Search Results (10,268)

Background/Objectives: This study assessed the reliability of the Barrett True-K formula in patients who had undergone laser-based corneal refractive surgery by comparing outcomes using measured vs. predicted posterior corneal astigmatism (PCA) within the Barrett True-K No History formula. Methods: We selected 49 eyes out of 41 patients with a history of uncomplicated laser visual correction (LVC) that underwent cataract surgery between 2020 and 2024. The Front K1 and K2, the Back K1 and K2, the anterior chamber depth, the lens thickness, the horizontal white-to-white, and the central corneal thickness were measured using Pentacam. The axial length was measured using the IOL Master 500 or NIDEK AL-Scan. These data were then imported into the freely available online Barrett True-K calculator for post-LVC eyes, and the postoperative results were compared with the predicted IOL target. The cumulative distribution of the refractive prediction error, absolute refractive prediction error, and refractive prediction error were calculated as the difference between the postoperative spherical equivalent and the expected spherical equivalent for both the predicted and measured PCA calculations. Results: The results suggest improved accuracy with the Barrett True-K formula when incorporating measured PCA values, supporting the use of corneal tomography for optimized refractive outcomes in post-LVC cataract patients. Conclusions: It is always advisable to measure the posterior corneal surface using corneal tomography in all patients who have undergone LVC to achieve better refractive outcomes after cataract surgery. Full article

Postoperative pain management after hospital discharge remains one of the main clinical challenges. The use of digital and telemedicine tools offers new opportunities for the continuous monitoring of, and timely intervention in, patients discharged and followed at home. This scoping review, conducted according to the PRISMA-ScR checklist and the Joanna Briggs Institute methodology, analyzed 26 studies selected through a search of PubMed, Scopus, and Web of Science databases. Inclusion criteria comprised studies published between 2015 and 2025 that involved patients discharged home after surgery, that used digital or telemedicine tools for pain management, and that included active involvement of healthcare professionals and reported clinical outcomes. Studies show the use of a variety of digital tools, including mobile applications, web platforms, wearable sensors, automated messaging systems, and virtual reality technologies, alternating across settings for the assessment and management of pain at home, educational and therapeutic support, and to enhance communication between healthcare professionals and patients. Most reported outcomes focus on improved home-based pain control, a reduction in opioid consumption, and a high level of patient satisfaction. However, some challenges remain, particularly the low level of digital literacy among certain segments of the population. In conclusion, the implementation of telemedicine and digital technologies for managing postoperative pain at home proves to be a promising strategy. Nonetheless, it requires further scientific investigation and, from policymakers, significant investments in professional training and technological infrastructure to ensure an increasingly equitable and sustainable distribution of home healthcare services. Full article

Objectives:The purpose of the study is to determine whether FOXL2 circulating tumor DNA can be used as a prognostic biomarker and marker for monitoring treatment response in patients with an adult-type granulosa cell tumor (aGCT). Methods: Plasma samples of patients included in the multicenter GRANULOSA study were collected before and after surgery for primary or recurrent aGCT, during follow-up, and during systemic treatment. The presence of ctDNA containing the FOXL2 402C>G mutation was analyzed in 284 samples from 20 primary and 34 recurrent aGCT patients, using digital droplet PCR. Clinical data were retrieved from electronic patient records, and patients were followed through January 2025. Results: FOXL2 mutant ctDNA was detected in 28 of 54 patients (48%). In primary aGCT, recurrences were more frequently seen in patients with detectable ctDNA (33% vs. 18%), and ctDNA remained detectable postoperatively in some cases despite complete cytoreduction. In recurrent aGCT patients, detectable ctDNA was associated with significantly worse overall survival (p = 0.023), and the postoperative presence of ctDNA following complete debulking surgery was significantly associated with a shorter recurrence-free survival (4.7 vs. 11.6 months, p = 0.025). Conclusions: FOXL2 mutant ctDNA could be a prognostic biomarker in aGCT, being associated with worse overall survival in recurrent aGCT patients. In addition, the presence of ctDNA after surgery could reflect the presence of minimal residual disease, negatively impacting the disease course. The implementation of FOXL2 ctDNA measurement in clinical practice may help to identify high-risk aGCT patients. Full article

Dysthyroid optic neuropathy (DON) represents a severe ocular complication in thyroid eye disease (TED) that can lead to vision loss. Although surgical decompression is a well-established treatment modality, the optimal decompression area remains controversial in orbital decompression surgery. Purpose: This study aims to develop and validate a finite element analysis (FEA) model of DON to compare the biomechanical behavior between patients undergoing conventional or augmented orbital decompression surgery, with potential clinical implications for surgical planning. Methods: FEA models were established using magnetic resonance imaging data from patients with myopathic TED. Pre-disease, preoperative, and postoperative FEA models were developed for both the conventional orbital decompression group and the augmented group, in which the posteromedial floor and the orbital process of the palatine bone were additionally removed to analyze the stress distribution and displacement of the optic nerve, eyeball, and orbital wall. A retrospective analysis was performed to validate the biomechanical analysis results. Results: The FEA results reveal that DON patients experience higher stress on the optic nerve, eyeball, and orbital wall than healthy individuals, mainly concentrated at the orbital apex. Postoperatively, the stress on the optic nerve was significantly reduced in both groups. In addition, postoperative stress on the optic nerve was significantly lower in the augmented group than in the conventional group. The clinical results demonstrate that patients in the augmented group experienced significantly faster and more pronounced improvements in visual acuity and visual field. Conclusions: FEA shows that augmented orbital decompression surgery can alleviate stress more effectively, especially for the optic nerve, which was validated by clinical analysis. This developed FEA model of DON may facilitate determining the appropriate surgical procedure for orbital decompression. Full article

Background/Objectives: Congenital rubella syndrome (CRS) is an infection caused by rubella virus transmitted to the fetus during pregnancy, which can cause congenital hearing loss. Cochlear implant can be an effective therapy in patients with severe to profound bilateral hearing loss. The aim of this study was to evaluate the benefits of cochlear implantation in patients with profound hearing loss caused by congenital rubella syndrome. Methods: In total, 38 patients with profound hearing loss caused by intrauterine rubella virus infection were considered for cochlear implantation. Patients ranged in age from 8 to 72 years on the day of surgery, with a mean age of 27 years and median of 25 years (SD = 13.2). Preoperatively, all patients underwent pure-tone audiometry, and free-field speech audiometry was conducted in a quiet environment with the patient wearing a fitted hearing aid. Postoperatively, patients underwent pure-tone audiometry to assess residual hearing, and free-field speech audiometry was conducted when the patients had an active implant. Results: The average preoperative hearing threshold (averaged across the seven frequencies from 0.125 to 8 kHz) was 99.2 dB HL (SD = 6.79), while the average postoperative hearing threshold was 103.4 dB HL (SD = 5.74). Twelve months after the operation, patients achieved a WRS in quiet scores ranging from 10% to 90%, with an average of 59.1% and median of 70% (SD = 25.8). Conclusions: Rubella during pregnancy can lead to severe congenital defects, with sensorineural hearing loss being the most common. Cochlear implants appear to be an effective treatment for profound hearing loss caused by congenital rubella syndrome. Full article

Background/Objectives: The Visual Function and Corneal Health Status (V-FUCHS) questionnaire assesses vision-related quality of life in patients affected by Fuchs endothelial corneal dystrophy (FECD) through 15 items, which are divided into the “visual acuity (VA) Factor” and “glare Factor” domains. The purpose of this study was to translate and validate the Italian version of the V-FUCHS instrument. Methods: The original V-FUCHS questionnaire was translated into Italian using certified forward and backward translation methods and administered to patients with FECD undergoing a unilateral or bilateral Descemet membrane endothelial keratoplasty (DMEK) for FECD and healthy controls. Its test–retest reliability was assessed by administering the questionnaire twice, four weeks apart. Modified Krachmer grade, best-corrected visual acuity (BCVA) and central corneal thickness (CCT) were also measured. Results: A total of 74 participants, aged 45 to 83 years, were prospectively enrolled and divided into five subgroups: mild-to-moderate FECD (n = 18), advanced FECD (n = 15), unilateral DMEK (n = 9), bilateral DMEK (n = 12), and healthy controls (n = 20). Retest reliability confirmed the consistency and agreement of their responses (intraclass correlation coefficient > 0.90 for both factors). The Italian V-FUCHS effectively discriminated between different stages of FECD severity, with significant differences in VA and glare factor scores across all subgroups (p < 0.001). While both BCVA and CCT showed correlations with V-FUCHS scores, only the association between the VA factor and BCVA was statistically significant (p < 0.05), indicating that the VA factor meaningfully reflects patients’ measured VA. Conclusions: The proposed Italian version of the V-FUCHS questionnaire is a valid and reliable tool for assessing visual disability in patients with FECD before and after DMEK. This instrument may aid in optimizing endothelial keratoplasty timings and evaluating postoperative symptomatic improvements in FECD patients. Full article

The incidence of surgical site infection (SSI) following mastectomy in female dogs remains poorly characterized, despite its relevance to postoperative outcomes and patient welfare. This retrospective cohort study aimed to determine the incidence of SSI and identify associated clinical and surgical risk factors in dogs undergoing mastectomy procedures at a veterinary teaching hospital between 2013 and 2022. SSI diagnosis was based on the Centers for Disease Control (CDC) criteria and identified structured passive surveillance of medical records. Univariate logistic regression was carried out to screen for potential risk factors, followed by multivariate analysis of selected variables. Among 376 mastectomy procedures performed in 306 dogs, 33 SSIs were detected, resulting in an overall incidence of 8.8% (95% CI: 6.1–12.1). The majority were superficial infections (93.9%), with only two cases classified as deep SSI; no organ/space infections were recorded. Prolonged anaesthesia duration (p = 0.041) and intraoperative hypothermia (p = 0.026) were independently associated with increased SSI risk. These findings indicate that the incidence of SSI after canine mastectomy is comparable to that reported for other clean surgeries. Prolonged anaesthesia and hypothermia represent modifiable risk factors, highlighting the importance of perioperative temperature control and optimized anaesthetic management. No significant associations were observed with patient-related variables, mastectomy type, or wound soaker catheter use, supporting its safe inclusion in multimodal analgesia. Full article

Background/Objectives: Postoperative pain occurs in approximately 80% of patients undergoing surgery. Although opioids remain the mainstay of postoperative pain management, their side effects have led to the development of multimodal analgesia strategies that aim to limit their use. Some studies have shown a correlation between vitamin C supplementation and a reduction in postoperative pain. The aim of this review was to describe the effect of vitamin C administration on postoperative pain intensity and opioid consumption. Methods: A systematic review was conducted in the fourth quarter of 2024. Results: Two authors systematically searched PubMed, CINAHL, Web of Science, and Cochrane Library databases. A total of 14 studies were included in the analysis. In these studies, the visual analog scale (VAS) was most often used to assess the postoperative pain intensity. In all studies, regardless of the measurement time, a reduction in the pain intensity was demonstrated compared to control or placebo groups. The analysis showed that intraoperative or preoperative vitamin C infusion reduced opioid consumption. The administered vitamin C doses ranged from 1 g to 3 g or 50 mg/kg intravenously during the perioperative period. Conclusions: The results showed a reduction in opioid requirements and pain intensity in patients receiving perioperative vitamin C, suggesting that vitamin C can be incorporated into multimodal postoperative analgesia strategies for surgical patients. Full article

Three-dimensional (3D) printing has gained substantial interest among scientists and surgeons over the past decade due to its broad potential in medical applications. Its clinical utility has been increasingly recognized, demonstrating promising outcomes for patient care. Currently, 3D printing technology enables surgeons to enhance operative precision by facilitating the creation of patient-specific anatomical models, customized implants, biological tissues, and even surgical instruments. This personalization contributes to improved surgical outcomes, reduced operative times, and shorter postoperative recovery periods. Furthermore, 3D printing significantly aids in the customization of prostheses to conform closely to individual anatomical structures. Beyond therapeutic applications, 3D printing serves as a valuable educational tool in medical training. It enhances case-specific visualization, elucidates fracture mechanisms, and provides tangible models for simulation-based practice. Although the use of 3D printing might be seen as useful mostly in orthopedics, it has expanded into multiple medical specialties, including plastic surgery, dentistry, and emergency medicine. Presently, 3D-printed constructs are routinely employed for preoperative planning, prosthetic development, fracture management, and the fabrication of patient-specific surgical tools. Futuristically, the integration of 3D printing into clinical practice is expected to play a pivotal role in the advancement of personalized medicine, offering substantial benefits for both healthcare providers and patients. Full article

Endometriosis is a chronic, hormone-dependent disorder characterized by an inflammatory response. The disease affects approximately 10% of the general female population, with prevalence rates reaching 30–40% in women with dysmenorrhea and 50–60% in those experiencing infertility. In addition to pelvic pain and reproductive issues, gastrointestinal symptoms, such as acute abdominal pain, constipation, diarrhea, or alternating bowel habits, are frequently reported and can be highly disabling. Emerging evidence indicates that dietary patterns may modulate the inflammatory environment associated with endometriosis, potentially influencing symptom severity by affecting oxidative stress, estrogen metabolism, and levels of sex hormone-binding globulin (SHBG). Diets rich in antioxidants, polyunsaturated fatty acids (PUFAs), and vitamins D, C, and E—alongside the avoidance of processed foods, red meat, and animal fats—may offer beneficial effects. This narrative review explores the relationship between nutrition and endometriosis, emphasizing the therapeutic potential of dietary interventions as a complementary strategy. Notably, dietary approaches may serve not only to alleviate pain and improve fertility outcomes but also to reduce lesion growth and recurrence, particularly in patients seeking pregnancy or those unable to undergo hormonal therapy due to contraindications. Furthermore, nutritional strategies may enhance postoperative recovery and act as a viable first-line therapy when conventional treatments are not applicable. A total of 250 studies were initially identified through PubMed and Scopus. After removing duplicates and non-relevant articles, 174 were included in this review. Our findings underscore the urgent need for further studies to develop evidence-based, personalized nutritional interventions for managing endometriosis-related symptoms. Full article

Background: Arthroscopic rotator cuff repair faces high retear risks in multi-tendon injuries due to insufficient biological healing; leukocyte-rich PRP may enhance tendon–bone integration through inflammatory modulation and growth factor release. Methods: Four databases including PubMed, Embase, Cochrane Library, and Web of Science were searched until March 2025. Literature screening, quality evaluation, and data extraction were performed according to inclusion and exclusion criteria. GRADE was used to grade the strength of the evidence and the results. Results: The main finding of this study was that leukocyte-rich platelet-rich plasma combined with arthroscopic surgery for rotator cuff injuries can improve the Constant Score (MD = 1.13, 95% CI: 0.19, 2.07, p = 0.02, I² = 47%), American Shoulder and Elbow Surgeons score (MD = 6.02, 95% CI: 4.67, 7.36, p < 0.01, I² = 0%), and University of California, Los Angeles score (MD = 1.20, 95% CI: 0.34, 2.06, p < 0.01, I² = 0%) of patients with rotator cuff tear after treatment, and reduce the postoperative Visual Analog Scale score (MD = −0.62, 95% CI: −1.16, −0.08, p = 0.02, I² = 83%) of patients. However, there were no statistical differences regarding the Simple Shoulder Test (MD = 0.08, 95% CI: −0.23, 0.39, p = 0.61, I² = 5%). Conclusions: Based on current evidence, the use of LR-PRP in arthroscopic rotator cuff repair could lessen postoperative pain and improve postoperative functional scores in individuals with rotator cuff injuries. Full article

Introduction: Adequate protein intake is essential for maintaining lean body mass during weight loss, particularly for patients undergoing bariatric surgery (BS). Whey protein supplementation may help meet daily protein requirements. This study aimed to assess the effects of whey protein supplementation on weight loss and body composition in women during the medium-term postoperative phase following BS. Methods: In a double-blind, controlled study over four weeks, 24 women received 30 g of whey protein (Whey group), while 19 received 30 g of maltodextrin (Malto group). Body composition, energy expenditure, muscle thickness, muscle strength, walking performance, and dietary intake were evaluated. Results: Compared to the Malto group, the Whey group showed greater reductions in body weight (median: −0.6 kg vs. −0.2 kg, respectively) and fat mass (median: −1.1 kg vs. −0.25 kg, respectively), along with an increase in fat-free mass (−0.7 kg vs. 0.6 kg, respectively). Muscle thickness improved in the Whey compared to the Malto group in the abdominal (0.07 mm vs. −0.04 mm, respectively) and thigh (0.4 mm vs. −0.15 mm, respectively) regions. Additionally, muscle mass reduction was less pronounced in the Whey group (−3 kg vs. −0.13 kg). No significant differences were observed in handgrip strength, gait speed, or nutrient intake. Conclusions: Whey protein supplementation may be beneficial, as it enhances weight loss and preserves fat-free and muscle mass more effectively than a diet without this supplementation in women during the stabilization phase or late postoperative period of BS. Full article

Background: Spinal arachnoid cyst development (SAC) is a rare and debilitating disease with a non-well-defined treatment strategy: a series of five patients diagnosed with SAC and submitted to neurosurgical treatment was retrospectively analyzed. Objectives: SACs represent 1–2% of all spinal neoplasms; they can be extradural, intradural, or intramedullary, with intradural arachnoid cysts (IDACs) comprising only 10% of these cases. The rarity of SACs and the lack of consensus on the best treatment strategies represent a care challenge: the aim of this study is to explore the effectiveness and outcomes of the neurosurgical management in patients with SACs treated at our institution. Methods: Adult patients who underwent surgical treatment for SACs between January 2020 and December 2023 were included in the study: clinical onset, imaging, surgical technique, and neurological long-term status were retrospectively analyzed. Results: Five patients (three males, two females; average age 53.4 years) were included. The most common symptoms described were paresthesia, gait disturbances, and back pain. Radiological imaging indicated that most cysts were at the thoracic level. Surgical interventions primarily involved cyst resection and adhesiolysis. Post-operative outcomes showed overall improvement or stability in Karnofsky Performance Status (KPS) and American Spinal Injury Association Impairment Scale (ASIA) scores in the majority of cases, although complications and recurrences occurred. Conclusions: Surgical resection combined with adhesiolysis may prevent the worsening of neurological impairment and potentially improve pain control and clinical outcomes in patients with SACs. However, careful and tailored management is required due to the high potential of complications and recurrences. Full article

Background: Looking for anomalies and vascular control gains a central role in colon cancer surgery. Complete mesocolic excision (CME) presents technical challenges, primarily due to the considerable variability in the arterial configuration of the right colon. The importance of understanding colonic vascular anatomy has become more prominent with the adoption of this surgical technique. The aim of this study is to systematically review the vascular anatomical variations in the superior mesenteric artery (SMA) in the setting of extended lymphadenectomy for CME in right colon cancer and to show its impact in clinical practice. Methods: A systematic review of the literature on Medline (PubMed), Web of Science (WOS), and Scopus was performed according to PRISMA guidelines. The following criteria were set for inclusion: (1) studies reporting minimally invasive (robotic, laparoscopic, and hybrid techniques) or open CME/D3 lymphadenectomy; (2) studies reporting patients with right-sided colon cancer; (3) studies reporting the description or illustration of SMA variations. The methodological quality of all included studies was evaluated using the Newcastle–Ottawa Scale (NOS). Results: After the literature search, 800 studies were recorded, 31 studies underwent full-text reviews, and 9 studies met the inclusion criteria. All studies reported vascular variations in SMA, and the total number of patients was 813. No intraoperative complications were reported. In 6.4% of patients, post-operative bleeding occurred. Conclusions: Vascular anatomical variations are not a rare entity. In experienced centers, vascular anomalies are not associated with an increase in complications, both in traditional open and minimally invasive surgery (MIS). However, in MIS, full access to central vessels and intraoperative vascular control, moderate retraction, safety maneuvers, and accurate vascular dissection are mandatory. Full article

Malnutrition is one of the stronger predictors of morbi-mortality in end-stage kidney disease patients. Moreover, malnutrition in hospitalized patients severely affects multiple clinical outcomes, increasing the risk of complications. The Nutritional Risk Index and Geriatric Nutritional Risk Index are indexes used to evaluate the risk of malnutrition in hospitalized adults, which have been validated for dialysis patients and have been reported to be a validated prognostic index of nutrition-related morbidity and mortality. Objectives: The aim of this study is to evaluate the prevalence of early postoperative infections and their possible relationship with malnutrition in renal transplantation. Methods: We conducted a retrospective observational study, including all patients who received a kidney transplant, a total of 140, between January 2020 and December 2023, at a tertiary-level Spanish hospital. Results: The average GNRI was 110.1 ± 11.6, equivalent to adequate nutrition, and only 16.4% of patients were at risk of malnutrition. The mean NRI was 111.4 ± 11.8, equivalent to no risk of malnutrition, and only 17.2% of patients had a moderate-to-severe risk of malnutrition. A total of 30 patients (21.4%) required oral nutritional supplementation at discharge, especially modular protein supplements (86.7%), and 52 patients (37.1%) presented an infection during their stay. The most frequent infections were urinary tract infections (69.8% of the total). Malnutrition calculated by the GNRI or NRI correlated to a longer postoperative hospital stay and a higher rate of infectious complications (p < 0.05). Conclusions: Malnourished patients have a higher risk of early postoperative complications, including infection, and a longer hospitalization stay. The evaluation of nutritional status for the diagnosis and treatment of malnutrition is strongly recommended in ESKD patients on the waiting list for a kidney transplant. Full article