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Search Results (300)

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Keywords = interventional non-vascular

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23 pages, 429 KB  
Article
Psychological and Behavioral Adjustment in Patients with Non-Traumatic Lower Limb Amputation and Prosthesis: A Mixed-Method Triangulation Study
by Marina Maffoni, Alessandra Casati, Clara Tambussi, Valeria Torlaschi, Marco Baldini, Roberto Dragoni, Cira Fundarò, Laura Bagnara, Chiara Ferretti and Antonia Pierobon
J. Clin. Med. 2025, 14(19), 6973; https://doi.org/10.3390/jcm14196973 - 1 Oct 2025
Abstract
Background: Lower limb amputation (LLA), due to non-traumatic causes such as vascular diseases and diabetes, significantly impacts patients’ physical, psychological, and social well-being. While multidisciplinary rehabilitation programs commonly address physical and functional recovery, psychological and subjective experiences related to limb loss remain [...] Read more.
Background: Lower limb amputation (LLA), due to non-traumatic causes such as vascular diseases and diabetes, significantly impacts patients’ physical, psychological, and social well-being. While multidisciplinary rehabilitation programs commonly address physical and functional recovery, psychological and subjective experiences related to limb loss remain less explored. Thus, this preliminary study aimed to investigate the psychological and behavioral adaptation processes in patients undergoing rehabilitation following lower limb amputation. Methods: A preliminary observational study with a mixed-method approach based on quantitative and qualitative data triangulation was conducted. This approach involves integrating multiple data sources and methodologies—in this case, quantitative psychometric measures and qualitative interviews via the prospective of amputees and those who use prostheses—to enhance the validity and depth of the research findings. Results: Fourteen inpatient amputees and fourteen inpatient prosthesis users (years: 66.6 ± 2.5 for amputee and 61.5 ± 1.9 for prosthesis users, male amputees: 85.7%, male prosthesis users: 100%) of a research hospital in the North of Italy were assessed using validated psychometric tools (GAD-7, PHQ-9, PID-5-BF, BIS, ASonA) alongside semi-structured interviews analyzed through the Interpretive Description approach. Key themes highlighted illness acceptance, prosthesis adaptation, body image, medication and behavioral adherence, anxiety, depression, quality of life, denial, optimism, and social support. Overall, anxiety–depressive symptomatology tended to decrease with the prosthesis, and pharmacological and behavioral adherence improved, as did the disease acceptance. Body image was fairly preserved in all patients despite some fears of others’ judgment with respect to the prosthesis. Interestingly, there was poor agreement between quantitative and qualitative data in both the amputee’ and prosthesis users’ groups: while the former returned a partial and neutral picture, a more multifaceted picture emerged from the interviews collected. Conclusions: These findings underline the importance of integrating quantitative psychometric evaluations with qualitative methods to comprehensively understand patients’ adaptive experiences. Such combined insights are essential to inform tailored psychological interventions throughout the rehabilitation journey. Full article
(This article belongs to the Section Clinical Rehabilitation)
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15 pages, 1926 KB  
Article
Effect of Myofascial Release on Pain and Uterine Artery Hemodynamic Indices in Women with Primary Dysmenorrhea: A Randomized Controlled Trial
by Shiyu Jin, Jongwon Choi and Haneul Lee
Medicina 2025, 61(10), 1736; https://doi.org/10.3390/medicina61101736 - 24 Sep 2025
Viewed by 84
Abstract
Background: Primary dysmenorrhea (PD) is a common gynecological condition among women of reproductive age, often leading to pain and functional limitations. Myofascial release (MFR) has been suggested as a potential non-pharmacological intervention. This study aimed to investigate the immediate effects of a [...] Read more.
Background: Primary dysmenorrhea (PD) is a common gynecological condition among women of reproductive age, often leading to pain and functional limitations. Myofascial release (MFR) has been suggested as a potential non-pharmacological intervention. This study aimed to investigate the immediate effects of a single MFR session on pain intensity, menstrual symptoms, and uterine artery hemodynamics in women with PD. Methods: In this randomized controlled trial, 34 women with PD were randomly assigned to either the MFR group (n = 18) or the placebo MFR group (n = 16). All participants received 10 min of thermotherapy followed by 30 min of either MFR or placebo MFR. Pain intensity (NRS), pressure pain thresholds (PPT) at myofascial trigger points, menstrual symptoms (MDQ-T), and uterine artery pulsatility index (PI) and resistance index (RI) were assessed at three time points: baseline, immediately after the intervention, and 3 h post-intervention. Results: Both groups demonstrated significant within-group reductions in pain intensity and menstrual symptoms post-intervention (p < 0.01), with no significant group-by-time interaction. However, significant interaction effects were observed for the PI and RI of the right uterine artery, showing greater reductions in the MFR group compared to the placebo group at 3 h post-intervention (p < 0.05). Conclusions: A single MFR session resulted in improvements in uterine hemodynamics, suggesting autonomic modulation as a potential mechanism. Although subjective symptom improvements were observed in both groups, only MFR showed objective vascular benefits. These findings support the physiological plausibility of MFR in PD management and suggest its potential application as a personalized, non-pharmacological intervention. Further studies are warranted to explore its long-term and individualized therapeutic effects. Full article
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19 pages, 630 KB  
Article
The Diagnostic Role of Novel Echocardiography Indices and Arterial Stiffness in Diabetic Cardiomyopathy
by Elina Khattab, Stefanos Sokratous, Michaela Kyriakou, Georgios Parpas, Ioannis Korakianitis, Paraskevi Papakyriakopoulou and Nikolaos P. E. Kadoglou
Biomedicines 2025, 13(9), 2317; https://doi.org/10.3390/biomedicines13092317 - 22 Sep 2025
Viewed by 202
Abstract
Background/Objectives: Diabetic cardiomyopathy (DBCM) is characterized by cardiac dysfunction in the absence of ischemic heart disease, hypertension, or valvular disease, often manifesting as heart failure with preserved ejection fraction (HFpEF). Early recognition of DBCM is clinically important, as it enables timely initiation [...] Read more.
Background/Objectives: Diabetic cardiomyopathy (DBCM) is characterized by cardiac dysfunction in the absence of ischemic heart disease, hypertension, or valvular disease, often manifesting as heart failure with preserved ejection fraction (HFpEF). Early recognition of DBCM is clinically important, as it enables timely initiation of tailored therapies and may slow down the progression to overt heart failure with reduced ejection fraction (HFrEF). This study aimed to evaluate the diagnostic utility of advanced echocardiographic techniques—myocardial work (MW), diastolic stress echocardiography (DSTE), Cardio-Ankle Vascular Index (CAVI)—and selected serum biomarkers in identifying DBCM. Methods: In this prospective observational study with 12-month follow-up, 125 diabetic patients with preserved ejection fraction and symptoms of HF or recent HF hospitalization were enrolled. Using the Heart Failure Association Pre-test Probability of HFpEF criteria, 37 were classified as DBCM-HFpEF and 88 as diabetic controls. An additional 47 age- and sex-matched non-diabetic individuals served as controls. All participants underwent resting echocardiography (MW, GLS), DSTE, CAVI assessment, and biomarker measurement (BNP, troponin, galectin-3). Results: Compared to non-diabetics, diabetic patients had significantly higher TRVmax (2.21 vs. 2.05 m/s), LAVI (39.70 vs. 33.50 mL/m2), E/e′ (8.64 vs. 7.59), CAVI (8.51 vs. 7.82 m/s), BNP (91.50 vs. 35.10 pg/mL), and troponin (3.94 vs. 2.43 ng/mL) (all p < 0.01), while galectin-3 levels showed no significant difference between groups. Differences were more pronounced between DBCM and No-DBCM diabetic groups. Multivariate analysis identified BNP (OR 5.45), TRVmax (OR 8.56), and CAVI (OR 1.91) as independent predictors of DBCM. Conclusions: DSTE and CAVI, alongside BNP and echocardiographic parameters, may provide valuable noninvasive tools for the early detection of DBCM in diabetic patients presenting with otherwise unexplained dyspnea, potentially enabling earlier intervention and improved outcomes. This is clinically important guiding an efficient management of an increasing number of diabetic patients presented with unexplained dyspnea. Full article
(This article belongs to the Section Endocrinology and Metabolism Research)
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6 pages, 2027 KB  
Case Report
MSSA Thoracic Mycotic Aneurysm Repaired with TEVAR: A Case Report
by Umabalan Thirupathy, Vikramaditya Samala Venkata and Viraj Panchal
Reports 2025, 8(3), 184; https://doi.org/10.3390/reports8030184 - 19 Sep 2025
Viewed by 248
Abstract
Background and Clinical Significance: Mycotic aortic aneurysm is a rare but life-threatening vascular condition characterized by infection-induced dilation or pseudoaneurysm formation in the aorta. The condition carries a high risk of rupture and mortality, especially in individuals with underlying cardiovascular disease, who have [...] Read more.
Background and Clinical Significance: Mycotic aortic aneurysm is a rare but life-threatening vascular condition characterized by infection-induced dilation or pseudoaneurysm formation in the aorta. The condition carries a high risk of rupture and mortality, especially in individuals with underlying cardiovascular disease, who have undergone recent vascular procedures, or with immunocompromising comorbidities such as diabetes. Its diagnosis is challenging due to its non-specific symptoms and often requires a high index of suspicion, especially in patients presenting with persistent fever and negative initial imaging. Early recognition and intervention are critical, as delayed treatment significantly worsens outcomes. Case Presentation: A 68-year-old male with a history of coronary artery disease, recent stent placement, and hypertension presented with two days of fever, chills, rigors, and a mild nonproductive cough. The laboratory findings were only significant for leukocytosis. The initial chest X-ray and non-contrast CT scans were unremarkable. He was admitted for presumed pneumonia and started on intravenous antibiotics. Persistent fever prompted further investigation with contrast-enhanced CT, which revealed a distal-aortic-arch pseudoaneurysm and mild mediastinal stranding. Blood cultures grew methicillin-sensitive Staphylococcus aureus (MSSA). Transthoracic echocardiogram was negative for endocarditis. The patient was transferred to a tertiary center, where repeat imaging confirmed a 1.5 cm pseudoaneurysm and a 4 mm penetrating atherosclerotic ulcer. After multidisciplinary assessment, he underwent thoracic endovascular aortic repair (TEVAR) and completed four weeks of intravenous cefazolin. Follow-up imaging showed successful aneurysm repair with no complications. Conclusions: Thoracic mycotic aneurysm is a rapidly fatal entity despite intervention. High clinical suspicion is necessary given its non-specific presentation. It is diagnosed most practically using CTA. In addition to antibiotics, TEVAR is gaining traction as a feasible and a safe alternative to open surgical repair (OSR). Full article
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27 pages, 1876 KB  
Article
Genetic Susceptibility and Genetic Variant-Diet Interactions in Diabetic Retinopathy: A Cross-Sectional Case–Control Study
by Sunmin Park, Suna Kang and Donghyun Jee
Nutrients 2025, 17(18), 2983; https://doi.org/10.3390/nu17182983 - 17 Sep 2025
Viewed by 262
Abstract
Background/Objectives: Diabetic retinopathy is a leading cause of blindness in diabetic patients, with disease susceptibility influenced by both genetic and environmental factors. This study aimed to identify novel genetic variants associated with DR and evaluate interactions between polygenic risk scores (PRS) and lifestyle [...] Read more.
Background/Objectives: Diabetic retinopathy is a leading cause of blindness in diabetic patients, with disease susceptibility influenced by both genetic and environmental factors. This study aimed to identify novel genetic variants associated with DR and evaluate interactions between polygenic risk scores (PRS) and lifestyle factors in a Korean diabetic cohort. Methods: After excluding subjects with non-diabetic retinopathy eye diseases (n = 2519), we analyzed data from 50,361 non-diabetic controls, 4873 diabetic participants without retinopathy (DM-NR), and 165 with diabetic retinopathy (DM-DR). We conducted genome-wide association studies comparing DM-NR and DM-DR groups, performed generalized multifactor dimensionality reduction (GMDR) analysis for epistatic interactions, developed unweighted PRS models, and examined PRS–lifestyle interactions using two-way analysis of covariance. Results: DM-DR prevalence showed strong associations with metabolic syndrome and its components. Five novel genetic variants were identified: ABCA4_rs17110929, MMP2-AS1_rs2576531, FOXP1_rs557869288, MRPS33_rs1533933, and DRD2_rs4936270. A significant three-way epistatic interaction among the first three variants was discovered through GMDR analysis. High-PRS individuals (scores 5–6) showed a 49-fold higher odds ratio of DM-DR compared to low-PRS individuals (scores 0–2; p < 0.0001). MAGMA analysis revealed enrichment in pathways related to protein degradation, vascular function, and neuronal signaling, with predominant upregulation in brain tissues. Significant PRS × lifestyle interactions were identified for fruit intake, coffee consumption, alcohol intake, eating duration, and physical activity, with lifestyle factors modifying genetic risk effects (all p < 0.003). Conclusions: These findings identify novel genetic variants and epistatic interactions in DM-DR pathogenesis, supporting the use of PRS-based risk stratification for intensive monitoring and personalized lifestyle interventions. The discovery of brain tissue-enriched pathways suggests DM-DR shares mechanisms with neurodegenerative diseases, expanding therapeutic targets beyond traditional vascular approaches. Full article
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16 pages, 4058 KB  
Article
Sedentary Duration and Systemic Health Burden: Nonlinear Associations with Muscle, Fat, and Vascular Phenotypes in a US Population-Based Study
by Chen Hu, Yang Song, Dong Sun, Zhenghui Lu, Hairong Chen, Xuanzhen Cen, Danica Janićijević, Zsolt Radak, Zixiang Gao, Julien Steven Baker and Yaodong Gu
Healthcare 2025, 13(18), 2309; https://doi.org/10.3390/healthcare13182309 - 16 Sep 2025
Viewed by 306
Abstract
Background: Sedentary behavior (SB) is a growing public health concern associated with cardiometabolic risk; yet few studies have assessed integrated physiological responses across the muscle–fat–vascular system. Methods: This retrospective cross-sectional analysis used data from 13,637 participants (≥12 years) in the 2011–2018 National Health [...] Read more.
Background: Sedentary behavior (SB) is a growing public health concern associated with cardiometabolic risk; yet few studies have assessed integrated physiological responses across the muscle–fat–vascular system. Methods: This retrospective cross-sectional analysis used data from 13,637 participants (≥12 years) in the 2011–2018 National Health and Nutrition Examination Survey (NHANES). Sedentary duration (SD) was self-reported via a validated questionnaire. Outcomes included the sarcopenic index (SI), fat distribution index (FDI), and pulse pressure index (PPI). Associations were examined using multivariable linear regression and restricted cubic spline models, adjusting for sociodemographic and lifestyle factors. Subgroup analyses explored effect modification by body mass index (BMI), sex, race/ethnicity, education, and self-rated health. Results: Each additional hour/day of SD was associated with a lower SI (β = −0.004, 95% CI: −0.005 to −0.002), lower FDI (β = −0.009, 95% CI: −0.012 to −0.007), and higher PPI (β = 0.001, 95% CI: 0.000 to 0.002). The SD–SI association was nonlinear, with a threshold at 10.73 h/day: below this point, the SI declined sharply (β = −0.001, p < 0.001), while above it the slope plateaued or reversed. The FDI showed consistent adverse associations across the SD range, particularly in men and individuals with lower education. The PPI was significantly elevated with SD only among non-Hispanic Black participants. Conclusions: SD is differentially associated with muscle mass, fat distribution, and vascular function, with overlapping inflection points indicating a coordinated multisystem response to sedentary stress. These findings support targeting <10.7 h/day sedentary time as a potential intervention threshold. Full article
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13 pages, 1668 KB  
Article
Sex Steroids in COVID-19 Patients with Hypertension: An Exploratory Study
by Pavitra Kotini-Shah, Shaveta Khosla, Felipe Borges Almeida, Luca Spiro Santovito, Heather Prendergast and Graziano Pinna
Int. J. Mol. Sci. 2025, 26(18), 8976; https://doi.org/10.3390/ijms26188976 - 15 Sep 2025
Viewed by 1050
Abstract
Sex and gender disparities have emerged as critical determinants of COVID-19 outcomes, with males exhibiting higher hospitalization and mortality rates than females. Sex steroids such as estradiol, progesterone, and testosterone have been proposed as modulators of these differences, given their known roles in [...] Read more.
Sex and gender disparities have emerged as critical determinants of COVID-19 outcomes, with males exhibiting higher hospitalization and mortality rates than females. Sex steroids such as estradiol, progesterone, and testosterone have been proposed as modulators of these differences, given their known roles in inflammation, immune function, and vascular health. However, the precise hormonal mechanisms underlying COVID-19 severity, particularly among individuals with comorbid hypertension—a major risk factor for adverse outcomes—remain unclear. In this study, we investigated circulating levels of key sex hormones and their neuroactive metabolites in 116 hypertensive COVID-19 patients enrolled through an urban academic emergency department. Our findings revealed distinct sex-based hormonal profiles and associations with disease severity. Males exhibited higher serum estradiol and testosterone levels, while progesterone levels were significantly higher in postmenopausal females. Notably, hospitalized patients showed elevated estradiol and progesterone levels compared to non-hospitalized individuals, whereas ICU-admitted patients had significantly lower concentrations of all three hormones. A unique exception was ICU-admitted postmenopausal females, who exhibited increased serum testosterone levels relative to non-ICU females. Additionally, in males, elevated 3α-diol was associated with hospitalization and ICU admission, while lower allopregnanolone and estradiol levels correlated with hypoxia in males and females, respectively. These results highlight a dynamic, sex-specific hormonal response to COVID-19 progression in hypertensive individuals, suggesting early upregulation and late depletion of protective sex steroids. Understanding these patterns may improve clinical risk stratification and inform the development of sex-targeted therapeutic interventions for COVID-19 and related inflammatory conditions. Full article
(This article belongs to the Section Molecular Endocrinology and Metabolism)
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16 pages, 1046 KB  
Review
How Can Technology Improve Burn Wound Care: A Review of Wound Imaging Technologies and Their Application in Burns—UK Experience
by Nawras Farhan, Zakariya Hassan, Mohammad Al Mahdi Ali, Zaid Alqalaf, Roeya E. Rasul and Steven Jeffery
Diagnostics 2025, 15(17), 2277; https://doi.org/10.3390/diagnostics15172277 - 8 Sep 2025
Viewed by 585
Abstract
Burn wounds are complex injuries that require timely and accurate assessment to guide treatment decisions and improve healing outcomes. Traditional clinical evaluations are largely subjective, often leading to delays in intervention and increased risk of complications. Imaging technologies have emerged as valuable tools [...] Read more.
Burn wounds are complex injuries that require timely and accurate assessment to guide treatment decisions and improve healing outcomes. Traditional clinical evaluations are largely subjective, often leading to delays in intervention and increased risk of complications. Imaging technologies have emerged as valuable tools that enhance diagnostic accuracy and enable objective, real-time assessment of wound characteristics. This review aims to evaluate the range of imaging modalities currently applied in burn wound care and assess their clinical relevance, diagnostic accuracy, and cost-effectiveness. It explores how these technologies address key challenges in wound evaluation, particularly related to burn depth, perfusion status, bacterial burden, and healing potential. A comprehensive narrative review was conducted, drawing on peer-reviewed journal articles, NICE innovation briefings, and clinical trial data. The databases searched included PubMed, Ovid MEDLINE, and the Cochrane Library. Imaging modalities examined include Laser Doppler Imaging (LDI), Fluorescence Imaging (FI), Near-Infrared Spectroscopy (NIR), Hyperspectral Imaging, Spatial Frequency Domain Imaging (SFDI), and digital wound measurement systems. The clinical application and integration of these modalities in UK clinical practice were also explored. Each modality demonstrated unique clinical benefits. LDI was effective in assessing burn depth and perfusion, improving surgical planning, and reducing unnecessary procedures. FI, particularly the MolecuLight i:X device (MolecuLight Inc., Toronto, ON, Canada), accurately identified bacterial burden and guided targeted interventions. NIR and Hyperspectral Imaging provided insights into tissue oxygenation and viability, while SFDI enabled early detection of infection and vascular compromise. Digital measurement tools offered accurate, non-contact assessment and supported telemedicine use. NICE recognized both LDI and MolecuLight as valuable tools with the potential to improve outcomes and reduce healthcare costs. Imaging technologies significantly improve the precision and efficiency of burn wound care. Their ability to offer objective, non-invasive diagnostics enhances clinical decision-making. Future research should focus on broader validation and integration into clinical guidelines to ensure widespread adoption. Full article
(This article belongs to the Special Issue Diagnostics in the Emergency and Critical Care Medicine)
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24 pages, 4575 KB  
Review
Intercostal Artery Screening with Color Doppler Thoracic Ultrasound in Pleural Procedures: A Potential Yet Underexplored Imaging Modality for Minimizing Iatrogenic Bleeding Risk in Interventional Pulmonology
by Guido Marchi, Sara Cinquini, Francesco Tannura, Giacomo Guglielmi, Riccardo Gelli, Luca Pantano, Giovanni Cenerini, Valerie Wandael, Beatrice Vivaldi, Natascia Coltelli, Giulia Martinelli, Alessandra Celi, Salvatore Claudio Fanni, Massimiliano Serradori, Marco Gherardi, Luciano Gabbrielli, Francesco Pistelli and Laura Carrozzi
J. Clin. Med. 2025, 14(17), 6326; https://doi.org/10.3390/jcm14176326 - 7 Sep 2025
Viewed by 705
Abstract
Hemorrhagic complications during pleural interventions—such as thoracentesis and chest tube insertion—remain a significant clinical concern, primarily due to inadvertent injury of the intercostal artery (ICA). The highly variable ICA anatomy is frequently not visualized on conventional imaging, limiting the reliability of landmark-based techniques. [...] Read more.
Hemorrhagic complications during pleural interventions—such as thoracentesis and chest tube insertion—remain a significant clinical concern, primarily due to inadvertent injury of the intercostal artery (ICA). The highly variable ICA anatomy is frequently not visualized on conventional imaging, limiting the reliability of landmark-based techniques. Color Doppler thoracic ultrasound (CDUS) has emerged as a non-invasive, real-time modality capable of identifying ICAs and their anatomical variants prior to pleural access. This narrative review synthesizes current evidence on CDUS-guided ICA screening, focusing on its technical principles, diagnostic performance, and clinical applicability. While feasibility and utility are supported by multiple observational studies, robust evidence demonstrating a reduction in bleeding complications is still lacking. Barriers to widespread implementation include heterogeneous scanning protocols, operator dependency, and the absence of standardized training. We discuss the anatomical rationale for pre-procedural vascular mapping and highlight emerging protocols aimed at standardizing ICA visualization. Although not yet incorporated into major clinical guidelines, CDUS represents a promising tool to enhance procedural safety. Emerging AI applications may further improve vessel detection by reducing operator dependency and enhancing reproducibility. High-quality prospective studies are essential to validate potential clinical benefits, optimize implementation strategies, and support integration into routine pleural practice. Full article
(This article belongs to the Special Issue Interventional Pulmonology: Advances and Future Directions)
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12 pages, 678 KB  
Review
Superior Capsule Reconstruction Graft Selection: The Influence of Biological Properties of Grafts on Healing and Re-Tearing
by Mingde Cao, Mingguang Bi, Shuai Yuan, Yuhao Wu, Patrick Shu-Hang Yung and Michael Tim-Yun Ong
Bioengineering 2025, 12(9), 942; https://doi.org/10.3390/bioengineering12090942 - 31 Aug 2025
Viewed by 624
Abstract
Arthroscopic Superior Capsular Reconstruction has emerged as a promising surgical intervention for irreparable massive rotator cuff tears, aiming to restore glenohumeral joint stability and improve patient outcomes. A critical determinant of ASCR success is the selection of an appropriate graft material. This review [...] Read more.
Arthroscopic Superior Capsular Reconstruction has emerged as a promising surgical intervention for irreparable massive rotator cuff tears, aiming to restore glenohumeral joint stability and improve patient outcomes. A critical determinant of ASCR success is the selection of an appropriate graft material. This review explores the spectrum of grafts utilized in ASCR, including autografts, allografts, xenografts, and synthetic materials. The primary focus is on how the inherent biological properties of these grafts—such as cellularity, vascularity, immunogenicity, and extracellular matrix composition—profoundly influence the processes of graft healing, integration into host tissues, and ultimately, the rates of re-tearing. Autografts, particularly fascia lata, often demonstrate superior biological incorporation due to their viable cells and non-immunogenic nature, leading to high healing rates. Allografts, while offering advantages like reduced donor site morbidity, present biological challenges related to decellularization processes and slower remodeling, resulting in more variable healing outcomes. Xenografts face significant immunological hurdles, often leading to rejection and poor integration. Synthetic grafts provide an off-the-shelf option but interact with host tissue primarily as a scaffold, without true biological integration. Understanding the nuanced biological characteristics of each graft type is paramount for surgeons aiming to optimize healing environments and minimize re-tear rates, thereby enhancing the long-term efficacy of ASCR. Full article
(This article belongs to the Special Issue Tendon/Ligament and Enthesis Injuries: Repair and Regeneration)
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9 pages, 332 KB  
Review
Endothelial Dysfunction in Adolescent Hypertension: Diagnostic Challenges and Early Cardiovascular Risk
by Vladimir Micieta, Michaela Cehakova and Ingrid Tonhajzerova
J. Cardiovasc. Dev. Dis. 2025, 12(9), 326; https://doi.org/10.3390/jcdd12090326 - 26 Aug 2025
Cited by 1 | Viewed by 661
Abstract
Hypertension in adolescence causes early vascular injury manifesting as endothelial dysfunction (ED), which signifies elevated cardiovascular risk. This review synthesizes recent insights (2020–2025) into ED’s mechanisms and detection in hypertensive youth. We highlight how reduced nitric oxide bioavailability, oxidative stress, inflammation, and hormonal [...] Read more.
Hypertension in adolescence causes early vascular injury manifesting as endothelial dysfunction (ED), which signifies elevated cardiovascular risk. This review synthesizes recent insights (2020–2025) into ED’s mechanisms and detection in hypertensive youth. We highlight how reduced nitric oxide bioavailability, oxidative stress, inflammation, and hormonal changes in puberty contribute to ED and consequent vascular remodeling. Non-invasive diagnostic tools (e.g., flow-mediated dilation, peripheral arterial tonometry) reveal that even asymptomatic hypertensive adolescents have measurable ED linked to arterial stiffness and cardiac changes. Encouragingly, ED in youth appears reversible: exercise and dietary interventions improve endothelial function, and pharmacotherapy (ACE inhibitors, ARBs) can restore endothelial health beyond blood pressure control. Early identification of ED in hypertensive adolescents is therefore critical—it not only refines risk stratification (e.g., unmasking high-risk “white-coat” hypertension) but also presents an opportunity to initiate lifestyle modifications and therapy to preserve vascular function. Full article
(This article belongs to the Special Issue Feature Review Papers in Cardiovascular Clinical Research)
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24 pages, 2057 KB  
Review
Drugs, Mother, and Child—An Integrative Review of Substance-Related Obstetric Challenges and Long-Term Offspring Effects
by Atziri Alejandra Jiménez-Fernández, Joceline Alejandra Grajeda-Perez, Sofía de la Paz García-Alcázar, Mariana Gabriela Luis-Díaz, Francisco Javier Granada-Chavez, Emiliano Peña-Durán, Jesus Jonathan García-Galindo and Daniel Osmar Suárez-Rico
Drugs Drug Candidates 2025, 4(3), 40; https://doi.org/10.3390/ddc4030040 - 25 Aug 2025
Viewed by 945
Abstract
Substance use during pregnancy is an increasingly important yet under-recognized threat to maternal and child health. This narrative review synthesizes the current evidence available on the epidemiology, pathophysiology, clinical management, and policy landscape of prenatal exposure to alcohol, tobacco, opioids, benzodiazepines, cocaine, cannabis, [...] Read more.
Substance use during pregnancy is an increasingly important yet under-recognized threat to maternal and child health. This narrative review synthesizes the current evidence available on the epidemiology, pathophysiology, clinical management, and policy landscape of prenatal exposure to alcohol, tobacco, opioids, benzodiazepines, cocaine, cannabis, methamphetamines, and other synthetic drugs. All major psychoactive substances readily cross the placenta and can remain detectable in breast milk, leading to a shared cascade of obstetric complications (hypertensive disorders, placental abruption, pre-term labor), fetal consequences (growth restriction, structural malformations), and neonatal morbidities such as neonatal abstinence syndrome and sudden infant death. Mechanistically, trans-placental diffusion, oxidative stress, inflammatory signaling, and placental vascular dysfunction converge to disrupt critical neuro- and cardiovascular developmental windows. Early identification hinges on the combined use of validated screening questionnaires (4 P’s Plus, CRAFFT, T-ACE, AUDIT-C, TWEAK) and matrix-specific biomarkers (PEth, EtG, FAEE, CDT), while effective treatment requires integrated obstetric, addiction, and mental health services. Medication for opioid use disorders, particularly buprenorphine, alone or with naloxone, confers superior neonatal outcomes compared to methadone and underscores the value of harm-reducing non-punitive care models. Public-health strategies, such as Mexico’s “first 1 000 days” framework, wrap-around clinics, and home-visiting programs, demonstrate the potential of multisectoral interventions, but are hampered by structural inequities and punitive legislation that deter care-seeking. Research gaps persist in polysubstance exposure, culturally tailored therapies, and long-term neurodevelopmental trajectories. Multigenerational, omics-enabled cohorts, and digital longitudinal-care platforms represent promising avenues for closing these gaps and informing truly preventive perinatal health policies. Full article
(This article belongs to the Section Clinical Research)
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15 pages, 301 KB  
Review
Menopause-Related Changes in Sleep and the Associations with Cardiometabolic Health: A Narrative Review
by Joshua R. Sparks and Xuewen Wang
Healthcare 2025, 13(17), 2085; https://doi.org/10.3390/healthcare13172085 - 22 Aug 2025
Viewed by 1120
Abstract
This narrative review examines the complex relationship between sleep changes during the menopausal transition and cardiometabolic risks. The most common complaint about sleep is increased awakenings during sleep. Other complaints include having trouble falling asleep, waking up too early, insufficient and non-restorative sleep, [...] Read more.
This narrative review examines the complex relationship between sleep changes during the menopausal transition and cardiometabolic risks. The most common complaint about sleep is increased awakenings during sleep. Other complaints include having trouble falling asleep, waking up too early, insufficient and non-restorative sleep, and overall poor quality. Sleep determined using objective methods also indicates that greater awakenings after sleep onset are associated with the period of menopausal transition. Polysomnography recordings suggest physiological hyperarousal during sleep. Changes in other sleep metrics, such as sleep latency and sleep duration, are less consistent, and some studies suggest they may not worsen during the menopausal transition. These sleep issues are influenced by multiple factors, such as hormonal fluctuations, vasomotor symptoms, and psychosocial factors, and evidence suggests that hypothalamic kisspeptin/neurokinin B/dynorphin (KNDy) neurons are key underlying mechanisms for these associations. The menopausal transition is also associated with increases in cardiometabolic risk factors, such as body fat, altered lipid profiles, blood pressure, and vascular health. Emerging evidence suggests that poor sleep health during this period is associated with increased cardiometabolic risks and adverse cardiovascular outcomes. Thus, addressing sleep disturbances is crucial for comprehensive healthcare during the menopausal transition to safeguard long-term cardiometabolic health. Future research is needed to investigate interventions that can improve sleep and their impact on cardiometabolic health in this population experiencing increases in cardiometabolic risk. Full article
(This article belongs to the Special Issue Menopause Transition and Postmenopausal Health)
19 pages, 1485 KB  
Review
The Influence of Insulin Resistance and Type 2 Diabetes on Cognitive Decline and Dementia in Parkinson’s Disease: A Systematic Review
by Osama Zeidan, Noor Jaragh, Maya Tama, Maryam Alkhalifa, Maryam Alqayem and Alexandra E. Butler
Int. J. Mol. Sci. 2025, 26(16), 8078; https://doi.org/10.3390/ijms26168078 - 21 Aug 2025
Viewed by 1044
Abstract
Parkinson’s disease (PD) is a common neurodegenerative disorder caused by progressive loss of dopaminergic neurons in the substantia nigra and the presence of Lewy bodies. While PD is most recognized by its motor symptoms (resting tremor, rigidity, bradykinesia, and postural instability), cognitive decline [...] Read more.
Parkinson’s disease (PD) is a common neurodegenerative disorder caused by progressive loss of dopaminergic neurons in the substantia nigra and the presence of Lewy bodies. While PD is most recognized by its motor symptoms (resting tremor, rigidity, bradykinesia, and postural instability), cognitive decline (CD) may become apparent as PD progresses, leading to Parkinson’s disease dementia (PDD). Type 2 diabetes mellitus (T2DM) and insulin resistance (IR) are risk factors for dementia, especially Alzheimer’s disease; however, their influence on dementia in PD is underexplored. Therefore, we sought to determine the effect of T2DM and IR on dementia in PD. A systematic search of articles from 2005 to March 2025 was undertaken using Embase, PubMed, Scopus, Web of Science, and citation searching. Case–control, cross-sectional, longitudinal, and non-human population studies assessing cognitive outcomes in individuals with PD, with and without T2DM and IR, were included (PROSPERO registration number CRD420251013367). In total, 27 studies met the inclusion criteria, with clinical sample sizes ranging from 23 to 544,162 participants. Among the 23 clinical studies, 15 identified T2DM as a contributor to cognitive decline (CD) in PD, and 4 specifically examined insulin resistance (IR). Elevated HbA1c was consistently associated with poorer cognitive performance and increased risk of Parkinson’s disease dementia (PDD); HbA1c ≥ 7% independently predicted cognitive impairment (OR = 4.25, 95% CI: 1.59–11.34). Vascular and inflammatory markers, including elevated LDL-C, fibrinogen, and hs-CRP, further exacerbated CD. MoCA and MMSE scores were the most common cognitive measures, consistently showing worse outcomes in PD patients with T2DM. Preclinical studies supported these associations, showing that high-fat-diet-induced T2DM and IR aggravated dopaminergic neuronal loss by 38–45%, increased α-synuclein by 35%, and heightened microglial activation, providing mechanistic evidence for the observed clinical associations. This systematic review, the first to examine the impact of T2DM and IRs on the occurrence and advancement of CD in PD patients, demonstrates a possible association between the two. However, these results demonstrate the need for larger sample sizes and the inclusion of additional clinical variables, such as HbA1c levels and pharmacological interventions, providing further information about the link between metabolic dysfunction and CD in PD. To further strengthen this link, longitudinal studies with systematic follow-ups are essential to establish causal links and avoid misdiagnosis in clinical practice. Full article
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17 pages, 2559 KB  
Systematic Review
Optical Coherence Tomography Angiography (OCTA) Characteristics of Acute Retinal Arterial Occlusion: A Systematic Review
by Saud Aljohani
Healthcare 2025, 13(16), 2056; https://doi.org/10.3390/healthcare13162056 - 20 Aug 2025
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Abstract
Purpose: To systematically review the evidence regarding the characteristics of Optical Coherence Tomography Angiography (OCTA) in acute retinal arterial occlusion (RAO), with a particular focus on vascular alterations across the superficial and deep capillary plexuses, choroid, and peripapillary regions. Methods: A comprehensive [...] Read more.
Purpose: To systematically review the evidence regarding the characteristics of Optical Coherence Tomography Angiography (OCTA) in acute retinal arterial occlusion (RAO), with a particular focus on vascular alterations across the superficial and deep capillary plexuses, choroid, and peripapillary regions. Methods: A comprehensive literature search was performed across PubMed, Web of Science, Scopus, EMBASE, Google Scholar, and the Cochrane Database up to April 2025. The search terms included “Optical coherence tomography angiography,” “OCTA,” “Retinal arterial occlusion,” “Central retinal artery occlusion,” and “Branch retinal artery occlusion.” Studies were included if they evaluated the role of OCTA in diagnosing or assessing acute RAO. Case reports, conference abstracts, and non-English articles were excluded. Two reviewers independently conducted the study selection and data extraction. The methodological quality of the included studies was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. Results: The initial search yielded 457 articles, from which 10 studies were ultimately included in the final analysis after a rigorous screening process excluding duplicates, non-English publications, and ineligible articles based on title, abstract, or full-text review. The included studies consistently demonstrated that OCTA is a valuable, noninvasive modality for evaluating microvascular changes in RAO. Key OCTA findings in acute RAO include significant perfusion deficits and reduced vessel density in both the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Several studies noted more pronounced involvement of the SCP compared to the DCP. OCTA parameters, such as vessel density in the macular region, have been found to correlate with visual acuity, suggesting a prognostic value. While findings regarding the foveal avascular zone (FAZ) were mixed, the peripapillary area frequently showed reduced vessel density. Conclusion: Acute RAO is an ocular emergency that causes microvascular ischemic changes detectable by OCTA. This review establishes OCTA as a significant noninvasive tool for diagnosing, monitoring, and prognosticating RAO. It effectively visualizes perfusion deficits that correlate with clinical outcomes. However, limitations such as susceptibility to motion artifacts, segmentation errors, and the lack of standardized normative data must be considered. Future standardization of OCTA protocols and analysis is essential to enhance its clinical application in managing RAO. Full article
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