MedNEXT Journal of Medical and Health Sciences

Main considerations in orthognathic and aesthetic surgery: a systematic review

Yasmin Mirieli Suave Inácio — 2026-10-02

Introduction: Orthognathic surgery (OS) is an important tool for correcting facial deformities. Autologous fat injection enables precise contouring and volumization in conjunction with OS to optimize aesthetics. Objective: To present key considerations regarding orthognathic surgery and aesthetics. Methods: The study followed PRISMA guidelines for systematic reviews and AMSTAR 2 criteria for methodological quality. Searches were conducted between May and July 2026 across the Web of Science, Scopus, PubMed, LILACS, EBSCO, SciELO, and Google Scholar databases. Study quality was assessed using the GRADE tool, and risk of bias was analyzed using the Cochrane tool. Results and Conclusion: A total of 137 articles were identified. Fifty-seven articles were evaluated in full, with 36 included and analyzed in this systematic review. Clinical studies showed homogeneity in their results, with a Chi-square (X²) value of 71.6% (>50%). Regarding the Cochrane risk-of-bias tool, the overall assessment identified 15 studies with a high risk of bias and 20 studies that failed to meet GRADE and AMSTAR-2 criteria. According to the Cochrane tool, the risks of bias did not compromise scientific progress. It was concluded that volume augmentation with adipose tissue can be a viable intervention for mild to moderate facial deficiency following orthognathic surgery. Most studies analyzed in this review demonstrated that fat grafting in orthognathic surgery is a safe and effective tool for improving healing and aesthetic outcomes, as well as for providing anti-inflammatory effects and reducing edema.

Assessment of nutritional status among a sample of pregnant women in Al-Samawah City in Iraq: a cross-sectional study

Tabark J. Abd AL-kadhim — 2026-09-30

Introduction: Pregnant women experiencing poor nutritional status remains a problem which is still commonly found in Iraq. Poor nutritional status is one of the causes of increased mortality in pregnant women. Objective: Assess the nutrition status of pregnant women, and to determine the obese by nutrition and demographic variables Methods: A cross-sectional design study with 400 samples of pregnant women were collected. The sample distributed throughout (Al-Hussein Teaching Hospital, Maternity and Children's Teaching Hospital, and Samawah Primary Healthcare Sector). The data collection period starts on 21, December 2025 to 1, March 2026. The reliability of the questionnaire was assessed to determine its internal consistency and stability. Result: The two primary variables that were substantially linked to a higher BMI were age and gravidity. The relationship between age group and BMI was statistically significant (p = 0.044). The incidence of overweight and obesity was lowest in the under-20 age group, while it was highest in women aged 20–34. This suggests that the bulk of this population's overweight and obese individuals are in the reproductive age range (20–34 years). BMI and gravidity were substantially correlated (p = 0.025). Compared to prim-gravida women, multigravida women were more likely to be overweight or obese. Conclusion: Pregnant women in Samawah are frequently overweight or obese, and these conditions are strongly linked to maternal age, gravidity, and progressing gestation. However, there was no significant correlation found between BMI and socioeconomic indicators or reported physical activity.

Approaches of bisphosphonates and osseointegrated implants: a review of the major outcomes

Igor Luis Rodrigues Volpi — 2026-09-30

The most common bone disorder found by implant dentists is osteoporosis, a systemic skeletal disorder associated with aging characterized by loss of bone mass, making bones fragile and more susceptible to fractures. The World Health Organisation has defined osteoporosis as a bone mineral density level greater than 2.5 standard deviations below the mean of young normal women. After 60 years of age, a third of the population has this disorder; it occurs twice as often in women as in men. It is estimated that 1.3 million fractures and 133,000 hip fractures occur every year as a result of osteoporosis. The aim of this study was to discuss aspects of the pharmacological action of Bisphosphonates (BP) and their influence on bone tissue when associated with treatment with dental implants. The PRISMA rules were followed. The search was conducted from February to April 2026 across the PubMed, Scopus, Web of Science, Embase, Cochrane, Ovid, Periodicos.com, Harvard Library, and Google Scholar. 64 articles were found, 35 articles were evaluated in full, and 26 were included and developed in the present systematic review study. There are several types of treatments that prevent or prevent the progression of osteoporosis. So, BP, such as alendronate, are inhibitors of bone resorption. Act as controlling the development of osteoporosis by increasing the process of bone density and decreasing its reabsorption, often supporting the process of osseointegration of dental implants.

Importance of hospital dentistry for patients undergoing vertical mandibular osteotomy: a systematic review

Alexander Rafael Pontes Azevedo — 2026-09-30

Introduction: Deformities can be defined as changes in the development of facial bones, especially of the maxilla and mandible, and may cause changes in other structures, organs, and systems, such as the airways. Given this, the dental surgeon assumes a leadership role in the hospital care of these cases. Objective: It was to conduct a systematic review on the importance of hospital dentistry for patients undergoing vertical mandibular osteotomy. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from May to July 2026 across the Web of Science, Scopus, Embase, PubMed, ScienceDirect, SciELO, and Google Scholar databases. The quality of the studies was assessed using the GRADE instrument, and the risk of bias was evaluated according to the Cochrane instrument. Results and Conclusion: According to the GRADE instrument, most studies presented homogeneity in their results, with X²=71.6%>50%. A total of 119 articles were found and submitted for eligibility analysis, with 30 final studies selected to compose the results of this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 31 studies with a high risk of bias and 25 studies that did not meet GRADE and AMSTAR-2 standards. The articles consulted in the scientific literature analyzed teleradiographs taken before and after vertical jaw osteotomy in 2,342 patients. It was evaluated quantitatively lateral cephalometric radiographs of patients of both genders, who needed to undergo vertical osteotomy of the mandibular branch to correct dento-skeletal deformity of the Class III type, whose purpose was to mandibular retreat. There were mandibular retreatments with a decrease in mandibular length with a change in the amount of indentation in millimeters with an amplitude of 2 mm to 22 mm and linear (25.7%) or rotational movement. The cases submitted to Mandibular Intraoral Vertical Osteotomy showed a reduction of the Gonial Angle in some cases. After evaluating, radiographically, the pharyngeal airspace, facial height, mandibular length, and gonial angle, it was analyzed that there were mandibular retreatments with decreased mandibular length with change in the amount of indentation and linear or rotational movement.

Major approaches to dental treatment in patients with cardiovascular disease: a concise systematic review

Natalia Gomes Furlan — 2026-09-30

Introduction: Cardiovascular diseases can have a congenital origin, that is, present from birth, such as interatrial and interventricular communication, defects of the artery, coronary arteries, or acquired coronary artery anomalies that involve several risk factors such as smoking, alcohol, old age, and a sedentary lifestyle. Thus, acquired ones are the most frequent in the routine of a dental practice, so the dentist should be able to attend to those patients who need special care, regarding the correct use of medications due to the risk of drug interactions, the type of local anesthetic to be used, and the management of patients who use anticoagulant therapy. Objective: It was to analyze the major approaches to dental treatment in patients with cardiovascular disease. Methods: A search was made in the databases Scopus, Embase, Scielo, PubMed, and Academic Google in the period 2003 to 2026, following the rules of systematic review-PRISMA. Results: A total of 36 papers that were submitted to the eligibility analysis were collated and, after that, 18 studies were selected. Most studies presented homogeneity in their results, with Chi-Square (X²)=79.7%>50%. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 07 studies with a high risk of bias and 04 studies that did not meet GRADE and AMSTAR-2. In all cases of patients with cardiovascular diseases, the preoperative anamnesis should be done with all the details, always observing the risk factors, that progress to include the medications used; if the patient makes use of cardiac prostheses, monitor the vital signs before and after dental procedures, always recording all occurrences and procedures in medical records. Conclusion: It is necessary for the dental treatment of these patients with heart disease to have good knowledge of the subject and requires medical and dental coordination. Dental surgeons need to be prepared to identify possible medical and dental emergencies and take steps to prevent or treat them effectively and quickly.

Oral mucositis and treatment with low-level laser therapy: a concise systematic review

Letícia Alves Fernandes — 2026-09-30

Antineoplastic treatments, such as chemotherapy and radiotherapy, have the main objective of destroying malignant cells. However, they also affect sensitive tissues such as the oral mucosa, causing side effects including oral mucositis. This inflammatory condition can range from mild erythema to extensive, painful ulcers, affecting antineoplastic treatment, disease control, and patient survival rates. Although several measures are adopted to control this condition – including rigorous oral hygiene, cryotherapy, and the use of analgesics – many of these approaches only temporarily relieve the symptoms. In this context, the use of low-level laser therapy emerges as a promising therapeutic alternative. This non-invasive technique has the ability to penetrate soft tissues, providing pain relief while modulating inflammatory responses and accelerating healing processes. This study aims to demonstrate the effectiveness of low-level laser treatment in patients affected by oral mucositis. Information was collected from the National Library of Medicine (NIH-PubMed), Scientific Electronic Library Online (SciELO), Scopus, Web of Science, LILACS, EBSCO, and Google Scholar, using the descriptors oral mucositis, antineoplastic treatments, and low-level laser therapy. Inclusion criteria were scientific studies in English, published between 2020 and 2026. Duplicate articles and those not related to the topic were excluded. Studies have shown that low-level laser therapy is considered a non-invasive method and has proven to be an effective ally in the treatment of oral mucositis. It provides a faster response compared to medications, as it has the capacity to modulate inflammatory markers with a low therapeutic cost compared to medications.

QuPath-assisted digital scoring of ER, PR, HER2 and Ki-67 compared with manual assessment for surrogate molecular subtyping of invasive breast carcinoma: a diagnostic agreement study from Salah Al-Din, Iraq

Sara Faez Hassan — 2026-10-02

Introduction: Manual scoring of breast cancer biomarkers is subject to observer variability, and opensource digital image analysis has not been evaluated in Iraqi practice. Objective: This study aimed to compare QuPath-assisted digital scoring with manual assessment of ER, PR, HER2 and Ki-67 in invasive breast carcinomas from Salah Al-Din, Iraq, both for the individual measurements and for the surrogate molecular subtypes derived from them. Secondary aims were to characterise the cases in which the two methods disagreed, to examine how QuPath-measured HER2 membrane positivity related to the manual HER2 score, and to explore the associations of the digital readouts with standard histopathological parameters and survival. Methods: ER, PR, HER2 and Ki-67 were scored manually and with QuPath in 120 invasive breast carcinomas from Salah Al-Din, Iraq. Agreement was assessed with intraclass correlation coefficients (ICC), Lin’s concordance coefficient, Bland–Altman analysis and κ statistics, and surrogate subtypes derived by both methods were compared. Results: Agreement was excellent for all continuous measurements (ICC 0.9390.994). Categorical agreement was 99.2% for ER status, 97.5% for PR status, 97.5% for Ki-67 ≥20% and 92.5% for HER2 score (weighted κ 0.940). Subtype agreement was 114/120 (95.0%; κ 0.935). All six discordant cases had ER/PR expression of 1–10%, Ki-67 at the 20% cut-off, or HER2 upgraded from 2+ to 3+ despite non-amplified in situ hybridisation. Triplenegative status was associated with shorter disease- free survival (QuPath hazard ratio 3.65, 95% CI 1.489.00), although events were few. Conclusion: QuPath scoring agreed closely with manual assessment in this cohort. Cases near clinical cut-offs and HER2 2+ tumours still require pathologist review and in situ hybridisation. Multicentre validation is needed.

Biocompatibility testing of domestically produced ultra-high molecular weight polyethylene with vitamin E through manufacturing and design evaluation with analysis of toxicity, inflammatory response, and tissue reaction in an Oryctolagus cuniculus rabbit model

Putu Feryawan Meregawa — 2026-09-16

Introduction: Life expectancy in Indonesia will increase along with economic and health advancements. Osteoarthritis is a degenerative disease that can affect joints in various parts of the human body, including the hip joint, one of the most frequently affected areas. Significant pain can lead to impaired mobility and dependence on support devices or assistance from others. Objective: To assess and compare the safety and biocompatibility of domestically produced vitamin E-stabilized UHMWPE (GUR® 1050-E) against commercial UHMWPE as acetabular liner material in the Total Hip Arthroplasty system. Methods: In vivo experimental study with a comparison of 2 groups. Laboratory of the Faculty of Veterinary Medicine, Airlangga University, 1 August–12 September 2025 (observation period 6 weeks). A total of 12 male rabbits aged 3–6 months (1500–2000 g) were divided into 2 groups (each n=6): domestically produced UHMWPE + vitamin E and commercial UHMWPE (control). After 7 days of acclimatization, sterile 6 × 5 mm UHMWPE implants were implanted into the right femur near the periosteum under ketamine–xylazine anesthesia. Outcomes included Draize Test and Body Condition Score (weeks 0, 3, 6), serum IL-6 and TNF-α levels by ELISA (weeks 0 and 6), and histopathology of the tissue around the implant (H&E) with Modified ISO 10993-6 assessment after euthanasia. Statistical analysis used SPSS 25.0. Results: All Draize scores at weeks 0, 3, and 6 were 0 in both groups without erythema or edema, and there were no significant differences across time points or between groups (p=1.000). IL-6 and TNF-α levels decreased significantly intragroup from week 0 to week 6 in both groups. The decrease in IL-6 in the UHMWPE + vitamin E group was greater than in the control group (Δ IL-6: 221.03 ± 200.91 vs. 21.26 ± 12.44; p=0.035), while the change in TNF-α between groups was not significantly different (p=0.073). The BCS was relatively stable without significant differences between groups. Local tissue response scores based on Modified ISO 10993-6 did not differ significantly between groups (p=0.945). Conclusion: Domestically produced vitamin E-stabilized UHMWPE has equivalent biocompatibility to commercial UHMWPE with no evidence of additional adverse effects.

Major clinical and systemic impacts of periodontal diseases in pregnant: a systematic review

Isadora Espinosa dos Santos — 2026-08-21

Introduction: Periodontal disease (PD) represents several pathological changes that occur in the periodontium, that is, the tissues surrounding the teeth. These include the periodontal ligament, cementum, alveolar bone, and gingiva. During pregnancy, women enter a period in which oral health should be a priority. During this period, estrogen and progesterone levels, their sex hormones, potentially increase over time and are detrimental to tissue metabolism. Objective: It was to conduct a systematic review of the risk of periodontal disease in pregnant women. Methods: The research was conducted from June to July 2026 in the Scopus, Embase, PubMed, Science Direct, and Scielo databases, using older gold-standard scientific articles up to 2025. Study quality was based on the GRADE instrument, and risk of bias was assessed using the Cochrane tool. Results and Conclusion: A total of 145 studies were found and submitted to eligibility analysis. The final sample contained 17 eligible studies, which were described in the systematic review. Most studies presented homogeneous results, with X²=70.5% >50%. This study highlighted that periodontal disease in pregnant women may be one of the determinants of low birth weight. Studies were conducted to verify the existence of an association between maternal periodontal disease and low birth weight. The gestational period is when the occurrence of PD is more likely due to its hormonal and physiological changes. Pregnant women should be vigilant and take appropriate care, have prenatal care with their dentist, and in addition to oral care, they should be aware of the risks of low birth weight and preterm birth. Infections in the genitourinary tract, such as PD, may be associated with the occurrence of low birth weight newborns through the same mechanisms as other maternal infections and preterm birth. Uterine contraction and cervical dilation, which trigger premature birth, can be caused by inflammatory stimuli, which can induce hyperirritability of the uterine smooth muscle. Infection and the resulting inflammatory process can damage the placenta, thus restricting fetal development. Throughout life, women experience various phases of hormonal fluctuations that, in addition to interfering with the reproductive system, influence other organs and systems, such as the periodontium, especially in the presence of preexisting plaque-induced gingival inflammation. During pregnancy, women are exposed to several significant hormonal changes, as the placenta produces high amounts of estrogen and progesterone, which, in turn, affect oral tissues. It was concluded that Black women over 40 are more likely to have PD, presenting a higher risk of poor fetal development.

Major considerations on the periodontal biological space and treatments for dental implants: a concise systematic review

Livia Baldan Landin Santos — 2026-08-29

Introduction: Proper planning, coupled with improved technique, knowledge of the dental anatomy and adjacent structures, commences for successful treatment. In preparing for a prosthesis, we must know how to respect the limits of soft-tissue anatomy. The biological space must be strictly respected, in order that there is harmony between the prosthesis and the soft tissue. Objective: This study aimed to review, through literature, the importance of respecting the limits of the biological space when preparing for a fixed prosthesis. Methods: The PRISMA Guidelines were followed. The search was conducted from January to February 2026 across the Web of Science, Scopus, Embase, PubMed, ScienceDirect, SciELO, and Google Scholar databases. The quality of the studies was assessed using the GRADE instrument, and the risk of bias was evaluated according to the Cochrane instrument. Results and Conclusion: According to the GRADE instrument, most studies presented homogeneous results, with X2 = 65.7% > 50%. A total of 120 articles were found and submitted for eligibility analysis, with 16 final studies selected to compose the results of this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 31 studies with a high risk of bias and 28 studies that did not meet GRADE and AMSTAR-2 standards. Information on the biological space and its limits that must be respected is consistent in the literature. Harmony and success of treatment depend on strict planning, adequate materials, and respect for biological limits.

Main clinical findings on the osseointegration in dental implants: a systematic review

Letícia Nunes Ulian — 2026-08-13

Introduction: In the dental implant and osseointegration scenario, the treatment of oral rehabilitation with implants obtained a substantial evolution. At the time when the concept of osseointegration was pioneered by Branemark, the primary focus was directed toward functional rehabilitation. Objective: The present study aimed to carry out a systematic review of the main considerations of dental implants in osseointegration, as well as to emphasize all the processes involved. Methods: The rules of the Systematic Review-PRISMA Platform were followed. The research was carried out in June to July 2026 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 152 articles were found. A total of 72 articles were fully evaluated and 22 were included in the systematic review. A total of 44 studies were excluded because they did not meet the GRADE and AMSTAR-2 criteria, and 6 studies were excluded because they had a high risk of bias. It was concluded that to maintain osseointegration and prevent bone loss from implants, a better understanding of the osteoimmunology of the peri-implant environment would lead to the development of new therapeutic approaches. It is necessary to discuss immunomodulatory strategies to improve and preserve a long-term functional integration between dental implants and the human body. It is concluded that the bone saucerization around osseointegrated implants represents one of those specific concepts that are part of the implant dentist jargon.

Major considerations and clinical outcomes of maintaining or rehabilitating red aesthetics in dental implants: a systematic review

Beatriz Affonso Cucolo — 2026-08-13

Introduction: In implant dentistry, maintaining the red aesthetics of the gingiva is very important for smile quality and patient comfort. In this context, immediate loading or function requires primary implant stability, necessitating the maintenance of gingival architecture and alveolar bone tissue. Objective: It was to analyze the main considerations and clinical outcomes of maintaining or rehabilitating red aesthetics in dental implants. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from February to April 2026 in the Scopus, PubMed, Science Direct, SciELO, and Google Scholar databases. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 133 articles were found, 38 articles were evaluated in full, and 29 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 16 studies with a high risk of bias and 24 studies that did not meet GRADE and AMSTAR-2 standards. Most studies did not show homogeneity in their results, with X²=77.2%>50%. It was concluded that the aesthetic effect of using porcelain veneers to repair developmental anterior interdental spaces is ideal, and that filling the papillae between the teeth meets patients' expectations. Digitalization plays an important role in anterior aesthetic restorations. The use of digital technology to manage the entire process of anterior aesthetic restorations can improve results, reduce the number of follow-up appointments, shorten consultation time, and increase patient satisfaction. Collaborative decision-making is crucial to optimizing aesthetic results.

Main clinical outcomes of biomaterials in dental implants: a systematic review

João Pedro Cardin Rocha — 2026-08-13

Introduction: Over the past 30 years, the number of dental implant procedures has grown significantly worldwide, reaching approximately 1 million per year. In Brazil, implantology has evolved very rapidly in recent decades, with high success rates. Various materials can be used as bone grafts, each with different properties, such as those related to neovascularization. Guided bone regeneration promotes the formation of new bone tissue. When grafting procedures are necessary, the focus is often on the type of biomaterial to be used and the success and predictability of the results. Objective: This study aimed to conduct a concise systematic review of bone regeneration processes using biomaterials and the main molecular and cellular constituents for implantology. Methods: The research was conducted from January to February 2026 in the Scopus, PubMed, Science Direct, and SciELO databases, using older scientific articles considered gold standard references up to 2026. The quality of the studies was based on the GRADE instrument, and the risk of bias was assessed using the Cochrane instrument. Results and Conclusion: 158 studies were found and submitted to eligibility analysis. The final sample presented 22 eligible studies, which were described in the systematic review. Most studies showed homogeneity in their results, with X² = 68.8% > 50%. Due to bone regeneration and biological barriers in graft surgeries, there has been technological growth in these materials, as they are seen as potential tools for treating bone loss. The greater potential of guided bone regeneration was associated with graft material due to the higher degree of vital bone and the lower percentage of residual graft particles. All bone substitute materials studied resulted in efficient bone formation for dental implants and alveolar ridge preservation procedures.

Major considerations and clinical findings of micro-focused ultrasound and collagen biostimulation in human skin aesthetics: a systematic review

Dennise Jiménez Cervantes — 2026-07-17

Introduction: As a safe and effective alternative for addressing aesthetic skin concerns, studies have shown that transcutaneous micro-focused ultrasound (TMU)—a device approved by the Food and Drug Administration (FDA)—can be beneficial for the noninvasive regeneration of the skin's collagen fibers. Objective: It was to describe and present clinical results on the skin after the use of micro-focused ultrasound to improve the aesthetics of human skin. Methods: The search was carried out from May to June 2026 in the Embase, Scopus, PubMed, Science Direct, SciELO, and Google Scholar databases. Results and conclusion: A total of 139 articles were found, and 19 articles were included in the systematic review. Most studies showed homogeneity in their results, according to Chi-Square analysis, with X2=82.5%>50%. It was evidenced that TMU is an effective method for facial rejuvenation and firming. High-resolution MFU, when combined with diluted calcium hydroxyapatite, polycaprolactone, and/or poly-L-lactic acid, is effective in addressing skin laxity and yields significant aesthetic improvement. The sequential application of MFU immediately prior to poly-L-lactic acid enhances dermal remodeling more effectively than either treatment alone, without compromising poly-L-lactic acid stability.

Hospital dentistry and the care provided by dental surgeons at the nutrological and palliative level: a systematic review

Isabela Aguiar de Souza — 2026-07-10

Introduction: Dentistry is of paramount importance in preventive actions as well as in the elimination of inflammatory, infectious, and painful symptomatological processes that may contribute to the loss of hospitalized patients. Nutrition directly impacts oral health, as well as the management of surgical patients. Cancer patients receiving specialized palliative care present a wide variety of oral symptoms that affect oral functions, psychosocial well-being, and quality of life. Objective: This study aimed to emphasize hospital dentistry and the care provided by dental surgeons at the nutritional and palliative levels. Methods: The PRISMA Guidelines were followed. The search was conducted from February to April 2026 across the Web of Science, Scopus, Embase, PubMed, ScienceDirect, SciELO, and Google Scholar databases. The quality of the studies was assessed using the GRADE instrument, and the risk of bias was evaluated according to the Cochrane instrument. Results and Conclusion: According to the GRADE instrument, most studies presented homogeneous results, with X2=82.5% > 50%. A total of 113 articles were found and submitted for eligibility analysis, with 21 final studies selected to compose the results of this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 31 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2 standards. The elaboration of the work made it possible to achieve the initially proposed objectives: highlighting the importance of the dentist's role in the hospital environment, as well as nutritional care and probiotics. It also made it possible to discuss dentistry in general, address dental care in the hospital environment, and highlight the difficulties faced in its integration into hospitals. It is necessary to empower and qualify all the hospital staff and the dentists so that oral health is offered to the patients, as well as to know the impact caused by the oral problems on the systemic health of the patients, and to implement specific protocols on the subject in all aspects. Cancer patients receiving specialist palliative care present with a wide range of oral symptoms that affect oral functions, psychosocial well-being, and quality of life.

Clinical considerations regarding drug-induced gingival enlargement: a concise systematic review

Stefany Andrade Zangarini — 2026-06-28

Introduction: In the context of gingival conditions, certain medications can affect periodontal tissues by altering the inflammatory response and promoting gingival growth, resulting in gingival hyperplasia (GH) or gingival enlargement. Objective: It was to present the key clinical considerations regarding drug-induced gingival enlargement. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from March to April 2026 across the Web of Science, Scopus, Embase, PubMed, ScienceDirect, SciELO, and Google Scholar databases. A systematic review of the incidence of gingival hyperplasia and its relationship to the predictor phenytoin, nifedipine and cyclosporine A. The quality of the studies was assessed using the GRADE instrument, and the risk of bias was evaluated according to the Cochrane instrument. Results and Conclusion: According to the GRADE instrument, most studies presented homogeneous results, with X²=78.5% > 50%. A total of 83 articles were found and submitted for eligibility analysis, with 21 final studies selected to compose the results of this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 33 studies with a high risk of bias and 13 studies that did not meet GRADE and AMSTAR-2 standards. It was concluded that drug-induced gingival overgrowth faces two therapeutic challenges: uncertain pathogenesis and a high recurrence rate. Analyzing the associations between medications and adverse reactions can help determine the treatment approach. Understanding the cytotoxicity thresholds of these medications is crucial for improving clinical outcomes and minimizing the incidence of gingival enlargement in patients requiring long-term therapy.

Major management of urethroplasty after trauma: a systematic review

Fagner Henrique Costa — 2026-06-12

Introduction: In the context of urethroplasty, epidemiological data show that urethral trauma accounts for approximately 4.5% of all genitourinary traumas. Most urethral traumas, both blunt and penetrating, result in complete urethral rupture, while the remaining 1/3 result in at least a partial urethral laceration. Urethroplasty remains a significant challenge in urethral and penile reconstruction, and the use of robotics and artificial intelligence is a significant tool for improving urethroplasty. Objective: This study aimed to present the main surgical approaches for urethroplasty after trauma or subsequent comorbidities, highlighting the use of robotic surgery and artificial intelligence to optimize surgical techniques. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from February to April 2026 in the Scopus, Embase, PubMed, Science Direct, SciELO, and Google Scholar databases. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 117 articles were found, and 35 articles were evaluated in full, and 12 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 27 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=81.1%>50%. It was concluded that, regardless of the urethral injury pattern and treatment options, well-planned, rigorous follow-up with a urologist is of utmost importance for accurate assessment of outcomes and proper management of complications. Patient characteristics and needs should be considered before developing a surgical plan. The tube-in-tube technique is the first choice for single-stage penile and urethral reconstruction for thinner patients. For other patients, a different flap can be used as a substitute for urethral reconstruction. Superficial circumflex iliac artery, pudendal-thigh, and pedicled scrotal flaps can be used to reconstruct the urethra. The tubularized superficial circumflex iliac artery flap and the pudendal-thigh flap are reliable, simple, and suitable for revision urethroplasty. Finally, buccal mucosal grafts with auxiliary maneuvers, such as flap interposition or transfer of adjacent tissue, in robotic reconstruction of the lower urinary tract are durable, safe, and comparable to open surgical approaches, especially when aided by the use of artificial intelligence to enhance urethroplasty.

Cancer stem cell niche in oral squamous cell carcinoma and its surgical margins: an immunohistochemistry study

Gargi Sarode — 2026-06-03

Introduction: With almost 350,000 cancer deaths each year in developed countries, head and neck cancer (HNC) the sixth most frequently noted malignancy [1]. Oral malignancies account for the vast majority of HNC (85%), with oral squamous cell carcinoma (OSCC) being the most common kind. Objective: Oral squamous cell carcinoma (OSCC) has a lower survival range and poor prognosis despite the existing advanced treatment modalities due to the formation of metastasis and ‘drug resistance’ of the tumor cells. The objective of this research was to analyze the cancer stem cell (CSC) niche in lesional tissue of OSCC and it’s all surgical margins with the help of CD44, CD133, OCT-4 markers through immunohistochemistry (IHC) study. Methods: A total of 11 excisional biopsy tissues of OSCC with four surgical margins (anterior, posterior, lateral and medial) each were selected. The immunoreactivity of CSCs in lesional tissue and surgical margins of OSCC was evaluated with the help of CD133, CD44 and Oct-4 markers. The immunoreactivity was then compared between the lesional tissue and surgical margins, and the outcome were related with patient survival of patient over a time of 3 years. Results: CD44 and CD133 in most of the cases showed moderately positive in higher grade OSCC, the weak expression of OCT4 was also expressed in higher grade tumors. Conclusion: The increased expression of CD133 and CD44 in advanced grades would be the important result for OSCC cases could suggesting the characterization of CD133 and CD44 in oral mucosal carcinogenesis oral mucosa.

Importance of physical exercise on macrophage polarization: a relation to disease concern

Ashok Chakraborty — 2026-06-03

Macrophages are specialized cells, originated from blood monocyte, differentiate in tissues, and involved in the destruction of foreign pathogens. They also can release cytokines and activate other cells and initiate inflammation. Macrophage polarization from M1 type to M2 –type has been found to be related to various diseases including cancer, diabetes, coronary artery diseases (CAD), etc. Here we did a brief review to convince that regular light to intense type physical exercise can induce polarization of macrophage from its one form (M1) to the other form (M2), and can improve the various disease conditions. The cellular as well as the molecular events that are found with the physical exercise (PE) indicate that the PE could be a non-pharmacological management for various diseases with minimal side effects.

Major considerations of sealing materials in parendodontic surgery: a concise systematic review

Taisla Caroline da Silva Carriero — 2026-05-28

Introduction: Parendodontic surgery or periapical surgery has been described in the literature for several decades as a treatment option for endodontic failure. Several techniques have been described; however, we can currently say that the success of periapical surgery is directly linked to new technologies, such as operating microscopy, ultrasonic inserts for proper decontamination of the region, and new materials that provide adequate sealing of the retrograde filling cavity. Objective: It was to conduct a concise systematic review on the main considerations of sealing materials in periapical surgery. Methods: The PRISMA Guidelines were followed. The search was conducted from January to February 2026 across the Web of Science, Scopus, Embase, PubMed, ScienceDirect, SciELO, and Google Scholar databases. The quality of the studies was assessed using the GRADE instrument, and the risk of bias was evaluated according to the Cochrane instrument. Results and Conclusion: According to the GRADE instrument, most studies presented homogeneous results, with X² = 78.7% > 50%. A total of 126 articles were found and submitted for eligibility analysis, with 30 final studies selected to compose the results of this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 30 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2 standards. Among the desired properties of new materials for sealing the retrograde filling cavity, low cytotoxicity, good radiopacity, ease of handling, and the ability to seal and adhere to dentin stand out. With the discovery of MTA in the 1990s, a new class of materials, bioceramics, has been developed for this purpose.

Major clinical approaches on the bone regeneration with bone morphogenetic protein and platelet-rich plasma: a systematic review

Victoria Eduarda da Silva — 2026-05-25

Introduction: The production or regeneration of any tissue is a complex biological process in itself, since it requires intrinsically regulated interactions between cells, the action of systemic hormones, the participation of extracellular matrix components, and the local action of so-called growth factors. Objective: It was to review the concepts related to growth factors, as well as in relation to platelet rich plasma and bone morphogenetic protein as an adjuvant in bone regeneration therapies directed to implant dentistry. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from January to March 2026 across the Embase, Scopus, PubMed, Web of Science, and Google Scholar databases. The quality of the studies was assessed using the GRADE instrument, and the risk of bias was evaluated according to the Cochrane instrument. Results and Conclusion: According to the GRADE instrument, most studies presented homogeneous results, with X²=81.7% > 50%. A total of 134 articles were found and submitted for eligibility analysis, with 45 final studies selected to compose the results of this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 14 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2 standards. It was concluded that the greatest advantages of the use of platelet-rich plasma are its ability to accelerate the process of bone regeneration by increasing the number of growth factors present in human platelets. On the other hand, it is observed that one of its major disadvantages is the low life expectancy of these platelets in the recipient or graft bed. However, it is also known that the PRP technique would only accelerate a process of bone regeneration that normally already occurs, and this process follows its path until the formation of mature bone.

Cross-Sectional Study on the Assessment of Awareness Regarding Nutritional Diet, Physical Activity, and Obesity: A Pre- and Post-Intervention Survey

Pranali Vinod Patil — 2026-05-19

Introduction: The increasing number of university students who suffer from obesity and other lifestyle-related health issues has highlighted the necessity of successful health awareness campaigns. Objective: The purpose of this study was to assess how a structured awareness program affected pharmacy students at Marathwada Mitra Mandal's College of Pharmacy in Pune's eating patterns, levels of physical activity, obesity-related factors, and health awareness. Material and Method: A survey-based study involving 300 pharmacy students, ages 17 to 24, was carried out for three months before and after the intervention. Five components of a standardized, validated questionnaire were used to gather data: demographics, physical activity, nutritional diet, obesity and health-related factors, and behavior and awareness. For continuous variables, a paired t-test was used, and for categorical data, chi-square tests; a P-value of less than 0.05 was deemed statistically significant. Results: The mean scores for body weight satisfaction, physical activity, health behaviour and awareness, and nutritional diet all showed significant improvements (p<0.05). Chi-square analysis showed a decrease in weight-related health problems and a substantial increase in participation in weight management programs and prior weight management attempts. Conclusion: At Marathwada Mitra Mandal's College of Pharmacy, the awareness intervention program effectively improved students' knowledge of body weight control, physical activity, health-related behaviours, and nutritional practices. These findings emphasize how crucial it is to put in place organized health education programs at pharmacy schools in order to encourage young adults to lead better lifestyles.

Main clinical considerations in restorative dentistry and aesthetic rehabilitation of implant-supported prostheses: a systematic review

Nathalia Godoi Mendonça — 2026-04-27

Introduction: In the field of restorative dentistry and aesthetic rehabilitation, the long-term success of a dental implant depends on the prosthesis. The key to obtaining perfect dentures depends on the passive seating between its connector and the implant itself. The compromised fit between the contact surfaces of implant-supported prostheses creates uncontrolled tensions in the peri-implant components and tissues, evoking biological and mechanical complications. Objective: Considering that choosing the most precise technique and material for each particular case has become a challenging task for professionals, this study aimed to review the literature on the types of impression used in implant prostheses for the best aesthetic rehabilitation. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from December 2025 to January 2026 in the Web of Science, Embase, Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 228 articles were found, and 84 articles were evaluated in full, and 29 were included and developed in the present systematic review study. According to the GRADE instrument, most studies presented homogeneity in their results, with an X2 = 85.8% > 50%. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 20 studies with a high risk of bias and 90 studies that did not meet GRADE and AMSTAR-2. The choice of closed tray or open tray impression techniques depends on the number, depth, angulation, and relative parallelism of the implants. The materials of choice for making impressions, following the closed-tray and open-tray printing techniques, were polyether and polyvinylsiloxane. Most studies reported more accurate impressions with the splinting technique than with the non-splitting technique. Acrylic resin was the most frequently used material. Therefore, minimizing contraction appears to be the most important factor in ensuring an accurate impression for this technique. Digital printing has achieved high patient acceptance, reduces possible impression and master mold errors, reduces time in the chair, provides a three-dimensional image of the preparation, and ease of communication between the clinician and the laboratory. However, there is a dearth of scientific data regarding implant fingerprints and their accuracy. Research on implant fingerprinting has been limited to a few in vitro studies and case reports.

Major clinical considerations regarding the drug-induced gingival overgrowth: a systematic review

Ana Lívia Campos — 2026-04-15

Introduction: Some systemic medications can affect the periodontal tissues, modifying their inflammatory response and promoting gingival growth, which causes gingival hyperplasia (GH). This can be intensified when two drugs are used synergistically, worsening the GH picture. Objective: It was to perform a systematic review on the incidence of gingival hyperplasia and its relation to the predictors of phenytoin, nifedipine and cyclosporine A. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from December 2025 to January 2026 across the Web of Science, Scopus, Embase, PubMed, ScienceDirect, SciELO, and Google Scholar databases. A systematic review of the incidence of gingival hyperplasia and its relationship to the predictor phenytoin, nifedipine and cyclosporine A. The quality of the studies was assessed using the GRADE instrument, and the risk of bias was evaluated according to the Cochrane instrument. Results: According to the GRADE instrument, most studies presented homogeneous results, with X²=70.8% > 50%. A total of 62 articles were found and submitted for eligibility analysis, with 20 final studies selected to compose the results of this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 02 studies with a high risk of bias and 10 studies that did not meet GRADE and AMSTAR-2 standards. It was found that gingival growth in patients with kidney transplantation was associated with a significant increase in gingival hyperplasia (GH) and also with other pathologies leading to the use of drugs such as phenytoin, nifedipine and cyclosporin A. However, G H can be mistakenly mistaken for gingival hyperplasia. The name "gingival growth and / or gingival hypertrophy" is a function of histological study, the occurrence of increased extracellular matrix synthesis, mainly in collagen, and increase in the size and number of fibroblasts present in the tissue. Scientific research has shown that Ciclosporin A can modify the metabolism of the gingival and bone tissue and the composition of the oral biofilm, the flow and composition of the gingival fluid. Conclusion: The surgeon-dentist should be aware during the anamnesis to the cases of patients who use medications that induce gingival hyperplasia, such as anticonvulsants. It is imperative for the dentist to understand the general condition and the limitations of each patient, so that he can control and cure the most varied oral manifestations, in order to maintain a good quality of life in his patient.

Importance of clinical evaluation for successful bone elevation for immediate implant placement: a systematic review

Amanda Barros Bonelli — 2026-04-15

Introduction: Early implant follow-up studies laid the scientific foundation for modern implantology. Early loading was identified as a critical factor; therefore, various waiting times were explored until a period of at least three months was established for the mandible and five to six months for the maxilla. Thus, an immediate dental implant (IDI) was defined as the placement of a prosthetic element on the implant without osseointegration occurring. Objective: This systematic review aimed to analyze the importance of clinical evaluation and bone elevation for the success of the immediate implant technique, presenting criteria for the indication and follow-up of these procedures. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from December 2025 to January 2026 across the Web of Science, Scopus, Embase, PubMed, ScienceDirect, SciELO, and Google Scholar databases. The quality of the studies was assessed using the GRADE instrument, and the risk of bias was evaluated according to the Cochrane instrument. Results and Conclusion: According to the GRADE instrument, most studies presented homogeneous results, with X²=71.7% > 50%. A total of 132 articles were found and submitted for eligibility analysis, with 22 final studies selected to compose the results of this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 33 studies with a high risk of bias and 21 studies that did not meet GRADE and AMSTAR-2 standards. It was concluded that the high success rate is a consequence of correct surgical and prosthetic planning, and the harmony between the implant system, the patient, and the dentist. Immediate dental implant placement in total jaw rehabilitation is a procedure with high success rates that should and can be applied in all cases where the technique is efficient in providing adequate primary stability to the implants.

Nutrological care for athletes in overtraining: a brief systematic review

Walter Ludwig Armin Schroff — 2026-03-31

Introduction: Training can cause stress to an athlete, changing their physical and psychological well-being, and progressing from acute to chronic fatigue (overtraining). Athletes must be monitored closely to ensure training can deliver the desired effects on the athlete's well-being and performance. In this sense, physiological, biochemical, metabolic, and subjective performance measures are all options for monitoring the athlete, including prioritizing the relationship between metabolism and functional nutrition. Objective: It was to carry out a systematic review to elucidate and describe the importance of metabolic tracking and nutrological care in athletes. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from October to November 2025 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 127 articles were found, and 46 articles were evaluated, and 34 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 14 studies with a high risk of bias and 33 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X² =69.5%>50%. The biases did not compromise the scientific basis of the studies. It was concluded that subjective well-being responded consistently to training stress, deteriorating with increased and chronic training and improving with reduced training. Athletes need to consume adequate energy in the quantity and timing of intake during periods of high-intensity and/or long-duration training to maintain health and maximize training outcomes. Low energy availability can result in unwanted loss of muscle mass, menstrual dysfunction, hormonal disturbances, suboptimal bone density, an increased risk of fatigue, injury and illness, impaired adaptation, and a prolonged recovery process.

Dental management in children with autism spectrum disorder: a systematic review

Beatriz Vaine Vilela de Carvalho — 2026-03-18

Introduction: In the context of autism spectrum disorder (ASD), this condition represents a complex neurodevelopmental disorder in children and adults. Anxiety and fear of dental treatment are frequently observed in children with ASD, manifesting through difficult behaviors and uncooperative reactions during treatment. Objective: It was to develop a concise systematic review study to highlight the main clinical approaches to dental care in autistic children. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from December 2025 to January 2026 across the Web of Science, Scopus, Embase, PubMed, ScienceDirect, SciELO, and Google Scholar databases. The quality of the studies was assessed using the GRADE instrument, and the risk of bias was evaluated according to the Cochrane instrument. Results and Conclusion: According to the GRADE instrument, most studies presented homogeneous results, with X² = 79.5% > 50%. A total of 80 articles were found and submitted for eligibility analysis, with 09 final studies selected to compose the results of this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 05 studies with a high risk of bias and 12 studies that did not meet GRADE and AMSTAR-2 standards. It was concluded that children with autism spectrum disorder face unique challenges in maintaining oral health due to sensory sensitivities, communication difficulties, and behavioral barriers. Culturally adapted dental visual aids have demonstrated effectiveness in modifying behavioral patterns in children diagnosed with autism spectrum disorder during dental appointments. Furthermore, it is necessary for children with ASD to undergo a pre-operative psychological evaluation to investigate parental expectations and cooperation and to determine if appropriate dental treatment should be initiated.

Major clinical approaches and treatment in malocclusion: a systematic review

Fernanda Ruiz Pereira — 2026-03-18

Introduction: Malocclusion has been an aggravating factor in the development of caries, and may not be the main factor for the development of some temporomandibular dysfunction, but it is an untreated cofactor when diagnosed. The use of orthodontic restraint in the post-treatment phase is of great importance so that there is no recurrence of tooth movement that may occur during the period of remodeling of the dental structures. Objective: It was to explore the literary findings about the importance of knowing the advances in orthodontics in order to better understand the main treatments of malocclusions and the importance of their use for rehabilitation in the functional, aesthetic and psychological aspects of the patient. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from December 2025 to January 2026 across the Web of Science, Scopus, Embase, PubMed, ScienceDirect, SciELO, and Google Scholar databases. The quality of the studies was assessed using the GRADE instrument, and the risk of bias was evaluated according to the Cochrane instrument. Results and Conclusion: According to the GRADE instrument, most studies presented homogeneity in their results, with X2=72.7%>50%. A total of 138 articles were found and submitted for eligibility analysis, with 28 final studies selected to compose the results of this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 27 studies with a high risk of bias and 26 studies that did not meet GRADE and AMSTAR-2 standards. Due to the aging of the stomatognathic apparatus the orofacial functions can be modified, such as malocclusion, therefore for greater effectiveness and longevity of the final result of the orthodontic treatment the indefinite use of fixed inferior containment should be established and accompanied by the professional.

Main considerations of the immune system and caries disease: a systematic review

Gabrieli Camila Peniani Nunes — 2026-03-01

Introduction: According to the World Dental Federation, the hypothesis that more than 90.0% of the world population will have any oral disease in their lifetime. The discovery of an immunoenzymatic mucosal defense system, coupled with the advances of immunology, demonstrate the need to know their concepts and their possible interrelations with the installation and progression of the cariogenic process. Objective: Therefore, the present work carried out a literature review to verify the main approaches regarding the influence of the immune system on caries disease. Methods: Experimental and clinical studies were included (case reports, retrospective, prospective and randomized trials) with qualitative and/or quantitative analysis. Initially, the keywords were determined by searching the DeCS tool (Descriptors in Health Sciences, BIREME base) and later verified and validated by MeSh system (Medical Subject Headings, the US National Library of Medicine). Series of Articles And Eligibility: A total of 27 articles were found involving. Initially, it was held the exclusion existing title and duplications in accordance with the interest described this work. After this process, the summaries were evaluated and a new exclusion was held. A total of 22 articles were evaluated in full, and 18 were included and discussed in this study. Conclusion: There are an important network and cascade of defense events between immunological processes and caries disease. Thus, it is necessary to have a healthy immune response to reduce the incidence of caries.

Metabolomic and transcriptomic effects of melatonin and gut microbiota through microbes and exosomes on muscle regeneration and enhancement of sports performance: a systematic review

Cristiano Villanova Andrade — 2026-02-24

Introduction: Sleep and recovery are essential for optimizing exercise performance. However, the effectiveness of melatonin supplementation in improving sleep quality and next-day physical performance remains uncertain. Research has demonstrated the ergogenic effect of melatonin (N-acetyl-5-methoxytryptamine) (MEL) in increasing exhaustive aerobic activity. Associated with the effects of MEL, adult tissue stem cells (mesenchymal stem cells) mediate homeostasis and regeneration of tissues and organs, integrating signaling cues and metabolic inputs with the release of exosomes and microRNAs to enhance athletic performance. Objective: It was demonstrated through a systematic review study the regulation of melatonin and gut microbiota by cellular and molecular metabolic pathways, such as microRNAs and exosomes, in the process of muscle regeneration and increased sports performance. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from July to August 2025 in the Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 136 articles were found, and 55 articles were evaluated in full and 29 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 25 studies with a high risk of bias and 12 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X²=82.9%>50%. It was concluded that administering 6 mg of melatonin at night improved performance during high-intensity exercise the following day and enhanced perceived recovery up to 72 hours after exercise. Melatonin intake during training has beneficial effects on physical performance and protects tissues against the deleterious effects of reactive oxygen species and cellular damage. Furthermore, nocturnal melatonin supplementation during an athlete's intense training session alleviated oxidative stress, leukocytosis, and cellular damage, and improved performance recovery. Melatonin plays important roles in regulating the regenerative activities of mesenchymal stem cells, which, along with nutrients, modulate the activities of exosomes and microRNAs in the muscle regeneration process.