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Surgical possibilities and implant options in reconstructive and corrective breast surgery have expanded considerably, making comparative outcome data essential for informed preoperative decision-making. This study presents and compares a single surgeon's long-term experience with Becker expander and fixed-volume implants in a large patient series, supplemented by a systematic review of the literature on postoperative and long-term complications. Records of 183 patients (247 implants) who underwent reconstructive or corrective breast surgery using fixed-volume or Becker expander implants in a single-surgeon setting were retrospectively reviewed. Patient characteristics, risk factors, and surgical indications were analyzed within each implant group. Complications were categorized as minor or major, the latter defined as any event leading to revision surgery and implant loss. Results were compared to other large (n > 100) retrospective studies identified through a PubMed literature review. Cohorts of 90 patients with 112 Becker expander implants and 93 patients with 135 fixed-volume implants were compared. Groups did not differ significantly in patient history or risk factors. Complications were documented over a minimum follow-up of 24 months (median 5.87 years). Overall complication rates did not differ significantly between groups (31.25% vs. 32.59%, p &#x2265; 0.05). Major complications leading to implant loss were significantly more frequent in the Becker group (9.73% vs. 2.21%, p < 0.05), though this difference could not be reproduced in any individual subgroup. Despite the higher rate of major complications, overall complication rates in both groups were lower than average rates reported in the literature. Becker expanders remain a valid alternative to fixed-volume implants in single-stage reconstruction when patient selection is made carefully and aesthetic expectations favor volume adjustability.

Shoulder arthroplasty has evolved substantially in surgical technique, implant design, and indications. Careful coordination across the patient care pathway remains central to optimizing outcomes. Concurrently, rapid advances in digital health, wearable technologies, smart implants, and intraoperative innovations are being explored across orthopedics, with emerging applications in shoulder arthroplasty. This narrative review synthesizes current evidence on digital technologies relevant to shoulder arthroplasty, with particular attention to the strength and origin of the available data. A structured review of recent literature was performed, including primary studies in shoulder arthroplasty as well as relevant evidence extrapolated from hip and knee arthroplasty. Areas examined included CT-based 3D planning, navigation, patient-specific instrumentation, robotics, augmented/mixed reality, mobile health (mHealth) platforms, wearable devices, tele-rehabilitation, sensor-enabled implants, and artificial intelligence (AI). In shoulder arthroplasty, digital planning tools, navigation systems, and patient-specific instrumentation have demonstrated improvements in implant positioning accuracy in selected studies; however, evidence linking these technologies to superior long-term clinical outcomes remains limited. Robotic systems and augmented reality applications are in early investigational phases. Postoperative digital health tools, including tele-rehabilitation and wearable monitoring, have shown non-inferior functional outcomes compared with conventional care in hip and knee arthroplasty, with only preliminary and pilot data currently available in shoulder populations. Sensor-enabled implants and AI-based predictive models represent emerging areas of research, but external validation, workflow integration, and cost-effectiveness analyses remain insufficient. Digital and smart health technologies in shoulder arthroplasty are evolving and largely investigational. While early findings and extrapolated evidence from other arthroplasty domains suggest potential benefits in planning accuracy, patient engagement, and outcome monitoring, robust shoulder-specific clinical validation is limited. Further prospective studies are required before widespread clinical adoption can be recommended. This narrative review synthesizes emerging evidence in this field, which is currently dominated by feasibility studies, technical reports, and early-phase clinical investigations, with limited high-level outcome data specific to shoulder arthroplasty.

Peri-implantitis is one of the frequent complications associated with dental implants. Although several protocols have been given by different authors, there is no unified protocol for the management of peri-implantitis. A male patient aged 74 years reported to the department of implantology with a chief complaint of pain and swelling around the implants in regions 36 and 37. Probing depths ranging from 4 to 7 mm (Williams probe) were noted in respect to 36 and 37. Initial management was done nonsurgically by antibiotics and oral prophylaxis. Deep pockets and bleeding on probing persisted on re-evaluation. Surgical management involved elevation of a full-thickness mucoperiosteal flap, followed by thorough soft-tissue curettage using plastic curettes. The implant surface was detoxified with a tetracycline-saline slurry in conjunction with a titanium brush. Xenograft particulates were used to restore the osseous defect. Postoperative healing was uneventful, and probing depths were within the normal limits. Bleeding on probing was noted below 10%. Significant bone fill was also evident. This case report reveals successful management of peri-implantitis using regenerative procedures.

To compare fascia lata allograft (FLA) and subepithelial connective tissue graft (SCTG) for peri-implant mucosal augmentation performed simultaneously with implant placement. This prospective, randomized, examiner-blinded pilot clinical trial enrolled 16 patients requiring single-tooth implant placement with a thin peri-implant soft-tissue phenotype. Participants were randomly allocated (1:1) to SCTG or FLA. The primary outcome was peri-implant mucosal thickness (PMT) measured by using a customized stent-guided transmucosal method at standardized buccal reference points. Secondary outcomes included keratinized mucosal width (KMW), postoperative pain (VAS), and modified wound healing index (MWHI). Follow-up was 24 weeks. Both groups demonstrated significant improvements in PMT and KMW over time. Between-group differences were generally non-significant, except localized PMT differences at the intermediate reference level, favoring SCTG at later visits. FLA showed lower postoperative pain at selected time points. Healing outcomes were comparable. Both SCTG and FLA were effective for peri-implant mucosal augmentation. FLA may represent a viable alternative that avoids donor-site morbidity. Larger long-term trials are required. FLA can be considered a viable alternative for enhancing peri-implant mucosal thickness around simultaneously placed dental implants. ClinicalTrials.gov NCT04679922, registered on December 22, 2020, and retrospectively registered.

Mastectomy rates remain high in the management of breast cancer, which reflects the evolution of post-mastectomy breast reconstruction into a critical component of multidisciplinary care. The two primary methods for breast reconstruction consist of using the patient's own tissue (autologous) and implant-based procedures. The selection between the two procedures depends on three main factors, which include oncological requirements, surgical risk, and patient preferences. This article aims to synthesize recent clinical guidelines and literature to provide an evidence-based comparison of these surgical modalities.&#xa0;A comprehensive literature search was conducted to find current clinical practice guidelines and high-quality clinical studies about post-mastectomy breast reconstruction. The research assessed how cancer treatments affect patients through their evaluation of radiotherapy effects and complication rates, and patient-reported outcome measures (PROMs), which used the BREAST-Q tool for both autologous and implant-based groups. The use of prepectoral implants decreased pain and animation deformity but showed higher seroma rates and can also fail&#xa0;with radiotherapy. Autologous reconstruction provides superior long-term psychosocial and sexual life quality. The two main factors that determine reconstructive failure success rates include patients who are obese and smokers.

Recent advancements in implant therapy have improved the management of edentulism by reducing surgical invasiveness and enhancing clinical outcomes. Conventional flap techniques, although providing adequate access, are associated with complications such as crestal bone loss and soft-tissue recession. Flapless surgery has emerged as a minimally invasive alternative that preserves periosteal integrity, reduces trauma, and promotes faster healing and patient comfort. The aim of the study was to compare soft- and hard-tissue changes following endosseous implant placement using flap and flapless technique. This randomized controlled single-blinded study included 30 participants, with 15 implants each allocated to flap (control) and flapless (test) groups. Patients with adequate ridge dimensions and good oral health were included. Clinical parameters, including keratinized mucosa width (KMW) and peri-implant probing depth, were recorded at baseline and at 4 months. Radiographic evaluation using intraoral periapical radiographs was performed to assess crestal bone levels immediately after implant placement and at 4 months. Both groups showed a significant reduction in KMW, with a greater reduction in the flapless group. Crestal bone levels were better preserved in the flapless group compared to the flap group at 4 months. No statistically significant difference in peri-implant probing depth was observed between the groups. Flapless implant surgery may offer advantages in preserving peri-implant hard tissues and reducing postoperative complications. However, long-term studies with larger sample sizes are required to confirm these findings.

Nipple-sparing mastectomy (NSM) with immediate implant-based breast reconstruction (IBBR) offers excellent aesthetic outcomes, but nipple-areolar complex (NAC) necrosis remains a major complication. Although arterial insufficiency has been emphasized, venous injury may also play a critical role. To characterize NAC venous anatomy and determine whether venous injury contributes to clinically significant NAC necrosis after NSM. We performed a cadaveric study of superficial peri-areolar venous anatomy and a prospective clinical cohort study of 123 breasts undergoing NSM with immediate IBBR. Cutaneous NAC veins were visualized using near-infrared (NIR) imaging, and venous injury was quantified as vein branch loss (VBL). We evaluated predictors of clinically significant NAC necrosis and developed a prediction model, compared with intraoperative indocyanine green angiography (ICGA) in 32 breasts. Cadaveric dissection demonstrated a polygonal venous network adjacent to the areolar margin. In the clinical cohort, significant NAC necrosis occurred in 19 of 123 breasts (15.4%). On univariate analysis, higher VBL, greater mastectomy weight, higher body mass index, and diabetes were associated with NAC necrosis (P < .05). Multivariable analysis demonstrated that the effect of VBL increased with mastectomy weight. The final model showed strong discrimination (AUROC 0.902; 95% CI, 0.82-0.98) and identified a low-risk subset among breasts with poor ICGA perfusion in which no significant NAC necrosis occurred. Venous integrity is a key determinant of NAC viability after NSM. NIR-based vein analysis enables quantitative assessment of venous injury and may complement ICGA in perioperative risk stratification and surgical planning.

Periodontal regeneration aims to restore the natural structure of the periodontium, therefore improving the long-term stability and function of the affected teeth. Traditional bone graft materials such as allografts, autografts, xenografts, and alloplasts serve as a scaffold for new bone formation and are employed for the regeneration of osseous defects. Autogenous dentin graft (ADG), which is characterized by both osteoinductive and osteoconductive properties, is a biomaterial that mimics the mineral and organic composition of alveolar bone, whereas anorganic deproteinized bovine graft, a xenograft, is renowned for its osteoconductive properties. The current study investigates the comparative clinical and radiographic effectiveness of ADG versus xenograft in intrabony defects. The present study aims to compare the clinical and radiographic effectiveness of ADG and xenograft in managing periodontal defects. Patients with Stage III and Stage IV periodontitis were selected, and Phase I therapy was performed. After Phase I (nonsurgical periodontal therapy), re-evaluation was carried out, and patients with probing pocket depth (PPD) &#x2265;5 mm and an intrabony defect (two-walled or three-walled) were selected for the study. 24 surgical sites were selected for the study and were divided into two groups of 12 sites each (test group - ADG and control group - xenograft). The sites were assessed for radiographic parameters (bone fill [BF], bone crest change [BCC], defect resolution [DR], and relative bone mineral density indicator [RBMD]) using cone beam computed tomography at Visit-1 (screening) and at 6 months (6-month follow-up). The sites were assessed for clinical parameters (gingival bleeding index [GBI], probing pocket depth [PPD] and clinical attachment level [CAL]) at baseline (day of the surgery) and at 6 months (6-month follow-up). On evaluation, clinical parameters (PPD and CAL) showed significant results from baseline to 6 months on intragroup comparison. However, no significant difference was seen on intergroup comparison. In intergroup comparison, radiographic evaluation showed a higher BF in the ADG group (test group), while no difference was seen in BCC, DR, and RBMD parameters. Within the limitations of this study, ADG can be a promising alternative to xenograft in periodontal intrabony defects. However, larger randomized controlled trials with longer follow-up are necessary to validate these findings.

Oral diseases represent one of the most widespread global health burdens, affecting billions of people worldwide, causing pain, disability, and substantial treatment costs. Despite their prevalence, progress in prevention and therapy has been limited, in part, by experimental models that do not fully capture the complexity of the oral biological and environmental landscape. Over the past decade, however, major advances in model development have expanded the possibilities for studying oral disease. This mini-review summarizes advances from 2015 to 2025, focusing on caries and endodontic infections, gingivitis and periodontitis, peri-implantitis, mucosal disorders, oral and oropharyngeal cancers, and salivary gland diseases. Recent innovations include saliva-derived biofilm systems that reproduce ecological transitions, organ-on-chip systems that replicate fluid dynamics, and patient-derived organoids and xenografts that preserve clinical characteristics. In parallel, immune-integrated models now allow direct interrogation of host responses to pathogens. Separate from these experimental platforms, advanced analytical and computational approaches, including single-cell profiling, spatial transcriptomics, radiomics, and artificial intelligence (AI)-assisted image analysis, are increasingly linking molecular signatures with structural and functional disease outcomes. Together, these experimental models and complementary analytical tools mark a shift from reductionist approaches toward dynamic, patient-relevant frameworks that better capture the complexity of oral diseases. Remaining challenges include modeling chronic disease progression, incorporating viral and autoimmune components, and improving reproducibility through standardization across platforms. Addressing these limitations will be important for translating next-generation experimental models into clinically meaningful advances in oral health care.

Cochlear implant (CI) electrode arrays must navigate the delicate, spiraling microanatomy of the human cochlea. Optimizing their intrinsic mechanical properties is crucial for ensuring smooth surgical insertion and preventing extracochlear buckling. This study presents a parametric, bench-type biomechanical evaluation of tapered cochlear electrode arrays, combining three-dimensional (3D) finite element analysis (FEA) with a design of experiments (DOE) methodology. The array was modeled as a heterogeneous composite, comprising platinum-iridium (Pt-Ir) conductors embedded in a polydimethylsiloxane (PDMS) (silicone) matrix and evaluated as a free-space cantilever under simulated surgical deflection conditions of up to 30&#xb0;. This approach isolates the intrinsic bending stiffness and longitudinal column strength independent of complex tribological friction. A 15-run factorial design varying apical radius, basal radius, and array length was utilized to quantify their interactive effects on tip deflection and reaction force. The FEA results demonstrated that across the parametric sweeps, maximum tip deflection ranged from 6.16 to 8.27&#x2009;mm, while the reaction force varied between 1.096 and 4.66&#x2009;mN. Peak Von Mises stress localized at the fixed basal end at 205.86&#x2009;MPa, operating safely within the elastic limit of the composite's alloy. Analysis of variance (ANOVA) revealed that array length is the dominant driver of tip deflection, whereas the basal radius governs reaction force due to its fourth-power scaling of the area moment of inertia. Predictive regression models achieved adjusted R-squared values approaching unity; as the experimental runs are derived from deterministic FEA simulations rather than stochastic physical trials, this near-perfect fit reflects exact mathematical mapping of the response surface rather than real-world physical variance. To validate this deterministic numerical framework, the outputs were successfully correlated against previously published experimental data using optical fibers as structural proxies under precision force measurement. Ultimately, these findings provide an efficient, predictive parametric design framework for benchmarking and comparing tapered electrode array geometries, utilizing flexural rigidity and reaction forces as fundamental proxies for safe surgical handling and structural trackability.

This qualitative study aimed to explore experiences related to learned helplessness and support needs among patients with recurrent implantation failure undergoing in vitro fertilization and embryo transfer, and to provide evidence for targeted psychological support and nursing interventions in clinical practice. A descriptive phenomenological study was conducted. Using purposive sampling, 17 patients with recurrent implantation failure undergoing in vitro fertilization and embryo transfer were recruited from the Reproductive Medicine Center of a tertiary Grade A hospital in Guangzhou between December 2025 and March 2026. Data were collected through semi-structured interviews and analyzed using Colaizzi's seven-step phenomenological method, supported by NVivo 15.0 software. The analysis identified four themes and 13 subthemes, covering perceived sources of learned helplessness, manifestations in daily life and psychological well-being, participants' coping responses, and external support needs. These themes reflected how repeated treatment failure, invasive procedures, uncertainty about pregnancy outcomes, and medical and family-related pressures shaped participants' helplessness experiences, influenced daily life and psychological well-being, and generated needs for information, emotional support, continuity of care, and supportive family and peer communication. Patients with recurrent implantation failure undergoing in vitro fertilization and embryo transfer described learned helplessness as a multifaceted experience related to repeated treatment failure, invasive procedures, uncertainty about pregnancy outcomes, and medical and family-related pressures. This experience was closely associated with disruptions in daily life, persistent psychological distress, differentiated coping patterns, and multidimensional support needs. Healthcare professionals are encouraged to identify feelings of helplessness early and provide continuous, individualized nursing support based on patients' coping patterns and support needs.

Stent fracture (SF) is a rare but potentially serious complication after percutaneous coronary intervention, which may lead to in-stent restenosis or acute coronary syndrome. A 70-year-old woman with a history of hypertension and diabetes mellitus presented with acute anterior wall myocardial infarction. She had previously undergone multiple stent implantations in the left anterior descending (LAD) artery. Coronary angiography and optical coherence tomography (OCT) demonstrated a complete stent fracture accompanied by neointimal hyperplasia in the mid-LAD segment. A new drug-eluting stent was subsequently implanted at the fracture site, and the patient had an uneventful recovery. This case highlights that long and overlapping stents may predispose to mechanical fatigue and subsequent fracture. Early detection using intravascular imaging modalities such as OCT is crucial for prompt management and the prevention of recurrent ischemic events.

This systematic review aimed to evaluate the current literature on mass spectrometry (MS)-based proteomic analysis of the crevicular fluid in different periodontal and peri-implant conditions, and to summarize methodological differences among studies. A search of electronic databases was conducted and clinical studies using MS-based proteomics in gingival (GCF) and/or peri-implant crevicular fluid (PICF) were considered for inclusion. The findings were synthesized and methodological variations described. A modified QUADOMICS tool was applied for risk of bias assessment. Thirteen studies; five longitudinal and eight cross-sectional were analyzed. Patients ranged from 10 to 190, with 42 to 3070 human proteins identified. Sample preparation and preanalytical procedures differed among studies. Protein identification, characterization and quantification were conducted using different algorithms and computer software against different databases. Different strategies were used to select distinctive proteins. Six studies attempted at biomarker development using different protein selection and validation criteria. While six studies presented moderate quality, seven were considered to be low quality. The present findings emphasize the need for methodological harmonization, including standardized protocols for GCF/PICF collection, harmonized proteomic workflows, multicenter longitudinal validation studies, and targeted mass spectrometry approaches for biomarker verification before they can be translated into the clinical practice.

Epithelial cancers such as stomach and ovarian cancer tend to metastasize to the peritoneum, often leading to intractable disease and poor survival. The mechanisms that enable gastric cancer cells to implant, invade, and survive in the peritoneal niche are poorly understood. We developed a novel human peritoneal explant model using freshly harvested peritoneal tissue samples. GFP-labeled human gastric adenocarcinoma cells (AGS) were co-cultured with the peritoneal samples, and 2% of these cells implanted into the peritoneum. The transcriptomic profile of the implanted AGS cells was compared to AGS cells that failed to implant using RNA sequencing. Differentially expressed genes in implanted AGS cells were enriched for cell adhesion and motility. We functionally validated these genes with CRISPR knockout and identified ADAM12 as a regulator of peritoneal metastasis. ADAM12 KO significantly impaired peritoneal metastasis in vivo and ex vivo and marked disruption of the ITG&#x3b2;1 interactome in GCa cells. Our approach and the new data identify a distinct peritoneal metastasis gene set that facilitates the implantation and invasion of gastric cancer cells within the peritoneum. Disruption of these pathways with peritoneal-directed therapies has the potential to improve survival in patients with high-risk primary gastric cancer.

Patients with left ventricular assist devices (LVAD) experience unique challenges shaped by both device characteristics and cultural context. Their psychosocial and cultural implications remain underexplored, especially in non-Western contexts. This study explored the lived experiences of LVAD implantation patients in the context of Chinese culture. A hermeneutic phenomenological approach was employed, involving five Chinese patients who had undergone LVAD implantation. Data were collected through semi-structured interviews, audio-recorded, and transcribed verbatim. And data analysis based on the methodology of Interpretive phenomenological analysis (IPA). Two themes that emerged from the analysis: (1) Perceived loss of mastery, (2) Coping Strategies. The former includes five subthemes: contrast-induced disparity, restrictions imposed by the device, insufficient external support, loss of control over self-management, and emotional dysregulation, which represent the core adaptive challenge following implantation. The latter encompasses two subthemes: reconstruction of self-care ability and emotional adjustment. This study reveals that Chinese LVAD patients experience a pervasive loss of mastery after implantation and adopt adaptive coping strategies through self-care reconstruction and emotional adjustment. Family support has a unique yet paradoxical influence on patients' adaptation in the Chinese cultural context. Targeted interventions that combine functional and psychological support with culturally appropriate family-based strategies are essential for restoring patients' sense of mastery and improving long-term clinical outcomes.

The aim of this systematic review was to determine whether suture button fixation is superior to traditional screw fixation for injuries to the distal tibiofibular syndesmosis. Injuries to the distal tibiofibular syndesmosis requiring surgical intervention are common. Effectiveness of surgical management of these injuries has been firmly established; however, there remains ongoing debate surrounding which implant should be used. Suture button fixation offers theoretical benefits allowing dynamic fixation of a mobile structure compared to the static alternative offered with screw fixation. A systematic literature search was conducted in October 2022 and again in May 2024, identifying 16 randomized controlled trials, involving 783 unique participants comparing outcomes for suture button compared to screw fixation of acute syndesmotic injuries. Patients treated with suture button fixation had a significantly better complication profile with fewer overall complications (odds ratio [OR] 0.22, 95% CI 0.10-0.50, P=<0.01), overall reoperations (OR 0.34, 95% CI 0.19-0.62, P=<0.01), implant breakage (OR 0.09, 95% CI 0.03-0.21, P=<0.01), and unplanned implant removal (OR 0.37, 95% CI 0.18-0.76, P=0.01) without significant differences in rates of infection (OR 1.58, 95% CI 0.61-4.14, P=0.35), syndesmotic malreduction (OR 0.48, 95% CI 0.22-1.03, P=0.06), or range of ankle plantarflexion (mean difference [MD] = 0.22, 95% CI -0.07-0.51, P=0.13) or dorsiflexion (MD = 0.07, 95% CI -0.22-0.36, P=0.62). Across a range of clinical outcome measures, suture button fixation had comparable outcomes to screw fixation, with the only statistically significant difference being an improvement in American Orthopaedic Foot and Ankle Society (AOFAS) score at 1 year. Suture button fixation has a significantly improved complication profile when compared to screw fixation for the management of acute syndesmotic injuries. Suture button fixation also had slightly improved early functional outcomes, with similar short-, medium-, and long-term clinical outcomes. Suture button fixation should be recommended for the surgical management of syndesmotic injuries. PROSPERO CRD42022331211.

Tooth loss in the posterior maxilla frequently leads to alveolar ridge resorption and maxillary sinus pneumatization, compromising implant placement and often requiring sinus lift (SL) procedures. This study evaluated volumetric changes in the alveolar ridge and maxillary sinus using cone-beam computed tomography (CBCT) after SL, inorganic bovine bone grafting, and implant placement. A retrospective analysis was performed on 16 maxillary sinuses from 12 patients (6 female and 6 male; mean age: 55.8 years). CBCT scans were obtained at baseline (T0), postgraft evaluation before implant planning (T1), and postimplant healing (T2; mean follow-up 29 months). Alveolar ridge and sinus volumes were measured using ITK-SNAP software. The outcomes evaluated were alveolar ridge volume (mm3), maxillary sinus volume (mm3), percentage of bone gain (T1-T0), and graft resorption (T1-T2). Volumetric measurements at different time points were compared using analysis of variance; bone gain and resorption were compared using t-test, and clinical/demographic variables were assessed for associations. The significance level was P < 0.05. A significant increase in alveolar ridge volume was observed at T1, followed by 11% resorption at T2 over 4 years, primarily in the cervical implant region. Maxillary sinus volume significantly decreased at T1 without subsequent re-pneumatization at T2. Sites with a volumetric gain exceeding 200% at T1 exhibited lower resorption rates at T2 (P = 0.036). Clinical and demographic variables had no association with bone gain nor resorption (P > 0.05). Bone gain and graft volume maintenance were primarily influenced by the extent of grafting, while patient-related variables showed no significant association.