IS practice

Objectives: This study aimed to determine whether adults with tinnitus exhibit altered phase-specific mandibular kinematics during saliva swallowing and increased prevalence of tongue thrust and Eustachian-tube insufficiency versus tinnitus-free controls. Methods: This was a cross-sectional case–control study including adults with tinnitus and controls. Standardized computerized kinesiography recorded three spontaneous saliva swallows per participant. Primary outcomes were opening/closing time (OCT) and post-closure stabilization time (STT); total swallowing time (SWT) was secondary. Tongue thrust (TT) and tubal insufficiency (TI) were assessed clinically. Distributional assumptions were checked with Shapiro–Wilk; between-group comparisons used two-sided Mann–Whitney U tests and Fisher’s exact tests (TT, TI). Effect sizes included rank-biserial correlation (r), Hodges–Lehmann median difference (Δ), and odds ratios (ORs) with 95% confidence intervals. Co-occurrence of TT and TI and their relationships with OCT, STT, and SWT were evaluated within strata (cases vs. controls) using Fisher’s exact test, φ, Mann–Whitney U tests, and Spearman’s ρ. Given the marked imbalance in age and sex between groups, unadjusted non-parametric comparisons were complemented by multivariable models with adjustment for age and sex. An omnibus non-parametric combination test summarized case–control differences across OCT, STT, and SWT. Results: Statistical analysis was performed on 77 cases with tinnitus and 78 controls. Tinnitus cases showed longer OCT (1.75 ± 0.92 vs. 1.12 ± 0.62 s; p < 0.001; r ≈ 0.40; Δ ≈ +0.60 s) and STT (1.44 ± 0.88 vs. 0.84 ± 0.62 s; p < 0.001; r ≈ 0.42; Δ ≈ +0.60 s), while SWT differed modestly and was not significant (2.75 ± 0.69 vs. 2.57 ± 0.65 s; p = 0.115; r ≈ 0.15; Δ ≈ +0.18 s). TT was more frequent in cases (18.2%) than controls (6.4%; OR = 3.05, 95% CI 1.08–8.61; p = 0.029), whereas TI occurred in 16.9% of cases and 0% of controls (corrected OR = 32.85, 95% CI 1.92–563.49; p < 0.001). Within tinnitus cases, TT and TI did not show meaningful co-occurrence (φ ≈ −0.03; p = 1.00). TT+ tinnitus patients exhibited markedly prolonged OCT compared with TT− (median 2.22 vs. 1.45 s; Δ ≈ +0.88 s; r ≈ 0.60; p < 0.001), whereas STT and SWT were minimally affected; TI was not materially associated with any swallowing-time parameter. Spearman analyses confirmed a moderate monotonic association between TT and OCT in tinnitus cases (ρ ≈ 0.40; p < 0.001), with all other correlations small and clinically negligible. Age- and sex-adjusted analyses confirmed longer OCT and STT in tinnitus cases, whereas SWT remained non-significant; TT and TI also remained more frequent in cases after adjustment. The omnibus test indicated a clear global separation between groups across OCT, STT, and SWT (permutation p < 0.001). Conclusions: Adults with tinnitus exhibit a distinct swallowing signature characterized by prolonged OCT and STT, together with higher prevalence of TT and TI. TT in tinnitus patients is specifically linked to a pronounced prolongation of OCT, while STT and SWT remain largely unchanged, and TI shows no relevant impact on kinematic indices.

BackgroundMedial epicondylitis is an overuse syndrome characterized by degeneration of the flexor-pronator tendons in the elbow, resulting from repetitive forced wrist flexion and forearm pronation. Due to its anatomical location, medial epicondylitis patients may also feature ulnar nerve instability, which can exacerbate symptoms and negatively impact treatment outcomes. Although conservative treatments remain the cornerstone of care for managing medial epicondylitis, the optimal treatment method remains an open question.ObjectiveTo evaluate the effects of a combined extracorporeal shockwave therapy (ESWT) protocol on pain, symptom severity, and functional outcomes in medial epicondylitis patients with concomitant ulnar nerve instability.DesignRetrospective case series study with two-year post-treatment follow-up.SettingCenter for Rehabilitative Medicine “Sport and Anatomy”, University of Pisa.InterventionsPatients underwent a combined ESWT using the Duolith SD1 ultra device (Storz Medical AG., Switzerland), consisting of sequential focal (0.15–0.20 mJ/mm2, 5–6 Hz, 1,000 shocks) and radial (1.3–1.8 mJ/mm2, 14 Hz, 2,000 shocks) shockwave application per session. Each patient received three to five weekly sessions.ParticipantsMedial epicondylitis patients with concomitant ulnar nerve involvement who underwent a combined ESWT protocol between September 2019 and May 2023.Main outcome measuresPain severity and upper limb disability were assessed with the numerical rating scale, the shortened Disabilities of the Arm, Shoulder and Hand questionnaire, and the Ulnar Neuropathy at the Elbow Questionnaire. Patient treatment satisfaction was evaluated with the Roles and Maudsley score.ResultsOf the reviewed 15 consecutive medical charts, only three subjects fulfilled the inclusion criteria. Two patients showed a marked decrease in pain and improved functionality scores at all time points; one patient remained unchanged throughout the study; no adverse effects were observed.ConclusionsThis retrospective study suggests that ESWT may be efficacious and safe for treating medial epicondylitis patients with concurrent ulnar nerve instability. Prospective studies with a larger sample size are needed to warrant the present results.

Premature loss of primary molars remains a frequent clinical problem in pediatric dentistry and may lead to space loss, occlusal disturbances, and the need for future orthodontic intervention. Conventional space maintainers, such as the band-and-loop appliance, are effective in preserving arch length but do not restore occlusal function or esthetics. This case report describes an easy and practical technique for fabricating esthetic-functional space maintainers without the need for silver or laser soldering during the laboratory phase, eliminates the need for orthodontic wire and without the use of CAD-CAM technology. A 4-year-old child presented with extensive carious destruction, irregular distal root resorption and furcation involvement of the mandibular right first primary molar, for which extraction was indicated. Radiographic evaluation revealed that the permanent successor was at an early stage of development, justifying the need for space maintenance. A fixed esthetic-functional space maintainer was fabricated using the anatomy of the child's own primary tooth as a guide. Clinical and radiographic follow-up at 12 months demonstrated satisfactory space preservation and stable occlusion. This simplified, low-cost technique represents a practical alternative for pediatric dentists seeking to restore function and esthetics while maintaining space during the mixed dentition period.

The Interim Canada Dental Benefit (CDB) provided financial support to families to cover dental care expenses for children < 12 years of age. The purpose of this study was to investigate oral health professionals' (OHPs) views of the Interim CDB. OHPs in Manitoba, Canada were invited by e-mail to complete an online questionnaire. Data analysis included descriptive statistics (frequencies, means, and standard deviations), bivariate analysis (chi-squared and t-test), and multivariable logistic regression. A p-value < 0.05 was considered significant. Overall, 383 OHPs participated, the majority being women (80.9%), from metropolitan areas (77.8%), and working for 16.6 ± 12.9 years. Main respondents included dentists (24.3%), dental hygienists (23.3%), and dental assistants (38.7%). Awareness of the benefit was high (92.7%) yet 45.8% were uncertain whether it increased public awareness of children's oral health. Encouragement to apply was low (39.3%), although 56.5% believed that the Interim CDB improved access to children's oral care. Multivariate logistic regression showed that rural OHPs encouraged application 43% more than those working in urban areas. Significantly more positive responses were observed among rural-based OHPs and women toward the benefit's ability to improve access to oral health for children. Overall, awareness was high among the OHPs, but uncertainty remained whether the benefit improved access to care for young children. OHPs in rural areas were more likely to believe that the Interim CDB improved access to care and were more likely to promote the program to families.

The COVID-19 pandemic significantly impacted the mental health of the Swiss population. This study analyzed data from the Collaborative Outcome study on Health and Functioning during Infection Times (COH-FIT) across three pandemic waves: T1 (April-June 2020), T2 (July-December 2020) or T3 (January-June 2021). Each participant participated only once, during one of these three waves. Participants reported their subjective well-being and mental health status for the two weeks prior to the pandemic (pre-pandemic baseline) and during their respective pandemic wave. Subjective well-being was assessed using the World Health Organization Well-Being Index (WHO-5) from 4,037 participants, while mental health was measured via the P-score, completed by 3,375 participants. The WHO-5 ranges from 0 to 100, with higher scores indicating better well-being, while the P-score also ranges from 0 to 100 whereas higher scores represent greater levels of perceived burden across five domains of mental health. Pre- and intra-pandemic differences were analyzed using Wilcoxon tests and ANOVA, with subgroup analyses across seven Swiss regions utilizing the Kruskal-Wallis test. Participants had a mean age of 45.6 years (61.9% female). Results showed a substantial decline in well-being during the pandemic, with average WHO-5 scores decreasing from 75.3 pre-pandemic, to 66.5 during the first wave, 69.1 during the second, and 65.1 during the third, representing relative reductions of 11.7%, 8.2%, and 13.5%. The percentage of participants at risk for depression (WHO-5 <50) peaked during the third wave at 19.8%, up from 10.0% pre-pandemic. Mental health burden, as measured by the P-score, increased significantly during the first wave (from 20.6 to 27.3, +32.5%), and remained elevated across the two subsequent waves, with no significant recovery observed. Wilcoxon tests indicated significant differences between pre-pandemic and intra-pandemic WHO-5 and P-scores, with the largest effect sizes during the third wave (r = 0.652 for WHO-5; r = 0.487 for P-score). ANOVA showed significant intra-pandemic differences in WHO-5 across waves (p < 0.001), with improvements noted in the second wave. However, no intra-pandemic differences in P-scores were found (p = 0.298). Regional analyses revealed that Ticino, the Lake Geneva region, and Northwestern Switzerland experienced the most pronounced declines in well-being and increases in mental health burden. In contrast, Espace Mittelland and Eastern Switzerland experienced a less severe impact. Overall, these findings highlight the considerable and lasting impact of COVID-19 on mental health in Switzerland, emphasizing the need for targeted interventions, particularly in the most affected regions.

Autogenous tooth-derived grafts have been proposed as an alternative to xenografts for alveolar ridge preservation, offering biological similarity to bone and potentially more favorable remodeling. This study compared the healing outcomes of a collagenated xenograft, and a tooth-derived graft prepared with an automated processing device. Six Beagle dogs underwent bilateral extraction of the third and fourth mandibular premolars. Each animal contributed two sockets grafted with root-derived particulate prepared using an automated device for tooth cleaning, grinding, and demineralization, and two sockets grafted with a collagenated xenograft, all covered by a collagen membrane. After 3 months, histological sections were analyzed to assess crestal dimensions and the relative proportions of mature (lamellar) and immature bone (woven/parallel fibered), residual graft material, and soft tissues. Lingual crest height did not differ between groups, whereas the buccal crest was slightly higher at xenograft sites compared with the tooth-graft sites. The tooth-graft group exhibited significantly fewer residual particles (0.5 ± 1.1%) and a higher proportion of total bone (65.6 ± 9.1%) compared with the xenograft group, which showed 19.7 ± 16.0% graft remnants (p = 0.032). Corticalization at the socket entrance was observed predominantly in the tooth-graft sites. No inflammatory infiltrates were detected in the examined section. Tooth-derived grafts promoted an almost complete replacement by vital bone with minimal residual material, whereas xenografts provided slightly better buccal contour preservation but resulted in regenerated tissues containing persistent graft particles. The biological differences observed may have implications for subsequent implant placement.

Background. Metabolic Syndrome (MetS) is a prevalent cluster of conditions that significantly increases the risk of cardiovascular disease and type 2 diabetes mellitus. Lifestyle modification is universally recognized as the primary therapeutic strategy, with aerobic exercise playing a crucial role in improving metabolic health and reducing mortality risks in affected populations. Aim. This review synthesizes current evidence on the efficacy and mechanisms of aerobic exercise as a fundamental non-pharmacological strategy for managing Metabolic Syndrome (MetS). Material and methods. A search of major databases (2015–2025) was performed, focusing on systematic reviews and RCTs. Keywords included "Metabolic Syndrome," "aerobic exercise," "insulin resistance," "dyslipidemia," and "exercise prescription." Results. Regular aerobic exercise improves cardiometabolic risk factors independently of significant weight loss. It enhances insulin sensitivity via GLUT4 translocation, optimizes the lipid profile (reducing triglycerides, increasing HDL), and reduces visceral adiposity and inflammation. Additionally, High-Intensity Interval Training (HIIT) is highlighted as a potent strategy, often offering superior efficacy to moderate-intensity continuous training (MICT). Conclusions. Aerobic exercise is an essential component of MetS management. Professionals should prioritize individualized prescriptions, incorporating both MICT and HIIT, to effectively mitigate cardiometabolic risk and improve patient health.

Background. Lipedema is a chronic and progressive fat disorder that affects ~11% of the female population. It is characterized by bilateral, disproportionate accumulation of subcutaneous adipose tissue predominantly in the lower body. Symptoms include pain, bruising, swelling, and subcutaneous nodules that are resistant to traditional interventions such as diet and exercise. Aim. The objective of this review is to summarize recent evidence on the characteristics, pathophysiology, diagnosis and treatment of lipedema. Matherial and Methods. A literature search was conducted using the PubMed database. The inclusion criteria were “full free text” and English scientific articles, published between 2015 and 2025. A total of 74 records were found, of which publications were ultimately included in the review. Results. Awareness of lipedema in the medical field is increasing, but its differential diagnosis still remains a challenge. Lipedema is often unrecognized or misdiagnosed as obesity or lymphedema. Conclusion. This narrative review provides a deeper understanding of lipedema as a serious condition, discusses its pathophysiology and treatment options. The data reveal advances in knowledge, particularly in conservative and surgical treatment with a focus on improving quality of life. However, there is a lack of scientific evidence confirming the safety and efficacy of various treatment methods. Further research is required to ensure the safety and increase the efficacy of treatment for this complex condition known as lipedema.