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- Get a grip! – Baseline handgrip strength and sarcopenia as predictors of survival in patients with head and neck squamous cell carcinomaPublication . Orell, Helena; Pohju, Anne; Ravasco, Paula; Schwab, Ursula; Osterlund, Pia; Mäkitie, Antti A.Background: Low handgrip strength (HGS) and sarcopenia are common in patients with head and neck squamous cell carcinoma (HNSCC). This study aimed to explore associations between baseline HGS, fat-free mass index (FFMI), nutritional indices, and survival. Methods: This was a prospective observational sub-study of a randomized nutritional intervention trial, including 50 male patients with HNSCC undergoing curative-intent treatment (surgery and/or (chemo)radiotherapy). Sarcopenia was defined as low HGS (<27 kg) and FFMI (<17 kg/m2). Chi-square, Kaplan–Meier, and Cox analyses were used. Results: Low HGS was observed in 16%, low FFMI in 46%, and sarcopenia in 12%. Patients with low HGS had lower body weight, BMI, and FFMI, alongside more malnutrition, elevated CRP, and heavy smoking. Low HGS and sarcopenia were associated with shorter overall survival (HR 3.7, [95% CI 1.5–9.1] and 5.5, [2.2–14.5], respectively); FFMI was not. Adjustment removed significance. Findings should be interpreted cautiously due to the small, all-male cohort size. Conclusion: In this small exploratory cohort HGS may serve as a simple screening surrogate for sarcopenia and survival.
- Development and benchmarking of sensing technologies for Tenebrio molitor dead pupae identificationPublication . Oliveira, Francisco; Tinoco, Vítor; Rodrigues, Leandro; Santos, Filipe N.; Cunha, Mário; Vieira, Inês; Santos, Marisa V.The production of insects for both human and animal consumption has seen an interest increase in recent years. Tenebrio molitor, a beetle species whose larval stage was considered by the European Commission safe for human consumption, represents a promising candidate for large-scale production. Efficient production of T. molitor requires the separation of its different metamorphic stages to optimize productivity and reduce cannibalism. Additionally, dead pupae must be removed to prevent contamination and ensure the healthy development of the remaining individuals. Currently, the identification of dead pupae relies primarily on visual inspection based on colour changes, as dead individuals tend to exhibit surface melanization. However, this method becomes inefficient in large-scale operations. This study presents a benchmark of hyperspectral imaging (HSI) and thermal imaging as alternative sensing technologies for automated dead pupae identification. Hyperspectral data acquired in the near-infrared range (900–1700 nm) enabled accurate discrimination between dead and live pupae using both a PLS-DA and a Logistic Regression model, achieving F1-Scores above 90 % for both classes. Furthermore, key wavelengths (903 nm and 1259 nm) were identified and used to develop a normalized difference index (NDI) capable of distinguishing pupae health status using only two spectral bands. Thermal imaging revealed consistent temperature differences, with dead pupae presenting approximately 1–3 % lower temperatures than live pupae. The proven reliability and precision of the proposed sensing technologies validate their use in contributing to the development of scalable and reliable solutions for quality control in the insect farming industry.
- Clinical efficiency of lasers in endodontic treatment of primary endodontic cases : an umbrella review of systematic reviewsPublication . Duarte, Marta Alves; Neves, João Albernaz; Caçador, Madalena; Flores-Fraile, JavierObjectives: To evaluate and synthesise the current evidence on the efficacy of laser-activated irrigation in endodontics, with a focus on microbial reduction, postoperative outcomes, and its potential as an adjunct to conventional irrigants. Method: A comprehensive search was conducted to identify relevant systematic reviews. A total of 319 systematic reviews were initially identified. After the removal of 116 duplicates, 203 records were screened. Of these, 22 systematic reviews met the eligibility criteria. However, reviews that included exclusively in vitro studies or were considered to have limited clinical relevance were excluded. Ultimately, 9 systematic reviews were included in this umbrella review, evaluating different laser systems such as Er:YAG, Er,Cr:YSGG, Nd:YAG, and diode lasers in the context of root canal irrigation. This review was registered at PROSPERO (CRD42025599352). For this umbrella review, 5 electronic databases (PubMed/MEDLINE, Cochrane Database of Systematic Reviews, SciELO, Web of Science, and LILACS) were systematically searched from inception through December 2024, with no language or publication date restrictions applied. Study selection followed predefined eligibility criteria, and the methodological quality of the included systematic reviews was assessed using the AMSTAR 2 tool. Conclusions: The available evidence on laser-activated irrigation in endodontics remains limited and heterogeneous. Although some systematic reviews suggest potential benefits in canal disinfection and postoperative outcomes, the findings are inconsistent and largely constrained by variability in laser wavelengths, study designs, and outcome measures. Consequently, further standardised, high-quality clinical research is required before definitive conclusions regarding the clinical effectiveness of laser-activated irrigation can be established.
- Polyethylene fiber reinforcement in resin composite restorations : a systematic review of clinical trialsPublication . Bourgi, Rim; Holiel, Ahmed A.; Delgado, António H. S.; Flores-Ledesma, Abigailt; Khafaja, Souheir; Cuevas-Suárez, Carlos EnriquePurpose: To synthesize evidence from randomized controlled trials (RCTs) on the clinical performance of ultra-high-molecular-weight polyethylene (UHMWPE) fiber-reinforced direct composite restorations compared to conventional composites in posterior teeth and non-carious cervical lesions. Methods: A systematic review was conducted following PRISMA guidelines (PROSPERO: CRD420251178877). Databases were searched up to November 2025 for RCTs evaluating fiber-reinforced versus non-reinforced direct composite restorations in Class I, II, or V cavities. Grey literature and trial registries were not searched, framing this as a restricted-source systematic review of peer-reviewed published evidence. The primary outcome was restoration failure/survival; secondary outcomes included marginal adaptation, discoloration, and postoperative sensitivity. Risk of bias was assessed using RoB 2, and certainty of evidence was evaluated with GRADE. Results: Four RCTs (404 patients, 494 restorations) with 12–24 month follow-up were included. All trials reported 100% restoration survival in both fiber-reinforced and control groups. No statistically significant differences were found in any clinical performance parameter. The evidence was of moderate certainty for primary outcomes in adults but low to very low for secondary outcomes and pediatric/NCCL indications, limited by short follow-up, imprecision, and risk of bias. Conclusions: Within the limited observation period of up to 24 months, UHMWPE fiber reinforcement did not demonstrate a measurable clinical advantage over contemporary non-reinforced composite protocols for posterior teeth. The uniformly high survival rates and comparable performance indicate excellent short-term outcomes for both approaches under controlled conditions. Absence of observed benefit should not be interpreted as equivalence; long-term RCTs are required to determine if fiber reinforcement mitigates late complications such as fracture in structurally compromised teeth.
- Physicochemical properties of gutta-percha cones before and after a rapid disinfection protocol and its clinical relevancePublication . Martsynyshyn, Mar’yana; Brito, José; Proença, Luís; Barroso, Helena; Neves, João Albernaz; Almeida, Maria GabrielaThis study aimed to evaluate the chemical composition, radiopacity, and antimicrobial activity of five standardized (#25) commercially available gutta-percha points (ProTaper Gold, Zarc, Cerkamed, Autofit, and Reciproc R25), before and after a rapid disinfection protocol. The cones were divided into three groups: untreated (control), treated with sodium hypochlorite, and treated with sodium hypochlorite followed by ethanol rinsing. Significant compositional differences, as assessed by a solvent extraction method, were observed among brands, with gutta-percha content ranging from 11.6 to 17.5%, wax and/or resin from 1.2 to 4%, and inorganic fraction between 74.0 and 83.0%, with ZnO as the predominant component. Radiopacity determined via digital radiography varied among brands and showed a stronger correlation with ZnO content than with BaSO₄, challenging the common assumption that barium is the principal radiopacifying agent; Zarc exhibited the highest radiopacity, whereas Cerkamed showed the lowest. None of the gutta-percha points exhibited antimicrobial activity against Enterococcus faecalis and Staphylococcus aureus under standard clinical conditions, underscoring the necessity of proper disinfection procedures in clinical practice. The disinfection protocols produced minor changes in the wax/resin content of Cerkamed, Reciproc, Autofit, and ProTaper, with the effect being more pronounced in the latter two. In contrast, the metal oxide composition analyzis with wavelength dispersive X-ray fluorescence (WDXRF), showed that only Zark exhibits slight variations in ZnO, BaSO₄, SiO₂, and CuO. However, these changes remain insufficient to be considered clinically relevant. Importantly, no effect on the radiographic integrity of the gutta-percha cones was observed, confirming the safety and adequacy of the NaOCl-based disinfection protocols for clinical purposes.
- Prosthetic outcomes of implant-assisted maxillary restorations in the edentulous maxilla : a systematic review and meta-analysisPublication . Ng, Ethan; Tay, John Rong Hao; Rahmat, Maria; Mezzomo, Luis; Alcoforado, Gil; Donos, NikosObjectives: To evaluate the prosthetic outcomes of implant-assisted maxillary full-arch restorations with ≥ 3 years of follow-up. Materials and Methods: A systematic electronic literature search was conducted in five databases to identify randomised controlled trials and prospective clinical studies involving patients who received full-arch rehabilitation in the maxilla. The primary outcome was prosthesis loss; secondary outcomes included complication-free prosthesis survival, complication-free implant survival, implant loss, technical complications, patient-reported outcome measures (PROMS), and marginal bone loss. Meta-analyses of proportions using random-effects models were performed to estimate pooled rates of prosthetic survival, success, and complications. Results: A total of 20 studies involving 913 patients were included. Among these, 542 patients received fixed prostheses and 371 received removable prostheses. Most of the studies had an observation period in the range of 3 to 6 years, with only two studies (overdentures) reaching 10 years. Overall prosthesis loss was 4.6% (95% CI: 1.2%–10.1%) and complication-free prosthesis survival was 61.9% (95% CI: 48.4%–74.5%). Overall complication-free implant survival was 46.5% and technical complications were 62.9%. Pooled implant loss was 5.5% after adjusting for clustering effects and mean marginal bone loss was < 0.8 mm. Subgroup analysis of fixed and removable prosthesis over a similar observation period revealed similar outcomes. Conclusions: Implant-assisted maxillary full-arch restorations have low rates of prosthesis and implant loss. However, complication-free survival is moderate, underscoring the importance of maintenance and patient education.
- Lymph node remodelling underlies the attenuated form of HIV/AIDS in people with HIV-2Publication . Fernandes, Susana M.; Farias, Guilherme B.; Pires, Ana R.; Santos, Diana F.; Antão, Ana Vieira; Pires, André; Moura, Rita; Godinho-Santos, Ana; Marques, Rita T.; Gomes, André M. C.; Ferreira, Cristina; Nunes-Cabaço, Helena; Gomes, Perpétua; Poças, José; Vasconcelos, Carlos; Badura, Robert; Sousa, Ana E.HIV-2 infection is associated with low-to-undetectable plasma viral load, broad and sustained specific antibody and T cell responses, and a slow course of CD4 T cell decline, even in the absence of antiretroviral therapy (ART). Here, we investigated the secondary lymphoid organs of people with HIV-2 (PWH2) as compared to people with HIV-1 (PWH1) and seronegative subjects. We found active HIV-2 replication and major disruption of lymph node architecture in PWH2, also attested by the alterations that we demonstrated in the blood counterparts of follicular T and B cells. These findings were corroborated by in vitro infection assays using tonsil organ cultures and HIV-2 or HIV-1 primary isolates with distinct co-receptor usage, CCR5 or CXCR4, which showed significant HIV-2 cytopathogenicity associated with post-transcriptional control of HIV-2 replication, revealed by high titres of cell-associated viral DNA and mRNA transcripts but reduced HIV-2 protein production. Overall, our findings support a major impact of HIV-2 on secondary lymphoid tissue organisation throughout the disease course, stressing the relevance of this neglected infection to understand host-pathogen equilibrium in retroviral zoonoses and to identify strategies towards a functional HIV cure.
- Can poor nutrition and diet influence temporomandibular disorder? A systematic reviewPublication . Lima, Flávio Fidêncio de; Razavian, Artin; Hosokawa, Mai; Foscaldo, Tatiana Ferreira; Koldzo, Melisa; Poluha, Rodrigo Lorenzi; Christidis, Maria; Christidis, Nikolaos; Canales, Giancarlo De la TorreBackground: The relationship between diet, nutrition, and painful temporomandibular disorders (TMD) is not well established, despite increasing interest in lifestyle factors in chronic pain. This systematic review aimed to synthesize available evidence on how dietary patterns and nutritional status may be associated with painful TMD. Methods: An electronic search was conducted in the databases MEDLINE, CINAHL, EMBASE, the Cochrane Central Registry of Controlled Trials (CENTRAL) and Web of Science for clinical and observational trials from the beginning of each database to November 2025. Risk of bias was performed using the Study Quality Assessment Tools from the National Heart, Lung, and Blood Institute (NHLBI). Results: Out of 7,760 records and after the risk of bias assessment, only seven studies judged as having a low risk of bias were included. Overall, the included studies indicate that the association between dietary factors and TMD remains unclear. Prospective cohort studies did not demonstrate that prenatal or adolescent diet quality independently predicted TMD. Cross-sectional studies suggested that specific dietary patterns may be related to TMD-related symptoms. Women with myogenous TMD showed lower intake of several nutrients compared with controls. Experimental evidence indicated that monosodium glutamate ingestion increased pain intensity in myofascial TMD, while the only randomized trial found no significant pain differences between vitamin D supplementation and diclofenac. Conclusions: Current evidence suggests that some dietary components and nutritional factors may be associated with TMD-related symptoms or pain responses; however, the findings are limited, heterogeneous, and insufficient to support firm causal or therapeutic conclusions.
- Effect of a tea tree oil mouthwash on plaque-induced gingivitis when comparing to chlorhexidine: an exploratory randomised clinical trialPublication . Menat, Alfred; Rozan, Cecília; Barroso, Helena; Proença, Luís; Salema-Oom, Madalena; Botelho, João; Zhiri, Abdesselam; Manso, Ana CristinaGingivitis, the most common periodontal disease, is an inflammatory condition of the gingiva resulting from bacterial biofilm accumulation without periodontal attachment loss. Chlorhexidine (CHX) is the gold standard for chemical plaque control, yet its prolonged use is associated with undesirable side effects. Tea tree essential oil (TTO, Melaleuca alternifolia), with documented antimicrobial and anti-inflammatory properties, has emerged as a potential natural alternative. This exploratory randomized, controlled, triple-blind clinical trial evaluated the antimicrobial, cytotoxic, and clinical effects of a 1% TTO-based mouthwash compared with 0.12% CHX in 30 adults with plaque-induced gingivitis. Both mouthwashes significantly reduced plaque and gingival indices as well as bacterial counts after 15 days (p < 0.001), with no significant intergroup differences in clinical outcomes. CHX achieved a greater reduction in bacterial load, while TTO presented fewer adverse effects, limited to mild taste alteration and transient increase in salivary flow. Both formulations exhibited in vitro cytotoxicity, though clinical tolerance was high. These results suggest that, under the tested conditions, TTO formulation at 1% (v/v) exerts an antibacterial effect comparable to CHX, while displaying a dose-dependent pattern.
- Enhancing preclinical proficiency in aesthetic medicine and cosmetic dermatology : an evidence-based review of interactive visual simulation techniquesPublication . Khalil, Hassan; Pereira, Inês Novo; Shatta, Bashar; Magrin, Anna Maria Fenech; Hassan, HaidarBackground: Unlike many clinical disciplines where simulation is already embedded in curricula, aesthetic medicine and cosmetic dermatology present distinctive training challenges. Interactive visual simulation techniques offer immersive, risk-free environments for developing technique-dependent competencies, but their evidence base within this specific field remains comparatively limited. Aims: To identify the key features and potential value of interactive visual simulation techniques for aesthetic medicine and cosmetic dermatology, and to provide evidence-based insights for integrating these technologies into academic training programs. Methods: An evidence-based review using the Best Bets methodology was conducted. Two independent reviewers searched PubMed and Google Scholar (October 2024–February 2025) for literature published between 2015 and 2025. Evidence was graded using the Oxford Centre for Evidence-Based Medicine (OCEBM) 2011 Levels of Evidence, and quality was assessed using Critical Appraisal Skills Programs (CASP) checklists. Results: Thirteen studies met the inclusion criteria, encompassing 897 reported participants across nine simulation modalities: virtual reality (n = 2), augmented/mixed reality (n = 1), 3D-printed models (n = 2), 3D digital simulation (n = 1), hands-on simulation (n = 2), simulation-based education (n = 2), haptic feedback (n = 1), smartphone applications (n = 1), and AI applications (n = 1). Three of the 13 studies were cross-disciplinary (general dermatological suturing, smartphone adoption patterns, and AI-assisted patient education) and were retained as contextual evidence rather than as direct tests of aesthetic-specific training efficacy. Evidence was predominantly low-level: Level II (n = 2), Level III (n = 3), Level IV (n = 2), and Level V (n = 6). Risk of bias was high across the majority. Reported outcomes clustered at Kirkpatrick Levels 1–2a (learner satisfaction and confidence), with only one study demonstrating objective skill improvement (Level 2b). Despite these limitations, simulation-based techniques consistently demonstrated potential to improve self-reported procedural knowledge and trainee confidence. Conclusion: Simulation-based training shows promise for aesthetic medicine and cosmetic dermatology. Although favorable outcomes were reported, these were predominantly confidence-based (Kirkpatrick Level 2a) rather than objective skill measures. These results cautiously support integration of simulation technologies into training programs but underscore the urgent need for rigorous, randomized controlled trials with objective competence outcomes to establish long-term efficacy and generalizability.