Tag: pubmed

Evid Based Dent. 2026 Aug 1. doi: 10.1038/s41432-026-01245-9. Online ahead of print.

ABSTRACT

BACKGROUND: Ozonated water is increasingly being explored as a gentler alternative to chlorhexidine for chemical plaque control because of its antimicrobial and anti-inflammatory properties and the absence of common side effects such as staining or altered taste. However, the evidence on its effectiveness-especially in healthy individuals-remains unclear. This systematic review and meta-analysis aimed to determine whether ozonated water is more effective than placebo or chlorhexidine mouthwash in reducing dental plaque.

METHODS: An extensive literature search was carried out across PubMed, Cochrane Library, Scopus, Web of Science, LILACS, ScienceDirect, EBSCOhost, and Google Scholar up to August 5, 2025. Randomized controlled trials involving healthy participants and comparing ozonated water with placebo or chlorhexidine were included. In total, five studies were selected for qualitative synthesis, of which four were included in the meta-analysis. Risk of bias was assessed using the RoB 2 tool, and the certainty of evidence was evaluated using the GRADE approach. A random-effects model was applied to calculate standardized mean differences (SMDs) with 95% confidence intervals.

RESULTS: The meta-analysis suggested that ozonated water may provide slightly better short-term plaque reduction than placebo or chlorhexidine (SMD = -1.35; 95% CI: -2.77 to 0.06). However, as the confidence interval crossed the line of no effect, this difference was not statistically significant. Risk of bias was high in one study, unclear in three studies, and low in one study. The overall certainty for plaque reduction was rated as “low”.

CONCLUSION: While ozonated water appears to be a promising short-term option for plaque control-especially for individuals unable to tolerate chlorhexidine-the current evidence is not strong enough to confirm that it works better than standard rinses or even plain water. Well-designed, longer-term clinical trials are needed before ozonated water can be recommended for routine daily use.

PMID:42542467 | DOI:10.1038/s41432-026-01245-9

Eur J Orthop Surg Traumatol. 2026 Aug 1;36(1):314. doi: 10.1007/s00590-026-04883-y.

ABSTRACT

PURPOSE: Renin-angiotensin-aldosterone system (RAAS) inhibitors, including angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs), are commonly prescribed antihypertensive medications with proposed antifibrotic and bone-protective effects. Their impact on outcomes following total shoulder arthroplasty (TSA) remains unclear. This study evaluates the association between perioperative RAAS inhibitor exposure and postoperative outcomes after TSA.

METHODS: A retrospective cohort study using the TriNetX network identified patients undergoing primary shoulder arthroplasty (2005-2025), stratified by ACEi or ARB use. One-to-one propensity score matching was performed. Outcomes included 90-day medical complications and 1-year mechanical complications and revision.

RESULTS: Post-matching, 27,938 patients per cohort (ARB vs. control) and 30,602 per cohort (ACEi vs. control) were included. Neither ARB nor ACEi use reduced rates of manipulation under anesthesia or capsular release at one year. Both cohorts had higher 90-day rates of emergency department visits, readmission, myocardial infarction, and acute renal failure. ACEi use was additionally associated with pulmonary embolism, deep-vein thrombosis, transfusion, and sepsis. At one year, both cohorts showed higher rates of periprosthetic joint infection, aseptic loosening, and revision. Dislocation risk was increased with ACEi use only.

CONCLUSION: Perioperative RAAS inhibitor use was not associated lower rates of antifibrotic procedures following TSA. Instead, RAAS inhibitor use was associated with higher rates of several perioperative medical complications and longer-term surgical events, including infection and revision. ACE inhibitor exposure demonstrated a broader complication profile compared with ARB exposure. However, because patients receiving RAAS inhibitors often have greater comorbidity burden, these findings should be interpreted as associative rather than causal.

LEVEL OF EVIDENCE III: Retrospective Cohort Study.

PMID:42542466 | DOI:10.1007/s00590-026-04883-y

Support Care Cancer. 2026 Aug 1;34(8):820. doi: 10.1007/s00520-026-11054-6.

ABSTRACT

BACKGROUND AND AIM: The increasing incidence of cancer and the fact that the family is an important factor in cancer care; attention to the positive mental health of cancer patients should be sought to provide solutions to improve the mental health of these caregivers. The present study aimed to investigate the effect of web-based education on positive mental health of family caregivers of breast cancer patients undergoing chemotherapy in educational and treatment centers of Zahedan University of Medical Sciences.

MATERIALS AND METHODS: This study is a semi-experimental study. The statistical population of the study included all family members of breast cancer patients undergoing chemotherapy who referred to Imam Ali Hospital in Zahedan in 1402. The samples included 70 people who were randomly assigned to two groups: the intervention group and the control group. Caregivers in the intervention group received the necessary training and education for 20 days through a website prepared by the researcher. Data collection was carried out using the demographic information formula and the 9-question positive mental health questionnaire of Lockett before the intervention and 30 days after the intervention. The data were analyzed using descriptive and analytical tests using SPSS 27 statistical software and independent t-tests, paired t-tests, and chi-square tests.

RESULTS: Before the intervention, there was no significant difference between the two groups in terms of positive mental health (p = 0.43). However, after web-based training, the results of the analysis of covariance (ANCOVA) with adjustment for pre-test scores showed that the positive mental health score in the intervention group was 19.02 ± 3.05, compared to 15.94 ± 2.61 in the control group (p = 0.0001).

CONCLUSION: The findings of this study suggest that web-based educational programs can enhance the positive mental health of family caregivers of breast cancer patients undergoing chemotherapy. Accordingly, such interventions may be considered an effective supportive approach for family caregivers in oncology care settings.

PMID:42542461 | DOI:10.1007/s00520-026-11054-6

Diabetologia. 2026 Aug 1. doi: 10.1007/s00125-026-06807-1. Online ahead of print.

ABSTRACT

AIMS/HYPOTHESIS: The aim of this study was to evaluate hepatic, pancreatic and abdominal fat depots across glycaemic categories in Asian Indians with matched BMI, and to identify predictors of dysglycaemia.

METHODS: In this cross-sectional study, 45 adults (15 each with normoglycaemia or living with prediabetes and newly diagnosed type 2 diabetes) were matched for BMI. Fat fractions in the liver and pancreas were quantified on the basis of the proton density fat fraction (PDFF) measured using multi-echo chemical-shift-encoded MRI (CSE-MRI). We quantified the cross-sectional area of following abdominal fat compartments by MRI: subcutaneous adipose tissue (SCAT) (anterior, posterior, superficial, deep), intra-abdominal adipose tissue (IAAT), intra-peritoneal adipose tissue, retroperitoneal adipose tissue etc. Total body fat (%) and total fat mass (g) were measured using dual-energy x-ray absorptiometry (DEXA). Insulin sensitivity and beta cell function were derived from HOMA indices.

RESULTS: The hepatic fat fraction (HFF) was nearly twofold higher in the prediabetes group (10.78 ± 6.50%) and the type 2 diabetes group (10.35 ± 9.95%) compared with the normoglycaemia group (5.34 ± 4.69%), with significant differences for both comparisons (p=0.009 and p=0.026, respectively). The fat fractions in the pancreas were similarly elevated in individuals living with prediabetes (5.83 ± 4.73%) and type 2 diabetes (5.35 ± 4.75%) compared with the normoglycaemic group (2.97 ± 3.56%, p<0.05). IAAT, superficial SCAT, posterior SCAT and retroperitoneal adipose tissue were significantly higher in individuals living with prediabetes and those with type 2 diabetes than in the normoglycaemic group (p<0.05). Superficial SCAT and posterior SCAT were also significantly higher in individuals living with prediabetes compared to those with type 2 diabetes (p<0.05). After adjustment for age and BMI, only fat fractions in the liver remained an independent predictor of dysglycaemia (OR 1.11 per 1% increase; p=0.023). Each 1% increase in the fat fraction in the liver increased odds of prediabetes by 16% and those of overall dysglycaemia by 11%. HOMA-β was preserved or elevated in individuals living with prediabetes but decreased in those with type 2 diabetes.

CONCLUSIONS/INTERPRETATION: Asian Indians living with prediabetes or type 2 diabetes at a modestly increased BMI of approximately 25 kg/m² exhibit marked ectopic fat. The fat fraction in the liver independently predicted dysglycaemia. These findings highlight the need for early and aggressive interventions at the stage of normoglycaemia and prediabetes to avert beta cell decline and diabetes progression in Asian Indians.

TRIAL REGISTRATION: Clinical Trials Registry of India (CTRI/2023/06/054228).

PMID:42542458 | DOI:10.1007/s00125-026-06807-1

Eur J Pediatr. 2026 Aug 1;185(8):632. doi: 10.1007/s00431-026-07286-7.

ABSTRACT

Sudden Unexplained Death in Youth (SUDY) requires thorough investigation to identify underlying causes and guide prevention strategies. In the Netherlands, cases are investigated using the standardized Postmortem Evaluation of Sudden Unexplained Death in Infants and Children (PESUDIC), in which autopsy is offered as a standard component. However, its invasive nature and associated time burden may limit parental acceptance. This study evaluated to what extent the cause of death can be established using a limited set of diagnostic tests compared to the standard procedure including autopsy. In this observational study, children > 2 years of age who died suddenly and unexpectedly and underwent PESUDIC, including imaging and autopsy, were included. Two expert panels, consisting of a forensic and a pediatric specialist, independently assessed early diagnostic tests available before autopsy. Cases were classified by level of diagnostic certainty and need for autopsy. Panel conclusions were compared with the reference standard: a multidisciplinary audit incorporating all available information, including autopsy findings. Sixty-six cases were included (median age 12 years (IQR 4-14.7), 63% male). Panels identified indicative information for a cause of death in 60 patients (91%). Nevertheless, autopsy was required in most cases (n = 59) to confirm the diagnosis. In 7 cases (10.6%), panels were sufficiently confident to establish the cause of death without autopsy with complete agreement with the reference standard. Causes included obstructive gastrointestinal pathology (n = 5) and diabetic ketoacidosis with dehydration (n = 2).

CONCLUSIONS: Only a small proportion of children > 2 years of age with sudden unexpected death have a cause of death that can be established with sufficient certainty at an early stage. In the vast majority of cases, the cause of death remains uncertain, supporting the recommendation to perform an autopsy.

WHAT IS KNOWN: • Autopsy in sudden unexplained death in youth is worldwide recognized as the gold standard for postmortem examination. However, its invasive nature and associated time burden may limit parental acceptance.

WHAT IS NEW: • In 7 of 60 sudden and unexplained deceased minors (10%), sufficient certainty regarding the cause of death can be obtained by other minimal invasive diagnostic test, so without the need of an autopsy. Causes without the need of an autopsy included obstructive gastrointestinal pathology and diabetic ketoacidosis with dehydration.

PMID:42542442 | DOI:10.1007/s00431-026-07286-7

Eur J Pediatr. 2026 Aug 1;185(8):633. doi: 10.1007/s00431-026-07295-6.

ABSTRACT

Obesity is a chronic relapsing disease leading to weight-related health risks for disorders such as cardiovascular diseases, type 2 diabetes, osteoarthritis, and depression. Many studies focus on these weight-related health risks. However, research on current self-reported social impacts and health complaints is limited. This study aims to investigate self-reported social impact and health complaints, received care aiming at lifestyle change, and perceived effectiveness of this care, by children with obesity and their parents. Secondarily, differences concerning sex, age, obesity-severity and frequency of received care were studied. Questionnaires were collected from children and adolescents aged 0-18 years visiting Obesity Center CGG. Data were analyzed regarding their social impacts, health complaints, received care, and perceived care effectiveness (0-10 scale). Children were categorized into sex, age, BMI, and care categories. Descriptive statistics were performed using chi-square tests and post hoc analyses to examine differences between categories. 86.8% of the patients self-reported experiencing social impact and 92.3% reported health complaints. Most frequently reported social impacts were difficulty to find fitting clothes (70.1%), problems in mobility and sports (63.7%), and bullying (41.6%); most reported health complaints were abdominal pain (38.8%), headache (34.8%), and musculoskeletal pain (34.1%). The dietician (64.1%) was most frequently reported as received care, and effectiveness scores ranged between 0 and 4 out of 10.

CONCLUSIONS: A substantial percentage of patients experience social impacts and health complaints affecting their well-being and quality of life. Low perceived effectiveness of interventions calls for a more innovative and comprehensive care framework incorporating these children’s needs.

WHAT IS KNOWN: • Children with overweight and obesity face a wide range of adverse health consequences and social challenges. • However, the number and types of health issues experienced by children themselves and studying per range of age, BMI-stage or care trajectory have not been systematically investigated.

WHAT IS NEW: • A high percentage of children experience social impacts (87%) and health complaints (70%) aff ecting their well-being and quality of life, and perceived eff ectiveness of lifestyle interventions is low. The main reported healthcomplaints abdominal pain, headache, musculoskeletal pain and snoring loudly were mostly observed in girls withobesity aged 12-18 years, who received three or more care types. • The study demonstrated that perceived treatment effectiveness by children and parents declined with increasingobesity severity.

PMID:42542436 | DOI:10.1007/s00431-026-07295-6

Int J Gynecol Cancer. 2026 Jul 3:104852. doi: 10.1016/j.ijgc.2026.104852. Online ahead of print.

ABSTRACT

OBJECTIVE: Evidence on the clinical utility of baseline human epididymis protein 4 levels and their kinetics in recurrent ovarian cancer remains limited. This study evaluated longitudinal human epididymis protein 4 dynamics in real-world patients treated with platinum-based chemotherapy, aiming to determine the prognostic significance of human epididymis protein 4 kinetic parameters compared with CA125 response and established prognostic factors for progression-free and overall survival.

METHODS: This retrospective analysis included 220 patients with recurrent epithelial ovarian cancer treated with second-line platinum-based chemotherapy between 2000 and 2020. Four mathematical models were tested to describe human epididymis protein 4 kinetics, with model selection based on goodness of fit, visual predictive checks, and prognostic performance. The prognostic value of the most informative human epididymis protein 4 kinetic parameter (the modeled residual human epididymis protein 4 level), was assessed in univariable and multi-variable analyses.

RESULTS: Among the 93 assessable patients, no clear associations were observed between baseline human epididymis protein 4 levels and disease characteristics. Longitudinal human epididymis protein 4 kinetics differed from those of CA125 and showed an initial decline followed by a plateau at approximately 40 days. The best-fitting model was a mono-exponential decline incorporating the modeled residual human epididymis protein 4 parameter, which was subsequently evaluated as a prognostic factor. Baseline human epididymis protein 4 levels lacked prognostic significance for progression-free or overall survival. In contrast, a higher modeled residual human epididymis protein 4 level was significantly associated with shorter progression-free and overall survival in univariable analyses (residual human epididymis protein 4 ≥median vs <median; median progression-free survival: 7.2 vs 12.6 months, p =.002; median overall survival: 16.5 vs 34.9 months; p =.001) and in multi-variable models (overall survival: hazard ratio 2.65; 95% confidence interval 1.23 to 5.71, p =.012) alongside CA125 response.

CONCLUSIONS: In this study, we identified residual HE4 levels in patients treated with second-line platinum-based chemotherapy as an independent dynamic marker of overall survival, with higher levels indicating poorer outcomes and potential chemoresistance.

PMID:42542430 | DOI:10.1016/j.ijgc.2026.104852

Dent Mater. 2026 Aug 1:S0109-5641(26)00397-0. doi: 10.1016/j.dental.2026.07.024. Online ahead of print.

ABSTRACT

OBJECTIVES: To develop remineralizing dental composites incorporating prepolymerized TMPTMA-HEMA particles charged with CaF₂ (THCaF₂).

METHODS: Blends of TMPTMA-HEMA (50/50 wt%), charged with CaF₂ (5, 10, and 15 wt%), were heat-polymerized and crushed to a micrometric scale (THCaF₂). Four dental composites were produced using the same organic matrix (30 wt%) of Bis-GMA/TEGDMA (70/30 wt%). The control composite (C) contained 70 wt% barium borosilicate (BaBSi) fillers, whereas, in CaF5, CaF10, and CaF15, BaBSi fillers were partially replaced by 20 wt% of THCaF₂ particles. The remineralizing potential was evaluated through F⁻ release and the remineralization of caries-like enamel lesions induced by S. mutans biofilm using micro-CT. Physicomechanical properties included degree of conversion (DC%), flexural strength (FS), flexural modulus (FM), water sorption (Wsp), and water solubility (Wsl). Data were analyzed using one-way ANOVA and Tukey’s HSD test (α = 0.05).

RESULTS: All composites containing THCaF₂ released F⁻ ions, whereas only CaF10 and CaF15 induced enamel remineralization. The DC% did not differ among the dental composites (p > 0.05). C showed the highest FS and FM (p < 0.05), whereas the FS and FM of the other composites did not differ from one another (p > 0.05). The lowest Wsp was observed for C (p < 0.05), followed by CaF5, CaF10, and CaF15, which did not differ statistically from one another (p > 0.05). No statistical difference in Wsl was found among the dental composites (p > 0.05).

SIGNIFICANCE: The incorporation of prepolymerized particles charged with CaF₂ (THCaF₂) conferred remineralizing potential to experimental dental composites and represents a promising strategy for developing dental composites capable of preventing enamel demineralization caused by the caries process.

PMID:42542396 | DOI:10.1016/j.dental.2026.07.024

J Rheumatol. 2026 Aug 1:jrheum.2026-0072. doi: 10.3899/jrheum.2026-0072. Online ahead of print.

ABSTRACT

OBJECTIVE: Adverse changes in body composition are increasingly being recognized in Rheumatoid Arthritis (RA) patients. This study aims to explore the relationship between RA’s disease activity, disease impact, and functional disability with bioelectrical phase angle (PhA) and appendicular skeletal muscle mass index (ASMI).

METHODS: RA patients were recruited at a tertiary hospital in Portugal. Disease Activity Score in 28 Joints calculated with erythrocyte sedimentation rate (DAS28-ESR) and CReactive Protein (DAS28-CRP) were used to assess disease activity. The impact of disease and functional status were evaluated using the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire and the Health Assessment Questionnaire (HAQ), respectively. Body composition was measured by bioelectrical impedance analysis (BIA). PhA was stratified into tertiles, and ASMI was classified according to the EWGSOP2 criteria.

RESULTS: 104 patients with RA were included (74.0% female, 60.9 ± 9.6 years old). RAID scores were significantly lower in patients in the highest PhA group (PhA-T3) compared with patients with lower PhA tertiles (PhA-T2 and PhA-T1: p<0.001). HAQ scores were also significantly lower in patients in the highest PhA group (PhA-T3) than in patients in the lower PhA tertiles (PhA-T2: p=0.033; PhA-T1: p<0.001). Median DAS28-ESR and DAS28-CRP were lower among patients with higher PhA, but the difference did not reach statistical significance (p=0.069 and p=0.159). No differences were found between the groups of ASMI for DAS28-ESR (p=0.625), DAS28-CRP (p=0.970), RAID (p=0.300), and HAQ (p=0.514) scores.

CONCLUSION: A lower PhA was associated with increased disease impact and more significant functional disability in RA patients.

PMID:42542378 | DOI:10.3899/jrheum.2026-0072

Soins Gerontol. 2026 Jul-Aug;31(180):36-38. doi: 10.1016/j.sger.2026.06.009. Epub 2026 Jul 20.

ABSTRACT

In Réunion, people aged 75 and older visit hospital emergency rooms more often than their demographic weight would suggest. This finding, based on recent data from the Directorate for Research, Studies, Evaluation, and Statistics (Drees) and viewed within the local context, highlights several organizational weaknesses. The analysis underscores the importance of strengthening preventive care, developing community-based solutions, and improving coordination among healthcare providers to benefit the region’s elderly population.

PMID:42542359 | DOI:10.1016/j.sger.2026.06.009