Search Results (684)

Objective: Type B aortic dissection is a life-threatening medical condition. Endovascular closure of the primary entry by means of TEVAR is considered, nowadays, the gold standard if operative treatment is necessary. The aim of this study is to analyse the theoretical applicability of selective endovascular entry sealing using different occluder systems. Methods: A CT-graphic analysis of 102 patients who received TEVAR from January 2017 to June 2023 was performed. Patients with an intramural haematoma were excluded. The study patients were divided in two groups: type B aortic dissection (n = 87) and distal stent graft-induced new entry (n = 15). The TBAD group included patients with acute (n = 63), subacute (n = 12), and chronic aortic dissections (n = 12). The CTA analysis of the location, length, and width of the entry was performed using Aquarius iNtuition (TeraRecon, Inc., Foster City, CA, USA). After completion of the data collection, the possible application of all three occluder systems (ASD-Occluder, Septal-Occluder, and Amplatzer™-Occluder) was analysed, with reference to the Instructions for Use. Results: The ASD-Occluder from GORE is produced in five different sizes. It can be used in 81.4% (n = 83) of all patients in the overall study, including 82.8% TBAD (n = 72) and 73.3% of dSINE (n = 11) patients. When using the ASD-Occluder, 10.3% (n = 9) of patients are expected to have complete vascular coverage of the LSA based on our CTA analysis. The Septal-Occluder from GORE is offered in three different sizes. Complete entry closure can theoretically be achieved in fifty patients (57.5%) with TBAD and in nine patients (60%) with dSINE, based on CTA analysis and IFU criteria. With the use of the Septal-Occluder, 3.9% (n = 4) of the dSINE patients and 4.6% (n = 4) of the TBAD patients were expected to have complete aortic branch occlusion. The Amplatzer™-Occluder from Abbott is provided in 27 different sizes to effectively seal defects with a diameter of 4 to 56 mm. It can technically be used in 90.1% of patients (n = 92), of which 89.7% with TBAD (n = 78) and 93.3% with dSINE (n = 14) to completely seal the entry. Conclusions: CTA analysis in patients with TBAD and dSINE demonstrated that by the theoretical application of occluder systems, a seal of the entry would be achieved in 57.8% to 90.1% of the patients. However, in addition to entry closure, the use of occluder systems can also lead to unintentional partial (10.7–23.5%) or complete (3.9–22.5%) coverage of adjacent aortic branches. The clinical significance and applicability of the occluder system should be reviewed in future studies and practical applications to evaluate safety, efficacy, and possible complications in order to define the benefit–risk balance. Full article

Alzheimer’s disease is a degenerative neurological condition mostly affecting memory and cognitive abilities in older people. This study aimed to determine how acteoside, a major plant phytoconstituent, protects against neuronal death in the hippocampus region, activates the cholinergic system, and acts as an antioxidant to help people with Alzheimer’s-type dementia. Early research on the extraction process and subsequent in vitro testing revealed that the plant extract had potent antioxidant qualities. Initial assessment highlighted the yield percentage, which was 14.10% using the Soxhlet method. In order to explore this plant’s possible medical uses, further in vivo studies are required. Full article

Background: Therapeutic abortion is a controversial topic since people throughout the world have different views on it. Methods: In this qualitative study, 12 adults (ages 19–36 years) from Irbid, in the Northern region of Jordan, were selected from a variety of public locations (markets, mosques) in April and May 2025 to participate in semi-structured interviews with the goal of exploring attitudes toward therapeutic abortion. The interviews, which lasted an average of 30 min, focused on two primary topics: attitudes about therapeutic abortion and determining who has the authority to make abortion decisions. An audio recorder was used to capture the responses, which were then preserved in their original, unaltered state. Following verbatim transcription, the responses were subjected to thematic analysis in order to determine the main themes. The original code was made manually. Results: Three themes were identified under the first topic: “unconditional rejection”, “conditional acceptance”, and “empathetic and woman-centered attitudes”. Medical and religious experts’ decision-making arose by the theme of “abortion decision” that emerged in relation to the second topic. Conclusions: Jordanians have conflicting views on therapeutic abortion and are adamantly opposed to making their own decisions on the matter. Full article

Background: Epilepsy and cognitive impairment frequently coexist, yet their relationship remains complex and insufficiently understood. This study aims to explore the clinical and electrophysiological features of patients presenting with both conditions in order to identify patterns that may inform more accurate diagnosis and effective management within a personalized medicine framework. Methods: We retrospectively analyzed 14 patients with late-onset epilepsy and coexisting cognitive impairment, including mild cognitive impairment and Alzheimer’s disease. Clinical history, cognitive assessments, neuroimaging, and electroencephalographic recordings were reviewed. EEG abnormalities, seizure types, and treatment responses were systematically documented. Results: Patients were categorized into two groups: (1) those with established Alzheimer’s disease who later developed epilepsy and (2) those in whom epilepsy preceded cognitive impairment. Temporal lobe involvement was a key feature, with EEG abnormalities frequently localizing to the frontal–temporal electrodes and manifesting as background slowing, focal multiform slow waves, and epileptiform discharges. Levetiracetam was the most commonly used antiseizure medication, and it was effective across both groups. Conclusions: This case series highlights the value of EEG in characterizing patients with subclinical and overt epileptic activity and cognitive impairment comorbidity. The inclusion of a substantial number of cases with documented EEG abnormalities provides valuable insight into the interplay between epilepsy and neurodegenerative diseases. By integrating neurophysiological data with clinical and cognitive trajectories, this work aligns with the principles of precision medicine, facilitating a more comprehensive evaluation and tailored management approach. Further longitudinal studies are required to validate prognostic markers and guide optimal therapeutic strategies. Full article

At present, polypharmacy—which is the use of several medications to treat a single case at the same time—has become a fairly common medical practice, particularly in chronic illnesses or with older patients. But this relatively ‘faster’ form of treatment brings the problem of cumulative polypharmacy, which occurs when there is an increase in drug–drug interactions (DDIs) due to the large number of medicines taken. While the aftermath, such as the reduction in strength of medication taken or catastrophic and fatal responses to certain drugs, is clearly not worth the initial effort put into trying to ease the condition, attempting to resolve these issues requires excessive research. With these difficulties in mind, we describe our research that uses graph neural networks (GNNs) focused on DDI prediction by modeling drugs and their interactions in the form of graphs. The research is divided into two parts. In this research, the relevant literature is reviewed in order to understand how modern GNN-based algorithms can be applied for the detection of optimal drugs. Full article

Background and Objectives: Inflammatory bowel diseases (IBDs) are chronic conditions of the digestive tract, often requiring life-long treatments in order to achieve and maintain remission. However, treatment adherence among patients with IBD can frequently be suboptimal, which can compromise disease control and long-term outcomes. The aim of this study was to analyze the adherence rate and to identify factors that significantly influence treatment adherence in patients with IBD. Materials and Methods: The study employed a cross-sectional design and was conducted at the Fundeni Clinical Institute, a tertiary medical center in Bucharest, Romania. The treatment adherence was assessed using the Medication Adherence Report Scale-5 (MARS-5), with patients scoring greater than 23 considered adherent. Anxiety, depression and perceived stress were assessed using the Depression, Anxiety and Stress Scale-21 (DASS-21). Perceived social support was measured with the Multidimensional Scale of Perceived Social Support (MSPSS), and coping strategies were assessed using the Brief Coping Orientation to Problems Experienced Inventory (Brief COPE Inventory). Results: A total of 188 patients were included in the final analysis. Of these, 99 patients (52.7%) were male and 109 (58.0%) had a diagnosis of Crohn’s disease. The majority of patients (81.9%) were receiving treatment with advanced therapies, including biologics or small molecules. Forty patients were receiving their therapy through more than one route of administration. Optimal adherence was noted in 160 patients (85.1%). Patients treated with advanced therapies (biologics and small molecules) had significantly higher odds of optimal adherence (OR 10.52, 95% CI: 4.3–25.74, p < 0.001), with a rate of adherence of 92.2%. Significantly lower odds of adherence were found for the oral (OR 0.35, 95% CI: 0.14–0.83, p = 0.01) and rectal (OR 0.09, 95% CI: 0.03–0.29, p < 0.001) routes of administration, while the intravenous administration had higher odds of adherence (OR 4.85, 95% CI: 1.02–22.9, p = 0.04) compared to the subcutaneous route. Other factors associated with an improved adherence were being retired (OR 3.5, 95% CI: 1.13–10.8, p = 0.029) and using positive reframing (p = 0.04), planning (p = 0.01) and venting (p = 0.02) as coping strategies; active smoking (OR 0.26, 95% CI: 0.11–0.6, p = 0.002), active disease (OR 0.36, 95% CI: 0.16–0.81, p = 0.014) and behavioral disengagement (p = 0.04) were associated with impaired treatment adherence. No significant differences in adherence were observed between disease phenotypes. Conclusions: The route of administration, smoking status and psychosocial factors, such as perceived stress of social support and coping strategies, may play an important role in influencing treatment adherence in patients with IBD. While the disease phenotype was not associated with differences in adherence, patients with active disease had significantly lower odds of optimal adherence. Full article

Background/Objectives: Human leukocyte antigen B27 (HLA-B27) is a genetic marker strongly associated with various inflammatory rheumatic diseases, particularly those within the spondyloarthritis spectrum. Its presence influences disease onset, clinical severity, and therapeutic strategies. However, comparative data between HLA-B*27-positive and -negative patients, especially in Eastern European populations, remain limited. The study aimed to investigate the clinical, paraclinical, and psychosocial differences between HLA-B*27-positive and -negative individuals diagnosed with rheumatic diseases, in order to better understand the implications of HLA-B27 status on disease expression and patient quality of life. Methods: A cross-sectional, observational study was conducted between June 2023 and December 2024 at the Emergency Clinical Hospital for Children “Sf Ioan” in Galati, Romania, in collaboration with “Dunarea de Jos” University. Fifty adult patients with various rheumatic conditions were enrolled and stratified into HLA-B*27-positive (n = 22) and -negative (n = 28) groups. Data collection included clinical evaluations, laboratory biomarkers (CRP = C-reactive protein; ESR = erythrocyte sedimentation rate), and a structured quality-of-life questionnaire. Statistical analysis was performed using SPSS v27. Results: HLA-B*27-positive patients were significantly younger (mean age 46.00 vs. 55.07 years, p = 0.018) and had higher CRP levels (>1 mg/dL in 53.33% vs. 0%, p = 0.001). Ankylosing spondylitis was more prevalent in this group (22.73% vs. 3.57%, p = 0.039). Magnetic resonance imaging (MRI) was more frequently used (68.18% vs. 39.29%, p = 0.042), indicating greater suspicion of axial involvement. HLA-B27-positive patients also reported higher perceived stress (mean score 2.41 vs. 1.21, p < 0.001). Conclusions: HLA-B*27 positivity is associated with earlier disease onset, increased systemic inflammation, greater axial involvement, and higher psychological stress. These findings emphasise the need for personalised, multidisciplinary care that integrates both medical and psychological support for HLA-B*27-positive patients. Full article

This study presents a mathematical model to describe the transmission dynamics of asthma, explicitly accounting for the impact of dust waves and airborne particulate matter in the environment, recognized as key triggers of asthma exacerbations. The model incorporates a single endemic equilibrium point, which is shown to be locally asymptotically stable. To mitigate the burden of asthma, we employed the Pontryagin Maximum Principle within an optimal control framework, incorporating three time-dependent intervention strategies: vaccination, treatment, and avoidance of environmental triggers such as dust exposure. The model was numerically solved using the fourth-order Runge–Kutta method in conjunction with a forward–backward sweep algorithm to investigate the effects of various control combinations on the prevalence of asthma. Additionally, a comprehensive cost-effectiveness analysis was conducted to evaluate the economic viability of each strategy. The results indicate that the combined application of vaccination and treatment is the most cost-effective approach among the strategies analyzed, significantly reducing the number of asthma cases at minimal cost. All simulations and numerical experiments were performed to validate the theoretical findings and quantify the effectiveness of the proposed interventions under realistic environmental conditions driven by dust activity. The model highlights the importance of integrated medical and environmental control policies in mitigating asthma outbreaks, particularly in regions frequently exposed to dust storms. Full article

With the rapid development of internet technologies, enhancing security protection for patient information during its transmission has become increasingly important. Compared with traditional image encryption methods, chaotic image encryption schemes leveraging sensitivity to initial conditions and pseudo-randomness demonstrate superior suitability for high-security-demand scenarios like medical image encryption. In this paper, a novel 3D fractional-order memristive Hopfield neural network (FMHNN) chaotic model with a minimum number of neurons is proposed and applied in medical image encryption. The chaotic characteristics of the proposed FMHNN model are systematically verified through various dynamical analysis methods. The parameter-dependent dynamical behaviors of the proposed FMHNN model are further investigated using Lyapunov exponent spectra, bifurcation diagrams, and spectral entropy analysis. Furthermore, the chaotic behaviors of the proposed FMHNN model are successfully implemented on FPGA hardware, with oscilloscope observations showing excellent agreement with numerical simulations. Finally, a medical image encryption scheme based on the proposed FMHNN model is designed, and comprehensive security analyses are conducted to validate its security for medical image encryption. The analytical results demonstrate that the designed encryption scheme based on the FMHNN model achieves high-level security performance, making it particularly suitable for protecting sensitive medical image transmission. Full article

Styles are invasive medical devices that are visible on images and are used in several medical specialties, including cardiology, neurology, orthopaedics, anaesthesia, oto-rhino-laryngology (ENT), and dentistry. With their thin and flexible design, they allow for the optimal positioning and precise guidance of medical devices such as nerve stimulation, defibrillation, electrode positioning, and catheter insertion. Generally, they are made of stainless steel, offering a combination of rigidity and flexibility. The aim of this study is to evaluate the sensitivity of austenitic stainless steel 304L used for the manufacture of J-stylets in uniform, pitting, crevice, and intergranular corrosion. We follow the manufacturing process step by step in order to analyse the risks of corrosion sensitisation and the cumulative effects of various forms of degradation, which could lead to a significant release of metal cations. Another objective of this study is to determine the optimal heat treatment temperature to minimise sensitivity to the intergranular corrosion of 304L steel. Uniform corrosion: Two samples were taken at each stage of the manufacturing process (eight steps in total), in the form of rods. After one hour of immersion, potentiodynamic polarisation curves were plotted up to ±400 mV vs. SCE. A coulometric analysis was also performed by integrating the anode zone between E (i = 0) and +400 mV vs. SCE. The values obtained by integration are expressed as mC/cm². The test medium used was a simulated artificial plasma solution (9 g/L NaCl solution). Intergranular corrosion: (a) Chemical test: Thirty rod-shaped samples were tested, representing the eight manufacturing steps, as well as heat treatments at 500 °C, 620 °C, and 750 °C, in accordance with ASTM A262 (F method). (b) Electrochemical Potentiokinetic Reactivation (EPR) according to ASTM G108–94 (2015). Two samples were tested for each condition: without heat treatment and after treatments at 500 °C, 620 °C, and 750 °C. Release of cations: The release of metal ions was evaluated in the following two media: artificial sweat, according to EN 1811:2011+A1:2015, and bone plasma, according to the Fitton-Jackson and Burks-Peck method. Six samples that had been heat-treated at 500 °C for one hour were analysed. Results, discussions: (a) Analysis of the polarisation curves revealed significant disturbances in the heat treatment steps, as well as the μC/cm² quantities, which were between 150,000 and 400,000 compared to only 40–180 for the other manufacturing steps; (b) Electrochemical Potentiokinetic reactivation (EPR) tests indicated that the temperature of 500 °C was a good choice to limit 304L steel sensitisation in intergranular corrosion; and (c) the quantities of cations released in EN 1811 sweat were of the order of a few μg/cm² week, as for Fe: 2.31, Cr: 0.05, and Ni: 0.12. Full article

Objective: This study aimed to investigate whether the subjective assessments of strong and weak muscles in the Functional Myodiagnosis muscle test (FMD-MT) can be objectively and reproducibly verified using physically measurable parameters. Additionally, we sought to evaluate the reliability of the manual muscle test in order to reinforce the scientific evidence supporting this accepted, yet not widely adopted, complementary medicine method. Methods: In a crossover observational study, three experienced medical practitioners conducted the FMD-MT of the rectus femoris muscle on 24 healthy participants using a specially designed therapy bench, with all measurements recorded via an oscillogram. The study investigated the force–time integral, joint angle change, additional force load, mean force turning point 1, as well as the interrater reliability and validity of both examiner assessments and instrumental analyses for the two muscle reaction variants: strong and weak. Results: A significant difference between the response pattern of strong and weak muscles was identified for the force–time integral (p = 0.005), the change in joint angle (p < 0.001), and the additional force load (p = 0.001). No difference between strong and weak muscles could be detected regarding the force turning point 1 (p = 0.972). The examiners demonstrated 100% accuracy in identifying weak muscle reactions as weak, and 99.2% accuracy in identifying strong muscle reactions as strong (p = 0.316). The overall intra-class correlation coefficient was 0.984. The oscillogram correctly visualized weak muscle reactions in weak muscles with an accuracy of 81.7%, and strong muscle reactions in strong muscles with an accuracy of 86.7% (p = 0.289). Conclusions: The Functional Myodiagnosis muscle test (FMD-MT) enables a clear and objective differentiation between strong and weak muscles, with statistically significant differences observed in the force–time integral, additional force load, and joint angle changes. Under rigorously standardized testing conditions, the FMD-MT of the rectus femoris muscle demonstrates a validity rate of 99.6% and an excellent reliability (ICC 0.984). Consequently, the FMD muscle test proves to be a reliable, reproducible, and objective diagnostic method. Trial registration: German Register of Clinical Studies U1111-1212-6622. Full article

Background and Objectives: Acute respiratory failure (ARF) represents an increasingly relevant clinical challenge in older subjects due to population aging and the high prevalence of cardiopulmonary comorbidities. Non-invasive ventilation (NIV), developed as continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP), has become a first-line treatment in various forms of ARF, including acute cardiogenic pulmonary oedema (ACPE) and acute exacerbations of COPD (AECOPD), offering several clinical advantages. In this context, the limited evidence on the efficacy of NIV in older patients leaves considerable uncertainty as to whether it constitutes a valid therapeutic option or represents medical futility in these patients. Materials and Methods: This narrative review explores the use of NIV and its outcomes in four key clinical scenarios in the elderly: ARF due to ACPE, AECOPD, community-acquired pneumonia (CAP), and palliative/end-of-life care. Results: Strong evidence supports NIV use with improved outcomes in ACPE and AECOPD, even in older populations. Conversely, data on its use in pneumonia are inconclusive, with potential harm if applied inappropriately. In palliative care, NIV can help relieve symptoms, but if not used appropriately, it may extend suffering. Conclusions: Age alone does not appear to be a sufficient factor to determine whether or not to use NIV; it becomes relevant only when considered in conjunction with the purpose of its use and the patient’s clinical history and condition. Data remain limited and often conflicting, particularly when investigating the elderly population and patients with a “do not intubate” (DNI) order. There is a need for additional research on these patients, focusing on long-term outcomes and quality of life. Full article

Background/Objectives: Generating real-world data on the efficacy of multidisciplinary care in cardiometabolic risk management is essential to ensure that guidelines are both applicable and effective, especially in public healthcare settings, where organizational structures may impede healthcare professionals’ agility. This study aimed to generate data on patient follow-up and cardiometabolic risk management during the early years of a public university family medicine group in Québec (Canada) that provides multidisciplinary care to adults with cardiometabolic conditions, in order to evaluate the implementation and effectiveness of its care model. Methods: This was a retrospective longitudinal study. Patients treated at the clinic from 31 January 2020 (clinic opening) to 8 May 2024 (n = 96) were invited to consent to the use of their medical data for research. Results: A total of 52 patients consented and were included in the study. Upon entry at the clinic, >90% of patients had anthropometry and blood pressure (BP) measured, but plasma glucose and lipids were assessed among 50% and 79% of patients, respectively. A total of 36 patients completed the personalized multidisciplinary care program. No evidence of associations between the total number of appointments or appointments with the registered dietitian specifically with changes in BMI, waist circumference, and BP was found. However, each pharmaceutical intervention was associated with a −0.51 cm (95%CI: −1.03, 0.02; p = 0.06) change in waist circumference and a −1.49 mm Hg (95%CI: −2.56, −0.43, p = 0.01) change in diastolic BP. Conclusions: These data highlight the challenges of implementing a research-oriented clinic within Québec’s public healthcare system. Full article

Background and Objectives: Questionnaires are patient-reported outcome measures that require a validation process to assess their reliability and replicability. Over time, questionnaires have not only focused on a single health condition, such as neck pain, but also expanded their assessment spectrum to other areas in order to gather additional and relevant information from the patient. The main objective of this study was to conduct a systematic review of the different structural and psychometric characteristics of neck pain questionnaires. Materials and Methods: A systematic review was conducted following the PRISMA recommendations. The search strategy was implemented across various databases (PubMed, Cochrane, EMBASE, CINHAL, Trip Medical Database, Scopus) using terms such as neck pain, cervicalgia, cervical pain, questionnaire, survey, index, validity, validation, and reliability. COSMIN criteria were used to identify valid questionnaires for this systematic review based on their psychometric properties. Results: A total of 15 articles were identified in this systematic review, of which 8 assessed the level of disability, while the rest evaluated dizziness in neck pain, anxiety and/or depression, beliefs about fear and avoidance, and perception of scarring and symptoms after neck surgery. The main findings show that neck pain questionnaires exhibit very good values for reliability and internal consistency, along with a high variability for construct validity. Conclusions: This study highlights the good values exhibited by neck pain questionnaires despite their heterogeneity in structural characteristics, demonstrating good values in psychometric properties. Nevertheless, the latter should be further investigated to gather more information. Full article

Background/Objectives: Adult vaccination remains suboptimal, particularly among older adults and individuals with chronic conditions. Hospitals represent a strategic setting for improving vaccination coverage among these high-risk populations. This systematic review and meta-analysis evaluated hospital-based interventions aimed at enhancing vaccine uptake in adults aged ≥60 years or 18–64 years with at-risk medical conditions. Methods: We conducted a systematic review and meta-analysis following PRISMA and MOOSE guidelines. Searches in PubMed, EMBASE, and Scopus identified studies published in the last 10 years evaluating hospital-based interventions reporting vaccination uptake. The risk of bias was assessed using validated tools (NOS, RoB 2, ROBINS-I, QI-MQCS). A meta-analysis was conducted for categories with ≥3 eligible studies reporting pre- and post-intervention vaccination coverage in the same population. Results: We included 44 studies. Multi-component strategies (n = 21) showed the most consistent results (e.g., pneumococcal uptake from 2.2% to 43.4%, p < 0.001). Reminder-based interventions (n = 4) achieved influenza coverage increases from 31.0% to 68.0% and a COVID-19 booster uptake boost of +38% after SMS reminders. Educational strategies (n = 11) varied in effectiveness, with one study reporting influenza coverage rising from 1.6% to 12.2% (+662.5%, OR 8.86, p < 0.01). Standing order protocols increased pneumococcal vaccination from 10% to 60% in high-risk adults. Hospital-based catch-up programs improved DTaP-IPV uptake from 56.2% to 80.8% (p < 0.001). For patient education, the pooled OR was 2.11 (95% CI: 1.96–2.27; p < 0.001, I² = 97.2%) under a fixed-effects model, and 2.47 (95% CI: 1.53–3.98; p < 0.001) under a random-effects model. For multi-component strategies, the OR was 2.39 (95% CI: 2.33–2.44; p < 0.001, I² = 98.0%) with fixed effects, and 3.12 (95% CI: 2.49–3.92; p < 0.001) with random effects. No publication bias was detected. Conclusions: Hospital-based interventions, particularly those using multi-component approaches, effectively improve vaccine coverage in older and high-risk adults. Embedding vaccination into routine hospital care offers a scalable opportunity to reduce disparities and enhance population-level protection. Future policies should prioritize the institutional integration of such strategies to support healthy aging and vaccine equity. Full article