Current Concepts Research Articles

Modern Approaches to the Treatment of Acute Facial Pain.

Acute facial pain presents a complex challenge in medical practice, requiring a comprehensive and interdisciplinary approach to its management. This narrative review explores the contemporary landscape of treating acute facial pain, delving into pharmacological, non-pharmacological, and advanced interventions. The significance of tailored treatment strategies, rooted in the diverse etiologies of facial pain, such as dental infections, trigeminal neuralgia, temporomandibular joint disorders, sinusitis, or neurological conditions like migraines or cluster headaches, is underscored. We particularly emphasize recent advances in treating trigeminal neuralgia, elucidating current treatment concepts in managing this particular acute facial pain. Recent research sheds light on various treatment modalities for acute facial pain. Pharmacotherapy ranges from traditional NSAIDs and analgesics to anticonvulsants and antidepressants. Non-pharmacological interventions, including physical therapy and psychological approaches, play pivotal roles. Advanced interventions, such as nerve blocks and surgical procedures, are considered in cases of treatment resistance. Moreover, we explore innovative technologies like neuromodulation techniques and personalized medicine, offering promising avenues for optimizing treatment outcomes in acute facial pain management. Modern management of acute facial pain requires a nuanced and patient-centric approach. Tailoring treatment strategies to the individual's underlying condition is paramount. While pharmacotherapy remains a cornerstone, the integration of non-pharmacological interventions is essential for comprehensive care. Advanced interventions should be reserved for cases where conservative measures prove inadequate. Furthermore, leveraging innovative technologies and personalized medicine holds promise for enhancing treatment efficacy. Ultimately, a holistic approach that considers the diverse needs of patients is crucial for effectively addressing acute facial pain.

Current concept: personalized alignment total knee arthroplasty as a contrast to classical mechanical alignment total knee arthroplasty

Mechanical alignment (MA) total knee arthroplasty (TKA), with neutral leg alignment, mechanical component alignment, and parallel gaps, has achieved good long-term survival. Patient satisfaction, however, is not always perfect. In contrast to the MA, which aims for an ideal goal for all patients, an alternative has been proposed: kinematic alignment (KA)-TKA. In KA, the articular surface is replicated using components aligning with the three kinematic axes. KA-TKA has been gaining popularity, and in addition to the true or calipered KA, various derivatives, such as restricted KA, soft-tissue respecting KA, and functional alignments, have been introduced. Moreover, the functional approach encompasses several sub-approaches. This somewhat complicated scenario has led to some confusion. Therefore, the terminology needs to be re-organized. The term “personalized alignment (PA)” has been used in contrast to the MA approach, including all approaches other than MA. The term “PA-TKA” should be used comprehensively instead of KA and it represents the recent trends in distinct and unique consideration of each individual case. In addition to a comparison between MA and KA, we suggest that evaluation should be conducted to decide which approach is the best for an individual patient within the “personalized alignment” concept.

An integrative approach highlights the discrepancy in the genetic, phenotypic, and presumptive taxonomic structure of Phoxinus (Actinopterygii, Leuciscidae, Phoxininae) in Bulgaria.

The present drainage network of Bulgaria is the result of a complex Neogene and Quaternary evolution. Karst, which has developed on 23% of the territory, further complicates the hydrological pattern. Fresh waters of Bulgaria drain into the Black Sea and the Aegean Sea basins and can be roughly divided into the Danube (Middle and Lower Danube), non-Danube Black Sea, East Aegean, and West Aegean hydrological regions. Phoxinus, a small leuciscid fish, has a mosaic distribution in all four of these regions, inhabiting small mountainous and semi-mountainous streams. Based on morphology, it was identified as three species, Phoxinus phoxinus in the Danube, Phoxinus strandjae in the non-Danube, and Phoxinus strymonicus in West Aegean region. Later, molecular data revealed Phoxinus csikii and Phoxinus lumaireul in the Middle Danube and P. csikii in the Lower Danube. Phoxinus has been the focus of many studies, showing a high molecular and morphological diversity, which is not entirely consistent with previous morphology-only-based taxonomic concepts. In this study, molecular (a mitochondrial marker and a nuclear marker) and morphological data from both historical and recently sampled collections were analysed to assess the applicability of the integrative approach in Phoxinus. The results showed a significant influence of the complex paleo- and recent hydrology on the currently observed genetic structure of the considered populations and species. Furthermore, the study also demonstrated a strong influence of phenotypic plasticity on the morphological analysis of Phoxinus and the lack of a clear differentiation between P. csikii and P. strandjae. A barcoded specimen was designated as neotype to fix the species named P. strandjae in the current taxonomic concept. Finally, a significant discordance between genetically delimited clades and phenotypic groups did not allow a proper delineation of the species distributed in Bulgaria, demonstrating that more molecular markers are needed for further taxonomic study of the Phoxinus complex.

Practical training using BEWE aimed at improving the diagnosis ability of erosive tooth wear for dental students-A randomized trial.

Erosive tooth wear (ETW) has been gaining attention due to its high prevalence. However, ETW clinical diagnosis is difficult and may go unnoticed by many professionals. The present study aimed to develop, implement and evaluate a theoretical-practical training using active methodologies in the development of undergraduate students' skills for the diagnosis of ETW compared to the traditional teaching method. This randomized controlled study involved two parallel groups: control group (n = 22), with learning based only on theoretical content and test group (n = 24), learning by theoretical-practical activity mediated by monitors/tutors. The theoretical class covered the current concepts of ETW, aetiology, diagnosis, use of the BEWE index, prevention and treatment. The practical training included exercises and discussions based on the diagnosis using BEWE scores of a collection of images and extracted teeth. To evaluate the efficacy of the teaching-learning methods, a theoretical multiple-choice questionnaire and a practical test using images and extracted teeth were applied. The outcome was the number of correct answers. Groups were compared by Mann-Whitney (theoretical knowledge) and T tests (practical ability in diagnosis) (p < .05). There was no significant difference between groups in the theoretical evaluation (p = .866). The test group showed higher ability to diagnose ETW lesions compared to the control group in the practical tests (p = .001). The performance of ETW diagnosis was similar when images were used in comparison to extracted teeth (p = .570). The practical activity associated with theoretical classes can be a promising strategy to improve the development of undergraduate students' skills in the diagnosis of ETW.

Differential diagnosis and treatment of enthesopathies

The article provides a review of the literature on the pathology of the periarticular structure of the enthesis - the site of attachment of a tendon or ligament to the bone. The anatomical and functional features of the fibrocartilaginous enthesis are presented in detail from the position of the “enthesis organ”, which includes the enthesis and the adjacent synovial membrane, bursae and adipose tissue. The issues of the occurrence of degenerative changes against the background of mechanical stress and inflammatory rheumatic pathological processes in the above structural and functional anatomical unit are analyzed. The anatomical zones whose entheses are most often affected are given. The terminology of degenerative and inflammatory lesions of the enthesis is considered, including from the standpoint of ICD-10 codes. The advantages and disadvantages of modern terms are discussed, current concepts corresponding to the etiology of the pathological process are proposed: degenerative-dystrophic or traumatic enthesopathy and inflammatory enthesitis. This division of concepts is aimed at adopting the correct diagnostic and treatment tactics for a doctor of any specialization. The differential diagnosis of these nosologies and approaches to conservative treatment are considered. The possibilities of local injection therapy for enthesitis and enthesopathies, the use of  anti-inflammatory and reparative techniques are discussed in detail. Based on our own clinical experience, the features of the treatment of various enthesopathies with glucocorticoids, autologous plasma, microinductive collagen, linear hyaluronates and polynucleotides are considered. Issues of priority methods in different clinical situations and the possibility of prolonging the therapeutic effect, as well as a combination of local and non-drug methods, were discussed. The tactics for ineffective local treatment, methods for correcting therapy and the choice of a leading specialist for various pathologies are discussed.

Emerging Concepts of Mechanisms Controlling Cardiac Tension: Focus on Familial Dilated Cardiomyopathy (DCM) and Sarcomere-Directed Therapies

Novel therapies for the treatment of familial dilated cardiomyopathy (DCM) are lacking. Shaping research directions to clinical needs is critical. Triggers for the progression of the disorder commonly occur due to specific gene variants that affect the production of sarcomeric/cytoskeletal proteins. Generally, these variants cause a decrease in tension by the myofilaments, resulting in signaling abnormalities within the micro-environment, which over time result in structural and functional maladaptations, leading to heart failure (HF). Current concepts support the hypothesis that the mutant sarcomere proteins induce a causal depression in the tension-time integral (TTI) of linear preparations of cardiac muscle. However, molecular mechanisms underlying tension generation particularly concerning mutant proteins and their impact on sarcomere molecular signaling are currently controversial. Thus, there is a need for clarification as to how mutant proteins affect sarcomere molecular signaling in the etiology and progression of DCM. A main topic in this controversy is the control of the number of tension-generating myosin heads reacting with the thin filament. One line of investigation proposes that this number is determined by changes in the ratio of myosin heads in a sequestered super-relaxed state (SRX) or in a disordered relaxed state (DRX) poised for force generation upon the Ca2+ activation of the thin filament. Contrasting evidence from nanometer–micrometer-scale X-ray diffraction in intact trabeculae indicates that the SRX/DRX states may have a lesser role. Instead, the proposal is that myosin heads are in a basal OFF state in relaxation then transfer to an ON state through a mechano-sensing mechanism induced during early thin filament activation and increasing thick filament strain. Recent evidence about the modulation of these mechanisms by protein phosphorylation has also introduced a need for reconsidering the control of tension. We discuss these mechanisms that lead to different ideas related to how tension is disturbed by levels of mutant sarcomere proteins linked to the expression of gene variants in the complex landscape of DCM. Resolving the various mechanisms and incorporating them into a unified concept is crucial for gaining a comprehensive understanding of DCM. This deeper understanding is not only important for diagnosis and treatment strategies with small molecules, but also for understanding the reciprocal signaling processes that occur between cardiac myocytes and their micro-environment. By unraveling these complexities, we can pave the way for improved therapeutic interventions for managing DCM.

Post-traumatic proximal radioulnar synostosis: current concepts on the clinical presentations, classifications and open surgical approaches

In the forearm, post-traumatic heterotopic ossification usually forms as a proximal radioulnar synostosis. It can occur after soft tissue injury involving the interosseous membrane or after surgery involving the radio and ulna, like distal biceps tendon repair. It can also be induced by radial head dislocation or fracture. Screening radiography can be used to select the appropriate time for excision. The synostosis can be resected when the ectopic bone margin and trabeculation appear mature on x-rays. An interval of 6-12 months from the injury is generally recommended based on ectopic bone maturity. Selection of the surgical approach depends on: site, extension (elbow joint or proximal radioulnar joint, severity of the initial articular surface and periarticular tissue injury. The posterolateral approach is indicated for synostoses: at or distal to the bicipital tuberosity, at the level of the radial head and proximal radioulnar joint. The posterior global approach is recommended when the forearm synostosis is associated with complete bony ankylosis of the elbow involving the distal aspect of the humerus. After surgical resection of a proximal radioulnar synostosis, the exposed bone surfaces can be covered with interposition material to minimize recurrence

Current Concepts and Recent Updates of Optical Biometry- A Comprehensive Review.

One of the most recent advancements in the field of cataract surgery is optical biometry. With the advent of optical biometry ocular measurements are now simpler, quicker, and more precise. The devices have made intraocular lens (IOL) power calculations easier in difficult situations too, such as in cases with extremes of axial lengths, silicone filled eyes, cataract surgery in post-keratoplasty eyes, post Laser-Assisted in Situ Keratomileusis (LASIK) eyes, etc. The gold standard for IOL power calculation in the present day is by the use of optical biometry devices. The anatomical measurements by these devices are highly precise and because of these measurements and the incorporation of various IOL power calculation formulas the optical biometry devices give the accurate power and the post-operative visual outcome is highly satisfactory among the patients. The growing use of these devices has made cataract the most commonly performed refractive surgical procedure nowadays. In the current scenario, optical biometry has widespread acceptance in almost all countries and has many advantages over ultrasound or immersion biometry. Cataract surgeons can obtain easy and reliable measurements from these devices. Refractive surprises have also decreased considerably with their use. This article will comprehensively review the principles of the various optical biometry devices, the parameters used in each of the devices, the advantages and disadvantages, and add more like what all this article will add.

Current concept of hip arthroscopy in patients with osteoarthritis: is it effective as a hip preservation surgery?

Current concept of hip arthroscopy in patients with osteoarthritis: is it effective as a hip preservation surgery?

Deep learning-Assisted Monitoring of Trastuzumab Efficacy in HER2-Overexpressing Breast Cancer via SERS Immunoassays of Tumor-Derived Urinary Exosomal Biomarkers

Monitoring drug efficacy is significant in the current concept of companion diagnostics in metastatic breast cancer. Trastuzumab, a drug targeting human epidermal growth factor receptor 2 (HER2), is an effective treatment for metastatic breast cancer. However, some patients develop resistance to this therapy; therefore, monitoring its efficacy is essential. Here, we describe a deep learning-assisted monitoring of trastuzumab efficacy based on a surface-enhanced Raman spectroscopy (SERS) immunoassay against HER2-overexpressing mouse urinary exosomes. Individual Raman reporters bearing the desired SERS tag and exosome capture substrate were prepared for the SERS immunoassay; SERS tag signals were collected to prepare deep learning training data. Using this deep learning algorithm, various complicated mixtures of SERS tags were successfully quantified and classified. Exosomal antigen levels of five types of cell-derived exosomes were determined using SERS-deep learning analysis and compared with those obtained via quantitative reverse transcription polymerase chain reaction and western blot analysis. Finally, drug efficacy was monitored via SERS-deep learning analysis using urinary exosomes from trastuzumab-treated mice. Use of this monitoring system should allow proactive responses to any treatment-resistant issues.

Managing Periodontitis with Host Modulation Therapy: Current Concept and Future Perspective

Managing Periodontitis with Host Modulation Therapy: Current Concept and Future Perspective

Root Canal Treatment: A Bibliometric Analysis

Introduction: Root canal treatment is a cornerstone in contemporary endodontic therapy. Bibliometric analyses allow comparisons among countries, institutions, or academic schools of thought. Scientific communication can be examined from a broad perspective. Objective: This comprehensive article aims to elucidate the historical evolution, current concepts, and emerging trends in root canal treatment. Materials and Methods: The Web of Science database was utilized in our research. The analysis ultimately incorporated 5,018 articles. The Bibliometrix software was employed to analyze the data obtained. Our examination of 5,018 articles was divided into four segments: performance analysis, word analysis, thematic analysis, and collaboration network analysis. Results: The peak of annual scientific production was reached in 2023 with 547 articles, while the highest annual average citation count was achieved in 2006 with 3.7 citations per article. India, the USA, and China are prominent in single-country publications, while the USA, Brazil, and China stand out in multi-country publications. Conclusion: Based on the data about the research at hand, the literature surrounding RCT is expansive and continually growing, featuring contributions on an international scale and incorporating a diverse array of document types.

Folk Concepts and the Effective Regulation of New Technologies

One argument that is at times adduced against proposals for legal change, such as granting personhood to autonomous agents, is that the change in question will be inefficacious if it takes the law too far from the folk world of people. By contrast, in this article we argue that legal concepts and folk concepts are more malleable than we tend to assume. We turn to (legal) history to demonstrate that the relationship between legal concepts and folk concepts is not one-directional, which means that changes in the law can and have influenced folk psychology as well as vice versa. This has implications for debates around the regulation of new technologies: the ‘lack of efficacy’ argument is not a strong one and mere reference to current folk concepts cannot suffice in such debates. Moreover, the efficacy argument does not, and cannot, replace normative arguments in this respect, so the malleability of folk concepts needs to be considered by legal decision-makers. Current conceptual apparatuses (legal or folk) are not immutable, and reification of the current status quo should not be presupposed.

Hyperbaric Oxygen in Otorhinolaryngology: Current Concepts in Management and Therapy

Background: In otorhinolaryngology and head and neck surgery, oxygen is a therapeutic tool used for various pathologies. Oxidative stress is the imbalance between the production of free radicals (ROS) and the antioxidant capacity of the body, which can represent the pathogenesis of several pathologies or contribute to their worsening. This narrative review aims to analyze the benefits, indications, and side effects of hyperbaric oxygen therapy (HBOT) in different head and neck disorders. Methods: The search was carried out on multiple electronic databases such as PubMed and Google Scholar, and prospective, randomized, and reviewed studies were analyzed from January 1982 to February 2024. Results and Conclusions: The most common tools used to manage oxidative stress in the ear, nose, and throat (ENT) field are continuous positive airway pressure (CPAP) and HBOT. A common ENT pathology, while the latter can be used for osteoradionecrosis treatment in head and neck cancer patients, infections, malignant external otitis, head and neck reconstruction, facial cosmetic surgery, and among patients with sudden sensorineural hearing loss. From our analysis, it emerged that HBOT is a currently used effective therapy in various ENT pathologies’ treatment, alone or in association with other treatments; it can guarantee functional recovery and healing depending on the type of pathology for which it is used and on its severity.

Endometriosis, a common but enigmatic disease with many faces: current concept of pathophysiology, and diagnostic strategy.

Endometriosis is a benign, common, but controversial disease due to its enigmatic etiopathogenesis and biological behavior. Recent studies suggest multiple genetic, and environmental factors may affect its onset and development. Genomic analysis revealed the presence of cancer-associated gene mutations, which may reflect the neoplastic aspect of endometriosis. The management has changed dramatically with the development of fertility-preserving, minimally invasive therapies. Diagnostic strategies based on these recent basic and clinical findings are reviewed. With a focus on the presentation of clinical cases, we discuss the imaging manifestations of endometriomas, deep endometriosis, less common site and rare site endometriosis, various complications, endometriosis-associated tumor-like lesions, and malignant transformation, with pathophysiologic conditions.

Food protein-induced enterocolitis syndrome in adults: review and practice recommendations

Food protein-induced enterocolitis syndrome (FPIES) is an allergic disorder that manifests as reproducible gastrointestinal symptoms within hours of ingestion of the causative food, which can progress to dehydration and hypotension. Historically, FPIES has been recognized as a disease affecting the pediatric population but it can also develop de novo in adults. The pathophysiology is not well understood; however, the local adaptive immune system and gene expression linked to innate immune activation are implicated. Adult-onset FPIES has some differences with pediatric FPIES. Vomiting may be absent, while abdominal pain is the most common manifestation. A clear predominance in women occurs, being seafood the most common trigger, although many other foods have also been implicated. Diagnosis of adult-onset FPIES is based on a thorough clinical history but in many cases, it should be followed by an oral food challenge (OFC), due to the absence of vomiting in some patients and the lack of confirmatory diagnostic test. The first-line treatment for acute FPIES reactions is fluid replacement, by the oral route in mild to moderate reactions or via the intravenous route in severe reactions. Ondansetron may be effective in shortening the duration of emesis. Management of patients after diagnosis includes dietary advice and follow-up with supervised OFC at regular intervals to monitor for resolution. Tolerance to the trigger food in children is commonly achieved, a finding not so common in adult-onset FPIES. The aim of this article is to review the most important current concepts in epidemiology, pathophysiology, diagnosis, and management of FPIES.

The Tibial Tuberosity–Trochlear Groove Distance Can either Increase or Decrease during Adolescent Growth

Increased Tibial Tuberosity–Trochlear Groove (TT-TG) distance is a risk factor for recurrent lateral patella dislocations (RLPD). Population-based cross-sectional studies on healthy subjects demonstrate that the TT-TG increases gradually during growth until skeletal maturity, but changes in the TT-TG distance during adolescence in patients with RLPD on an individual basis have not been previously investigated. This study aimed to measure changes in TT-TG distance during skeletal maturity. The TT-TG of 13 consecutive patients with open physes (mean age 13 years) with RLPD was measured on MRI at baseline and three years later. The change in TT-TG distance over the three-year period was measured. The mean change in TT-TG distance from the baseline to the three-year follow-up increased overall (2.9 mm, 95% Confidence Interval (CI) 2.1–3.7). However, the TT-TG distance could either increase or decrease during final growth. Our results suggest that the TT-TG distance in patients suffering from RLPD may either decrease or increase individually during the growth spurt. This contradicts the current concept that the TT-TG distance increases gradually during growth.

Primary Management of Operable Locally Advanced Oral Cavity Squamous Cell Carcinoma: Current Concepts and Strategies.

Locally advanced oral cavity carcinoma (LAOCSCC) is primarily treated with surgery followed by radiotherapy with or without chemotherapy. A review of literature using PubMED was performed for studies reporting the management of LAOCSCC. Based on the reviewed literature and opinions of experts in the field, recommendations were made. Studies have shown that outcomes following resection of T4a and infranotch (inferior to mandibular notch) T4b are comparable. We discuss the concept of compartmental resection of LAOCSCC and issues concerning the management of the neck. Further, patients who refuse or are unable to undergo surgery can be treated with chemoradiotherapy with uncertain outcomes. The role of neoadjuvant chemotherapy has shown promise for organ (mandibular) preservation in a select subset of patients. The management strategy for LAOCSCC should be determined in a multidisciplinary setting with emphasis on tumor control, functional preservation, and quality of life of the patient.

The role of patient-reported outcomes in peripheral nerve surgery.

Measuring the outcome of peripheral nerve surgery is challenging because of the spectrum of functional impairment is dependent on the level and severity of the lesion. There are no nerve-specific patient-reported outcome measures, and no universally accepted outcome measurement both in terms of the parameters to be assessed and the methods and timing of the assessment. Nevertheless, the use of patient-reported outcome measures is fundamental to better understand the needs and expectations of patients, to take advantage of all treatment opportunities to offer the best possible support to these patients. This paper outlines current concepts in the measurement of outcome in peripheral nerve surgery.

Whole-body cryotherapy in orthopaedics: current concepts

Whole-body cryotherapy in orthopaedics: current concepts