Search Results (5,621)

Background: Although adolescents are at a lower risk of developing scaphoid non-union than adults, this complication is not uncommon in younger patients. The current gold standard for surgical treatment is non-vascularized bone grafting from the iliac crest or distal radius, and it is often considered the first-line option. However, non-union can persist in 10–20% of cases, and failure rates can reach up to 50% when the proximal pole is necrotic. Methods: We evaluated a modified vascularized bone graft surgical technique in selected adolescent patients, with the goal of avoiding growth-related complications. Our experience is based on three cases of scaphoid non-union treated surgically between June 2019 and June 2022. Results and Conclusions: The modified surgical technique has shown promising results in the selected cases and carries no risk of donor site morbidity. It enables preservation of severely compromised scaphoid bones, prevents early-onset wrist osteoarthritis, and facilitates the return to sports activities for young patients. Full article

Background: The asymptomatic progression of initial gingival inflammation in children often remains unnoticed or undiagnosed. Although full-mouth periodontal examination is considered the gold standard in diagnosing periodontal diseases, it is usually time-consuming and expensive. Therefore, the aim of this study was to assess gingival status using partial-mouth examination with the Community Periodontal Index of Treatment Needs (CPITN) and full-mouth examination with Bleeding on Probing (BOP) in the periodontal diagnosis of adolescents. Methods: This cross-sectional study was conducted in a sample of 457 Bulgarian children aged 11 to 14 years. Full-mouth examination was performed with the BOP index on all fully erupted permanent teeth, probing four gingival sites––three buccal and one oral. Partial-mouth examination was performed with CPITN, probing six representative teeth at six sites. Statistical analysis was conducted using Pearson’s chi-square test (χ²) and t-tests to compare relative proportions. Results: The BOP index identified significantly more healthy children compared to the CPITN (t = 1.90, p < 0.05). The CPITN has limitations in distinguishing between initial (BOP 10–30%) and advanced (BOP 30–60%) gingival inflammation. The comparative evaluation of the two indices by sextant showed that a healthy periodontium is most commonly observed in the posterior segments of both jaws in children, while gingival inflammation is localized predominantly in frontal areas. Conclusions: The CPITN has the advantage of providing a quick and easy method for recording gingival status in children, but it does not allow for the determination of the severity of gingival inflammation. Clinical significance: Full-mouth examination using the BOP index is a more appropriate method for periodontal diagnosis in children, as it provides a detailed and comprehensive picture of the condition of the gingival tissues, especially when a clinical diagnosis is required to guide further treatment planning. Full article

Vital sign monitoring is fundamental to patient care. Although traditional intermittent systems are flawed, barriers to implementing continuous monitoring systems remain. The SMART MAT is a novel continuous monitoring device that detects vital signs remotely via fibre optic technology. The study aims to validate the SMART MAT and its paired devices against gold/clinical standard measurements for measuring heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and oxygen saturation (SpO2). Healthy adults aged 21 to 80 were recruited for this cross-sectional study. Participants rested supine on a standardised mattress with the SMART MAT below. Vital signs were recorded over three five-minute intervals. Statistical analysis included descriptive statistics, two-way ANOVA, Mean Absolute Percentage Error (MAPE), and Bland–Altman plots. Among 321 participants recruited, HR and most RR measurements saw non-statistically significant differences (p > 0.05). Statistically significant differences were observed for SBP, SpO2, and most DBP measurements (p < 0.05). Only SBP measurements exceeded the acceptable limits of differences. Effect sizes were small to negligible (n² < 0.04) and MAPE values were <20%. The SMART MAT has demonstrated reasonable accuracy and validity in monitoring vital signs in healthy adults. Alternative paired BP devices are recommended to enhance SBP measurement accuracy. Full article

Background: Diagnosing food allergy (FA) typically involves a detailed clinical history and confirmation of allergen-specific IgE. Oral food challenges (OFCs) remain the gold standard in FA diagnosis. This study aimed to present our experience in performing OFCs in pediatric patients with particular focus on challenges performed with cow’s milk and hen’s egg. Methods: We conducted a retrospective analysis of 205 OFCs. Clinical data were evaluated and multiple logistic regression was used to identify associations between challenge outcomes, reaction severity, and comorbidities. Results: The mean age of patients was 5.7 ± 3.1 years, with 135 (65.9%) being male. The tested foods included cow’s milk protein (CMP, 103 challenges; 50.2%), hen’s egg white protein (HEWP, 84; 41.0%), peanuts (3; 1.5%), tree nuts (4; 2.0%), gluten (3; 1.5%), hen’s egg yolk (4; 2.0%), and other foods (4; 2.0%). The overall OFC failure rate was 32.2%, and five challenges (2.4%) yielded inconclusive results. The median cumulative reactive dose was 0.27 g for baked CMP and 0.58 g for baked HEWP. Most failed OFCs involved mucocutaneous symptoms (44 cases; 66.7%). Severe multisystemic reactions occurred in four patients (2.0%), all of whom required epinephrine (6.1% of positive challenges). An increased risk of OFC failure was associated with asthma (p = 0.028; 95% CI: 0.07–1.27) and multi-food allergy (p = 0.021; 95% CI: 0.14–1.67). Additionally, the coexistence of asthma and a prior history of anaphylaxis to any food was related to OFC failure (p = 0.049; 95% CI: 0.01–2.19), as was the combination of multi-food allergy and previous anaphylaxis (p = 0.043; 95% CI: 0.03–1.70). Receiver operating characteristic (ROC) curve analysis was utilized to predict outcomes of OFCs to baked milk and baked egg and determined a specific IgE (sIgE) cutoff level of 58.1 kU/L for baked milk challenges (AUC: 0.77; sensitivity: 0.588; specificity: 0.882), and 11.3 kU/L for baked egg challenges (AUC: 0.66; sensitivity: 0.692; specificity: 0.607). Conclusions: Our findings confirm that OFCs are a safe and effective tool for diagnosing FA in children. With appropriate patient selection, the risk of severe reactions remains low. Nonetheless, comorbidities such as asthma and multi-food allergy are associated with an increased likelihood of OFC failure. Full article

Exclusive breastfeeding for the first six months is the gold standard in infant nutrition, yet rates in Europe remain below recommendations. This descriptive cross-sectional study identified maternal, perinatal and social determinants associated with shorter exclusive breastfeeding duration in the Algarve region. Statistically significant factors included in-hospital formula use, caesarean section, lack of skin-to-skin contact, and negative or absent previous experience of breastfeeding. In-hospital formula use and previous breastfeeding duration emerged as key predictors. These findings emphasise the importance of integrated strategies across the healthcare, workplace, and policy sectors, aligned with the lived experiences of women, to effectively support breastfeeding. Full article

Background: The normal pattern of nipple enhancement on magnetic resonance imaging (MRI) is defined based on healthy individuals, as it correlates with the structural anatomy of the nipple–areola complex (NAC). Understanding the normal range of nipple morphology and enhancement on MRI allows radiologists to better identify abnormalities. Some authors have previously detailed the morphology and characteristics of nipple–areola complex enhancement, both in normal and pathologically infiltrating conditions. Our aim is to present a case series involving a population of women with breast cancer infiltrating the NAC, retrospectively evaluated at our institution. Furthermore, based on previously published literature and our own experience, we intend to propose potential standardized language to describe tumor-infiltrating NAC enhancement on MRI and compare it with CT and PET findings. Methods: Our study included 110 breast cancer patients with NAC infiltration, who were referred to our hospital from August 2023 to July 2024. All patients were candidates for neoadjuvant chemotherapy and therefore underwent MRI and CT; 33 of them also underwent PET/CT. We distinguished the MRI enhancement pattern based on morphology and intensity. There were three types of morphology: SLE (superficial linear enhancement) at the skin level, NEZ (non-enhancing area immediately below the SLE), and INE (nipple enhancement below the NEZ but above the nipple base). In INE, the pattern could be linear or patchy. Depending on the intensity, the enhancement could be minimal, mild, moderate, or marked. The enhancement on CT depended on the distribution of pathological tissue in the infiltrated NAC and could be present or absent; it could involve the nipple base, the nipple body, or both. For quantitative analysis, we used the maximum standardized uptake value (SUV) measured in early-stage PET/CT images, obtained by delineating a three-dimensional volume of interest (VOI) on the NAC. Results: In our population, the most represented enhancement pattern was INE (110), while slightly less than half of the patients showed invasion of the NEZ (49). Approximately one quarter of the patients presented linear ductal INE (36), while the majority presented patchy INE (74). On CT and PET/CT, NAC enhancement was detectable in almost all patients (102), mainly involving the base and the body together. Correlation analysis in the following pairs of variables showed a high association, with a Kendall’s tau value greater than 0.7 (p < 0.001): (1) involvement of the NEZ on ce-MR and pattern of nipple involvement on ce-CT (CT score); (2) morphological pattern of INE on ce-MR (INE score) and intensity of INE enhancement on MR; and (3) pattern of nipple involvement on ce-CT (CT score) and intensity of INE enhancement on MR. The calculated mean SUV of pathological NACs on PET/CT for early-stage images was 3.59, while the mean SUV of contralateral normal NACs was 2.12. The calculated mean NAC-SUV ratio was 1.7. Conclusions: Although pathological involvement of the NAC cannot always be assessed in the final surgical specimen due to the effects of neoadjuvant chemotherapy, so the “gold standard” of histological reference is missing, MRI and CT with morphology and enhancement descriptors, and additionally PET/CT with SUV measurement can, in our opinion, provide valuable information on the infiltrated nipple. Standardized language for describing breast tumors infiltrating the NAC is desirable to ensure consistent interpretation across different radiologists. Full article

Background/Objectives: Penile urethral stricture is a therapeutically challenging condition that significantly impacts quality of life and is often managed initially with urethral dilation or internal urethrotomy. However, both techniques are associated with high recurrence rates, limited long-term efficacy, and potential adverse effects, particularly in the penile urethra. Urethroplasty remains the gold standard but is invasive and not suitable for all patients. Optilume, a paclitaxel-coated balloon, combines mechanical dilation with localized drug delivery to reduce recurrence rates and the need for re-intervention. This study evaluated its effectiveness in patients with penile urethral strictures. Methods: A retrospective, multicenter study was conducted at two German clinics. Eight male patients (mean age 59) with symptomatic penile urethral strictures underwent Optilume treatment. Symptom severity was assessed using the International Prostate Symptom Score (IPSS) and quality of life (QoL) scores before and after treatment. The primary endpoint was symptom improvement, while the secondary endpoint was the need for reintervention. Patients were followed for a median of 16.5 months. Statistical analyses included Wilcoxon signed-rank and Mann–Whitney U tests. Results: The median IPSS improved from 25.5 to 5.0 and QoL scores from 4.5 to 1.0 after treatment (p < 0.01 for both). No patients required reintervention during follow-up. The subgroup analysis showed slightly better outcomes in patients without prior interventions, although differences were not statistically significant. The stricture length did not correlate with treatment response. Conclusions: Optilume significantly reduces urinary symptoms and improves QoL in penile urethral strictures, and the absence of re-interventions during follow-up underscores its durable mid-term success. It offers a minimally invasive alternative to urethroplasty, particularly for patients seeking symptom relief with a shorter recovery time and no hospital stay or general anesthesia. These preliminary findings suggest that Optilume may be a promising minimally invasive option for selected patients. Larger, controlled studies are warranted to validate these results and refine patient selection criteria. Full article

Schmallenberg virus (SBV) is a negative-sense RNA virus transmitted by insect vectors, causing arthrogryposis-hydranencephaly syndrome in newborn ruminants. Since its discovery in Germany and the Netherlands in 2011, SBV has rapidly spread across multiple European countries, resulting in significant economic losses in the livestock industry. With the increasing global animal trade and the expanded range of insect transmission, the risk of SBV introduction into non-endemic regions is also rising. As the gold standard for serological testing, the virus neutralization test (VNT) is crucial for tracking the spread of SBV and evaluating the efficacy of vaccines. However, in non-endemic regions, the lack of local viral strains and the biosafety risks associated with introducing foreign strains pose challenges to the implementation of VNT. In this study, we employed reverse genetics techniques using vesicular stomatitis virus (VSV) to substitute the VSV G protein with the envelope glycoproteins of SBV, thereby successfully generating and rescuing the recombinant virus rVSVΔG-eGFP-SBVGPC. The recombinant virus was then thoroughly characterized in terms of SBV Gc protein expression, viral morphology, and growth kinetics. Importantly, rVSVΔG-eGFP-SBVGPC exhibited SBV-specific cell tropism and was capable of reacting with SBV-positive serum, enabling the measurement of neutralizing antibody titers. The results suggest that this recombinant virus can serve as a feasible alternative for SBV neutralization tests, with promising potential for application in serological screening and vaccine evaluation. Full article

Objectives: In localized upper-tract urothelial carcinoma (UTUC), radical nephroureterectomy (RNU) represents the surgical gold standard, but kidney-sparing surgery (KSS) offers an alternative. The surgical perspective, including complications, remains understudied in this context. This study aimed to compare KSS and RNU, assess kidney function and survival, and identify the surgical risk factors. Methods: This retrospective analysis included UTUC patients undergoing KSS (n = 46) or RNU (n = 46) at a single center from 2016 to April 2024, matched by propensity scores. The primary endpoint was Clavien–Dindo complications. Other endpoints included Days Alive and Out of the Hospital within 30 days (DAOH30), changes in the eGFR, cancer-specific survival (CSS), and disease-free survival (DFS). A UTUC Surgery Risk Score was developed to identify the surgical risk factors for severe complications. Results: KSS was significantly associated with higher rates of Clavien–Dindo grades ≥ 3 (KSS: 14; RNU: 3). DAOH30 was significantly longer following RNU. The UTUC Surgery Risk Score, based on a non-endoscopic KSS approach, an ASA score ≥ 3, and preoperative creatinine > 0.9 mg/dL, was significantly associated with overall and severe complications and DAOH30 (both p < 0.001). KSS showed significantly better early postoperative eGFR preservation (+0.55 mL/min vs. −4.3 mL/min for RNU, p = 0.015). No significant differences were observed in the median CSS or DFS between the groups. Conclusions: KSS is associated with a higher rate of certain postoperative complications, but offers superior kidney function preservation, with comparable oncological outcomes to RNU. The novel UTUC Surgery Risk Score can aid in patient counseling and personalized decision-making prior to surgery. Full article

Infectious keratitis (IK), including bacterial, fungal, parasitic, and viral etiologies, continues to represent a significant cause of ocular morbidity in the United States and around the world. Corneal scraping for smears and cultures remains the gold standard in diagnosing IK; however, molecular diagnoses, including metagenomic deep sequencing (MDS), are promising emerging diagnostic tools. Despite recent interest in procedural treatment such as riboflavin photoactivated chromophore corneal collagen cross-linking (PACK-CXL) and Rose Bengal photodynamic antimicrobial therapy (RB-PDAT), medical treatment advances have remained stagnant. Methods: This review highlights IK pathogens obtained from corneal cultures at Bascom Palmer Eye Institute (BPEI) from 2011 to 2021 and provides the current BPEI algorithms for initial management of IK or as a referred clinically worsening patient. The roles of corticosteroid therapy, PACK-CXL, and RB-PDAT for IK are also summarized. Results: A total of 9326 corneal cultures were performed at BPEI between 2011 and 2021, and only 3609 (38.7%) had a positive organism identified, of which bacteria were the most common (83.4%). Fortified vancomycin and tobramycin are recommended as first-line medical therapy for IK patients based on culture sensitivity data for the top Gram-negative (Pseudomonas aeruginosa) and Gram-positive (Staphylococcus aureus) bacteria. PACK-CXL and RB-PDAT may benefit IK patients with corneal melting and fungal IK, respectively. Conclusions: Drug holidays, minimizing contamination, and optimizing sample order are crucial to maximizing corneal culture positivity. PACK-CXL and RB-PDAT are promising procedural advancements for IK therapy. Full article

Background/Objectives: Veillonella species are Gram-negative, non-motile, non-fermentative, obligate anaerobic cocci. They are typically considered commensals of the oral cavity, respiratory tract, genitourinary tract, and gastrointestinal tract. It may be a rare cause of dental infections and discitis/spondylodiscitis. Methods: We report the case of an 80-year-old patient diagnosed with discitis caused by Veillonella parvula, isolated from blood. In addition, we performed a comprehensive literature review summarizing all reported cases of discitis or spondylodiscitis caused by Veillonella species. Results: In our case, antimicrobial susceptibility testing was performed using the Kirby–Bauer disc diffusion method. Based on the results, the patient was treated with amoxicillin/clavulanate, which led to a favourable clinical outcome. A review of the literature revealed that, to date, only 14 cases of spondylodiscitis or discitis caused by Veillonella spp. have been reported. Potential risk factors for Veillonella spp. bacteremia were identified in only 9 cases. The most commonly affected site was the lumbar or lumbosacral spine. Magnetic resonance imaging was consistently regarded as the diagnostic gold standard. Most patients presented with localized pain. The overall therapeutic approach generally consisted of an initial course of intravenous antibiotics, typically ceftriaxone administered either as monotherapy or in combination with metronidazole, followed by an oral regimen with amoxicillin/clavulanate, given alone or alongside metronidazole. Conclusions: Spondylodiscitis due to V. parvula remains extremely rare. Although antimicrobial susceptibility patterns remain heterogeneous, beta-lactams, particularly amoxicillin/clavulanate, appear effective in most cases, and treatment regimens typically involve an initial intravenous phase followed by oral therapy. Full article

Pesticides are essential for modern agriculture but leave harmful residues that threaten human health and ecosystems. This paper reviews key pesticide detection technologies, including chromatography and mass spectrometry, spectroscopic methods, biosensing (aptamer/enzyme sensors), and emerging technologies (nanomaterials, AI). Chromatography-mass spectrometry remains the gold standard for lab-based precision, while spectroscopic techniques enable non-destructive, multi-component analysis. Biosensors offer portable, real-time field detection with high specificity. Emerging innovations, such as nano-enhanced sensors and AI-driven data analysis, are improving sensitivity and efficiency. Despite progress, challenges persist in sensitivity, cost, and operational complexity. Future research should focus on biomimetic materials for specificity, femtogram-level nano-enhanced detection, microfluidic “sample-to-result” systems, and cost-effective smart manufacturing. Addressing these gaps will strengthen food safety from farm to table while protecting ecological balance. This overview aids researchers in method selection, supports regulatory optimization, and evaluates sustainable pest control strategies. Full article

Linezolid (LNZ) is a synthetic oxazolidinone antibiotic that inhibits bacterial protein synthesis through binding to ribosomal RNA, also preventing the assembly of the initiation complex during translation. It is one of the last-line therapeutic options for serious infections caused by problematic Gram-positive pathogens, including vancomycin-resistant and multidrug-resistant Enterococcus species. Data from recent large-scale studies show a 2.5-fold increase in the prevalence of clinical LNZ-resistant enterococci (LRE) over the past decade with a global detection rate of 1.1% for LNZ-resistant E. faecium (LREfm) and 2.2% for LNZ-resistant E. faecalis (LREfs). Most reported cases have originated from China, followed by South Korea and the United States. LREfm typically belongs to the high-risk clonal complex 17, whereas LREfs demonstrates a heterogeneous population structure. Mutations in the 23S rRNA and ribosomal proteins, as well as acquired resistance genes such as cfr, optrA, and poxtA are involved in the development of LNZ resistance among enterococci. Whole-genome sequencing (WGS) has been recognized as a gold standard for identifying the underlying molecular mechanisms. It exposes that numerous LRE isolates possess multiple LNZ resistance determinants and mutations, further complicating the treatment strategies. The present review article summarizes all known mutational and non-mutational LNZ resistance mechanisms and presents a global overview of WGS-based studies with emphasis on resistome analysis of clinical LREfs and LREfm isolates published in the literature during the period 2014–2025. Full article

Background: Pulmonary arterial pressure is a key parameter for diagnosing cardiovascular and pulmonary diseases. Its measurement through right heart catheterization is considered the gold standard, and it is an invasive procedure that entails significant risks for patients. This has motivated the development of non-invasive techniques based on patient-specific imaging, such as Physics-Informed Neural Networks (PINNs), which integrate clinical measurements with physical models, such as the 1D reduced Navier–Stokes model, enabling biologically plausible predictions with limited data. Methods: This work implements a PINN model that uses velocity and area measurements in the main bifurcation of the pulmonary artery, comprising the main artery and its secondary branches, to predict pressure, velocity, and area variations throughout the bifurcation. The model training includes penalties to satisfy the laws of flow and momentum conservation. Results: The results show that, using 4D Flow MRI images from a healthy patient as clinical data, the pressure estimates provided by the model are consistent with the expected ranges reported in the literature, reaching a mean arterial pressure of 21.5 mmHg. Conclusions: This model presents an innovative approach that avoids invasive methods, being the first study to apply PINNs to estimate pulmonary arterial pressure in bifurcations. In future work, we aim to validate the model in larger populations and confirm pulmonary hypertension cases diagnosed through catheterization. Full article

Pulmonary carcinoids (PCs) are rare tumors, with an incidence ranging from 0.2 to 2 cases per 100,000 population per year. They account for 1–2% of all invasive pulmonary malignancies and represent approximately one-fourth to one-third of all well-differentiated neuroendocrine tumors (NETs) in the body. PCs are generally classified as low- to intermediate-grade malignant tumors, further subdivided into typical carcinoid (TC) and atypical carcinoid (AC), respectively. These tumors exhibit neuroendocrine morphology and differentiation, originating from mature cells of the pulmonary diffuse neuroendocrine system. Traditionally, they are categorized as central or peripheral based on their location relative to the bronchial tree; however, they can arise anywhere within the lung parenchyma. Over 40% of cases may be detected incidentally on a standard chest X-ray, although contrast-enhanced computed tomography (CT) remains the diagnostic gold standard. Surgical resection is the treatment of choice for PCs, with the goal of complete tumor removal while preserving as much healthy lung tissue as possible. In contrast, advanced cases are typically not amenable to surgery, and medical management is focused on controlling hormone-related symptoms and limiting tumor progression. This review aims to provide an overview of the current diagnostic and therapeutic approaches to pulmonary carcinoids. Full article