Search Results (5,220)

Objectives: Myofascial pain syndrome (MPS) is a common musculoskeletal condition, and while percutaneous needle electrolysis (PNE) and intramuscular electrical stimulation (IMES) are emerging therapies for myofascial pain syndrome and tendinopathies, their effects remain unclear. This systematic review aimed to characterize the methodological features and synthesize the evidence on the clinical improvement and adverse events rates of PNE and IMES in treating MPS and tendinopathies. Data Sources: PubMed, Scopus, Web of Science, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, Google Scholar, and reference lists. Searches were carried out on 10 July 2025 and repeated on 16 March 2026, just before final analysis. New results found during final searches were screened for inclusion to ensure currency of the review. Methods: We selected studies based on the PICOS framework and predefined selection criteria: Population: adults with MPS or active myofascial trigger points (TrPs), or tendinopathies; Intervention: PNE or IMES; Comparator: sham procedures, other interventions, or no intervention; Outcomes: pain intensity (e.g., Visual Analogue Scale or Numeric Pain Rating Scale), pressure pain threshold (PPT), and functional measures; and Study Design: experimental studies. Studies focused exclusively on post-surgical or neuropathic pain, studies without a relevant comparator, and studies not reporting clinically meaningful outcomes were excluded. We assessed the risk of bias of included studies and performed a narrative synthesis. Results: From 737 identified records, 30 studies met the selection criteria. PNE was generally effective in reducing pain and improving function in tendinopathies and MPS, although results varied across outcomes and follow-ups. IMES showed moderate evidence for reducing pain and enhancing function, particularly cervical range of motion and PPT. However, both interventions had inconsistent clinical improvement and adverse events rates on disability indices and quality of life. Most studies had a high risk of bias due to challenges in blinding. Reported adverse events were minor and self-limiting, indicating that both therapies are generally safe when performed by trained clinicians. Conclusions: PNE and IMES may improve pain and some functional outcomes in MPS and tendinopathies; however, these findings should be interpreted cautiously because most included studies had a high risk of bias. Full article

Introduction: Bacterial multidrug resistance (MDR) drives treatment with expensive, toxic, or pharmacokinetically suboptimal antibiotics. Objectives: To assess the prevalence of MDR Gram-positive cocci among isolates from cardiac implantable electronic device (CIED) infections at a Polish reference center. Methods: Data come from the “EXTRACT” registry (ClinicalTrials.gov ID NCT05775783), which covers 702 transvenous lead extraction procedures. Blood samples and intraoperative swabs were collected from participants with CIED infection. Results: From 209 cases with isolated pocket infection (PI) (107, 51.2%) or systemic infections (102, 48.8%), 263 Gram-positive cocci were cultured. They were: coagulase-negative staphylococci (CoNS) (177, 67.3%), Staphylococcus aureus (62, 23.6%), enterococci (15, 5.7%), streptococci (8, 3.0%), and others (1, 0.4%). The highest MDR rate was among CoNS (46.9%). CoNS exhibited methicillin resistance (MR-CoNS) in 55.9% with co-resistance to macrolides (73.2%), lincosamides (51.0%), fluoroquinolones (56.1%), aminoglycosides (41.4%), tetracyclines (29.6%), and co-trimoxazole (29.3%). Resistance to daptomycin (5.3%) and linezolid (2.0%) in MR-CoNS was rare. The frequency of MDR S. aureus was 8.1%. Methicillin resistance in S. aureus (MRSA, 6.5%) co-occurred with resistance to macrolides/lincosamides and fluoroquinolones (100% for both) or linezolid (25.0%). All MDR staphylococci were vancomycin-susceptible. High-level aminoglycoside resistance (HLAR) in Enterococcus faecalis (53.8%) was accompanied by levofloxacin co-resistance (66.7%). Conversely, E. faecium HLAR (50.0%) strains showed 100.0% β-lactam resistance. Vancomycin-resistant enterococci (VRE) accounted for 6.7%; the VRE E. faecium strain was tigecycline- and linezolid-susceptible. Among viridans group streptococci, β-lactam and lincosamides resistance was common (40.0% for both), with 50.0% of co-resistance. Conclusions: Epidemiological data may improve the effectiveness of empirical antibiotic therapy for CIED-related infections. Full article

Although the estimated tuberculosis (TB) incidence in Gabon is declining, there have been challenges with treatment coverage, HIV status and treatment outcome documentation. Thus, the National TB Program (NTP) conducted an innovative data review at the Nkembo Health Treatment Center in Libreville, which manages more than 70% of Gabonese TB patients. Since our hypothesis was that the Nkembo treatment center was struggling with data mismanagement due to the workload, the objective was to perform a TB data quality review and triangulation exercise at the Nkembo health facility in Libreville, from January to August 2023, and propose recommendations for data improvement. Methods: The study used the data reconciliation method. This is a process that involves comparing and aligning data from multiple sources to ensure consistency, accuracy, and integrity. The primary purpose of data reconciliation is to identify and resolve discrepancies or differences between datasets and make them consistent. Using the “TB onion model”, analysis identified data mismanagement as a key contributor to underreporting. A data review compared TB records to TB registry data and patient folders from January to August 2023 for notification and to the 2022 cohort for treatment results. The study focused on notified TB cases, HIV status and TB treatment outcome documentation. Discrepancies were reconciled, and treatment outcomes re-evaluated. Results: After review, statistically significant increases were observed: +22% for total TB cases (p = 0.0003), +141% for the number of TB cases with known HIV status (p = 0.0017) and +104% for the number of TB cases successfully treated (p = 0.0001), as compared with the previous data. Discussion: This data reconciliation showed the usefulness of triangulation across data sources to improve the completeness of data. Also, current reported data underestimate the number of reported cases, documentation of HIV status, and treatment success. Conclusions: The study shows that data reconciliation can improve TB programmatic data completeness to better reflect program performance. Full article

Background: Severe Alpha-1-Antitrypsin deficiency (AATD), phenotype PiZZ, is a leading cause of liver disease in neonates, children, and adults. Nevertheless, the prevalence of liver disease and mortality within PiZZ adults remains unclear. Between 1972 and 1974, a cohort of 129 individuals with severe AATD (PiZZ) was identified through the Swedish national screening of 200,000 newborns. The cohort has been followed up regularly since birth. This prospective cohort follow-up study, with a cross-sectional comparison at 50 years of age, aims to characterize the natural history of liver disease and mortality in this cohort in their early fifties, compared with an age-matched control group (PiMM) randomly selected from the population registry. Methods: Study participants completed questionnaires regarding occupation, medical history, medication, and alcohol consumption. They underwent physical examination and measurement of liver stiffness using transient elastography (TE, FibroScan^®). Blood samples were obtained for evaluation of liver function, alcohol consumption, calculation of liver fibrosis scores, and detection of viral hepatitis and autoimmune liver disease. Results: Ninety-five PiZZ and 124 PiMM individuals participated in the study, of whom 47 PiZZ and 96 PiMM underwent TE measurement. PiZZ individuals had significantly higher median liver stiffness compared with PiMM individuals (5.9 kPa vs. 4.5 kPa, p < 0.01). No significant differences were found in Fib-4 score or the Non-Alcoholic Fatty Liver Disease Fibrosis Score (NFS) between the groups. Since identification of the cohort at birth, 13 (10%) of the 129 PiZZ individuals have died. Of these, liver disease was the main or underlying cause of death in 8 individuals (6%). Conclusions: In their early fifties, PiZZ individuals show a small but significant increase in liver stiffness measured by TE, indicating early liver fibrosis. In contrast, conventional fibrosis scores, such as Fib-4 and NFS, do not differ between PiZZ individuals and PiMM, suggesting that serum-based fibrosis scores may underestimate fibrosis in AATD. In this cohort, liver disease and its complications represented the main cause of death in PiZZ individuals by the age of 50, an observation that is uncommon in the general population at this age. Full article

Objectives: Real-world data on surgical and multimodal management of upper tract urothelial carcinoma (UTUC) are limited. This study examined epidemiological trends, nephron-sparing surgery adoption, and the perioperative impact of lymphadenectomy (LND) and neoadjuvant chemotherapy (NAC). Methods: The German Nationwide Inpatient Data (GRAND) registry (2005–2023) identified UTUC patients undergoing radical nephroureterectomy (RNU), endoscopic laser destruction, or segmental ureteral resection (SUR) using OPS codes. Demographics, comorbidities, complications, and in-hospital mortality were extracted from ICD-10-GM data. Multivariable regression adjusted for baseline comorbidities assessed associations between treatment type, LND, NAC, and perioperative outcomes. Results: Among 53,427 UTUC patients, 77.3% underwent RNU, 13.8% endoscopic laser destruction, and 8.9% SUR. Endoscopic laser use rose from <10% (2005) to about 20% (2023). LND was performed in 13% of RNU cases, increasing from 1.1% to 19%. LND was associated with higher risks of transfusion (OR 1.47, 95% CI 1.37–1.57), acute kidney injury (OR 1.19, 95% CI 1.07–1.32), and ICU admission (OR 1.21, 95% CI 1.13–1.30), without affecting in-hospital mortality. NAC was given to 1.7% of patients, with a five-fold increase over time, and was associated with more transfusions (OR 1.28, 95% CI 1.07–1.52) and urinomas (OR 2.31, 95% CI 1.31–3.78), but not mortality. Conclusions: UTUC management is evolving, with growing use of endoscopic laser therapy and guideline-aligned lymphadenectomy during nephroureterectomy. Neoadjuvant chemotherapy remains underused despite acceptable perioperative safety, highlighting the need for increased awareness to optimize multimodal treatment. Full article

Hereditary cancer syndromes (HCSs), including BRCA 1/2-associated hereditary breast and ovarian cancer (HBOC) and Lynch syndrome (LS), confer substantial lifetime cancer risks, yet adherence to recommended risk-management strategies remains variable. This population-based retrospective cohort study examined cancer prevention practices, outcomes, and predictors of cancer occurrence among 476 BRCA and LS carriers identified through the Provincial Medical Genetics Program in Newfoundland and Labrador, Canada (2001–2022). Linked genetic, surgical, screening, and cancer registry data were evaluated, with adherence assessed during two intervals (2018–2020 and 2020–2022) based on NCCN guidelines. Participants were predominantly female (69%), with a mean age of 48.5 years at genetic testing; nearly 70% of primary cancers were already diagnosed at the time of testing. BRCA carriers demonstrated higher uptake of breast MRI (58–61%) and risk-reducing salpingo-oophorectomy (63–66%) compared with LS carriers’ colonoscopy uptake (42–44%). In univariate analyses, non-adherence during 2018–2020 was associated with increased odds of cancer after testing (OR ≈ 4.43, p < 0.001); this remained significant in the multivariate model (OR = 8.70; p = 0.0004). Individuals who did not follow recommended risk-management guidelines had nearly nine times greater odds of developing cancer after genetic testing than those who fully adhered to guidelines. Older age at referral (OR = 1.07/year, p < 0.001) also increased the odds of developing cancer. Study findings indicate that late referral and pre-existing cancers diminish the preventive impact of guideline-based risk management. System-level initiatives to promote earlier genetic testing, enhance cascade outreach, and strengthen surveillance pathways are needed to optimize cancer prevention and earlier cancer detection in high-risk populations. Full article

Facial vascularized composite allotransplantation (fVCA) is one of the most complex forms of vascularized composite allotransplantation and requires lifelong immunosuppression to ensure graft survival. Despite significant advances in surgical techniques and postoperative care over the past two decades, the true incidence of cutaneous malignancies in fVCA recipients remains poorly characterized due to the limited number of procedures, heterogeneous immunosuppressive protocols, and relatively short follow-up. This narrative review summarizes current evidence on oncologic risk in facial VCA, focusing on the effects of different immunosuppressive regimens and the challenges posed by the high immunogenicity of skin and mucosa. Available data indicate that malignancies, including cutaneous and other neoplasms, occur in approximately 10% of recipients, based on heterogeneous case-series data with immunosuppressive therapies largely extrapolated from solid organ transplantation. Calcineurin inhibitors, corticosteroids, and azathioprine are associated with increased oncologic risk, whereas mycophenolate mofetil and mTOR inhibitors may confer a more favorable profile. Overall, fVCA, unlike solid organ transplantation, is a life-enhancing procedure, highlighting the need for tailored immunosuppressive strategies, rigorous dermatologic surveillance, and further research supported by dedicated registries to better define long-term malignancy risk. Full article

The aim of the present study was to compare the cost-effectiveness of 3DMorphic’s spinal 3DFusion Lumbar (3DFL) cages versus Off-The-Shelf (OTS) cages for patients undergoing lumbar interbody fusion in an Australian healthcare setting. 3DFL cages differ from generic OTS cages in that they are Patient-Specific Interbody Cages (PSICs). While several studies have discussed the clinical benefits of PSIC versus OTS cages, no studies have evaluated the cost-effectiveness of this technology. Without a direct randomised controlled trial between the two implant categories, an indirect treatment comparison was performed. The indirect comparison was informed by a clinical trial of 3DFL cages, the Australian Spine Registry and an analysis of reoperation rates for patients undergoing spinal fusion in an Australian cohort. In conclusion, the PSICs were demonstrated to be clinically superior to OTS cages as measured by Health Related Quality of Life (HRQoL) and reoperation rates. The cost-utility analysis demonstrated that 3DFL cages were cost-effective compared to OTS cages in an Australian healthcare setting. Full article

Objective: To longitudinally investigate the effect of non-surgical periodontal therapy (NSPT) on the transcriptional and translational levels of Superoxide Dismutase (SOD) and Insulin Receptor Substrate type 2 (IRS2) in individuals with Type 2 Diabetes Mellitus (T2DM) and Periodontitis (P). Methods: This clinical study was registered at the Brazilian Clinical Trials Registry (ReBEC-RBR-5m3yxmb). Saliva, peripheral blood mononuclear cells (PBMCs), and gingival biopsies were collected from 156 individuals, distributed into five groups, each with at least 30 participants: T2DM_poorly_controlled+P, T2DM_well_controlled+P, T2DM_without_P, Periodontitis, and Control. Systemic levels of messenger RNA (mRNA) of Superoxide Dismutase 1 (SOD1) and IRS2 were measured using real-time polymerase chain reaction at baseline, 90, and 180 days after NSPT. SOD enzymatic activity in Saliva and IRS-2 immunohistochemistry in gingival biopsies were also assessed. Results: Higher SOD1 mRNA levels were observed in Control individuals at baseline. In contrast, higher IRS2 mRNA levels were detected in individuals with Periodontitis at baseline, followed by a significant reduction over time. A significant positive longitudinal correlation was identified between IRS2 and SOD1 gene expression in the groups without T2DM, indicating potential functional interaction between the molecules. Salivary SOD enzymatic activity was lower in individuals from the T2DM_poorly_Controlled+P and T2DM_well_Controlled+P groups. SOD concentration (U/g) normalized to the total protein content was higher in the saliva of individuals with Periodontitis. T2DM+P and Periodontitis groups showed extensive inflammatory infiltrate in the gingival biopsies, with predominant IRS-2 immunopositive cells in the T2DM+P groups, independently of the metabolic control. Conclusions: This study shows that non-surgical periodontal therapy (NSPT) is followed by longitudinal changes in IRS2 and SOD1 expression at the mRNA and protein levels in individuals with T2DM+P (poorly/well controlled) and periodontitis, reinforcing the clinical relevance of periodontal treatment in the systemic context of T2DM. Full article

Background: Medical emergencies occur at varying rates across the globe. Given the significant effort invested in identifying them and assessing dentists’ preparedness to deliver treatment in these life-threatening conditions, a global overview was needed. Materials and Methods: In this scoping review, data from PubMed, Cochrane Library, and Google Scholar databases were examined to identify all relevant studies reporting on the impact of medical emergencies on dentists and determine their operational preparedness at a national or regional level. Operational preparedness was determined in accordance with existing emergency operational preparedness frameworks across six domains: Anticipate, Assess, Prevent, Prepare, Respond, and Recover. Significant Findings: Global data show that dentists will invariably encounter medical emergencies across their careers. However, our investigation found that in countries where there is strong foundational training and regular refresher training, fewer frequent emergencies and stronger operational preparedness are reported. Governmental regulation emerged as a key facilitator of operational preparedness. Still, barriers exist, primarily limited access to medical emergency courses, shortages of office supplies for emergency drugs and materials, and the absence of medical emergency registries. Conclusions: A reassessment of the medical emergency training courses’ content appropriateness is paramount. Training interventions should also focus on raising awareness about the importance of preventive measures and office optimization through planning. Further research is needed to identify any overlooked facilitators and barriers to operational preparedness in medical emergencies. This will help identify opportunities for improvement and minimize the impact of emergencies on dental practices. Full article

Background/Objectives: Photobiomodulation (PBMT) has been shown to improve tissue healing; however, the best protocol for different clinical challenges is not clearly determined. Despite the good previous outcomes of the PBMT in healing of the third molar surgical sites, the ideal protocol of PBMT was not determined. The objective of this split-mouth double-blinded randomized clinical trial was to compare the effect of photobiomodulation (PBMT) with red and infrared wavelengths combined and PBMT with only red wavelength on the healing of post-extraction alveoli of third molars. Methods: Twenty patients underwent third molar extraction. The alveoli were treated randomly in a split mouth model with: PBMT with red laser (R-PBMT) or PBMT with red and infrared laser combined (IR-R-PBMT). PBMT was applied immediately, and 3 and 7 days after surgery. Patients were clinically evaluated in relation to repair (bleeding, exudate, color, and consistency of the tissues), degree of the edema, and through the application of a VAS scale (pain, edema, bleeding, chewing, and mouth opening) in the baseline period, and 3, 7, 14, 30, and 90 days after the surgical procedure. In addition, bone tissue density and structure were measured by radiographic analysis at 7 and 90 days postoperatively. Results: Clinical analysis showed that IR-R-PBMT induce more reduction in the edema 7 days after surgery compared with the R-PBMT; however, no significant differences were noted between groups in other parameters. Conclusions: IR-R-PBMT reduces the edema after 7 days of third molar extraction compared with the R-PBMT. Registration: This study was registered with the Brazilian Registry of Clinical Trials (REBEC-RBR-103g7j28; date of registration 12 July 2023) under number U1111-1297-6962. Full article

Background/Objectives: Paediatric renal tumours, particularly Wilms tumours, have good survival outcomes following multimodal therapy; however, long-term morbidity related to nephrectomy and adjuvant treatment remains a major concern. As treatment paradigms increasingly prioritize nephron preservation and minimization of late effects, there is growing interest in technologies that can enhance intraoperative precision. Methods: A scoping review following the PRISMA guidelines was performed. We analysed articles on fluorescence for childhood renal tumours on 1 November 2025. Case reports, opinion articles, and narrative reviews were excluded. An Ovid Medline search with search terms “Kidney neoplasm” AND “Fluorescent Dyes”, along with a Cochrane trials registry search for “kidney” AND “neoplasm” AND “Fluorescent Dye”, was performed, along with a hand search of citations. Results: The Ovid Medline search yielded 21 results, and the Cochrane trials search gave 4 results. Following review, five papers were included, of which one was an ex vivo study and one was a randomised, controlled trial that is currently recruiting. Conclusions: There is a lack of evidence around the use of near-infrared fluorescence in paediatric renal tumour surgery. This review summarizes the key current findings and future perspectives. Full article

Community land management plays an important role in wildfire-prone landscapes in Mediterranean Europe. However, in Portugal, information on the spatial extent and boundaries of community land remains fragmented across multiple institutions. This study addresses a critical but often overlooked issue in wildfire management: the fragmentation of institutional data on community land boundaries in mainland Portugal and its direct implications for forest fire risk management, planning, and accountability. We harmonized georeferenced datasets from various government and public institutions, applying multi-institutional spatial integration supported by legal land use criteria using the Land Use Land Cover map 2018 (LULC2018). The resulting national map represents the first fully harmonized spatial assessment of community land (baldios) in mainland Portugal. Our results show that baldios currently occupy approximately 595 thousand hectares, significantly exceeding official estimates. Of this total, around 74% are under partial forest regime law, and approximately 76% are classified as having a high or very high wildfire hazard. This means that three out of every four hectares of baldios in mainland Portugal are structurally susceptible to extreme wildfire conditions. Beyond improving cartographic data, the study’s findings demonstrate how the lack of land registry weakens the institutional foundations for community-based wildfire management. Without a functional, legally validated national map of community land boundaries, responsibilities, co-management mechanisms, and prevention measures remain spatially inconsistent. Full article

As data exploitation continues to demonstrate its value, ontologies, thesauri, and other semantic datasets are increasingly recognized for enabling semantically meaningful data integration across disparate domains. With the proliferation of dataset catalogs, the MOD ontology (Metadata for Ontology Description and publication) was adopted, and an associated API was developed to support the future European Open Science Cloud (EOSC). Their aim is to harmonize catalogs of semantic datasets with respect to metadata vocabularies and access mechanisms, thereby ensuring compliance with the FAIR principles. Within an implementation action involving developers of prominent dataset catalogs, we were selected to integrate the MOD-API into ShowVoc, our platform for publishing and consuming ontologies, thesauri, lexicons, and other Semantic Web datasets. However, ShowVoc already relied on an expressive metadata model, the MDR (acronym for “Metadata Registry”), named after the component responsible for managing the platform’s internal catalog. Due to precise dissemination requirements, the MDR provides multiple abstraction levels and detailed specifications concerning the distributions and formats in which a dataset may be made available. In this article, we report on the challenges that we faced and the trade-offs that we made while reconciling these metadata models, highlighting limitations in the current MOD standard that may inform future enhancements. Full article

Segmental mandibular resection may be indicated as a treatment in, for example, advanced stages of oral squamous cell carcinoma (OSCC). Osseous reconstruction of these defects is a fundamental part of static and dynamic masticatory rehabilitation, particularly when dental implants are required. The Segmental Mandibular Defect Reconstruction (SMDR) Registry aims to generate real-world evidence on SMDR through an international, prospective, multicentre case series designed as a registry. While OSCC is a common indication for segmental mandibular resection, the SMDR Registry also aims to capture outcomes for rarer mandibular conditions and the increasing number of collateral damage cases resulting from systemic medication therapies (antiresorptive drugs, immunotherapeutics) or irradiation, which may likewise lead to medication-related osteonecrosis of the mandible (MRONJ) or osteo(radio)necrosis with tumour-like segmental resection of the mandible, highlighting the value of an international database for these less frequent pathologies. Primary objectives are to describe the patient population and current treatment modalities, describe the outcomes and adverse events (AEs) for different treatment modalities, and identify potential predictors for successful autologous reconstruction of SMDs. Approximately 300 patients with a mandibular lesion resulting from bisphosphonate- and immunomodulatory drug-induced osteonecrosis of the mandible, ameloblastoma or osteosarcoma of the mandible, oral metastases related mandibular lesions indicated for segmental resection, or OSCC undergoing SMDR or intending to undergo one- or two-stage reconstruction will be prospectively recruited over a 36-month period. Baseline information, treatment details, and outcome measures will be documented. All treatments will be per the usual practice at participating sites. Outcome measures include clinical, patient-reported, and radiological outcomes; AEs related to the condition and/or treatment with a possible influence on the outcome will be recorded. Full article