Search Results (5,496)

Background and clinical significance. Penetrating cardiothoracic wounds require prompt treatment in order to decrease mortality and morbidity. Surgical therapy, aimed at bleeding control and removal of damaged tissue, varies widely from the direct suture of parenchymal lacerations to pneumonectomy, which is characterized by high mortality rates. We report our experience with a patient in hemorrhagic shock due to a gunshot wound to the chest, successfully treated by pneumorrhaphy under cardiopulmonary bypass (CPB). Case presentation. A 53-year-old man with a gunshot wound to the chest was admitted to our Emergency Department. A bedside ultrasonography revealed left pleural and pericardial effusion. He was hemodynamically instable, so he was immediately transferred to the operating room by the cardiac and Thoracic Surgery teams. Through a median sternotomy approximately 2 L of blood were evacuated and a deep laceration of the left upper lobe was discovered. The massive bleeding could not be controlled, leading to pleural cavity flooding. The surgical team decided to institute emergency CPB and perform lung repair by pneumorrhaphy, under circulatory support. The patient survived and was discharged on p.o. day 20. Conclusions. Clinical expertise, adequate instrumental equipment and a high level of interdisciplinary team-work favorably affected the patient’s outcome. Full article

Background/Objectives: Thoracic trauma remains a leading cause of trauma-related illness and death. Despite advances in imaging, ventilation strategies, and surgical fixation, its management remains a topic of debate, with varying practices across hospitals. Current Gaps: Although surgical stabilization of rib fractures (SSRF) has shown a mortality benefit in cases of flail chest and in elderly patients, its indications for non-flail cases remain uncertain. Analgesia strategies are evolving, and epidural remains the gold standard; however, it is limited by contraindications. In contrast, regional blocks, such as the erector spinae plane block (ESPB) and serratus anterior plane block (SAPB), are emerging as safer alternatives to opioid and thoracic epidural analgesia (TEA). Artificial intelligence (AI) is transforming imaging interpretation and risk stratification; however, its integration into daily trauma care is still in its early stages of development. Perspective: This article examines the integration of surgical innovation, regional anesthesia, and AI-powered diagnostics as integral components of future thoracic trauma care. We emphasize the importance of standardized surgical criteria, multimodal pain management approaches, and AI-assisted decision-making tools. Conclusions: Thoracic trauma care is shifting toward a personalized, multidisciplinary, and technology-enhanced approach. Incorporating evidence-based SSRF, advanced pain management techniques, and AI-supported imaging can help reduce mortality, enhance recovery, and optimize resource utilization. Full article

Background and Objectives: Cardiac myxoma (CM) is the most common primary benign neoplasm of the heart. This study’s objective was to analyse diagnostic features of CM, surgical data and postoperative courses of patients over a 20-year period in a single institution. Materials and Methods: We conducted a retrospective analysis of patients with diagnosed and pathologically confirmed CM who underwent surgical resection in our hospital from 1 January 2004 to 1 January 2024. Data was assessed and analysed from medical records. Results: The study included 76 patients (mean age, 61.7 ± 12.6 years; 60.5% female). The majority of patients (93.7%) had symptoms, most commonly presenting with dyspnoea (64.5%), chest pain (39.5%) and arrhythmias (35.5%). Myxomas were found in the left atrium (89.5%), right atrium (9.2%) and left ventricle (1.3%). Isolated tumour extirpation surgery was performed in 50 patients (65.8%). During the early postoperative period, arrhythmias were the most common complication (n = 16, 21.1%). Early in-hospital mortality occurred in two patients due to cardiopulmonary failure. In the late postoperative period, 11 deaths (14.9%) were observed 4 to 17.5 years after surgery. No recurrence of CM was found in any patient during the follow-up period, yet tumours of other localisations were detected in nine patients. Conclusions: Surgery is the first-line treatment for CM, with a good prognosis. Although during the late postoperative period no cardiac tumour recurrence was observed in our study, 12.2% patients were newly diagnosed with non-cardiac neoplasms. Therefore, we suggest monitoring patients not only for cardiac disorders but also for the occurrence of extracardiac tumours. Full article

Background: Silicosis is a lung disease caused by inhalation of crystalline silica dust, leading to lung fibrosis, respiratory symptoms, and impaired lung function. This study aimed to determine the prevalence of silicosis, asthma, and chronic obstructive pulmonary disease (COPD), and to identify factors associated with abnormal pulmonary function among residents living in dust-exposed areas in Thailand. Methods: A cross-sectional study was conducted from March 2024 to July 2024 among adults aged 18 years or older in Saraburi, Thailand. Data collected included demographics, comorbidities, respiratory symptoms, risk of silicosis, chest radiographs, and spirometry (forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), and bronchodilator responsiveness (BDR)). Silicosis was confirmed based on a history of significant silica exposure and characteristic chest radiographic findings. Results: Among 290 participants (55.9% female, mean age 47.6 ± 16.4 years), the prevalence of silicosis, asthma, and COPD was 0.3%, 4.5%, and 10.3%, respectively. Abnormal chest radiographs were observed in 8.3%, and abnormal lung function in 34.1%, including restrictive lung patterns (16.6%), airway obstruction (9.0%), mixed defects (2.8%), and small-airway disease (5.9%). BDR was observed in 4.8%. Logistic regression identified increasing age as a significant predictor of abnormal lung function. Conclusions: Silicosis prevalence was lower than that of asthma and COPD, but abnormal pulmonary function—especially restrictive defects—was common. Notably, the prevalence of asthma and COPD was higher than previously reported community-based diagnosis rates, suggesting potential underdiagnosis. Older age was associated with a higher likelihood abnormal lung function. These findings highlight the need for targeted surveillance, preventive measures, and public health interventions to mitigate the respiratory impacts of dust exposure in community settings Full article

We report the case of a 42-year-old, non-smoking male admitted with right upper-lobe pneumonia. Chest computed tomography (CT) demonstrated findings consistent with an infectious process. For further evaluation, serial bronchoscopies with biopsy sampling were performed. Histopathological examination revealed moderate squamous dysplasia of the tracheal epithelium, and subsequent immunohistochemical testing detected human papillomavirus (HPV) genotype 45. This case underscores the value of integrating imaging, endoscopic assessment, and molecular diagnostic techniques in the evaluation of atypical pulmonary lesions and highlights the potential role of HPV infection in airway epithelial dysplastic changes. Full article

(1) Background: There have been previous reports of autonomic modulation by aromatherapy. In this study, we recorded heart rate variability (HRV) to assess its relationship with the effects on feeling. (2) Methods: Twenty-three healthy subjects, who were blind to the aroma type, were exposed to citrus aurantium oil (CAO) or rose water (RW) aroma for 5 min using a diffuser situated in a room. Electrocardiographic data were measured continuously using a wireless device attached to the chest. R-R intervals were used to calculate HRV scores, including high-frequency (HF) variation, low-frequency (LF) variation, LF/HF ratios, the coefficient of variation in R-R (CVRR), and heart rate. A visual analog scale (VAS) was used to evaluate disfavor, fatigue, anxiety, tension, and somnolence at the end of the treatment. (3) Results: CAO significantly reduced disfavor, anxiety, and tension, while RW did not affect VAS scores. HF scores were high during the treatment with both CAO and RW, indicating parasympathetic activation. Treatment with CAO was also accompanied by an increase in LF and the CVRR, whereas treatment with RW was not. HF scores during CAO treatment were negatively correlated with somnolence. No relationships between VAS scores and HRV scores were observed in the RW treatment. (4) Conclusions: In CAO treatment, parasympathetic activation is related to feeling. RW, on the other hand, exerts its autonomic effects without changes in feeling. These results suggest that autonomic modulation by rose water may not depend on the generated feelings, suggesting the usefulness of HRV monitoring in aromatherapy. Full article

Early diagnosis and rapid treatment of respiratory abnormalities such as many lung diseases including pneumonia, TB, cancer, and other pulmonary problems depend on accurate and fast classification of chest X-ray images. Delayed diagnosis and insufficient treatment lead to the subjective, labour-intensive, error-prone features of current manual diagnosis systems. To tackle this pressing healthcare issue, this work investigates many deep convolutional neural network (CNN) architectures including VGG16, VGG19, ResNet50, InceptionV3, Xception, DenseNet121, NASNetMobile, and NASNet Large. LungVisionNet (LVNet) is an innovative hybrid model proposed here that combines MobileNetV2 with multilayer perceptron (MLP) layers in a unique way. LungVisionNet outperformed previous models in accuracy 96.91%, recall 97.59%, precision, specificity, F1-score 97.01%, and area under the curve (AUC) measurements according to thorough examination on two publicly available datasets including various chest abnormalities and normal cases exhibited. Comprehensive evaluation with an independent, real-world clinical dataset from King Hussein Cancer Centre (KHCC), which achieved 95.3% accuracy, 95.3% precision, 78.8% recall, 99.1% specificity, and 86.4% F1-score, confirmed the model’s robustness, generalizability, and clinical usefulness. We also created a simple mobile application that lets doctors quickly classify and evaluate chest X-ray images in hospitals, so enhancing clinical integration and practical application and supporting fast decision-making and better patient outcomes. Full article

Objective: The omentum is a highly vascularized and immunologically active tissue with significant regenerative potential. Despite its versatility, its use has traditionally been limited to intra-abdominal applications due to access challenges. Conventional open harvest requires laparotomy, and laparoscopic techniques are hindered by limited visualization and poor ergonomics. We describe the use of robotic-assisted omental flap harvest for thoracic reconstruction, offering a minimally invasive alternative. Methods: A retrospective review was conducted of patients who underwent robotic omental flap harvest for intrathoracic reconstruction at a single-center institution between January 2023 and January 2024. Data collected included demographics, indications, surgical technique, operative details, and postoperative outcomes, with a focus on flap viability and complications. Additionally, a systematic review was conducted to evaluate current evidence and experiences with this type of technique. Results: Three patients underwent robotic omental flap harvest for indications including chest wall reconstruction and pleural space obliteration in infected thoracic cavities. The average robotic flap harvest time was 79 ± 13 min, with an estimated ± blood loss of 20 cc. The mean postoperative hospital stay was 10 days, influenced by the primary procedure and patient comorbidities. At an average follow-up of 8 months, all flaps remained viable, with no flap-related complications or losses. The systematic review demonstrated limited data in the current literature regarding this type of surgical approach. Conclusions: Robotic-assisted omental flap harvest is a safe, feasible, and effective technique for complex thoracic reconstructions. It provides a minimally invasive alternative to traditional harvest methods, with reduced morbidity and excellent clinical outcomes. This technique expands the reconstructive options for intrathoracic defects and infections. Full article

This study evaluated the accuracy of heart rate (HR) measures of a commercial wearable device on tattooed skin and assessed tattoo characteristics associated with HR accuracy. Participants (n = 25) wore a chest strap HR monitor (criterion) and an armband HR monitor (experimental) during rest and self-paced walking and running. Conditions with the experimental device on tattooed and non-tattooed sections of skin were completed, and HR was collected every second and compared via Lin’s correlation (CCC) and the mean absolute percent error (MAPE). Skin tone and tattoo age and intensity were evaluated with HR accuracy. HR from tattooed skin was not accurate during rest (MAPE = 22.9%; CCC = 0.25), walking (MAPE = 7.5%; CCC = 0.68), or running (MAPE = 5.1%; CCC = 0.83). Measures taken on non-tattooed skin were within acceptable standards for accuracy throughout all three conditions (MAPE < 5%; CCC > 0.90). Skin tone was the only characteristic found to contribute to HR accuracy during rest (p = 0.046) and walking (p = 0.045). No variables loaded for running. The presence of arm tattoos affected HR readings, with the greatest inaccuracy occurring at rest. Specific tattoo characteristics did not statistically contribute to HR accuracy, as shown by the regression analysis. More research is needed to clarify how the varied tattoo characteristics affect HR devices. Full article

Background: Early stratification of patients at emergency department (ED) admission is crucial. The soluble urokinase plasminogen activator receptor (suPAR) has emerged as a promising biomarker to identify the worsening of different clinical conditions. We aimed at evaluating whether baseline suPAR values predict 28-day and 90-day mortality in patients presenting to the ED with different conditions. Methods: In this prospective observational study, we enrolled patients with dyspnoea (D), chest pain (CP), and abdominal pain (AP). suPAR levels, together with clinical and laboratory data, were recorded at ED admission. The data collected included 28-day and 90-day mortality data, as well as 28-day and 90-day hospital readmission; and their correlation with suPAR values was assessed. Results: We enrolled 298 consecutive patients (CP 23.8%, D 31.9%, AP 44.3%). suPAR was significantly higher in patients with dyspnoea, compared to both patients with chest and abdominal pain (5.50 [3.50–8.60], 3.20 [2.30–4.10], 3.20 [2.33–4.48] ng/mL, respectively; p < 0.001). suPAR plasmatic levels were also higher in patients admitted to semi-intensive or intensive care units compared to other patients (4.10 [3.15–8.05] vs. 3.50 [2.55–5.50] ng/mL, respectively; p = 0.049). suPAR levels were significantly higher in patients dead at 28 days than in survivors (12.65 [9.83–18.53] vs. 3.60 [2.60–5.48] ng/mL, respectively; p < 0.001). Using the stepwise logistic regression analysis, only suPAR emerged as an independent predictor of 28-day mortality with an odds ratio of 1.31 (95% CI 1.10–1.56). Conclusions: Baseline suPAR levels are an independent predictor of mortality in ED patients with chest pain, dyspnoea, or abdominal pain. Full article

Background and Clinical Significance: Endobronchial leiomyoma is a rare benign tumor of the respiratory tract, accounting for less than 2% of all benign pulmonary neoplasms. Most cases have been treated surgically or with endoscopic modalities such as laser or rigid bronchoscopy-assisted cryotherapy. Flexible bronchoscopic cryoextraction has been rarely reported, typically with 2.2-mm probes. Small-caliber cryoprobes (1.1- and 1.7-mm) have been validated for diagnostic transbronchial cryobiopsy but not for therapeutic removal of leiomyoma. We report a case of complete removal of endobronchial leiomyoma using a 1.7-mm cryoprobe via flexible bronchoscopy, demonstrating full airway and physiologic recovery. Case Presentation: A 25-year-old never-smoking man was referred after an abnormal health-screening chest radiograph demonstrated right middle and lower lobe atelectasis. Chest CT revealed a mass obstructing the proximal bronchus intermedius. Spirometry showed reduced FEV₁ and FVC with preserved FEV₁/FVC ratio, consistent with central airway obstruction. Therapeutic flexible bronchoscopy (Olympus BF-1TQ290) was performed under endotracheal intubation. Initial forceps biopsies were followed by transbronchial cryobiopsy with a 1.7-mm cryoprobe, applied for five freeze–adhesion cycles. The mass detached en bloc and was retrieved without complications, resulting in complete airway recanalization and visualization of the right middle and lower lobe bronchi. Histopathology showed interlacing fascicles of bland spindle cells with cigar-shaped nuclei, positive for SMA and desmin and negative for S-100 and CD34, confirming leiomyoma. The patient was discharged the next day. At one-year follow-up, bronchoscopy and CT demonstrated no recurrence, and spirometry normalized. Conclusions: Reports combining flexible bronchoscopy with a 1.7-mm small-caliber cryoprobe for en bloc removal of endobronchial leiomyoma are rare. This technique may represent a minimally invasive option for selected cases, provided careful hemostatic planning and appropriate case selection. Full article

Background: Anxiety disorders, including panic disorder, agoraphobia, specific phobias, and generalized anxiety disorder, are among the most frequent psychiatric conditions in primary care. They often present with somatic symptoms such as dyspnea, palpitations, chest or gastrointestinal discomfort, sweating, or flushing. Adaptol^® is a non-benzodiazepine anxiolytic with nootropic properties that modulates the limbic-reticular system, hypothalamic emotional centers, and multiple neurotransmitter systems. This study aimed to assess the association between Adaptol^® use and changes in anxiety symptoms, including somatic manifestations, in routine practice. Methods: A noninterventional observational study was conducted in 100 adults diagnosed with anxiety disorders in primary care. All received Adaptol^® 500 mg as prescribed. Patients had to have mild-to-moderate anxiety (5–14 points according GAD-7) to be enrolled. Exclusion criteria ruled out individuals with concomitant psychiatric or severe somatic conditions and those with use of other medications or any interventions that could affect the symptoms. Anxiety severity and somatic symptom burden were assessed at baseline and after treatment. Results: Adaptol^® treatment was associated with reduction in anxiety and somatic complaints. Improvements were reported in palpitations, chest discomfort, gastrointestinal disturbances, and autonomic symptoms. Greater benefit was observed in male patients, though without significance testing, and in those with severe baseline anxiety, as demonstrated by correlation between GAD-7 scores at baseline and changes after the treatment (r = 0.5). No unexpected adverse events occurred. Conclusions: In this real-world study, Adaptol^® showed anxiolytic efficacy and good tolerability, improving both psychological and somatic manifestations of anxiety disorders. These findings support its use in primary care, especially in severe cases of anxiety. Controlled trials are needed to support these results. Full article

Body measurement plays a crucial role in cattle breeding selection. Traditional manual measurement of cattle body size is both time-consuming and labor-intensive. Current automatic body measurement methods require expensive equipment, involve complex operations, and impose high computational costs, which hinder efficient measurement and broad application. To overcome these limitations, this study proposes an efficient automatic method for cattle body measurement. Lateral and dorsal image datasets were constructed by capturing cattle keypoints characterized by symmetry and relatively fixed positions. A lightweight SCW-YOLO keypoint detection model was designed to identify keypoints in both lateral and dorsal cattle images. Building on the detected keypoints, 11 body measurements—including body height, chest depth, abdominal depth, chest width, abdominal width, sacral height, croup length, diagonal body length, cannon circumference, chest girth, and abdominal girth—were computed automatically using established formulas. Experiments were performed on lateral and dorsal datasets from 61 cattle. The results demonstrated that the proposed method achieved an average relative error of 4.7%. Compared with the original model, the parameter count decreased by 58.2%, compute cost dropped by 68.8%, and model size was reduced by 57%, thus significantly improving lightweight efficiency while preserving acceptable accuracy. Full article

The rapid advancement of deep learning is significantly hindered by its vulnerability to adversarial attacks, a critical concern in sensitive domains like medicine where misclassification can have severe, irreversible consequences. This issue directly underscores prediction unreliability and is central to the goals of Explainable Artificial Intelligence (XAI) and Trustworthy AI. This study addresses this fundamental problem by evaluating the efficacy of denoising techniques against adversarial attacks on medical images. Our primary objective is to assess the performance of various denoising models. The authors generate a test set of adversarial medical images using the one-pixel attack method, which subtly modifies a minimal number of pixels to induce misclassification. The authors propose a novel autoencoder-based denoising model and evaluate it across four diverse medical image datasets: Derma, Pathology, OCT, and Chest. Denoising models were trained by introducing Impulse noise and subsequently tested on the adversarially attacked images, with effectiveness quantitatively evaluated using standard image quality metrics. The results demonstrate that the proposed denoising autoencoder model performs consistently well across all datasets. By mitigating catastrophic failures induced by sparse attacks, this work enhances system dependability and significantly contributes to the development of more robust and reliable deep learning applications for clinical practice. A key limitation is that the evaluation was confined to sparse, pixel-level attacks; robustness to dense, multi-pixel adversarial attacks, such as PGD or AutoAttack, is not guaranteed and requires future investigation. Full article

Precise segmentation of COVID-19 lesions in chest Computed Tomography (CT) scans can directly impact patient care, yet existing methods struggle, when undertaking this task, with the heterogeneous appearance of ground-glass opacities, consolidations, and the availability of limited labeled data. We propose herein CoviSwin, a Transformer-based U-shaped encoder–decoder network that combines the Large model of Swin Transformer Version 2 with attention and residual connections to capture both global context and fine details. A two-phase training strategy is applied whereby in the first phase the encoder is initially frozen while training the decoder on the public SemiSeg dataset, then in the second phase, the encoder is partially unfrozen while the whole model is trained on the publicly available MedSeg dataset. The model achieves a ten-run mean sensitivity value of 0.790 ± 0.012, an average Dice Similarity Coefficient (DSC) score of 0.781 ± 0.0068, and an average specificity of 0.962 ± 0.0049, outperforming the sensitivity results obtained by recent models such as NextSeg of 2024 and GFNet of 2022 by 8.07% and 7.48%, respectively. These findings demonstrate the potential of CoviSwin as an effective model for clinical COVID-19 lesion segmentation. Full article