Search Results (4,441)

In Melbourne, Australia, strict ‘lockdowns’ were implemented in 2020 to suppress COVID-19, significantly disrupting daily life. Young people (<18 years) with medical conditions have an elevated risk of mental health problems and may have been disproportionately affected by the distress associated with the COVID-19 restrictions. To investigate this, we conducted a single-site, longitudinal cohort study involving the parents of 135 children and adolescents with medical conditions. Using an adapted version of the CoRonavIruS Health Impact Survey (CRISIS), parents rated their child’s mental health, activities and healthcare experiences pre-COVID-19 (retrospectively), during lockdown and 6 months post-lockdown. General linear mixed models revealed that mental health symptoms, including anxiety, fatigue, distractibility, sadness, irritability, loneliness and worry, were higher during lockdown compared to pre-COVID-19. Notably, anxiety, sadness and loneliness remained elevated 6 months post-lockdown. Covariates such as older child age, increased parent stress and child screen time contributed to greater mental health difficulties. While most mental health symptoms resolved post-lockdown, the persistence of anxiety, sadness and loneliness highlights the need for ongoing clinical monitoring for young people with medical conditions during periods of community stress and restrictions. Full article

Background/Objectives: Oral cancers in patients with proliferative verrucous leukoplakia (PVL-OSCC) exhibit different clinical and prognostic outcomes from those seen in conventional oral squamous cell carcinomas (cOSSCs). The aim of the present study is to compare the genome-wide DNA methylation signatures in fresh frozen tissues between oral squamous cell carcinomas in patients with PVL and cOSCC using the Illumina Infinium MethylationEPIC BeadChip. Methods: This case–control study was carried out at the Stomatology and Maxillofacial Surgery Department of the General University Hospital of Valencia. For the epigenomic study, unsupervised exploratory bioinformatic analyses were performed using principal component and heatmap analysis. Supervised differential methylation analyses were conducted using a rank-based regression model and a penalized logistic regression model to identify potential prognostic biomarkers. Results: The unsupervised analyses of the global methylation profiles did not allow us to differentiate between the distinct oral cancer groups. However, the two supervised analyses confirmed the existence of two oral carcinoma phenotypes. We identified 21 differentially methylated CpGs corresponding to 14 genes. Among them, three CpGs had not been previously assigned to any known gene, and the remaining were associated with genes unrelated to oral cancer. The AGL, WRB, and ARL15 genes were identified as potential prognostic biomarkers. Conclusions: This study emphasizes the significant role of epigenetic dysregulation in OSCC, particularly in cases preceded by PVL. We have provided data on differential methylation genes that could be involved in the molecular carcinogenesis of PVL-OSCC. Full article

Background/Objectives: Interincisive midline deviation is frequent. Determining the cause (dental versus skeletal) is crucial for treatment planning. This study assessed the null hypothesis that neither clinical dental midline shift nor the temporomandibular disorder (TMD)-affected side correlate with maxillary/mandibular asymmetry. Methods: Thirty-eight CBCT scans were analyzed: thirty-five (92.1%) females, three (7.9%) males; mean (SD) age 34.6 (11.9) years old. Tomographic images were acquired using the i-CAT^® Imaging System; mandibular/maxillary measurements were obtained with the Planmeca Romexis^® software v.6.This is an ancillary study of a clinical trial (NCT02144233) that included chronic pain (TMD diagnosis; DC/TMD criteria), fully dentate, and stable normo-occlusion participants. Results: We found sixteen (42.1%) dental midline deviations to the right and thirteen (34.2%) to the left. In the study population, the right side was more developed: a hemimandible length of 119.4 (5.7) mm versus 118.6 (5.3) mm for the right and left sides, respectively (95% CI 0.21 to 1.51), p = 0.01. Conclusions: Neither the dental midline shift side nor the affected side predicted a less developed hemimandible. Full article

Background and Objective: The aim of this systematic review was to assess clinical trials on the efficiency of sinus lift techniques with and without bone grafting in the atrophic posterior maxilla. Materials and Methods: This article was written under the PRISMA and the Cochrane Handbook for Systematic Reviews of Interventions guidelines. PubMed, Scopus, and Web of Science databases were electronically searched until December 2023. The risk of bias was assessed according to Cochrane Risk of Bias tool guidelines. Statistical analysis was performed for implant survival rate (ISR), marginal bone loss (MBL), and endo-sinus bone gain (ESBG). Results: At the end of the electronic search, 5 clinical trials were considered eligible. Statistical analysis was achieved for osteotome sinus floor elevation. The ISR at 3 years had a risk ratio (RR) of 0.98 [0.90, 1.07] (CI 95%), p = 0.7, and at 5 years, RR 1.02 [0.93, 1.11] (CI 95%), p = 0.68. The MBL, at 3 years, indicated a weighted mean difference (WMD) of 0.01 [−0.15, 0.16] (CI 95%), p = 0.93, and at 5 years, WMD of −0.08 [−0.53, 0.37] (CI 95%), p = 0.73. ESBG at 3 years had a WMD of −0.44 [−1.05, 0.17] (CI 95%), p = 0.16, and at 5 years, WMD of −0.61 [−1.63, 0.41] (CI 95%), p = 0.24. Conclusions: The available evidence underlines that the osteotome sinus floor elevation technique without bone graft may be used. Full article

Objectives: This study aimed to compare the effects of surgically assisted rapid palatal expansion (SARPE) techniques and their combinations on the stresses (von Mises, maximum principal, and minimum principal) and displacements that occur in the maxilla, facial bones, and maxillary teeth using three-dimensional finite element analysis (FEA). Methods: SARPE was simulated using seven different osteotomy techniques. The FEA models were simulated with a combination of various osteotomies, including midpalatal and lateral osteotomies, lateral osteotomy with a step, and separation of the pterygomaxillary junction. For each osteotomy variant, the instantaneous displacements and stresses resulting from forces applied by a 1 mm expansion of a tooth-borne appliance were evaluated. Results: Midpalatal osteotomy increased lateral displacement in the alveolar bone margins and intermaxillary suture while significantly reducing stresses around the intermaxillary suture. The addition of a pterygomaxillary osteotomy to the midpalatal and lateral osteotomies effectively reduced stresses in the posterior maxilla and cranial structures while enhancing lateral displacement. Although lateral osteotomy significantly reduced stresses in the midface, its effect on maxillary expansion was limited. Stepped lateral osteotomy had minimal effects on transverse displacement and stress reduction. Conclusions: Increasing the number of osteotomies reduced stress levels in the maxilla while enhancing lateral displacement. These results highlight the importance of selecting the most appropriate osteotomy technique to achieve optimal outcomes. Full article

Background/Objectives: Computer-assisted mandibular reconstruction requires sophisticated technical expertise alongside surgical knowledge. This study aims to establish and validate an efficient collaborative protocol between oral and maxillofacial surgeons and bioengineers for virtual surgical planning in mandibular reconstruction. Methods: We developed a structured protocol with four sequential phases: (1) generation of 3D models from CT data, (2) virtual resection planning, (3) reconstruction design, and (4) surgical guide fabrication. Protocol efficiency was assessed through seven simulation trials measuring planning duration and required revisions. Clinical validation was performed in four mandibular reconstruction cases. Accuracy was evaluated by comparing virtual surgical plans to postoperative outcomes using 3-matic 13.0 software analysis. Results: Protocol implementation showed consistent efficiency across simulations with a mean planning duration of 2.86 working days (SD = 1.35). Only two of seven simulations required design revisions. Clinical application in four cases (three ameloblastomas, one odontogenic myxoma) demonstrated high precision with a mean virtual-to-actual discrepancy of 0.90 mm (SD = 0.34). Successful reconstructions were achieved across varying defect spans (29–53 mm) using both bicortical deep circumflex iliac artery (DCIA) flaps and monocortical iliac block bone grafts. The collaborative workflow resulted in optimized surgical guide design, reduced planning iterations, and improved surgical precision. Conclusions: The established surgeon–bioengineer collaborative protocol enhances the efficiency and accuracy of computer-assisted mandibular reconstruction while making advanced surgical planning techniques more accessible. While initial results are promising, future studies with larger patient cohorts and extended follow-up periods are needed to fully validate the protocol’s long-term benefits and broader applicability. Full article

Background/Objectives: Kynurenine aminotransferase II (KAT-II) is a target for treating several diseases characterized by an excess of kynurenic acid (KYNA). Although KAT-II inactivators are available, they often lead to adverse side effects due to their irreversible inhibition mechanism. This study aimed to identify potent and safe inhibitors of KAT-II using computational and in vitro approaches. Methods: Virtual screening, MM/GBSA, and molecular dynamics simulations were conducted to identify the top drug candidates, followed by kinetic measurements and in vitro cytotoxicity evaluation. Results: The study showed that two compounds, herbacetin and (-)-Epicatechin exhibited the best scores. Their Glide docking scores are −8.66 kcal/mol and −8.16 kcal/mol, respectively, and their MM/GBSA binding energies are −50.30 kcal/mol and −51.35 kcal/mol, respectively. These scores are superior to those of the standard inhibitor, PF-04859989, which has docking scores of −7.12 kcal/mol and binding energy of −38.41 kcal/mol. ADMET analysis revealed that the selected compounds have favorable pharmacokinetic parameters, moderate bioavailability, and a safe toxicity profile, which supports their potential use. Further, the kinetic study showed that herbacetin and (-)-Epicatechin are reversible KAT-II inhibitors and exhibit a competitive inhibition mechanism. Their half-maximal inhibitory concentrations (IC50) are 5.98 ± 0.18 µM and 8.76 ± 0.76 µM, respectively. The MTT assay for cell toxicity indicated that the two compounds do not affect HepG2 cell viability at the necessary concentration for KAT-II inhibition. Conclusions: These results suggest that herbacetin and (-)-Epicatechin are suitable for KAT-II inhibition and are promising candidates for further development of KAT-II inhibitors. Full article

Oral squamous cell carcinoma (OSCC) is a highly aggressive malignancy with poor prognosis, mainly due to the presence of cancer stem cells (CSCs), a small subpopulation of cells that contribute to therapy resistance and tumor progression. The principal objective of this study was to investigate the role of miRNA-21 in the maintenance of cancer cell stemness and the possibility of altering it. The CD44 antigen was used as a marker for CSC isolation from oral cancer cell cultures. CD44+ and CD44− populations were sorted via magnetic separation. miRNA-21 inhibition was performed in CD44+ cells via transfection. CD44+ cells possessed a significantly higher migration and invasion potential compared to CD44− cells, higher levels of miRNA-21 (p = 0.004) and β-catenin (p = 0.005), and lower levels of BAX (p = 0.015). miRNA-21 inhibition in CD44+ cells reduced migration, invasion, and colony formation while increasing apoptosis. Stemness markers were significantly downregulated following miRNA-21 inhibition: OCT4 (p = 0.013), SOX2 (p = 0.008), and NANOG (p = 0.0001), as well as β-catenin gene (CTNNB1) (p < 0.05), an important member of WNT signaling pathway. Apoptotic activity was enhanced, with a significant downregulation of the antiapoptotic Bcl-2 (p = 0.008) gene. In conclusion, miRNA-21 plays a critical role in the regulation of oral cancer CD44+ cells properties. Targeting and inhibiting miRNA-21 in CD44+ cells could represent a promising novel strategy in OSCC treatment. Full article

Background: Tumors, as intricate ecosystems, comprise oncocytes and the highly dynamic tumor stroma. Tumor stroma, representing the non-cancerous and non-cellular composition of the tumor microenvironment (TME), plays a crucial role in oncogenesis and progression, through its interactions with biological, chemical, and mechanical signals. This review aims to analyze the challenges of stroma mimicry models, and highlight advanced personalized co-culture approaches for recapitulating tumor stroma using patient-derived tumor organoids (PDTOs). Methods: This review synthesizes findings from recent studies on tumor stroma composition, stromal remodeling, and the spatiotemporal heterogeneities of the TME. It explores popular stroma-related models, co-culture systems integrating PDTOs with stromal elements, and advanced techniques to improve stroma mimicry. Results: Stroma remodeling, driven by stromal cells, highlights the dynamism and heterogeneity of the TME. PDTOs, derived from tumor tissues or cancer-specific stem cells, accurately mimic the tissue-specific and genetic features of primary tumors, making them valuable for drug screening. Co-culture models combining PDTOs with stromal elements effectively recreate the dynamic TME, showing promise in personalized anti-cancer therapy. Advanced co-culture techniques and flexible combinations enhance the precision of tumor-stroma recapitulation. Conclusions: PDTO-based co-culture systems offer a promising platform for stroma mimicry and personalized anti-cancer therapy development. This review underscores the importance of refining these models to advance precision medicine and improve therapeutic outcomes. Full article

Background and Objective: Arytenoid dislocation (AD) and subluxation (AS) impact vocal fold mobility, potentially affecting the quality of life. Their management, including the timing and modality of treatment, remains a subject of research. Our primary objective was to assess and compare the available treatment strategies for AS and AD. Material and methods: the protocol was registered on PROSPERO (CRD42023407521). Manuscripts retrieved from a previously published systematic review were evaluated. To comprehensively cover the last 25 years, an updated literature search was conducted, screening PubMed, Scopus, and Cochrane databases. Review Methods: We included studies that reported treatment modalities and the time to treatment (TT) for AS/AD, with outcomes objectively evaluated. Data on treatment success were pooled, and the impact of TT on recovery outcomes was analyzed. Results: Thirteen studies involving 361 patients were included. The majority of cases were attributed to iatrogenic trauma following intubation. Closed reduction (CR) was the primary treatment, with high success rates for both general (success rate: 77%, CI: 62–87%) and local anesthesia (success rate: 89%, CI: 70–97%). The standardized mean difference for the TT effect on treatment outcome was −1.24 (CI: −2.20 to −0.29). Conclusions: The absence of randomized controlled trials and the overall moderate-to-low quality of the studies highlighted the importance of the finding’s careful interpretation. This meta-analysis underscores the effectiveness of CR in managing AS/AD, with both general and local anesthesia yielding high success rates. The findings highlight the importance of TT, suggesting that early intervention is paramount. Future clinical research is needed to further refine these findings and optimize treatment protocols. Full article

Objective: Malocclusion affects oral health and quality of life, emphasizing the critical need to assess the knowledge and practices of healthcare providers in the prevention and treatment of malocclusion. The aim of this cross-sectional study was to investigate the knowledge and practice of Croatian pediatricians and family physicians regarding malocclusion, its causes and its impact on children’s health. Methods: An online self-structured questionnaire with 34 closed-ended questions was distributed to pediatricians and general practitioners throughout Croatia. The questionnaire addressed demographic data, knowledge of the causes of malocclusion, impact on children’s health and referral practices. Data were summarized in descriptive statistics, and a generalized linear model (GLM) examined the relationships between knowledge, referral practices and sociodemographic factors (p < 0.05). Results: Of 446 participants, including 364 general practitioners and 82 pediatricians (77.8% women), the mean knowledge score was 12.77 ± 3.41 out of 18, with 54.9% scoring at or above the median (Md = 13.00). Pediatricians had a higher mean score (13.77 ± 1.19) than family physicians (12.54 ± 3.60, p = 0.042). A higher level of knowledge was found among physicians working in community health centers (p ≤ 0.001) and among those recommending orthodontic examinations (p = 0.042). Over 90% of pediatricians and family physicians recognized hereditary factors, pacifier use, thumb and finger sucking, bottle feeding, trauma and accidents as causes of malocclusion. In addition, over 80% of respondents reported informing parents about harmful habits that can lead to misaligned teeth, with 100% of pediatricians giving such advice. Conclusions: Pediatricians have better knowledge about malocclusion compared to family physicians, and physicians in community health centers have the highest level of knowledge. It is recommended to improve the training of general practitioners and to promote early orthodontic examinations to improve preventive care. Full article

The purpose of this study was to analyze computer-aided surgical planning (CAS) and margin status following oncological reconstructive surgery of the jaws. A retrospective study was conducted on patients who underwent microvascular reconstructive surgery from 2014 to 2021. The predictor variable was the use of CAS. The primary and secondary outcomes were histopathological bone margin status, local recurrence, and disease-free survival (DFS). Covariates included demographic, operative, pathological, and clinical outcomes. Thirty-five CAS and fifty-two non-CAS subjects were included for analysis. Demographic characteristics such as age, sex, and comorbidities were comparable between the study groups, with all p-values > 0.05. For operative variables, the osteocutaneous radial forearm flap was more commonly used in the non-CAS group (34.6%) compared to the CAS group (2.9%) (p < 0.01). The mean follow-up period was shorter in the CAS group (31.9 months) than in the non-CAS group (42.6 months) (p < 0.01). CAS was not associated with margin status (p = 0.65) or local recurrence (p = 0.08). DFS was comparable between the study groups (p = 0.74). Bone margin involvement was not associated with any covariates. The use of CAS in oncological reconstructive jaw surgery was not associated with increased bone margin involvement. Full article

Background: During the routine removal of osteosynthesis materials after surgical treatment (ORIF) of condylar head fractures (CHFs), as performed at our clinic, localised and sometimes pronounced intra-articular scarring were observed quite regularly. This prospective study therefore investigates the causes of intra-articular scarring and its impact on functionality after surgical treatment (ORIF) of condylar head fractures (CHFs). Methods: Moreover, 80/98 patients with 96/114 CHFs (ORIF between 2014 and 2024) were evaluated when performing hardware removal. Statistical analysis used logistic regression and sign tests. Results: Postoperative scarring was seen in 72/96 cases (75%), either localised (n = 54; 56%) or pronounced (n = 18; 19%). Scarring correlated with limitations of laterotrusion for pronounced scarring (p = 0.016; OR = 6.806; 95% CI [1.422, 32.570]; large effect size) and with limitations of mediotrusion for localised scarring (p = 0.013; OR = 0.236; 95% CI [0.076, 0.734]; very small effect size). Factors favouring localised scarring were reduced ipsilateral dental support (p = 0.022; OR = 3.36; 95% CI [1.191, 9.459]; medium effect size) and major fragmentation (p = 0.029; OR = 3.182; 95% CI [1.123, 9.013]; medium effect size). However, there was no correlation between scarring and types (screws w/wo microplates) or number of osteosynthesis materials. Pronounced scarring showed a significantly higher risk for osseous degenerative complications (p = 0.041; OR = 4.171; CI [1.058, 16.452]; medium effect size). Conclusions: Intra-articular scarring after ORIF of CHFs poses a risk for functional limitations and osseous degenerative changes. Early adhesiolysis during the removal of hardware seems favourable for functional outcomes after CHFs. Full article

Background and Objectives: Up until now, behavioral interventions and pharmacological therapies were the main approach available for the management of obesity. Diet and exercise, when used as a singular therapeutic method, are inadequate for a successful outcome. Research shows promising results for the surgical treatment of obesity, especially in the area of bariatric surgery (BaS). The relevance of this study is the valuable analysis of the evolution of obese patients with increased cardiovascular risk. Materials and Methods: The patients eligible for BaS commonly suffer from multiple chronic conditions, including type 2 diabetes, obstructive sleep apnea, cardiovascular diseases, and non-alcoholic fatty liver disease. Additionally, obesity contributes to an increased probability of developing certain types of cancer, osteoarthritis, urinary incontinence, and chronic kidney disease. In this review, we focused especially on the cardiovascular status of obese patients who underwent bariatric procedures. Results: BaS has been found to be strongly associated with a reduced incidence of severe complications in individuals with a history of myocardial infarction (MI) and severe obesity. Specifically, this procedure is linked to a lower occurrence of major adverse cardiovascular events and a decrease in overall mortality. Also, BaS is correlated with a reduced risk of recurrent MI and the development of new-onset heart failure. Conclusions: The results of BaS involve a significant amelioration of the BMI, contributing to a considerable decrease in cardiovascular risk factors and to a notable refinement in the cardiovascular structure and function. Full article

Objectives: To discuss the prognostic outcomes, controversies and assessment of bone erosion or invasion of oral squamous cell carcinoma (OSCC). Methods: A structured literature review was conducted to critically analyse relevant evidence. The Web of Science database was searched using specific keywords aligned with the review question. After identifying initial studies, their references were also reviewed to include any additional relevant publications, ensuring a comprehensive evaluation of the available evidence. Results: The search identified 11 relevant studies, including 5 from the initial search and 6 from reference review. The significance of bone involvement is unclear in OSCC, with varying definitions of cortical bone erosion and medullary bone infiltration contributing to conflicting results regarding the prognostic significance of bone involvement. The majority of evidence stems from retrospective cohort studies without clear study criteria and a lack of power to draw valid conclusions. Conclusions: There are currently a lack of high-quality studies assessing bone invasion in OSCC. While there appears to be some evidence that medullary bone infiltration is prognostic, further well-designed studies are warranted. Full article