Controlled Study Research Articles

Oral Health Complications of SCUBA Diving

OBJECTIVE This review aims to assess the specific oral health complications associated with SCUBA diving, including barodontalgia, barosinusitis, and temporomandibular joint (TMJ) disorders, and to examine the dental implications of hyperbaric oxygen therapy (HBOT) used in decompression sickness treatment. Additionally, this review identifies gaps in the literature and suggests areas for further research to improve dental care guidelines for divers. MATERIALS AND METHODS A systematic literature search was conducted using PubMed and Scopus databases from 2004 to 2024, focusing on terms such as "barodontalgia," "dental barotrauma," and "diving dentistry." From 77 initial articles, 25 studies were selected based on relevance to pressure-induced oral complications, diving-related barotrauma, and dental management for SCUBA divers. RESULTS The review identifies barodontalgia as a prevalent issue, commonly triggered by untreated caries or defective restorations, with symptoms intensified by pressure changes. TMJ disorders, linked to prolonged clenching on diving mouthpieces, and sinus-related barotrauma also emerged as significant concerns. Preventive measures, including regular dental checkups, use of resin-based cements, and customized mouthpieces, are recommended to reduce risks. Furthermore, the review highlights a need for larger, controlled studies across diverse diver populations to validate current recommendations and develop accessible guidelines, especially for recreational divers who may lack access to specialized dental care.

MOBILE APPLICATIONS AND SUICIDE: A SYSTEMATIC ANALYSIS ON THE EFFECTIVENESS OF MOBILE APPLICATIONS FOR SUICIDE PREVENTION

MOBILE APPLICATIONS AND SUICIDE: A SYSTEMATIC ANALYSIS ON THE EFFECTIVENESS OF MOBILE APPLICATIONS FOR SUICIDE PREVENTION ABSTRACT Objective: This study aimed to evaluate the effectiveness of mobile applications designed to prevent suicide. Design: Within the scope of the study, open access Turkish and English articles published in online databases (Web of Science, PubMed (MEDLINE), WİLEY, Taylor & Francis Online, Science Direct) between 2019 and August 2024 were reviewed. Randomized controlled trials on mobile applications whose role in preventing suicide was clearly stated in the articles were included in the study. Results: As a result of the screening, seven studies that met the inclusion criteria were included in this study. In four of the included studies, a routine intervention (awareness training, psychotherapy or medical treatment) was compared with an additional mobile application; in three studies, a routine intervention was compared with a mobile application. As a result of the evaluation, different results were obtained in terms of the effectiveness, acceptability and usability of mobile applications. It was concluded that mobile applications with psychotherapy content, especially applied together with face-to-face interventions, provided more positive results in reducing the risk of suicide. However, the level of effectiveness may vary depending on the content of the application, the characteristics of the sample, and whether it is a treatment support. At the same time, it has been determined that mobile applications are usable but that there is limited data on their acceptability. Conclusion: Mobile applications aimed at preventing suicide are potential tools that can be used in preventing suicide. However, there is no definitive result regarding their effectiveness. It is important to increase randomized controlled studies with a large sample, long follow-up period, and high level of evidence. Keywords: Mental health, mobile application, suicide

The effect of singing or playing melodica on disease symptoms, self-efficacy level and exercise capacity in chronic obstructive pulmonary patients: a randomized controlled study.

The aim of this randomized controlled experimental study is to determine the effect of singing or playing melodica activity applied to COPD patients on their symptoms, self-efficacy levels, and exercise capacities. The study was carried out in the chest diseases polyclinics of a hospital in Turkey between September 2020 and August 2021 with 30 patients: 15 in the control group and 15 in the song/melodica group. The data were collected with a patient information form and the scales examining disease symptoms, self-efficacy, and exercise capacity. The physical symptom, anxiety, Borg dyspnea, and fatigue scores of the disease in the post-test were significantly lower in the patients in the song/melodica group than those in the control group. In the post-test, the self-efficacy level, walking distance values were found to be significantly higher in the song/melodica group than in the control group. It is concluded that singing or playing melodica was an effective method in reducing the symptoms of the disease and enhancing the level of self-efficacy and exercise capacity in COPD patients.

Pd Nanoparticles Decorated CeZrOx for Enhanced Photocatalytic Hydrogenation of Biomass‐Derived Compounds

AbstractThe photocatalytic conversion of biomass‐derived compounds into value‐added chemicals presents a promising protocol for the sustainable production of renewable chemicals. Our study explores the hydrogenation of biomass model compounds under visible light illumination. Zr was incorporated into the CeO2 framework, forming a CeZrOx(1:0.5) solid solution, confirmed by powder X‐ray diffraction (PXRD) and X‐ray photoelectron spectroscopy (XPS) analyses. The light uptake capacity of the CeZrOx solid solution was characterized using UV–visible spectroscopy. Additionally, the band structure of the CeZrOx solid solution was assessed using valance band X‐ray photoelectron spectroscopy (VB‐XPS) and Ultraviolet photoelectron spectroscopy (UPS) analysis, revealing a Z‐Scheme, which was further confirmed by various control experiments. Upon decorating the CeZrOx(1:0.5) solid solution with 1 wt% palladium (Pd), the resulting 1Pd/CeZrOx(1:0.5) composite exhibited improved charge separation and enhanced visible light absorption capacity. This composite achieved ∼99% conversion of furfural to tetrahydrofurfuryl alcohol under a 15 W blue LED illumination and 0.2 MPa hydrogen. Similarly, it demonstrated ∼99% conversion of benzyl phenyl ether (BPE) to toluene and phenol under a 10 W blue LED illumination. Our findings elucidate the active sites and demonstrate the recyclability of mixed metal oxides for selective furfural hydrogenation and BPE hydrogenolysis under visible light.

Carbon-silicon-switch effect in enantioselective construction of silicon-stereogenic center from silacyclohexadienones.

Carbon-silicon-switch strategy, replacing one specific carbon atom in organic molecules with a silicon, has garnered significant interest for developing new functional molecules. However, the influence of a reaction regarding its selectivity and reactivity by carbon-silicon-switch strategy has far less been investigated. Here we discover an unusual carbon-silicon-switch effect in the enantioselective construction of silicon-stereogenic center. It is found that there has been a significant change in the desymmetrization reaction of silacyclohexadienones using asymmetric conjugate addition or oxidative Heck reaction with aryl/alkyl nucleophiles when compared with their carbon analogues cyclohexadienones. Specifically, the carbon-silicon-switch leads to a reversal in enantioselectivity with arylzinc as the nucleophile by the same chiral catalyst, and results in totally different reactivity with arylboronic acid as the nucleophile. Control experiments and density functional theory (DFT) calculations have shown that the unusual carbon-silicon-switch effect comes from the unique stereoelectronic feature of silicon.

An Extreme Predecessor Rain Event in Central China Amplified by Upper-Level Jet Streak

Abstract A comprehensive study is conducted on a predecessor rain event (PRE) closely associated with the upper-level jet (ULJ) in central China during July 2021, utilizing the Weather Research and Forecasting Model (WRF). The ULJ and precipitation patterns are reasonably reproduced in the control experiment. In the sensitivity experiment (NOULJ), the ULJ is largely suppressed by the piecewise potential vorticity inversion method. The comparison of the two simulations indicates that the ULJ promotes the development of secondary circulation, lower-level jet (LLJ), moisture transport, and atmospheric instability. Synergistic effects among these processes amplify this PRE. The strong updrafts in the precipitation region are closely associated with the inverse secondary circulation that develops on the south side of ULJ entrance. The upper-level mass divergence associated with the ULJ enhances the lower-level convergence, promoting the development of lower-level vorticity and LLJ. The LLJ facilitates moisture transport into the precipitation region and increasing atmospheric instability. In contrast, the precipitation in NOULJ is decreased by 34% due to the weakening of favorable conditions.

Iron-Catalyzed Cross-Dehydrogenative Coupling of para-Quinone Methides with Formamides: In Situ Activation of C(sp2)-H Bonds.

A novel and straightforward method for the iron-catalyzed regioselective cross-dehydrogenative coupling of para-quinone methides (p-QMs) with formamides has been developed, facilitated by the in situ activation of the C(sp2)-H bonds of the formyl and alkenyl substituents via a radical strategy. This method does not require the preactivation of the substrates, and it can accommodate a wide range of p-QMs and formamides under the optimized reaction conditions, resulting in the formation of the expected C-7 acetamides-functionalized para-quinone methides with moderate to good yields. The control experiments revealed that the reaction follows the fundamental equation of second-order kinetics. Additionally, an exploration of the Hammett effect was undertaken to elucidate the impact of the substituents for the reaction. In combination with the DFT calculation, a plausible reaction mechanism was proposed through meticulously controlled experiments.

Enantioselective synthesis of inherently chiral sulfur-containing calix[4]arenes via chiral sulfide catalyzed desymmetrizing aromatic sulfenylation.

Inherently chiral calixarenes hold great potential for applications in chiral recognition, sensing, and asymmetric catalysis due to their unique structures. However, due to their special structures and relatively large sizes, the catalytic asymmetric synthesis of inherently chiral calixarenes is challenging with very limited examples available. Here, we present an efficient method for the enantioselective synthesis of inherently chiral sulfur-containing calix[4]arenes through the desymmetrizing electrophilic sulfenylation of calix[4]arenes. This catalytic asymmetric reaction is enabled by a chiral 1,1'-binaphthyl-2,2'-diamine-derived sulfide catalyst and hexafluoroisopropanol. Various inherently chiral sulfur-containing calix[4]arenes are obtained in moderate to excellent yields with high enantioselectivities. Control experiments indicate that the thermodynamically favored C-SAr product is formed from the kinetically favored N-SAr product and the combination of the chiral sulfide catalyst and hexafluoroisopropanol is crucially important for both enantioselectivity and reactivity.

Iron-Catalyzed sp3 C-H Alkylation of Fluorene with Primary and Secondary Alcohols: A Borrowing Hydrogen Approach.

The utilization of earth-abundant, cheap, and nontoxic transition metals in important catalytic transformations is essential for sustainable development, and iron has gained significant attention as the most abundant transition metal. A mixture of FeCl2 (3 mol %), phenanthroline (6 mol %), and KOtBu (0.4 eqivalent) was used as an effective catalyst for the sp3 C-H alkylation of fluorene using alcohol as a nonhazardous alkylating partner, and eco-friendly water was formed as the only byproduct. The substrate scope includes a wide range of substituted fluorenes and substituted benzyl alcohols. The reaction is equally effective with challenging secondary alcohols and unactivated aliphatic alcohols. Selective mono-C9-alkylation of fluorenes with alcohols yielded the corresponding products in good isolated yields. Various postfunctionalizations of C-9 alkylated fluorene products were performed to establish the practical utility of this catalytic alkylation. Control experiments suggested a homogeneous reaction path involving borrowing hydrogen mechanism with the formation and subsequent reduction of 9-alkylidene fluorene intermediate.

Anti-industry beliefs and attitudes mediate the effect of culturally tailored anti-smoking messages on quit intentions among sexual minority women.

We conducted a longitudinal randomized controlled experiment between September 2021 and May 2022 to evaluate whether anti-tobacco industry beliefs and attitudes mediate the effect of culturally tailored anti-smoking messages on quit intentions among US young adult sexual minority women (SMW) ages 18-30 who smoke. Participants were randomized to view up to a total of 20 tailored versus non-tailored messages over one month. Outcomes were assessed at baseline and one-month follow-up. We fit a structural equation model testing the effect of LGBTQ + community-tailored, anti-smoking messages on quit intentions and mediating roles of anti-industry attitudes and beliefs (n = 966). Anti-industry beliefs (indirect effect size = 0.024, 95% confidence interval [CI] = [0.040, 0.056]) and attitudes (indirect effect size = 0.034, 95% CI = [0.006, 0.077]) significantly mediated the effect of the tailored condition on quit intentions. These findings suggest that LGBTQ + -tailored cues in anti-smoking messaging may promote quit intentions indirectly through influencing young adult SMW's beliefs and attitudes about the tobacco industry. Future campaigns to promote quitting among young adult SMW who smoke should consider incorporating themes to change their beliefs and attitudes about the tobacco industry.Trial registration This study was registered in ClinicalTrials.gov (NCT04812795) on 24/03/2021.

Erythropoietin for the prevention of postoperative neurocognitive disorder in older adult patients undergoing total joint arthroplasty: a randomized controlled study.

Post-operative delirium (PD) is a common post-operative complication with significant clinical and financial impacts on patients. Erythropoietin (EPO), a multi-functional glycoprotein hormone, exhibits erythropoietic and non-erythropoietic anti-inflammatory properties. This study aimed to determine the role of perioperative EPO administration in the development of postoperative delirium in older adult patients undergoing total joint arthroplasty. Seventy-one patients (> 65 years old) scheduled for total joint arthroplasty were randomly assigned to two groups: EPO-treated (EPO, n = 35) and placebo (control, n = 36). All patients completed the Mini Mental State Examination (MMSE) pre-operatively and on post-operative day (POD) 2. The confusion assessment method (CAM) was used to assess the patients until discharge (POD 5). Serum C-reactive protein (CRP) and inflammatory cytokine levels were measured and compared pre- and post-operatively. The development of delirium and cognitive dysfunction was evaluated post-operatively. One patient in the control group developed delirium on POD 2 (3.2%), whereas no patient in the EPO group developed PD (0% vs. 3.2%, p = 0.500). Post-operatively there was no significant difference in MMSE scores between groups. Both groups showed increases in pro- and anti-inflammatory cytokine levels, with no significant differences. Similarly, CRP levels, neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR) showed no intergroup differences in post-operative inflammatory responses. Perioperative EPO reduced the incidence of post-operative delirium, although not statistically significant, with no differences in post-operative cognitive function and inflammatory responses. The trial was registered on December 12, 2023 at http//clinicaltrials.gov, registration number NCT06178835.

Arthroscopic assisted versus open core decompression for osteonecrosis of the femoral head: A systematic review and meta-analysis.

Minimally invasive treatment options for osteonecrosis of the femoral head (ONFH) have been a prominent area of research in recent years. Arthroscopic-assisted treatments have been applied in the clinical management of ONFH; however, high-quality evidence verifying their effectiveness and safety is still lacking. To systematically assess the clinical efficacy and safety of arthroscopic-assisted core decompression (AACD) in treating ONFH. A comprehensive literature search was conducted in PubMed, Web of Science, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, WanFang, and the Chinese BioMedical Literature Database, from inception to June 25, 2024. We identified randomized controlled trials and non-randomized controlled studies on AACD for the treatment of ONFH based on predefined inclusion and exclusion criteria. A meta-analysis was performed using Review Manager 5.4.1 and Stata 17.0 software. The analyzed outcomes included operative time, intraoperative blood loss, length of hospital stay, postoperative femoral head collapse rate, Harris hip score, and postoperative complication rate. The Grades of Recommendations, Assessment, Development, and Evaluations (GRADE) system was used to assess the quality of evidence for the outcome indicators. A total of fourteen studies were included in this meta-analysis, comprising 1,063 patients-541 in the core decompression (CD) group and 522 in the AACD group. The meta-analysis revealed no significant differences between the two groups in terms of intraoperative blood loss, length of hospital stay, 12-month postoperative Harris hip score, or overall postoperative complication rate (P > 0.05). However, the AACD group had a longer operative time (MD = 31.19, 95% Cl: 5.32 to 57.07, P = 0.02) and a lower overall postoperative femoral head collapse rate (RR = 0.49, 95% Cl: 0.27 to 0.89, P = 0.02) compared with the CD group. Additionally, the AACD group showed significant improvements in Harris hip scores at 3 months (MD = 6.39, 95% Cl: 5.44 to 7.33, P < 0.00001), 6 months (MD = 7.56, 95% Cl: 6.63 to 8.49, P < 0.00001), ≥ 24 months (MD = 7.00, 95% Cl: 4.80 to 9.21, P < 0.00001), and at the last follow-up (MD = 6.89, 95% Cl: 5.30 to 8.48, P < 0.00001) compared to the CD group. The GRADE evidence assessment indicated that the overall postoperative complication rate was supported by moderate-quality evidence, while the evidence for operative time, intraoperative blood loss, postoperative femoral head collapse rate, and Harris hip score was of low quality. The evidence for length of hospital stay was deemed very low quality. This meta-analysis suggests that AACD is an effective and safe treatment for patients with ONFH. However, due to the limited quantity and quality of the included studies, these results should be interpreted with caution. Further high-quality studies are recommended to confirm these findings.

Effect of different degrees of wound eversion sutures on scar formation at donor site of anterolateral thigh flaps: A prospective randomized controlled study

To investigate the effect of different degrees of wound eversion on scar formation at the donor site of anterolateral thigh flaps by a prospective clinical randomized controlled study. According to the degree of wound eversion, the clinical trial was designed with groups of non-eversion (group A), eversion of 0.5 cm (group B), and eversion of 1.0 cm (group C). Patients who underwent anterolateral femoral flap transplantation between September 2021 and March 2023 were collected as study subjects, and a total of 36 patients were included according to the selection criteria. After resected the anterolateral thigh flaps during operation, the wound at donor site of each patient was divided into two equal incisions, and the random number table method was used to group them ( n=24) and perform corresponding treatments. Thirty of these patients completed follow-up and were included in the final study (group A n=18, group B n=23, and group C n=29). There were 26 males and 4 females with a median age of 53 years (range, 35-62 years). The body mass index was 17.88-29.18 kg/m 2 (mean, 23.09 kg/m 2). There was no significant difference in the age and body mass index between groups ( P>0.05). The incision healing and scar quality of three groups were compared, as well as the Patient and Observer Scar Assessment Scale (POSAS) score [including the observer component of the POSAS (OSAS) and the patient component of the POSAS (PSAS)], Vancouver Scar Scale (VSS) score, scar width, and patient satisfaction score [visual analogue scale (VAS) score]. In group C, 1 case had poor healing of the incision after operation, which healed after debridement and dressing change; 1 case had incision necrosis at 3 months after operation, which healed by second intention after active dressing change and suturing again. The other incisions in all groups healed by first intention. At 6 months after operation, the PSAS, OSAS, and patient satisfaction scores were the lowest in group B, followed by group A, and the highest in group C. The differences between the groups were significant ( P<0.05). There was no significant difference between the groups in the VSS scores and scar widths ( P>0.05). Moderate everted closure may reduce the formation of hypertrophic scars at the incision site of the anterior lateral thigh flap to a certain extent.

Impact of gestational diabetes mellitus on women's sexual function: a systematic review and meta-analysis.

Gestational diabetes mellitus (GDM) is a prevalent pregnancy complication with well-established adverse effects on maternal and fetal health. However, research on its impact on sexual health is inconsistent. Currently, there is no comprehensive review on sexual function in pregnant women with GDM. The purpose of this study is to systematically gather and synthesize the available evidence, addressing this important research gap. This systematic review and meta-analysis utilized a comprehensive literature search strategy and incorporated the following databases: the Cochrane Library, Scopus, PubMed, Web of Science, SID, and Google Scholar. The search was conducted until February 21, 2024. The quality of the cross-sectional and case‒control studies included in the current study was evaluated via the modified and standard Newcastle‒Ottawa scale. The certainty of the evidence was evaluated via the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. A meta-regression was conducted to examine the variables that influence total sexual function. Additionally, sequential analysis was performed to determine the required information size for the meta-analysis. The systematic search process yielded a total of 370 studies. The final analysis included six studies. The meta-analysis findings revealed that compared with controls, women with GDM had significantly lower total scores for sexual function (SMD - 1.80, 95% CI -3.44 to -0.15, p = 0.03), sexual desire (SMD - 5.14, 95% CI -8.14 to -2.14, p < 0.001), arousal (SMD - 0.58, 95% CI -0.95 to -0.21, p = 0.002), lubrication (MD -0.41, 95% CI -0.59 to -0.22, p < 0.001) and satisfaction (SMD - 3.82, 95% CI -6.08 to -1.57, p < 0.001). However, the analysis did not reveal statistically significant differences in sexual pain, or orgasm between the GDM and control groups. The meta-regression analysis revealed that older age in the control group was associated with poorer sexual function. Compared with control women, pregnant women diagnosed with GDM have lower sexual function. Further research with larger sample sizes is necessary to enhance the robustness of the evidence, given the low level of certainty. Healthcare providers should focus on the sexual well-being of women with GDM and create tailored interventions to address their specific needs.

Effect of ultrasound-guided individualized positive end-expiratory pressure on the severity of postoperative atelectasis in elderly patients: a randomized controlled study.

Postoperative pulmonary complications (PPCs) are common in patients undergoing general anesthesia, with atelectasis being a key contributor that increases postoperative mortality and prolongs hospitalization. Our research hypothesis is that ultrasound-guided individualized PEEP titration can reduce postoperative atelectasis. This single-center randomized controlled trial recruited elderly patients for laparoscopic surgery. Patients were randomly assigned to two group: the study group (individualized PEEP groups, PEEP Ind group) and the control group (Fixed PEEP group, PEEP 5 group). All patients in these two groups received volume-controlled ventilation during general anesthesia. Patients in the study group were given ultrasound-guided PEEP, while those in the control group were given a fixed 5 cmH2O PEEP. Bedside ultrasound assessed lung ventilation. The primary outcome was the severity of atelectasis within seven days post-surgery. Eighty-nine patients scheduled for elective laparoscopic radical surgery for colorectal cancer were enrolled in our study. Lung ultrasound scores (LUSs) in the study group during postoperative seven days was significantly decreased compared with that in the control group (P < 0.05). The severity of postoperative atelectasis in the study group was significantly improved. The incidence of PPCs during postoperative 7 days in the study group was significantly less than that in the control group (48.6% vs. 77.8%; RR = 0.625; CI = 0.430-0.909; P = 0.01). In elderly patients undergoing laparoscopic radical resection, lung ultrasound-guided individualized PEEP can alleviate the severity of postoperative atelectasis.Clinical trial number and registry URL: No. ChiCTR2200062979 ( https://www.chictr.org.cn ).

Copper‐Catalyzed Regioselective Cyanation/Diarylmethylation of Formamides: Construction of α‐Cyano Functionalized Tetra‐Substituted Olefins

Comprehensive SummaryA copper‐catalyzed cyanation/diarylmethylation of formamides has been developed for the synthesis of α‐cyano functionalized tetra‐substituted olefins by utilizing para‐quinone methides (p‐QMs) and trimethylcyanosilane as functionalization sources. Various kinds of p‐QMs and formamides are well tolerated, delivering the desired products with 72%—94% yields, demonstrating broad functional group tolerance. Notably, the reaction does not require noble metals and proceeds regioselectively under mild conditions. Based on step‐by‐step control experiments, Hammett studies and DFT calculation, a plausible mechanism is proposed.

Visible-Light-Mediated Three-Component Decarboxylative Coupling Reactions for the Synthesis of 4-Alkylpyridines.

4-Alkylation of pyridines has been achieved by a photocatalyzed three-component reaction of an olefin, an aryloxyacetic acid, and cyanopyridine using Ir[dF(CF3)ppy]2(dtbbpy)PF6 as a photocatalyst. In this way, a new type of 4-alkylpyridines bearing aryl and aryloxy substituents on the phenyl was accessed with potential pharmaceutical value. In addition to mild reaction conditions, the method has several other advantages, including a multicomponent one-pot protocol, good functional group tolerance, and easy amplification of the reaction scale. The reaction mechanism has been clarified by control experiments and computation of the reaction energy profile.

Measurement of rRNA Synthesis and Degradation Rates by 3H-Uracil Labeling in Yeast.

In order to measure the actual synthesis and degradation rates (SR, DR) for rRNA in yeast, we developed a method based on the pulse labeling and quantification of newly synthesized large rRNA molecules by a known mass of cells. The SR is calculated as the ratio of new rRNA molecules (synthesized after a short [5,6-3H]-uracil pulse) to total rRNA (a proxy of cell mass), calculated by northern blotting after hybridization with a 32P-labeled rRNA probe. Then to measure the DR we perform a chase of the existing 3H-labeled rRNA for several hours during yeast culture growth. We have used this method in control experiments where the yeast cell volume varies as a way to check if the SR and DR are constant with the cell volume.

Evaluating the clinical potential of bioceramic-rods for revascularization in osteonecrosis of the femoral head: a systematic review.

To evaluate the safety, reliability, and effectiveness of bioceramic rods (BR) in treating osteonecrosis of the femoral head (ONFH), compared with other treatments such as core decompression and autologous bone grafting. Systematic review and meta-analysis. Pubmed, Embase, and CNKI databases from January 2011 to July 2023. Included studies involved patients treated with bioceramic rods. Studies were required to have a follow-up time of more than six months and no statistically significant differences in baseline information between groups in controlled studies. Exclusions included literature reviews, case reports, conference abstracts, animal experiments, and studies without defined success criteria or lacking analysis on factors influencing efficacy. The primary outcome measure was the Harris Hip Score (HHS) improvement rate. Secondary outcomes included the femoral head stability and survival rate, alongside the hip replacement rate. The systematic review revealed significant improvements in symptom relief and functional recovery using BR for the treatment of ONFH. An average follow-up of 20.44 months showed an overall HHS improvement rate of 33.93%. Hip preservation efficacy with BR was superior to core decompression and autologous bone grafting. The overall femoral head survival rate was 84.42%, with results sustained for three years. The success rate of hip preservation was notably higher with early intervention, which showed better outcomes when the overall HHS improvement exceeded 27%, and rates of excellent and good outcomes approached 90%. Bioceramic rods offer a safe, minimally invasive, reliable, and effective treatment option for ONFH, ensuring substantial symptom relief and functional recovery. The technique's success in early disease stages suggests a strong potential for broader clinical adoption. Although additional benefits from combining BR with stem cells, platelet-rich plasma, and traditional Chinese medicine are noted, definitive conclusions on enhanced therapeutic effects remain inconclusive.

"Elucidating the immunomodulatory role of endocannabinoids in intervertebral disc degeneration".

The endocannabinoid system (ECS) has been well-established to play a crucial role in the regulation of several physiological processes as well as many inflammatory disease conditions. However, its role in intervertebral disc degeneration has been least explored. We aim to investigate the immunomodulatory role of endocannabinoids in regulating IVD health. The study population included 20 healthy volunteers (controls) and 40 patients with disc degeneration (disease group) (20 Modic and 20 Non Modic). 16S metagenome sequencing of the V3-V4 region was performed for the DNA extracted from NP tissue samples of both control and disease groups. Sequencing was carried out using the Novaseq 6000 platform using 250bp paired-end chemistry. A global metabolic profile was obtained using the uHPLC system coupled with Q Exactive Plus Hybrid Quadrupole-Orbitrap mass spectrometer. Our study revealed a higher prevalence of gram-negative bacteria, particularly opportunistic pathogens like Pseudomonas, in diseased discs (71-81%) compared to healthy controls (54%). Further investigation using metabolomics identified significant changes in the lipid profiles of diseased discs. We found that the signalling molecules of the ECS, 2-arachidonylglycerol (2-AG) and N-arachidonoylethanolamine (AEA), were significantly lower in diseased discs compared to controls (Log2FC -2.62 for 2-AG and -3.15 for AEA). Conversely, pro-inflammatory metabolites like LTA4, HPETE, HETE, and Prostaglandin G2 were elevated in diseased discs, with a Log2 fold increase greater than 2.5. The study reveals that the endocannabinoid metabolites (2-AG and AEA) of the ECS could be a significant molecule influencing susceptibility to infection and inflammation within the intervertebral discs, which could be a potential target for improving disc health. Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.