Medical Research: Emerging Concepts and Applications Vol. 1

The Hot Tooth: Unlocking Predictable Anesthesia in Endodontic Emergencies

B. Shyam, T. Vinay Kumar Reddy, K. Vijay Venkatesh, Seetha Kunhikannan — Tue, 04 Aug 2026 00:00:00 +0000

The “hot tooth” is a clinically challenging endodontic condition commonly associated with symptomatic irreversible pulpitis and difficulty in achieving profound pulpal anaesthesia. This chapter discusses the diagnostic and therapeutic considerations involved in managing such teeth during emergency endodontic care. The clinical problem is explained through inflammation-related peripheral sensitisation, tissue acidosis, altered sodium channel activity, accessory innervation and psychological factors that may reduce the effectiveness of conventional local anaesthetic techniques. Emphasis is placed on careful diagnosis using patient history, thermal and electric pulp testing, percussion, palpation and radiographic assessment, as well as differentiation from conditions such as reversible pulpitis, cracked tooth syndrome, dentinal hypersensitivity, symptomatic apical periodontitis and non-odontogenic pain. The chapter outlines a stepwise approach to management, beginning with patient counselling, anxiety assessment and objective confirmation of anaesthetic depth. When a primary inferior alveolar nerve block is inadequate, supplemental methods such as buccal infiltration, intraosseous injection, periodontal ligament injection and intrapulpal anaesthesia may be considered according to clinical need. Pharmacological premedication, postoperative pain control, irrigation, disinfection and definitive endodontic treatment are also discussed. The chapter further considers the selected use of vital pulp therapy and the importance of patient-centred communication. Overall, the hot tooth should be approached as a predictable clinical challenge requiring accurate diagnosis, staged anaesthetic planning and evidence-informed endodontic management.

Proprioceptive Neuromuscular Facilitation as an Adjunct in Return-to-Sport Rehabilitation Following Musculoskeletal Injuries: A Narrative Review

Csongor Kicsi — Tue, 04 Aug 2026 00:00:00 +0000

Proprioceptive neuromuscular facilitation (PNF) is widely used in rehabilitation, but its role in contemporary return-to-sport (RTS) practice is often obscured by an overly narrow emphasis on stretching and by extrapolation from non-athletic populations. This narrative review critically evaluates the conceptual foundations, clinical evidence, phase-specific application, and practical limits of PNF after musculoskeletal injury. A structured search of PubMed/MEDLINE, Scopus, Web of Science Core Collection, PEDro, and Google Scholar covered January 2020 to May 2026, with a targeted update of PubMed and publisher records completed on 22 July 2026. Earlier publications were retained when necessary to explain foundational mechanisms or directly relevant sport applications. The final synthesis comprised 66 core publications, including systematic and scoping reviews, meta-analyses, consensus statements, clinical practice guidance, randomised and comparative trials, and selected clinical commentaries. Evidence was classified as direct, indirect, mechanistic, or clinically extrapolated according to population, intervention, and outcome relevance to athletic RTS. The most consistent support for PNF concerns impairment- and function-level outcomes in chronic ankle instability, heterogeneous knee disorders, chronic low back pain, and selected shoulder conditions. PNF stretching can increase range of motion, while resisted patterns and stabilisation procedures may support balance, movement control, and coordinated activation. Emerging studies in basketball and volleyball athletes indicate that chronic and acute PNF effects depend on the protocol and outcome; these findings do not establish improved RTS or reinjury prevention. Direct evidence that PNF increases RTS rate, shortens time to RTS, reduces reinjury, or restores competitive performance remains insufficient. PNF should therefore be used as a targeted adjunct to progressive loading, strength and power development, plyometric and running exposure, neuromuscular training, sport-specific conditioning, psychological readiness assessment, and criterion-based RTS testing. Its clinical value is greatest when a specific mobility, activation, coordination, or stability deficit is identified, the response is objectively reassessed, and any immediate gain is transferred to active and progressively demanding tasks.

Precision Beyond Perception: Mixed Reality Transforming Modern Endodontics

Tue, 04 Aug 2026 00:00:00 +0000

Successful endodontic treatment depends on accurate interpretation of complex root canal anatomy, which may be obscured by calcification, restorations, curvature, or limited direct visibility. This narrative review examines the development of computer-assisted and immersive technologies in endodontics, with particular emphasis on mixed reality as an emerging adjunct for access cavity preparation, canal localisation, treatment planning, and education. It traces the progression from static guided endodontic templates to dynamic navigation systems and head-mounted augmented- or mixed-reality displays that use cone-beam computed tomography or computed tomography data to support three-dimensional spatial understanding of the tooth. The evidence reviewed indicates that guided and immersive approaches may improve the accuracy of access preparation and canal localisation compared with conventional freehand methods, particularly in technically difficult cases such as calcified canals. Mixed reality may also support treatment planning by keeping three-dimensional anatomical information within the clinician’s visual field. However, the available evidence remains largely based on in vitro studies, ex vivo models, proof-of-concept reports, narrative reviews, and limited case-level evidence. Important barriers include registration accuracy, depth perception, headset comfort, restricted field of view, cost, the learning curve, and the absence of standardised clinical outcome measures. Mixed reality should therefore be regarded as a promising research direction rather than an established routine chairside procedure.

From Dysbiosis Control to Ecological Repair: Postbiotics, Precision Microbiome Modulation, and Host-Resolution Strategies in Contemporary Periodontology: A Systematic Review

Mehmet Murat Taskan, Ozkan Karatas, Tugce Yapisoglu, Ali Firat Basutcu — Tue, 04 Aug 2026 00:00:00 +0000

Background: Periodontitis is a biofilm-mediated and host-modulated inflammatory disease in which dysbiosis, epithelial barrier injury, osteoimmune activation, and incomplete resolution of inflammation interact to sustain tissue destruction.

Objective: This systematic review evaluated evidence on postbiotics, precision microbiome modulation, and host-resolution strategies as adjuncts to established periodontal care.

Methods: A reproducible search of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar was conducted for publications available up to 15 June 2026 using terms related to periodontitis, dysbiosis, probiotics, postbiotics, complement inhibition, specialised pro-resolving mediators, biomarkers, and precision periodontology. Eligible sources included clinical guidelines, systematic reviews, randomised or early-phase clinical trials, and mechanistic studies directly relevant to periodontal dysbiosis or host modulation. Evidence was synthesised qualitatively because interventions and outcomes were heterogeneous.

Results: Thirty-five publications were included. Conventional mechanical biofilm disruption and risk-factor control remain the foundation of treatment. Probiotic evidence shows modest and strain-dependent adjunctive benefits. Postbiotics are biologically plausible because inanimate microbial cells, cell components, and associated metabolites may affect biofilm behaviour, epithelial barrier integrity, and inflammatory signalling, but direct periodontal clinical evidence remains limited. Complement C3 inhibition, specialised pro-resolving mediators, NLRP3 modulation, and biomarker-guided patient selection provide promising translational directions.

Conclusion: The evidence supports a cautious mechanism-matched adjunctive model rather than replacement of guideline-based periodontal therapy. Robust manufacturing standards, verified product characterisation, risk-of-bias reporting, and adequately powered randomised trials are required before routine clinical implementation.

Entrance Dose Verification in Cobalt-60 Radiotherapy for Head and Neck Cancer Using P-Type Diode Dosimetry

Nureddin A. S. Musa, M. Mohamed Elfadil, Ali I. Allagi — Tue, 04 Aug 2026 00:00:00 +0000

This study examined the accuracy of entrance radiation dose delivery in patients receiving Cobalt-60 radiotherapy for head and neck cancer using a p-type diode dosimetry system, with the aim of adopting diode-based in-vivo dosimetry as a quality assurance protocol. Four p-type ISORAD diodes were tested and calibrated using a Cobalt-60 radiotherapy unit employed for the treatment of malignant diseases. The diode response was calibrated and evaluated before patient measurements were performed. Entrance dose measurements were obtained at the depth of maximum dose for each treatment field and were compared with the corresponding dose calculated by the treatment planning system for each individual beam. The study included 22 patients with head and neck cancer and a total of 45 treatment fields. The action level for the comparison between measured and calculated entrance doses was set at ±5%. Approximately 97.77% of the measurements for head and neck treatments were within this action level. For the 45 measurements, the average discrepancy between diode-measured and treatment-planning-system-calculated entrance dose was 3.23%, with a corresponding standard deviation of 3.05%. One measurement exceeded the ±5% action level and required review before continuation of treatment. The findings indicate that real-time diode readings were practical for clinical use, did not add substantial measurement time and provided direct dose information before treatment delivery. Within the scope of this study, p-type diode in-vivo dosimetry supported verification of entrance dose delivery and helped identify discrepancies between measured and calculated doses during Cobalt-60 radiotherapy for head and neck cancer.

Cancer-Related Cognitive Impairment (CRCI): An Updated Review

Tomas Koltai — Tue, 04 Aug 2026 00:00:00 +0000

The improved survival rates made possible through advances in cancer treatment have brought to light a range of long-term sequelae that profoundly affect patient quality of life. Among these, cancer-related cognitive impairment (CRCI) stands out as particularly prevalent and debilitating.

Chemotherapy-induced cognitive impairment, also known as cancer-related cognitive impairment (CRCI), commonly referred to as “chemo brain” or “brain fog”, is a common consequence of cancer treatment, affecting domains such as memory, attention, executive function, and processing speed. Initially described mainly in patients receiving chemotherapy, CRCI is now known to occur across multiple cancer types and treatment modalities, including hormonal, targeted, and immune-based therapies. A substantial proportion of cancer survivors report persistent cognitive difficulties that can last for months or years after therapy. The effects of CRCI can range from very mild to severe, significantly impacting daily functioning and quality of life.

Emerging evidence highlights a multifactorial biological basis for CRCI, involving neuroinflammation, oxidative stress, mitochondrial dysfunction, and direct neurotoxic effects of chemotherapeutic agents, as well as transcriptomic alterations that disrupt neuronal signalling and plasticity. Two principal pathways leading to CRCI can be recognised: direct CNS toxicity despite the blood–brain barrier, and indirect toxicity mediated by cytokines released from tumour and normal tissues in response to chemotherapeutic drugs. Both can induce neuroinflammation, reduce hippocampal neurogenesis, and affect grey- and white-matter density in the frontal and temporal areas.

Recent transcriptomic studies reveal widespread changes in genes regulating immune activation, synaptic integrity, and metabolic pathways, suggesting that chemotherapy perturbs both central nervous system homeostasis and neuroimmune communication.

Most studies have focused on breast cancer patients treated with anthracyclines. This population includes many long-term survivors and has a high reported incidence of CRCI. However, anthracyclines are only one of many chemotherapeutic drugs that can lead to this syndrome.

Given the growing number of cancer survivors, understanding the mechanisms underlying CRCI is essential for developing targeted interventions.

This comprehensive review summarises epidemiological trends, mechanistic insights, molecular fundamentals, diagnostic hurdles, and therapeutic innovations in CRCI, advocating for routine screening in clinical guidelines (e.g., ASCO survivorship updates). Future directions include longitudinal biobanking initiatives, AI-driven predictive modelling for at-risk patients, development of targeted neuroprotectants (e.g., anti-inflammatory biologics, antidepressants), and inclusive trials addressing underrepresented groups. Ongoing research into molecular signatures and neurobiological pathways holds promise for refining diagnostic criteria and guiding the development of mechanism-based therapeutics. Although no conventionally accepted treatment is available, as cancer therapies evolve toward precision medicine, mitigating CRCI is critical to optimising functional outcomes in the growing survivor population.

Initial Validation of the FACT-Hep Questionnaire for Assessing Health-Related Quality of Life in Advanced Intrahepatic Cholangiocarcinoma

Teerachat Saeheng, Kesara Na-Bangchang — Tue, 04 Aug 2026 00:00:00 +0000

Health-related quality of life (HRQOL) assessment is an important component of clinical evaluation in patients with advanced intrahepatic cholangiocarcinoma (iCCA), particularly when disease burden and treatment-related effects affect physical, emotional, social, and functional well-being. This study examined the applicability of the Functional Assessment of Cancer Therapy-Hepatobiliary questionnaire for assessing HRQOL in patients with advanced-stage iCCA. The analysis was conducted within an open-label, randomised, controlled phase IIA clinical trial evaluating Atractylodes lancea capsules. Thirty-nine eligible patients completed the baseline assessment and were included in reliability and validity analyses. The Thai version of FACT-Hep was assessed at baseline and during follow-up using internal consistency, test-retest reliability, construct validity, discriminant validity, effect size, minimally important clinical difference estimates, and associations with clinical response indicators. The questionnaire demonstrated acceptable internal consistency at baseline and early follow-up, with Cronbach's alpha values exceeding the commonly accepted threshold during the initial assessment period. Test-retest reliability showed moderate-to-good performance across several domains, although estimates were weaker for some components and later time points. Construct validity analysis indicated that most items met the predefined correlation threshold, whereas a small number showed weaker convergence. The Hepatobiliary Cancer Subscale distinguished patients by baseline ECOG performance status, and selected functional and emotional well-being scores differed by disease progression status during follow-up. Interpretation of longitudinal findings was limited by high attrition and the small number of patients available at later assessments. Overall, FACT-Hep may be useful for preliminary HRQOL assessment in advanced iCCA, although further validation in larger cohorts is required.