This study evaluated the potential for biomimetic new bone regeneration synchronized with developing strength when the Zn proportion was increased in Mg-Zn-Ca alloys (Mg1Zn0.6Ca and Mg6Zn0.6Ca alloys). Two types of magnesium (Mg) alloys, Mg1Zn0.6Ca and Mg6Zn0.6Ca, with a total of 100 samples (n = 50/group), were studied. The groups were divided into subgroups (n = 10/group) A; subjected to electrochemical corrosion, (B, C, and D) subgroups were biomimetic immersed in SBF for different time intervals (2,4,and 8weeks), receptively, to assess the degradation/regeneration rate. Another subgroup (n = 10/group) were used as control for initial flexural strength test. Changes in weight were recorded, and surface chemistry was analyzed through X-ray diffraction (XRD) and FTIR. Surface morphology changes were examined via environmental scanning electron microscopy (SEM) and EDXA. The formation of new bone was estimated by assessing mineral content, crystallinity, hydroxyapatite (HA) maturity, matrix amount, and the calcium/phosphorus (Ca/P) ratio. Additionally, surface roughness (Ra) and flexural strength before and after the biomimetic immersion in SBF at different intervals were measured. Mg1Zn0.6Ca (Group I) demonstrated controlled long-term degradation; weight loss corrosion rate reduced from 1.81 to 0.26 mm/year over 8 weeks, mature HA formation (65.5% crystallinity, 161% crystal maturity by 8 weeks), the Ca/P ratio increased from 0.29 ± 0.03 to 0.68 ± 0.03 and preserved mechanical competence (88.75 ± 0.03 MPa flexural strength). On the other hand, Mg6Zn0.6Ca (Group II) showed rapid initial passivation (Ra ∼4.87 μm at 2 weeks) but unsustainable performance because of premature embrittlement (50.87 ± 0.03 MPa), immature HA (44% maturity, 37.7% crystallinity decline), the Ca/P ratio dropped from 1.42 ± 0.03 to 0.35 ± 0.03 and persistent high degradation (~ 2 mm/year). Electrochemical corrosion revealed that group II showed a higher corrosion potential (Ecorr), Icorr, and corrosion rate value than group I. Group II (Mg6Zn0.6Ca) showed a higher biodegradation rate (about 7.37 ± 0.02 mm/year) and higher surface roughness than group I (Mg1Zn0.6Ca) over time. Mg1Zn0.6Ca (Group I) shows superior biomimetic synchronization for maxillofacial bone regeneration, achieving controlled long-term degradation, as it revealed a controlled degradation with stable hydroxyapatite formation that promotes osteointegration and sustained mechanical strength. It is recommended to be used in short and long-lasting load-bearing maxillofacial appliances. In contrast, Mg6Zn0.6Ca (Group II) degrades too rapidly, leading to premature strength loss and unstable mineralization. It is recommended in short loading- bearing maxillofacial appliance.1 wt% Zn is the ideal amount for biomimetic maxillofacial implants in accordance with ISO 10993-5 biomechanical thresholds.
Delayed healing of maxillofacial soft tissue wounds is closely associated with inffammatory injury and mitochondrial dysfunction in fibroblasts, while effective therapeutic strategies remain limited. This study investigated whether activation of the mechanosensitive ion channel Piezo1 by Yoda1 could promote wound healing. An LPS-induced inflammatory model was established in human gingival fibroblasts (HGFs) and treated with Yoda1. Intracellular calcium influx, cell viability, oxidative stress, mitochondrial membrane potential, apoptosis, migration, wound closure, and type I collagen expression were assessed. The involvement of the PINK1/Parkin-mediated mitophagy pathway was analyzed. An in vivo inflammatory wound model was used to evaluate therapeutic efficacy. Yoda1 significantly increased intracellular calcium influx, improved cell viability, reduced oxidative stress, restored mitochondrial membrane potential, and inhibited apoptosis in LPS-treated HGFs. It also enhanced HGFs migration, wound closure, and type I collagen expression in vitro. Mechanistically, these effects were associated with activation of the PINK1/Parkin-mediated mitophagy pathway. In vivo, Yoda1 accelerated wound closure, accompanied by increased collagen deposition and improved tissue regeneration. Activation of Piezo1 by Yoda1 can alleviate its inflammatory damage by restoring mitochondrial homeostasis and regulating the cellular functions of HGFs. Piezo1 may be a promising therapeutic target for promoting maxillofacial wound repair.
Artificial intelligence (AI), particularly large language models (LLMs), is increasingly applied to radiographic interpretation in healthcare. In dentistry, radiographic imaging is essential for diagnosis and treatment planning, yet remains subject to variability and human error. AI may enhance diagnostic accuracy and consistency. To evaluate and compare the diagnostic accuracy, consistency, and interpretive performance of multimodal AI models-ChatGPT, Grok, and MANUS-with expert radiologists in dental radiograph interpretation. A total of 120 anonymised radiographs (40 OPGs, 40 periapical, 40 CT slices) were selected from validated academic sources. Two board-certified oral and maxillofacial radiologists established gold standard diagnoses. Each image was independently assessed by the three AI models under standardised prompting. Diagnostic accuracy and intra-model consistency were analysed using descriptive statistics, Cohen's kappa, McNemar's test, and logistic regression. In the first assessment, MANUS and ChatGPT achieved 92.5% accuracy (111/120), while Grok reached 88.3% (106/120). Performance improved in the second round: MANUS 95.0%, ChatGPT 93.3%, and Grok 90.8%, compared with 96.7% for radiologists. ChatGPT showed the highest reproducibility (κ = 0.937), whereas MANUS demonstrated the highest overall accuracy. Strong agreement was observed between ChatGPT and MANUS, with greater variability in Grok. No significant systematic bias was detected between AI outputs and radiologist benchmarks. The evaluated LLMs demonstrated diagnostic performance comparable to expert radiologists. MANUS excelled in accuracy and ChatGPT in reproducibility, supporting their potential as adjunct tools in dental radiology, while maintaining the need for expert oversight.Clinical trial number: Not applicable.
Technology-assisted planning is increasingly integrated into reconstructive plastic surgery, including virtual reality, augmented reality, and three-dimensional (3D) printing. 3D printing has been especially useful in maxillofacial surgery, both for patient-specific cutting guides for osteotomies and for biomodels to customize osteosynthesis plates. However, to our knowledge, there have been no reports of a 3D-printed cutting guide to harvest a custom iliac crest bone flap based on the deep branch of the superficial circumflex iliac artery perforator (SCIP) flap, together with a biomodel of the foot skeleton with the bone defect for intraoperative use. We report a 36-year-old man with a 45-mm bone defect of the first metatarsal and a 9 × 8 cm skin defect on the dorsum of the right foot after firearm trauma. Computer-aided design and computer-aided manufacturing (CAD/CAM) using open-source software were used to prepare a cutting guide that allowed harvesting a bone flap of precise dimensions and a biomodel that enabled intraoperative adjustment of the flap without pedicle division. Reconstruction was achieved with a 45-mm bone flap based on the deep branch of the SCIP and a 9 × 8 cm skin flap based on the superficial branch of the SCIP. Both flaps survived without complications; bone consolidation was observed at 4 months, and at 10 months, the patient had an adequate, pain-free gait. This case illustrates that an open-source, low-cost 3D-printing workflow may be a useful adjunct for planning and execution of metatarsal reconstruction with osteocutaneous free flaps.
Maxillofacial bone defects pose significant clinical challenges due to unresolved inflammation, mechanical instability, and insufficient vascular integration. To address these limitations, we designed a multifunctional Ca/SrP microflower-doped triple-network hydrogel (MFs@PPB) engineered with polyethylene glycol diacrylate (PEGDA), poly(vinyl alcohol) (PVA), and borax to create a hydrogel with superior mechanical strength, self-healing properties, and adhesive interfaces. The triple-network structure enables dynamic self-healing under mechanical stress, while its bioactive ionic release, particularly strontium (Sr2+), modulates macrophage polarization, suppressing pro-inflammatory M1 macrophages and promoting pro-regenerative M2 polarization. This coordinated immunomodulation fosters angiogenesis and osteogenesis. The hydrogel's unique composition allows precise conformance to irregular mandibular defects, ensuring stable scaffold integration. In vivo, MFs@PPB effectively initiates immunomodulation to suppress chronic inflammation, followed by functional vascular network formation and biomimetic bone deposition, outperforming conventional strategies in structural and functional restoration. This study introduces a biomaterial strategy that bridges immune reprogramming with bioactive material properties, offering a transformative solution for mandibular reconstruction by overcoming the inflammation-regeneration paradox. The harmonized integration of immune modulation, angiogenic activation, and osteoinductive signaling within a single platform has broad implications for regenerative medicine.
To evaluate the long-term mineralizing effects of an experimental ion-releasing, short fiber-reinforced flowable composite (SFC-active) applied to human teeth with molar-incisor hypomineralization (MIH). A total of 16 first permanent molars, extracted due to MIH, received two occlusal restorations each. All cavities were acid-etched for 15 seconds before applying the restorative materials. One of the cavities in each tooth was restored with a commercial conventional particulate-filled composite (PFC; G-aenial Universal Injectable) after placement of the SFC-active liner. The other cavities were restored without the liner, using PFC alone (n = 8) or resin-modified glass ionomer cement (RMGIC; Fuji II LC) alone (n = 8). The teeth were stored in simulated body fluid at 37°C for 30 months. The mineralization effect was assessed at three regions (coronal, middle, and apical) under the restorations using micro-computed tomography (CT) (dentin density), micro-indentation (dentin hardness) and scanning electron microscopy/energy-dispersive spectroscopy (microstructure and calcium-to-phosphorus [Ca/P] ratio) analyses. Micro-CT analyses revealed no statistically significant differences (p > 0.05) in dentin mineral density between the restorative materials at any of the three regions beneath the restorations. At the coronal region of interface, dentin hardness was higher with SFC-active than with PFC, but lower than with RMGIC (p < 0.05). The Ca/P ratios of dentin varied beneath the different restorations, ranging from 1.49 to 1.60, with the highest ratios observed at the coronal region of the interface with SFC-active. Strontium and fluorine were detected in the dentin adjacent to the RMGIC restorations. SFC-active demonstrated a positive mineralizing effect on dentin, reflected by higher hardness and Ca/P ratios at the coronal region of the interface. These findings indicate that SFC-active is a promising restorative material for the management of MIH-affected teeth.
Displacement of dental implants into the maxillary sinus is an uncommon yet clinically significant complication in implant dentistry. Migration toward the maxillary sinus ostium is rare and presents unique management challenges. This case report describes a 75-year-old woman who experienced intraoperative implant displacement into the left maxillary sinus during full-arch rehabilitation. Initially positioned at the sinus floor, the implant was later found at the ostium on cone-beam computed tomography one week after the incident, likely due to patient head movement. The patient reported mild discomfort but showed no signs of sinusitis or oroantral communication. Declining endoscopic surgery, she opted for a less invasive intraoral approach under local anesthesia. A custom-modified dental explorer with a notched tip was designed to securely engage the implant threads. A lateral sinus window was created, and indirect visualization was achieved using rhodium-coated mirrors. The implant was successfully retrieved through the intraoral route, and the sinus entry was sealed using a Bichat fat pad graft. Postoperative management included antibiotics, nasal decongestants, and analgesics. Healing progressed uneventfully, with no complications observed at 10-day, one-month, and three-month follow-ups. This case underscores the potential for dynamic implant migration within the sinus and demonstrates the effectiveness of customized instrumentation and early intervention in achieving successful, minimally invasive retrieval without the need for endoscopic techniques.
Achieving adequate concentrations of beta-lactam antibiotics in patients with severe infections is challenging, and therefore therapeutic drug monitoring (TDM) would be optimal for guiding beta-lactam dosing, but is often limited by availability. UV/VIS spectrophotometry can quantify drug levels in saline, and if those levels truly reflect plasma concentrations, it could enable bedside TDM. We set out to determine whether ultraviolet and visible light range (UV/VIS) spectrophotometry can accurately estimate plasma meropenem concentrations in patients with severe infections compared with liquid chromatography with tandem mass spectrometry (LC‑MS/MS). Blood samples were collected before the first meropenem dose, or if not possible, at least 24 h after the last meropenem dose (baseline), and 2 h after administration. Total plasma concentrations were determined by LC‑MS/MS. A total of 36 patients and 59 samples were included. The correlation between absorbance and meropenem concentrations was r2 = 0.44 in after administration samples and r2 = 0.18 for the difference between after administration and baseline samples. In Bland-Altman plots the bias and limits of agreement were 0.00 (-29.7 to 29.7) mg/L when meropenem concentrations were estimated using the equation on the basis of the correlation between absorbances and meropenem concentrations, 1.32 (-28.5 to 31.2) mg/L when the standard curve in saline was used to estimate meropenem concentrations, and 2.6 (-23.8 to 29) mg/L when using the correlation between the difference in absorbance versus meropenem concentrations between after administration and baseline samples. In patients with severe infections, UV/VIS spectrophotometric estimation of plasma meropenem concentrations currently lacks the precision to estimate meropenem measured by LC‑MS/MS. NCT04282785, 25/02/2020.
The repair of dental pulp injury is the cornerstone of vital pulp therapy. Traditional research has predominantly focused on the roles of immune cells, vascular endothelial cells, and dental pulp stem cells, often overlooking the active regulatory functions of the sensory neural network. Sensory nerve fibers constitute nearly 40% of the dental pulp volume, and their released neuropeptides, such as calcitonin Gene-Related Peptide (CGRP), are hypothesized to coordinate the repair process via intercellular communication. This study aims to systematically elucidate the molecular mechanisms by which sensory nerves and their key neuropeptide, CGRP, regulate angiogenesis and the activation of stromal cells within the injured pulp microenvironment, thereby providing a theoretical basis for novel pulp regeneration strategies targeting neural signaling pathways. The cell-cell communication network in dental pulp was using single-cell transcriptome analysis (GSE197289, GSE274562, GSE280528). A series of in vitrocellular experiments, including qPCR, Western blot, immunofluorescence, scratch wound healing assay, and tube formation assay, were employed to evaluate the effects of CGRP on cell migration, angiogenesis, and mineralization. A mouse model of dentin-pulp injury was established, and the in vivoangiogenic changes were validated through intervention with the CGRP receptor antagonist BIBN4096BS. RNA sequencing was conducted to analyze the transcriptional reprogramming of human dental pulp cells (DPCs) induced by CGRP. Single-cell communication analysis revealed intensive CGRP signaling interactions between sensory neurons, endothelial cells, and dental pulp cells. In vitroexperiments demonstrated that CGRP directly enhanced the tube-forming and migratory capabilities of human umbilical vein endothelial cells (HUVECs) and upregulated the expression of CD31/VEGFA. Furthermore, CGRP potentiated the mineralization of dental Pulp Stem Cells (DPSCs) via a paracrine mechanism. Concurrently, CGRP significantly accelerated the migration of DPCs, and the conditioned medium from CGRP-pretreated DPCs enhanced endothelial tube formation, a mechanism involving the upregulation of VEGFA and the activation of IL-17/TNF signaling pathways. In vivoexperiments confirmed that inhibition of CGRP signaling significantly reduced angiogenesis (CD31+ signals) in the injured pulp area of mice. This study elucidates that the sensory neuropeptide CGRP drives a "neuro-vascular-stromal cell" collaborative network during pulp repair through dual pathways: directly activating endothelial cell function and indirectly modulating the paracrine profile of dental pulp cells (e.g., upregulating VEGFA), thereby promoting angiogenesis and stem cell differentiation. This discovery not only deepens the understanding of the self-repair mechanisms of dental pulp but also offers a new perspective for developing precise vital pulp therapy strategies targeting CGRP signaling, such as modulating the neuro-microenvironment interaction.
Social media has fundamentally altered the landscape of health communication, creating new opportunities for patient education, peer support, and clinical engagement in medical practice. Platforms such as Facebook, YouTube, X (formerly Twitter), and Instagram now serve as primary conduits for health information, enabling patients with acute and chronic conditions to seek guidance, compare clinical experiences, and build supportive communities. Literature shows that well-implemented social media strategies can improve self-management behavior, medication adherence, and disease awareness across diverse patient populations. However, these gains are counterbalanced by substantive risks, including the proliferation of misinformation amplified by automated bots, ethical dilemmas surrounding professional boundaries and patient confidentiality, and the uneven quality of user-generated health content. Artificial intelligence (AI) is increasingly being integrated with social media channels to provide personalized, scalable health information and chatbot-assisted patient education. This narrative review examines current literature to delineate the scope and prospects of social media for patient education and engagement and to propose best practices for clinicians navigating this rapidly evolving digital environment.
Various non-living models have been developed and showed their different characteristics for microvascular anastomosis training, but each has limitations. The aim of this study was to evaluate the training efficiency and the practicality of a novel 3D-printed model designed to address these shortcomings. Sixty postgraduate students from the School of Stomatology were randomly assigned to either the 3D-printed model group or the chicken wing group to perform end-to-end anastomosis. After training, participants performed end-to-end anastomosis on the caudal artery of live rats to assess the training effect. Procedures were recorded and evaluated by two blinded experts using the validated Objective Structured Assessment of Technical Skills (OSATS) scoring system. A post-training questionnaire was also administered to gather participants' feedback on the models. Compared with pre-training, OSATS scores improved significantly in both the chicken wing group (from 9.083 ± 0.736 to 22.330 ± 1.252, P < 0.000) and the 3D-printed model group (from 8.750 ± 0.880 to 23.080 ± 1.158, P < 0.000). However, the magnitude of improvement did not differ significantly between the two groups (mean difference in change: 1.083 ± 0.970, P = 0.290). In addition, the post-training questionnaire revealed that participants were more likely to recommend the 3D-printed model for microvascular anastomosis training (P = 0.013). The 3D-printed model demonstrated a similar training effect to the chicken wing model for microvascular anastomosis. It can be considered a viable alternative to the chicken wing model in microvascular anastomosis training.
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To explore the prevalence of discrepancies between estimated and actual orthodontic treatment duration and identify predictors of treatment delays. A total of 96 patients (62.5% female; age = 15.6 ± 6.8 years) who completed an orthodontic treatment with pre-adjusted edgewise fixed appliances between 2015 and 2023 were retrospectively included. Differences between actual and estimated treatment duration >3 months were classified as discrepancies and categorized as "overestimation" or "underestimation." Such discrepancies were compared on demographics, COVID period, and orthodontic parameters using Student's t-tests and chi-square tests, as appropriate. Predictors of underestimated treatment duration were assessed with logistic regression analysis. Actual treatment duration significantly differed from the estimated duration (26.5 ± 9.6 vs. 21.6 ± 3.6 months; P <0.001), with 65.6% cases exhibiting treatment discrepancy (P = 0.003) and 61.5% of them being underestimated (P = 0.032). Cases with underestimated durations more commonly displayed posterior crossbite (30.9% vs. 5.4%; P = 0.004), larger SNA angle (83.7 ± 3.7 vs. 78.8 ± 3.8; P = 0.005), bracket debonding (53.4% vs. 31.4%; P = 0.039; odds ratio [OR] = 2.51, 95% confidence interval [CI] = 1.04-6.04), and were most likely conducted during COVID period (33.9% vs. 10.8%; P = 0.011; OR = 4.23, 95% CI = 1.31-13.62) compared to overestimated ones. Posterior crossbite (P = 0.006) and COVID period (P = 0.007) were significant predictors of treatment underestimation. Approximately two-thirds of orthodontic treatments showed discrepancies between estimated and actual duration, with 61.5% being underestimated especially in presence of posterior crossbite and during COVID period. Why orthodontic treatment takes longer than expected?Why was this study done? People who start orthodontic treatment with braces often want to know how long their treatment will last. Knowing the expected treatment time is important because it affects motivation, comfort, and overall satisfaction. However, orthodontic treatment does not always go as planned, and treatment may take longer than expected. When this happens, patients and families may feel frustrated or disappointed. This study aimed to understand how often orthodontic treatment lasts longer than expected and why this happens. What did the researchers want to find out? The researchers wanted to find out which factors are linked to longer-than-expected orthodontic treatment time. They expected that certain bite problems or unexpected events could increase treatment length. What did the researchers do? The research team looked at 96 patients who received orthodontic treatment at a university dental clinic. For each patient, they compared the estimated treatment time given at the start with the actual time it took to complete treatment. They also looked at common features among patients whose treatment lasted longer than expected. What did the researchers find? In approximately two out of three patients, the estimated treatment time was not accurate. In most cases, treatment lasted longer than expected by about 4 months. These patients most likely had a posterior crossbite (a problem with how the back teeth fit together) or their treatments were carried out during the COVID-19 pandemic. What do the findings mean? Estimating orthodontic treatment time in advance is challenging, even for experienced clinicians. Some factors that affect treatment length cannot be predicted at the start of care. Clear communication with patients and families about the possibility of delays is needed. Setting realistic expectations will improve patient satisfaction.
Vibrio parahaemolyticus, a major seafood-borne pathogen, causes human gastroenteritis and significant aquaculture economic losses. While bacteriophage lysins show promise against bacterial pathogens, their effectiveness against Gram-negative species remains limited by outer membrane impermeability. Through computational analysis, we identified 893 Vibrio-targeting lysins and selected 25 representatives using sequence similarity networks and biochemical parameters. Ten novel lysins, including LysV569, were successfully expressed and 5 of them were able to reduce V. parahaemolyticus ATCC 17802 by more than 2 log10 CFU/mL without outer membrane permeabilizers. LysV569 demonstrated dose- and time-dependent bactericidal activity against V. parahaemolyticus ATCC 17802. Impressively, after pre-incubation for 30 min over a wide temperature range (4 °C to 85 °C), it retained >99% of its activity, demonstrating exceptional thermostability. At 100 μg/mL, LysV569 removed 96.6% of existing biofilms (with EDTA), inhibited >95% new biofilm formation within 24 h (without EDTA) and reduced bacterial load by 2-3 log10 CFU/mL on salmon and food-contact surfaces. This work identified a promising candidate for the control of V. parahaemolyticus in food and environmental settings.
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Major salivary gland carcinomas (MSGCs) are rare, heterogeneous malignancies with high recurrence rates. Recurrent-metastatic (RM) MSGCs frequently represent a clinical challenge due to their unpredictable behavior and the absence of established prognostic markers for the disease course of relapsed disease. This multicenter retrospective study, involving 10 tertiary centers worldwide, included patients affected by loco-regional and/or distant relapse after surgery with curative intent. The study aimed to analyze residual survival (recurrent-metastatic survival, RMS) and identify key prognostic factors to support personalized treatment strategies, especially for exclusive loco-regional and distant recurrences. Among 212 patients, the median disease-free interval (DFI) after the initial treatment was 14 months, with a 1-year RMS of 58.1% (95% CI, 51.6-65.6%). Longer DFI (>30 months), adenoid cystic carcinoma histology, loco-regional recurrence rather than failure at distance, and absence of nodal metastasis (pN0) at initial diagnosis were significantly associated with a better residual overall survival. In patients with exclusive loco-regional recurrence, independent positive prognostic factors included DFI, salvage surgery, primary low-grade tumor, and lower pT classification. In contrast, for patients with exclusive distant metastasis, longer DFI (>30 months) and the type of intervention (metastasectomy for oligometastatic disease) were independent prognosticators. Disease-free interval is a key prognostic factor for the residual overall survival after a recurrence event. Primary tumor characteristics were associated with survival outcomes in the loco-regional recurrent setting, but not if the recurrence is at distance. Whenever feasible, salvage surgery for loco-regional recurrence and metastasectomy for oligometastatic disease may be considered in highly selected patients.
Disc perforation represents an advanced stage of temporomandibular joint degeneration, and the optimal arthroscopic treatment remains controversial. The study purpose was to evaluate and compare the outcomes of 3 arthroscopic techniques-level II arthroscopy, discopexy, and discectomy-for disc perforations, and to identify variables associated with better results. This prospective nonblinded cohort was conducted between 2022 and 2024 at a tertiary center (Clinica Bupa Santiago). The study included subjects with arthroscopically confirmed disc perforation. Exclusion criteria were prior open joint surgery, systemic connective tissue disease, incomplete imaging or operative data, and loss to follow-up. The predictor variable was arthroscopic technique. Subjects were allocated to level II, discopexy, or arthroscopic discectomy based on intraoperative findings. The primary outcomes were pain, measured using a visual analogue scale (0 to 10), and maximum interincisal opening (MIO, mm), assessed preoperatively and at 1 week, and 1, 2, 3, and 6 months postoperatively. The covariates were demographic, clinical, and imaging variables. Associations between clinical, imaging, and intraoperative variables and the arthroscopic treatment type were examined using χ2, Fisher's exact, and Kruskal-Wallis tests. Independent predictors were identified through multinomial logistic regression. Variables with the highest discriminative performance (based on area under the curve and likelihood ratios) were subsequently integrated into a clinical decision algorithm to support treatment selection. Statistical significance was set at P< .05. The sample included 99 joints from 75 subjects (mean age 41.2 ± 12.8 years; 60 females, 80%). At 6 months, pain and MIO improved significantly in all groups (P< .001), with no between-group differences for pain (P= .3) or MIO (P= .6). Disc perforation ≥7 mm, prior arthrocentesis, and crepitus were independently associated with treatment selection (odds ratios: 2.20, 5.81, and 4.03). The combination of perforation ≥7 mm and crepitus showed the highest discriminative ability for discectomy (area under the curve= 0.83; likelihood ratios+= 3.10). All 3 arthroscopic techniques were associated with significant reductions in pain and improvements in MIO. Preoperative and intraoperative findings, particularly disc perforation size, joint crepitus, and prior arthrocentesis demonstrated discriminatory value in guiding the selection of the most appropriate arthroscopic treatment.
Interleukin-33 (IL-33) and its receptor Suppression of tumorigenicity 2 (ST2), along with IL-10 and IFN-γ, exert contrasting roles in tumor growth, immune evasion, and host defense. IL-33/ST2 signalling can either promote tumor progression or, in some contexts, enhance anti-tumor immunity. However, the role of serum IL-33 and soluble ST2 in Oral squamous cell carcinoma (OSCC) or its precursor, Oral potentially malignant disorders (OPMDs), remains largely unexplored. To evaluate whether IL-33 and ST2, in conjunction with their interactions with IL-10 and IFN-γ, influence tumor dynamics in OSCC, as reflected in their serum levels. Ninety participants were enrolled in this cross-sectional observational study and divided into three groups: Healthy controls (HC) (n = 30), OPMDs (n = 30), and OSCC (n = 30). Clinicopathological data were recorded, and 5 mL of venous blood was collected from each subject prior to treatment. Serum IL-33, soluble ST2, IL-10, and IFN-γ levels were quantified using ELISA. The data were analysed by applying the Kruskal-Wallis/Mann-Whitney U-tests, Receiver operating characteristics (ROC) curve analysis, DeLong's test and binomial logistic regression (BLR), with significance set at p < 0.05. The analysis demonstrated a progressive and significant increase in IL-33, ST2, and IL-10 levels from HC to OPMDs to OSCC (p < 0.001). In contrast, IFN-γ levels exhibited a significant inverse trend, being highest in OPMDs, comparable in HC, and lowest in OSCC (p < 0.001). Immune mediators in OSCC showed significant associations with clinicopathological parameters, including tumor stage, depth of invasion, lymph nodal metastasis (LNM), tumor budding, and surgical margin status (p < 0.05). Serum IL-10 was the strongest positive predictor, effectively discriminating lymph node status (LNS). IL-33 and soluble ST2 showed positive trends toward predicting LNM with high classification accuracy. ROC analysis showed excellent discriminatory ability of all immunomodulatory mediators for distinguishing OSCC from OPMDs. Although soluble ST2 had the highest AUC, DeLong's test (p = 0.592) showed no significant difference, indicating comparable diagnostic potential. BLR confirmed their diagnostic relevance, with elevated IL-33, soluble ST2, and IL-10 increasing the odds of OSCC, while higher IFN-γ reduced the risk. The panel of immunomodulatory mediators analysed here reflects a biologically relevant shift toward pro-tumorigenic inflammation and immune evasion, underscoring their role as biomarkers of malignant progression. Collectively, these immunomodulatory mediators demonstrated strong diagnostic accuracy in differentiating OSCC from OPMDs and showed potential for risk stratification.
Intensified collaboration between general practitioner surgeries and emergency departments has led to more efficient triage and patient flow. Emergency departments now focus on more complex cases, while dental emergencies do not primarily fall within their scope of care. This study explores the experiences of emergency department staff of the organization of emergency dental care. Although dental care primarily is a responsibility of primary care providers, emergency department staff are frequently confronted with dental issues. Of emergency departments 79% report having no collaboration with an on-call dentist. In cases of dental emergencies, 76% of emergency departments require patients to contact a dentist themselves. Case studies indicate that dental issues often are not immediately referred to a dentist, resulting in delay and unnecessary strain on healthcare services. Collaboration is necessary to improve the quality and efficiency of emergency care and for better integration of dental emergency care into the emergency care system. De intensievere samenwerking tussen huisartsenposten en spoedeisende hulp-afdelingen heeft geleid tot effici ntere triage en doorstroming van pati nten. Spoedeisende hulp-afdelingen richten zich nu op complexere situaties, waarbij tandheelkundige spoedzorg niet primair tot hun taken behoort. Onderzocht werden de ervaringen van medewerkers op spoedeisende hulp-afdelingen met de organisatie van tandheelkundige spoedzorg. Hoewel tandheelkundige zorg in de eerste lijn thuishoort, worden medewerkers van spoedeisende hulp-afdelingen regelmatig geconfronteerd met tandheelkundige klachten. Van deze afdelingen heeft 79% geen samenwerking met een dienstdoende tandarts en gebruikt 76% bij tandheelkundige spoedklachten een koude overdracht , waarbij pati nten zelf contact moeten opnemen met een tandarts. Casu stiek geeft aan dat pati nten met tandheelkundige klachten vaak niet direct bij een tandarts terechtkomen, wat leidt tot vertraging en onnodige zorgdruk. Er zal moeten worden samengewerkt om de kwaliteit en effici ntie van spoedzorg te verbeteren en tandheelkundige spoedzorg beter te integreren in de acute-zorgketen.