Search Results (14,467)

Background: Genicular Artery Embolization (GAE) is an emerging minimally invasive procedure for the treatment of pain due to knee osteoarthritis (OA) in patients who are not candidates for joint replacement surgery. The aim of this study is to evaluate the clinical and functional outcomes of GAE performed with a temporary embolic agent and the persistence of its benefits up to 6 months of follow-up. Methods: In this prospective study, 15 consecutive patients (mean age 64.5 ± 6.7 years) with Kellgren–Lawrence grade III–IV knee OA, severe pain refractory to conservative treatments, and not eligible for joint replacement surgery were enrolled. All patients underwent GAE with selective embolization of hypervascular genicular branches using an imipenem/cilastatin suspension as a temporary embolic agent. Patients were evaluated before the procedure, on the first postoperative day, and at 3 and 6 months of follow-up using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Oxford Knee Score (OKS), and the Visual Analog Scale (VAS). Results: All clinical scores showed a significant improvement over time (p < 0.05). WOMAC decreased from 55.6 ± 7.3 to 16.3 ± 4.1 at 6 months; KOOS increased from 40.7 ± 8.1 to 70.3 ± 6.4; OKS improved from 18.4 ± 4.2 to 38.9 ± 4.6; VAS decreased from 7.8 ± 1.0 to 1.5 ± 0.8. No major complications were observed. Two patients (13.3%) developed a subcutaneous hematoma at the femoral access site, which resolved spontaneously. In two patients, pain recurred at the 1-month follow-up. Conclusions: GAE with a temporary embolic agent appeared to be a safe and effective procedure in improving pain and function in patients with advanced knee OA who are not candidates for joint replacement surgery. The clinical benefit was progressive and sustained up to 6 months, supporting the role of synovitis modulation as a therapeutic target. Full article

Background/Objectives: The basis for treatment of sarcoma is surgical resection. However, since the introduction of limb salvage surgery, guidelines recommend radiation as a complement to surgery for high-grade sarcomas. The aim of the present narrative review was to provide a comprehensive update about the role of surgery and radiotherapy (RT) for extremity soft tissue sarcoma (ESTS), to increase both surgeons’ and oncologists’ understanding of radiation as an adjuvant to sarcoma surgery and to illuminate areas of uncertainty that requires further research. Methods: A search on PubMed using relevant MeSH terms was performed, focusing on original research, meta-analyses and review articles. Related articles were identified through snowballing. Results: The support for the use of radiotherapy in conjunction with limb salvage is strong. Complication profiles differ between pre- and postoperative RT and attempts to further limit these are both technological and surgical. Preoperative radiotherapy provides the best results regarding long-term complications so far. Hypo-fractionation is showing promise, but awaiting long-term results for complications remains an area of research rather than clinical practice. Particle beam therapy and internal radiation show effects on control, but due to technical and availability issues, their role is mainly in previously irradiated or inoperable tumors. Conclusions: Upcoming research into adjusted deliveries, doses and planning is anticipated. To further personalize treatment, studies into sarcoma subtypes are indicated. Full article

Osteoarthritis (OA) of the knee is characterized by cartilage matrix degeneration, which eventually leads to joint dysfunction and surgical replacement. Preoperative radiography, the standard for treatment decision making, provides limited information on the extent of degeneration, emphasizing the need for quantitative intraoperative techniques. This study evaluates the potential of vibroacoustic signals generated from instrument–tissue interactions to assess cartilage degeneration severity. A total of 136 ex vivo cartilage specimens of varying degeneration severity, histologically graded using the OARSI score, were collected from 41 patients undergoing arthroplasty. The specimens were classified into three groups: healthy cartilage (OARSI $\le 2.0$), degenerated cartilage (OARSI ≥ 2.5), and subchondral bone. Vibroacoustic signals were captured during specimen palpation using a vibration measurement system affixed to a surgical probe. 26 characteristic signal features were extracted using Continuous-Wavelet Transformation, and their discriminative power was assessed using Support Vector Machine and k-Nearest-Neighbor classifiers under patient- and specimen-level grouped cross-validation with nested hyperparameter tuning. Bone was distinguished from cartilage with 84–$91\%$ recall. Healthy cartilage (OARSI $\le 2.0$) was identifiable with 74–$80\%$ sensitivity, whereas the specificity for degenerated cartilage (OARSI ≥ 2.5) remained limited (40–$57\%$), constituting the principal limitation of the approach. Interpreting the binary cartilage classification as a diagnostic test, a receiver-operating characteristic (ROC) analysis yielded an area under the curve (AUC) of up to $0.66$ ($95\%$ CI [$0.56$, $0.76$]). The study demonstrates that vibroacoustic signals from instrument–tissue interactions may provide complementary information for intraoperative cartilage evaluation and may contribute to decision making in arthroplasty, while the reliable grading of cartilage degeneration remains an open challenge. Full article

A 14-year-old neutered male domestic shorthair cat was evaluated for long-standing, non-pruritic, crusty skin lesions on the pinnae, neck, and ventral abdomen that had persisted for at least 4 years. The histopathological examination of biopsies from the neck and abdomen revealed multicentric squamous cell carcinoma in situ confined to the epidermis. Papillomavirus diagnostics on ear crusts using PCR, rolling circle amplification (RCA), and next-generation sequencing (NGS) identified coinfection with Felis catus papillomavirus type 7 (FcPV7) and a putative novel feline papillomavirus type. This is the first reported case of multicentric carcinoma in situ with coinfection by these two papillomaviruses. The condition was successfully managed medically with topical imiquimod cream applied twice weekly for 3 months, resulting in complete clinical remission. Over 1.5 years of follow-up, they remained well. Two mild recurrences on the dorsal neck were effectively controlled with a short repeat course of imiquimod. This case report documents coinfection with different feline papillomavirus types in a cat and highlights an efficacious, practical, non-surgical treatment with the topical immunomodulatory imiquimod cream. Full article

Background and Objectives: Superficial peritoneal endometriosis (SPE) remains one of the most difficult endometriosis phenotypes to diagnose non-invasively, because lesions are frequently small, multifocal, and poorly detectable using conventional imaging. Diagnostic laparoscopy therefore remains the reference standard for direct visualization of superficial peritoneal lesions. However, the inconsistent relationship between visible lesion burden and pain severity, together with the multifactorial nature of chronic pelvic pain, highlights the limitations of a purely lesion-based diagnostic model. This narrative review reassesses SPE from a cautious functional and molecular perspective, focusing on clinically established evidence, emerging but incompletely validated tools, and hypothesis-generating concepts. The novelty of this review lies in its specific focus on SPE as an unresolved diagnostic phenotype and in the proposed integration of surgical diagnosis, expert imaging, pain phenotyping, empirical treatment response, and molecular research within a non-replacement framework. Materials and Methods: A narrative literature review was performed using PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library for English-language articles published between January 2010 and April 2026. The search focused on SPE, diagnostic laparoscopy, dynamic transvaginal ultrasound, sliding sign, chronic pelvic pain, hormonal treatment response, neuroinflammation, liquid biopsy, circulating biomarkers, epigenetics, and microbiome research. Results: Dynamic transvaginal ultrasound, sliding sign assessment, pelvic organ mobility evaluation, and tenderness-guided examination may provide indirect functional information in selected patients with suspected SPE, but they remain operator-dependent and insufficiently standardized for this phenotype. Response to hormonal therapy may support clinical reasoning, but it has low specificity and may also reflect improvement of adenomyosis, primary dysmenorrhea, ovulation-related pain, abnormal uterine bleeding, or other estrogen-sensitive conditions. Liquid biopsy and molecular biomarkers, including circulating microRNAs, extracellular vesicles, cell-free DNA, inflammatory mediators, epigenetic signatures, adipokine-related markers, and microbiome-related signals, remain investigational and require phenotype-specific validation. Conclusions: Functional and molecular stratification of suspected SPE represents a promising research direction rather than a current clinical standard. Laparoscopy remains essential when definitive diagnosis or surgical treatment is required, particularly in patients with infertility, refractory symptoms, suspicious imaging, or suspected complex disease. Future validated models may help integrate clinical phenotype, expert imaging, treatment response, pain mechanisms, and molecular profiles to support more individualized and selective diagnostic pathways. Full article

Background/Objectives: Incretin-based pharmacotherapies are the most effective non-surgical treatments for obesity to date, yet 85% of patients discontinue within the second year of real-world use. No established framework exists for managing this post-cessation transition. This narrative review evaluates the evidence for structured exercise to mitigate physiological rebound and support long-term weight management following discontinuation. Methods: A narrative review was conducted per Assessment of Narrative Review Articles (SANRA) guidelines using PubMed, Scopus, and Web of Science from January 2005 through to June 2026. Results: Post-cessation weight regain averages 5.6 kg within one year and is observationally associated with dose-dependent cardiometabolic worsening. Lean mass losses averaging 6–7 kg and reductions in bone mineral density are seen during active treatment, creating a metabolically unfavorable state at cessation compounded by fat-preferential regain. Exercise and pharmacotherapy generate fundamentally different body composition outcomes. Exercise preserves lean mass, bone density, cardiorespiratory fitness, and insulin sensitivity, while pharmacotherapy alone does not, with downstream implications for resting metabolic rate and post-cessation rebound. Controlled trial data show exercise initiated during incretin treatment is associated with significantly less weight regain, greater sustained weight loss, and maintained physical activity levels one year after medication and supervised program end. This evidence derives from a single liraglutide-based trial and may not generalize directly to semaglutide, tirzepatide, or next-generation agents. Real-world data associate exercise counseling with durable weight loss after discontinuation. Conclusions: No randomized controlled trial has directly evaluated exercise at pharmacotherapy cessation; conclusions are based on post-treatment extension, real-world observational, and mechanistic evidence. Combined aerobic and resistance training is a biologically plausible, low-risk adjunct to incretin-based pharmacotherapies. Resistance training, adequate dietary protein, and individualized clinical screening are likely important components pending direct evidence from post-cessation trials. Full article

Background: Fractures of the lower extremity are commonly associated with impaired mobility, whereas injuries of the upper extremity primarily affect limb-specific function. Wearable devices allow the objective and continuous monitoring of physical activity and may therefore provide additional insight into postoperative recovery processes under real-world conditions. This exploratory study aimed to compare postoperative trajectories of daily step count following surgical treatment of upper versus lower extremity fractures and to explore possible associations with general health status and return to work. Methods: In this prospective observational study, 38 patients with upper extremity fractures and 55 patients with lower extremity fractures were included. Daily step counts were recorded postoperatively. Patient-reported general health (PROMIS Global Health) and work status at three months were assessed. Results: During the early postoperative period, patients with lower extremity injuries recorded lower daily step counts than patients with upper extremity injuries. Within three months, 89% of patients with upper extremity injuries and 49% of patients with lower extremity injuries had returned to work. Conclusions: In this exploratory cohort, postoperative step count trajectories differed between surgically treated upper and lower extremity fractures during the early postoperative period. Return-to-work rates at three months also differed between groups. Interpretation of these findings is limited by the real-world use of heterogeneous consumer wearable devices and the exploratory study design. These findings should be considered preliminary and hypothesis-generating. Full article

Background/Objectives: Depression is a frequently overlooked but clinically important complication following surgical treatment of benign prostatic hyperplasia (BPH). This study aimed to compare the risk of new-onset postoperative depression following transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) in patients with BPH. Methods: We conducted a retrospective cohort study using the Korean Health Insurance Review and Assessment database. Patients diagnosed with BPH between 2013 and 2022 who underwent TURP or HoLEP and had no prior diagnosis of a psychiatric disorder were included (n = 30,878 and n = 21,521, respectively). The primary outcome was a diagnosis of depression within one year after surgery. Multivariable logistic regression and propensity score matching were used to adjust for covariates, including age, comorbidities, medication use, geographic region, and hospital level. Sensitivity analyses were conducted using follow-up periods of one, three, six, and nine months. Results: In the unadjusted model, HoLEP was associated with higher odds of postoperative depression compared with TURP (odds ratio [OR] = 1.338, 95% confidence interval [CI]: 1.245–1.438; p < 0.0001). This association remained significant after multivariable adjustment (OR = 1.350, 95% CI: 1.255–1.451; p < 0.0001) and propensity score matching (OR = 1.364, 95% CI: 1.259–1.476; p < 0.0001). The association was observed across alternative follow-up windows in the sensitivity analyses. Conclusions: HoLEP is associated with higher odds of new-onset postoperative depression compared with TURP. These findings may inform perioperative mental health assessment for patients undergoing surgical treatment for BPH, and warrant further evaluation to establish causality or clarify the underlying mechanism. Full article

Cushing’s syndrome is a common endocrine disorder in dogs managed with both medical and non-medical treatments; however, the effects of non-medical interventions on survival, perioperative, and clinical outcomes remain uncertain. A comprehensive search was conducted across MEDLINE, Embase, Web of Science, Academic Search Complete, and the Cochrane Library databases. Five studies (n = 248 dogs) met the inclusion criteria. Three studies evaluated laparoscopic and open adrenalectomy in dogs with adrenal-dependent hypercortisolism, whereas two studies evaluated radiotherapy in dogs with pituitary-dependent hypercortisolism. Meta-analysis demonstrated no significant differences in the survival rates between laparoscopic and open adrenalectomy at 12, 24, or 36 months. Fractionated radiotherapy improved survival rates at 12 months, while both fractionated and stereotactic radiotherapy improved survival rates at 24 months. This benefit, however, was not maintained at 36 months. Radiotherapy was also associated with improved neurologic outcomes (OR = 109.17, 95% CI 3.99–2985.49) and longer survival time (MD = 624.00 days, 95% CI 227.93–1020.07). Among dogs undergoing adrenalectomies; laparoscopic adrenalectomy was associated with shorter surgical times (MD = −28.38 min, 95% CI −41.39 to −15.38) and hospitalization (MD = −0.66 days, 95% CI −1.00 to −0.32) compared to open adrenalectomy. Full article

Pediatric obstructive sleep apnea (OSA) is a common disorder associated with significant neurocognitive, behavioral, cardiovascular, and metabolic consequences. Although adenotonsillectomy remains first-line therapy for many children, residual OSA is common, particularly among those with obesity, craniofacial abnormalities, genetic syndromes, neuromuscular disease, or other forms of medical complexity. Continuous positive airway pressure (CPAP) is the standard non-surgical treatment; however, long-term effectiveness is frequently limited by poor tolerance and adherence. Heated high-flow nasal cannula (HFNC) therapy has emerged as a potential alternative for selected children with sleep-disordered breathing, particularly those who are unable to tolerate conventional positive airway pressure therapy. Unlike CPAP, HFNC delivers heated, humidified gas through an open nasal interface and may improve sleep-disordered breathing through a combination of flow-dependent positive airway pressure generation, dead-space washout, improved ventilatory efficiency, enhanced gas conditioning, and reductions in inspiratory resistance. However, the relative contribution of these mechanisms during sleep remains incompletely understood. Current clinical evidence consists primarily of physiological studies, retrospective cohorts, case series, and a limited number of prospective comparative studies. Collectively, these data suggest that HFNC can reduce obstructive respiratory events and improve oxygenation in selected pediatric populations, including children with persistent OSA, CPAP intolerance, medical complexity, and syndromic conditions. Nevertheless, important uncertainties remain regarding optimal patient selection, titration strategies, patient monitoring, long-term adherence and comparative effectiveness relative to CPAP. This review summarizes the physiological basis of HFNC therapy, critically appraises the current clinical evidence, discusses practical considerations related to adherence and implementation, and highlights key knowledge gaps and future research priorities. Overall, HFNC should be viewed as an alternative for selected children who cannot tolerate CPAP, rather than as a universal substitute for pressure-based therapy. Full article

Background: Pediatric pleural empyema is a major complication of community-acquired pneumonia and remains associated with substantial morbidity despite advances in vaccination, antimicrobial therapy, and supportive care. Intrapleural fibrinolytic therapy has become an important minimally invasive treatment for complicated parapneumonic effusions and empyema, but uncertainty persists regarding the optimal fibrinolytic agent, treatment protocols, patient selection, and indications for surgical intervention. Methods: A narrative review of the literature was conducted to summarize current evidence on the use of intrapleural fibrinolytic therapy in pediatric pleural empyema. Experimental studies, randomized controlled trials, observational studies, systematic reviews, meta-analyses, and international clinical practice guidelines were critically reviewed. Particular attention was paid to the biological rationale for fibrinolysis, pharmacological characteristics of available agents, comparative effectiveness with video-assisted thoracoscopic surgery (VATS), practical treatment protocols, safety, and future research priorities. Results: Intrapleural fibrinolysis effectively improves pleural drainage by lysing fibrin septations during the fibrinopurulent stage of empyema and is associated with shorter hospitalization compared with chest-tube drainage alone. Urokinase remains the fibrinolytic agent supported by the highest-quality pediatric randomized evidence, whereas alteplase has demonstrated favorable outcomes in observational studies and randomized comparisons with VATS. Current evidence indicates comparable clinical outcomes between fibrinolysis and primary VATS in appropriately selected children, although fibrinolysis is generally associated with lower treatment costs and avoidance of surgery in most patients. Conventional-dose fibrinolytic therapy has an acceptable safety profile, with clinically significant bleeding reported only rarely. Current pediatric evidence does not support the routine addition of DNase to tissue plasminogen activator. Conclusions: Intrapleural fibrinolytic therapy represents a safe, effective, and minimally invasive first-line treatment for most children with complicated parapneumonic effusions and pleural empyema requiring drainage. Management should be individualized within a multidisciplinary framework, integrating timely diagnosis, image-guided pleural drainage, appropriate antimicrobial therapy, and selective surgical intervention. Future multicenter studies are needed to optimize fibrinolytic protocols, validate predictive biomarkers, and further standardize clinical management. Full article

Background: Surgical wound dehiscence (SWD) is defined as a complete or partial separation of the surgical incision site after surgery and represents a serious complication in soft tissue surgery. Case presentation: We present a clinical case of wound dehiscence in a 7-month-old dachshund. The primary cause was an attack by another dog, leading to the development of a deep bite wound in the back area perforating the anus and numerous minor injuries in the same area. After initial treatment and apparently good general health, numerous necrotic foci were observed during wound cleaning on the 3rd day after treatment. The wound was subsequently revised and an experimentally developed biomaterial based on chitosan in combination with manuka honey was applied. The use of this combination resulted in an accelerated healing process and almost complete closure of the wound already on the 12th day after application. Conclusions: This case demonstrates and simultaneously points to the promising possibilities of using chitosan-based biomaterials and honey as natural products for the successful treatment of wounds and management of postoperative complications. Full article

Background/Objectives: Intussusception is a common pediatric emergency characterized by bowel telescoping, often leading to ischemia, necrosis, and perforation if untreated. Early identification of prognostic biomarkers could improve management strategies. This study aimed to evaluate the association between admission biomarkers and treatment outcomes in children with intussusception, to identify potential predictors. Methods: A retrospective analysis was conducted on 141 pediatric patients diagnosed with intussusception over ten years. Patients were stratified into three groups based on treatment outcome: spontaneous resolution, hydrostatic reduction, or surgery. Data collected included demographic, clinical, radiological, and laboratory parameters. Results: Among the cohort, 34% experienced spontaneous resolution, 27.7% underwent hydrostatic reduction, and 38.3% required surgery. Biomarkers such as erythrocyte count, hemoglobin, hematocrit, and platelets differed significantly across groups. Multivariate analysis identified erythrocyte count, platelet count, and potassium as variables independently associated with surgical management. Lower erythrocyte counts, higher platelet counts, and lower potassium were associated with increased likelihood of surgical intervention. The erythrocyte count, platelet count, and serum potassium showed ROC AUCs of 0.64, 0.65, and 0.70, respectively. Conclusions: Admission erythrocyte count, platelet count, and serum potassium were independently associated with the need for surgery but each showed only modest standalone discrimination. They are therefore best regarded as candidate variables for multivariable or composite predictive models rather than as standalone, clinically actionable triage markers. Further prospective studies are warranted to validate their incremental value within such models. Full article

Background: Infrazygomatic crest (IZC) miniscrews provide reliable extra-alveolar skeletal anchorage for orthodontic tooth movement while minimizing dependence on patient compliance. Although guided insertion techniques have been proposed to improve placement accuracy, freehand insertion remains widely used because of its simplicity and clinical practicality. This retrospective study evaluated the clinical performance and survival of freehand-placed IZC miniscrews over a minimum follow-up period of 30 months. Materials and Methods: A retrospective observational study was conducted on 23 consecutive patients receiving a total of 30 IZC miniscrews between January 2022 and July 2024. All miniscrews were placed freehand by the same experienced orthodontist following individualized radiographic planning based on panoramic radiography and/or cone-beam computed tomography (CBCT), according to the patient’s anatomical requirements. Miniscrews were immediately loaded using light orthodontic forces (<100 g), with progressive force increases during subsequent appointments based on treatment objectives. Patients were reviewed at approximately 30–35-day intervals. Clinical records were analyzed to assess miniscrew survival, timing of failure, and procedure-related complications using descriptive statistical analysis. Results: Twenty-seven of the 30 miniscrews remained clinically stable throughout treatment, corresponding to an overall success rate of 90.0%. Three failures occurred during the early treatment phase, while no late failures were observed. Because of the limited number of failure events, potential contributing factors—including screw dimensions, mechanical interference, and deterioration of oral hygiene during treatment—were evaluated descriptively and should be interpreted with caution. No major surgical or radiographic complications were detected during follow-up. Conclusions: Within the limitations of this retrospective observational study, freehand placement of IZC miniscrews demonstrated favorable clinical performance when performed by an experienced operator following appropriate radiographic planning. However, the relatively small sample size, absence of a control group, and descriptive nature of the analysis preclude definitive conclusions regarding factors influencing miniscrew failure or the comparative effectiveness of freehand versus guided insertion. Larger prospective controlled studies are warranted to validate these preliminary findings. Clinical relevance Manual IZC miniscrew insertion represents a predictable, efficient, and cost-effective alternative to guided approaches in orthodontic practice. Full article

Mismatch repair deficiency (MMRd) is a critical biomarker in endometrial cancer (EC) for prognostication, Lynch syndrome screening, and immunotherapy eligibility. This study aimed to determine the prevalence of MMRd and its correlation with clinicopathological characteristics in EC. This prospective observational cohort included 93 patients with EC undergoing primary surgical treatment, managed as per the European Society of Gynaecological Oncology (ESGO) guidelines. MLH1, PMS2, MSH2, and MSH6 expression was assessed through immunohistochemistry (IHC) on formalin-fixed, paraffin-embedded hysterectomy specimens. Associations between mismatch repair (MMR) status and histology, grade, lymphovascular space invasion (LVSI), myometrial invasion, FIGO 2023 stage, nodal status, recurrence, and survival were analyzed. The median age was 66 years. Most tumors were endometrioid (86%), 29% were grade 3, 45.2% showed deep myometrial invasion, and 23.7% had substantial LVSI. MMRd was identified in 41.9% of cases, with MLH1 and PMS2 loss being most frequent, and was significantly associated with endometrioid histology (p = 0.027) and deep myometrial invasion (p = 0.011). No significant correlations were found with grade, LVSI, FIGO stage, nodal involvement, recurrence, or overall survival. Routine MMR assessment may refine risk stratification and guide individualized treatment decisions. Full article