Search Results (88)

Background and Objectives: The joint study of cerebral asymmetries and bipolar disorder (BD) has long attracted the interest of researchers and clinicians. Nevertheless, despite the increasing awareness of hemispheric asymmetries in BD, the combined investigation of these two constructs constitutes a relatively recent area of inquiry. The main objective of the present systematic review is to systematically examine the existing literature in order to identify, integrate and critically discuss evidence of hemispheric asymmetry in BD patients in terms of brain anatomy, physiology and neuropsychological function. The initial hypotheses support the presence of atypical cerebral asymmetry and differential hemispheric activation as a function of mood states in BD. Materials and Methods: Following the collection and analysis of numerous research papers through several databases and search engines, specific papers were identified and screened according to specified inclusion and exclusion criteria. Research papers on the adult bipolar population were included, while papers including comorbidity with other disorders, lesions, or an underage or elderly population, as well as meta-analyses and reviews, were excluded. This paper aligns with the procedures in the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020) guidelines, and was assessed for risk of bias according to the Cochrane guidelines by the Newcastle–Ottawa Scale (NOS). Results: A total of 56 papers were identified as eligible in this review. Despite inconsistent findings across the included studies, an emerging pattern suggests the presence of atypical hemispheric asymmetry in BD, both in terms of specific brain structures and functional activity. Moreover, several studies associate depressive states with increased activation of the right hemisphere, whereas manic states appear to be linked with increased activation of the left hemisphere. Conclusions: These findings support the aforementioned hypotheses and partly align with the theoretical framework of emotional laterality theories. However, although certain patterns were observed, a comprehensive understanding of functional hemispheric asymmetry in BD has not yet been achieved. The presence of contradictory findings highlights the need for further extensive and systematic research to improve understanding of this topic. Full article

Introduction: Non-muscle-invasive bladder cancer (NMIBC) represents approximately 78% of newly diagnosed bladder cancers and is characterized by high recurrence rates and variable progression risk. While transurethral resection of bladder tumor (TURBT) followed by intravesical therapy remains standard management, optimal treatment of high-risk and Bacillus Calmette-Guerin (BCG)-unresponsive disease remains controversial. Radiotherapy (RT), particularly in combination with chemotherapy, has been explored as a bladder-preserving alternative. Material and Methods: We conducted a narrative review of published literature evaluating the role of definitive RT in high-risk NMIBC, with emphasis on T1 disease. Retrospective series, prospective trials, meta-analyses, and contemporary guideline recommendations were examined. For each included study, we extracted data on the extent of TURBT (maximal vs. incomplete/non-specified), use and type of concurrent chemotherapy, radiotherapy technique (3D-conformal, IMRT, or proton), treatment volume (bladder only vs. whole pelvis), and dose/fractionation schedule. Results: Early studies evaluating RT alone demonstrated modest complete response rates. More recent approaches incorporating maximal TURBT followed by concurrent chemoradiotherapy report improved outcomes, with complete response rates of approximately 80–88% and 5-year overall survival comparable to surgical series. The phase II NRG/RTOG 0926 trial in recurrent high-risk T1 disease after intravesical therapy failure demonstrated an 81% complete response rate and favorable bladder preservation outcomes. Meta-analytic data suggest 5-year recurrence-free survival around 54% and overall survival near 70%, although evidence remains limited and largely non-randomized. Advances in image-guided and hypofractionated RT may further improve therapeutic outcomes while limiting toxicity. Conclusions: while definitive chemoradiotherapy is a promising option for selected patients, it remains investigational and should be considered only in those who are unfit for or decline radical cystectomy. Prospective randomized studies are needed to better define its role in contemporary management. Full article

The load characteristics of the helicopter tail rotor system are critical to flight safety and handling performance, and flight testing remains the most direct and reliable means to obtain authentic load data. In this paper, the well-established Wheatstone bridge strain measurement method is adopted to carry out accurate load testing on the helicopter tail rotor system. The tail rotor assembly mainly consists of the tail rotor shaft, pitch link, and tail rotor blades, which undertake different load transfer tasks during flight. Under actual operating conditions, the tail rotor shaft bears significant axial tension as well as combined lateral and vertical bending moments; the pitch link is primarily subjected to alternating axial tension and compression; and the tail rotor blades withstand complex loads including flapping bending, lagwise bending, and torsional moments. According to the distinct stress characteristics and force transmission paths of each component, targeted flight test maneuvers are reasonably designed. These maneuvers include steady-level flight at low, medium, and high speeds, zigzag climbing flight, near-ground side-rear flight, as well as deceleration-to-sprint and obstacle slope maneuvers specified in ADS-33E. Key flight parameters are selected for in-depth analysis to reveal the load distribution and dynamic variation patterns of the tail rotor under typical operating conditions. On this basis, a helicopter load risk test point matrix is established to identify high-risk working conditions and key monitoring positions. This study provides a solid theoretical and data foundation for subsequent flight test monitoring and structural strength verification. It effectively reduces flight test risks, improves monitoring efficiency and accuracy, and helps cut down the human, material, and financial costs associated with flight test monitoring. The research results can also provide important references for the design optimization and safety evaluation of helicopter tail rotor systems. Full article

Background and Objectives: Coronavirus disease 2019 (COVID-19) is characterized by excessive inflammatory responses, including the so-called cytokine storm, which contributes substantially to morbidity and mortality in hospitalized patients. The vagus nerve, through the cholinergic anti-inflammatory pathway, represents a theoretically attractive therapeutic target for modulating systemic inflammation. Vagus nerve stimulation (VNS) has emerged as a potential adjunctive treatment for COVID-19, with several randomized controlled trials (RCTs) investigating its efficacy on inflammatory biomarkers and clinical outcomes. The quality of this evidence base has not been rigorously evaluated. This systematic review critically appraises all available RCT evidence for VNS in hospitalized COVID-19 patients. Materials and Methods: We systematically searched PubMed, Scopus, Cochrane (CENTRAL), and Web of Science from database inception to January 2026, for RCTs evaluating any form of VNS (invasive, non-invasive, cervical, or auricular) in hospitalized patients with confirmed acute COVID-19. Two reviewers independently screened titles, abstracts, and full texts according to pre-specified eligibility criteria. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool, with assessments initially performed using multiple artificial intelligence tools and subsequently validated by the authors in accordance with PRISMA 2020 guidelines. Given substantial heterogeneity and high risk of bias, narrative synthesis was performed rather than meta-analysis. Also, GRADE assessment was performed. Results: From 437 records identified, six RCTs comprising 221 patients met the inclusion criteria. Five trials (83%) were rated as high risk of bias, primarily due to inadequate blinding, substantial baseline imbalances, significant missing data and extensive multiple testing without statistical correction. The single double-blind trial with a credible sham control (Rangon et al.) found null results across all outcomes, including clinical progression, ICU transfer, and mortality, while the five “high” risk-of-bias trials generally reported positive findings on various inflammatory markers and clinical outcomes. One trial (Corrêa et al.) measured heart rate variability as a direct indicator of vagal activation and found no change despite claiming anti-inflammatory effects, contradicting the proposed mechanism of action. Significant cognitive findings from an interim analysis (Uehara et al., n = 21) disappeared in the larger completed trial (Corrêa et al., n = 52), providing empirical demonstration of false positive findings in small, underpowered studies. Conclusions: Currently available evidence supporting the use of VNS for acute COVID-19 remains scarce; however, the physiological rationale remains sound, although the absence of reliable target engagement markers in the included studies limits confidence in this treatment method. Large-scale, double-blind, sham-controlled trials are required before VNS can be firmly recommended for COVID-19 management. Full article

This study employs a constructivist grounded theory approach based on 69 in-depth interviews conducted between March 2022 and December 2023 to examine socio-cognitive dynamics in Korea’s bottled water and household water purifier markets. The study addresses a gap in prior research by explaining how product meanings and stakeholder strategies co-evolve across adjacent “safe-water” markets under regulatory and sustainability pressures. Drawing on qualitative data from 69 stakeholders, including producers (n = 30), consumers (n = 19), and institutional experts (n = 20), we analyze how distrust, risk perception, and health consciousness reshape conceptual systems and market strategies. These shifts drive innovation across markets, including new technologies, service models, and branding strategies. The findings show that socio-cognitive stabilization arises through iterative interactions among institutional shocks, producer reinterpretation, and consumer adaptation. In the bottled water market, the meanings of “natural purity” became materially embedded in packaging, mineral labeling, and brand narratives. In the purifier sector, “technological reliability” was institutionalized through service-based maintenance systems and visible quality control technologies. These processes developed within asymmetric communicative environments shaped by corporate branding capacity and media amplification. This study refines socio-cognitive market theory by specifying boundary conditions under institutional distrust in developed economies. Although Republic of Korea possesses advanced drinking water infrastructure comparable to that of other developed economies, public confidence in tap water has periodically weakened following highly salient contamination incidents and regulatory transitions. This paradox provides a theoretically informative context for examining how product meanings and stakeholder behaviors mutually adapt over time. Although environmental impact metrics were not directly measured, the findings suggest that sustainability policies must address socio-cognitive trust dynamics alongside regulatory instruments such as plastic levies, certification schemes, and transparent risk communication. Full article

Background: Thyroid tuberculosis abscesses (TTA) are rare manifestations of extrapulmonary tuberculosis, with the available literature consisting almost exclusively of individual case reports and small observational series. This systematic review aimed to evaluate current management strategies and associated clinical outcomes for TTA. Methods: Reports describing confirmed TTA, specified treatment regimens and clinical outcomes were systematically identified and synthesised from PubMed, Embase, Web of Science and Google Scholar from the period 1990 to 2025. Studies with suspected but unconfirmed cases were excluded. Risk of bias was assessed using the Joanna Briggs Institute tool. A total of 22 studies comprising 33 patients were included. Results: Significant diagnostic delays were seen. When diagnosis was established, standard four-drug anti-tubercular therapy (ATT) for at least 6 months emerged as the predominant first-line treatment. Surgical or percutaneous drainage procedures were typically reserved for large abscesses, treatment failure, acute suppurative presentations or suspected malignancy. Across published cases, lesion resolution and preservation of euthyroid function were reported in 92% of patients. However, the absence of comparative studies and the reliance on highly selected case material limit definitive conclusions and raise concerns about publication bias. Conclusions: TTA is a rare entity, with established treatment success with ATT, with surgery reserved for selected cases. Higher-quality comparative data are required to inform optimal management strategies. Full article

Objective: The present study aimed to verify two key hypotheses: (1) whether the session rating of perceived exertion (sRPE) can serve as a reliable indicator for workload monitoring in cricket and (2) to compare the injury risk sensitivity of sRPE-derived indicators—including the coupled and uncoupled acute:chronic workload ratio (ACWR), exponentially weighted moving average (EWMA), and robust exponential decreasing index (REDI)—across three pre-specified latency periods (no latency, 7-day latency, and 14-day latency), and to identify the optimal indicator and latency period for cricket injury risk assessment. Material: Twenty-four elite female cricket athletes from the Chinese National Women’s Cricket Team were monitored during daily training throughout the Los Angeles Olympic Games preparation period. Methods: Correlation analysis, Kendall’s tau correlation coefficients, and Bland–Altman plots were employed to assess the relationships and consistency between sRPE and various workload indicators. ROC curves were constructed to compare the performance of sRPE-derived indicators for injury risk across the three pre-specified latency conditions. Results: sRPE and its derived indicators exhibited significant correlations with health status indicators (sleep, fatigue, delayed onset muscle soreness (DOMS), stress, mood, and resting heart rate (RHR)) and physiological and biochemical indicators (testosterone, cortisol), with the majority of these correlations reaching the 0.01 significance level (p < 0.01). Kendall’s tau correlation coefficients and Bland–Altman plots revealed that sRPE and ACWR based on EWMA (hereafter referred to as EWMA) had moderate correlations with health status indicators, while ACWR based on REDI (hereafter referred to as REDI) showed a strong correlation with such indicators. sRPE and its derived indicators were strongly correlated with physiological and biochemical indicators (Kendall’s tau > 0.8) with good consistency, as the majority of scattered points fell within the limits of agreement (mean difference ± 1.96 × standard deviation, MD ± 1.96 × SD). Analysis of injury risk sensitivity indicated that the 7-day latency model yielded the highest average area under the curve (AUC = 0.85). Among all indicators, REDI and EWMA achieved the highest AUC values (AUC = 0.665 and 0.667, respectively; p < 0.001). Notably, EWMA exhibited optimal performance in the 7-day latency time series (AUC = 0.859, >0.80), followed by REDI under the 7-day latency condition (AUC = 0.857). Conclusion: EWMA with 7-day latency is a more sensitive indicator for detecting injury risk. Full article

Bridges are critical components of transportation networks, and fire accidents can significantly impair their structural integrity, leading to safety risks and major economic losses. This study presents a comprehensive inspection, materials testing, repair, and field load testing program for a full-scale concrete box girder bridge (Delta Bridge, Alexandria, Egypt) following a fire exposure on two spans. A total of 28 concrete core samples were extracted and tested, revealing average compressive strengths of 48.50 MPa (slab), 53.90 MPa (web), and 45.88 MPa (columns), representing moderate reductions of approximately 8.5%, 7.9%, and 10.8%, respectively, relative to the original in situ concrete strength recorded during construction, and 29.2%, 43.7%, and 30.0% increases over the minimum acceptance limits specified by Egyptian code of practice (ECP 203). Tensile strength tests on reinforcement bars indicated an average yield strength reduction coefficient of 0.87, corresponding to an estimated peak exposure temperature of 600 °C, yet still satisfying Egyptian code requirements (≥500 MPa). Field static load tests using 40-ton tri-axle trucks demonstrated maximum midspan deflections of 6.7 mm in fire-exposed spans and full recovery (>94%) upon unloading, confirming that the residual stiffness and load-carrying capacity were within acceptable limits. Based on these results, a targeted repair program was executed, including concrete cover replacement with shotcrete; steel derusting; surface coating; and bearing replacement, followed by a verification load test that confirmed the effectiveness of the rehabilitation. This case study demonstrates a robust framework for post-fire condition assessment, residual capacity evaluation, and repair validation of concrete box girder bridges. The methodology and findings provide valuable guidance for engineers and transportation authorities in mitigating fire-induced risks and ensuring the safe reopening of critical bridge infrastructure. Full article

Background and Objectives: Psychosocial symptoms and oral behaviors can complicate routine dental care, yet available screeners yield multiple separate scores. Explainable artificial intelligence offers a pragmatic way to integrate such multidomain measures into a single, auditable output that can support screening-oriented stratification and standardized documentation (non-diagnostic). Therefore, we aimed to develop an interpretable, deterministic Mamdani fuzzy inference system (FIS) integrating GAD-7, PHQ-9, and OBC-21 into a 0–10 psychobehavioral composite score (PCS) to support screening-oriented stratification and standardized documentation (non-diagnostic). Materials and Methods: Cross-sectional multicenter study in 18 private dental clinics in Romania (October 2024–March 2025; n = 460). A rule-based Mamdani Type-1 FIS was specified a priori (48 rules; triangular membership functions; centroid defuzzification) without supervised training. Internal evaluation assessed coherence across severity strata, robustness to predefined input perturbations (±1 point; ±5%) and membership-function variation (±10%), and benchmarking against linear composites (Z-mean; PCA PC1). Results: Median PCS was 2.30 (IQR 2.03–3.56). PCS correlated with GAD-7 (Spearman ρ = 0.886), PHQ-9 (ρ = 0.792), and OBC-21 (ρ = 0.687) (all p < 0.001), increased monotonically across anxiety and depression severity strata, and was higher in high OBC-21 risk. Robustness was excellent under input perturbations (ICC(3,1) = 0.983 for ±1 point; 0.992 for ±5%) and high under ±10% membership-function variation (ICC(3,1) = 0.959). Concordance with linear baselines was high (Spearman ρ = 0.956 for Z-mean; 0.955 for PCA PC1), with a small systematic nonlinearity at higher scores. Conclusions: PCS provides a fully auditable, rule-based integration of three patient-reported measures with coherent internal behavior and robustness to plausible measurement noise and specification changes. This study reports internal evaluation of a deterministic, rule-based aggregation; external clinical validation against independent outcomes is required before any clinical utility claims. Full article

This study focuses on the development of wood-based particleboard that address resource efficiency, environmental sustainability, and health-related concerns. The conventional particleboard industry relies on synthetic, predominantly formaldehyde-based adhesives, which pose environmental, health, and end-use risks. Rising raw material prices, regulatory restrictions, and increasing competition in the wood-processing sector have further highlighted the importance of alternative biomass resources for particleboard production. In response to these challenges, this study investigates the suitability of available sawdust resources derived from the production residues of cellular wood materials and recycled particleboards, combined with natural suberinic acids mixture obtained from birch outer bark as a binder. The effects of furnish structure, binder content (15–21%), pressing temperature (190–220 °C), pressing rate (0.9–1.7 min/mm), and board density (650–850 kg/m³) on the resulting particleboard properties were evaluated. The results demonstrate that it is possible to meet the requirement values for thickness swelling (≤17%) and internal bonding strength (≥0.40 N/mm²) specified for interior fitment boards, including furniture applications according to EN 312, Type P2. The bending properties of the best-performing particleboards are very close to the requirement values (MOE ≥ 1800 N/mm², MOR ≥ 11 N/mm²), indicating the potential for further improvement at the target density range. Furnish structure, board thickness, density, and pressing temperature were identified as the most influential factors affecting the final board properties. Full article

Background and Objectives: Borderline ovarian tumours (BOTs) predominantly affect women of reproductive age. Following concerns about minimally invasive surgery (MIS) in cervical cancer, the oncological safety of the surgical approach in BOTs requires evaluation, particularly in fertility-sparing procedures where clinical implications are greatest. This study aimed to assess whether MIS is associated with increased recurrence risk in BOTs, with stratified analysis by fertility-sparing status based on a pre-specified hypothesis of differential effects. Materials and Methods: Single-centre cohort study of 91 BOT patients treated at Nottingham City Hospital Cancer Centre between 2014–2023. The primary outcome was progression-free survival comparing MIS versus open surgical approaches. Results: Minimally invasive surgery was associated with higher observed recurrence compared to open surgery (5/25 [20.0%, 95% CI: 6.8–40.7%] vs. 3/66 [4.5%, 95% CI: 0.9–12.7%], absolute risk difference 15.5% [95% CI: 2.1–28.9%]; unadjusted HR 5.29, 95% CI: 1.26–22.17; p = 0.022). Conclusions: This study identifies an association between minimally invasive surgery and higher recurrence in borderline ovarian tumours, particularly in fertility-sparing procedures. While based on small numbers necessitating cautious interpretation, the consistency across analytical approaches, substantial magnitude of observed differences, and biological plausibility warrant validation in larger cohorts to inform surgical counselling. Full article

Cracking occurred in the surface coating of a screw rotor during shale gas well operations. To determine whether the coating cracks could contribute to the failure of the 42CrMo substrate, the microstructure and morphology of surface cracks and local corrosion pits were examined and analyzed using a metallographic microscope, an SEM, and an EDS. To investigate the cross-sectional morphology and elemental distribution of corrosion pits, EDS mapping was performed. The composition of the corrosion products was characterized using Raman spectroscopy and XPS. In addition, four-point bend stress corrosion tests were conducted on screw rotor specimens under simulated service conditions. The results indicate that the P and S contents in the screw rotor substrate exceeded the specified limits, whereas its tensile and impact strengths satisfied the standard requirements. The microstructure consisted of tempered sorbite and ferrite, along with a small amount of sulfide inclusions. The corrosion products on the fracture surface were primarily identified as FeOOH, Fe₃O₄, and Cr(OH)₃. All specimens failed during the four-point bend tests. The chlorine (Cl) content in the corroded regions reached up to 8.05%. These findings demonstrate that the crack resistance of the 42CrMo screw rotor was markedly reduced under the simulated service conditions of 130 °C in a saturated, oxygenated 25% CaCl₂ solution. The study concludes that stress concentration induced by sulfide inclusions in the screw rotor, together with the combined effects of chloride ions, dissolved oxygen, and applied load, promotes the initiation and propagation of stress corrosion cracking. Therefore, it is recommended to strictly control the chemical composition and inclusion content of the screw rotor material and to reduce the oxygen content of the drilling fluid, thereby mitigating the risk of corrosion-induced cracking of the rotor. Full article

Background and Objectives: Obesity, heart failure (HF), and atherosclerosis have common pathways, including chronic inflammation, immune cells activation, and metabolic disturbances. These pathways often coexist and overlap, increasing cardiometabolic risk. Growth differentiation factor 15 (GDF-15) is an emerging cytokine linked to inflammation, oxidative stress, and metabolic dysregulation, which are common pathways between heart failure, obesity and atherosclerosis. Beyond its established prognostic value in cardiovascular diseases (CVD) and HF, recent evidence suggests that GDF-15 may also reflect subclinical atherosclerosis, potentially improving early risk stratification in obese and HF populations. The aim of this review is to synthesize current evidence on the association between GDF-15 and markers of subclinical atherosclerosis, and to evaluate whether GDF-15 may serve as an integrative biomarker reflecting shared cardiometabolic pathways. Materials and Methods: We conducted a systematic review following PRISMA recommendations registered by CRD420251267457 number on PROSPERO. PubMed, Embase, Scopus, and Web of Science were searched for human studies evaluating the correlation between markers of subclinical atherosclerosis and GDF-15 concentration. We excluded the studies not published in English, not involving human participants, and not meeting the inclusion criteria. We assessed the risk of bias using the Joanna Briggs Institute appraisal tool. Due to the heterogeneity of studies, a narrative synthesis was performed. Result: The review included 18 studies, which evaluated the association between GDF-15 and subclinical atherosclerosis markers, such as intima media thickness, coronary artery calcium score, ankle-brachial index, and atherosclerotic plaques. Studies included patients with metabolic disorders, chronic inflammatory diseases, HIV cohorts, and general population samples. Most of the studies reported that GDF-15 levels were associated with greater atherosclerotic burden; however, results were frequently influenced by confounders. Methodological limitations, such as limited or highly specified samples, cross-sectional designs, variability in atherosclerotic-imaging technique, and inconsistent adjustment for confounders, restrict generalization of the results. Conclusions: Current evidence supports GDF-15 as a biomarker integrating inflammatory and metabolic stress signals, indirectly linking obesity, HF and subclinical atherosclerosis. While current data supports its prognostic relevance, further studies are needed to confirm its clinical utility in routine assessment and preventive cardiovascular care. Full article

This study introduces a comprehensive modeling framework for the evaluation of automotive hydraulic shock absorbers, developed on the basis of an interdisciplinary coupled model that integrates the shock absorber and the servo-hydraulic test-rig subsystems. The coupled formulation captures the key dynamic interactions within the damper assembly and establishes a virtual experimental environment for multi-criteria design exploration and optimization. Three interdependent performance objectives are addressed concurrently: (i) ensuring damping-force conformity within specified tolerance limits to maintain vehicle stability and safety, (ii) minimizing vibration amplitudes, quantified by piston-rod acceleration as an NVH (Noise, Vibration, and Harshness) performance indicator, and (iii) evaluating the fatigue life of the shim-stack valve system based on alternating stress analysis and experimentally determined Wöhler material characteristics, to ensure long-term operational durability. A Pareto-frontier-based multi-objective optimization strategy is applied to identify and interpret the trade-offs and synergies among these competing criteria. The resulting set of non-dominated solutions provides engineering insight into optimal configuration selection under conflicting design constraints, thereby supporting early-stage, risk-informed decision-making in the development of advanced suspension systems. Full article

Background and Objectives: Lateral osteotomies in rhinoplasty run adjacent to the lacrimal drainage system (LDS), risking postoperative tearing. Piezoelectric (piezo) devices enable precise bone cuts that may reduce LDS trauma. We compared the 1-month incidence of objective lacrimal dysfunction after piezo versus classic osteotomy. Materials and Methods: Retrospective, single-center controlled cohort (1 January 2024–1 January 2025) at a tertiary ENT clinic. Consecutive patients aged 19–45 with pre-operative paranasal sinus CT and no prior lacrimal disorder were grouped by osteotomy technique (piezo vs. classic; n = 65 per arm). Assessments were performed at postoperative day 7–10 and at 1, 3, and 6–12 months. The primary endpoint was 1-month objective lacrimal dysfunction, defined as fluorescein dye disappearance test (FDDT) grade ≥1 or reflux/resistance on irrigation plus symptoms (Munk ≥2). Pre-specified statistical tests were used. Results: Early tearing favored piezo. At week 1, epiphora occurred in 32.3% with piezo versus 46.1% with classic (p = 0.041); by month 6, rates were 4.6% versus 15.1% (p = 0.031). Differences at months 1 and 3 also favored piezo but were not statistically significant (p = 0.062 and p = 0.088). FDDT positivity was lower with piezo at week 1 (23.0% vs. 38.4%, p = 0.045) and month 6 (3.0% vs. 10.7%, p = 0.048). Irrigation obstruction was less frequent with piezo at week 1 (7.6% vs. 21.5%, p = 0.026), but groups converged by months 1 (15.4% vs. 12.3%, p = 0.80) and 3 (6.2% vs. 4.6%, p > 0.99). Punctum stenosis/occlusion remained uncommon in both groups without significant differences. Conclusions: Piezo-assisted lateral osteotomy is associated with less early lacrimal dysfunction and lower 6-month epiphora compared with the classic technique. Convergence of irrigation findings by 1–3 months suggests postoperative edema as the dominant transient mechanism. Given the retrospective, single-center design and low event rates, multicenter prospective studies powered for early LDS outcomes are warranted. Full article