Search Results (477)

Chronic subdural hematoma (cSDH) is a common neurosurgical condition in the elderly, often resulting from minor head trauma. Traditional surgical treatments such as burr-hole drainage carry recurrence rates of 10–20% and significant risks in older patients, especially those on anticoagulation therapy. Middle meningeal artery (MMA) embolization has emerged as a minimally invasive alternative, aiming to reduce blood flow to the dura and thereby promote hematoma resolution and lower recurrence. We conducted a bibliometric analysis of publications on MMA embolization for cSDH up to December 2023. The analysis shows a sharp increase in research activity over the past decade. North America, Japan, and Europe are leading contributors, with collaborative networks forming among major institutions. Key journals in neurosurgery and neurointervention have published much of this research, and author collaborations are extensive. Frequently used keywords such as “recurrence” and “treatment outcome” reflect an emphasis on reducing rebleeding and improving patient outcomes. In conclusion, MMA embolization is rapidly gaining attention as a promising treatment for cSDH. While early results are favorable and multi-center efforts are expanding the evidence base, further research is needed to establish long-term efficacy, optimize patient selection, and standardize techniques. Full article

Chronic pancreatitis (CP) precipitates complex malnutrition through synergistic mechanisms: exocrine pancreatic insufficiency–driven maldigestion, duodenal or pancreatobiliary strictures limiting nutrient flow, cholestasis impairing micelle formation, alcohol-related anorexia, pain-induced hypophagia, proteolytic catabolism from type 3c diabetes, and a chronic inflammatory milieu that accelerates sarcopenia and bone demineralisation. Consequent calorie–protein depletion, micronutrient and fat-soluble vitamin deficits, and metabolic derangements markedly amplify morbidity. Pancreatic enzyme replacement therapy (PERT) with targeted micronutrient repletion is foundational; high-protein regimens co-administered with PERT curb muscle loss, and medium-chain triglycerides (MCTs) can augment caloric delivery by bypassing lipase dependence, although their benefit over personalised dietetic counselling is marginal. Optimal dietary fat thresholds and timing of escalation from oral to enteral or parenteral feeding remain unresolved. Comprehensive care also demands alcohol abstinence, effective analgesia and stringent glycaemic control. Serial monitoring—biochemical indices, densitometry, dual-energy X-ray absorptiometry and imaging-based body-composition metrics—permits early detection of high-risk patients and precision tailoring of interventions. Intensified multidisciplinary programmes already improve prognostic endpoints and are unveiling biomarkers of nutritional resilience. A structured, evidence-based strategy integrating PERT, macronutrient engineering, micronutrient repletion and metabolic surveillance is essential to mitigate nutrition-related morbidity, enhance long-term outcomes and optimise quality of life in CP. Full article

Dry powder inhalers (DPIs) are the mainstay in the treatment of obstructive pulmonary diseases. However, the performance of DPI formulations is highly dependent on the used inhaler device and the patient’s inspiratory effort. This study aimed to evaluate and compare the aerosolization behavior of three commercially available capsule-based DPI medications—formoterol (Foradil^®), glycopyrronium (Seebri^® Breezhaler), and tiotropium (Spiriva^®)—delivered using three different capsule-based inhalers (Aerolizer, Breezhaler, and Handihaler), under varying flow conditions. Methods: The aerodynamic performance of each formulation–inhaler combination was assessed using the Next-Generation Impactor (NGI) and Dosage Unit Sampling Apparatus (DUSA) methodology. Fine particle dose (FPD) and aerodynamic particle size distribution (APSD) were determined at fixed flow rates of 15, 30, 60, and 100 L/min, as well as at inhaler-specific flow rates corresponding to a 4 kPa pressure drop. Chromatographic quantification of active ingredients was performed using validated HPLC methods specific to each drug. Results: The FPD values increased consistently with higher flow rates across all tested formulations and inhalers. At a 4 kPa pressure drop, Aerolizer and Breezhaler achieved significantly higher FPDs compared to Handihaler. Notably, in some instances, non-dedicated inhalers produced greater respirable fractions than the originally intended devices. APSD profiles revealed that drug deposition shifted toward smaller NGI stages at higher inspiratory flows, supporting enhanced deep lung delivery potential under optimal conditions. Conclusions: Device resistance, capsule orientation, and piercing mechanics substantially influence drug aerosolization. Although non-dedicated inhalers may offer improved FPDs in vitro, clinical use should adhere to approved drug–device combinations, as these have been validated for efficacy and safety under real-world conditions. Full article

Background and Objectives: Deep venous thrombosis (DVT) is associated with pulmonary embolism and long-term complications such as post-thrombotic syndrome (PTS). Anticoagulation prevents thrombus extension but does not actively remove clot. Interventional techniques, including catheter-directed thrombolysis, mechanical and pharmacomechanical thrombectomy, and venous stenting, have been introduced to restore venous patency and reduce complications. This systematic review summarizes current evidence on outcomes, safety, and patient selection for these procedures. Materials and Methods: A systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science was conducted for studies published between January 2000 and February 2024. Eligible studies included randomized controlled trials, systematic reviews, meta-analyses, and observational studies with ≥20 patients. Extracted outcomes were technical success, thrombus clearance, venous patency, PTS, quality of life, and complications. Risk of bias was assessed using the Cochrane Risk of Bias Tool, Newcastle–Ottawa Scale, and AMSTAR-2. Results: Of 456 records screened, 35 studies were included. Randomized trials (CaVenT, ATTRACT, CAVA) showed that catheter-directed and pharmacomechanical approaches improved venous patency and reduced moderate-to-severe PTS in selected patients with iliofemoral DVT, though overall benefit was variable. Mechanical thrombectomy devices (e.g., AngioJet, ClotTriever, FlowTriever) achieved high thrombus clearance and shorter procedural times, with device-specific complication profiles. Observational data demonstrated venous stenting patency rates of 74–89% at 12 months. Study heterogeneity limited direct comparisons. Conclusions: Interventional procedures can reduce PTS and improve outcomes in carefully selected patients, particularly those with acute iliofemoral DVT. Modern mechanical and pharmacomechanical techniques enhance efficiency and safety, while venous stenting addresses underlying obstructions. Further high-quality trials with long-term follow-up are needed to define optimal patient selection and comparative effectiveness. Full article

Recent documents from leading international pediatric respiratory societies have strongly encouraged the use of lung function tests in clinical practice and research. These tests can explore ventilatory function across its volumetric and temporal domains, providing information on the intrapulmonary location and extent of damage caused by respiratory diseases. The choice of which test to use in each case to investigate presenting respiratory symptoms depends on the patient’s symptoms and the diagnostic–therapeutic phase being addresse d. In the most common and representative chronic pediatric condition—bronchial asthma—lung function tests play an especially important role due to the disease’s complexity and the fluctuating nature of airway obstruction. This review aims to examine the potential of various lung function tests in asthma, helping clinicians and researchers to optimize diagnosis and follow-up with the most appropriate methodology. While spirometry and flow resistance measurements using the interrupter technique have historically been the cornerstones of diagnosis and clinical monitoring in childhood asthma, the advent of new technologies—such as multiple breath nitrogen washout (MBNW) and the forced oscillation technique (FOT)—is opening up the door to a more nuanced view of the disease. These tools allow for an evaluation of asthma as a structurally complex and topographically and temporally disorganized condition. FOT, in particular, facilitates measurement acceptability in less cooperative subjects, both in respiratory physiology labs and even at the patient’s home. Full article

Background/Objectives: Acute Lymphoblastic Leukemia (ALL) poses significant diagnostic challenges due to its ambiguous symptoms and the limitations of conventional methods like bone marrow biopsies and flow cytometry, which are invasive, costly, and time-intensive. Methods: This study introduces Neuro-Bridge-X, a novel neuro-symbolic hybrid model designed for automated, explainable ALL diagnosis using peripheral blood smear (PBS) images. Leveraging two comprehensive datasets, ALL Image (3256 images from 89 patients) and C-NMC (15,135 images from 118 patients), the model integrates deep morphological feature extraction, vision transformer-based contextual encoding, fuzzy logic-inspired reasoning, and adaptive explainability. To address class imbalance, advanced data augmentation techniques were applied, ensuring equitable representation across benign and leukemic classes. The proposed framework was evaluated through 5-fold cross-validation and fixed train-test splits, employing Nadam, SGD, and Fractional RAdam optimizers. Results: Results demonstrate exceptional performance, with SGD achieving near-perfect accuracy (1.0000 on ALL, 0.9715 on C-NMC) and robust generalization, while Fractional RAdam closely followed (0.9975 on ALL, 0.9656 on C-NMC). Nadam, however, exhibited inconsistent convergence, particularly on C-NMC (0.5002 accuracy). A Meta-XAI controller enhances interpretability by dynamically selecting optimal explanation strategies (Grad-CAM, SHAP, Integrated Gradients, LIME), ensuring clinically relevant insights into model decisions. Conclusions: Visualizations confirm that SGD and RAdam models focus on morphologically critical features, such as leukocyte nuclei, while Nadam struggles with spurious attributions. Neuro-Bridge-X offers a scalable, interpretable solution for ALL diagnosis, with potential to enhance clinical workflows and diagnostic precision in oncology. Full article

Background: Large vessel occlusion (LVO) strokes account for a significant proportion of ischemic strokes and are often cardioembolic in origin, particularly following atrial fibrillation (AF) with thrombus formation in the left atrial appendage (LAA). Although direct oral anticoagulation (DOAC) therapy reduces stroke risk in AF, anatomical and flow-related factors may still allow thrombi to form and persist, revealing the limitations of anticoagulation in high-risk patients. Examining structural and hemodynamic factors contributing to thrombus persistence is essential for optimizing patient management. Methods: We retrospectively analyzed 169 AF patients with LVO stroke who underwent cardiac CT (cCT) during acute stroke assessment. Patients were categorized based on the presence or absence of persistent LAA thrombi and further stratified by DOAC status. LAA volume, blood stasis and left ventricular (LV) diameter were measured. Thrombi were assessed using Hounsfield Unit (HU) analysis to evaluate potential differences in thrombus composition. Logistic regression analysis was performed to identify independent predictors of thrombus persistence with adjustment for DOAC therapy. Results: Persistent LAA thrombi were identified in 23 patients (13.6%). Patients with thrombi had significantly higher rates of stasis (p = 0.004), larger left ventricular diameters (p = 0.0019) and higher LAA volumes (p = 0.004). When adjusted for DOAC therapy, larger LAA volume (OR 1.05, p = 0.011), presence of LAA stasis (OR 6.14, p = 0.013) and increased LV diameter (OR 1.06, p = 0.006) were independent predictors of thrombus persistence. Thrombus size and HU values did not differ significantly between DOAC and non-DOAC groups. Notably, 30.4% of patients with persistent thrombi were on adequate DOAC therapy. Conclusions: LAA volume, stasis and LV enlargement predict thrombus persistence in the LAA of AF patients with LVO stroke, even under adequate DOAC therapy. These findings highlight the potential need for alternative antithrombotic strategies, including interventional LAA occlusion, and warrant further investigation into individualized stroke prevention in high-risk AF populations. Full article

Background/Objectives: Colorectal cancer (CRC) ranks third in the Western world in cancer incidence and second as the cause of cancer-related deaths. Despite advances in perioperative care, minimizing postoperative morbidity is crucial in clinical practice. Digitalization of the healthcare process plays a key role in genuinely and effectively engaging patients. Our aim was to evaluate a digital solution for remote monitoring of patients with CRC, from surgery indication to postoperative discharge. Methods: We developed a digital solution using Value Stream Mapping (VSM) to identify patient care flow and Lean Sigma for optimization and efficiency. We incorporated the Enhanced Recovery After Surgery (ERAS)/RICA pentamodal recommendations to create a program with an individualized schedule for each patient, who received tailored educational, medical, and practical information at every stage of the process. Results: A total of 193 patients used the digital solution, with >75% adhering to ERAS recommendations. The median length of hospital stay was 5 days, with low adherence leading to 3.4 (p = 0.628) or 3.27 (p = 0.642) extra days in the hospital compared to patients with intermediate and high adherence, respectively. The mean comprehensive complication index (CCI) was 9.1/100, which was higher in patients with low adherence (15) versus intermediate (8.17; p = 0.027) and high (7.42; p = 0.011) adherence. An increase in self-perception of quality of life by 9.2% was identified at the end of the process compared to the outcome at the beginning (p = 0.09), and 80% rated their overall satisfaction with the care process as 8 or higher out of 10. Conclusions: The digital solution facilitates the monitoring of CRC care and implementation and adherence to ERAS recommendations, improving patient engagement and satisfaction. Full article

Endotoxins, lipopolysaccharides released from the outer membrane of Gram-negative bacteria, pose a significant risk in healthcare environments, particularly in Central Sterile Supply Departments (CSSDs), where the delivery of sterile pyrogen-free medical devices is critical for patient safety. Traditional methods for controlling endotoxins in water systems, such as ultraviolet (UV) disinfection, have proven ineffective at reducing endotoxin concentrations to comply with regulatory standards (<0.25 EU/mL). This limitation presents a significant challenge, especially in the context of reverse osmosis (RO) permeate used in CSSDs, where water typically has very low conductivity. Despite the established importance of endotoxin removal, a gap in the literature exists regarding effective chemical-free methods that can meet the stringent endotoxin limits in such low-conductivity environments. This study addresses this gap by evaluating the effectiveness of the eBooster™ electrochemical technology—featuring proprietary electrode materials and a reactor design optimized for potable water—for endotoxin removal from water, specifically under the low-conductivity conditions typical of RO permeate. Laboratory experiments using the B250 reactor achieved >90% endotoxin reduction (from 1.2 EU/mL to <0.1 EU/mL) at flow rates ≤5 L/min and current densities of 0.45–2.7 mA/cm². Additional real-world testing at three hospitals showed that the eBooster™ unit, when installed in the RO tank recirculation loop, consistently reduced endotoxin levels from 0.76 EU/mL (with UV) to <0.05 EU/mL over 24 months of operation, while heterotrophic plate counts dropped from 190 to <1 CFU/100 mL. Statistical analysis confirmed the reproducibility and flow-rate dependence of the removal efficiency. Limitations observed included reduced efficacy at higher flow rates, the need for sufficient residence time, and a temporary performance decline after two years due to a power fault, which was promptly corrected. Compared to earlier approaches, eBooster™ demonstrated superior performance in low-conductivity environments without added chemicals or significant maintenance. These findings highlight the strength and novelty of eBooster™ as a reliable, chemical-free, and maintenance-friendly alternative to traditional UV disinfection systems, offering a promising solution for critical water treatment applications in healthcare environments. Full article

Stroke is a significant global health concern characterized by the abrupt disruption of cerebral blood flow, leading to neurological impairment. Accurate and timely diagnosis—enabled by imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI)—is essential for differentiating stroke types and initiating interventions like thrombolysis, thrombectomy, or surgical management. In parallel, recent advancements in wearable technology, particularly smart clothing, offer new opportunities for stroke prevention, real-time monitoring, and rehabilitation. These garments integrate various sensors, including electrocardiogram (ECG) electrodes, electroencephalography (EEG) caps, electromyography (EMG) sensors, and motion or pressure sensors, to continuously track physiological and functional parameters. For example, ECG shirts monitor cardiac rhythm to detect atrial fibrillation, smart socks assess gait asymmetry for early mobility decline, and EEG caps provide data on neurocognitive recovery during rehabilitation. These technologies support personalized care across the stroke continuum, from early risk detection and acute event monitoring to long-term recovery. Integration with AI-driven analytics further enhances diagnostic accuracy and therapy optimization. This narrative review explores the application of smart clothing in conjunction with traditional imaging to improve stroke management and patient outcomes through a more proactive, connected, and patient-centered approach. Full article

Background: Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of severe aortic valve stenosis (AS). Balloon post-dilatation (PD) remains an important procedural step to optimize valve function by resolving incomplete valve expansion, which may lead to paravalvular regurgitation and other potentially adverse effects. There are only limited data on the predictors, incidence, and clinical impact of PD during TAVI. Methods: This retrospective, single-center study analyzed 585 patients who underwent TAVI (2016–2022). Pre-procedural evaluations included transthoracic echocardiography and CT angiography to assess key parameters, including the aortic valve calcium score (AVCS); aortic valve calcium density (AVCd); aortic valve maximal systolic transvalvular flow velocity (AV Vmax); and aortic valve mean systolic pressure gradient (AV MPG). We identified imaging predictors of PD and evaluated associated clinical outcomes by analyzing procedural endpoints (according to VARC-3 criteria) and long-term survival. Results: PD was performed on 67 out of 585 patients, with elevated AV Vmax (OR: 1.424, 95% CI: 1.039–1.950; p = 0.028) and AVCd (OR: 1.618, 95% CI: 1.227–2.132; p = 0.001) emerging as a significant independent predictor for PD in TAVI. Kaplan–Meier survival analysis revealed no significant differences in short- and mid-term survival between patients who underwent PD and those who did not. Interestingly, patients requiring PD exhibited a lower incidence of adverse events regarding major vascular complications, permanent pacemaker implantations and stroke. Conclusions: The study highlights AV Vmax and AVCd as key predictors of PD. Importantly, PD was not associated with increased procedural adverse events and did not predict adverse events in this contemporary cohort. Full article

Cardiac devices have transformed the management of heart failure, ventricular arrhythmias, ischemic cardiomyopathy, and valvular heart disease. Technologies such as cardiac resynchronization therapy (CRT), conduction system pacing, left ventricular assist devices (LVADs), and implantable cardioverter-defibrillators have contributed to abated global cardiovascular risk through action onto pathophysiological processes such as mechanical unloading, electrical resynchronization, or hemodynamic optimization, respectively. While their clinical benefits are well established, their long-term molecular and structural effects on the myocardium remain under investigation. Cardiac devices dynamically interact with myocardial and vascular biology, inducing molecular and extracellular matrix adaptations that vary by pathology. CRT enhances calcium cycling and reduces fibrosis, but chronic pacing may lead to pacing-induced cardiomyopathy. LVADs and Impella relieve ventricular workload yet alter sarcomeric integrity and mitochondrial function. Transcatheter valve therapies influence ventricular remodeling, conduction, and coronary flow. Understanding these remodeling processes is crucial for optimizing patient selection, device programming, and therapeutic strategies. This narrative review integrates the current knowledge on the molecular and structural effects of cardiac devices, highlighting their impact across different disease settings. Full article

Background: Overcrowded emergency departments (EDs) create significant challenges for patient management and hospital efficiency. In response, Amiens Picardy University Hospital (APUH) developed the “Prediction of the Patient Pathway in the Emergency Department” (3P-U) model to enhance patient flow management. Objectives: To develop and clinically validate an explainable artificial intelligence (XAI) model for hospital admission predictions, using structured triage data, and demonstrate its real-world applicability in the ED setting. Methods: Our retrospective, single-center study involved 351,019 patients consulting in APUH’s EDs between 2015 and 2018. Various models (including a cross-validation artificial neural network (ANN), a k-nearest neighbors (KNN) model, a logistic regression (LR) model, and a random forest (RF) model) were trained and assessed for performance with regard to the area under the receiver operating characteristic curve (AUROC). The best model was validated internally with a test set, and the F1 score was used to determine the best threshold for recall, precision, and accuracy. XAI techniques, such as Shapley additive explanations (SHAP) and partial dependence plots (PDP) were employed, and the clinical explanations were evaluated by emergency physicians. Results: The ANN gave the best performance during the training stage, with an AUROC of 83.1% (SD: 0.2%) for the test set; it surpassed the RF (AUROC: 71.6%, SD: 0.1%), KNN (AUROC: 67.2%, SD: 0.2%), and LR (AUROC: 71.5%, SD: 0.2%) models. In an internal validation, the ANN’s AUROC was 83.2%. The best F1 score (0.67) determined that 0.35 was the optimal threshold; the corresponding recall, precision, and accuracy were 75.7%, 59.7%, and 75.3%, respectively. The SHAP and PDP XAI techniques (as assessed by emergency physicians) highlighted patient age, heart rate, and presentation with multiple injuries as the features that most specifically influenced the admission from the ED to a hospital ward. These insights are being used in bed allocation and patient prioritization, directly improving ED operations. Conclusions: The 3P-U model demonstrates practical utility by reducing ED crowding and enhancing decision-making processes at APUH. Its transparency and physician validation foster trust, facilitating its adoption in clinical practice and offering a replicable framework for other hospitals to optimize patient flow. Full article

Optical Coherence Tomography (OCT) is a further light-based intravascular imaging modality and provides a high-resolution, cross-sectional view of coronary arteries. It has a useful anatomic and increasingly physiological evaluation in light of coronary artery disease (CAD). This review provides a critical examination of the increased application of the OCT in assessing coronary artery physiology, beyond its initial mainstay application in anatomical imaging. OCT provides precise information on plaque morphology, which can help identify vulnerable plaques, and is most important in informing percutaneous coronary interventions (PCIs), including implanting a stent and optimizing it. The combination of OCT and functional measurements, such as optical flow ratio and OCT-based fractional flow reserve (OCT-FFR), permits a more complete assessment of coronary stenoses, which may provide increased diagnostic accuracy and better revascularization decision-making. The recent developments in OCT technology have also enhanced the accuracy in the measurement of coronary functions. The innovations may support the optimal treatment of patients as they provide more personalized and individualized treatment options; however, it is critical to recognize the limitations of OCT and distinguish between the hypothetical advantages and empirical outcomes. This review evaluates the existing uses, technological solutions, and future trends in OCT-based physiological imaging and evaluation, and explains how such an advancement will be beneficial in the treatment of CAD and gives a fair representation concerning other imaging applications. Full article

Extracorporeal cardiopulmonary resuscitation (ECPR) is an established intervention for select patients experiencing refractory cardiac arrest. Among modifiable predictors of survival and neurologic recovery during ECPR implementation, timely restoration of circulation remains critical in the setting of refractory cardiac arrest (CA). The in-hospital cardiac arrest (IHCA) setting is particularly amenable to reducing the low-flow interval through structured system-based design and implementation. Despite increasing utilization of ECPR, the literature remains limited regarding operational standards, quality improvement metrics, and performance evaluation. Establishing operational standards and performance metrics is a critical first step toward systematically reducing low-flow interval duration. In support of this aim, we conducted a comprehensive literature review structured around the Extracorporeal Life Support Organization (ELSO) framework for ECPR implementation. At each step, we synthesized evidence-based best practices and identified operational factors that directly influence time-to-circulation. Our goal is to provide a stepwise evaluation of ECPR initiation to consolidate existing best practices and highlight process components with potential for further study and standardization. We further evaluated the literature surrounding key technical components of ECPR, including cannula selection, placement technique, and positioning. Ongoing research is needed to refine and standardize each stage of the ECPR workflow. Developing optimized, protocol-driven approaches to ensure rapid, high-quality deployment will be essential for improving outcomes with this lifesaving but resource-intensive therapy. Full article