Introduction: Previous studies have reported a positive correlation between the Thyroid Feedback Quantile-based Index (TFQI), which reflects the central sensitivity of thyroid hormones, and the prevalence of cardiovascular diseases. However, the relationship between the TFQI and the prognosis of heart failure (HF) remains unclear. This study aimed to identify the optimal threshold for risk stratification and to determine which specific TFQI range is associated with poorer outcomes in HF patients.

Methods: This retrospective study included 402 individuals admitted to the Cardiology Department of Heze Hospital, affiliated with Shandong First Medical University, between 2022 and 2023. The primary outcome was 90-day all-cause mortality or HF readmission, as determined by routine follow-up. The X-tile project was used to obtain a threshold based on the composite outcome. Univariate and multivariable Cox regression, restricted cubic spline (RCS) analysis, and the construction of Kaplan–Meier curves were conducted.

Results: An analysis using X-tile software revealed that the optimal TFQI threshold for predicting adverse composite outcomes was 0.10. Patients with a TFQI value > 0.10 remained independently associated with adverse composite outcomes (adjusted HR: 1.89, 95% CI: 1.144, 3.121, P =0.013). The RCS analysis demonstrated a linear relationship between continuous TFQI values and the hazard ratio of the composite inferior outcome. The Kaplan–Meier curves revealed a significant difference in the survival rates between patients with TFQI values ≤0.10 and those with values > 0.10 (Log-rank test: P = 0.004).

Conclusions: A TFQI value > 0.10 can be used to identify HF inpatients who are at increased risk of mortality or readmission. Incorporating the TFQI into routine clinical assessments could enable healthcare providers to identify high-risk patients and implement more targeted interventions.

The increasing effect of climate change and disasters presents health threats globally, as it brings about infectious diseases, heat-related diseases, and related stress. This study aims at examining disaster- and climate-change-related medicine, a field that tackles the means, methods, and ways through which the sector ensures that it becomes more resilient during disasters and is prepared adequately to handle disasters and strengthens health systems' capacity to cope with disaster risks in regions that are prone to such disasters.

Methodology: Quantitative surveys of health information from disaster zones were conducted and complemented by qualitative interviews with doctors and relevant authorities. Actual flood and heat wave situations in India were modelled to capture healthcare response scenarios. Quantitative data analysed the impact of climate change on medical interventions, and in terms of qualitative data, reviews discussed the major advances in disaster medicine.

Results: The completed analysis showed that the implementation of specific climate-related protocols decreased the mortality by 25% in disaster situations. Public awareness and regular pre-disaster immunisation checks took massive steps towards controlling diseases that are spread by vectors such as dengue and malaria. Efforts that provided mental health support, such as telemedicine, lowered the psychological distress in the targeted groups by 40%. The specific recommendations for climate change adaptation are the extension of healthcare structures that are immune to climate change, disaster preparedness education for medical personnel, and a focus on and the enhancement of community-based health initiatives.

Introduction: Minimally invasive procedures have been introduced to increase the horizontal ridge volume for implant placement driven by prosthetic indications. Using these clinical cases, we describe an innovative horizontal ridge augmentation approach that employs a tunnel preparation technique and grafting with xenogeneic bone, hyaluronic acid, and an acellular dermal matrix.
Procedure: Two patients were treated. A single vertical incision was made mesial to the bone defect. A dermal matrix was contoured and placed in the subperiosteal tunnel. A sticky bone graft was placed between the dermal matrix and the buccal bone plate. Primary wound closure was obtained, preserving periosteum integrity and blood supply to the flap. Optical scans were taken at baseline, five months after surgery, and two months after implant placement. Horizontal ridge thickness was measured digitally.
Results: No clinical complications were observed after the surgical procedure. The implants were successfully placed with minimal tissue damage and reduced patient morbidity. A quantitative analysis of ridge thickness, based on the superimposition of intraoral scans, showed an approximate horizontal ridge augmentation of 3.00 ± 0.15 mm at the site of the inserted implant.
Conclusions: Application of this novel horizontal ridge augmentation technique led to a considerable increase in horizontal volume, enabling implant placement with less morbidity. Further research is needed to confirm and enhance this approach.

Introduction: Odontogenic myxoma (OM) is a rare benign odontogenic tumor originating from the periodontal ligament or dental pulp, often associated to MAPK/ERK gene mutation. Radiologically, it usually appears as a radiolucency with variable features, while histologically, it shows a myxoid substance, an absence of epithelial remnants, and collagen deposits. OM may show infiltrative behavior with a recurrence rate of 25%.

The aim of this report is to present a case of odontogenic myxoma localized in the periodontal region of tooth 1.4, from diagnosis to rehabilitation.

Methods: We investigated a 45-year-old female patient presented with a tense–elastic neoformation located in the mucosa corresponding to tooth 1.4. The lesion extended into the vestibular and palatal sides, was non-painful and non-bleeding, and upon probing revealed a pseudo-periodontal pocket measuring 10 mm in depth. A CBCT evaluation was performed to assess the lesion, providing detailed information about its extent and relation to the surrounding structures. Surgical management involved the excision of tooth 1.4 with the lesion, bone curettage using a piezoelectric handpiece, and coronal repositioning of the flap for primary intention healing. The sample was sent for histological examination to the Department of Pathology, leading to the diagnosis of OM. One month after, frenotomy and deepening of the vestibular fornix using diode-laser-assisted surgery (1.5W, CW) were performed. Three months post-surgery, implant rehabilitation was performed. A fully digital workflow was utilized, ensuring precise planning and execution of the treatment.

Results: The follow-up showed no recurrence. The mucosa was restored to a healthy state, and the implant rehabilitation achieved safe, aesthetic, and functional outcomes.
Conclusions: Collaboration between oral surgeon, oral pathologist, pathologist, and prosthodontist was crucial for successful outcomes in similar cases. Furthermore, using the most advanced technologies enabled the rehabilitation with a minimally invasive, accurate, and predictable approach.

Introduction: The laser-assisted new attachment procedure (LANAP) protocol, leveraging the advanced capabilities of the Nd:YAG laser, is driving a paradigm shift in periodontal treatment, transitioning from traditional resective approaches to regenerative and reconstructive procedures. The aim of this report is to present a clinical case demonstrating the use of the Nd:YAG laser (1064 nm) as an adjunct to full-mouth disinfection in the management of drug-induced gingival hypertrophy.

Methods: A 50-year-old male patient with amlodipine-related gingival hypertrophy presented to our clinic. A thorough periodontal evaluation was performed, including radiographic examinations and the completion of a periodontal chart. One month after drug replacement, supragingival and subgingival scaling and root planning, oral hygiene instructions, and chlorhexidine 0.20% rinses were continued. Finally, two sessions of Nd:YAG laser-assisted curettage were performed, spaced 40 days apart.

Results: The patient showed a continuous reduction in hypertrophy and pseudo-gingival pockets over time, until a normally colored gingiva with an absence of bleeding and further classic signs of inflammation was achieved.

Conclusions: Nd:YAG laser fiber optics, when introduced into the gingival pseudo-pockets, is effective in disintegrating periodontopathogen bacteria and sulcular debridement, demonstrating promising short-term benefits for patients with gingival hypertrophy. This technique should be considered as a complementary therapy, not a replacement, for traditional root scaling and root planing techniques, allowing the avoidance of resective surgical techniques conventionally used in cases of gingival hypertrophy.

INTRODUCTION: Odontogenic fibroma is a rare benign neoplasm of ectomesenchymal origin. The intraosseous variant, "central odontogenic fibroma" (COF), occurs across a wide age range (4-80 years), with a female predominance. It primarily affects the posterior mandible, particularly the premolar and molar regions. This report presents a case of mandibular COF in a 27-year-old female and discusses diagnostic and treatment options alongside a literature review.
METHODS: A 27-year-old female patient presented for a routine dental examination, during which swelling of the lingual cortex was noted. Radiographic examination performed with RX-OPT and CT imaging revealed a multilocular radiolucent lesion extending from teeth 4.3 to 4.6. All teeth in the involved area were vital. An incisional biopsy was firstly performed, leading to the diagnosis of central odontogenic fibroma (COF). The lesion was subsequently treated with complete surgical excision, curettage, and extraction of teeth 4.4 and 4.5. Histological examination confirmed the diagnosis of COF. A literature review was conducted to analyze data from 2008 to 2024 concerning all mandibular COF cases published, analyzing patient age, lesion localization, treatment modalities, and recurrence rates.

RESULTS: The histological examination confirmed the diagnosis of COF. We also found papers reporting nine cases of COF occurring in the mandible. Seven patients were young and two were old. Two patients were asymptomatic and six showed swelling. Among the lesions, five were unilocular and four were multilocular in nature. Treatment varied between the patients: five were treated with enucleation and four with surgical excision. No recurrences were observed in the literature and in our presented case.

CONCLUSIONS: The significance of this study is seen in the need to further expand clinicians' awareness about both the diagnosis and treatment of asymptomatic bone lesions. Such findings emphasize the critical importance of radiographic examination within routine dental checkups as a means of early identification and appropriate intervention at any age.

Introduction

Oral squamous cell carcinoma (OSCC) is the most frequent cancer in the oral cavity; because of its aggressiveness, clinicians should diagnose it in its early stages (T1 and T2) to minimize post-operative complications and surgical invasiveness. In low-stage lesions, a pre-operative evaluation with Intraoral High-Definition Ultrasound (IHDS) is recommended for assessing lateral margins and depth of invasion with a diode laser (DL) surgery, which avoids any bleeding during excision or complications, resulting in a less invasive surgical treatment that is minimally damaging to irradiated tissues.

We describe a case of a tongue carcinoma entirely excised with DL after a pre-operative assessment by IHDUS.

Methods

A patient referred to our Complex Unit of University of Bari “Aldo Moro” complained of a painful ulcerated swelling of the right tongue margin. An IHDUS of the lesion revealed a hypoechogenic area measuring 2,7 mm in depth. Surgical excisional biopsy was performed with a diode laser (4W, c.w.; Lasotronix, Poland), also including wide perilesional margins. The specimen was sent for histopathological exam. No stiches were needed.

Results

The histopathological exam confirmed the diagnosis of highly differentiated OSCC.

Clinical follow-ups were performed weekly for 1 month and monthly for 6 months; complete healing was observed in 30 days. No complications or recurrences were detected.

Conclusion

OSCCs must be intercepted and treated in their early stages (T1 and T2) to reduce mortality incidence and to possibly avoid surgical invasiveness associated with tumor size. Histological examination is the gold standard for staging and diagnosis; diode laser excisional biopsy of early-stage OSCCs is recommended to reduce surgical bleeding or complications and to minimize damage to perilesional tissues.

Introduction: In the literature, a variety of peripheral lesions exist, including rare variants of odontogenic lesions, which makes their differential diagnosis more challenging for clinicians and radiologists too. Among all of these, Odontogenic Keratocysts (OKCs) are benign cysts arising from the dental lamina’s remnants. OKCs are commonly located in the mandibular posterior body and ramus; their peripheral localization is noticeably rare. We report a case of peripheral OKC and also define the criteria for the correct differential diagnosis and treatment of such peripheral lesions; data from the literature are reported too.

Methods: A 68-year-old female patient was referred to the Complex Unit of Odontostomatology at the University of Bari “Aldo Moro” due to asymptomatic swelling of the right inferior vestibular gingiva. A radiograph revealed well-defined roundish radiotransparent evidence between elements #4.3 and #4.4. After local anesthesia, the elevation of a full-thickness flap revealed a cystic wall, whose rupture caused the release of a straw-colored fluid. Due to the uncertain diagnosis, the patient underwent complete surgical excision of the lesion and careful curettage of the cavity, including the adjacent dental roots. The specimen was sent for histopathological examinations.

Results: The histopathological report led to the diagnosis of a peripheral OKC. The patient underwent clinical–radiographical follow-ups every 3 months, showing complete healing of the osteolytic area. No complications or recurrence was detected.

Conclusions: The data from the literature highlight the rarity of peripheral OKCs, as only 33 cases have been reported to date. This herein-presented case shows how the wide variety and clinical aspects of peripheral lesions could be misleading for a differential diagnosis, which makes a histopathological examination both mandatory and exclusively diriment for the final diagnosis. The absence of pathognomonic features for both clinical and radiological diagnoses, combined with the possibility of an odontogenic extraosseous manifestation with high recurrence rates, makes a preventive and complete excision of peripheral lesions crucial for proper healing without recurrence.

Introduction: Multiple myeloma (MM) is a rare hematologic malignancy characterized by uncontrolled plasma cell proliferation. About one-third of MM patients develop maxillary advanced-stage lesions, which are usually associated with poorer survival outcomes, serving as prognostic indicators of disease progression. The aim of this report is to describe a case of an extensive, aggressive and invasive osteolytic lesion of the mandibular angle in a patient with a complex medical history.

Methods: An 80-year-old female patient with a medical history of multiple vertebral fractures, paroxysmal atrial fibrillation, cardiac disease, hypotension, arteriopathy, type 2 diabetes mellitus, dysthyroidism, dyslipidemia and obesity presented to our attention with painful swelling of the left mandibular angle, also including the submandibular area. Radiography showed a radiotransparent osteolytic lesion with irregular borders, which incorporated the left mandibular angle and inferior mandibular border. CT was required to better evaluate the dimensions of the lesion. Considering that performing an FNA was not possible, under local anesthesia, a mucoperiosteal flap was elevated to reveal the mandibular ramus and access to the lesion for an incisional biopsy. Specimens were sent for histopathological examination.

Results During surgery, the patient experienced episodes of atrial fibrillation and was sent to Cardiology for a specialist check. The histological exam led to diagnosis of MM with extensive plasma cell infiltration, and then the patient was sent to the Hematology Section for an adequate treatment. The patient was lost at the follow-up.

Conclusions: Biopsy of malignant extensive osteolytic lesions in patients with a complex medical history is particularly challenging because of the high intra- and post-operative risks. When diagnosed, management becomes complicated due to systemic complications, which lead to difficulties in implementing effective therapy and adequate follow-up.

AIM
Medication-related osteonecrosis of the jaw (MRONJ) is a rare complication associated with the long-term use of bisphosphonates. This clinical condition is characterized by exposed bone that fails to heal. Diagnosis is established when necrotic bone is present in the maxilla or mandible for at least 8 weeks in patients who have not undergone head and neck radiotherapy. MRONJ may cause pain or remain completely asymptomatic. The aim of this study is to present a clinical case involving the non-invasive use of Low-Level Laser Therapy (LLLT), with a focus on the improvement of hard tissue defects.

METHODS
A 57-year-old female patient presented to the Complex Unit of Odontostomatology in May 2024 with purulent discharge and pain around two mandibular implants in the symphysis region. The patient had been taking alendronate (oral) for osteoporosis from April to June 2024 every ten days. She underwent orthopantomography and cone-beam computed tomography (CBCT), which revealed an area of sclerotic bone surrounding existing implants. The patient was treated with intramuscular ceftriaxone (1g) and oral metronidazole (250mg) every day for two weeks. Due to the patient’s medical history and the size of the lesions, the authors opted not to perform surgery, but instead to use LLLT (980 nm, CW, 1 W), using a dedicated handpiece for photobiomodulation. The lesion received 4 minutes of defocused irradiation (150-200 J) once a week for four months.

RESULTS
The patient underwent clinical follow-up weekly and radiological follow-up monthly until a reduction in lesion size was observed.

CONCLUSIONS
LLLT is a simple, non-invasive procedure that resulted in pain reduction and a decrease in lesion size in this case. This technique can be considered for patients who are not candidates for surgery due to other underlying conditions or the size of the lesion.