Szilárd Váncsa

Introduction: We aimed to compare the efficacy of pancreas transplantation, islet transplantation, and insulin therapy in patients with type 1 diabetes mellitus (T1DM) undergoing renal transplantation. Methods: We conducted a systematic search across three databases on November 26, 2024 for studies on simultaneous pancreas-kidney transplant (SPKT), pancreas-after-kidney (PAK), simultaneous islet-kidney (SIK), islet-after-kidney (IAK), and kidney transplant alone with insulin (KTA-I) in T1DM. We analyzed changes in glycated hemoglobin (HbA1c %) from baseline, as well as other glucose metabolism, renal, and cardiovascular parameters. Pooled single means or mean differences (MD) were calculated with 95% confidence intervals (CIs). Overall survival (OS) and graft survival were assessed using the restricted mean survival time, derived from Kaplan-Meier curves at the truncated time. Results: We included 286 studies in the systematic review and 142 in the meta-analysis. We found that SPKT offers a greater reduction in HbA1c than KTA-I (MD:-3·2; CI:-5·26, -1·14) after 3 years. At 12 months, mean C-peptide (ng/mL) levels were higher after SPKT than after SIK/IAK (2·76 CI:2·49, 3·02 vs. 1·54 CI:0·16, 2·92). At 60 months after transplantation, OS was similar for SPKT, PAK, and KTA-I, whereas SIK/IAK was associated with the lowest OS (P=0·0095). At 120 months, overall and kidney graft survival were higher in LDK than DDK, and LDK was not inferior to SPKT. Pancreas graft survival was higher after SPKT than PAK (P=0·0018). Interpretation: Pancreas transplantation provides the best glucose metabolism. LDK offers higher graft survival than DDK and is comparable to SPKT, which in turn offers better pancreas graft survival than PAK. Islet transplantation is associated with the lowest OS.

Background: Most children recover after an initial acute pancreatitis (AP) episode; however, some progress to recurrent AP (RAP) or chronic pancreatitis (CP).Purpose: We aimed to quantify progression rates and identify the risk factors associated with these transitions.Methods: PubMed/MEDLINE, Embase, and Cochrane databases were searched on December 21, 2024, for pediatric studies reporting progression to RAP or CP (PROSPERO number: CRD420251086520). All observational studies were included, while case reports and case series were excluded. To evaluate the differences in RAP rates, we conducted subgroup analyses of etiology and severity. We also assessed clinical, structural, and genetic risk factors for disease progression. A random-effects model was used to pool proportions and odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was assessed using the I² statistic.Results: A total of 68 studies met the inclusion criteria. After the first AP attack, RAP developed in 18% (95% CI, 16–22%; I2=76%; k=39 studies) and CP developed in 10% (95% CI, 6–16%; I2=67%; k=5 studies) of patients. Among children with RAP, 35% (95% CI, 24–49%; I2=78%; k=7 studies) progressed to CP. The RAP rates varied according to etiology and severity: hypertriglyceridemia, 33%; idiopathic, 28%; biliary, 19%; traumatic, 16%; drug-induced, 14%; virus-induced, 3%; severe, 39%; moderate, 24%; and mild, 21%. Structural abnormalities were associated with a higher risk of RAP (OR, 3.15; 95% CI, 1.51–6.56; I2=0%; k=5 studies). Pancreas divisum (OR, 2.64; 95% CI, 1.51–4.63; I2=17%; k=7 studies) and PRSS1 mutation (OR: 4.56; 95% CI, 3.06–6.80; I2=0%; k=7 studies) were associated with CP.Conclusion: Approximately one in five pediatric AP episodes recurred, and over one-third of the RAP cases progressed to CP. The risk of RAP is influenced by the underlying etiology and severity of the initial episode, whereas structural and genetic factors are associated with later progression.

Background: The predictability of regenerative outcomes in non-contained intrabony periodontal defects remains limited. Autogenous tooth bone grafts (ATB) may represent a biologically active and osteoconductive scaffold with minimal residual graft material. This study evaluated the clinical and radiographic outcomes of ATB combined with enamel matrix derivative (EMD) in intrabony defects. Methods: Nine systemically healthy patients (15 defects) were treated with ATB + EMD in a retrospective proof-of-concept design. Clinical parameters—probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession (GR)—were recorded at baseline and 6 months. Radiographic changes in defect depth and width were also assessed. Statistical significance was set at p < 0.05. Results: Mean PPD decreased from 7.73 ± 0.96 mm to 3.87 ± 0.74 mm (p < 0.001), and CAL improved from 9.20 ± 1.47 mm to 5.53 ± 1.36 mm (p < 0.001). GR changes were not significant. Radiographically, mean defect depth and width were reduced from 3.81 ± 1.59 mm and 2.56 ± 0.75 mm to 0.72 ± 1.08 mm and 0.44 ± 0.70 mm, respectively (p < 0.001). Conclusions: The combination of ATB and EMD yielded substantial clinical and radiographic improvements in intrabony periodontal defects. These findings suggest that autogenous tooth bone grafts may serve as a reliable biologically active scaffold for regenerative periodontal surgery. This is the first study evaluating the combination of EMD and ATB. Within the study limitations, ATB + EMD demonstrated promising regenerative potential, warranting future controlled clinical trials.

Background/Objectives: Osteoarthritis, the principal indication for joint arthroplasty, has doubled in incidence since 1990. Advances in surgical techniques, combined with an ageing population, have driven a substantial rise in arthroplasty procedures, presenting numerous challenges for healthcare systems worldwide. This study analyses historical trends in joint arthroplasty, assesses the accuracy of prior projections, and forecasts future demand using data from international arthroplasty registries. The goal is to guide healthcare resource management and policymaking. Methods: A systematic registry search identified 15 nations’ joint arthroplasty registries, and 209 annual reports provided high-quality data on primary total hip (THA) and knee arthroplasties (TKA) over the past two decades. Future arthroplasty volumes were projected using a deterministic negative-exponential saturating growth model. Results: From 2010 to 2023, THA incidence rose by 130% to 210%, while TKA increased by 150% to 664% across the analysed national registries. Projections to 2050 indicate sustained growth: THA volumes are expected to rise by 121% to over 200% and TKA by at least 130% across all countries. Conclusions: The ongoing escalation in joint arthroplasty demand necessitates proactive healthcare planning. Without strategic investments in infrastructure, workforce capacity, and digital resources, national healthcare systems risk being overwhelmed by the projected growth in both primary and revision procedures in the coming decades.

Observational studies reported conflicting results regarding the association between proton pump inhibitors (PPIs) and intestinal dysbiosis. We assessed the risk of enteric infections, including Clostridioides difficile infection (CDI), and small intestinal bacterial overgrowth (SIBO) among PPI users compared to non-users in randomized controlled trials (RCTs). A systematic search was conducted on April 15th, 2025 (CRD42023403322). Eligible RCTs compared adults treated with PPIs versusplacebo or alternative therapies. Risk ratios (RR) with corresponding 95% confidence interval (CI) were calculated using random effects models. Eight RCTs with 29,880 participants reported CDI rates. No significant difference was observed between PPI users and non-users (RR = 1.19, 95% CI: 0.75; 1.89). Four RCTs totaling 27,254 participants compared PPIs to H2-receptor blockers, showing no significant difference in CDI risk (RR = 0.72, 95% CI: 0.49; 1.07). Similarly, three RCTs (1,645 participants) comparing PPIs with potassium-competitive acid blockers found no significant difference (RR = 1.23, 95% CI: 0.43; 3.55). The qualitative synthesis found that other enteric infections and SIBO may be more common in PPI users. Data from RCTs suggest that PPIs do not seem to increase the risk of CDI compared to placebo and other acid-suppressive medications.

Purpose: Methods: Results: Conclusion:

Background: Acromioclavicular (AC) joint dislocations are frequent, especially kocsisamong young male athletes. While over 150 surgical techniques exist, consensus on optimal treatment—particularly for Rockwood type III injuries—remains elusive. This study evaluates the Lockdown procedure’s efficacy, safety, and patient satisfaction, a synthetic ligament technique for AC joint stabilization. Methods: A multicenter prospective study was conducted on 39 patients across three Hungarian hospitals (2018–2023). Outcomes included shoulder function, pain levels, and complication rates, with subgroup analysis of acute (≤3 weeks) versus chronic (>3 weeks) cases. A systematic review of nine studies (205 cases) was also performed to assess broader outcomes and complications. Results: Significant improvements were observed in functional scores (OSS, Constant, DASH, SST, ASES, Nottingham, Imitani) and pain reduction, especially in acute cases with no prior shoulder surgery. The mean patient age was 38.9 ± 12.68 years, with a 24.5-month average follow-up. OSS improvement between acute and chronic cases was 14.96 (95% CI: 6.45–23.47; p = 0.0017). Complications (30.8%) occurred in eleven patients, mainly minor infections; implant failure necessitated revision in 5.1%. The systematic review reported a 34.6% complication rate (predominantly minor complications, like asymptomatic subluxation −16%) and 5.4% implant removal due to failure. A meta-analysis was not feasible due to data heterogeneity. Conclusions: The Lockdown procedure significantly enhances shoulder function and reduces pain, particularly in acute dislocations. However, the procedure showed a moderate complication rate, underscoring the need for careful patient selection and postoperative management.

Background/Objectives: This systematic review and meta-analysis aimed to determine the effectiveness of different aspirin dosages in preventing preeclampsia and its effect on other pregnancy-associated conditions. Methods: A comprehensive search of three databases (Pubmed, Embase, and Cochrane Library) was conducted for randomized controlled trials without time interval criteria, comparing aspirin at various doses with placebo or no specific preeclampsia prophylaxis. Eligible randomized controlled trials (RCTs) examined pregnant women receiving aspirin at any dose and time during their pregnancy, while the control group received a placebo, or placebo and a different dose of aspirin, or no specific preeclampsia prevention. No exclusion criteria were established regarding the population, study size, study site, or length of aspirin prophylaxis. Studies examining additional preventive medication (such as low-molecular-weight heparin) compared to aspirin without a placebo group were excluded. For all outcomes, the risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Meta-regression was performed to examine the relation between aspirin dosage and preeclampsia. Results: Based on the analysis of 31 studies involving 28,318 pregnancies and 20 studies involving 26,551 pregnancies, the early initiation of aspirin significantly reduced the overall incidence of preeclampsia (RR = 0.63, CI: 0.47–0.84) and perinatal death risk (RR = 0.82, CI: 0.72–0.93), respectively. Based on our meta-regression model, we could not establish a dose-dependent correlation between aspirin dosage and the risk of preeclampsia. Conclusions: Early-initiated aspirin prophylaxis is effective in preventing preeclampsia, without raising the incidence of placental abruption or increasing the amount of peripartum bleeding. No specific dose was superior to others; thus, further research should explore higher doses and focus on preterm preeclampsia, maternal–fetal complications, and bleeding.