Successful Clinical Outcome Research Articles

Leveraging mathematical modeling framework to guide regimen strategy for phage therapy

Bacteriophage (phage) cocktail therapy has been relied upon more and more to treat antibiotic-resistant infections. Understanding of the complex kinetics between phages, target bacteria, and the emergence of phage resistance remain hurdles to successful clinical outcomes. Building upon previous mathematical concepts, we develop biologically-motivated nonlinear ordinary differential equation models to explore single, cocktail, and sequential phage treatment modalities. While the optimal pairwise phage treatment strategy was the double simultaneous administration of two highly potent and asymmetrically binding phage strains, it appears unable to prevent the evolution of resistance. This treatment regimen did have a greater lysis efficiency, promoted higher phage population sizes, reduced bacterial density the most, and suppressed the evolution of resistance the longest compared to all other treatments strategies tested. Conversely, the combination of phages with polar potencies allows the more efficiently replicating phages to monopolize susceptible host cells, thereby quickly negating the intended compounding effect of cocktails. Together, we demonstrate that a biologically-motivated modeling-based framework can be leveraged to quantify the effects of each phage’s properties to more precisely predict treatment responses.

Time to successful outcome vs. treatment duration in cranial remolding orthosis treatment.

Cranial remolding orthoses are an effective treatment of deformational plagiocephaly. Typical treatment durations are well documented. However, treatment duration can be affected by multiple factors and may not be a true representation of the time necessary to achieve a successful clinical outcome. This study compared the time to achieve a successful clinical outcome against the total treatment duration for cranial remolding orthosis therapy in infants with deformational plagiocephaly. This is a retrospective study of infants treated for deformational plagiocephaly with a cranial remolding orthosis. A total of 300 infants with deformational plagiocephaly who were treated with a cranial remolding orthosis were grouped by corrected age at initiation of treatment and by severity of deformity. A successful outcome was defined as achieving a final cranial vault asymmetry of 5 mm or less. For the 226 infants who achieved a successful outcome, time to successful outcome and treatment duration were compared between the groups. The time to successful outcome depended on severity but not on age at initiation. The median time to successful outcome ranged from 6 weeks to 17.5 weeks, depending on the severity of the deformity. Time to successful outcome was significantly shorter than treatment duration for infants with an initial cranial vault asymmetry of less than 17 mm. Current treatment durations for infants with moderate plagiocephaly may be longer than necessary. Estimated treatment time lines should be based on the initial severity of the infant's deformity.

One-Step Cartilage Repair of Full-Thickness Knee Chondral Lesions Using a Hyaluronic Acid-Based Scaffold Embedded With Bone Marrow Aspirate Concentrate: Long-term Outcomes After Mean Follow-up Duration of 14 Years.

One-step cell-based techniques of cartilage repair that lead to restoration of durable chondral tissue and long-term maintenance of joint function are cost-effective and ideal for routine use. To examine the long-term clinical outcomes, after a mean follow-up duration of 14 years, of cartilage repair in the knee using a hyaluronic acid-based scaffold in association with bone marrow aspirate concentrate (HA-BMAC) and to evaluate the effect of age, lesion characteristics, and associated treatments on the outcome of this cartilage repair method. Case series; Level of evidence, 4. Patients were followed prospectively for a mean duration of 14.0 years after undergoing treatment of knee full-thickness articular cartilage injury using HA-BMAC. Clinical evaluation consisted of the patient-reported scoring tools of the visual analog scale and the Knee injury and Osteoarthritis Outcome Score, which were completed preoperatively and at the time of final follow-up. A total of 26 patients with a mean age of 48.3 years (17 male, 9 female) and median chondral lesion size of 6.6 cm2 (range, 1-27 cm2) were followed prospectively. There were 3 treatment failures, and 1 patient who underwent medial compartment unicompartmental arthroplasty 12 years after HA-BMAC treatment of patellar chondral injury. Of the 22 remaining patients, after a mean final follow-up duration of 14.0 years (range, 12-16 years), the median visual analog scale score of 0.6 was significantly decreased from the preoperative median score of 5.0 (P < .001). The median Knee injury and Osteoarthritis Outcome Score Pain (92), Symptoms (86), Activities of Daily Living (96), Sports (85), and Quality of Life (88) subscale values were all increased compared with the preoperative scores (P≤ .001). There was no correlation of clinical outcome score and body mass index. One-step cartilage repair of full-thickness chondral defects in the knee using an HA-BMAC led to successful long-term clinical outcomes and maintenance of joint junction after a mean follow-up duration of 14 years. Long-term clinical success in active, nonobese patients has been uniformly demonstrated across a wide range of patient ages and lesion types, including cases of multicompartment involvement, treatment of associated conditions, and large or bipolar chondral lesions.

A keep-it-simple embolisation approach to treat pelvic congestion syndrome without compromising clinical effectiveness.

There are two approaches to treating pelvic congestion syndrome (PCS): (i) the keep-it-simple (KIS) approach, which involves embolising only the refluxing vein(s), typically the left ovarian vein (LOV) unless the right ovarian vein (ROV) or left/right internal iliac vein (IIV) tributaries are also refluxing; and (ii) the extensive (EXT) approach, which empirically embolises almost all of the LOV, ROV, and left and right IIV tributaries. The aim of this study is to determine whether the KIS approach can effectively treat PCS while minimising the number of treated veins and coils used, without the need for injecting sclerosing agents into pelvic veins or the use of occlusion balloons. This is a single-institution retrospective cohort study. Our records identified 154 women who underwent venograms for possible PCS, with the intent to proceed with embolisation. Refluxing veins were treated using the KIS approach, deploying minimal number of coils, 'sandwiching' sclerosing foam. Short-term follow-up was conducted at 6 weeks; long-term follow-ups (between 12 and 60 months) were conducted via an electronic survey consisting of 19 questions assessing pelvic pain/pressure, leg and back pain, fatigue, and bladder and menstrual symptoms. Fifteen women had negative venogram; 139 women had one or more refluxing veins on venogram. Most women (73%) required unilateral ovarian vein (OV) embolisation, 14% required bilateral OV embolisation, and 12% underwent pelvic vein embolisation. Most cases required only four pushable coils. Clinical success was 89% at 6 weeks and 84% at 1-5 years. A visual analogue scale reduction of 5.2 points (from 7.8 to 2.7) was achieved. There were no instances of coil dislodgement or other complications. The keep-it-simple approach, embolising only the refluxing ovarian and/or iliac veins, can achieve a successful clinical outcome for pelvic congestion syndrome. The extensive approach of empirically embolising all ovarian veins and internal iliac veins may not be necessary. This carries implications for potential savings in procedure time, cost and radiation dose.

Influence of Stroke-Onset Location on the Efficacy of Endovascular Thrombectomy: Comparison of Outcomes between In-Hospital versus Community-Onset Strokes.

Previous studies have suggested that patients experiencing an in-hospital stroke may face delays in treatment and worse outcomes compared with patients with community-onset strokes. However, most studies occurred when IV thrombolysis was the primary treatment. This study aimed to examine the outcomes of patients experiencing an in-hospital stroke in the endovascular thrombectomy era. This was a single-center retrospective cohort study of patients older than 18 years of age with acute ischemic stroke treated with endovascular thrombectomy within 12 hours of stroke onset from January 1, 2015, to April 30, 2021. Patients were classified into 2 groups: in-hospital strokes and community-onset strokes. We compared the time metrics of stroke care delivery, the rate of successful reperfusion, and functional outcome as scored using the mRS score at 90 days (favorable outcome was defined as mRS 0-2). Differences in proportions were assessed using the Fisher exact and χ2 tests as appropriate. For continuous variables, differences in medians between groups were evaluated using Mann-Whitney U tests. A total of 676 consecutive patients were included, with 69 (10%) comprising the in-hospital stroke group. Patients experiencing in-hospital stroke were more likely to have diabetes (36% versus 18%, P = .02) and less likely to receive thrombolysis (25% versus 68%, P < .001) than those in the community-onset stroke group, but they were otherwise similar. Patients with in-hospital stroke had significantly faster overall time metrics, most notably from stroke recognition to imaging (median, 70 [interquartile range, 38-141] minutes versus 121 [74-228] minutes, P < .001). Successful recanalization was achieved in >75% in both groups (P = .39), with a median NIHSS score at discharge of <4 (P = .18). The 90-day mRS was similar in both groups, with a trend toward higher in-hospital mortality in the in-hospital stroke group (P = .06). Patients with in-hospital stroke had shorter workflow delays to initiation of endovascular thrombectomy compared with their community counterparts but with a similar rate of successful recanalization and clinical outcomes. Most important, 90-day mortality and mRS scores were equivalent between in-hospital stroke and community-onset stroke groups.

Analysis on Syndrome and Treatment of Shaoyin Cold Type Acute Tonsillitis

Acute tonsillitis belongs to the category of &amp;quot;milk moth&amp;quot; in traditional Chinese medicine. TCM clinical syndrome differentiation is often divided into two types: wind-heat pathogens affecting the lung meridian and dietary excess leading to heat accumulation in the lungs and stomach. The author&amp;apos;s clinical practice found that some acute tonsillitis patients are often manifested as Shaoyin cold type, and the syndrome and treatment of general acute tonsillitis are totally different. &amp;quot;Throat Science Family Instructions&amp;quot; put forward the specific treatment of pharyngeal pain is Shaoyin typhoid type, and the prescription is Banxia Gangui Decoction, which is composed of eight kinds of drugs: Guizhi, Banxia, Fuling, Jiegeng, Yiyiren, Buguzhi, Ganjiang, and Zexie. It is traditionally used to treat symptoms such as sore throat, diarrhea, deep and thin pulse, and white tongue coating without thirst. Combining theory and clinical experience, the author reports successful clinical outcomes using this decoction to treat acute tonsillitis of the Shaoyin cold type. This paper aims to analyze the internal connection between Banxia Gangui Decoction and Shaoyin cold type acute tonsillitis. The paper outlines the symptom characteristics, etiology and pathogenesis, treatment based on syndrome differentiation, differential diagnosis of this condition, along with the therapeutic rationale for Banxia Gangui Decoction. A case study is included.

Borderline Hip Dysplasia - Best Treated with Hip Arthroscopy or Periacetabular Osteotomy?

As the field of hip preservation evolves, the diagnosis of borderline dysplasia (defined as a lateral center edge angle between 18°-25°) has shown itself to be one of the more challenging diagnoses to treat. As the nuances of acetabular coverage have come to light, the question of whether borderline hip dysplasia is best treated with isolated hip arthroscopy, periacetabular osteotomy, or whether a combined procedure is best, is now top of mind. The goal of these procedures is to not only improve patient symptoms, but to correct underlying pathology and ideally slow the development of hip osteoarthritis. The purpose of this review is to summarize the recent literature and clinical findings regarding both isolated hip arthroscopy and periacetabular osteotomy in the surgical management of borderline hip dysplasia. Current research demonstrates improved postoperative clinical outcome scores for both patients who had isolated hip arthroscopy in the setting of borderline hip dysplasia and for those patients who underwent periacetabular osteotomy. Mid-term outcomes for patients in both groups have showed low rates of conversion to total hip arthroplasty. No gold standard in the surgical management of borderline hip arthroscopy exists. Improved clinical outcomes have been seen postoperatively in patients who undergo hip arthroscopy and in patients who undergo periacetabular osteotomy. Successful clinical outcomes seem to rely on treatment of the underlying clinical pathology and are largely based on the appropriate surgical indications and appropriate surgical techniques. Surgical decision making in this patient population should be individualized based on a comprehensive evaluation of the patient.

Outcome of recycle bone reconstruction using liquid nitrogen in primary malignant bone tumor

Primary malignant bone tumors constitute a small but significant portion, accounting for 3–5% of childhood cancers. Cryosurgery, utilizing liquid nitrogen to induce tumor necrosis through extreme cold, emerges as a favorable surgical technique for bone tumor. This study delves into the clinical and radiological outcomes of individuals underwent cryosurgery. This descriptive study focused on patients with primary malignant bone tumors subjected to wide resection and cryosurgery with follow-up period from 6 up to 48 months from year 2018 - 2023. The data was collected from medical records and database, we evaluated the demographic data, clinical with Musculoskeletal Tumor Society (MSTS), radiological outcome with International Society of Limb Salvage (ISOLS) score, and the complications of cryosurgery observed. Among the 37 patients examined, 20 males and 17 females were averaging 21.7 years of age. 29 of 37 (78%) cases identified as osteosarcoma most common location in the epimetaphyseal of the long bone with Grade Enneking IIB. MSTS score averaged 25.35 ± 5.54, with more than 68% achieving excellent and good score. ISOLS for radiological score revealed 37.8% with an excellent score, 48.6% with a good score. The most common complication, reccurence, occurs in 6 cases (16.2%). Patients with primary malignant bone tumors who underwent cryosurgery showed successful clinical and radiological outcomes, as measured by MSTS and ISOLS scores. This underscores the significance of cryosurgery in primary malignant bone tumor as favorable and cost-effective treatment, showcasing improved functionality and positive radiological results.

High Lumbar Spinal Fusion Rates Using Cellular Bone Allograft Irrespective of Surgical Approach.

Mounting evidence demonstrates a promising safety and efficacy profile for spinal fusion procedures using cellular bone allograft (CBA). However, limited data exists on fusion outcomes stratified by surgical approach. The current study investigates the effectiveness of CBA in lumbar spinal fusion by surgical approach (ie, anterior, lateral, and posterior approaches). Patients undergoing lumbar spinal fusion with CBA (Trinity Elite) were enrolled into a prospective, multi-center, open-label clinical study (NCT02969616). Fusion status was assessed by an independent review of dynamic radiographs and computed tomography images. Clinical outcome measures included quality of life (QoL; EQ5D), disability (Oswestry Disability Index [ODI]), and pain (visual analog scale [VAS]) for back pain and leg pain). Patient data extending to 24 months were analyzed in a post-hoc analysis. A total of 252 patients underwent interbody fusion (159 women; 93 men). Patients had a mean age of 58.3 years (SD 12.5), height of 168.3 cm (SD 10.2), and weight of 87.3 kg (SD 20.0) with a body mass index of 30.8 kg/m2 (SD 6.5). At 12 months, the overall fusion success rate for bridging bone was 98.5%; fusion success was 98.1%, 100.0%, and 97.9% for anterior, lateral, and posterior approaches, respectively. At 24 months, the overall fusion success rate for bridging bone was 98.9%; fusion success was 97.9%, 100.0%, and 98.8% for anterior, lateral, and posterior approaches, respectively. The surgical approach did not significantly impact fusion success. A significant (P < 0.0001) improvement in QoL, pain, and disability scores was also observed. Significant differences in the ODI, VAS, and EQ5D were observed between the treatment groups (P < 0.05). CBA represents an attractive alternative to autograft alone, reporting a high rate of successful fusion and clinical outcomes across various surgical approaches. The use of CBA for spinal fusion procedures, regardless of surgical approach, provides high rates of fusion with a favorable safety profile and improved patient outcomes. NCT02969616.

Prevention, detection and management of adverse events of third-space endoscopy.

Third space endoscopy (TSE) or sub-mucosal endoscopy using a mucosal flap valve (SEMF) enables the endoscopist to operate in the deeper layers of the gastrointestinal tract or gain access to the mediastinal/peritoneal cavity for natural orifice transoral endoscopic surgery (NOTES). TSE procedures are essentially endoscopic surgical procedures with a variable learning curve. Adverse events (AEs) during TSE are specific and follow a certain pattern across the spectrum of TSE procedures. These can be broadly categorized according to either type of AE, time of presentation relative to the procedure or according to degree of severity. Three major categories of AEs encountered during TSE include insufflation related AEs, mucosal injuries (MIs) and bleeding. Other relevant AEs include infectious complications, aspiration pneumonia, post-procedural chest/abdominal pain, atelectasis, cardiac arrhythmias, pleural effusion and pulmonary embolism. Reported incidence of AEs during TSE procedures varies according to the type and complexity of procedure. Acquaintance regarding potential risk factors, technical tips and precautions, alarm signs for early recognition, assessment of degree of severity, morphological characterization of AEs and finally, expeditious selection of appropriate management strategy are crucial and imperative for successful clinical outcomes. The current review discusses the current evidence and practical guidelines for prevention, early detection and management of TSE-related AEs.

High-Throughput Assay for Predicting Diarrhea Risk Using a 2D Human Intestinal Stem Cell-Derived Model.

Gastrointestinal toxicities (GITs) are the most prevalent adverse events (AE) reported in clinical trials, often resulting in dose-limitations that reduce drug efficacy and delay development and treatment optimization. Preclinical animal models do not accurately replicate human GI physiology, leaving few options for early detection of GI side effects prior to human studies. Development of an accurate model that predicts GIT earlier in drug discovery programs would better support successful clinical trial outcomes. Chemotherapeutics, which exhibit high rates of clinical GIT, frequently target mitotic cells. Therefore, we hypothesized that a model utilizing proliferative cell populations derived from human intestinal crypts would predict the occurrence of clinical GITs with high accuracy. Here, we describe the development of a multiparametric assay utilizing the RepliGut® Planar system, an intestinal stem cell-derived platform cultured in an accessible high throughput Transwell™ format. This assay addresses key physiological elements of GIT by assessing cell proliferation (EdU incorporation), cell abundance (DAPI quantification), and barrier function (TEER). Using this approach, we demonstrate that primary proliferative cell populations reproducibly respond to marketed chemotherapeutics at physiologic concentrations. To determine the ability of this model to predict clinical diarrhea risk, we evaluated a set of 30 drugs with known clinical diarrhea incidence in three human donors, comparing results to known plasma drug concentrations. This resulted in highly accurate predictions of diarrhea potential for each endpoint (balanced accuracy of 91% for DAPI, 90% for EdU, 88% for TEER) with minimal variation across human donors. In vitro toxicity screening using primary proliferative cells may enable improved safety evaluations, reducing the risk of AEs in clinical trials and ultimately lead to safer and more effective treatments for patients.

A NEW TREND IN ORTHOPEDICS: RADIOFREQUENCY ABLATION FOR THE TREATMENT OF INTRACTABLE PLANTAR FASCIITIS

BACKGROUND: One of the most common causes of pain in the plantar region of the foot is plantar fasciitis (PF), for which there are numerous treatment options. Several invasive and non-invasive treatment modalities have been developed for this condition. One of these options for patients who do not respond to conservative treatment is radiofrequency ablation (RFA). Due to its early functional benefits and minimally invasive nature, RFA is believed to achieve successful clinical outcomes in patients with persistent early-stage PF. This study aims to evaluate the efficacy and clinical outcomes of RFA in the treatment of PF. METHODS: A total of 35 patients (46 feet), aged 31-50 years, who were treated with RFA from December 2018 to December 2019 were included in the study. AOFAS (American Orthopaedic Foot &amp; Ankle Society) and Visual Analog Scale (VAS) of patients who received conservative treatment for 3 months or longer and whose complaints persisted were pre-treatment (PrT) of RFA. These scores were re-evaluated after 3 months. RESULTS: Among the patients in the study, 10 (28.57%) were male and 25 (71.43%) were female. The mean age of the patients was 40.43±5.37 years. The PrT and post-treatment (PsT) VAS scores were 8.97±1.36 and 5.89±3.66, respectively. The PrT and PsT AOFAS scores were 48.51±10.67 and 65.86±22.74, respectively. Statistical analyses showed that the clinical outcomes of RFA were significantly improved after treatment for both scores (p

An end-to-end deep learning pipeline to derive blood input with partial volume corrections for automated parametric brain PET mapping

Dynamic 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography (dFDG-PET) for human brain imaging has considerable clinical potential, yet its utilization remains limited. A key challenge in the quantitative analysis of dFDG-PET is characterizing a patient-specific blood input function, traditionally reliant on invasive arterial blood sampling. This research introduces a novel approach employing non-invasive deep learning model-based computations from the internal carotid arteries (ICA) with partial volume (PV) corrections, thereby eliminating the need for invasive arterial sampling. We present an end-to-end pipeline incorporating a 3D U-Net based ICA-net for ICA segmentation, alongside a Recurrent Neural Network (RNN) based MCIF-net for the derivation of a model-corrected blood input function (MCIF) with PV corrections. The developed 3D U-Net and RNN was trained and validated using a 5-fold cross-validation approach on 50 human brain FDG PET scans. The ICA-net achieved an average Dice score of 82.18% and an Intersection over Union of 68.54% across all tested scans. Furthermore, the MCIF-net exhibited a minimal root mean squared error of 0.0052. The application of this pipeline to ground truth data for dFDG-PET brain scans resulted in the precise localization of seizure onset regions, which contributed to a successful clinical outcome, with the patient achieving a seizure-free state after treatment. These results underscore the efficacy of the ICA-net and MCIF-net deep learning pipeline in learning the ICA structure’s distribution and automating MCIF computation with PV corrections. This advancement marks a significant leap in non-invasive neuroimaging.

Anatomical medial patellofemoral ligament reconstruction improves sport participation and activity levels in adolescents with recurrent patellar dislocation.

This study aims to evaluate the clinical outcomes of an anatomical medial patellofemoral ligament (MPFL) reconstruction and the effects of concomitant patellofemoral joint injuries and radiological findings on outcomes in adolescents with recurrent patellar dislocation (RPD). Between January 2011 and January 2020, a total of 34 patients (19 males, 15 females; median age: 15.6 years; range, 13 to 17 years) with RPD who underwent anatomic MPFL reconstruction were retrospectively analyzed. Lateral release was performed as indicated. Clinical outcomes were evaluated preoperatively and at the final follow-up using the Visual Analog Scale (VAS), Lysholm, Kujala, and Tegner activity rating scales. Magnetic resonance imaging was performed to detect concomitant injuries such as bone, cartilage, and soft tissue injuries. The mean follow-up was 5±2 years. All postoperative knee functions and activity levels were statistically significantly improved without re-dislocation (p<0.001). There was no statistically significant relationship between the presence and location of cartilage lesions and clinical outcomes (p>0.05). Patients with cartilage lesions had a significantly higher CatonDeschamps index and a higher incidence of bone edema in both the patella and femur than patients without. Anatomic MPFL reconstruction with meticulous physical therapy has successful clinical outcomes, prevents re-dislocation, and increases participation in sports and activity levels in adolescent patients with RPD. Although cartilage injuries are common after RPD, it has no adverse effect on clinical outcomes in the mid-term.

Production of recombinant adeno-associated virus 5 using a novel self-attenuating adenovirus production platform

Recombinant adeno-associated virus (rAAV) has become a prominent vector for clinical use. Despite an increase in successful clinical outcomes, the amount of high-quality rAAVs required for clinical trials and eventual commercial demand is difficult to produce, especially for genetic diseases that are prevalent or require high doses. Many groups are focused on establishing production processes that can produce sufficient rAAV while maintaining potency and quality. Our group used a novel production platform to increase our yield of rAAV5. This production platform uses tetracycline-enabled self-silencing adenovirus (TESSA) to deliver the wild-type AAV replication and capsid genes alongside the adenovirus helper genes necessary for production. Here, we describe our efforts to evaluate the TESSA platform in house. We conducted numerous experiments to determine the optimal conditions for producing rAAV5 from the TESSA production system. We then produced rAAV5 from the TESSA system to compare against rAAV5 produced from triple transfection. Ultimately, we generated data that showed that the vector genome yield of rAAV5 produced with TESSA was >20-fold higher than rAAV5 produced with triple transfection. Additionally, our data show that quality as well as potency in mice of rAAV5 produced with the TESSA system and by triple transfection are equivalent.

Antral membrane balloon technique versus Densah bur in crestal sinus lift with simultaneous implant placement: a randomized clinical trial

BackgroundThe posterior maxilla presents challenges for implant insertion because of the poor bone quality as well as the loss of vertical bone height. Indirect transcrestal sinus lift techniques are advised when a few millimeters of additional height are needed. This study aimed to evaluate the clinical and radiographic outcomes of antral membrane balloon technique versus Densah burs for transcrestal maxillary sinus lifting with simultaneous implant placement.Materials and methodsThis randomized clinical trial was conducted on 22 patients received 32 dental implants for replacement of missed maxillary posterior teeth after crestal maxillary sinus lifting. The patients were randomly divided into two groups. Group 1, patients underwent crestal sinus floor elevation with simultaneous implant placement using antral membrane balloon technique. Group 2, patients underwent crestal sinus floor elevation with simultaneous implant placement using Densah burs. Patients were evaluated clinically and radiographically using cone beam computed tomography (CBCT) at regular time intervals immediately, 6 months and 12 months after surgery. All clinical and radiographic parameters were statistically analyzed.ResultsAll dental implants were successful for 12 months of follow up. Regarding implant primary stability, there was a statistical significant difference between the study groups in favor of Densah group (P = 0.004), while there was no significant difference after 6 months (P = 0.07). Radiographically, balloon group showed a statistically significant immediate postoperative vertical bone height (P < 0.0001), and significant reduction in vertical bone height after 6 months (P < 0.0001). Densah group showed significant increase in bone density (P ≤ 0.05).ConclusionBoth techniques demonstrated successful clinical and radiographic outcomes for crestal sinus lift. The antral membrane balloon group demonstrated better immediate postoperative vertical bone gain, while Densah burs had higher implant primary stability and bone density.Trial registrationThis study was registered in Clinical-Trials.gov PRS (https://register.clinicaltrials.gov) under identification number NCT05922592 on 28/06/2023.

Effect of electrical muscle stimulation on the improvement of deltoid muscle atrophy in a rat shoulder immobilization model.

Immobilization following trauma or surgery induces skeletal muscle atrophy, and improvement in the muscle atrophy is critical for successful clinical outcomes. The purpose of this study is to evaluate the effect of electrical muscle stimulation (EMS) on muscle atrophy. The study design is a controlled laboratory study. Eighty rats (56 to establish the deltoid muscle atrophy [DMA] model and 24 to evaluate the effect of EMS on the model) were used. DMA was induced by completely immobilizing the right shoulder of each rat by placing sutures between the scapula and humeral shaft, with the left shoulder as a control. After establishing the DMA model, rats were randomly assigned into three groups: low-frequency EMS (L-EMS, 10 Hz frequency), medium-frequency EMS (M-EMS, 50 Hz frequency), and control (eight rats per group). After 3 weeks, the deltoid muscles of each rat were harvested, alterations in gene expression and muscle cell size were evaluated, and immunohistochemical analysis was performed. DMA was most prominent 3 weeks after shoulder immobilization. Murf1 and Atrogin were significantly induced at the initial phase and gradually decreased at approximately 3 weeks; however, MyoD expressed an inverse relationship with Murf1 and Atrogin. IL6 expression was prominent at 1 week. The time point for the EMS effect evaluation was selected at 3 weeks, when the DMA was the most prominent with a change in relevant gene expression. The M-EMS group cell size was significantly larger than that of L-EMS and control group in both the immobilized and intact shoulders (all p < 0.05), without significant differences between the L-EMS and control groups. The M-EMS group showed significantly lower mRNA expressions of Murf1 and Atrogin and higher expressions of MyoD and Col1A1 than that of the control group (all p < 0.05). In immunohistochemical analysis, similar results were observed with lower Atrogin staining and higher MyoD and Col1A1 staining in the M-EMS group. DMA model was established by complete shoulder immobilization, with the most prominent muscle atrophy observed at 3 weeks. M-EMS improved DMA with changes in the expression of relevant genes. M-EMS might be a solution for strengthening atrophied skeletal muscles and facilitating rehabilitation after trauma or surgery.

Giant free lying appendicolith perforated through the mid segment of appendix

Appendicoliths, though typically small and asymptomatic, occasionally manifest as giant calculi exceeding 2 cm in diameter and can precipitate acute appendicitis.1 This case report delineates the presentation, diagnostic challenges, and management of a rare 2.2 cm appendicolith-induced acute appendicitis in an adult male patient. Despite financial constraints necessitating an open appendicectomy, the procedure resulted in a successful clinical outcome without postoperative complications.

The Interaction between Oral Bacteria and 3D Titanium Porous Surfaces Produced by Selective Laser Melting-A Narrative Review.

The interaction between oral bacteria and dental implant surfaces is a critical factor in the success and longevity of dental implants. With advancements in additive manufacturing technologies, selective laser melting (SLM) has emerged as a prominent method for producing titanium implants with highly controlled microstructures and porosities. These 3D printed titanium surfaces offer significant benefits, such as enhanced osseointegration and improved mechanical properties. However, the same surface features that promote bone cell attachment and proliferation may also provide favorable conditions for bacterial adhesion and biofilm formation. Understanding the dynamics of these interactions is essential for developing implant surfaces that can effectively resist bacterial colonization while promoting tissue integration. This narrative review explores the complex interplay between oral bacteria and SLM-produced titanium porous surfaces, examining current research findings and potential strategies for optimizing implant design to mitigate the risks of infection and ensure successful clinical outcomes.

Orthodontic and Surgical Management of Impacted Maxillary Canines: A Narrative Review

AbstractMaxillary canine impactions are a significant challenge for orthodontic and oral surgical practices. In this narrative review, we aim to evaluate surgical and orthodontic approaches for treating maxillary canine impactions, evaluate their effectiveness, and compare the two treatment modalities.We reviewed several studies on databases such as Google Scholar, PUBMED, and MEDLINE to update recent knowledge for canine impactions and their treatment. We reviewed and included studies that matched our research objectives, including orthodontic management, open and closed eruption techniques, and contact and tooth alignment surgery.Successful treatment results of canine impactions were reported increasingly in literature, and good clinical outcomes were observed in most cases. However, factors such as the severity of the impaction, patient age, and surgical experience were found to influence the choice of surgical technique and success rates. Complications associated with surgical management of maxillary canine impactions were also reported. These complications, which include tooth resorption, postoperative infection, ankylosis, and damage to adjacent structures, are generally rare but emphasize the importance of careful patient selection, surgical planning accuracy, and emphasis on diligent postoperative care.Findings highlight surgical procedures' effectiveness, outcomes, and challenges to help clinicians make informed decisions and improve patient care. The results underscore the importance of evidence-based decision-making and a multidisciplinary approach for successful clinical outcomes. Future research will focus on long-term stability, patient-reported outcomes, and exploring emerging techniques to further improve the management of maxillary canine impactions.