Non-surgical Treatment Modalities Research Articles

Effect of pelvic floor muscle training combined with electrical stimulation therapy on stress urinary incontinence: a Meta-analysis.

Introduction SUI is a common pelvic floor dysfunction in middle-aged and elderly women, which has a serious negative impact on the patient's quality of Life (QoL), pelvic floor muscle training (PFMT) and electrical stimulation (ES), as common non-surgical treatment modalities, have been widely used in the management of SUI. However, there is controversy about the effectiveness of the combined application of these two interventions. For this reason, this study evaluated the efficacy of PFMT combined with ES in the treatment of SUI by Meta-analysis. To systematically evaluate the efficacy of PFMT combined with ES in improving urinary incontinence symptoms, increasing pelvic floor muscle strength, enhancing QoL, and improving clinical symptoms, with the aim of providing more adequate evidence to support clinical treatment. Methods A literature search was conducted in PubMed, Embase, Web of Science, and Cochrane Library databases from database construction to October 2024 to include RCTs and case-control studies evaluating PFMT combined with ES for the treatment of SUI. The Cochrane Risk Assessment Tool and NOS were used to assess the quality of the included literature, and effect sizes were calculated by random-effects model and fixed-effects model, and the main outcome indicators included incontinence symptoms, pelvic floor muscle strength, QoL and clinical symptoms. Results Eight studies were ultimately included, with a total sample size of 885 cases. Meta-analysis showed that PFMT combined with ES was significantly better than the control group on all outcome measures. The combined effect size for improvement in urinary incontinence symptoms was OR = 1.42 (95% CI: 1.10, 1.85, P < 0.05), that for pelvic floor muscle strength was OR = 1.55 (95% CI: 1.20, 2.05, P < 0.01), that for QoL improvement was OR = 4.29 (95% CI: 3.68, 4.99, P < 0.0001), and the combined effect size for clinical symptom improvement was OR = 1.35 (95% CI: 1.05, 1.70, P < 0.05). Heterogeneity between studies was low (I² values were less than 40%), indicating a high degree of consistency in the effect of the combination treatment. Conclusion PFMT combined with ES showed significant benefits in improving incontinence symptoms, enhancing pelvic floor muscle strength, boosting QoL and improving clinical symptoms. Future studies should further standardize the intervention parameters and extend the follow-up period to fully assess the long-term effects of the combined treatment.

Evaluating the Relationship Between Gastrointestinal Bleeding and Valvular Heart Disease: A Systematic Review of Clinical Studies

Background: Gastrointestinal angiodysplasia is a significant vascular anomaly characterized by dilated, tortuous blood vessels in the gastrointestinal tract. The current literature extensively documents the association between angiodysplasia and aortic stenosis, known as Heyde syndrome, characterized by the triad of aortic stenosis, GIB, and acquired von Willebrand syndrome. However, other valvular diseases, including mitral and tricuspid regurgitation, have also been implicated. This comprehensive systematic review aims to investigate the spectrum of valvular abnormalities, exploring the intricate mechanisms by which they contribute to gastrointestinal bleeding. Furthermore, it will evaluate the available surgical and nonsurgical treatment modalities, assessing their efficacy in mitigating the incidence of such bleeding. Methods: A comprehensive search of the Pubmed/MEDLINE database was conducted to identify relevant studies to retrieve relevant articles from August 2014 to August 2024. A combination of Medical Subject Heading (MeSH) terms and text words related to cardiac valvular diseases and GIB were used. MeSH terms included “gastrointestinal bleeding”, “heart valve diseases”, “hematochezia”, “heart valve prosthesis”, “bioprosthesis”, “native valve diseases”, and “mechanical valve”. Results: Forty-five papers met the inclusion criteria. Twenty-seven studies covered GIB in aortic valve disease, ten on mitral valve disease, two on tricuspid valve disease, and six on multiple valves. Conclusions: This systematic review demonstrates the association between angiodysplasia and aortic stenosis and highlights mitral regurgitation and tricuspid regurgitation as potential etiologies. Definitive management with valvuloplasty or valve replacement is vital to preventing the onset or recurrence of GIB in patients with valvular disease.

Becoming Active in Beating osteoarthritiS: study protocol of a randomised controlled trial on the effectiveness of an information campaign in improving the management of osteoarthritis and quality of care in general practices in the Netherlands

IntroductionDespite recommendations, non-surgical treatment modalities in knee and/or hip osteoarthritis (KHOA) are underused. An information campaign was developed targeting patients with early stage KHOA and healthcare professionals (HCPs) to optimise...

Lobectomy with Lymph Node Dissection Benefits N3 Stage Non-Small Cell Lung Cancer Patients: A Population-Based Study

Introduction: There remain controversies about the role of surgery for N3 stage non-small cell lung cancer (NSCLC) patients. Methods: N3 stage NSCLC patients were identified from the US National Cancer Institute Surveillance, Epidemiology, and End Results database (2010–2020). Survival analysis and multivariate regression models were used to adjust covariates and analyze factors associated with survival. Propensity score matching was used to balance selection bias. Results: Of 6,473 included patients, 121 received treatment that included lobectomy with mediastinal lymph node dissection. Overall survival (OS) was significantly prolonged in the lobectomy group than in the nonsurgery group (median survival time [MST]: 57 vs. 16 months; log-rank p < 0.001). A total of 403 patients were matched, and OS was significant longer in the lobectomy group (MST: 51 vs. 16 months; log-rank p < 0.001). Multivariate regression analyses indicated that lobectomy was independently associated with improved OS (hazard ratio [HR] 0.398, 95% confidence interval [CI] 0.302–0.526; p < 0.001) and lung cancer-specific death (LCSD) (subhazard ratio [SHR] 0.343, 95% CI: 0.249–0.474; p < 0.001). Conclusion: Compared with nonsurgical treatment modalities, lobectomy with lymph node dissection was associated with improved OS and LCSD in selected N3 stage NSCLC patients.

How safe is high-intensity focused ultrasound? An intriguing solution for obstetric and gynecological diseases: A systematic review.

High-intensity focused ultrasound (HIFU) is a non-surgical and noninvasive treatment modality that depends on external ultrasound energy sources that induce focused mass ablation and protein degeneration in the treatment area via thermal energy penetration under the intact skin. We aim in our study to collectively evaluate the safety of HIFU for the treatment of different obstetric and gynecological diseases in the literature. We searched PubMed, Scopus, and Science Direct databases, without restriction on date or language, from the inception of these databases until January 20, 2024. We also examined the references of the included studies in the Mendeley archive for eligible articles. We found a total of 706 studies. After the screening and selection process, 56 participants were included. Our dichotomous outcomes were pooled in our single-arm meta-analysis as risk ratio (RR) and with 95% confidence interval (CI) while our continuous outcomes were pooled as mean change and 95% CIs. Fixed- or random-effects models were applied depending on the heterogeneity detected. Our systematic review and meta-analysis included 56 studies including 11.740 patients. Depending on the Society of Interventional Radiology (SIR) classification for adverse effects. The results of this meta-analysis for the type A category that did not require clinical intervention found that pain in the treatment site estimated RR with 95% CI: 0.61 (0.33, 0.89), abnormal vaginal discharge 0.16 (0.073, 0.24), low-grade fever (<38 °C) 0.005 (0.002, 0.009). Sensory abnormalities of the lower limbs were examined in 3390 individuals and observed in only 19 patients who experienced gradual relief of symptoms within one month after treatment. Regarding SIR type B, 99 of a total of 6.437 patients had small vesicles and superficial burns with pooled RR and 95% CI: 0.012 (0.007, 0.018). In terms of groin or perianal and lower abdominal pain, our RRs with 95% CIs were 0.1 (0.067, 0.13) and 0.38 (0.25, 0.51). However, vaginal bleeding was detected in only 32 out of a total of 3.017. Major adverse events like lumber disc herniation, thrombocytopenia, and renal failure, were unmentionable. Additionally, our included studies did not record any deaths. HIFU, either alone or in combination with oxytocin or any other enhancing agent, is safe for patients with different gynecological and obstetric diseases. In terms of efficacy, it showed promising results compared with traditional treatment lines. To our knowledge, we are the first and most comprehensive meta-analysis in the literature that has studied the different safety outcomes related to HIFU as a treatment modality for different obstetric and gynecological diseases with a very large sample size, making our evidence strong and less attributed to errors.

Kiteboarding Injuries: Epidemiology, Common Treatment Strategies, and Time to Return to Kiteboarding Following Injury.

To evaluate the prevalence and types of injuries incurred during kiteboarding (1), along with treatment approaches (2). In addition, the time to return to kiteboarding following injury (3) and factors associated with the rate and type of injury were analyzed (4). Recreational kiteboarding. Retrospective cohort. Three hundred twelve kiteboarders (280 men, 32 women, mean age 42.91 ± 13) were included in the study. Age, sex, experience, and the use of protective gear. Kiteboarding experience, injury location, type, incidence, nonsurgical and surgical treatment modalities, and return-to-kiteboarding data. The number of injuries calculated per 1000 sessions was a mean of 7.82 (4.83-10.81). Patients with less than 2 years of kiteboarding experience were at a greater risk of injury than more experienced kiters (P < 0.001). The knee (24.1%), ankle and foot (18.9%), ribs (12.7%), and shoulder (10.2%) were the body parts most frequently injured. Overall, 14.4% of kiters underwent surgical intervention, with knee surgery being the most common site of operation (41.9%) and the most frequently performed procedure being anterior cruciate ligament reconstruction. The pattern of reported injury was found to be different from that previously reported in the scientific literature among freeriding kiters, with knees, ribs, and shoulders being most frequently involved. Participants with <2 years of experience had a significantly greater risk of injury; therefore, proper technical and physical training is advisable.

Pyogenic Granuloma Diagnosis and Management: A Practical Review.

Pyogenic granuloma (PG), or lobular capillary hemangioma, poses a clinical challenge with its uncertain etiology and treatment options. Although the clinical features and prevalence of PGs are well established, definitive evidence-based treatments remain elusive. This practical review aims to illuminate the complexities of PG management by analyzing surgical interventions based on literature analysis. A PubMed/Medline search of "pyogenic granuloma" and "surgery" yielded 1171 studies. Inclusion criteria targeted intervention-associated PG complications over 5% and treatment modalities, excluding nonclinical studies and topics unrelated to plastic and reconstructive surgery. Screening involved Oxford level of evidence, patient data extraction, complications, intervention types, success rates, sessions, follow-ups, and treatments. Thirty-one studies met inclusion criteria. Most studies were retrospective (67.7%). Ten studies satisfied intervention-linked eruptions, primarily oculoplastic, whereas 21 investigated both surgical and nonsurgical treatment modalities. Across interventions, 3579 patients (age: 34.2-85.7 years) were involved. Postsurgical PG complications averaged 15.1% and were treated predominantly with surgical excision, achieving nearly complete resolution. Surgical and nonsurgical treatment studies included 1233 patients (age: 3-46.5 years), demonstrating a 68.2% average resolution after a single session, with surgical excision exhibiting the highest success rate (96.2%) and minimal complications. This practical review highlights the complexities of managing PG, emphasizing a spectrum of effective treatments and potential postoperative complications. Ophthalmologic procedures showed PG incidences of 9%-24.4%. Surgical excision proved highly effective, surpassing methods like lasers and injectables that exhibited varied success rates requiring multiple treatment sessions. Challenges included study diversity and varying evidence levels, warranting further comparative research for PG management strategies.

Evaluation of Folic Acid-Containing Mouthrinse and Chlorhexidine Mouthrinse as an Adjunct to Scaling and Root Planing in Patients With Periodontal Disease.

Periodontal disease is a host-mediated inflammation caused due to microbial challenge. Hence, mechanisms involving the control of host-associated mediators can be a potential target. The conventional nonsurgical periodontal treatment modality includes scaling and root planing(SRP), which is often combined with adjunctive chemical plaque control agents for effective disease control. Chlorhexidine (CHX) is the most common chemical plaque control agent used. Recent research is now being focused on exploring other medicinal substitutes that may benefit control of inflammation and tissue healing. Folic acid is an important nutrient that increases the ability of oral epithelial cells to resist local irritants and inflammation if supplemented either systemically or locally. The current study aimed to evaluate the effect of folic acid and CHX mouthwash as an adjunct to scaling and root planing for treating patients with chronic periodontitis. In this study, 30 patients with chronic periodontitis were included and assigned to either of the two groups: Group A (receiving folic acid-containing mouthrinse) and Group B (receiving CHX mouthrinse). Periodontal measurements, including plaque index, probing pocket depth, gingival index, and healing index, were evaluated at baseline and again four weeks after scaling and root planing. Significant reduction was detected in all clinical parameters (plaque index, gingival index,probing pocket depth, healing index) for both groups (p<0.05) when evaluated from baseline to four weeks. Both mouthrinses were effective when used as an adjunct to scaling and root planing in the treatment of periodontitis. Hence, folic acid-containing mouthrinse can be used in patients with chronic periodontitis.

Advancements in de Quervain Tenosynovitis Management: A Comprehensive Network Meta-Analysis

This study presents a network meta-analysis aimed at evaluating nonsurgical treatment modalities for de Quervain tenosynovitis. The primary objective was to assess the comparative effectiveness of nonsurgical treatment options. The systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Searches were performed in multiple databases, and studies meeting predefined criteria were included. Data extraction, risk of bias assessment, and statistical analysis were carried out to compare treatment modalities. The analysis was categorized into short-term (within six weeks), medium-term (six weeks up to six months), and long-term (one year) follow-up. The analysis included 14 randomized controlled trials encompassing various treatment modalities for de Quervain tenosynovitis. In the short-term, extracorporeal shockwave therapy demonstrated statistically significant improvement in visual analog scale pain scores compared with placebo. Extracorporeal shockwave therapy also ranked highest in the treatment options based on its treatment effects. Corticosteroid injections (CSIs) combined with casting and laser therapy with orthosis showed favorable outcomes. Corticosteroid injection alone, platelet-rich plasma injections alone, acupuncture, and orthosis alone did not significantly differ from placebo in visual analog scale pain score. In the medium-term, extracorporeal shockwave therapy remained the top-ranking option for visual analog scale pain score, followed by CSI with casting. In the long-term (one year), CSI alone and platelet-rich plasma injections demonstrated sustained pain relief. Combining CSI with orthosis also appeared promising when compared with CSI alone. Corticosteroid injection with a short duration of immobilization remains the primary and effective treatment for de Quervain tenosynovitis. Extracorporeal shockwave therapy can be considered a secondary option. Alternative treatment modalities, such as isolated therapeutic injection, should be approached with caution because they did not show substantial benefits over placebo. Therapeutic I.

Demystifying the pink enigma: A succinct overview on the interdental papilla

Abstract Nowadays, the scope of dentistry has extended beyond the realm of functionality to include the elusive domain of esthetics as well. Gingival black triangle (GBT) is a cosmetic aberration caused by the absence of the papilla, resulting in black gaps or exposed embrasures. Loss of interdental papilla is significantly linked to advancing age, periodontal diseases, and orthodontic therapy. The lack of an interdental papilla raises the concerns about phonetics, food accumulation, and plaque deposition, all of which exacerbate the current situation and cause esthetic issues. In dental procedures, replacing the missing interdental papilla is a difficult and unpredictable process. Because of its complicated anatomy and numerous contributing elements, attaining a successful reconstruction is not always assured. This review article discusses the anatomy of interdental papilla, different classifications of interdental papillary loss, the etiology of the GBT, and the currently available nonsurgical and surgical treatment modalities recommended for preservation of interdental papilla and management of interdental papilla loss.

Central Giant Cell Tumour of the Maxillofacial Region: A 10-Year Retrospective Analysis.

Central giant cell tumour (CGCT) accounts for < 7% of all benign tumours of the jaws with various non-surgical and surgical treatment modalities. In this study, the authors perform one of the largest retrospective analysis on central giant cell tumour over a ten-year period. A total of 157 cases of CGCT treated in service hospitals by a single operator were retrospectively analysed in terms of basic demographic data, clinical and radiographic features, surgical intervention protocols, reconstruction modalities and complications. Out of the 157 patients, 70 were male and 87 were female with 97 cases (62%) localised to the maxilla and 60 cases (38%) localised to the mandible. Sixty-three patients presented with facial asymmetry whilst paraesthesia was noted in 20 patients. Radiographically, 105 lesions were multilocular (66%), whereas 52 were unilocular (33%). Out of the 97 maxillary CGCT, subtotal maxillectomy was performed in 60 cases and total maxillectomy without orbital exenteration in 37 cases. Radial forearm free flap reconstruction was done in 65 cases, fibula free flap was done in 15 cases, deep circumflex iliac artery free flap was done in 7 cases and patient-specific implant reconstruction was done in 10 cases. Out of the 60 mandibular CGCT, en block marginal resection was done in 37 cases, segmental resection was done in 13 cases and hemimandibulectomy was done in 10 cases. Fibula free flap was used as the reconstructive option in 20 cases, reconstruction plate was used in 25 cases and patient-specific implant reconstruction was done in 15 cases. Partial flap necrosis was noted in 5 patients (3%) and wound dehiscence in 8 patients (5%) and was managed conservatively. Proper diagnosis and treatment planning is paramount for successful management of central giant cell tumour of the maxillofacial skeleton. In the present study, aggressive resection keeping a 5-mm safety margin was the preferred treatment modality with the reconstruction options ranging from autogenous options like radial forearm, fibula free flap and deep circumflex iliac artery free flap to alloplastic options like reconstruction plates and more recently patient-specific implants (PSIs). Though PSIs with their immediate functional and dental rehabilitation along with decreased patient morbidity mark an exciting and accessible alternate treatment modality with can revolutionise how we treat CGCT, long-term randomised controlled trials comparing autogenous reconstruction and patient-specific implants are needed before PSIs can be considered the primary reconstructive option.

Transcriptomic insights into UTUC: role of inflammatory fibrosis and potential for personalized treatment

BackgroundUpper tract urothelial carcinoma (UTUC) is a rare disease, belonging to the same category of urothelial cancers as bladder cancer (BC). Despite sharing similar non-surgical treatment modalities, UTUC demonstrates a higher metastasis propensity than BC. Furthermore, although both cancers exhibit similar molecular disease emergence mechanisms, sequencing data reveals some differences. Our study investigates the transcriptomic distinctions between UTUC and BC, explores the causes behind UTUC's heightened metastatic tendency, constructs a model for UTUC metastasis and prognosis, and propose personalized treatment strategies for UTUC.MethodsIn our research, we utilized differential gene expression analysis, interaction networks, and Cox regression to explore the enhanced metastatic propensity of UTUC. We formulated and validated a prognostic risk model using diverse techniques, including cell co-culture, reverse transcription quantitative polymerase chain reaction (rt-qPCR), western blotting, and transwell experiments. Our methodological approach also involved survival analysis, risk model construction, and drug screening leveraging the databases of CTRPv2, PRISM and CMap. We used the Masson staining technique for histological assessments. All statistical evaluations were conducted using R software and GraphPad Prism 9, reinforcing the rigorous and comprehensive nature of our research approach.ResultsScreening through inflammatory fibrosis revealed a reduction of extracellular matrix and cell adhesion molecules regulated by proteoglycans in UTUC compared with BC, making UTUC more metastasis-prone. We demonstrated that SDC1, LUM, VEGFA, WNT7B, and TIMP3, are critical in promoting UTUC metastasis. A risk model based on these five molecules can effectively predict the risk of UTUC metastasis and disease-free survival time. Given UTUC's unique molecular mechanisms distinct from BC, we discovered that UTUC patients could better mitigate the issue of poor prognosis associated with UTUC's easy metastasis through tyrosine kinase inhibitors (TKIs) alongside the conventional gemcitabine and cisplatin chemotherapy regimen.ConclusionsThe poor prognosis of UTUC because of its high metastatic propensity is intimately tied to inflammatory fibrosis induced by the accumulation of reactive oxygen species. The biological model constructed using the five molecules SDC1, LUM, VEGFA, WNT7B, and TIMP3 can effectively predict patient prognosis. UTUC patients require specialized treatments in addition to conventional regimens, with TKIs exhibiting significant potential.

Beyond the Scalpel: Advancing Strategic Approaches and Targeted Therapies in Nonexcisable Melanomas.

Melanoma in challenging anatomical locations such as the face, acral surfaces, and mucosal areas presents unique hurdles for surgical excision. This review examines alternative nonsurgical treatment modalities in the context of these complexities, addressing the gaps in current guidelines and the varied efficacy of existing therapies. A comprehensive literature search was conducted using PubMed, Embase, and Web of Science databases. The review focuses on peer-reviewed articles discussing nonsurgical treatment options for melanoma in complex anatomical locations. Articles were screened by three independent researchers, ensuring a broad analysis of topical agents, immunotherapies, radiotherapies, and targeted therapies. The review highlights significant advancements in localized treatments such as imiquimod and intralesional therapy with talimogene laherparepvec (T-VEC), which show promise in managing nonexcisable melanomas. BRAF and MEK inhibitors, as well as checkpoint inhibitors targeting CTLA-4 and PD-1/PD-L1 pathways, demonstrate improved survival rates but pose challenges with resistance and systemic side effects. Radiotherapy serves as an adjunctive strategy due to melanoma's inherent radioresistant properties. Despite advancements, there is a notable absence of comprehensive, evidence-based protocols to guide the treatment of melanoma in these critical areas. This paper underscores the need for standardized treatment guidelines that account for the efficacy, side effects, and psychosocial impacts of therapies. Future research should focus on refining existing treatments and exploring innovative modalities to enhance patient outcomes in the management of nonexcisable melanomas. Comprehensive guidelines and long-term efficacy studies are essential to optimize care and improve the quality of life for patients afflicted with melanoma in challenging anatomical locations.

Efficacy of Levonorgestrel Intrauterine System in the Management of Abnormal Uterine Bleeding: A Retrospective Analysis of a 100 Women.

Abnormal uterine bleeding (AUB) is a common gynaecological complaint affecting around 10-30% women during reproductive years. It adversely affects a woman's life, leading to psychological, medical, social and sexual problems. We aim to study the efficacy of a levonorgestrel intrauterine system (LNG-IUS) in 100 women suffering from AUB. A retrospective study was carried out at a private nursing home in Mumbai over a period of 4years. A total of 100 patients aged 30years to 50years (average age = 42.9years) who underwent LNG-IUS insertion for abnormal uterine bleeding were studied. Cases were evaluated according to clinical findings, hemogram and transvaginal ultrasound. The women were called for follow-up at 1week, 1month, 6months, 1 and 2years to analyse type and amount of bleeding and development of amenorrhea. At the end of 6months, 75% patients experienced decreased menstrual blood loss. Five patients underwent removal of the LNG-IUS at the end of 6months as they experienced no relief of symptoms. At the end of 2years, 95% patients were fully satisfied with the LNG-IUS insertion. A levonorgestrel intrauterine system significantly reduces bleeding in menorrhagia due to benign causes and is found to be highly effective in the management of various gynaecological pathologies such as endometrial polyps, adenomyosis and endometrial hyperplasia when insertion perfomed after dilatation and curettage/polypectomy. It has proven to be superior to various surgical and other non-surgical treatment modalities.

Intralesional 5-fluorouracil as a management for cutaneous squamous cell carcinomas: A rural Australian retrospective case series.

While the gold standard treatment for cutaneous squamous cell carcinomas (cSCCs) is surgical removal, there is a risk of infection, cosmetic and functional deficits. Intralesional 5-fluorouracil (5-FU) has been shown to be a potential non-surgical treatment modality for cSCCs in the literature. The aim was to investigate the safety and feasibility of using intralesional 5-FU to treat cSCCs. A literature review was conducted and a retrospective case series analysed patients who commenced intralesional 5-FU treatment for at least one cSCC between 1 January 2018 and 1 January 2019 at a private clinic in Orange, Australia. Inclusion criteria include: at least one cSCC was treated; only intralesional 5-FU was used; and treatment was ceased due to complete or inadequate remission, or adverse effects. There were 15 patients (7 female, 8 male, 60-99 years) and 20 out 21 cSCC lesions (82.6%) cleared while one lesion (4.3%) recurred. Six lesions (26.1%) ulcerated, four lesions became infected (17.4%) and one patient had an allergic reaction. The average number of treatments required for clearance was four (range 1-35), and the average 5-FU dose used was 75 mg (range 50-150 mg). Across 25 studies, 656 out of 708 lesions cleared (92.66%). Adverse effects were self-limiting and mostly well-tolerated. Intralesional 5-FU is an affordable and non-invasive non-surgical treatment modality that appears feasible to use for cSCCs and has a relatively low treatment-associated morbidity. Future clinical trials can help develop a protocol to guide clinicians in its use.

Pronator Syndrome and other Nerve Compressions that Mimic Carpal Tunnel Syndrome a Case Report and Literature Review

The resolution of small to intermediate-sized anomalies affecting the craniofacial region can pose a formidable problem Proximal neuropathy of the median nerve (MN) is a relatively rare condition, accounting for approximately 1% of all compressive neuropathies affecting the upper limb. The existing body of literature documents two distinct clinical presentations, which are based upon the location of entrapment. These presentations are commonly referred to as pronator teres (PT) syndrome and anterior interosseous nerve (AIN) syndrome. Pronator teres syndrome, also known as median nerve compression in the upper forearm, manifests as a constellation of clinical manifestations and indications. Carpal tunnel syndrome is a dynamic condition that is commonly characterized by the compression of the median nerve within the carpal tunnel. Although relatively uncommon when compared to carpal tunnel syndrome, pronator syndrome and anterior interosseous nerve syndrome are conditions involving compression of the proximal median nerve. These conditions may be considered as potential diagnoses when a patient with carpal tunnel syndrome does not show improvement following conservative or surgical treatment. The process of differential diagnosis primarily relies on the evaluation of symptoms, the analysis of paresthesia patterns, and the identification of distinct patterns of muscle weakness. Initial management of all patients should primarily involve nonsurgical treatment modalities. However, it has been demonstrated through empirical evidence that surgical intervention may produce favorable outcomes. Many surgical methodologies have been established, with the majority of outcome data derived from retrospective case series. A full comprehension of the anatomical structure of the median nerve, possible points of compression, and distinctive clinical manifestations of carpal tunnel syndrome (CTS) is imperative for physicians in order to correctly identify and successfully manage their patients.

Bromelain-based enzymatic burn debridement: A systematic review of clinical studies on patient safety, efficacy and long-term outcomes.

In 2012 the European Medicines Agency approved a pineapple stem-derived Bromelain-based debridement concentrate of proteolytic enzymes (NexoBrid®, MediWound Ltd, Yavne, Israel) for adult deep burns. Over 10 000 patients have been successfully treated with NexoBrid® globally, including in the US. The aim of our study is to perform a systematic review of the current literature on Nexobrid® outcomes. We conducted a literature search in PubMed, Google Scholar, Embase, and other search engines (2013-2023). The online screening process was performed by two independent reviewers with the Covidence tool. The protocol was reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses, and it was registered at the International Prospective Register of Systematic Reviews of the National Institute for Health Research. We identified 103 relevant studies of which 34 were found eligible. The included studies report the positive effects of Nexobrid® on burn debridement, functional and cosmetic outcomes, scarring, and quality of life. Also, they validate the high patient satisfaction thanks to enhanced protocols of analgosedation and/or locoregional anaesthesia during Bromelain-based debridement. Two studies investigate potential risks (coagulopathy, burn wound infection) which concluded there is no strong evidence of these adverse events. NexoBrid® is a safe, selective, non-surgical eschar removal treatment modality. The benefits of Bromelain-based debridement are faster debridement and healing times, reduced operations, length of stay, cases of sepsis, blood transfusions, and prevention of compartment syndrome. Existing evidence suggests that the indications and the role of Bromelain-based debridement are expanding to cover "off-label" cases with significant benefits to the global healthcare economy.

Transarterial chemoembolization for hepatocellular carcinoma: 2023 expert consensus-based practical recommendations of the Korean Liver Cancer Association.

Transarterial chemoembolization (TACE) was introduced in 1977 with the administration of chemotherapeutic agent to gelatin sponge particles through the hepatic artery in patients with hepatocellular carcinoma (HCC) and was established as conventional TACE using Lipiodol in the 1980s. In the 2000s, drug-eluting beads were developed and applied clinically. Currently, TACE is a commonly used non-surgical treatment modality for patients with HCC who are unsuitable for curative treatment. Considering the vital role of TACE in the management of HCC, it is crucial to organize current knowledge and expert opinions regarding patient preparation, procedural techniques, and post-treatment care in TACE, which can enhance therapeutic efficacy and safety. A group of 12 experts in the fields of interventional radiology and hepatology, convened by the Research Committee of the Korean Liver Cancer Association (KLCA), has developed expert consensus-based practical recommendations in TACE. These recommendations have been endorsed by the Korean Society of Interventional Radiology and provide useful information and direction in performing TACE procedure as well as pre- and post- procedural patient care.

Stem Cell Therapy in Critical Limb Ischemia.

Critical limb ischemia (CLI), a serious outcome of peripheral artery disease, is frequently associated with morbid outcomes. The available treatment modalities do not provide satisfactory results, leading to marked morbidities such as joint contracture and amputations, resulting in a high economic burden. The peripheral vascular disease tends to cause more morbidity in patients with diabetes and atherosclerosis, given the pre-existing compromised perfusion of medium and small vessels in diabetic patients. With surgical procedures, the chance of vascular compromise further increases, inducing a significantly greater rate of amputation. Hence, the need for nonsurgical treatment modalities such as stem cell therapy (SCT), which promotes angiogenesis, is warranted. In CLI, SCT acts through neovascularization and the development of collateral arteries, which increases blood supply to the soft tissues of the ischemic limb, providing satisfactory outcomes. An electronic database search was performed in PubMed, SCOPUS, EMBASE, and ScienceDirect to identify published clinical trial data, research studies, and review articles on stem cell therapy in critical limb ischemia. The search resulted in a total of 2391 results. Duplicate articles screening resulted in 565 articles. In-depth screening of abstracts and research titles excluded 520 articles, yielding 45 articles suitable for full-text review. On review of full text, articles with overlapping and similar results were filtered, ending in 25 articles. SCT promotes arteriogenesis, and bone marrow-derived mesenchymal stromal cells produce significant effects like reduced morbidity, improved amputation-free survival (AFS ) rate, and improved distal perfusion even in "no-option" CLI patients. SCT is a promising treatment modality for CLI patients, even in those in whom endovascular and revascularization procedures are impossible. SCT assures a prolonged AFS rate, improved distal perfusion, improved walking distances, reduced amputation rates, and increased survival ratio, and is well-tolerated.

Effect of Microneedling and Injectable Platelet-Rich Fibrin on Gingival Phenotype – A Case Series

Introduction: Gingival phenotype is a crucial determinant of the periodontium. It not only maintains the health of the tissue but also plays a decisive role in the prediction of periodontal treatment outcomes. Thin gingival phenotype poses certain risks of poor periodontal treatment outcome in cases of implant, coronally advanced flap, and other root coverage procedures. Thus it becomes the duty of the clinician to deal with such cases by prior planning treatments which can improve the gingival phenotype and thereby enhancing the postperiodontal treatment outcomes to benefit patients. In this case series, a nonsurgical treatment modality microneedling (MN) and injectable platelet-rich fibrin (i-PRF) are employed in an attempt to increase the thickness of thin gingival phenotype. Methods: Five systemically healthy patients with thin gingival phenotypes were included in this study. The lower anterior teeth with split-mouth study pattern have been randomly allocated to nonsurgical treatment modality, i.e., MN alone and MN along with i-PRF. All the patients were followed up for 9 months. Outcomes Assessed: Gingival thickness (GT), Width of Keratinized Tissue (WKT), oral hygiene index, gingival index (GI), the patient reported outcome measures. Results: Both the groups showed an increase in the thickness of gingiva in 9-month follow-up. The mean increase of 0.62 mm in thickness was seen in Group 1 (42%), whereas Group 2 showed a 0.34 mm (27.3%) of increment. No difference is seen with respect to the change in the width of keratinized gingiva in both groups. Conclusion: MN along with i-PRF can provide an efficient nonsurgical option to clinicians to increase GT in cases of thin gingival phenotype.