Search Results (1,254)

Background: The optimal timing of surgical treatment for ankle fractures remains a topic that is associated with clinical uncertainty. While delayed surgery is often necessary for safe wound closure, prolonged immobilization, impaired functional outcomes, protracted hospitalization, and an increased risk of infection are potential disadvantages. This study was aimed at investigating the interval between trauma, surgical fixation, and postoperative infections among patients with closed ankle fractures. Methods: We conducted a retrospective cohort study involving 224 patients treated surgically for fractures of the upper ankle joint between January 2020 and December 2023. The patients were stratified into two groups based on surgical timing: within 24 h of hospital admission (early surgery) or after 24 h (delayed surgery). The primary outcome was the incidence of postoperative infections. A multivariate logistic regression model was constructed to assess independent risk factors. Results: Of the 224 patients, 30 (13.4%) developed postoperative infections. Infection occurred in 11.1% of patients who underwent early surgery and 13.7% of those subjected to delayed surgery. This difference was not statistically significant in the unadjusted analysis (p = 0.747). However, an additional day of surgical delay was associated with an 11% increase in the odds of postoperative infection (OR = 1.11; 95% CI: 1.01–1.22; p = 0.034). Female patients had over threefold higher odds of infection than males (OR = 3.20; 95% CI: 1.32–8.09; p = 0.011), and diabetes was a significant risk factor, with diabetic individuals showing more than fivefold increased odds (OR = 5.56; 95% CI: 1.30–25.00; p = 0.019). Patients with delayed surgery had significantly longer hospital stays (+2.83 days, p < 0.05). Conclusions: Early surgical intervention appears to lower the risk of postoperative infections, is associated with hospitalization duration, and should be considered when clinically appropriate. Full article

Background: Delayed onset muscle soreness (DOMS) frequently occurs after engaging in strenuous physical activity. The manifestation of DOMS is often associated with changes in the biomechanical and viscoelastic characteristics of the affected muscles. Materials and Methods: Forty participants were enrolled and randomly assigned to two groups: the intervention group receiving transcutaneous electrical nerve stimulation (TENS, n = 20) and a control group (n = 20). A fatigue-inducing protocol targeting the gastrocnemius muscle was implemented to elicit DOMS. The effectiveness of TENS was assessed by evaluating alterations in the biomechanical and viscoelastic properties of the muscle. Pain intensity was recorded using the Numeric Rating Scale (NRS) at five time points: before the study began, three times during the intervention, and once at the conclusion of the study. Results: No statistically significant changes have been found regarding muscle tone (p = 0.162) and stiffness (p = 0.212) in Group 1. However, a statistically significant lower level of stiffness in Group 1 after the end of therapy has been detected (p = 0.008). Decrement values decreased statistically significantly, both in Group 1 (p = 0.015) and in Group 2 (p = 0.014). There were no statistically significant differences in decrement level between Group 1 and 2. Relaxation and creep decreased statistically insignificantly in both groups. At the end of the observation period (Day 4), statistically significant (p = 0.027) lower pain intensity was observed in Group 1. Conclusions: It has been demonstrated that TENS has had limited effectiveness in restoring baseline biomechanical and viscoelastic parameters of muscles that undergo changes during DOMS. TENS significantly relieves pain symptoms occurring in DOMS. Full article

Patients undergoing immunosuppressive therapy are at risk of adverse gastrointestinal symptoms such as diarrhea, nausea, intestinal barrier leakage, and nutrient malabsorption. One mechanism underlying these complications may be increased levels of oxidative stress in the cell, and thus an increased predisposition of enterocytes to programmed death. We examined the effects of triple immunosuppressive regimens on the concentration of glutathione, the SLC1A5 receptor, caspase-3, caspase-9, Bcl-2, Bax, and apoptosis in the rat intestine. For this purpose, we used Western blot analysis, ELISA, and the TUNEL method. The study began with 36 rats divided into six groups, which were administered the drugs for a period of six months. Our results suggest that chronic use of standard immunosuppressive regimens increases the risk of oxidative stress in the rat intestine, as manifested by increased expression of glutathione or the SLC1A5 transporter. The use of rapamycin in combination with cyclosporine A or mycophenolate mofetil leads to increased cellular apoptosis in the rat intestine, which is associated with a failure of compensatory mechanisms for elevated oxidative stress. The combination of tacrolimus with rapamycin results in the highest percentage of TUNEL positivity, and the apoptotic pathway is not a result of increased oxidative stress in the tissue. Full article

Context: As quantum technologies advance with innovations in cardiovascular medicine, it can be challenging to distinguish genuine clinical progress from mere ideas. There will also be difficult transitions involved in moving technology from proof of concept demonstrated in the lab. This transition is complicated by the excitement and hype that comes with any new technology. Aim: This work aims to assess what quantum technologies are available in cardiovascular medicine for real-world use, to identify which applications are closer to clinically relevant translation, and to differentiate realistic advances from advanced-not-yet realities. Methods: A narrative review was conducted using PubMed, EMBASE, Scopus, Web of Science, IEEE Xplore, and arXiv. While real-world use of technologies was prioritized, we included all theoretical literature, regardless of date of publication. Search terms were a combination of the vocabulary of quantum technologies and the vocabulary of cardiovascular medicine. Peer-reviewed publications included primary research, reviews, theoretical works, and conference proceedings. Two reviewers independently screened all citations, and any disagreements were resolved through consensus discussion. Results: We identified three core application areas: (1) quantum sensing, such as cardiac magnetometry, where there is potential for SQUID magnetocardiography to be used for detecting cardiomyopathy; (2) quantum computing for cardiovascular risk prediction, and (3) next-generation quantum sensors for mobile cardiac imaging. Conclusions: Quantum technology in cardiovascular medicine represents modest promise in select applications, most notably, magnetocardiography. To go from “hype to hope”, clinical trials will be required to identify application domains where quantum technologies outweigh the challenges of implementation in clinical practice. Full article

Background: Tobacco smoking is a known risk factor for adverse cardiovascular events. Many patients after heart transplantation (HTX) have a history of smoking, but the prognostic role of pre-transplant smoking remains uncertain. We thus investigated the effects of pre-transplant heavy smoking (≥20 pack-years) on outcomes after HTX. Methods: This observational retrospective single-centre study included 639 patients receiving HTX at Heidelberg Heart Center between 1989 and 2019. Patients were stratified by intensity of pre-transplant smoking (<20 pack-years or ≥20 pack-years). Analysis covered donor and recipient demographics, post-transplant medications, mortality including causes of death after HTX, and early post-transplant atrial fibrillation (AF) after HTX. Results: A total of 219 of the 639 HTX recipients (34.3%) had a pre-transplant history of heavy smoking (≥20 pack-years). These patients showed an increased 5-year post-transplant mortality (44.3% versus 28.6%, p < 0.001) and had a higher percentage of death due to infection/sepsis (21.5% versus 12.1%, p = 0.002) as well as due to malignancy (5.5% versus 1.7%, p = 0.007). Multivariate analysis demonstrated pre-transplant heavy smoking (≥20 pack-years) as an independent risk factor for five-year mortality after HTX (HR: 2.173, 95% CI: 1.601–2.950, p < 0.001). Analysis of secondary outcomes also showed a significantly higher rate of 30-day post-transplant AF (17.8% versus 11.7%, p = 0.032) in patients with a pre-transplant history of heavy smoking (≥20 pack-years). Conclusions: Pre-transplant heavy smoking is associated with early post-transplant AF, lung cancer, infection, and reduced survival after HTX. Full article

Background: High-sensitivity cardiac troponin T serum concentration (hs-cTnT) measurement is a well-established tool in the diagnosis of acute cardiovascular (CV) disease. It remains unclear whether resting hs-cTnT could be useful for screening the status of the CV system. The purpose of this study was to compare the correlation between hs-cTnT, determined in patients without clinical symptoms of acute illness, and selected parameters of subclinical CV dysfunction in relation to the coexistence of arterial hypertension (AH). Methods: In total, 101 patients were included in the analysis. The following methods were used to assess the CV system: transthoracic echocardiography, Doppler ultrasonography of the carotid and lower extremity arteries with intima–media thickness (IMT) measurement, pulse wave velocity (PWV), central blood pressure measurement, ankle–brachial index (ABI), and toe–brachial index (TBI). Results: In patients with AH, significant correlations were found between hs-cTnT and maximal velocity of tricuspid regurgitation (R = 0.397; p = 0.003), left atrium volume index (LAVI) (R = 0.39; p = 0.002), and IMT in carotid arteries (cIMT) (R = 0.4; p = 0.001), common femoral arteries (cfIMT) (R = 0.384; p = 0.004), and superficial femoral arteries (sfIMT) (R = 0.352; p = 0.01), as well as PWV (R = 0.63; p < 0.001), central systolic blood pressure (cSBP) (R = 0.34; p = 0.006), central pulse pressure (cPP) (R = 0.354; p = 0.004), and ankle–brachial index (ABI) (R = −0.28; p = 0.024). In multivariate analysis, the relationship between subclinical CV dysfunction and hs-cTnT remained significant for LAVI, cSBP, cPP, and ABI, as well as showing borderline significance for sfIMT. In patients without AH, only the relationship between hs-cTnT and ABI was significant. According to interaction analysis, AH significantly influenced the relationship between hs-cTnT and cSBP, cPP, and sfIMT. Conclusions: Resting hs-cTnT correlates significantly with selected parameters of subclinical CV dysfunction in patients with AH. This relationship is clearly weaker in patients without AH. Further research is needed, especially prospective studies on a larger group of patients. Full article

Background: Diagnosing and predicting outcomes in elderly patients with heart failure (HF) is challenging due to atypical symptoms and the limited value of natriuretic peptides, highlighting the need to search for new risk stratification biomarkers in this population. Aim: We aimed to analyze factors associated with the composite endpoint (all-cause mortality or decompensated HF-related hospitalization) within six months of follow-up in elderly patients with left ventricular systolic dysfunction and decompensated HF, with particular emphasis on copeptin concentration. Methods: This is a retrospective observational study based on prospectively collected data of 279 consecutive elderly patients hospitalized between 2018 and 2023 due to decompensated HF. Inclusion criteria were age > 65 years, history of HF diagnosed at least two years before the index hospitalization, and left ventricular ejection fraction < 40% on admission echocardiography. Serum copeptin levels were measured using an Enzyme-Linked Immunosorbent Assay (ELISA) (Human Copeptin ELISA kit, Sunred Biological Technology Co, Shanghai, China). The primary endpoint was all-cause mortality or decompensated HF-related hospitalization during the six-month follow-up. Results: The median age of the study population was 77 years (IQR: 69–79), and 221 (79.2%) were male. The composite endpoint occurred in 110 patients (38.1%). Multivariable analysis showed that serum concentrations of copeptin [hazard ratio (HR) 1.053 (1.042–1.064), p < 0.0001], bilirubin [HR 1.085 (1.057–1.114), p < 0.0001], uric acid [HR 1.005 (1.003–1.006), p < 0.0001], high-sensitivity C-reactive protein (hs-CRP) [HR 1.208 (1.088–1.342), p < 0.0001], and sodium [HR 1.111 (1.025–1.203), p = 0.01], as well as ischemic etiology of HF [HR 3.969 (2.396–6.575), p < 0.0001], were independently associated with worse outcomes. Conclusions: Our study demonstrated that higher concentrations of copeptin, bilirubin, hs-CRP, and uric acid, as well as lower sodium levels and ischemic etiology of HF, were independently associated with all-cause mortality or HF-related hospitalization during a six-month follow-up in elderly patients with decompensated HF. Full article

Background: Posterior cranial fossa (PCF) infarctions are associated with elevated mortality rates; however, evidence regarding the prognostic value of comorbidity indices in this context remains scarce. This study investigates the association between the age-adjusted Charlson Comorbidity Index (aCCI) and clinical outcomes in patients with PCF infarctions, aiming to evaluate the aCCI as a prognostic indicator. The aCCI is a validated scoring system that quantifies a patient’s burden of chronic diseases, adjusting for age, to estimate overall comorbidity risk. Methods: In this retrospective, single-center analysis spanning two years, patient data were assessed to determine correlations between aCCI scores and clinical outcomes at discharge, specifically the modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS). Structural equation modeling (SEM) was employed to elucidate the relationships among these variables. Results: SEM demonstrated that higher pre-stroke comorbidity burden, as quantified by the aCCI, was significantly associated with increased stroke severity and poorer functional outcomes at discharge. The aCCI exhibited strong direct effects on both NIHSS (path coefficient: 0.70) and mRS (path coefficient: 1.43). Conclusions: Premorbid comorbidities, as measured by the aCCI prior to stroke onset, are significantly correlated with both neurological deficit and functional outcome at discharge in patients with PCF infarctions. These findings underscore the potential utility of the aCCI as a prognostic tool for outcome prediction in this patient cohort. Full article

Aim: This study aimed to investigate the effectiveness and safety of whole-body hyperthermia (WBH) in cancer patients, identifying predictive factors for successful treatment (reaching target temperature ≥ 38.5 °C) and assessing adverse effects. Methods: We conducted a retrospective analysis of 397 cancer patients receiving a total of 855 WBH treatment sessions at a single institution between January 2018 and December 2018. Results: A total of 855 WBH treatments were performed on 397 patients (76.6% female; median age 58 years). The most common cancer types included breast cancer (52.4%), followed by prostate cancer (13.1%) and gynecological cancers (10.6%), with 54.7% of patients having metastatic disease. Target temperature was reached in 90.1% (770 of 855) of sessions, with a median treatment time of 202 min and maximum temperature of 40.4 °C. Common side effects included headache (54.9%), skin reactions (11.7%), and cardiac effects (9.4%), with no serious adverse events. Serum creatinine (p = 0.01, OR 0.30, 95% CI: 0.11–0.78) and secale cornutum/galena co-medication during WBH (p < 0.001, OR 0.26 [0.12, 0.54]) emerged as independent predictors of achieving target temperature in multivariate analysis. Both elevated creatinine levels and the use of secale cornutum/galena were associated with an approximately 70% lower probability of achieving the target temperature. Conclusions: WBH demonstrates safety in cancer patients with high success rates in reaching target temperatures. Both elevated creatinine levels and the use of secale cornutum/galena were associated with a lower chance of reaching the target temperature and thus impacting and predicting WBH success. Full article

Background and Objectives: Deep venous thrombosis (DVT) is associated with pulmonary embolism and long-term complications such as post-thrombotic syndrome (PTS). Anticoagulation prevents thrombus extension but does not actively remove clot. Interventional techniques, including catheter-directed thrombolysis, mechanical and pharmacomechanical thrombectomy, and venous stenting, have been introduced to restore venous patency and reduce complications. This systematic review summarizes current evidence on outcomes, safety, and patient selection for these procedures. Materials and Methods: A systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science was conducted for studies published between January 2000 and February 2024. Eligible studies included randomized controlled trials, systematic reviews, meta-analyses, and observational studies with ≥20 patients. Extracted outcomes were technical success, thrombus clearance, venous patency, PTS, quality of life, and complications. Risk of bias was assessed using the Cochrane Risk of Bias Tool, Newcastle–Ottawa Scale, and AMSTAR-2. Results: Of 456 records screened, 35 studies were included. Randomized trials (CaVenT, ATTRACT, CAVA) showed that catheter-directed and pharmacomechanical approaches improved venous patency and reduced moderate-to-severe PTS in selected patients with iliofemoral DVT, though overall benefit was variable. Mechanical thrombectomy devices (e.g., AngioJet, ClotTriever, FlowTriever) achieved high thrombus clearance and shorter procedural times, with device-specific complication profiles. Observational data demonstrated venous stenting patency rates of 74–89% at 12 months. Study heterogeneity limited direct comparisons. Conclusions: Interventional procedures can reduce PTS and improve outcomes in carefully selected patients, particularly those with acute iliofemoral DVT. Modern mechanical and pharmacomechanical techniques enhance efficiency and safety, while venous stenting addresses underlying obstructions. Further high-quality trials with long-term follow-up are needed to define optimal patient selection and comparative effectiveness. Full article

Introduction: Heart failure (HF) remains a leading cause of morbidity and hospitalization among elderly patients. Therefore, identifying reliable prognostic indicators is crucial for improving clinical outcomes in this population. The aim of this study was to evaluate the association between the Model for End-stage Liver Disease excluding INR (MELD-XI) and clinical outcomes in elderly patients hospitalized for decompensated HF. Material and methods: This was a single-center observational study involving 242 elderly patients with end-stage HF who were hospitalized for decompensation at our institution between 2019 and 2023. Upon hospital admission and discharge, MELD-XI scores were calculated using serum bilirubin and creatinine levels. The primary endpoint of the study was all-cause mortality during the follow-up period. Results: The median age of the patients was 68 years (66–74.6), and 78.9% were men. The median (Q1–Q3) follow-up time was 1.47 (0.78–2.31) years. During the follow-up period, 47.1% of the patients died. Independent predictors of mortality were diabetes mellitus [HR 1.656 (1.113–2.463), p = 0.013] and MELD-XI at discharge [OR 1.267 (1.210–1.327), p < 0.001]. The area under the receiver operating characteristic curves (AUC) for MELD-XI at discharge was 0.827 (95% CI: 0.776–0.878). The cut-off value for MELD-XI at discharge (>11.7 points) had a sensitivity of 97% and a specificity of 59%. Conclusions: Independent predictors of death in the analyzed population of elderly patients with decompensated HF were diabetes mellitus and MELD-XI at discharge. Full article

Background: The varied shape and size of the sphenoid sinuses result in a highly variable degree of extension, described in different ways in the literature. The aim of the study was to create the authors’ classification of the sphenoid sinus extensions into the sphenoid bone processes. Methods: The study was retrospective, based on the results of head CT scans. The study group comprised 432 children, aged from birth to 18 years. Three types of sphenoid sinus extension into the sphenoid bone processes were proposed. Pneumatization of the lesser wing (type I), of the greater wing (type II), and of the pterygoid process (type III). Three subtypes were defined for each type. Pneumatization of the lesser wing in relation to the optic canal: only above (Ia), only below (Ib), and simultaneously above and below (Ic). Pneumatization of the greater wing in relation to the foramen rotundum: only above (IIa), only below (IIb), and simultaneously above and below (IIc). Pneumatization of the pterygoid process in relation to the pterygoid canal: only laterally (IIIa), only medially (IIIb), and simultaneously laterally and medially (IIIc). Results: Pneumatization of the lesser wings was observed in 19.44%, of the greater wings in 36.11%, and of the pterygoid processes in 25.00 of % children. As a result of the analysis conducted in accordance with the proposed classification, bilateral pneumatization of the lesser wings (type I), greater wings (type II), and pterygoid processes (type III) were found to occur more frequently than unilateral pneumatization. In the case of rare subtypes (Ia, Ic, IIa, Iic, or IIIb), a given subtype was observed to occur more frequently unilaterally. Conclusions: In the conducted analysis, we presented the authors’ classification of sphenoid sinus extensions into the sphenoid bone processes. Full article

Metabolic syndrome (MetS) is defined by a combination of metabolic abnormalities, such as central obesity, insulin resistance, hypertension, and dyslipidemia, and significantly increases the risk of cardiovascular diseases and type 2 diabetes. The high prevalence of MetS is a public health concern, necessitating rapid identification and intervention strategies to prevent this emerging epidemic. Diagnosing MetS requires the presence of three or more of these abnormalities, underscoring the need for effective management approaches. Despite a growing body of literature, limited reviews have critically evaluated the complex interplay between metabolic dysfunction, inflammation, and coagulation, particularly in the context of dietary interventions. Therefore, this article reviews the relationship between metabolic syndrome, inflammation, and thrombotic diseases, with an emphasis on their impacts on hematological health. Furthermore, this review explores the potential role of vegetarian and vegan dietary patterns in controlling these processes and improving hematological outcomes. This narrative review aims to critically evaluate current research on the inflammatory and thrombotic implications of MetS and assess the potential modulating role of vegan and plant-based diets within this context. Full article

Nepenthes L. species (tropical pitcher plants) are a classic example of carnivorous plants. The Nepenthes traps are highly specialized pitchers with a zoned structure. On the outer surface of the pitcher, there are nectaries and various types of trichomes, including glandular trichomes. The main aim of our study was to examine these glandular trichome structures and check the distribution of the homogalacturonans (HGs) and hemicelluloses in the cell wall of trichome cells. The structure of Nepenthes bicalcarata Hook. f. and Nepenthes albomarginata T.Lobb ex Lindl. trichomes was analyzed using light and electron microscopy. The antibodies were used against the wall components [anti-pectic homogalacturonans (HGs): JIM5 (low methylesterified HGs), LM19 (low methylesterified HGs), CCRC-M38 (a fully de-esterified HGs), JIM7 (highly esterified HGs), LM20 (esterified HGs), LM5 (galactan) and anti-hemicelluloses: LM25 (xyloglucan), LM15 (galactoxyloglucan), CCRC-M138 (xylan), and LM10 antibody (xylan)]. The localization of the examined compounds was determined using immunohistochemistry techniques. The presence of endodermal and transfer cells supports the idea that peltate trichomes actively transport solutes. Also, the presence of pectic homogalacturonans and hydrophilic hemicelluloses indicates that water or aqueous solutions are transported through the trichomes’ cell walls. Our study supports the idea that these trichomes may act as hydathodes or hydropotes. Full article

Background/Objectives: This study aimed to evaluate longitudinal changes in the subgingival microbiome over 12 months following non-surgical periodontal treatment, with or without adjunctive systemic antibiotics, in patients with stage III/IV periodontitis and peripheral artery disease. Materials: After randomizing patients to full-mouth mechanical debridement with/without adjunctive systemic antibiotics (PT1/PT2 group) or no subgingival debridement (control group), periodontal probing depths were measured, scores for ‘periodontal inflamed surface area’ (PISA) obtained, and subgingival plaque samples collected at baseline and during the 3-month and 12-month follow-up visits. Next-generation 16S DNA sequencing was used to characterize the microbiota of the samples for alpha/beta diversity and differentially abundant taxa. Results: Complete data was available for 76 patients. At 3 months, shallow (≤3.4 mm) or advanced (≥5.5 mm) pockets were significantly more, or less, prevalent in the PT1 than in the control group (p = 0.013/0.004). Microbiologically, the PT1 group was even more distinct, being associated with statistically significant changes over time (in alpha/beta diversity and differential taxa abundances) not seen in the PT2 and control groups. Conclusions: Although non-surgical treatment can reduce periodontal inflammation with or without antibiotics, subgingival microbial diversity can only be sustainably affected, and periodontitis-associated microbiota reduced, in the presence of adjunctive systemic antibiotics. Full article