Search Results (1,883)

Background: Dermal interstitial fluid (ISF) contains both plasma-derived biomarkers and biomarkers unique to ISF, making it a promising biofluid for painless, scalable, and decentralized liquid biopsy and continuous health monitoring. However, efficient ISF collection remains challenging due to the small accessible fluid volume in the dermis, slow physiological turnover, and stratum corneum. Methods: This review reframes dermal ISF sampling as a pressure gradient engineering problem using Darcy’s law. We examine how vacuum-assisted microneedle platforms can effectively drive ISF through the dermal extracellular matrix in a minimally invasive manner. We compare the two architectures: micropore-based and hollow microneedle approaches. Results: In the micropore approach, a vacuum chamber is placed over the transient micropores left by withdrawn microneedles, supporting off-device, multi-omic downstream analyses of the collected ISF. The hollow microneedle approach retains the microneedles in the skin and applies vacuum through internal lumens, allowing integration of the vacuum source, microneedles, and biosensors into a single wearable platform for in situ biomarker detection. Comparative studies across these architectures identify the vacuum seal between the device and the skin as the major engineering bottleneck shared by both architectures. Conclusions: Vacuum-assisted microneedle platforms provide a practical route for generating pressure gradient-driven ISF transport while preserving minimally invasive skin access. Future development should prioritize device–skin vacuum seal robustness, reproducible ISF recovery across users and skin sites, integrated vacuum sources, scalable fabrication, and usability in clinical or at-home settings. Full article

Background: Magnetic resonance imaging (MRI) has a central role in acute ischemic stroke (AIS) and transient ischemic attack (TIA) diagnosis; however, conventional high-field MRI remains limited by infrastructure requirements, patient transport, and restricted accessibility. Low-field and portable MRI systems have emerged as potential solutions for point-of-care neuroimaging in emergency, intensive care, and resource-limited settings. Methods: A systematic review was conducted according to PRISMA 2020 guidelines. PubMed, Scopus, Web of Science, and Cochrane Library databases were searched from inception through May 2026. Studies evaluating low-field or portable MRI systems (≤0.55 T) in adults with AIS, TIA, sub-acute ischemic stroke, or suspected stroke were included. Diagnostic accuracy, feasibility, safety, workflow, and clinical utility outcomes were extracted. Risk of bias was assessed using QUADAS-2. Results: Eleven studies encompassing portable and low-field MRI platforms ranging from 0.064 T to 0.55 T were included. Portable MRI demonstrated feasibility in bedside ICU and emergency department settings without major device-related adverse events. Diagnostic performance varied by field strength, lesion size, and imaging protocol. Conclusions: Low-field and portable MRI show promising diagnostic potential for AIS and TIA, particularly when conventional MRI is unavailable, delayed, or impractical. However, current evidence is limited by small, predominantly single-center studies with substantial risk of bias, and further prospective multicenter validation is required before these technologies can be incorporated into routine clinical decision-making. Full article

An automated cartridge-based Vcheck M Canine Vector 8 Panel for qualitative detection of Leishmania spp. DNA in canine lymph node aspirates, an off-label specimen type, using laboratory qPCR as the comparator, was evaluated. Fifty-seven residual lymph node aspirate suspensions from dogs investigated for suspected canine leishmaniosis (CanL) were tested. Reference qPCR detected L. infantum DNA in 29 samples. Vcheck M was positive in 22/29 qPCR-positive samples and negative in 28/28 qPCR-negative samples, corresponding to positive percent agreement/sensitivity of 75.9% (95% CI, 56.5–89.7) and negative percent agreement/specificity of 100.0% (95% CI, 87.7–100.0). Agreement was substantial (Cohen’s kappa, 0.76), and discordance was asymmetric (McNemar p = 0.016). Vcheck-negative/qPCR-positive results were mainly observed at low qPCR parasite loads: 6/7 discordant samples contained ≤30 parasites/mL, whereas all samples with ≥500 parasites/mL were Vcheck positive. Among Vcheck-positive clinical samples, Vcheck Ct correlated inversely with log10 qPCR parasite load (Spearman rho = −0.77; p < 0.001). In a single-run dilution series, the lowest instrument-positive L. infantum standard was 10³ parasites/mL. Purified L. major, L. braziliensis, and L. tropica DNA were also detected. Vcheck M showed high specificity as a rapid rule-in test for Leishmania spp. detection in canine lymph node aspirates. However, negative results should not exclude infection in symptomatic or strongly suspected dogs and should be confirmed by qPCR, particularly when low parasite burden is plausible or when the result is critical for diagnostic or therapeutic decision-making. Full article

Background/Objectives: In patients without clinically anticipated difficulty, an unexpected difficult airway carries the greatest potential for harm, yet routine bedside tests exclude difficulty poorly, and evidence for point-of-care ultrasonography remains heterogeneous, with difficult mask ventilation rarely studied as a distinct outcome. We evaluated three rapid anterior-neck ultrasonographic parameters—tongue thickness (TT), skin-to-hyoid-bone distance (SHBD), and cricothyroid membrane length (CTML)—for their diagnostic performance and independent association with a difficult airway in adults without anticipated difficulty. Methods: In this prospective, single-center, diagnostic-accuracy study reported per STARD 2015 and STROBE, 713 adults (ASA I–III) underwent neutral-position measurement of TT, SHBD, and CTML by a sonographer blinded to the clinical assessment and airway-management outcomes. A composite difficult airway (difficult mask ventilation, laryngoscopy, or intubation) was assessed independently. Discrimination was evaluated by ROC analysis with DeLong comparisons, multivariable logistic regression, and bootstrap internal validation; p-values used Benjamini–Hochberg correction. Results: A difficult airway occurred in 197/713 patients (27.6%). TT and SHBD were associated with the composite outcome and all components (AUC 0.68–0.73) and remained independent after adjustment for age, sex, BMI, and Mallampati class; CTML discriminated poorly (AUC ≈ 0.55), with only marginal significance after correction. Negative predictive values were high (78–99%) but prevalence-dependent, with modest likelihood ratios. Adding TT and SHBD to clinical variables improved discrimination (AUC 0.69 → 0.78; DeLong p < 0.001). Conclusions: TT and SHBD show a limited but independent diagnostic signal that may complement, not replace, clinical screening; CTML showed no clinically meaningful discrimination in this cohort. Proposed cut-offs are exploratory and require standardized measurement, reproducibility testing, and external validation before clinical adoption. Full article

Rapid, point-of-care detection of Escherichia coli O157:H7 remains an unmet clinical need, as culture and molecular methods are slow and poorly suited to decentralized or emergency settings. A label-free, monolithic aptasensor biochip was fabricated in a standard 65 nm CMOS process, featuring three aptamer-functionalized gold sensing pads with matched reference pads for differential readout. A 37-mer DNA aptamer targeting the E. coli O157:H7 lipopolysaccharide was immobilized via thiol–gold self-assembled monolayer chemistry. Binding events were transduced into surface-potential shifts, amplified by an on-chip analog front-end (~100 V/V gain, 101.5 µW), and evaluated using calibration standards, patient specimens, and hospital environmental samples, with fluorescence microscopy for validation. The sensor achieved 47.42 mV/decade sensitivity across 1–10,000 CFU/mL, an IUPAC detection limit near 3.74 CFU/mL, and an empirical LOD of about 11 CFU/mL, with outputs tracking bacterial load and ~5.7% matrix-related deviation. Hospital samples were detectable to 28 CFU/mL. Because the patient-derived and hospital-acquired cohorts (n = 10 and n = 6, respectively) were assembled for pilot analytical and matrix-tolerance characterization rather than for diagnostic-accuracy determination, these results establish detectability and matrix robustness in real clinical and environmental specimens rather than clinical diagnostic sensitivity or specificity, which will require a larger, prospectively enrolled cohort in future work. Sensor kinetics followed Langmuir-type adsorption, saturating within 16–25 min for target pathogens versus slower responses for non-target strains. Selectivity tests against six bacterial species showed discrimination, with cross-reactivity decreasing from related E. coli pathotypes to Enterobacteriaceae to Gram-positive species. Inter-pad variability stayed below 1.5 mV, supporting this compact, low-power platform for scalable, enrichment-free point-of-care pathogen detection. Full article

Pathogenic bacterial infections remain a persistent global public health crisis. However, traditional clinical detection methods—such as culture-based assays and polymerase chain reaction (PCR)—are often time-consuming and labor-intensive, and they lack sufficient sensitivity for low-abundance pathogens, hindering rapid point-of-care diagnosis. With label-free, ultra-sensitive molecular fingerprinting, Surface-Enhanced Raman Scattering (SERS) has emerged as a powerful tool for rapid pathogen identification. This review summarizes the evolution of SERS-based bacterial detection from fundamental nanomaterials to integrated clinical diagnostic platforms. The article explores four core dimensions: functional integration and enrichment strategies of colloidal probes; structural design and multifaceted capture mechanisms of solid substrates; synergistic advantages of microfluidic systems in enabling automated “sample-to-answer” architectures; and the translational potential of SERS-based lateral flow assays (LFAs) for robust point-of-care testing (POCT). This review reveals a research shift from maximizing electromagnetic enhancement toward overcoming matrix effects in clinical samples and ensuring robustness. In synergy with microfluidics, LFAs, and AI, SERS technology is bridging the bench-to-bedside gap, offering a roadmap for next-generation decentralized, high-precision diagnostics. Full article

Portable sensing systems are increasingly important in biological and chemical analyses because they can provide analytical information at the point of decision-making. While traditional laboratory methods remain crucial for reference measurements, regulatory validation, and high-precision quantification, portable systems emphasize rapid response, convenience, cost-effectiveness, robustness, and relevance to decision-making. This paper views portable sensing systems as integrated analytical platforms rather than isolated sensing elements. The paper discusses recognition elements, including enzymes, antibodies, nucleic acid probes, aptamers, molecularly imprinted polymers, nanomaterials, and hybrid recognition interfaces, as well as electrochemical, optical, mass-sensitive, thermal, field-effect, and hybrid sensing technologies. Furthermore, this paper reviews platform designs, including paper-based analytical devices, chip lab systems, smartphone-assisted sensors, wearable and flexible sensors, handheld instruments, and wireless sensor networks. It explores their applications in sample handling, calibration, data processing, and field deployment. Applications of this technology include point-of-care diagnostics, pathogen detection, wearable health monitoring, agriculture, veterinary medicine, environmental monitoring, food safety, industrial process control, forensic analysis, public safety, and occupational exposure assessment. The report focuses on sample acquisition, miniaturized preparation, reagent storage, matrix interference, calibration transfer, signal conditioning, machine learning, cloud platforms, analytical validation, and decision support. Furthermore, it identifies key obstacles to translating academic prototypes into industrial products, including reproducibility, stability, manufacturability, ease of use, cybersecurity, regulatory approval, and market acceptance. Future development requires fully integrated sample-to-result systems, multimodal sensing, artificial intelligence, sustainable single-use materials, self-powered devices, and system-level validation under real-world operating conditions. Full article

Background: Artificial intelligence (AI) is increasingly being integrated into modern dental practice, particularly in diagnostics, radiographic analysis, treatment planning, and practice management. Despite the rapid advancement of AI-based technologies, evidence regarding dentists’ attitudes toward AI in Central and Eastern Europe remains limited. This study aimed to evaluate Polish dentists’ attitudes toward artificial intelligence in contemporary dental practice and to investigate differences in AI acceptance according to sex, age group, and dental specialty. Materials and Methods: A cross-sectional online questionnaire-based study was conducted among licensed dentists practicing in Poland. An anonymous questionnaire comprising 15 attitude statements rated on a five-point Likert scale was distributed through professional social media groups. The survey assessed attitudes toward the use of AI in clinical, diagnostic, and administrative aspects of dentistry. Statistical analyses were performed using Statistica 16.0. Group comparisons were conducted using the Mann–Whitney U test and Kruskal–Wallis test with Benjamini–Hochberg false discovery rate correction. Internal consistency of the questionnaire was assessed using Cronbach’s alpha coefficient. Results: A total of 183 completed questionnaires were included in the analysis. The internal consistency of the questionnaire was high (Cronbach’s α = 0.900). The overall acceptance of AI was moderate (mean score: 3.18 ± 0.73). The highest levels of agreement were observed for the perceived potential of AI to improve dental practice management (mean = 4.05) and for general openness toward AI implementation in dentistry (mean = 4.05). Respondents also expressed a high willingness to use AI for generating clinical documentation (mean = 3.69). In contrast, the lowest acceptance was observed for statements suggesting that AI could replace dentists (mean: 1.36). Within the study sample, men demonstrated significantly higher overall AI acceptance than women (p < 0.001). Significant differences were also observed between age groups and dental specialties. Orthodontists demonstrated the highest AI acceptance among the surveyed specialties; however, these findings should be interpreted as exploratory because of unequal subgroup sizes. After FDR correction, significant differences between age groups remained only for selected questionnaire items. Conclusions: Within the limitations of this convenience sample, the findings suggest that Polish dentists generally perceive artificial intelligence as a supportive tool rather than a replacement for clinicians. Acceptance was greatest for administrative and organizational applications of AI, whereas autonomous clinical decision-making received substantially lower support. These findings suggest that the successful implementation of AI in dentistry should prioritize assistive technologies that enhance clinical workflows while preserving the central role of the dentist in patient care. Full article

Background: Rapid antigen tests were widely utilised during the COVID-19 pandemic to expand diagnostic access in resource-limited settings. However, prospective evaluations under intended-use conditions remained essential to define their role in decentralised testing strategies. Methods: We conducted a prospective multi-provincial clinical evaluation of the Panbio™ COVID-19 Antigen Rapid Test Device in South Africa between July 2021 and January 2022. Paired nasal and nasopharyngeal swabs were collected from 609 participants across three geographically diverse South African provinces. Antigen test results were compared with standard-of-care TaqPath RT-PCR, with BD MAX™ RT-PCR included as a secondary molecular comparator. Performance was assessed by viral load, symptom status, and variant predominance periods. Results: Standard-of-care RT-PCR identified 136 positive cases (22.3% prevalence). The Panbio™ test demonstrated overall sensitivity of 80.1% (95% CI: 72–87) and specificity of 98.5% (95% CI: 97–99). Sensitivity reached 90.1% in specimens with Ct values ≤25 and 85.2% among symptomatic participants tested within seven days of onset but declined at Ct values ≥30 and in asymptomatic individuals. Performance remained consistent during Delta- and Omicron-predominant periods. Discussion: The Panbio™ RDT demonstrates high diagnostic accuracy for detecting SARS-CoV-2 in individuals with high viral load, supporting its use for rapid identification of infectious cases during transmission surges. Molecular testing remains necessary for low viral load infections and asymptomatic screening. Full article

Background/Objectives: Type 2 diabetes mellitus (T2DM) has been evaluated through a glucocentric model centered on hyperglycemia, glycated haemoglobin (HbA1c) targets, and complications. However, obesity-associated T2DM reflects a broader metabolic ecosystem in which glycemic control interacts with adiposity, inflammation, muscle function, renal stability, and treatment mechanisms. Therapeutic response may be better captured through patient-level responder phenotypes than through mean changes in isolated outcomes. We aimed to determine, in adults with obesity-associated T2DM maintained on stable 12-month metformin-based regimens, the distribution of concordant versus discordant glycemic–adiposity response phenotypes and the frequency of high multidimensional response, and to describe how these phenotypes were distributed across treatment classes. Methods: This secondary patient-level analysis used a real-world cohort from a Bucharest tertiary diabetes center. Of 291 screened adults, 166 completed 12-month follow-up without treatment change. Regimens included metformin alone or combined with sulfonylurea, DPP-4 inhibitor, SGLT2 inhibitor, GLP-1 receptor agonist, or insulin. Responses were defined as HbA1c reduction ≥ 0.5 percentage points, fat mass reduction ≥ 5%, hs-CRP reduction ≥ 20%, and handgrip strength decline ≤ 1 kg. Primary phenotypes and a 0–4 multidimensional score were derived. Results: Mean age was 59.7 ± 13.0 years, BMI 36.3 ± 4.4 kg/m², and baseline HbA1c 8.9 ± 1.0%. Glycemic–adiposity, glycemic-only, adiposity-only, and low/non-response phenotypes occurred in 49 (29.5%), 88 (53.0%), 9 (5.4%), and 20 (12.0%) patients, respectively. A high multidimensional response occurred in 78 (47.0%), and complete response in 25 (15.1%). GLP-1 receptor agonists showed the most consistent concordant glycemic–adiposity response, whereas insulin was predominantly glycemic-only. Conclusions: In obesity-associated T2DM, therapeutic response was heterogeneous and frequently discordant across metabolic domains. Patient-level responder phenotyping may complement conventional HbA1c-centered evaluation by identifying response quality across glycemic, adiposity, inflammatory, and functional dimensions. This approach may support more individualized diagnostic interpretation and treatment optimization in real-world diabetes care. Full article

Within the Diagnostic Criteria for Temporomandibular Disorders, masticatory myalgia is framed around muscle hyperactivity, yet a recognizable subgroup shows the opposite profile—low muscle tone, fatigue, masticatory pain, and a persistent sense that the bite no longer fits, without structural dental change—and responds poorly to conventional conservative care. We introduce G-SCORE (Gum-chewing-mediated Sensorimotor Calibration of Occlusion through Rhythmic Exercise), a proprioceptive recalibration strategy delivered as a bilateral gum-chewing (BGC) protocol: two equal halves of one sugar-free gum chewed simultaneously and symmetrically on both posterior segments in short, patient-titrated sessions, delivering balanced, rhythmic, low-load input to the trigeminal sensorimotor system. In a retrospective series of 41 patients, we characterized within-subject changes in pain, mandibular mobility, and occlusal parameters. Masticatory pain fell from 5.0 ± 2.9 to 0.7 ± 0.9 (0–10; n = 27; p < 0.001; r = 0.87), with 85% achieving a ≥2-point reduction. Occluding tooth positions and mouth opening also recovered; in an anterior open-bite subgroup, overbite improved (n = 6; p = 0.031). The observed changes were dominated by pain relief and restored bilateral occlusal contact rather than by raw force—a pattern more compatible with sensorimotor recalibration than with muscle hypertrophy. This low-cost, non-invasive technique may help selected patients avoid irreversible occlusal treatment. Full article

Rapid and accurate identification of Candida species is critical for guiding antifungal therapy, especially with the emergence of intrinsically resistant pathogens. However, diagnostics using culture-based methods remain slow and labor-intensive, limiting timely treatment decisions. This systematic review evaluated the diagnostic performance and clinical applicability of nucleic acid amplification tests (NAATs) for Candida species identification using a PubMed search completed on 23 June 2025. A total of 888 records were screened, 333 full-text articles were assessed, and 158 studies were included based on criteria including comparison with standard diagnostic methods, diagnostic performance reporting, and involvement of clinical samples. PCR-based approaches were the most widely used, including conventional, nested, multiplex, real-time, and droplet digital PCR. Isothermal methods such as loop-mediated isothermal amplification (LAMP) and recombinase polymerase amplification (RPA) were increasingly represented. Common molecular targets included the ITS and 18S/28S rDNA regions. The risk of bias assessment was completed with the QUADAS-2 tool. Diagnostic performance varied depending on assay design, specimen type, gene target, and reference method. Excellent specificity and low limits of detection were achieved, especially with isothermal platforms offering the shortest turnaround times and greatest potential for point-of-care implementation. Multiplex assays were particularly advantageous for detecting mixed-species samples, while highly specific assays were optimal for distinguishing clinically important species such as Candidozyma auris, Nakaseomyces glabratus, and Pichia kudriavzevii. Overall, NAATs represent a promising diagnostic tool for Candida species identification, but broader clinical adoption will require improved standardization, validation across diverse patient populations, and clearer interpretation of fungal burden in the context of colonization versus infection. Full article

Brain plasticity is often described as the capacity of the nervous system to change in response to development, experience, injury, disease, or treatment. That definition is useful, but it can obscure two clinically important points: plasticity is biologically constrained, and change is not always beneficial. This narrative review examines sex-dependent brain plasticity as a context-sensitive process rather than as a simple male–female contrast. We distinguish four operational outcomes of plasticity: (i) reparative plasticity, which restores structure or function; (ii) compensatory plasticity, which preserves performance through alternative or more costly strategies; (iii) insufficient plasticity, in which reorganization is too weak or unstable to sustain function; and (iv) maladaptive plasticity, in which plastic change reinforces dysfunction, pain, excitability, rigidity, or decline. We also define adaptive reserve as the integrated capacity of neural, glial, vascular, immune, metabolic, endocrine, and gene-regulatory systems to support useful reorganization under stress. The review evaluates endocrine, synaptic, neuroimmune, mitochondrial, vascular, stress-related, and epigenetic mechanisms, indicating where evidence for sex-dependent effects is relatively strong and where it remains indirect, inconsistent, or context-dependent. Disease examples include autism spectrum disorder, attention-deficit/hyperactivity disorder, epilepsy, intellectual disability, Alzheimer’s disease, Parkinson’s disease, amyotrophic lateral sclerosis, Huntington’s disease, traumatic and ischemic injury, multiple sclerosis, chronic pain, aging, and systemic metabolic or inflammatory disorders. Throughout, biological sex is separated from gender-related social, diagnostic, and health-care determinants. We conclude that therapeutic strategies should not aim simply to enhance plasticity, but to guide it by matching intervention, timing, dose, biological readiness, and monitoring to the patient’s adaptive state. Full article

Background and Objectives: Despite evidence demonstrating the advantages of rheumatology-led point-of-care (POC) polarised light microscopy (PLM), it remains underutilised in many hospital settings. We aimed to identify barriers to its use and assess typical caseloads of crystal arthropathy, diagnostic methods and frequency of rheumatology-led POC PLM in practice in Ireland. We also assessed reliance on laboratory-led crystal analysis and the turnaround time for results to be reported. Solutions to improve implementation of rheumatologist-led POC PLM were also explored. Material and Methods: We surveyed 29 rheumatologists registered to the Irish Society of Rheumatology via SurveyMonkey, between May and October 2024. Textual responses were categorised into key themes, and word clouds were generated using Tagcrowd to visualise thematic content. Results: Fifty-five percent of respondents faced challenges using POC PLM for crystal analysis. Common barriers included lack of access to a microscope, lack of a polarising light function and lack of training in performing and interpreting of PLM. Fifty-two percent of rheumatologists highlighted the critical need for accessible and functional microscopes. Ninety-two percent of respondents relied on in-house laboratory crystal analysis. Thirty-two percent received inaccurate or incomplete results from laboratory reports and 28% of respondents reported delays in sample analysis from the laboratory. Laboratory turnaround was 1–2 days for 43% of rheumatologists and 3–5 days for 33%. Sixty-nine percent had not received training on PLM and 48% emphasised the need for improved education on POC PLM, including improved integration into the national rheumatology training. Conclusions: Rheumatology-led POC PLM remains underutilised despite its clinical advantage primarily due to equipment and training deficits. Addressing these barriers through improved infrastructure, education and equipment is essential to ensure effective and timely care for patients with crystal arthropathy. Full article

Trap–neuter–return (TNR) programs are the leading non-lethal approach to managing free-roaming cat populations. When cats are anesthetized for surgical sterilization, veterinarians have a brief opportunity to obtain blood samples for pre-surgical screening, infectious-disease surveillance, and contribution to population-level reference-interval research. Field conditions, however, make collecting good-quality blood samples difficult: cats are often dehydrated and stressed, the procedure is kept brief, and their medical history is unknown. This narrative review draws on the American Society for Veterinary Clinical Pathology (ASVCP) reference-interval guidelines, feline anesthesia and the blood-collection literature, and operational experience from Portuguese TNR programs to describe seven points in the sampling workflow at which technique most often fails: anesthetic depth verification, controlled aspiration speed, immediate EDTA-tube mixing, post-venipuncture hemostasis, hemolysis recognition, precise FIV/FeLV point-of-care test timing, and adherence to a maximum-attempts limit. Three recurrent failure modes—collapsed veins from excessive aspiration, clotted EDTA samples from inadequate mixing, and hematoma formation from insufficient hemostasis—account for the majority of poor samples observed in routine practice. The framework presented here is intended to support reproducible, welfare-compliant sample collection during TNR operations, giving veterinary teams a single, structured reference that supports both animal welfare and the diagnostic value of the samples they collect. Full article