Search Results (6,396)

Background: Composite restorations are the standard of care for posterior teeth due to their aesthetic properties and conservative nature. However, the choice between direct and semi-direct techniques can influence clinical longevity and performance. Objectives: This study aimed to compare the clinical performance of two restorative approaches: a direct technique and the semi-direct onlay technique in terms of aesthetic quality, surface finish, wear resistance, marginal integrity, and overall clinical efficiency over a two-year period. Methods: A total of 348 composite restorations were placed in 192 patients. Each restoration was evaluated at four timepoints: baseline (T0), 6 months (T1), 1 year (T2), and 2 years (T3). Clinical performance was assessed using standardised 5-point rating scales across the five dimensions. Repeated-measures ANOVA assessed changes over time, while Wilcoxon signed-rank and Mann–Whitney U tests were used for intra- and inter-group comparisons. Results: Significant time effects were observed across all clinical parameters (p < 0.0001). The direct technique exhibited superior initial results in aesthetics and surface finish at T0 and T1 (p < 0.001), but differences diminished by T3. In contrast, the semi-direct technique demonstrated improved performance in wear resistance and marginal integrity at T2 and T3. Both techniques showed progressive deterioration, particularly in marginal adaptation. Conclusions: The direct technique offers enhanced short-term aesthetics and procedural efficiency, while the semi-direct approach provides superior long-term durability and marginal adaptation. Full article

Background: Chronic kidney disease (CKD) represents a state of persistent, sterile low-grade inflammation in which sustained innate immune activation accelerates renal decline and cardiovascular complications. Diet-induced gut dysbiosis and intestinal barrier dysfunction lower mucosal immune tolerance, promote metabolic endotoxemia, and position the gut as an upstream modulator of systemic inflammatory signaling along the gut–kidney axis. Scope: Most studies address microbiota-derived metabolites, food-derived bioactive peptides, or omega-3 fatty acids separately. This review integrates evidence across these domains and examines their convergent actions on epithelial barrier integrity, immune polarization, oxidative-inflammatory stress, and inflammasome-dependent pathways relevant to CKD progression. Key mechanisms: CKD-associated dysbiosis is characterized by reduced short-chain fatty acid (SCFA) production and increased generation and accumulation of uremic toxins and co-metabolites, including indoxyl sulfate, p-cresyl sulfate, trimethylamine N-oxide, and altered bile acids. Reduced SCFA availability weakens tight junction-dependent barrier function and regulatory immune programs, favoring Th17-skewed inflammation and endotoxin translocation. Bioactive peptides modulate inflammatory mediator networks and barrier-related pathways through effects on NF-κB/MAPK signaling and redox balance, while omega-3 fatty acids and specialized pro-resolving mediators support resolution-phase immune responses. Across these modalities, shared control points include barrier integrity, metabolic endotoxemia, oxidative stress, and NLRP3 inflammasome activation. Conclusions: Although evidence remains heterogeneous and largely preclinical, combined nutritional modulation targeting these convergent pathways may offer greater immunomodulatory benefit than isolated interventions. Future multi-omics-guided, factorial trials are required to define responder phenotypes and translate precision immunonutrition strategies into clinical CKD care. Full article

Objective: Mobile head CT enables bedside neuroimaging in critically ill patients, reducing risks associated with intrahospital transport. Despite increasing clinical use, evidence on dose optimization for mobile CT systems remains limited. This study evaluated whether an optimized CT protocol can reduce radiation exposure without compromising diagnostic image quality in neurointensive care unit patients. Methods: In this retrospective single-center study, twenty-two non-contrast head CT examinations were acquired with a second-generation mobile CT scanner between March and May 2023. Patients underwent either a default (group A, n = 14; volumetric computed tomography dose index (CTDI_vol) 44.1 mGy) or low-dose CT protocol (group B, n = 8; CTDI_vol 32.1 mGy). Regarding dosimetry analysis, we recorded dose length product (DLP) and effective dose (ED). Quantitative image quality was assessed by manually placing ROIs at the basal ganglia and cerebellar levels to determine signal, noise, signal-to-noise ratio, and contrast-to-noise ratio. Two neuroradiologists independently rated qualitative image quality using a four-point Likert scale. Statistical comparisons were performed using a significance threshold of 0.05. Results: Median DLP and ED were significantly lower for group B (592 mGy·cm, 1.12 mSv) than for group A (826 mGy·cm, 1.57 mSv; each p < 0.0001). Quantitative image quality parameters did not differ significantly between groups (p > 0.05). Qualitative image quality was rated excellent (median score 4). Conclusions: The optimized mobile head CT protocol achieved a 28.7% reduction in radiation exposure while maintaining high diagnostic image quality. These findings support the adoption of low-dose strategies in mobile CT imaging in line with established radiation protection standards. Full article

Listeria monocytogenes (LM) contamination constitutes a paramount global threat to food safety, necessitating the urgent development of advanced, rapid, and non-destructive detection methodologies to ensure food security. This study successfully synthesized Bi₂WO₆ nanoflowers through optimized feed ratios of raw materials and further functionalized them with noble metal Au to construct a high-performance Au-Bi₂WO₆ composite nanomaterial. The composite exhibited high sensing performance toward acetoin, including high sensitivity (R_a/R_g = 36.9@50 ppm), rapid response–recovery kinetics (13/12 s), and excellent selectivity. Through UV-Vis diffuse reflectance spectroscopy (UV-Vis DRS) and X-ray photoelectron spectroscopy (XPS) characterizations, efficient electron exchange between Au and Bi₂WO₆ was confirmed. This electron exchange increased the initial resistance of the material, effectively enhancing the response value toward the target gas. Furthermore, the chemical sensitization effect of Au significantly increased the surface-active oxygen content, promoted gas–solid interfacial reactions, and improved the adsorption capacity for target gases. Compared to conventional turbidimetry, the Au-Bi₂WO₆ nanoflower-based gas sensor demonstrates superior practical potential, offering a novel technological approach for non-destructive and rapid detection of foodborne pathogens. Full article

Along with the growing demands for personalized medicine and public health surveillance, diagnostic technologies capable of rapid and accurate pathogen nucleic acid testing in home settings are becoming increasingly crucial. Paper-based microfluidic chips (μPADs) have emerged as a potential core platform for enabling molecular testing at home, owing to their advantages of low cost, portability, and independence from complex instrumentation. However, significant challenges remain in the current μPADs systems regarding nucleic acid extraction efficiency, isothermal amplification stability, and signal readout standardization, which hinder their practical and large-scale application. This review systematically summarizes recent research progress in μPADs for home-based nucleic acid testing from four key aspects: extraction–amplification–detection system integration, with a particular focus on the synergistic effects and development trends of critical technologies such as material engineering, fluid control, signal transduction, and intelligent readout. We further analyze typical application cases of this technology in the rapid screening of infectious disease. Promising optimization pathways are proposed, focusing on standardized manufacturing, cold-chain-independent storage, and AI-assisted result interpretation, aiming to provide a feasible framework and forward-looking perspectives for constructing home-based molecular diagnostic systems. Full article

Background and Objectives: Vaginal natural orifice transluminal endoscopic surgery, vNOTES, has become an increasingly preferred minimally invasive option for benign hysterectomy. General anesthesia is still the routine choice, yet regional methods such as combined spinal epidural anesthesia may support a smoother postoperative course. Although the use of vNOTES is expanding, comparative information on anesthetic approaches remains limited, and its unique physiologic setting requires dedicated evaluation. To compare combined spinal epidural anesthesia with general anesthesia for benign vNOTES hysterectomy, focusing on postoperative nausea and vomiting, recovery quality, and intraoperative physiologic safety. Materials and Methods: This retrospective cohort study was conducted in a single center and identified women who underwent benign vNOTES hysterectomy between March 2024 and August 2025 from electronic medical records. Participants received either combined spinal epidural anesthesia or general anesthesia according to routine clinical practice. All patients were managed within an enhanced recovery pathway that incorporated standardized analgesia and prophylaxis for postoperative nausea and vomiting. The primary outcome was the incidence of postoperative nausea and vomiting during the first day after surgery. Secondary outcomes included time to discharge from the recovery unit, pain scores at set postoperative intervals, early functional recovery, patient satisfaction and physiologic parameters extracted from intraoperative monitoring records. Analyses were performed according to the anesthesia group documented in the medical files. Results: One hundred forty patients met inclusion criteria and were included in the analysis. Combined spinal epidural anesthesia was linked to a lower incidence of postoperative nausea and vomiting, a shorter stay in the post-anesthesia care unit, and reduced pain scores in the first 24 h (adjusted odds ratio 0.32, ninety five percent confidence interval 0.15 to 0.68). Early ambulation and oral intake were reached sooner in the combined spinal epidural group, with higher overall satisfaction also noted. Adherence to ERAS elements was similar between groups, with no meaningful differences in early feeding, mobilization, analgesia protocols or PONV prophylaxis. During the procedure, combined spinal epidural anesthesia produced more episodes of hypotension and bradycardia, while general anesthesia was linked to higher airway pressures and lower oxygen saturation. Complication rates within the first month were low in both groups. Conclusions: In this observational cohort study, combined spinal epidural anesthesia was associated with lower postoperative nausea, earlier recovery milestones and greater patient comfort compared with general anesthesia. Hemodynamic instability occurred more often with neuraxial anesthesia but was transient and manageable. While these findings point to potential recovery benefits for some patients, the observational nature of the study and the modest scale of the differences necessitate a cautious interpretation. They should be considered exploratory rather than definitive. The choice of anesthesia should therefore be individualized, weighing potential recovery benefits against the risk of transient hemodynamic effects. Larger and more diverse studies are needed to better define patient selection and clarify the overall risk benefit balance. These findings should be interpreted cautiously and viewed as hypothesis-generating rather than definitive evidence supporting one anesthetic strategy over another. Full article

Background/Objective: Nasal pressure injuries following non-invasive ventilation (NIV) have remained a common complication. Available evidence on injury severity characteristics, timing, and predictors of progression to moderate–severe injury, especially in large cohorts, is limited. The objective was to assess the incidence, characteristics and risk factors for nasal pressure injuries among neonates on NIV in a large tertiary neonatal intensive care unit (NICU). Methods: This retrospective observational study recruited all infants who experienced nasal pressure injury while on NIV from March 2018 to November 2022. The severity of the injury was categorized by the Fischer classification. Demographics, perinatal, respiratory, and device-related factors were examined. Multivariable logistic regression revealed independent predictors of moderate to severe injury. Results: There were 237 nasal injury episodes in 226 infants (0.406 per 100 device-days), considering 17,004 NICU admissions and 58,363 NIV device-days. Most injuries were mild (Stage I 81%) while 19% were moderate–severe (Stage II–III). Early injuries (≤3 days after NIV) were present in 83.5% of patients and were often related to the nasal bridge. In particular, late-onset injuries (>3 days) were more likely in infants with previous injury, exposure to postnatal steroids, longer prior intubation, or septal involvement. Moreover, multivariable analysis identified three specific independent predictors of moderate–severe injury previous nasal injury (aOR 6.25, 95% CI 1.11–35.35), septal or combined bridge/septum involvement (aOR 2.98, 95% CI 1.04–8.43), and prolonged period of positive pressure ventilation at birth (aOR 1.23 per minute, 95% CI 1.04–1.45). Conclusions: Most nasal pressure injuries seen during NIV are mild and early; however, recurrence, septal involvement, and prolonged resuscitative ventilation markedly increase the risk of severe injury. Improving surveillance on early NIV use, monitoring of septal pressure points, and proactive interventions with interface management will aid in minimizing preventable nasal morbidity. Full article

Background and Objectives: Implant-supported rehabilitation after oral cancer surgery remains technically and biologically demanding due to altered anatomy, scar tissue, and prior radiotherapy. Digital workflows and hospital-based point-of-care (POC) manufacturing now enable personalized, prosthetically driven implant placement with static surgical guides fabricated within the clinical environment. This study reports the initial clinical experience of an academic POC manufacturing unit (UPAM3D) implementing static guided implant surgery in oral cancer patients and compares this approach with conventional outsourcing and dynamic navigation methods. Materials and Methods: A retrospective review of 30 consecutive cases (2021–2024) treated with POC-manufactured static guides was conducted using data from the UPAM3D registry. Each record included design, fabrication, and sterilization parameters compliant with ISO 13485 standards. Demographic, surgical, and prosthetic variables were analyzed, including anatomical site (maxilla or mandible), guide type, material, radiotherapy history, number of Ticare Implants^®, and loading strategy. Results: All surgical guides were designed and 3D printed in-house using biocompatible resins (BioMed Clear, Dental SG, or LT Clear). The annual number of POC procedures increased progressively (2 → 6 → 6 → 16). Most cases involved oncologic reconstructions of the maxilla or mandible, including irradiated fields. When recorded, primary stability values (mean ISQ ≈ 79) allowed immediate or early loading (ISQ ≥ 70). No major intraoperative or postoperative complications occurred, and all guides met sterilization and traceability standards. Conclusions: Point-of-care manufacturing enables efficient, accurate, and patient-specific guided implant rehabilitation after oral cancer surgery, optimizing functional and esthetic outcomes while reducing procedural time and dependence on external providers. Integrating this process into clinical workflows supports personalized treatment planning and broadens access to advanced implant reconstruction within multidisciplinary oncology care. Full article

Background: Dysglycemia remains a persistent challenge in hospital care. Despite advances in outpatient diabetes technology, inpatient insulin management largely depends on intermittent point-of-care glucose testing, static insulin dosing protocols and rule-based decision support systems. Artificial intelligence (AI) offers potential to transform this care through predictive modeling and adaptive insulin control. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, a scoping review was conducted to characterize AI algorithms for insulin dosing and glycemic management in hospitalized patients. An interdisciplinary team of clinicians and engineers reached consensus on AI definitions to ensure inclusion of machine learning, deep learning, and reinforcement learning approaches. A librarian-assisted search of five databases identified 13,768 citations. After screening and consensus review, 26 studies (2006–2025) met the inclusion criteria. Data were extracted on study design, population, AI methods, data inputs, outcomes, and implementation findings. Results: Studies included ICU (N = 13) and general ward (N = 9) patients, including patients with diabetes and stress hyperglycemia. Early randomized trials of model predictive control demonstrated improved mean glucose (5.7–6.2 mmol/L) and time in target range compared with standard care. Later machine learning models achieved strong predictive accuracy (AUROC 0.80–0.96) for glucose forecasting or hypoglycemia risk. Most algorithms used data from Medical Information Mart for Intensive Care (MIMIC) databases; few incorporated continuous glucose monitoring (CGM). Implementation and usability outcomes were seldom reported. Conclusions: Hospital AI-driven models showed strong algorithmic performance but limited clinical validation. Future co-designed, interpretable systems integrating CGM and real-time workflow testing are essential to advance safe, adaptive insulin management in hospital settings. Full article

Background: Compressive cryotherapy, which combines cold therapy with compression, has gained attention to relieve pain and swelling after the Knee arthroscopy. However, there is still limited evidence specifically related to its use after knee arthroscopy. Objective: This study investigated the efficacy of compressive cryotherapy in decreasing postoperative pain and swelling in patients following knee arthroscopy. Methods: A quasi-experimental study was conducted at the Kasr Al-Ainy Hospital. Sixty patients scheduled for knee arthroscopy were divided into two groups. The intervention group (n = 30) received compressive cryotherapy using a cold-pack knee wrap set at 2 to 5 °C for 15 to 20 min, three times daily. The control group (n = 30) received standard postoperative care. Pain was assessed with the Numerical Rating Scale. Swelling was measured by assessing knee circumference at the mid-patella. Assessments occurred immediately after surgery (baseline), and on the first and second postoperative days. Non-parametric tests used in the analysis included the Chi-square test, the Mann–Whitney U test, the Friedman test, and the Wilcoxon signed-rank test with Bonferroni–Holm correction. Results: Patients in the compressive cryotherapy group experienced a greater reduction in pain than those in the control group. By the first postoperative day, none of the patients in the intervention group reported severe pain (p < 0.001). Knee circumference decreased significantly in the intervention group, from a median of 51.05 cm [IQR: 49.1–53.2] at baseline to 40.90 cm [39.8–42.1] by the second day. In comparison, the control group showed a smaller reduction, from 52.70 cm [50.8–54.5] to 48.55 cm [46.8–50.9]. Between-group differences in swelling were significant at the first postoperative assessment (U = 105.0, p < 0.001) and on day 2 (U = 62.5, p < 0.001). Overall, differences in both pain intensity and knee swelling between groups were statistically significant across all time points (p < 0.001). Conclusions: Compressive cryotherapy is an effective non-pharmacological intervention for reducing pain and swelling in the early postoperative period following knee arthroscopy. These results suggest that it could be a valuable addition to routine postoperative care, helping patients recover more comfortably and quickly. Full article

The COVID-19 pandemic highlighted critical issues in health services and public policy, particularly in long-term care facilities across Canada. Failures in these facilities revolving around chronic underfunding, staffing shortages, inadequate infection control, and inconsistent regulatory oversight, underscore the need to rethink health service interventions, especially considering varying implementation contexts among provinces. The Ontario Long-Term Care COVID-19 Commission Final Report pointed to long-standing systemic issues as the primary causes of the sector’s failures. To explore this issue, a narrative review was conducted with findings indicating that the long-term care crisis in Canada cannot be solved by more privatization, regulation or efficiency measures, as these have contributed to the problem’s root causes. Ontario’s long-term care crisis stems from systemic misalignments in policy, structure and stakeholder dynamics, requiring a shift toward systems thinking and resident-centered care to build an equitable and sustainable long-term care sector. Ultimately, governments must lead a policy redesign that reflects shared responsibility, stakeholder interdependence, and public involvement, offering a model for broader healthcare reform. Full article

Flexible biosensors offer rapid and low-cost diagnostics but are often limited by the mechanical and electrochemical instability of polymer-based designs in biological media. Here, we introduce a metallic flexible microcrack transducer that exploits the intrinsic deformability of superelastic nickel–titanium (NiTi) for label-free impedimetric detection. Mechanical bending of NiTi wires spontaneously generates martensitic-phase microcracks whose metal–gap–metal geometry forms the active transduction sites, where functional interfacial layers and captured analytes modulate the local dielectric environment and govern the impedance response. Our approach imparts a novel dielectric character to the alloy, enabling its unexplored application in the megahertz (MHz) frequency domain (0.01–10 MHz) where native NiTi is merely conductive. Functionalization with Escherichia coli (E. coli)-specific antibodies renders these microdomains biologically active. This effectively transforms the mechanically induced microcracks into tunable impedance elements driven by analyte binding. The γ-bent NiTi sensors achieved stable and quantitative detection of E. coli ATCC 25922 in sterile human urine, with a detection limit of 64 colony forming units (CFU) mL⁻¹ within 45 min, without redox mediators, external labels, or amplification steps. This work pioneers the use of martensitic microcrack networks, mimicking self-healing behavior in a superelastic alloy as functional transduction elements, defining a new class of metallic flexible biosensors that integrate mechanical robustness, analytical reliability, and scalability for point-of-care biosensing. Full article

The building sector is significantly responsible for the world’s energy consumption and carbon emissions. Net-zero energy buildings (NZEBs) have become an effective solution to move towards sustainability, maximizing energy efficiency, and minimizing carbon footprint. However, achieving net-zero energy targets requires a comprehensive understanding of building performance from the perspectives of technologies, materials, and strategies, for which existing studies have a knowledge gap. This study aims to bridge the knowledge gap within existing studies through an empirical investigation. Based on a review of the literature, this study employs semi-structured interviews in the United Kingdom (UK) with industrial professionals experienced in NZEBs. The qualitative data collected from interview participants are analyzed minutely using NVivo to identify key themes and patterns, including 14 technologies, 12 materials, and seven strategies for NZEBs. Based on the literature review and, more importantly, the interview analysis, a conceptual framework is well established to describe an NZEB as a complex system that must incorporate appropriate technology adoption, careful material selection, and successful strategy implementation into consideration. This study provides a comprehensive understanding of NZEBs from a systematic point of view. It also contributes to the full fulfillment of Sustainable Development Goals (SDGs) established by the United Nations (UN). Full article

Infectious diseases caused by bacterial and viral pathogens remain a major global threat, particularly in areas with limited diagnostic resources. Conventional optical techniques are time-consuming, prone to operator errors, and require sophisticated instruments. Colorimetric biosensors, which convert biorecognitive processes into visible color changes, enable simple and low-cost point-of-care testing. Artificial intelligence (AI) enhances decision-making by enabling learning, training, and pattern recognition. Machine learning (ML) and deep learning (DL) improve diagnostic accuracy, but they do not autonomously adapt and are pre-trained on complex color variation, whereas traditional computer-based methods lack analysis ability. This review summarizes major pathogens in terms of their types, toxicity, and infection-related mortality, while highlighting research gaps between conventional optical biosensors and emerging AI-assisted colorimetric approaches. Recent advances in AI models, such as ML and DL algorithms, are discussed with a focus on their applications to clinical samples over the past five years. Finally, we propose a prospective direction for developing robust, explainable, and smartphone-compatible AI-assisted assays to support rapid, accurate, and user-friendly pathogen detection for health and clinical applications. This review provides a comprehensive overview of the AI models available to assist physicians and researchers in selecting the most effective method for pathogen detection. Full article

Glaucoma is a leading cause of irreversible blindness worldwide, with its asymptomatic progression highlighting the urgent need for early, minimally invasive biomarkers. Exosomes derived from the aqueous humor (AH) have emerged as promising candidates, as they carry proteins, nucleic acids, and lipids that reflect the physiological and pathological state of ocular tissues such as the trabecular meshwork and ciliary body. However, their low abundance, nanoscale size, and the limited volume of AH complicate detection and characterization. Conventional methods, including Western blotting, PCR or mass spectrometry, are labor-intensive, time-consuming, and often incompatible with microliter-scale samples. Electrochemical biosensors offer a highly sensitive, rapid, and low-volume alternative, enabling the detection of exosomal surface markers and internal cargos such as microRNAs, proteins, and lipids. Recent advances in nanomaterial-enhanced electrodes, microfluidic integration, enzyme- and nanozyme-mediated signal amplification, and ratiometric detection strategies have significantly improved sensitivity, selectivity, and multiplexing capabilities. While most studies focus on blood or serum, these platforms hold great potential for AH-derived exosome analysis, supporting early-stage glaucoma diagnosis, monitoring of disease progression, and evaluation of therapeutic responses. Continued development of miniaturized, point-of-care electrochemical biosensors could facilitate clinically viable, noninvasive exosome-based diagnostics for glaucoma. Full article