: The review included 35 studies. CRP POCT was generally found to be an effective and acceptable tool due to reductions in antibiotic prescribing, playing a role in supporting clinical decision-making and patient communication. However, widespread adoption and usage were inconsistent across studies. Further, qualitative findings raised operational and financial constraints as key barriers to sustained implementation. Reporting of RE-AIM domains varied across study type. Notable gaps were identified in reporting of the maintenance domain along with population representativeness, non-participation, and device uptake. Of the 35 studies, 13 included 'operational' and/or 'financial constraints' as identified themes or concerns about wider implementation. Conclusions: Although CRP POCT has routinely been found to be effective, a wider comprehensive assessment of implementation is restricted due to gaps in reporting. Key barriers to sustained and scalable global implementation of CRP POCT in primary care are predominantly financial and operational. Full article

Background: Flexor tendon rupture is a rare but potentially disabling complication following minimally invasive treatment of Dupuytren’s disease. This meta-analysis compared rupture incidence after collagenase Clostridium histolyticum (CCH) injection and percutaneous needle fasciotomy/aponeurotomy (PNF/PNA). Methods: PubMed, MEDLINE, and Embase were systematically searched for randomised trials, cohort studies, clinical trials, and case series reporting complications after CCH or PNF for Dupuytren’s disease. Case reports and secondary evidence were excluded from incidence calculations, although reference lists of reviews were screened for eligible primary studies. Flexor tendon rupture events and study denominators were extracted as reported. Pooled incidence was estimated using random-effects proportional meta-analysis with logit transformation and continuity correction. Separate pooled estimates were generated for CCH and PNF, followed by subgroup comparison. Results: Forty-one studies were included. Across eligible studies, 68 flexor tendon ruptures were identified, including 62 after CCH and 6 after PNF. Ruptures most commonly involved the flexor digitorum profundus, affected the small finger, and occurred early, with a median time to rupture of 8 days, where reported. Fourteen PNF cohorts comprising 6058 treated units reported 6 ruptures, producing a pooled incidence of 0.32% (95% CI: 0.18–0.55%) with no observed heterogeneity. Twenty-nine CCH cohorts comprising 60,949 treated units reported 62 ruptures, producing a pooled incidence of 0.83% (95% CI: 0.42–1.64%) with substantial heterogeneity. Subgroup comparison demonstrated a higher pooled rupture incidence following CCH than PNF. Conclusions: Flexor tendon rupture is uncommon after both CCH and PNF. Characterisation of anatomical and treatment-related patterns of rupture may support more individualised risk counselling and treatment selection in Dupuytren’s disease. Future studies are required to develop clinically meaningful risk-stratification strategies. Full article

Inflammatory bowel disease (IBD), encompassing Crohn’s disease (CD) and ulcerative colitis (UC), is a chronic immune-mediated condition with substantial global burden and rising incidence, requiring an expanding range of advanced therapies. This focused narrative review examines the mechanistic rationale, comparative clinical evidence, and translational implications of approved and emerging targeted therapies for adult IBD. A structured literature search was conducted in PubMed, Scopus, and Web of Science for publications from January 2021 to March 2026. Thirty-eight articles were selected as the core evidence set with landmark trials and clinical guidelines added when needed for historical or practice context. Evidence was synthesised narratively, with an explicit distinction between direct head-to-head comparisons, placebo-controlled trials, indirect network comparisons, and observational data. In UC, VARSITY showed higher week-52 clinical remission and endoscopic improvement with vedolizumab than adalimumab; in CD after anti–tumour necrosis factor (anti-TNF) failure, SEQUENCE showed risankizumab noninferior to ustekinumab for week-24 clinical remission and superior for week-48 endoscopic remission. Agents targeting tumour necrosis factor-like cytokine 1A (TL1A) have shown encouraging activity in phase 2/2b trials, but long-term effectiveness and safety remain uncertain. The current evidence supports mechanism-informed rather than biomarker-defined treatment selection. Confidence in comparative conclusions is greatest when supported by direct randomised evidence, whereas observational and indirect comparisons require caution because of confounding, heterogeneity, and differences in populations and outcome definitions. Clinical translation therefore requires the integration of the disease phenotype, prior treatment exposure, safety risks, and patient preference, with objective reassessment after therapy initiation. Full article

Skin health is increasingly recognised as a key determinant of overall well-being, and its decline is driven by multiple interconnected biological processes. Hydroxytyrosol (HT), an olive polyphenol, exhibits pleiotropic biological activities and has a potential role in supporting skin homeostasis. This narrative review critically evaluates the evidence on oral HT and HT-rich olive-derived nutraceuticals for skin health and healthy ageing with a focus on oxidative damage, inflammation, photoprotection, extracellular matrix (ECM) preservation, wound healing, and skin pigmentation conditions. HT exhibits high oral bioavailability and modulates antioxidant defences, inflammatory signalling, autophagy, apoptosis, and metabolic homeostasis. Preclinical studies consistently show protective effects against oxidative stress, ECM degradation, cellular senescence, photoageing, impaired wound healing, and ultraviolet-induced skin damage. Experimental evidence also indicates antiproliferative and pro-apoptotic effects in melanoma models through modulation of oncogenic signalling pathways, suggesting a potential role in skin cancer prevention. In vivo, oral HT administration improves glycative skin ageing, psoriasis, intestinal barrier integrity, and systemic inflammation. Clinical evidence supports systemic antioxidant and cardiometabolic benefits of purified HT and HT-rich formulations, while dermatological evidence remains preliminary for psoriasis, melasma, and wound healing. Overall, HT shows promise, but randomised controlled trials with validated dermatological endpoints are needed to confirm its clinical efficacy. Full article

Blue-light filters now span spectacle, contact and intraocular lenses, but the term encompasses technologies with markedly different spectral characteristics and intended outcomes. This state-of-the-art narrative review synthesises peer-reviewed evidence on optical performance, digital eye strain, glare, photostress, sleep and circadian physiology, retinal phototoxicity, macular health, reported adverse effects and commercial translation. Near-clear spectacle filters preserve high-contrast acuity in most studies, but randomised and systematic reviews show no clinically meaningful average reduction in short-term digital eye strain. Some products reduce blue-colour contrast, particularly under low-contrast or low-light conditions, and adverse-event reporting is sparse. Studies of evening filters are heterogeneous: substantial amber attenuation can alter circadian light exposure, yet several trials have found no objective sleep benefit. Conventional visual outcomes with blue-filtering intraocular lenses are broadly comparable with ultraviolet-only lenses, although some individual studies report small mesopic colour or contrast disadvantages; long-term macular protection remains unresolved. Research on contact lenses is limited, typically short-term and often manufacturer-associated, and focuses on glare, photostress, scatter and perceived brightness rather than long-term health outcomes. Taken together, the evidence should be interpreted by filter spectrum and intended outcome, rather than treating blue-light filtering as a single intervention. Full article

Acute pancreatitis is a common and heterogeneous inflammatory disorder whose clinical course ranges from a self-limited illness to persistent organ failure, infected pancreatic necrosis, and prolonged critical illness. Contemporary management has moved away from protocolised aggressive fluid loading, prolonged fasting, prophylactic antibiotics, and early open necrosectomy. Instead, current care emphasises repeated physiological assessment, moderate goal-directed resuscitation, early enteral or oral nutrition, organ-specific support, antimicrobial stewardship, and delayed minimally invasive intervention within a multidisciplinary step-up strategy. This narrative review examines acute pancreatitis from an intensive care perspective. Particular attention is given to early risk stratification, intensive care unit triage, haemodynamic and respiratory support, acute kidney injury, intra-abdominal hypertension, nutrition, biliary source control, diagnosis and treatment of infected necrosis, and the timing and selection of endoscopic, radiological, and surgical interventions. The implications of obesity, pregnancy, advanced age, and multimorbidity are also discussed. Recent randomised trials have clarified several clinically important questions: aggressive hydration increases fluid overload without improving outcomes; routine urgent endoscopic retrograde cholangiopancreatography is not beneficial in predicted severe biliary pancreatitis without cholangitis; postponed drainage may avoid invasive intervention in a substantial proportion of patients with infected necrosis; and endoscopic or minimally invasive approaches reduce treatment burden compared with primary open surgery. Persistent organ failure remains the principal determinant of mortality, while infected necrosis further increases risk and complexity. Future progress will depend on dynamic prediction models, biomarker-guided antimicrobial decisions, personalised haemodynamic strategies, phenotype-directed immunomodulation, and regionalised multidisciplinary care. Full article

Cardiovascular disease is the leading cause of death in Poland, and alcohol is among the principal modifiable determinants of cardiovascular health there. The view of light-to-moderate drinking as cardioprotective has been challenged by bias-corrected synthesis, Mendelian randomisation, and the 2023 World Health Organization position that no level of alcohol consumption is safe. We synthesised the primary epidemiological and modelling evidence on alcohol and cardiovascular mortality in Poland and the wider Central and Eastern European region. PubMed/MEDLINE and ClinicalTrials.gov were searched on 18 June 2026 from 1998 onward; 107 studies were included. Risk of bias was assessed with the Newcastle–Ottawa Scale and AMSTAR-2 and certainty with GRADE. Heterogeneity precluded meta-analysis, so the evidence was synthesised without meta-analysis (SWiM). The review was registered in PROSPERO (CRD420261427480) and follows PRISMA 2020. Excess cardiovascular and all-cause mortality tracked high average intake and alcohol use disorder rather than occasional intake. Polish data showed dose-graded rises in blood pressure, and stronger alcohol-control policy in the Baltic states and Poland was associated with lower mortality. The lower mortality of moderate drinkers relative to abstainers is consistent with sick-quitter bias rather than cardioprotection. Certainty was low to very low. The evidence does not support promoting any level of alcohol consumption for cardiovascular protection. Full article

Adhesive capsulitis is characterized by shoulder pain, stiffness, and limited range of motion. Although multimodal rehabilitation is commonly used, it is unclear which combination of physiotherapy interventions is optimal. The aim of this exploratory study was to compare the short-term effects of TECAR therapy combined with proprioceptive neuromuscular facilitation (PNF) with those of standard physiotherapy in women with stage II adhesive capsulitis. This was a prospective, longitudinal, non-randomized, and exploratory study in which participants were assigned either the TECAR + PNF group or the standard physiotherapy group. Both intervention groups were given treatment three times a week for four weeks. Pain intensity and upper-limb disability were measured using the Visual Analog Scale (VAS) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Shoulder flexion, abduction, internal rotation and external rotation were measured using goniometry. Within-group changes were analyzed with the Wilcoxon signed-rank test, and exploratory baseline-adjusted analyses were conducted with ANCOVA. Both groups showed statistically significant improvements in pain and disability as a result of treatment. The median reduction on the VAS was about 5.00 points in the TECAR + PNF group and 2.00 points in the standard physiotherapy group. The median DASH scores fell by about 43.25 points and 16.00 points, respectively. Exploratory ANCOVA models showed that the TECAR + PNF group had more favourable adjusted VAS and DASH scores after treatment. Nevertheless, the groups differed at baseline in abduction, internal rotation, and external rotation, and a full pre–post analysis of changes in range of motion was not available. Therefore, the mobility results cannot be regarded as providing evidence of treatment superiority. We can conclude that in this small, non-randomised pilot study, the combination of TECAR and PNF led to greater short-term reductions in pain and upper-limb disability compared with standard physiotherapy. Nevertheless, these findings are still only preliminary and hypothesis-generating, and it is essential to carry out larger, adequately powered randomised controlled trials with concealed allocation, balanced baseline characteristics, complete analyses of changes in range of motion, and longer follow-up periods in order to confirm their clinical relevance and determine their comparative effectiveness. Full article

Botulinum toxin, once known only as the cause of botulism, has become a versatile therapeutic agent whose use in children now extends across many medical and surgical specialties. This narrative review synthesises the clinical use of botulinum toxin in patients up to eighteen years of age. We describe its pharmacology, the non-interchangeable commercial preparations, and the weight-based dosing and safety principles specific to childhood, then examine its applications by organ system. Gastrointestinal uses include functional constipation and internal anal sphincter achalasia, persistent obstruction after surgery for Hirschsprung disease, anal fissure, and achalasia. Urological uses centre on neurogenic and idiopathic detrusor overactivity and on sphincter-directed injection for dysfunctional voiding. Neurological uses are dominated by cerebral palsy spasticity and, on considerably weaker evidence, dystonia, while head and neck uses include sialorrhoea, congenital muscular torticollis, and strabismus. We also address neonatal brachial plexus palsy together with hyperhidrosis and aesthetic use in adolescents. The evidence supporting these uses is markedly uneven. Randomised controlled trials exist for only a small number of paediatric indications, chiefly spasticity in cerebral palsy, neurogenic detrusor overactivity, and chronic sialorrhoea, whereas most remaining applications rest on observational cohorts, small case series, or extrapolation from adult practice, and we grade the certainty of evidence separately for every indication. Only a few indications are formally approved, and most remain off-label, though increasingly supported. Botulinum toxin is a reversible and generally safe adjunct, but rigorous paediatric trials are still needed. Full article

Background/Objectives: Food allergy prevention is no longer understood as the simple avoidance of allergenic foods. The first 1000 days (from conception to, approximately, 24 months of age) include prenatal, perinatal and postnatal windows in which diet, epithelial barrier integrity, microbial ecology, immune maturation and family-level implementation interact. This narrative review was developed as a Commission-proposed SIAIP-oriented clinical framework, rather than a formal guideline or consensus statement. Evidence from guidelines, systematic reviews, randomised trials, birth cohorts and mechanistic studies was organised by developmental window and interpreted according to endpoint validity, confounding, feasibility and clinical readiness. Prenatal factors include maternal allergen non-avoidance, whole-diet quality, micronutrient and fatty acid status, antibiotic exposure, environmental context and maternal microbiome. Perinatal factors include mode of delivery, intrapartum and neonatal antibiotics, gestational maturity, early colonisation, breastfeeding initiation and routine vaccination. Postnatal factors include eczema, skin barrier inflammation, the timing and regularity of allergen introduction, breastfeeding management, infant diet diversity, siblings, daycare, pets, smoke and pollution, physical activity and equitable implementation. The strongest actionable evidence remains eczema-linked risk recognition and timely, sustained oral exposure to peanut and well-cooked egg. Maternal and environmental factors are clinically important, but many are contextual rather than prescriptive; they should guide non-restrictive, non-blaming counselling rather than deterministic risk labelling. Full article

Background: Pain is a multidimensional experience shaped not only by nociceptive input but also by cognitive, emotional, and social processes. In musculoskeletal (MSK) rehabilitation, outcome variability among patients with similar clinical presentations suggests that determinants beyond tissue pathology may influence pain perception and recovery. Contextual factors (CFs)—communication, therapeutic relationship, patient expectations, and environmental cues—are increasingly recognized yet remain inconsistently integrated into routine practice. Objective: To map how CFs are represented in the physiotherapy literature indexed under that terminology, and to identify where empirical evidence in MSK rehabilitation is present and where it is absent. Methods: A narrative review with a systematic search strategy, reported following SANRA, was conducted in PubMed and Scopus, searched on 31 March 2026. Records were screened against predefined eligibility criteria, including publication from 2006 onwards and English language. Two reviewers independently screened records and resolved disagreements by consensus. Methodological quality was appraised using the Cochrane RoB2 tool for randomized controlled trials and an adapted Newcastle–Ottawa Scale for observational and cross-sectional studies. Conceptual publications were not formally appraised. Each publication was classified as direct clinical evidence (Tier A), indirect mechanistic or implementation-level evidence (Tier B), or conceptual contribution (Tier C). Results: Eight publications were included: no source provided direct clinical evidence in a musculoskeletal rehabilitation population (Tier A), five provided indirect mechanistic or implementation-level evidence (Tier B), and three were conceptual contributions (Tier C). The single randomised controlled trial retrieved was conducted in asymptomatic volunteers and was at high risk of bias for the between-group comparisons of all reported outcomes. Findings are organised as contextual domains, mediating mechanisms, and outcomes. No direct clinical evidence was retrieved; claims regarding expectations, therapeutic alliance, non-verbal communication, and the clinical environment rest on indirect or conceptual sources. Conclusions: CFs may contribute to pain and rehabilitation variability through cognitive, emotional, and relational pathways, complementing rather than replacing evidence-based care. The scarcity of direct clinical evidence within the literature indexed under this terminology is itself a finding. Construct-level searches and pragmatic trials are required to clarify the contribution of individual contextual domains. Full article