In the literature, this paper is the first to describe the use of plasma rich in growth factors (PRGF)–Endoret^® in hemodialyzed diabetic patients, to promote the healing of after amputation wounds. The PRGF–Endoret^® was primarily conceived to be used in maxillofacial surgery, oral implantology, etc., the innovation residing in the blood collection technique (quantity, moment of the week, rhythmicity), which was adapted to the specific conditions of the hemodialyzed patient. Moreover, in the initial phases, the two PRGF fractions were innovatively applied as single alternating layers on the wound surface. Only after the surface of the wound decreased, the two PRGF fractions were applied as overlapping layers. Nevertheless, the paper presents the optimal method to assess the clinical evolution of the wound. Histopathological examination of the biopsy performed during wound preparation for PRGF application brought additional, essential data for orienting the therapeutic approach. The exclusion of calciphylaxis, a disease with high mortality risk, encouraged the application of this method, and also demonstrated the microscopic features in hemodialyzed diabetic patients.

Background and Objectives: Implant osseointegration has been widely studied over the past few decades, particularly focusing on surface modifications that aim to improve integration. However, the literature includes few studies regarding the role of the endosteum in early osteointegration. Therefore, the aim of the present work is to approach the technique of implant insertion into bones with marrow, with an emphasis on the use of implants that are long enough to achieve marrow penetration. Materials and Methods: Titanium implants were inserted into the femurs of eight eleven-month-old rabbits. Fourteen days later, the animals were euthanized in accordance with the current legal and ethical guidelines. The histological processes that occur at the bone–implant interface were investigated. Histological sections of the bone–implant interface were colored using the Trichrome’s Goldner method, and were further analyzed and photographed using an Olympus microscope. Results: The histological analysis showed that during the initial osteointegration phases, the newly formed bone originated from the endosteal–medular zone. Periostal proliferation was observed only during the early stages. The bone that proliferated on the implant’s endosteal/medullary interface exhibited a surface area approximately 6 times larger than that of the bone formed on the osteal surface. Also, its length was approximately 25% longer. Conclusions: The bone tissue that proliferates on the endosteal and marrow surface of the implant increases significantly the bone–implant interface, and creates the setting for a good secondary stability. The findings suggest several clinical implications, as follows: penetrating the bone marrow during the insertion of short implants allows for increasing the bone–implant interface; the flap should be carefully managed; the integrity of the periosteum must be kept, as this is a key anatomical structure in cases of deficient bone marrow (i.e., severe mandible atrophy or vertical ridge augmentations).

Background: Heart failure (HF) is highly prevalent among patients on maintenance hemodialysis (HD) and contributes substantially to morbidity and mortality. This study aimed to evaluate the prevalence, clinical characteristics, and prognostic impact of HF in a chronic HD population. Methods: A single-center observational study was conducted on 271 HD patients (January 2022–September 2024). HF was defined and classified according to 2021 ESC criteria using echocardiography and NT-proBNP. Clinical, laboratory, and dialysis parameters were compared between HF and non-HF patients. Predictors of HF were assessed using multivariable logistic regression, and survival analyses were performed using Cox regression and Kaplan–Meier curves. Results: HF was identified in 75% of patients: 45% had a preserved EF, 31% had a mildly reduced EF, and 24% had a reduced EF. HF patients were older, had higher NT-proBNP, lower EF, more atrial fibrillation, CAD, and increased interdialytic weight gain. In the multivariable analysis, a reduced EF (OR = 0.77, p = 0.001), older age (OR = 1.12, p = 0.001), and UF rate (OR = 1.31, p = 0.02) were found to independently predict HF. During the 34-month follow-up, HF was found to be associated with significantly higher all-cause and cardiac mortality and more frequent HF-related hospitalizations (log-rank p < 0.001). In the multivariable Cox regression, two variables were found to independently predict all-cause death, NT-proBNP (per 1000 pg/mL) (HR 1.030, p = 0.029) and a lower EF: (HR 0.97, p = 0.019). For cardiac death, a higher NT-proBNP (HR 1.038, p = 0.033) and a lower EF (HR 0.933, p = 0.001) together with a lower BMI (HR = 0.929, p = 0.028) persisted as independent predictors. Conclusions: HF is extremely common in HD patients and identifies a subgroup with distinct clinical characteristics and poor prognosis. NT-proBNP and left ventricular ejection fraction are key independent predictors of mortality, underscoring the importance of early cardiac evaluation and integrated volume and dialysis management to improve outcomes.

Background/Objectives: Hypothyroidism is highly prevalent among HD patients, due to cumulative disturbances in thyroid hormone synthesis, metabolism, and clearance. Subclinical hypothyroidism—defined by elevated TSH with normal fT₄—is common in HD, along with a distinct entity, the low-T₃ syndrome. This study aims to examine the predictors of hypothyroidism in HD and its impact on cardiovascular morbidity and mortality. Methods: We conducted a retrospective cohort study including 282 hemodialysis (HD) patients, with evaluated thyroid function and monitored from January 2022 to June 2025. A total of 66 (23.4%) patients with hypothyroidism were identified, 15 (5.31%) of whom had autoimmune thyroiditis. Subclinical hypothyroidism was documented in 31.81% of the hypothyroid patients. Results: Hypothyroidism occurred predominantly in females (63.63% vs. 41.2%, p ≤ 0.001) and was associated with higher BMI (27.856 ± 6.216 vs. 25.759 ± 6.080, p = 0.017), hypoalbuminemia (3.534 ± 0.547 vs. 3.725 ± 0.471, p = 0.006), elevated LDL-cholesterol and triglyceride levels, as well as with amiodarone use. Hypothyroidism was further associated with atrial fibrillation (33.33 vs. 19.9%, p = 0.022), coronary artery revascularization procedures (18.18% vs. 9.72%, p = 0.047), neoplastic disease (25.75% vs. 12.03%, p = 0.008), and cancer-related mortality (10.6% vs. 1.85%, p = 0.001). Multivariable regression analysis revealed the following predictors of hypothyroidism: female sex (OR 3.848, 95%CI 1.704–8.693, p = 0.001), BMI (OR 1.072, 95%CI 1.007–1.146, p = 0.031), hypoalbuminemia (OR 0.412, 95%CI 0.177–0.962, p = 0.040), hypertriglyceridemia (OR 1.088, 95% CI 1.001–1.016, p = 0.022) and amiodarone use (OR 6.698, 95%CI 1.744–25.722, p = 0.006). Patients with autoimmune thyroiditis did not exhibit clinical or biochemical differences compared with other hypothyroid patients. Subclinical hypothyroidism was associated with longer HD duration (10.476 ± 7.910 vs. 6.567 ± 5.541, p = 0.003), dyslipidemia, hypertension, atrial fibrillation and amiodarone use. Cardiovascular conditions—particularly atrial fibrillation and ischemic coronary disease requiring revascularization—are more common in HD patients with clinical or subclinical hypothyroidism. However, in our cohort, the Kaplan–Meier survival curves at 12, 24, and 36 months for patients with both subclinical and clinical hypothyroidism do not show significant differences in cardiac or overall mortality. Conclusions: The increased incidence of hypothyroidism in HD patients, together with its impact on cardiovascular pathology, underscores the need for multidisciplinary management and supports annual routine assessment of thyroid hormones—particularly in overweight or dyslipidemic patients and in those receiving amiodarone.

Background and Objectives: The insertion of endosseous implants requires the alveolar bone to be drilled, which produces alterations of the osseous neoalveolus approximately 1 mm deep, an area that will later be subjected to osseous renewal. The healing of the bone around the inserted implant is complex and depends on numerous factors, amongst which the size of the insertion orifice relative to the diameter of the implant, the design, and the pace and depth of the threads play an essential part. Therefore, the aim of this paper is to investigate from a histologic point of view the osseointegration of the implants inserted in a rabbit cortical bone by creating a 150 µm high healing chamber. Materials and Methods: 5 mm-long and 2 mm-wide titan implants were inserted into the femur of 15 12-month-old rabbits by using a drill with a 1.8 mm diameter, obtaining a spiralled healing chamber 150 µm high. The animals were euthanized after 7, 14, and 28 days according to effective legal and ethical protocols. The bone around the implants was severed 5 µm thick. After coloring with the Tricrom Goldner method, the sections that intercepted most centrally the intervention area were examined and photographed with an Olympus microscope. Results: The histologic result showed osseous healing within the healing chamber in the third to the endosteum of the implant after 7 days from the insertion. After 14 days, the osseous healing spread to 2/3 of the healing chamber. After 28 days, the whole healing chamber was occupied by bone. Conclusions: The healing chamber favored proper conditions for osseous healing, which began at the level of the endosteum. This statement is based on the histologic findings of bone formation after 7 days only in the third of the endosteum of the healing chamber. A 150 µm height of the healing chamber obtained in the rabbit cortical bone does not pose a risk of connective tissue proliferation.

Background/Objectives: Psoriasis is a chronic, recurrent inflammatory skin disorder with a steadily rising prevalence worldwide. Current therapeutic strategies include topical and systemic treatments selected based on disease severity and associated comorbidities; however, no therapy provided a definitive cure. Topical therapy is associated with a lower risk of systemic adverse effects, although the altered skin barrier observed in psoriasis may significantly reduce the bioavailability of active pharmaceutical ingredients. The aim of this study was to develop and evaluate the efficacy of a topical formulation containing triterpenoid acids derived from lavender extract (Lavandula angustifolia Mill.) as a potential adjunctive approach for symptom management in patients with psoriasis and chronic kidney disease (CKD). Methods: Following removal of the volatile oil, oleanolic, ursolic, pomolic, and rosmarinic acids were identified and quantified. The preparation was analyzed in terms of organoleptic properties, colloidal stability, pH determination, and rheological characteristics. The clinical study included 18 patients (both sexes) aged 28 to 71 years, with psoriasis and CKD of varying etiologies. Urinary albumin/creatinine ratio (uACR) and estimated glomerular filtration rate (eGFR) were used as renal biomarkers, while high-sensitive C-reactive protein (hs-CRP), hs-CRP/albumin, and neutrophil–lymphocyte ratio (NLR) were selected as inflammatory biomarkers. Laboratory assessments were performed at baseline and after 60 days of topical treatment with the lavender extract-based formulation. Clinical outcomes were evaluated using validated measures of psoriasis severity and patient impact, including the Psoriasis Area and Severity Index (PASI), the Investigator Global Assessment (IGA), and the Dermatology Life Quality Index (DLQI). Results: The formulation contained 1.4% rosmarinic acid and up to 8% ursolic acid (extract mass) and demonstrated good stability, a pH of 5.5, favorable local tolerability, antiproliferative activity, reduction in pruritus, and no treatment-related adverse effects. Efficacy and tolerability scores showed statistically significant improvements at 60 days (T2) after topical terpenoid administration compared with baseline (T0): PASI (0.722 ± 0.714 vs. 2.044 ± 0.690 at T0, p < 0.001), DLQI (3.889 ± 1.997 vs. 13.333 ± 3.361 at T0, p < 0.001), and IGA (0.556 ± 0.616 at T2 vs. 2.167 ± 0.618, p < 0.001). uACR decreased significantly over the study period (308.714 ± 240.782 after 60 days vs. 379.78 ± 308.81 at T0, p < 0.001), while eGFR values remained similar at baseline and follow-up. All evaluated inflammatory biomarkers showed significant reductions: hs-CRP (4.33 ± 2.127 at T2 vs. 9.7 ± 10.045 at T0, p < 0.009), hs-CRP/albumin ratio (0.105 ± 0.052 at T2 vs. 0.241 ± 0.225, p < 0.011), and NLR (2.154 ± 2.171 vs. 2.253 ± 0.256 at baseline, p = 0.027). Linear regression analysis identified no predictors of responsiveness to topical triterpenoid therapy in patients with psoriasis and CKD. Conclusions: This topical lavender extract-based formulation showed promising clinical and anti-inflammatory effects and favorable local tolerability in this pilot cohort of psoriasis patients with CKD. However, these findings should be considered preliminary and require confirmation in larger randomized controlled studies.