Search Results (156)

Polydeoxyribonucleotide (PDRN) activates the adenosine A2A receptor (A2AR), triggering anti-inflammatory signaling and providing essential nucleotides for the salvage pathway, thereby helping bypass metabolic bottlenecks and promoting tissue repair. Combining PDRN with biochemical agents and physical stimuli represents a significant shift in medical treatment, moving from monotherapy to an integrated, multi-target regenerative approach. These combinatorial strategies effectively address the limitations of PDRN, such as its rapid degradation and diffusion, by simultaneously meeting the structural, metabolic, and signaling needs of injured tissues. The mechanism of action for PDRN involves a synergistic effect with hyaluronic acid, amplification of growth factors (e.g., Platelet-Rich Plasma (PRP), Epidermal Growth Factor (EGF), Platelet-Derived Growth Factor (PDGF)), and enhancements from extracorporeal shockwave therapy (ESWT) and lasers. This results in a notable acceleration of the repair process for chronic wounds, musculoskeletal disorders, and neurological injuries. As intelligent delivery systems like responsive hydrogels and sustainable L-PDRN production continue to advance, these synergistic protocols are poised to redefine global standards of care in regenerative medicine and esthetic dermatology. Future clinical success will hinge on the standardization of sequence-specific protocols and large-scale validation to ensure long-term safety and efficacy. Full article

Background: Acute portal vein thrombosis (aPVT) is a severe complication of the splanchnic venous system, often associated with portal hypertension, intestinal ischemia, and hepatic dysfunction. Anticoagulation is the first-line therapy but is frequently insufficient in advanced Yerdel grade III–IV cases, where recanalization rates remain low. Endovascular interventions have emerged as alternative therapeutic strategies in selected patients. Methods: We present three cases of patients with Yerdel grade III–IV aPVT who underwent endovascular management. The techniques included: (1) transhepatic aspiration thrombectomy combined with intra-thrombus thrombolysis using alteplase (Actilyse); (2) combined aspiration thrombectomy, intra-thrombus thrombolysis with alteplase, portal vein stenting, and transjugular intrahepatic portosystemic shunt (TIPS) creation; and (3) transsplenic aspiration thrombectomy followed by angioplasty, stent placement, and TIPS creation in a post-liver transplant patient. Results: All procedures were technically successful, achieving complete or near-complete recanalization of the portal venous system. Restoration of patency in the extrahepatic portal circulation was confirmed, and portal pressures were reduced in the TIPS-assisted case. No major periprocedural complications occurred. Clinical outcomes included preservation of transplant candidacy and graft salvage. Conclusions: Endovascular therapy may be an option in selected patients with acute portal vein thrombosis. Careful patient selection and an individualized technical approach are essential. Full article

Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) remains a high-risk entity despite advances in tyrosine kinase inhibitors (TKIs), immunotherapy, and cellular therapies. Relapse driven by clonal evolution, central nervous system (CNS) sanctuary disease, and TKI resistance, particularly T315I mutations, continues to limit durable disease control. Asciminib, a first-in-class allosteric BCR::ABL1 (STAMP) inhibitor, has demonstrated efficacy and favorable tolerability in chronic myeloid leukemia, but its optimal role in Ph+ ALL remains to be defined. We report a three-patient case series of Ph+ acute leukemia treated with asciminib across diverse high-risk clinical settings, including multiply relapsed disease, CNS involvement, T315I-mutated leukemia, post-CAR-T-cell relapses, and transplant bridging. Clinical outcomes are contextualized through a comprehensive review of emerging clinical trial data, real-world cohorts, and mechanistic studies evaluating asciminib in Ph+ ALL. Across all cases, asciminib was incorporated as part of combination or consolidation strategies rather than as monotherapy in active disease. Asciminib contributed to molecular disease control, CNS leukemia clearance, and successful bridging to allogeneic transplantation or cellular therapy, with acceptable tolerability and no major vascular toxicity. Integration of published evidence demonstrates that asciminib exhibits consistent biological activity in Ph+ ALL, with improved durability when used in rational combinations, particularly with immunotherapy or ATP-competitive TKIs. Preclinical data further support asciminib’s compatibility with antibody-based and cellular therapies through preservation of immune effector function. Asciminib represents a versatile but context-dependent therapeutic option in Ph+ ALL. Its greatest clinical value appears to lie in rational combination regimens, maintenance strategies, and bridging to definitive therapies rather than single-agent salvage. Emerging structural biomarkers and ongoing clinical trials are expected to further refine patient selection, sequencing, and optimal integration of asciminib, particularly in CNS-involved disease and post-CAR-T cell relapse. Full article

The use of excimer laser atherectomy (ELA) has significantly evolved from the mid-1990s to the present, showing substantial improvements in both coronary and peripheral artery interventions. Initially associated with suboptimal outcomes due to low-energy settings and limited techniques, advancements such as high-energy delivery, improved catheter designs, contrast injection protocols, and refined procedural approaches have greatly enhanced clinical efficacy. In coronary applications, ELA has become an established technique for treating intracoronary thrombus, under-expanded stents, in-stent restenosis, and heavily calcified lesions, offering favorable procedural and clinical outcomes with low complication rates. The excimer laser operates through photochemical, photothermal, and photomechanical mechanisms, enabling precise plaque ablation with minimal collateral damage. In peripheral interventions, especially in critical limb ischemia (CLI), ELA has emerged as a viable option for complex, non-crossable lesions and in-stent restenosis, demonstrating high technical success, improved patency, and promising limb salvage rates. Multiple clinical trials and registries support the safety and effectiveness of ELA, particularly in high-risk patient populations. This narrative review summarizes current evidence and practical considerations on the use of excimer laser atherectomy in coronary and peripheral interventions. Full article

This case report describes the successful management of a 7-month-old Pomeranian with congenital vertebral malformation (CVM) causing kyphosis and progressive myelopathy, characterized by non-ambulatory paraparesis, decreased postural reactions, and increased spinal reflexes in the hind limbs. Initial management involved a dorsal approach for decompression and stabilization; however, the patient failed to regain hindlimb function. Following two failed surgical attempts due to implant failure and progressive instability, a salvage stabilization was performed using a transthoracic approach. Stabilization was achieved using titanium screws and polymethyl methacrylate (PMMA) applied to the vertebral bodies. The patient exhibited marked postoperative improvement, regaining weight-bearing ability within one week and achieving a normal gait by four weeks. At the 19-month follow-up, the dog maintained normal ambulatory function with no recurrence of neurological deficits. While the transthoracic approach is well-documented in brachycephalic breeds, this is the first report describing its successful application in a toy breed. This case highlights the transthoracic approach as a highly effective salvage technique, offering a novel solution when conventional dorsal elements are irreversibly compromised due to the extremely diminutive and fragile nature of toy breed vertebrae. Full article

Background: Reconstruction of the proximal humerus after wide tumor resection is technically demanding, and traditional methods such as allograft–prosthetic composites, reverse shoulder arthroplasty, and metal implants are limited by graft unavailability, pediatric size mismatch, their high cost, and metal-related stress shielding. Polyether ether ketone (PEEK), with its modulus closer to cortical bone and radiolucency, offers a promising alternative. Building upon the success in craniomaxillofacial surgery and its favorable physical characteristics, we applied personalized 3D-printed PEEK implants for proximal humerus reconstruction. This study reports the first evidence of applying patient-specific 3D-printed PEEK implants in the proximal humerus. Methods: A retrospective cohort study was conducted on seven patients who underwent wide resection of primary malignant bone tumors of the proximal humerus, followed by reconstruction using patient-specific 3D-printed PEEK implants. Implant design was based on preoperative computed tomography (CT) imaging, incorporating contralateral humeral mirroring and computer-aided design. The implants were fabricated using fused deposition modeling (FDM) with medical-grade PEEK under stringent thermal control (nozzle temperature > 400 °C and heated build chamber), followed by a controlled annealing process to minimize internal stress, optimize polymer crystallinity, and enhance mechanical durability. Outcomes assessed included implant survival, oncologic control, shoulder range of motion, and functional outcomes measured using the Musculoskeletal Tumor Society (MSTS) score. The mean follow-up duration was 56.3 months. Results: All patient-specific PEEK implants were successfully manufactured and implanted with satisfactory geometric accuracy. Mechanical implant survival was 85.7% at final follow-up, with one implant fracture occurring at 28 months. No cases of deep infection, dislocation, loosening, or permanent neurovascular injury were observed. Local soft-tissue recurrence occurred in two patients (28.6%), without distant metastasis or tumor-related mortality. The limb-salvage rate was 100%. At final follow-up, the mean MSTS score was 23.0 ± 1.6. Shoulder motion was limited but comparable to outcomes reported for conventional anatomic megaprosthetic reconstructions. Conclusions: Patient-specific 3D-printed PEEK implants provide a feasible and oncologically safe option for proximal humerus reconstruction after tumor resection, with acceptable midterm implant survival and functional outcomes. The favorable elastic modulus and radiolucency of PEEK offer distinct biomechanical and imaging advantages over metallic implants. Further design optimization and larger prospective studies are warranted to enhance mechanical durability and functional restoration. Full article

Background/Objectives: Varicocele repair can improve semen parameters and pregnancy rates in appropriately selected men; however, persistence or recurrence remains a common cause of treatment failure with ongoing infertility or scrotal pain. Because mechanisms and definitions vary across studies, counseling and salvage selection can be challenging. This review synthesizes contemporary evidence on why varicocele recur and provides an anatomy-informed approach to evaluation and retreatment. Methods: A narrative evidence synthesis was performed using PubMed/MEDLINE, prioritizing clinical practice guidelines, systematic reviews, meta-analyses, and contemporary adult and adolescent clinical series addressing mechanisms of failure, diagnostic workup, and outcomes of salvage microsurgery and endovascular therapy. Results: Recurrence rates vary by technique and follow-up, with the lowest rates reported in contemporary microsurgical subinguinal series. The dominant drivers of failure are incomplete venous control and complex reflux pathways, including duplicated internal spermatic veins and missed collaterals such as cremasteric, external spermatic, gubernacular, and deferential veins. Clinical examination remains central; Doppler ultrasonography is most useful when pain persists or semen parameters and testicular growth do not improve. Venography can define culprit channels in complex or multiply treated cases and enables targeted embolization. Retreatment achieves high anatomic success with consistent improvements in semen parameters and meaningful pregnancy rates in available series, with modality-specific complication profiles. Conclusions: Recurrent varicocele should be managed with structured reassessment that links venous anatomy and the index procedure to the salvage option. Microsurgical redo is generally favored after non-microscopic repairs, whereas endovascular occlusion is often preferred after prior surgery or when venographic mapping is needed. Full article

The eastern Baltic region is rich in hemiboreal forests, which are both commercially important and provide habitats for rare and/or endangered forest-dwelling species, which are sensitive to accelerating climatic changes. Under the intensifying climatic disturbances that are stressing forests worldwide, sanitary logging is a widely used harvesting technique for the mitigation of commercial losses. The effects of salvage logging on the biodiversity of forests remain ambiguous due to the larger scale and higher intensity of timber harvesting, which can alter the recovery of stands and succession of their vegetation. Furthermore, EU legislation is increasingly emphasizing conservation/restoration and mandating its implementation. The recovery of ecosystems, and hence the biodiversity of disturbed managed forests, can take several decades to centuries, depending on the site conditions. Long-term (~60 years, four remeasurements) changes in the composition and structure of vegetation, as an indicator of overall health and nutrient cycling, were studied in conventionally managed hemiboreal forests. Potential forest transformation (paludification) risks associated with large-scale logging were assessed in mixed coniferous stands in the Baltics, Latvia. Following logging, the stands were conventionally managed, including artificial regeneration. According to ground cover vegetation, 50 years was the period for the disturbance effects to start subsiding, as a dynamic equilibrium was reached and the canopies of regenerating trees were closing. A gradual decrease in moisture levels in the middle parts of salvage-logged areas, and later at their edges, indicated that the stands have escaped paludification, likely as the climate has been warming. Distance from the edge of the salvage-logged areas had a secondary effect on ground cover vegetation recovery after storms, alleviating concerns about the explicit negative impact of the scale of harvesting. Thus, in managed seminatural forest landscapes with a historically small to moderate scale of anthropogenic disturbance, salvage logging at a scale locally deemed as large had a transient effect in the Baltics. This indicates successful regeneration of the forest ecosystem over a timeframe shorter than the conventional rotation period, suggesting overall conservation efficiency of conventionally managed forests. Accordingly, salvage logging can be sustainable in terms of biodiversity and forest continuity in the long run under traditional management, as environmental changes accelerate. Full article

Advances in medical care now enable significant functional recovery after traumatic limb injuries. The return-to-duty decision-making process is highly variable and dependent on multiple factors. To retain service members (SM) post-injury, there needs to be a robust method to inform the decision-making process. The collection of outcome data and decision tree analysis has the potential to assist in the development of an efficient decision support tool. Data were combined from two previous research studies on 31 injured SMs (26 with limb salvage wearing custom dynamic ankle–foot orthoses and 5 with varying levels of lower limb amputation wearing prostheses). Forty-two factors across military, demographic, injury, and outcome measures were used to develop categorical tree models to classify return to duty after injury. The feasibility of the final pruned model was evaluated using a 10-fold cross-validation to calculate sensitivity, specificity, and misclassification rate. The overall misclassification rate for the final pruned model was 29% (9/31). The model classified participants into successful return to duty: (1) Post Concussion Symptom Scale < 20 and (2) age at time of assessment ≥34. These preliminary results suggest that decision tree modeling could be an effective approach to augmenting the return-to-duty decision-making process. Full article

Replantation of an amputated finger is a complex microsurgical procedure that is rarely attempted in low-resource settings due to limited infrastructure and expertise. We report a case of complete amputation of a finger in rural Kenya that was successfully replanted during a humanitarian surgical mission. A 28-year-old man sustained a severe crush avulsion agricultural machine injury resulting in the amputation of all ten digits; only one digit was deemed suitable for replantation. The replantation was performed under loupe and microscope magnification by a visiting specialist team in collaboration with local staff. Intraoperatively, bony fixation with Kirschner wires, extensor and flexor digitorum profundus tendon repair, arterial and venous anastomoses, and neurorrhaphy of the digital nerve were achieved. Postoperatively, the finger survived with adequate perfusion. At one-month follow-up, the replanted finger was viable with progressing wound healing and early joint motion; further rehabilitation was arranged to maximize functional recovery. This case, which is, to our knowledge, one of the first documented digital replantations in East Africa, illustrates that successful microsurgical limb salvage is feasible in a non-specialized hospital setting. Our experience underscores that, with proper planning, training, and teamwork, advanced reconstructive procedures like finger replantation can be safely carried out even in resource-constrained hospitals, offering patients in low-income regions outcomes previously achievable only in high-resource centers. Full article

Purpose: Periprosthetic joint infection (PJI) is a devastating complication following limb salvage surgery with tumor megaprosthetic reconstruction, leading to high morbidity and complex management. Despite advancements in prosthesis design and materials, infection rates are notably higher than in conventional arthroplasty. This narrative review synthesizes current evidence on the etiology, diagnosis, and management of PJIs in this unique setting. Methods: We conducted narrative review of literature from PubMed and Embase using keywords related to PJIs and tumor megaprostheses, aiming to summarize risk factors, diagnostic criteria, pathogen profiles, and treatment outcomes. Results: Key findings indicate that the risk of PJI is multifactorial, involving patient-related, disease-related, and treatment-related factors. Diagnosis relies on a combination of clinical presentation, serological markers, imaging, and microbiological studies, though established criteria for conventional PJI may require adaptation for tumor cases. Treatment strategies include irrigation and debridement (I&D), debridement, antibiotics, implant retention with modular component exchange (DAIR), one-stage or two-stage revision, and amputation. Success rates vary, and optimal management requires a multidisciplinary, individualized approach. However, two-stage revision is considered the gold standard for chronic PJIs. Conclusions: PJIs after tumor megaprosthetic reconstruction presents distinct challenges. Management requires a multidisciplinary, individualized approach. Future research should focus on validated diagnostic criteria for this population, novel anti-biofilm strategies, and standardized treatment protocols. Full article

Despite advances in staged protocols and fixation techniques, treatment of pilon fractures remains a significant challenge in orthopedic trauma, with up to 21% of patients requiring revision surgery. Management of a pilon fracture that has failed initial treatment involves navigating a myriad of complicating variables, including infection, bone loss, malalignment, and nonunion. Although no single surgical approach can be aptly applied to the broad range of pathology and severity spanned by these patients, this narrative review provides a systematic framework for developing a revision pilon reconstruction plan. We present a protocol for pre-operative assessment and review current techniques for infection eradication, bone defect management, deformity correction, and joint-preserving versus joint-sparing surgery. These fundamental strategies form the foundation of a successful salvage plan and can be personalized to address specific fracture morphology, host factors, and goals of care. Full article

Background: Complex diabetic foot ulcers (DFUs) are a leading cause of morbidity and lower-limb amputation, and their management is profoundly challenging. Microvascular free tissue transfer is a primary limb salvage strategy, with the anterolateral thigh (ALT) free-flap recognized as a workhorse reconstructive solution. However, a quantitative summary of its performance specifically within this high-risk patient population is lacking. Methods: A systematic review and single-arm meta-analysis was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Five electronic databases (PubMed/MEDLINE, Embase, Scopus, Cochrane, and Web of Science Core Collection) were searched up to 9 September 2025 to identify studies reporting on outcomes of ALT free-flaps for diabetic foot reconstruction. The risk of bias was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Primary outcomes were set as the complete and partial flap necrosis rate. Secondary outcomes included functional recovery status and complication rates. All data were synthesized using a random-effects model. Results: Six retrospective cohort studies met the inclusion criteria, including a total of 162 patients. The pooled rate of total flap failure was 5.2% (95% CI: 2.5–10.6%), a finding that was highly consistent across all studies (I² = 0%). The pooled incidence of partial flap necrosis was 13.0% (95% CI: 6.3–25.1%), resulting in an overall weighted flap success rate of 81.8%. Notably, the pooled rate of return to ambulation was 95.2% (95% CI: 88.5–98.1%), which also demonstrated no statistical heterogeneity (I² = 0%). Conclusions: The anterolateral thigh free-flap appears to be a robust and highly reliable strategy for diabetic foot reconstruction, associated with low failure rates, minimal long-term complications, and excellent functional recovery. However, the current evidence is limited to a small number of poor-to-moderate-quality retrospective studies. High-quality, prospective, and comparative multicenter trials are necessary to confirm these findings and establish the ALT flap’s effectiveness in high-risk cohorts. Full article

The retail sector is the most demand-sensitive echelon in the supply chain, where non-moving items accumulate and become dead stock. Existing inventory management studies focus on fast-moving products and income generation. This paper focuses on dead stock management and proposes a mixed strategy solution using a pure integer non-linear programming model that minimizes the dead stock management cost of a retail chain operator. The number of products and volume of product-related data in a retail chain system require big data analysis to ensure sustainable inventory practices that reduce waste generated from dead stock inventory. Through hypothetical data sets, the 3-store, 10-product run showed that discount percentage, expected sales success probability of a product in a store location, and disposition of unsold products were the main drivers of the decisions made by the model. The most significant cost contributors arising from these decisions were the unrecovered product cost (UPC), disposed product cost (PC), and salvage value from the successful sale of dead stock. Inventory managers must balance the effect on these cost components when they choose the strategies to use in managing dead stock. Full article

In this paper, an underwater salvage robot is developed to retrieve foreign objects scattered in nuclear reactor pools. The robot mainly consists of an ROV platform and a 3-DOF Delta robotic arm. Utilizing fused IMU and LED beacon visual data for localization, it achieves pool traversal via six dynamically controlled thrusters. An improved YOLOv8s algorithm is employed to identify foreign objects in underwater environments. During traversal, the robot identifies and retrieves foreign objects along the way. The prototype of the robot was subjected to a series of experiments in an indoor pool. Results show that the improved YOLOv8 algorithm achieves 92.2% mAP, surpassing the original YOLOv8s and Faster-RCNN by 3.7 and 3.3 percentage points, respectively. The robot achieved a foreign-object identification rate of 95.42% and a retrieval success rate of 90.64% under dynamic traversal conditions, indicating that it meets the operational requirements and has significant engineering application value. Full article