Search Results (20,218)

Background/Objectives: Workplace violence is a critical issue in the healthcare sector, with verbal violence being the most common form. This study is the first of its kind in Romania aiming to analyze the prevalence, characteristics, contributing factors, and psychological correlates of verbal workplace violence on doctors and nurses. Methods: A cross-sectional study was conducted using a questionnaire distributed online between February and April 2022 to doctors and nurses across Romania. Data were analyzed using descriptive statistics, the chi-squared test, and multivariate logistic regression to evaluate contributing factors and response patterns. Results: Out of 7951 participants, 56% of doctors and 9.2% of nurses reported experiencing verbal violence in the past 12 months (p = 0.001). Shift work and night shifts significantly increased the risk of verbal violence for both groups. Women were more vulnerable, with higher exposure among nurses (OR = 1.687; p = 0.001) and doctors (OR = 1.940; p = 0.001). The main aggressors were patients and patients’ relatives in both groups of participants, while vertical violence was more common among doctors. Formal reporting was low, although active reactions were more common. In terms of psychological correlates, doctors reported greater psychological strain than nurses (p = 0.001). Conclusions: This study highlights a critical need for system-wide interventions to address verbal violence in the Romanian healthcare system. Measures such as reporting protocols, staff training on conflict management, and organizational support systems are essential to prevent verbal violence and combat its contributing factors. Implementing these strategies could significantly improve the safety and well-being of healthcare professionals. Full article

Background: Symptomatic patients with unilateral obstructive coronary artery disease (CAD) identified by coronary computed tomography angiography (CCTA), involving either the right or left coronary artery, typically undergo per-protocol bilateral coronary visualization during invasive coronary angiography (ICA). However, a selective visualization approach may be sufficient. Objectives: The objectives of this study were to assess the accuracy of CCTA in excluding hemodynamically significant coronary stenosis in patients with unilateral CAD and to evaluate whether a CCTA-guided selective ICA strategy can reduce procedure time and contrast agent use. Methods: In this cross-sectional cohort study, 454 patients with clinically suspected stable CAD who underwent CCTA prior to ICA were included. The study population consisted of 190 patients with unilateral obstructive CAD, defined as ≥50% diameter stenosis on CCTA, and an absence of obstructive CAD on the contralateral side. ICA with invasive functional assessment was used as the reference standard. Results: CCTA demonstrated a high accuracy, 97.4% (95% CI: 94–99%), in excluding hemodynamically significant disease in the contralateral arteries without obstructive CAD. Compared to the conventional ICA approach, a CCTA-guided selective visualization strategy resulted in significant reductions in procedure time and contrast agent usage: procedure time and contrast agent usage were reduced by 27% (95% CI: 12.1–47.5%) and 46.8% (95% CI: 27.5–67.0%), respectively. Conclusions: In patients with unilateral obstructive CAD identified by CCTA, a CCTA-guided selective ICA visualization strategy is highly accurate in ruling out hemodynamically significant CAD on the contralateral side. Additionally, this unilateral ICA approach has the potential to reduce both contrast agent usage and procedure time compared to the conventional bilateral visualization strategy. Full article

(1) Background: Achieving a complete and secure dural closure to prevent cerebrospinal fluid (CSF) leakage is a critical concern in microvascular decompression (MVD). Proper dural closure minimizes complications, such as infections caused by CSF leakage. This study introduces a novel three-step dural suturing method, termed the “triple-layer closing technique”. (2) Methods: From September 2020 to March 2023, a total of 475 patients underwent MVD surgery at our institution, all of whom received dural closure using the triple-layer closing technique. This technique incorporates three layers: Duragen^® (synthetic dura, Integra Lifesciences), TachoSil^® (collagen matrix, Nycomed), and polymethyl methacrylate (PMMC) bone cement. Postoperative complications, including CSF leakage and infections, were retrospectively analyzed. (3) Results: CSF leakage was observed in five patients (1.1%), all of whom presented with CSF rhinorrhea and radiological evidence of effusion within the mastoid air cells. These patients were successfully treated with lumbar drainage, and none required reoperation. No other postoperative infections or complications were reported. (4) Conclusions: The triple-layer closing technique, utilizing Duragen^®, TachoSil^®, and PMMC bone cement, is an effective and reliable method for dural closure. This technique significantly reduces the risk of CSF leakage and surgical site infections, enhancing postoperative outcomes in MVD procedures. Full article

Background: Rathke’s cleft cysts (RCCs) are non-neoplastic and rare sellar lesions derived from remnants of Rathke’s pouch. While asymptomatic RCCs often require only conservative management, symptomatic cases may necessitate surgical intervention. The aim of our study is to investigate the correlations between clinical, radiological and histological features of RCCs to propose a novel management model. Methods: We conducted a retrospective analysis from patients who underwent surgery for cystic lesions between 2013 and 2023 in the Neurosurgery Department of Treviso Hospital (Italy) using for our purpose only those confirmed by histological specimen as RCCs. Results: 20 patients for a total of 24 procedures (20 primary surgeries/4 cases for recurrence) were performed for RCCs. A gross total resection was achieved in 23 cases, resulting in improvement of headache and visual symptoms in all patients. Hyperintensity on T1-weighted MRI sequences is more strongly correlated with inflammation and with intralesional metaplasia (p = 0.009). Both characteristics are involved in the development of hypopituitarism (p = 0.057), headache, and visual impairment (p = 0.082) compared to cysts with CSF-like content, even when the latter are smaller in size (p = 0.078). Discussion and Conclusions: RCCs are rare lesions whose management is challenging due to a lack of established guidelines. Intraoperative cystic content and MRI cystic characteristics seem to correlate with clinical presentation and long-term outcome in these patients. The transsphenoidal endoscopic approach is a safe and effective treatment, especially in cysts with inflammatory aspect in histopathological specimens and in dedicated MRI sequences that could take advantage of an early surgical resection. A decision-making model based on clinical, radiological and histopathological features of cysts could be useful to guide RCCs’ treatment, underlining the role of inflammation that seems to be involved in the onset of visual and hormonal impairment and in recurrence risk. Full article

Glioblastoma is the most common and aggressive malignant brain tumor in adults, with an increasing incidence and a poor prognosis. Current challenges in glioblastoma management include rapid tumor growth, limited treatment effectiveness, high recurrence rates, and a significant impact on patients’ quality of life. Given the complexity of glioblastoma care and recent advancements in diagnostic and treatment modalities, updated guidelines are needed in Canada. This Delphi study aimed to develop Canadian consensus recommendations for the diagnosis, classification, and management of newly diagnosed and recurrent glioblastoma. A multidisciplinary panel of 14 Canadian experts in glioblastoma care was convened, and a comprehensive literature review was conducted to synthesize evidence and formulate initial recommendations. Consensus was achieved through three Delphi rounds, in which panelists rated their agreement with recommendation statements on a five-point Likert scale. Statements with ≥75% agreement were accepted, and others were revised for re-voting. Final recommendations were formulated based on the consensus level, strength of evidence, clinical expertise, and consideration of the Canadian healthcare context. These recommendations aim to standardize glioblastoma diagnosis and classification across Canada, provide evidence-based guidance for optimal treatment selection, integrate novel therapies, and enhance the overall quality of care for glioblastoma patients. Full article

Backwash ileitis (BWI) refers to inflammation in the distal ileum in patients with extensive ulcerative colitis (UC) that is thought to be caused by a “reflux” or “backwash” of colonic contents. In the absence of well-defined diagnostic criteria for BWI, more recently, the term UC-associated ileitis was proposed in favor of the backwash theory, which questions the existence of backwash ileitis as a distinct disease-specific subset of patients. Moreover, distinguishing UC-associated BWI from terminal ileitis of Crohn’s disease or other conditions could be a diagnostic challenge and significantly affect treatment management. Therefore, clinical, endoscopic, histologic, and imagistic diagnostic features may aid in making this distinction. This literature review related to BWI outlines the hypothesis that the ileum may also become involved in UC as a primary manifestation of UC based on recent findings. This study also highlights the possibility that associated ileitis in UC patients may represent a potential risk factor for neoplasia, a positive association with primary sclerosing cholangitis, and a higher risk for the subsequent development of pouchitis after restorative proctocolectomy. It synthesizes recent key findings and highlights areas for further research. Full article

(1) Background: Predicting hospitalization length for COVID-19 patients is crucial for optimizing resource allocation and patient management. Radiomics, combined with machine learning (ML), offers a promising approach by extracting quantitative imaging features from CT scans. The aim of the present study is to use and adapt machine learning (ML) architectures, exploiting CT radiomics information, and analyze algorithms’ capability to predict hospitalization at the time of patient admission. (2) Methods: The original CT lung images of 168 COVID-19 patients underwent two segmentations, isolating the ground glass area of the lung parenchyma. After an isotropic voxel resampling and wavelet and Laplacian of Gaussian filtering, 92 intensity and texture radiomics features were extracted. Feature reduction was conducted by applying a last absolute shrinkage and selection operator (LASSO) to the radiomic features set. Three ML classification algorithms, linear support vector machine (LSVM), medium neural network (MNN), and ensemble subspace discriminant (ESD), were trained and validated through a 5-fold cross-validation technique. Model performance was assessed using accuracy, sensitivity, specificity, precision, F1-score, and the area under the receiver operating characteristic curve (AUC-ROC). (3) Results: The LSVM classifier achieved the highest predictive performance, with an accuracy of 86.0% and an AUC of 0.93. However, reliable outcomes are also registered when MNN and ESD architecture are used. (4) Conclusions: The study shows that radiomic features can be used to build a machine learning framework for predicting patient hospitalization duration. The findings suggest that radiomics-based ML models can accurately predict COVID-19 hospitalization length. Full article

Background: Spinal subarachnoid hemorrhage (sSAH) is a very rare disease. Detailed information about the natural course, pathogenesis, radiological manifestation, and therapeutic management is lacking. This study aimed to analyze patients diagnosed with sSAH, focusing on the origin, management strategies, and therapeutic approaches to sSAH. Methods: The study included a cohort of patients admitted to the Department of Neurosurgery, LMU University Hospital, LMU Munich, between January 2021 and December 2024 with a confirmed diagnosis of spinal subarachnoid hemorrhage and, among other things, spinal aneurysms. Data on the included patients were recorded with emphasis on demographics, radiological examination (CT, MRI, and DSA), aneurysm-specific characteristics, and clinical outcome. Results: The study included six patients diagnosed with spinal subarachnoid hemorrhage via multimodal imaging. The etiology of sSAH was identified in all cases, encompassing spinal aneurysms in three patients, anticoagulation therapy in two cases, and bony microspurs in one case, with management strategies tailored as either conservative (monitoring and imaging) or surgical (aneurysm resection, arterial feeder coagulation, or evacuation of intraspinal bleeding). No major adverse events were observed, and all the patients demonstrated neurological improvement or exhibited only mild-to-moderate disability during follow-up. Conclusions: Spinal subarachnoid hemorrhage can be due to a ruptured spinal aneurysm, but in some cases, other underlying causes should be considered as the source of the hemorrhage. Given the scarcity of literature on this condition, it is crucial to identify the correct diagnosis and implement a patient-tailored therapeutic approach. Full article

Background/Objectives: Olfaction is in many ways the least understood sensory modality. Its organization and connectivity are still under debate. The aim of this study was to investigate the anatomy of the olfactory system by using a cadaver fiber dissection technique and in vivo tractography to attain a deeper understanding of the subcortical connectivity and organization. Methods: Ten cerebral hemispheres were used in this study for white matter dissection according to Klingler’s technique. Measurements of different cortical structures and interhemispheric symmetry were compared. Diffusion tensor imaging sequences from twenty-five healthy individuals from the Human Connectome Project dataset were used to explore the connectivity of the olfactory system using DSI Studio. White matter connectivity between the following were reconstructed in vivo: (1) Olfactory bulb to primary olfactory cortices; (2) Olfactory bulb to secondary olfactory cortices; (3) Primary to secondary olfactory cortices. The DTI metrics of the identified major associative, projection and commissural pathways were subsequently correlated with olfactory function and cognition in seventy-five healthy individuals with Spearman’s rank correlation and the Benjamini–Hochberg method for false discoveries (CI 95%, p < 0.05) using R. Results: 1. The dissection showed that the lateral stria was significantly longer on the left side and projected towards the amygdala, the entorhinal and piriform cortex. 2. The medial stria was not evident as a consistent white matter structure. 3. Both dissection and tractography showed that major associative white matter pathways such as the uncinate fasciculus, the inferior fronto-occipital fasciculus and cingulum supported the connectivity between olfactory areas together with the anterior commissure. 4. No significant correlation was found between DTI metrics and sensory or cognition test results. Conclusions: We present the first combined fiber dissection analysis and tractography of the olfactory system. We propose a novel definition where the primary olfactory network is defined by the olfactory tract/bulb and primary olfactory cortices through the lateral stria only. The uncinate fasciculus, inferior fronto-occipital fasciculus and cingulum are the associative pathways supporting the connectivity between primary and secondary olfactory areas together with the anterior commissure. We suggest considering these structures as a secondary olfactory network. Further work is needed to attain a deeper understanding of the pathological and physiological implications of the olfactory system. Full article

Background/Objectives: The accurate preoperative prediction of lymph node (LN) metastasis is essential to optimizing surgical management in renal pelvis urothelial carcinoma (RPUC) and ureteral urothelial carcinoma (UUC). This study evaluates the predictive value of preoperative computed tomography (CT) findings in detecting LN metastasis and determining primary metastatic LN location based on the tumor site. Methods: This retrospective study included 48 RPUC and 97 UUC patients who underwent surgery with lymph node dissection (LND) between 2005 and 2023. Preoperative CT images were assessed for tumor size, location, multifocality, peritumoral fat infiltration, hydronephrosis grade, LN status, and metastatic LN location. Logistic regression and receiver operating characteristic (ROC) curve analyses identified predictive factors for LN metastasis, while Pearson’s chi-square and Fisher’s exact tests determined the association between locations of LN metastasis and primary tumor sites after categorizing UUC into upper and lower UUC. Results: In RPUC, 13 of 48 patients had LN metastasis, with tumor size and peritumoral fat infiltration emerging as significant predictors (p < 0.05). In UUC, 39 of 97 patients had LN metastasis, with tumor size and hydronephrosis grade being significant predictors (p < 0.001). An optimal tumor size threshold of 4 cm was identified for predicting LN metastasis in UUC, and 4.4 cm for RPUC. Additionally, a hydronephrosis grade of 3 or higher was found to be a strong predictor in UUC. ROC analysis showed high accuracy, yielding an AUC of 0.907 in RPUC and 0.904 in UUC. Cross-validation supported the robustness of these findings. Primary LN metastatic sites were predominantly ipsilateral hilar nodes in RPUC and ipsilateral pelvic nodes in lower UUC (p < 0.001). Conclusions: Preoperative CT imaging provides a reliable, noninvasive tool for predicting LN metastasis in RPUC and UUC. Identifying key imaging-based predictors can facilitate risk stratification and surgical decision-making, particularly regarding the necessity and extent of LND. Full article

The present study was designed to establish the distribution pattern and immunohistochemical characteristics of phoenixin-immunoreactive (PNX-IR) urinary bladder afferent neurons (UB-ANs) of dorsal root ganglia (DRG) in female pigs. The sensory neurons investigated were visualized with a retrograde tracing method using Fast Blue (FB), while their chemical profile(s) were identified using double-labelling immunohistochemistry with antibodies against PNX, calcitonin gene-related peptide (CGRP), calretinin (CRT), galanin (GAL), neuronal nitric oxide synthase (nNOS), pituitary adenylate cyclase-activating polypeptide (PACAP), somatostatin (SOM) and substance P (SP). Nearly half of UB-ANs contained PNX (45%), and the majority of such encoded sensory neurons were small in size (66%). The most numerous subpopulation of FB/PNX-positive neurons were those containing SP (71%). CGRP, GAL or PACAP were observed in a smaller number of PNX-containing UB-ANs (50%, 30% or 25%, respectively), while PNX-positive sensory neurons simultaneously immunostained with nNOS, CRT or SOM constituted a small fraction of all retrogradely-traced DRG neurons (DRGs; 15%, 6.5% or 1.6%, respectively). Furthermore, the numerical analysis of neurons expressing individual antigens, performed on 10 μm-thick consecutive sections, allows us to state that studied sensory neurons can be classified as neurons “coded” either by the simultaneous presence of SP/CGRP/PACAP/GAL, SP/CGRP/PACAP/NOS, SP/CGRP/PACAP/NOS/CRT and/or SP/CGRP/GAL/PACAP, or, as a separate population, those capable of SOM synthesis (SP/CGRP/SOM/PACAP/GAL-positive neurons). The present study reveals the extensive expression of PNX in the DRGs supplying to the urinary bladder, indicating an important regulatory role of this neuropeptide in the control of physiological function(s) of this organ. Full article

Contrast-enhanced magnetic resonance imaging (CE-MRI) has become an essential modality in breast cancer diagnosis and management. It is particularly used for locoregional staging, high-risk screening, monitoring treatment response, and assessing complications related to breast implants. The integration of gadolinium-based contrast agents (GBCAs) enhances the sensitivity and specificity of CE-MRI by providing detailed morphological and functional insights, particularly highlighting tumor neoangiogenesis. Despite its advantages, CE-MRI faces challenges such as high costs, limited accessibility, and concerns about gadolinium retention in tissues, prompting ongoing research into safer, high-relaxivity contrast agents like gadopiclenol. Advances in multiparametric imaging, including dynamic contrast-enhanced sequences and diffusion-weighted imaging, have refined diagnostic accuracy, enabling precise staging, and treatment planning. The introduction of abbreviated breast MRI (AB-MRI) protocols offers a promising solution to barriers of cost and scan duration, maintaining diagnostic efficacy while improving patient accessibility and comfort. Future innovations in contrast agents, imaging protocols, and patient-centered approaches hold the potential to further enhance the utility of breast MRI, ensuring equitable and effective application in global healthcare systems. Full article

Background: This study aims to investigate stability and reproducibility of radiomics biomarkers for adrenal lesion characterization across different software packages. Methods: Unenhanced CT images from patients with adrenal tumors were analyzed. Radiomic features were extracted using SOPHIA Radiomics and SIBEX software. The datasets underwent Z-score normalization. Statistical comparisons were made using two-sample t-tests and Spearman correlation coefficients. Three classification models—Logistic Regression, Linear Discriminant Analysis, and Linear Support Vector Machine—were trained on the datasets. Model performance was evaluated using accuracy, precision, recall, F1 score, and ROC curves. Feature importance and the statistical significance of model performance differences were also analyzed. Results: The t-test results showed no significant differences in the radiomic features extracted by SOPHIA and SIBEX (p-values all equal to 1.0). Spearman correlation coefficients were high for most features, suggesting a strong similarity between the two software tools. Classification models generally performed better on the SOPHIA dataset, with higher accuracy and precision. Feature importance analysis identified “Quadratic mean” and “Strength” as consistently influential features. Paired t-tests indicated significant differences in accuracy and precision, while Wilcoxon signed-rank tests did not find significant differences across all performance metrics. Conclusions: Radiomic features extracted by SOPHIA and SIBEX are comparable, but slight variations in model performance highlight the need for standardized extraction protocols and fine-tuning of predictive features. The study underscores the importance of ensuring the stability and reproducibility of radiomics features for reliable clinical application in adrenal lesion characterization. Full article

Introduction: Ostrich farming is increasingly recognized for its economic potential but poses significant health challenges due to the risk of pathogen transmission, including multidrug-resistant Escherichia coli. Case study: This study reports a case of a four-month-old female ostrich from western Romania presenting with severe respiratory and digestive infections, progressing to septicemia and death. A post-mortem examination revealed extensive mucus in the trachea, pulmonary congestion, hemorrhagic enteritis, and approximately 1250 g of metal objects in the ventriculus. Pure cultures of E. coli were isolated from the lungs and bone marrow and identified via MALDI-TOF MS. The strain exhibited multidrug resistance to several antibiotics, including enrofloxacin, doxycycline, and amoxicillin, highlighting the critical issue of antimicrobial resistance in veterinary medicine. Discussions: This case underscores the need for enhanced management practices in ostrich farming to mitigate environmental and pathogenic risks, as well as the urgency of developing alternative strategies for controlling resistant bacterial infections in avian species. Conclusions: This case highlights the need for alternative treatments and stricter antimicrobial stewardship to combat multidrug-resistant E. coli in ostriches. Full article

Background: The accuracy of fracture diagnosis through radiographic imaging largely depends on image quality and the interpreter’s experience. In resource-limited settings (minimal-resource settings), imaging quality is often lower than in standard-resource facilities, potentially affecting diagnostic accuracy. Objective: This study aims to compare the diagnostic accuracy of plain radiograph interpretations between minimal-resource and standard-resource methods and assess the influence of interpreter experience on diagnostic precision. Methods: This cross-sectional study is based on secondary data from patients’ medical records at the Dr. Zainoel Abidin General Hospital (RSUDZA) Banda Aceh, Indonesia. Comparisons between minimal-resource and standard-resource interpretations were made and validated using a reference standard (gold standard). Statistical analyses included diagnostic testing, Chi-square tests, and ROC curve analysis to evaluate sensitivity, specificity, and accuracy. Results: The findings indicate that standard-resource radiographs have significantly higher accuracy than minimal-resource radiographs (p < 0.05). Radiologists demonstrated the highest diagnostic accuracy compared to general practitioners and radiology residents. Conclusions: The standard-resource method is superior in detecting fractures compared to the minimal-resource method. Enhancing imaging quality and providing additional training for medical personnel are essential to improve diagnostic accuracy in resource-limited settings. Full article