Search Results (472)

Penile prosthetic implants (PPIs) provide a definitive surgical solution for individuals requiring restoration of erectile function, most commonly due to medication-refractory erectile dysfunction (ED) or as part of gender-affirming surgical care. During the Anatomical Foundations of Clinical Practice (AFCP) course at Oakland University William Beaumont (OUWB) School of Medicine, a complete three-piece inflatable PPI was identified in a 66-year-old male donor with a medical history of congestive heart failure, hypertension, and diabetes mellitus type 2. The prosthesis included a fluid reservoir positioned in the lower abdominal cavity in the retropubic space, a scrotal pump with a release valve, and paired inflatable cylinders embedded within the penile shaft. This uncommon finding provided first-year medical students with a hands-on opportunity to examine the structure, placement, and function of a modern PPI. In addition to reinforcing foundational knowledge of ED treatment, the case highlighted the expanding clinical indications for penile implants, including their potential role in gender-affirming procedures. Integrating such real-world surgical findings into anatomical education enriches the learning experience of students and highlights the evolving scope of prosthetic urology across diverse patient populations. Full article

Micro-arc oxidation (MAO) technology demonstrates remarkable advantages in fabricating ceramic coatings on lightweight alloys. For aluminum alloys, MAO rapidly forms dense, pore-free ceramic layers within minutes, significantly enhancing corrosion and wear resistance at low processing costs. In magnesium alloys, optimized electrolyte compositions and process parameters enable composite coatings with a combination of high hardness and self-lubrication properties, while post-treatments like laser melting or corrosion inhibitors extend salt spray corrosion resistance. Titanium alloys benefit from MAO coatings with exceptional interfacial bonding strength and mechanical performance, making them ideal for biomedical implants and aerospace components. Notably, dense ceramic oxide films grown in situ via MAO on high-entropy alloys (HEAs) triple surface hardness and enhance wear/corrosion resistance. However, MAO applications on steel require pretreatments like aluminizing, thermal spraying, or ion plating. Current challenges include coating uniformity control, efficiency for complex geometries, and long-term stability. Future research focuses on multifunctional coatings (self-healing, antibacterial) and eco-friendly electrolyte systems to expand engineering applications. Full article

Left ventricular non-compaction cardiomyopathy (LVNC) is an uncommon myocardial phenotype characterized by prominent trabeculae and deep blood-filled recesses. The expanding use of cardiac magnetic resonance (CMR) has increased detection, yet uncertainty persists about whether LVNC is a distinct disease or a phenotype that overlaps with other cardiomyopathies. LVNC expression reflects the interplay among genotype, sex, ancestry, and hemodynamic load and thus serves as a model for precision cardiology. We conducted a narrative review of literature published between January 2000 and April 2025 in major databases. We included clinical studies with at least 10 patients, meta-analyses, reviews, and consensus statements addressing pathophysiology, genetics, diagnosis, prognosis, and treatment. Sarcomeric variants account for a substantial fraction of cases and connect LVNC with dilated and hypertrophic cardiomyopathies. Echocardiographic and CMR criteria identify the phenotype but blur the boundary between physiological and pathological hypertrabeculation. Fibrosis on late gadolinium enhancement and systolic dysfunction are consistently associated with worse outcomes. Current management largely adapts heart-failure strategies, including neurohormonal blockade, SGLT2 inhibitors, and implantable cardioverter-defibrillators in selected high-risk patients. Optimal care integrates clinical, imaging, and genetic information. The lack of universal diagnostic criteria highlights the need for prospective studies and consensus to standardize diagnosis and treatment. Future algorithms that combine multi-omics, quantitative imaging, and AI-based risk prediction could individualize surveillance, pharmacotherapy, and device therapy. Full article

Suture anchors are widely used for tendon and ligament repair, but their fixation strength is compromised in osteoporotic bone and limited bone volume such as the coracoid process. Existing designs are prone to penetration and insufficient cortical engagement under such conditions. In this study, we developed a novel short expandable-wing (SEW) suture anchor (Ti6Al4V) designed to enhance pull-out resistance through a deployable wing mechanism that locks directly against the cortical bone. Finite element analysis based on CT-derived bone material properties demonstrated reduced intra-bone displacement and improved load transfer with the SEW compared to conventional anchors. Mechanical testing using matched artificial bone surrogates (N = 3 per group) demonstrated significantly higher static pull-out strength in both normal (581 N) and osteoporotic bone (377 N) relative to controls (p < 0.05). Although the sample size was limited, results were consistent and statistically significant. After cyclic loading, SEW anchor fixation strength increased by 25–56%. In a 3D-printed anatomical coracoclavicular ligament reconstruction model, the SEW anchor provided nearly double the fixation strength of the hook plate, underscoring its superior stability under high-demand clinical conditions. This straightforward implantation protocol—requiring only a 5 mm drill hole without tapping, followed by direct insertion and knob-driven wing deployment—facilitates seamless integration into existing surgical workflows. Overall, the SEW anchor addresses key limitations of existing anchor designs in small bone volume and osteoporotic environments, demonstrating strong potential for clinical translation. Full article

Aortic stenosis (AS) is a common degenerative valvular disease in elderly patients, causing obstruction of left ventricular outflow and presenting with symptoms such as angina, syncope, and heart failure. Although surgical aortic valve replacement (SAVR) remains the gold standard, its high perioperative risk in frail patients has led to the adoption of transcatheter aortic valve implantation (TAVI) as a less invasive and effective alternative. The transfemoral (TF) access route is generally preferred, but severe peripheral arterial disease may limit its feasibility. We report the case of a 71-year-old woman with critical AS complicated by multiple comorbidities, including extensive vascular calcifications, a porcelain aorta, and significant subrenal abdominal aortic stenosis. Multimodal imaging, including computed tomography, was essential for procedural planning, revealing complex iliofemoral anatomy unsuitable for conventional device passage without intervention. Intravascular lithotripsy (IVL) was used to disrupt calcific plaques and facilitate safe vascular access. The TAVI procedure was successfully performed under local anesthesia via TF access using a 65 cm GORE® DRYSEAL Flex Introducer Sheath (W. L. Gore & Associates, Flagstaff, AZ, USA) (18-Fr). After balloon valvuloplasty performed over a SAFARI2™ Pre-Shaped TAVI Guidewire, Extra Small (Boston Scientific, Marlborough, MA, USA) Curve in the left ventricle, a self-expanding Medtronic Evolut™ FX 26 (Medtronic, Minneapolis, MN, USA)mm transcatheter valve was implanted. Postoperative imaging confirmed optimal valve function and vascular integrity without complications. This case highlights the role of IVL as an innovative adjunctive technique enabling TF-TAVI in patients with challenging vascular anatomy, thereby expanding treatment options for high-risk individuals with severe AS. Full article

Background: Breast reconstruction following mastectomy has become an essential procedure in breast cancer treatment due to its positive impact on patients’ quality of life. Among the various reconstruction techniques, the use of expanders followed by implants has gained popularity. In this context, acellular dermal matrices (ADM) have been introduced as an adjunct to improve implant coverage, lower pole support, and aesthetic outcomes. However, their use has also been associated with higher costs and a potential increase in postoperative complications, which remains a matter of debate. We aimed to determine the relationship between acellular dermal matrix and postoperative outcomes and complications. Methods: An observational retrospective study was conducted with patients who underwent immediately breast mastectomy followed by tissue expander reconstruction from January 2022 to June 2024. Patients were divided into two groups depending on reconstructive plane. Results: The final cohort contained 87 patients. Smoking, radiotherapy and dermal matrix were associated with a higher complication rates. After risk-adjustment, dermal matrix use led to a higher rates of surgical site infection (OR 7.62, p = 0.029) in the prepectoral plane, and higher rates of overall complications (OR 3.34, p = 0.05) and surgical wound dehiscence (OR 6.04, p = 0.048) in the retropectoral plane. Conclusions: These findings highlight the importance of individualized surgical planning, particularly concerning the use of acellular dermal matrix, which were associated with increased risks of surgical site infection, dehiscence, and global complications. Further research is required to establish standardized guidelines for the optimal selection surgical technique. Full article

The rapid expansion of structural heart interventions over the past decade has created unprecedented challenges in procedural planning and complication prediction. While traditional imaging provides essential anatomical information, translating two-dimensional images into a comprehensive three-dimensional understanding of complex cardiac structures remains challenging. This review encompasses finite element analysis (FEA), computational fluid dynamics (CFD), and fluid–structure interaction (FSI) technologies across major structural heart procedures, including transcatheter aortic valve implantation (TAVI), transcatheter mitral valve interventions, and left atrial appendage occlusion (LAAO). We evaluated the technical foundations, clinical validation studies, and practical applications of various simulation platforms. Advanced computer simulation has demonstrated feasibility and clinical utility across multiple structural heart procedures. Computer simulation for structural heart interventions has evolved from a proof of concept to clinical implementation, with growing evidence of procedural planning benefits in TAVI and LAAO. While feasibility has been established across multiple intervention types, this field requires larger validation studies to demonstrate accuracy and clinical outcome improvements. Future directions include integration of machine learning, real-time simulation capabilities, and expanding applications to complex anatomies and redo procedures. This technology represents an emerging paradigm that may facilitate precision medicine in structural heart interventions, with potential for significant improvements in procedural success and patient safety. Full article

Right heart failure (RHF) remains an under-recognized yet devastating condition in critically ill and chronic patients, frequently complicating cardiac surgery, pulmonary embolism, advanced heart failure, sepsis and left ventricular assist device (LVAD) implantation. Despite growing awareness, clinical decision making is still hampered by the complex pathophysiology, limitations in diagnosis and a fragmented therapeutic landscape. In recent years, progress in hemodynamic phenotyping, advanced echocardiographic and biomarker-based assessment, and the development of mechanical circulatory support (MCS) systems, including percutaneous and surgical right ventricle assist devices (RVAD), veno-arterial extracorporeal membrane oxygenation (V-A ECMO), Impella RP (right percutaneous) or BiPella (Impella CP/5.0/5.5 + Impella RP) has expanded the armamentarium for managing RHF. This review synthetizes current evidences on the anatomical, physiological and molecular underpinnings of RHF, delineates the distinction and continuum between acute and chronic forms and provides a comparative analysis of diagnostic tools and MCS strategies. By integrating mechanistic insights with emerging clinical frameworks, the review aims to support earlier recognition, tailored management and innovative therapeutic approaches for this high-risk population. Full article

Background: The COVID-19 pandemic caused unprecedented delays in elective surgery, including breast reconstruction, prolonging expander retention beyond recommended timelines. Methods: We retrospectively compared patients who underwent two-stage expander-to-implant reconstruction before the pandemic (2011–2020) and during the pandemic (2020–2022). Clinical outcomes and patient-reported experiences were analyzed, and multivariate regression was used to adjust for confounders. Results: Expander retention was significantly longer in the pandemic cohort (481 vs. 280 days). Capsular contracture around the expander was markedly increased, with pandemic group assignment and prolonged expander retention emerging as independent predictors in multivariate analysis, while overall complication rates were unaffected. Patient-reported outcomes showed more functional limitations but paradoxically higher satisfaction with the definitive implant. Conclusions: Surgical delay selectively increased the risk of expander contracture without raising overall morbidity. Patient-reported findings highlight the dual impact of delay, with both greater burden and a potential “relief effect”. Full article

Background: Hearing loss results from diverse biological insults along the auditory pathway, including sensory hair cell death, neural degeneration, and central auditory processing deficits. Implantable auditory neuroprostheses, such as cochlear and brainstem implants, aim to restore hearing by directly stimulating neural structures. Advances in neurobiology and device technology underpin the development of more sophisticated implants tailored to the biological complexity of auditory dysfunction. Aim: This narrative review of reviews aims to map the integration of artificial intelligence (AI) in auditory neuroprosthetics, analyzing recent research trends, key thematic areas, and the opportunities and challenges of AI-enhanced devices. By synthesizing biological and computational perspectives, it seeks to guide future interdisciplinary efforts toward more adaptive and biologically informed hearing restoration solutions. Methods: This narrative review analyzed recent literature reviews from PubMed and Scopus (last 5 years), focusing on AI integration with auditory neuroprosthetics and related biological processes. Emphasis was placed on studies linking AI innovations to neural plasticity and device–nerve interactions, excluding purely computational works. The ANDJ (a standard narrative review checklist) checklist guided a transparent, rigorous narrative approach suited to this interdisciplinary, rapidly evolving field. Results and discussion: Eighteen recent review articles were analyzed, highlighting significant advancements in the integration of artificial intelligence with auditory neuroprosthetics, particularly cochlear implants. Established areas include predictive modeling, biologically inspired signal processing, and AI-assisted surgical planning, while emerging fields such as multisensory augmentation and remote care remain underexplored. Key limitations involve fragmented biological datasets, lack of standardized biomarkers, and regulatory challenges related to algorithm transparency and clinical application. This review emphasizes the urgent need for AI frameworks that deeply integrate biological and clinical insights, expanding focus beyond cochlear implants to other neuroprosthetic devices. To complement this overview, a targeted analysis of recent cutting-edge studies was also conducted, starting from the emerging gaps to capture the latest technological and biological innovations shaping the field. These findings guide future research toward more biologically meaningful, ethical, and clinically impactful solutions. Conclusions: This narrative review highlights progress in integrating AI with auditory neuroprosthetics, emphasizing the importance of biological foundations and interdisciplinary approaches. It also recognizes ongoing challenges such as data limitations and the need for clear ethical frameworks. Collaboration across fields is vital to foster innovation and improve patient care. Full article

Background: Class II malocclusion is one of the most common and challenging orthodontic problems, often requiring complex, lengthy treatment and sometimes involving extractions or surgery. While conventional fixed appliances have been the gold standard, the increasing demand for aesthetic and comfortable treatment alternatives has made clear aligners a prevalent choice. Understanding the specific biomechanics, limitations, and successful clinical strategies for using aligners—especially in managing vertical dimension and achieving skeletal correction (mandibular advancement)—is crucial for expanding non-invasive treatment options and improving outcomes for a broad range of Class II patients. Objective: The objective of this review is to examine the effectiveness and clinical approaches of clear aligners in Class II correction across different age groups, with particular attention to vertical control, mandibular advancement methods, and the predictability of tooth movements in both growing and fully mature patients. Materials and Methods: This review narratively discusses the most relevant clinical findings and practical strategies for managing Class II malocclusions with clear aligners. Particular attention is given to the integration of auxiliary devices, such as elastics, attachments, and temporary anchorage devices (TADs), which can enhance biomechanical control. Results: The combination of aligners with mini-implants and attachments resulted in a consequent decrease in excessive overjet, improvement in facial profile, and long-term stability supported by fixed retention. In growing patients, correction benefited from mandibular advancement protocols and control of molar extrusion, allowing for preservation of the mandibular plane angle. Movement predictability showed higher reliability in anterior torque movements, whereas maxillary incisor intrusion remained less predictable. Conclusions: Clear aligners, especially when supported by auxiliary device, such as mini-implants and attachments, offer a reliable and aesthetic alternative to conventional orthodontic treatment for Class II malocclusions. However, certain tooth movements may still be less predictable, highlighting the need for careful planning, individualized biomechanics, and ongoing technological improvements. Full article

This review discusses the development of small-diameter silk-based vascular grafts, based on insights obtained through solid-state NMR structural analysis. With the increasing prevalence of cardiovascular diseases, the demand for vascular grafts with diameters of less than 6 mm is growing. Although synthetic grafts currently used in clinical settings—such as polyethylene terephthalate and expanded polytetrafluoroethylene—are effective, they tend to cause thrombosis and intimal hyperplasia when used as small-diameter vascular grafts. In response to this issue, research has been advancing on new materials that maintain excellent mechanical properties while improving biocompatibility. This review first describes how the detailed structure of silk fibroin (SF) before and after fiber formation was revealed for the first time through solid-state NMR analysis using stable isotope-labeled samples. Then it outlines design criteria for small-diameter SF-based vascular grafts, focusing on fabrication methods like electrospinning. Special attention is given to knitted SF grafts with SF sponge coatings, analyzed via ¹³C solid-state NMR in the dry and hydrated states of the sponges. In vivo performance in rat and canine models is discussed, along with chemically modified SF grafts such as silk-biodegradable polyurethane sponges and their structural and implantation results. Full article

Biosensors have undergone transformative advancements, evolving into sophisticated wearable and implantable devices capable of real-time health monitoring. Traditional manufacturing methods, however, face limitations in scalability, cost, and design complexity, particularly for miniaturized, multifunctional biosensors. The integration of 3D printing technology addresses these challenges by enabling rapid prototyping, customization, and the production of intricate geometries with high precision. This review explores how additive manufacturing techniques facilitate the fabrication of flexible, stretchable, and biocompatible biosensors. By incorporating advanced materials like conductive polymers, nanocomposites, and hydrogels, 3D-printed biosensors achieve enhanced sensitivity, durability, and seamless integration with biological systems. Innovations such as biodegradable substrates and multi-material printing further expand applications in continuous glucose monitoring, neural interfaces, and point-of-care diagnostics. Despite challenges in material optimization and regulatory standardization, the convergence of 3D printing with nanotechnology and smart diagnostics heralds a new era of personalized, proactive healthcare, offering scalable solutions for both clinical and remote settings. This synthesis underscores the pivotal role of additive manufacturing in advancing wearable and implantable biosensor technology, paving the way for next-generation devices that prioritize patient-specific care and real-time health management. Full article

Preimplantation genetic testing (PGT) reports play a decisive role in determining the fate of IVF-generated embryos. The identification of a chromosomal or genetic abnormality that could impact the health of the resulting newborn often leads to embryo disposal or indefinite storage in cryogenic containers. As a growing proportion of IVF cycles include PGT assessment, greater scrutiny is being placed on its clinical validity. Initially developed to detect monogenic disorders (PGT-M) and later expanded to identify full chromosomal aneuploidies, PGT is primarily used to identify embryos unlikely to implant (aneuploid), those that would lead to miscarriage, or those causing chromosomal syndromes or monogenic conditions. Advancements in genetic analysis now allow for the assessment of more complex traits and chromosomal features from a trophectoderm biopsy, including segmental aneuploidies, chromosomal mosaicism, and polygenic conditions. However, as technology pushes the limits of biological resolution, questions arise regarding the accuracy, clinical utility, and representativeness of these findings for the entire embryo. This article reviews the gold standards for validating clinical findings and reporting strategies, aiming to maximize diagnostic utility while minimizing false positives towards appropriately defined reproductive outcomes and phenotypes. Full article

Background and Objectives: This study aimed to assess the clinical and anatomical predictors of acute cardiac complications after transcatheter aortic valve implantation (TAVI). Materials and Methods: All patients who underwent a TAVI procedure for severe aortic stenosis between November 2016 and May 2025 at a tertiary center in Romania were screened for inclusion. Of those, patients who had available computer tomography valvular sizing reports were included in the present study. Results: A total of 485 patients were included in this study. Balloon-expandable valves were implanted in 381 patients (78.5%), while self-expanding valves were used in 104 patients (21.4%). A total of sixty-nine (14.2%) patients suffered at least one acute cardiac complication following TAVI, and in-hospital death occurred in nine (1.8%) patients. In the multivariable analysis, clinical parameters—such as diabetes mellitus, left bundle branch block, or left ventricular diameter—and anatomic parameters, such as left coronary artery height and sinotubular junction height, were predictors of acute complications. Similarly, periprocedural characteristics, such as maximum transprosthetic gradient and the use of the Portico/Navitor valve platform was also associated with the occurrence of acute complications. Conclusions: A high acute complications rate is typical for TAVI, although most complications can be successfully treated and the in-hospital death rate is low. Left coronary artery height and sinotubular junction height were predictors of acute complications, among other clinical and procedural characteristics. Full article