Search Results (131)

Over time, endoscopic retrograde cholangiopancreatography (ERCP) evolved into the preferred method for both diagnosing and treating diseases of the biliary, pancreatic, and ampullary systems. Traditionally performed under “conscious” sedation, anesthesiological management during ERCP increasingly involves the use of general anesthesia (GA) due to the complexity of procedures and patient comorbidities. This narrative review aims to underscore the current absence of definitive evidence supporting a single airway management strategy during ERCP. In each section, we examine the strengths and limitations of various airway management strategies, including spontaneous breathing, endotracheal intubation, and newer techniques such as high-flow nasal oxygen (HFNO) and supraglottic airway devices (SGAs), tailored for endoscopic procedures. We explore and discuss the multifactorial determinants that influence clinical decision-making, including patient-specific risk factors, procedural complexity, resource availability, and potential complications. Any anesthesiological choice must guarantee the immobility of the patient and the versatility of the position and must be integrated with the preferences and skills of the endoscopist, the available means in the endoscopic suite, and the internal protocols. Spontaneous breathing with sedation may be appropriate for low-risk, short-duration procedures but carries risks of hypoventilation and aspiration, while GA with a device to manage airways improves procedural conditions and perioperative risks. Still, it is resource-intensive and may delay recovery. Transitions between different strategies are inherently fluid, reflecting the need for a flexible, patient-centered approach tailored to the specific clinical context. Rigorous future research is essential to establish evidence-based guidelines that enhance both safety and efficiency of airway management in this setting. Full article

Full-thickness skin grafts are a cornerstone in reconstructive surgery for extensive skin defects, particularly in pediatric patients, where rapid vascularization is essential for successful engraftment. Traditional defatting methods using scalpels and scissors are labor-intensive and increase the risk of graft or operator injury. To improve efficiency and safety, a mechanical defatting device called LOMA (named after the inventors Loff and Maja) was developed at Klinikum Stuttgart. This study evaluates the first 28 transplants performed with it, assessing graft outcomes using the POSAS and comparing physical properties of the grafts with those of healthy contralateral skin, ankle skin, and palmar skin using DermaLab Combo’s ultrasound and elasticity probes. Results showed that grafts prepared with LOMA exhibited similar physical characteristics to contralateral healthy skin. Differences in elasticity were observed when compared to ankle skin, and significant disparities were found when compared to palmar skin. POSAS scores averaged 3.3 from patients and 2.2 from physicians, indicating satisfaction with functional and aesthetic outcomes. The findings support the effectiveness of full-thickness skin grafts, particularly when prepared using the LOMA system. Further multicenter studies are recommended to compare LOMA-prepared grafts with those using conventional techniques to quantify the added value of this mechanical defatting approach. Full article

Background/Objectives: Scars are formed from trauma to the dermis and more specifically during the wound-healing phase. Skin needling is a technique used in scar therapy which stimulates the skin to regenerate. The aim of this study was to objectively and subjectively evaluate the degree of scar reduction after skin needling treatments based on visible changes using specialized measuring devices—ultrasound, Courage & Khazaka, and standardized questionnaires. Methods: Six patients were enrolled. Participants were given a series of three skin needling treatments. Before and after the treatment, the participants were examined for selected skin parameters with the help of specialized measuring devices such as Courage & Khazaka and skin ultrasound. Skin firmness and elasticity and MEP and HEP skin echogenicity were taken into account. Each patient completed POSAS questionnaires on satisfaction, pain, and adverse effects. Results: Based on the results of the POSAS questionnaire, a significant improvement in patients’ scar evaluation was observed after the treatment. Patients reported the most noticeable improvements in parameters such as color (p = 0.035), stiffness (p = 0.009), thickness (p = 0.041), and irregularity (0.007). An improvement in scar elasticity was observed in all subjects after treatment. Conclusions: Skin needling treatment combined with the skin needling technique and post-treatment skincare is an effective method of scar therapy, and the risk of side effects or complications after a series of treatments is low. Full article

Background: Wound healing and scar management remain significant challenges in dermatology and aesthetic medicine. Recent advances in regenerative medicine have introduced plant-derived exosome-like nanoparticles (PDENs) as potential therapeutic agents due to their bioactive properties. This study examines the clinical application of rose stem cell exosomes (RSCEs) in combination with established treatments for managing different types of scars. Methods: A case series of four patients with different scar etiologies (dog bite, hot oil burn, forehead trauma, and facial laser treatment complications) was treated with RSCEs in combination with microneedling (Dermapen 4.0, 0.2–0.4 mm depth) and/or thulium laser therapy (Lutronic Ultra MD, 8–14 J), or as a standalone topical treatment. All cases underwent sequential treatments over periods ranging from two to four months, with comprehensive photographic documentation of the progression. The efficacy was assessed through clinical photography and objective evaluation using the modified Vancouver Scar Scale (mVSS) and the Patient and Observer Scar Assessment Scale (POSAS), along with assessment of scar appearance, texture, and coloration. Results: All cases demonstrated progressive improvement throughout the treatment course. The dog bite scar showed significant objective improvement, with a 71% reduction in modified Vancouver Scar Scale score (from 7/13 to 2/13) and a 61% improvement in Patient and Observer Scar Assessment Scale scores after four combined treatments. The forehead trauma case exhibited similar outcomes, with a 71% improvement in mVSS score and 55–57% improvement in POSAS scores. The hot oil burn case displayed the most dramatic improvement, with a 78% reduction in mVSS score and over 70% improvement in POSAS scores, resulting in near-complete resolution without visible scarring. The facial laser complication case showed a 75% reduction in mVSS score and ~70% improvement in POSAS scores using only topical exosome application without device-based treatments. Clinical improvements across all cases included reduction in elevation, improved texture, decreased erythema, and better integration with surrounding skin. No adverse effects were reported in any of the cases. Conclusions: This preliminary case series suggests that plant-derived exosome-like nanoparticles, specifically rose stem cell exosomes (RSCEs), may enhance scar treatment outcomes when combined with microneedling and laser therapy, or even as a standalone topical treatment. The documented objective improvements, measured by standardized scar assessment scales, along with clinical enhancements in scar appearance, texture, and coloration across different scar etiologies—dog bite, burn, traumatic injury, and iatrogenic laser damage—suggest that this approach may offer a valuable addition to the current armamentarium of scar management strategies. Notably, the successful treatment of laser-induced complications using only topical exosome application demonstrates the versatility and potential of this therapeutic modality. Full article

Obstructive sleep apnea (OSA) is a prevalent and heterogeneous sleep disorder associated with significant health and societal burdens. While continuous positive airway pressure (CPAP) remains the gold standard treatment, its limitations in adherence and patient tolerance have highlighted the need for alternative therapies. Positional therapy (PT), which targets apneas that occur predominantly in the supine position, has emerged as a promising option for individuals with positional OSA (POSA). This narrative review synthesizes the current literature on PT, examining its clinical indications, typologies, comparative efficacy with CPAP, oral appliances, and hypoglossal nerve stimulation, as well as data on adherence and barriers to long-term use. Traditional methods such as the tennis ball technique have largely been replaced by modern vibrotactile devices, which demonstrate improved comfort, adherence, and comparable short-term outcomes in selected POSA subjects. While PT remains inferior to CPAP in reducing overall AHI and oxygen desaturation, it performs favorably in terms of mean disease alleviation (MDA) and sleep continuity. Importantly, treatment effectiveness is influenced by both anatomical and non-anatomical traits, underscoring the need for accurate phenotyping and individualized care. PT should be considered within a broader patient-centered model that incorporates preferences, lifestyle, and motivational factors. Further research is needed to validate long-term efficacy, optimize selection criteria, and integrate PT into personalized OSA management strategies. Full article

Prompt and accurate identification of liver metastases from neuroendocrine tumors, arising from the gastrointestinal system and from the pancreas, through the means of both anatomical and functional diagnostic imaging techniques is mandatory. A patient’s prognosis and treatment planning are dependent on these diagnostic procedures. The aim of this narrative review is to depict the common appearance of liver metastases, as well as to depict atypical imaging patterns. Moreover, this review will cover the differential diagnosis between liver metastases from neuroendocrine tumors and other primary and secondary malignant liver lesions, as well as benign liver lesions. Full article

Background/Objectives: Liver metastases are common among patients with breast cancer and have a poor prognosis if left untreated. The aim of this systematic review is to evaluate and compare chemoembolization (TACE) versus radioembolization (TARE) treatments in patients with breast cancer liver-dominant metastases in terms of overall survival (OS), local tumor control (LC), and toxicity. Methods: The S.P.I.D.E.R framework was used to address the clinical question. A systematic literature search using PubMed and Scopus was performed to identify full articles evaluating the efficacy of TACE and TARE in patients with liver metastases from breast cancer. Results: The literature search resulted in 10 articles for TACE, 13 articles for TARE and 1 for combined TACE/TARE, totaling 462 patients for the TACE group and 627 for the TARE group. The median LC was 68.7% for TACE and 78.9% for TARE. The median OS was 15.3 months for TACE and 11.9 for TARE. Progression at three months was 32.5% for TACE and 20.6% for TARE. Conclusions: The included studies were heterogeneous, varying widely in design, patient selection, and therapeutic protocols. Nonetheless, this systematic review suggests that locoregional therapies are effective in the treatment of liver metastases in patients with breast cancer and may improve tumor burden, alleviate symptoms and extend overall survival. The median LC of the liver metastases at three months was higher in the TARE group compared to TACE. However, the TARE group showed lower OS rates after treatment. Full article

Protein function prediction plays a crucial role in uncovering the molecular mechanisms underlying life processes in the post-genomic era. However, with the widespread adoption of high-throughput sequencing technologies, the pace of protein function annotation significantly lags behind that of sequence discovery, highlighting the urgent need for more efficient and reliable predictive methods. To address the problem of existing methods ignoring the hierarchical structure of gene ontology terms and making it challenging to dynamically associate protein features with functional contexts, we propose a novel protein function prediction framework, termed Partial Order-Based Self-Attention for Gene Ontology (POSA-GO). This cross-modal collaborative modelling approach fuses GO terms with protein sequences. The model leverages the pre-trained language model ESM-2 to extract deep semantic features from protein sequences. Meanwhile, it transforms the partial order relationships among Gene Ontology (GO) terms into topological embeddings to capture their biological hierarchical dependencies. Furthermore, a multi-head self-attention mechanism is employed to dynamically model the association weights between proteins and GO terms, thereby enabling context-aware functional annotation. Comparative experiments on the CAFA3 and SwissProt datasets demonstrate that POSA-GO outperforms existing state-of-the-art methods in terms of Fmax and AUPR metrics, offering a promising solution for protein functional studies. Full article

Background: Episiotomy-related morbidity remains a substantial challenge in postpartum recovery, often affecting maternal quality of life. Given the crucial role of local microbiota and wound environment in perineal healing, intravaginal lactic acid gel emerges as a promising adjunctive therapy. Objective: To evaluate the effectiveness and safety of intravaginal lactic acid gel (Canesbalance^®, Bayer) in enhancing scar healing and reducing pain following mediolateral episiotomy. Methods: In this single-center randomized controlled trial, 100 postpartum women with mediolateral episiotomy were allocated to either a treatment group receiving intravaginal lactic acid gel (Canesbalance^®, Bayer) or a standard care group. Scar healing was assessed at 7 and 40 days postpartum using POSAS, VAS, and NRS scores; hematological parameters were also monitored. Results: The lactic acid gel group demonstrated significantly greater reductions in scar severity and pain scores over time (p < 0.05), with no adverse hematological effects. Effect sizes (Cohen’s d) were moderate to high for scar healing (d = 0.76) and pain reduction (VAS: d = 0.83; NRS: d = 0.79), indicating clinical relevance beyond statistical significance. Conclusions: Intravaginal application of lactic acid gel may offer a safe and effective strategy to enhance perineal wound healing and pain relief after episiotomy. Further large-scale studies are warranted to validate these promising findings and explore underlying mechanisms. Full article

Peptidylarginine deiminase 4 (PAD4) catalyzes protein citrullination, a post-translational modification implicated in type 1 diabetes mellitus (T1DM). This study examined PAD4 expression and activity in the pancreas of streptozotocin (STZ)-induced diabetic Wistar rats. Animals were divided into three groups: (A) STZ-induced diabetic rats (60 mg/kg, i.p.), (B) non-diabetic controls, and (C) diabetic rats treated with Cl-amidine (5 mg/kg), a pan-PAD inhibitor, from week six post-induction. Analyses included PAD4 mRNA and protein expression, citrullinated histone H3 (CitH3), calcium concentration, and neutrophil elastase activity. Diabetic rats exhibited increased PAD4 expression, CitH3 levels, and NETosis markers, alongside reduced pancreatic calcium, suggesting calcium consumption during PAD4 activation. Cl-amidine treatment attenuated NETosis. These results implicate PAD4 in T1DM pathogenesis via NETosis and support the utility of STZ-induced diabetic rats as a model for PAD4-targeted studies. Cl-amidine may represent a promising therapeutic approach to reduce pancreatic inflammation in T1DM. Full article

Background and Objectives: Infection, trauma, skin cancer, foreign substance injections and lymphedema are among the most frequent causes of penile skin defects. Scrotal flaps are a promising reconstructive option for penile resurfacing, offering improved functional and aesthetic outcomes; however, there is no clear consensus on their superiority. Materials and Methods: A review of the literature was performed in PubMed Central and Scopus, and multiple keywords were employed. The initial search retrieved 9181 articles; 32 articles were finally selected, of which 13 were case reports and 19 were case series. Results: A total of 368 patients were included, the majority (71%) consulting for sclerosing lipogranuloma. Seven types of scrotal flaps were used: unilateral scrotal flap (n = 1), bilateral anterior scrotal flaps (n = 149), two-stage scrotal flap (n = 57), bipedicled bilateral anterior scrotal flaps (n = 140), apron-style scrotal flap (n = 1), scrotal pull-up (n = 13), and island dartos musculocutaneous flap (n = 7). Patient satisfaction was high in all studies. Outcome evaluation was typically conducted using subjective questionnaires with 2 or 5 items or visual analog scales. Few studies employed validated sexual function questionnaires, as the IIEF-5 or the EHS. Conclusions: Scrotal flaps provide good quality tissue for penile resurfacing, having the closest resemblance to normal penis skin. For a better understanding of the outcomes of different scrotal flaps, a thorough evaluation of postoperative complications should be made. The LOS and revision surgery rates may serve as surrogates for the financial burden of the procedure. Erectile function should be thoroughly evaluated with a 10-item Likert scale, IIEF-5, EHS, and POSAS. Full article

Background: The Profunda Artery Perforator (PAP) flap is a viable alternative to the Deep Inferior Epigastric Perforator (DIEP) flap, particularly for patients with low BMI and therefore insufficient abdominal tissue. To reduce the high complication rate, especially in our low BMI patient population, we have adapted the use of the vertical skin island design. This study compares complication rates and long-term outcomes of vertical versus horizontal skin island designs in PAP flap breast reconstruction. Methods: This prospective, single-center study included 20 patients who underwent PAP flap breast reconstruction. Quality of life and scar quality were assessed using the BREAST-Q and POSAS questionnaires. Additionally, the cosmetic outcomes were analyzed by four plastic surgeons. Results: Mean BMI in the vertical group was 23.9 kg/m² and 22.7 kg/m² in the horizontal group. Mean flap weight was 326 g for the vertical group and 355 g for the horizontal group. Fewer complications were observed at the donor site in the vertical group (Clavien–Dindo Classification 3b at donor site: p = 0.25). The BREAST-Q evaluation revealed significantly better results regarding the psycho-social well-being (p = 0.04) in patients with the horizontalskin island design. Scar evaluation using the POSAS revealed that the scar was perceived as thinner (p = 0.02), less pigmented (p = 0.03), and showed less relief (p = 0.02) in the vertical group. No significant difference was observed in the overall scar assessment by observers (p = 0.46). The aesthetic analysis by plastic surgeons showed significantly better results in the horizontal group. Conclusions: The vertical skin island design in PAP flap breast reconstruction was associated with lower complication rates and better scar quality compared to the horizontal design. Surgeons, however, rated the overall aesthetic outcome of the vertical design less favorably. These findings highlight the importance of balancing donor site morbidity with overall aesthetic results. Full article

Mesh grafting and Meek micrografting are split-thickness skin graft expansion techniques. This study aimed to compare the effectiveness of Meek and Mesh expansion ratios 1:2 and 1:3 in smaller wounds. An intra-patient randomized controlled trial was conducted at two burn centers (the Netherlands and Belgium). Wound outcomes, e.g., take rate, re-epithelialization rate, and donor site size, were measured. At 3 months post-surgery, patient preference and scar quality were evaluated with the Patient and Observer Scar Assessment Scale (POSAS), cutometer and dermaspectrometer. Seventy patients with a TBSA of 10 ± 10% (mean ± SD) were included. The take rate was 79 ± 25% vs. 87 ± 19% (p = 0.003), Meek vs. Mesh, respectively. At follow-up, a majority of observer and patient POSAS items were statistically significantly lower, corresponding with better scar quality for Mesh grafting compared to Meek micrografting. The scar elasticity was 0.37 ± 0.20 vs. 0.42 ± 0.21 (p = 0.013) and mean melanin 13.3 ± 8.3 vs. 12.1 ± 7.7 (p = 0.019) for Meek vs. Mesh, respectively, and the patient preference was 32%, 49%, and 19% for Meek, Mesh, and no preference. Other outcomes showed no statistically significant difference. In patients with smaller wounds, Mesh showed superiority on most wound and short-term scar results. Nevertheless, patient preference within the 1:3 expansion ratio group and donor site size were in favor of Meek. Full article

Background: Although endothelial mesenchymal transition (EndMT) has been characterized as a basic process in embryogenesis, EndMT is the mechanism that accelerates the development of cardiovascular diseases, including heart failure, aging, and complications of diabetes or hypertension as well. Endothelial cells lose their distinct markers and take on a mesenchymal phenotype during EndMT, expressing distinct products. Methods: In this study, type 1 Diabetes mellitus (T1DM) was induced in rats with streptozotocin (STZ) by intraperitoneal injection at a 60 mg/kg dose. Diabetic rats were randomly divided into two groups, namely, control and diabetic rats, for 4 weeks. Heart, aorta, and plasma samples were collected at the end of 4 weeks. Sequentially, biochemical parameters, cytokines, reactive oxygen species (ROS), protein expression of EndMT markers (Chemokine C-X-C motif ligand-1 (CXCL-1), vimentin, citrullinated histone H3 (H3Cit), α-smooth muscle actin (α-SMA), and transforming growth factor beta (TGF-β) and versican), components of the extracellular matrix (matrix metalloproteinase 2 (MMP-2), tissue inhibitor of metalloproteinase-1(TIMP-1), and discoidin domain tyrosine kinase receptor 2 (DDR-2)) were detected by ELISA or Western blot, respectively. Results: Cytokines and ROS were increased in diabetic hearts, which induced partial EndMT. Among EndMT markers, histone citrullination, α-SMA, and CXCL-1 were increased; vimentin was decreased in DM. The endothelial marker endothelin-1 was significantly higher in the aortas of DM rats. Interestingly, TGF-β showed a significant decrease in the diabetic heart, plasma, and aorta. Additionally, MMP-2/TIMP-1 levels also decreased in DM. Conclusions: To sum up, the identification of molecules and regulatory pathways involved in EndMT provided novel therapeutic approaches for cardiac pathophysiological conditions. Full article

Background/Objectives: Pediatric obstructive sleep apnea (POSA) is a long-term sleep disorder characterized by repeated interruptions in breathing during sleep among children. These interruptions result from blockages in the upper airways, causing decreased oxygen intake and disturbed sleep. Assessing parents’ awareness level and the factors affecting their knowledge is vital for enhancing early diagnosis and management of POSA. Methods: This was a cross-sectional study that utilized data from a sample of 838 parents in the Central Region of the Kingdom of Saudi Arabia. The participants completed self-administered online surveys, which ensured anonymity. Results: Only 320 (38.2%) of the parents demonstrated good knowledge about POSA, while the majority, 518 (61.8%), had poor knowledge. Nearly a third, 261 (31.2%), of the parents indicated that their primary sources of information on POSA were the internet and social media platforms. The prevalence of OSA among children was quite significant, with nearly a quarter, 236 (28.2%), of parents having a child affected by the condition. Commonly recognized symptoms included snoring, reported by 425 (50.7%), and mouth breathing, reported by 156 (18.6%). Frequently cited risk factors included obesity, mentioned by 373 (44.5%), and enlarged tonsils, mentioned by 175 (20.9%). A statistically significant association was found between age, gender, marital status, education level, specialization/work, source of knowledge about POSA, knowing someone with OSA, and having a child with OSA and the level of knowledge about POSA (p < 0.05). The study identified several significant factors predicting poor parental awareness of pediatric obstructive sleep apnea (POSA) including gender [AOR = 1.65; 95% CI = 1.220–2.223; p = 0.001], source of knowledge about pediatric obstructive sleep apnea [AOR = 1.35; 95% CI = 1.167–1.572; p < 0.001], and knowing someone with OSA [AOR = 1.92; 95% CI = 1.301–2.832; p = 0.001]. Conclusions: The study revealed that parents in the Central Region had limited knowledge about POSA. There were notable gaps in recognizing and understanding the symptoms of POSA and its impact on children’s mental health and academic performance. This underscores the importance of introducing targeted educational programs and initiatives for both parents and healthcare providers to enhance children’s mental health and overall well-being. Full article