Search Results (153)

Background: Caesarean section (CS) is a critical intervention, yet stark inequities in access persist across low- and middle-income countries (LMICs). Over the last decade, governments have introduced policies to eliminate or subsidize user fees; however, the collective impact of these initiatives on utilization, equity, and financial protection has not been fully synthesized. Methods: We conducted a systematic review in line with PRISMA 2020 guidelines. Searches were conducted in PubMed, Dimensions, Google Scholar, Scopus, Web of Science, and government portals for studies published between 1 January 2009 and 30 May 2025. Eligible studies evaluated government-initiated financing reforms, including full user-fee exemptions, partial subsidies, vouchers, insurance schemes, and provider-payment restructuring. Two reviewers independently applied the PICOS criteria, extracted data using a 15-item template, and assessed the study quality. Given heterogeneity, results were synthesized narratively. Results: Thirty-seven studies from 28 LMICs were included. Most (70%) evaluated fee exemptions. Mixed-methods and cross-sectional designs predominated, while only six studies employed interrupted time series designs. Twenty-two evaluations (59%) reported increased CS uptake, ranging from a 1.4-fold rise in Senegal to a threefold increase in Kano State, Nigeria. Similar surges were also observed in non-African contexts such as Iran and Georgia, where reforms included incentives for vaginal delivery or punitive tariffs to curb overuse. Fourteen of 26 fee-exemption studies documented pro-rich or pro-urban drift, while catastrophic expenditure persisted for 12–43% of households, despite the implementation of “free” policies. Median out-of-pocket costs ranged from USD 14 in Burkina Faso to nearly USD 300 in Dakar’s slums. Only one study linked reforms to a reduction in neonatal mortality (a 30% decrease in Mali/Benin), while none demonstrated an impact on maternal mortality. Qualitative evidence highlighted hidden costs, delayed reimbursements, and weak accountability. At the same time, China and Bangladesh demonstrated how demographic reforms or voucher schemes could inadvertently lead to CS overuse or expose gaps in service readiness. Conclusions: Government-led financing reforms consistently increased CS volumes but fell short of ensuring equity, financial protection, or sustained quality. Effective initiatives combined fee removal with investments in surgical capacity, timely reimbursement, and transparent accountability. Future CS policies must integrate real-time monitoring of equity and quality and adopt robust quasi-experimental designs to enable mid-course correction. Full article

Breast cancer is one of the major health threats to women worldwide; thus, a need has arisen to reduce the number of instances and deaths through new methods of diagnostic monitoring and treatment. The present review is the synthesis of the recent clinical studies and technological advances in the application of magnetic resonance imaging (MRI) to monitor the pharmacological treatment of breast cancer. The specific focus is on high-risk groups (carriers of BRCA mutations and recipients of neoadjuvant chemotherapy) and the use of novel MRI methods (dynamic contrast-enhanced (DCE) MRI, diffusion-weighted imaging (DWI), and radiomics tools). All the reviewed studies show that MRI is more sensitive (up to 95%) and specific than conventional imaging in detecting malignancy particularly in dense breast tissue. Moreover, MRI can be used to assess the response and residual disease in a tumor early and accurately for personalized treatment, de-escalate unneeded interventions, and maximize positive outcomes. AI-based radiomics combined with deep-learning models also expand the ability to predict the therapeutic response and molecular subtypes, and can mitigate the risk of overfitting models when using complex methods of modeling. Other developments are hybrid PET/MRI, image guidance during surgery, margin assessment intraoperatively, three-dimensional surgical templates, and the utilization of MRI in surgery planning and reducing reoperation. Although economic factors will always play a role, the diagnostic and prognostic accuracy and capability to aid in targeted treatment makes MRI a key tool for modern breast cancer. The growing complement of MRI and novel curative approaches indicate that breast cancer patients may experience better survival and recuperation, fewer recurrences, and a better quality of life. Full article

Hurley Stage II or III hidradenitis suppurativa (HS) may necessitate surgical excision of diseased skin and subcutaneous fat for symptom control and disease management. These excisions result in open wounds in topographically challenging regions and typically cannot be primarily closed. This study evaluates the use of a synthetic electrospun fiber matrix (SEFM) as a post-resection regeneration template to accelerate re-granulation and improve subsequent skin graft incorporation. This prospective pilot study enrolled Hurley Stage II or III patients undergoing surgical resection of HS lesions. SEFM was applied to the resulting wounds in conjunction with negative pressure wound therapy (NPWT). Patients were monitored post-operatively for granulation tissue formation and underwent skin grafting once granulation was sufficient. Skin graft incorporation was assessed at follow-up visits. Complications, including graft loss (partial or complete) and infection, were assessed at each encounter. A total of 21 wounds in eight patients met the inclusion criteria and were enrolled. The average time to skin grafting was 14 ± 3.2 days. After grafting, the average graft incorporation was 71 ± 28%. No complications occurred during the study. These initial results indicate that by supporting granulation tissue formation, combined use of SEFM and NPWT may aid in successful engraftment of topographically challenging areas post-HS excision. Full article

Computer-assisted implant surgery (CAIS) using 3D-printed surgical templates has become a preferred approach for improving implant placement accuracy. Despite its clinical advantages over conventional freehand techniques, CAIS remains limited by the presence of cone beam computed tomography (CBCT) metal artefacts, which compromise the 3D data alignment during implant planning and guide fabrication. This narrative review aims to explore the impact of metal artefacts on the accuracy of 3D-printed surgical implant templates and to evaluate current approaches and modifications in implant planning workflows. This article reviews accuracy studies, case reports and technology research on CAIS from the past 5 years. It summarised the CAIS clinical decision framework and data alignment methods to provide alternatives for guided implant therapy in the future. Studies indicate that metal artefacts can distort anatomical data, leading to potential misalignment in 3D data superimposition during surgical guide designs and fabrication. However, various strategies have shown promise in reducing these distortions. Accurate implant planning and template fabrication are essential to ensure clinical success. Special consideration should be given to artefact management during data acquisition. Modified workflows that account for the presence of metal artefacts can enhance guide precision and improve patient outcomes. Full article

Burn injuries remain a complex clinical challenge, particularly in reconstructive settings where donor sites are limited. Integra^® Dermal Regeneration Template (IDRT), a bilayer dermal substitute, facilitates neodermis formation and supports functional and aesthetic recovery following burn trauma. This narrative review and expert opinion synthesizes current literature and clinical experience on the application of IDRT in post-burn reconstruction. It discusses the biological mechanism of dermal regeneration, surgical protocols including wound bed preparation and grafting, and considerations for anatomical regions such as the face, torso, and limbs. The review emphasizes key factors influencing successful outcomes, including patient selection, timing, and multidisciplinary coordination. Potential complications, such as infection, hematoma, and poor graft adherence, are addressed along with prevention and management strategies. Special considerations for pediatric and elderly populations are also highlighted. Through evidence-based insights and illustrative case examples, this review aims to inform surgical decision-making and promote best practices in reconstructive burn care using IDRT. Full article

Penile cancer is a rare malignancy, with approximately 2100 cases diagnosed annually in the United States. The 5-year overall survival rate varies significantly depending on the node involvement status, at 79% in node-negative disease versus 51% for patients with inguinal metastasis. Inguinal lymph nodes are involved in micrometastatic disease in up to one out of four patients. Early inguinal lymph node dissection (ILND) has been shown to provide a survival advantage, which is why many patients undergo inguinal lymph node dissection for diagnostic and therapeutic purposes. Unfortunately, ILND is associated with high morbidity rates, which have led to potential overtreatment and decreased quality of life in the penile cancer population. Several advancements have been made to mitigate these challenges, such as dynamic sentinel node dissection, modifications to the technique or surgical templates, the introduction of minimally invasive procedures, and changes to the postoperative pathway. This manuscript examines the evolution in managing the inguinal lymph nodes in penile cancer, its associated complications, and effective strategies for their prevention and management. Full article

Successful dental implant therapy relies on accurate planning and placement, e.g., through static, computer-aided implant surgery using CAD/CAM-fabricated surgical guides. This study examined production methods’ influence on surgical guide sleeve housing geometry. A model with two edentulous spaces was digitized using intraoral scanning and CBCT, and two virtually positioned implants were planned. Ten guides per group were produced using milling (MCX5), DLP printing (ASIGA and SHERA), and SLA printing (FORM), printing with 50 µm and 100 µm layers each. Each guide (n = 70) was then digitized using an industrial scanner before and after sterilization. Superimposition of the actual guide data with the reference data allowed for evaluation of deviations at the drill sleeve housing along the x-, y-, z-, and dxyz-axes. Descriptive and statistical evaluation was performed (significance level: p ≤ 0.0125). Significant differences existed among the production methods: Milling and SLA showed higher deviations than the DLP group (p < 0.001). Milled guides post-sterilization showed the highest deviations (0.352 ± 0.08 mm), while one DLP printer at 50 μm layer thickness showed lowest deviations (0.091 ± 0.04 mm). The layer thickness was insignificant, whereas sterilization increased deviation (p < 0.001). DLP produced the most precise implant surgical guides. All 3D printers were suitable for fabricating clinically acceptable surgical guides. Full article

Fragility fractures of the pelvis (FFPs) are common in elderly patients, particularly those with osteoporosis. FFPs can be associated with high mortality, morbidity, and functional decline. Known risk factors include being over 80 years old and delays in surgical intervention when this is required. While the role of surgery in FFPs remains less defined than in proximal femoral fractures in the elderly, studies indicate that surgical fixation offers improved survival and functional outcomes. Similarly, the choice of fixation method, whether posterior or anterior, and their combinations, vary between clinicians. It depends on the fracture type and patient-specific factors, such as bone quality and comorbidities, as well as the surgeon’s experience and the availability of resources. Additionally, orthobiologic adjuncts such as cement augmentation and sacroplasty can enhance the stability of an osteoporotic fracture during surgical intervention. Furthermore, medical treatments for osteoporosis, especially the use of teriparatide, have demonstrated beneficial effects in reducing fractures and promoting healing of the FFPs. Return to pre-injury activities is often limited, with independence rates remaining low at mid-term follow-up. Factors that influence clinical outcomes include fracture type, with Type III and IV fractures generally leading to poorer outcomes, and patient age, functional reserve, and comorbidities. The present tutorial aims to summarise the relevant evidence on all aspects of FFPs, inform an updated management strategy, and provide a template of the reconstruction ladder referring to the most available surgical techniques and treatment methods. Further research, based on large-scale studies, is needed to address the open questions described in this manuscript and refine surgical techniques, as well as determine optimal treatment pathways for this vulnerable patient population. Full article

Background/Objectives: Guided implant surgery relies on the use of surgical templates to direct osteotomy drills, but guide design may influence irrigation efficiency, hence bone overheating, a critical factor in preventing thermal necrosis. This ex vivo study compared temperature changes when drilling using two guide designs: a closed-frame (occlusive structure) and an open-frame (non-occlusive design), evaluating their clinical relevance in mitigating overheating. Methods: Sixteen pig ribs were scanned, and implant osteotomies were planned via a guided surgery software. Two 3D-printed resin templates, one with a closed-frame design and one with an open-frame design, were tested (8 ribs per group, 24 implants per group). Drilling was performed sequentially (diameter of 1.9 mm, 3.25 mm, and 4.1 mm) at 800 rpm, while bone temperatures were recorded at depths of 3 mm and 10 mm using K-type thermo§s. Results: Significantly higher temperature rises were observed with the closed-frame guide. Drilling depth had also a significant influence, with higher temperatures at 3 mm than 10 mm (p < 0.001), suggesting that cortical bone density may amplify frictional heat. No significant effect of drill diameter was detected. Conclusions: Within the limitations of this ex vivo model, the open-frame design kept the maximal temperature rise about 0.67 °C lower than the closed-frame guide (1.22 °C vs. 0.55 °C), i.e., a 2.2-fold relative reduction was observed during the most demanding drilling step. This suggests a more efficient cooling capacity, especially in dense cortical bone, which offers a potential benefit for minimizing thermal risk in guided implant procedures. Full article

Background/Objectives: Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare and aggressive cutaneous lymphoma, often misdiagnosed due to nonspecific clinical features. Early diagnosis and treatment remain challenging. Methods: We report the case of a 31-year-old female with a chronic non-healing gluteal wound initially treated as an abscess. The lack of improvement prompted repeated investigations, culminating in the diagnosis of SPTCL with an alpha–beta T-cell phenotype. Results: Management involved combined chemotherapy and surgical wound reconstruction. Six cycles of CHOEP-21 chemotherapy led to complete clinical remission. A soft tissue defect superinfected with multidrug-resistant organisms was successfully reconstructed using Integra Dermal Regeneration Template followed by split-thickness skin grafting. Conclusions: This case highlights the diagnostic complexity of SPTCL and the therapeutic potential of dermal matrix application in complex wound management, especially in immuno-compromised patients. Full article

Preoperative facial markings are critical to surgical precision and aesthetic outcomes in plastic surgery, yet remain operator-dependent and variably documented. Generative artificial intelligence (AI), particularly large multimodal models, offers potential for the automated illustration of surgical plans. This study compares the performances of ChatGPT-4o and Gemini Advanced in generating standardised preoperative markings for aesthetic facial procedures. Methods: Six text prompts describing common facial aesthetic surgeries were developed using established marking protocols. Each prompt was submitted once to ChatGPT-4o and Gemini Advanced, yielding twelve illustrations. Three board-certified plastic surgeons independently evaluated the images using a five-domain Likert scale assessing incision clarity, anatomical accuracy, template conformity, clinical usefulness, and overall graphic quality. A composite score out of 25 was calculated. Data were analysed using paired t-tests, and interrater reliability was assessed with intraclass correlation coefficients. Results: ChatGPT-4o significantly outperformed Gemini Advanced in composite scores (mean 18.0 ± 1.4 vs. 13.9 ± 1.6, p = 0.001, Cohen’s d = 1.69). Superior performance was noted across all domains, particularly in clarity (mean difference 0.83, p = 0.002) and graphic quality (mean difference 0.90, p = 0.001). Interrater reliability was good (ICC = 0.82). Discussion: ChatGPT-4o demonstrated higher fidelity in translating surgical prompts into anatomically appropriate, clinically useful illustrations. However, neither system achieved the precision required for clinical implementation without revision. These models may serve as adjuncts in education and preliminary planning. Future work should explore model fine-tuning, surgeon-guided generation, and performance in reconstructive procedures. Full article

Background: Odontogenic cysts can damage the surrounding bone tissue as they grow, making it essential to implement effective regenerative strategies tailored to each patient. Personalised approaches in oral surgery, such as selecting the most suitable bone graft materials, can lead to improved treatment outcomes. Filling the bone defect created after cyst removal, root resection, or extraction with a bone graft material can stabilise the weakened tooth and promote faster bone regeneration. This article shares our experiences with the therapeutic effects of albumin-coated bone allograft (BoneAlbumin^®) placed in the bone defect following cyst removal in the oral cavity, compared to cases where the defect was left untreated (controls). Methods: The study involved thirty patients who underwent the removal of maxillary odontogenic cysts. In 15 of these patients, the bone defect was filled with albumin-coated bone allograft (BoneAlbumin^®, OrthoSera, Budapest, Hungary). In the control group, which consisted of 15 patients, the defect was left untreated. A consistent surgical protocol was adhered to throughout the study. Follow-up periapical X-rays were taken immediately after surgery as well as at 6 and 12 weeks post-surgery, using a standardised template. These images were used to assess the shrinkage and healing of the defect caused by the cyst. Measurements were adjusted to reference points to account for potential distortions in the X-rays. Results: The control and study groups exhibited no statistically significant differences in their basic parameters. Additionally, there was no notable difference in the sizes of postoperative defects between the two groups. However, statistical analysis revealed a significant difference in the changes in defect size (∆defect size) between the groups at both 6 weeks (p < 0.000001) and 12 weeks (p = 0.000296). This suggests that the BoneAlbumin^®-graft group experienced significantly greater changes in defect size over time. Conclusions: The use of BoneAlbumin^® graft leads to a markedly better reduction in defect size as time progresses, although these changes have only been compared to graft-free healing. Full article

Background/Objectives: This retrospective study evaluates the predictive role of magnetic resonance imaging (MRI) in complications and recurrence in rectal cancer patients undergoing surgery and neoadjuvant therapy, highlighting the impact of structured reporting templates on MRI quality. Compared to traditional free-text reports, structured radiology reports offer a point-by-point evaluation, improving clarity and completeness by thoroughly addressing all relevant findings. MRI is critical in rectal cancer staging, guiding treatment based on tumor characteristics like T stage, sphincter involvement, vascular invasion, and lymph node status. Methods: A retrospective analysis of MRI and reports from 67 rectal cancer patients at the time of diagnosis, who were subsequently treated with neoadjuvant radiochemotherapy and surgery, was conducted. MRI report features, including tumor location, morphology, T stage, sphincter infiltration, mesorectal fascia involvement, lymph nodes, and extramural vascular invasion, were evaluated against European Society of Gastrointestinal and Abdominal Radiology (ESGAR) recommendations. Multivariate and univariate analyses were performed to correlate MRI findings with postoperative outcomes such as complications, local recurrence, bleeding, and 30-day anastomotic leaks. Results: Sphincter involvement showed a strong association with increased complications (multivariate β = 0.410, univariate r = 0.270). Extramural vascular invasion was linked to higher rates of local recurrence (multivariate β = 0.199, univariate r = 0.127). Lymph node involvement correlated with an elevated risk of postoperative bleeding (multivariate β = 0.133, univariate r = 0.293). Additionally, advanced T staging predicted a higher incidence of 30-day anastomotic leaks (multivariate β = 0.210, univariate r = 0.261). These findings may provide clinically relevant insights to support personalized surgical planning and improve preoperative risk stratification. Conclusions: Detailed MRI reporting, aligned with structured templates, significantly guides surgical and therapeutic strategies in rectal cancer management. However, the retrospective nature of the study and the limited sample size may affect the generalizability of the results. Full article

Purpose: The purpose of this scoping review was to systematically identify and summarize the existing literature on non-spinal clinical applications of EOS imaging and identify related evidence gaps. Method: The study followed the PRISMA-ScR guidelines. A systematic literature search was conducted in Embase, MEDLINE, CINAHL, Scopus, Cochrane, Academic Search Premier, and OpenGrey databases in November 2022 and updated in December 2023. Original research from 2003 to 2023 was eligible if in English, Danish, French, German, Norwegian, or Swedish. Two authors screened articles by title and abstract, while data extraction from full texts was performed by seven authors using a structured template. Results: A total of 8176 articles were identified, with 1350 selected for full-text review and 268 included in data extraction. Among adults, 187 articles were included, with 88 focused on surgical applications like hip arthroplasty or osteotomy. In pediatrics, 68 general and 13 surgery-related articles were included. Lower extremity analysis was the most frequent topic, with other uses identified, such as rib cage geometry, patellar dislocation, and X-linked hypophosphatemia. Conclusions: Key clinical applications of EOS imaging include lower extremity analysis, e.g., leg length assessment and knee/hip arthroplasty planning), pelvic and spinal alignment studies, and emerging uses in rib cage geometry. Evidence gaps include limited research on the diagnostic accuracy of EOS for cerebral shunt placement, reliability in bone age estimation, and an unclear role in foot and ankle morphology. Full article

Objective: Frontal sinus surgery is still challenging for surgeons; the frontal osteotomy with the preparation of a frontal bone flap to access the sinus is usually hand-crafted by experienced surgeons. The objective of our study is to present a fully digital protocol for the manufacturing of “in-house” surgical cutting guides, customized to the patient’s anatomy, to perform precise frontal sinus osteotomy, showing the costs, times, and intraoperative complications reduction. Materials and Methods: A prospective study was conducted on 12 patients with complex pathologies involving the frontal sinus who underwent frontal sinus osteotomy in the Maxillofacial Surgery Unit of the Federico II University of Naples, from January 2021 to April 2025, considering the last surgery in November 2023. The same digital protocol to manufacture the surgical cutting guide was used for all the 12 patients. The first step was to upload the preoperative CT images in DICOM format to the software Mimics Medical to perform a rapid segmentation of the skull region of interest to create a 3D object and to identify the frontal sinus margins and the osteotomy lines. The second step was to realize the surgical cutting guide, incorporating the design of titanium plates to fix onto the skull in order to make a precise osteotomy. The final digital step was to export the cutting guide 3D object in the software “Formlab-Form 3B” to print the model with a specific resin. The model was then used during the surgery to perform the precise frontal osteotomy by piezo surgery. The clinical outcomes, in terms of complications and recurrences, were then recorded. Results: In all the patients, no intraoperative complications occurred; the median follow-up was 31.7 months and at one year of follow-up only one patient experienced a recurrence. The mean operative time was about 4 h, with a frontal osteotomy time of about 23 min. Digital protocol time was about 4 h while printing times were between 2 and 4 h. Conclusions: This “in-house” protocol seems to demonstrate that the use of intraoperative templates for the realization of the frontal sinus osteotomy reduces preoperative and intraoperative costs and times, reducing the risk of intraoperative complications, and also allows less experienced surgeons to perform the procedure safely. Obviously, this study is to be considered a “pilot study”, and other studies with large cohorts of patients will have to confirm these promising results. Full article