Search Results (2,212)

Hepatic cancer is a world health concern due to its high lethality. The main risk factor worldwide is having hepatic cirrhosis. The etiology of hepatic cirrhosis has changed in recent years, with metabolic-associated steatotic liver disease (MASLD) becoming the leading cause, displacing hepatitis C and B viruses and alcoholic liver disease. It is of the utmost importance to develop screening programs in at-risk populations for early detection. The survival rate of HCC, as determined by a group of specialists or an interdisciplinary committee, is a challenge we have taken on in a public health hospital in Ecuador. This retrospective study identified 71 patients diagnosed with hepatocellular carcinoma, mostly middle-aged men with a history of liver cirrhosis. No significant association was found between the presence of cirrhosis, laboratory abnormalities, and survival. However, the identification by imaging vascular invasion and extrahepatic extension were associated. This study highlights that patients with liver lesions identified through HCC screening have a higher survival rate over a one-year follow-up period. Full article

Accurate spleen segmentation in abdominal CT scans remains a critical challenge in medical image analysis due to variable morphology, low tissue contrast, and proximity to similar anatomical structures. This paper presents an enhanced U-Net architecture that addresses these challenges through multi-slice contextual integration and interpretable deep learning. Our approach incorporates three-channel inputs from adjacent CT slices, implements a hybrid loss function combining Dice and binary cross-entropy terms, and integrates Grad-CAM visualization for enhanced model interpretability. Comprehensive evaluation on the Medical Decathlon dataset demonstrates superior performance, with a Dice similarity coefficient of 0.923 ± 0.04, outperforming standard 2D approaches by 3.2%. The model exhibits robust performance across varying slice thicknesses, contrast phases, and pathological conditions. Grad-CAM analysis reveals focused attention on spleen–tissue interfaces and internal vascular structures, providing clinical insight into model decision-making. The system demonstrates practical applicability for automated splenic volumetry, trauma assessment, and surgical planning, with processing times suitable for clinical workflow integration. Full article

Aortic stenosis (AS) is a common degenerative valvular disease in elderly patients, causing obstruction of left ventricular outflow and presenting with symptoms such as angina, syncope, and heart failure. Although surgical aortic valve replacement (SAVR) remains the gold standard, its high perioperative risk in frail patients has led to the adoption of transcatheter aortic valve implantation (TAVI) as a less invasive and effective alternative. The transfemoral (TF) access route is generally preferred, but severe peripheral arterial disease may limit its feasibility. We report the case of a 71-year-old woman with critical AS complicated by multiple comorbidities, including extensive vascular calcifications, a porcelain aorta, and significant subrenal abdominal aortic stenosis. Multimodal imaging, including computed tomography, was essential for procedural planning, revealing complex iliofemoral anatomy unsuitable for conventional device passage without intervention. Intravascular lithotripsy (IVL) was used to disrupt calcific plaques and facilitate safe vascular access. The TAVI procedure was successfully performed under local anesthesia via TF access using a 65 cm GORE® DRYSEAL Flex Introducer Sheath (W. L. Gore & Associates, Flagstaff, AZ, USA) (18-Fr). After balloon valvuloplasty performed over a SAFARI2™ Pre-Shaped TAVI Guidewire, Extra Small (Boston Scientific, Marlborough, MA, USA) Curve in the left ventricle, a self-expanding Medtronic Evolut™ FX 26 (Medtronic, Minneapolis, MN, USA)mm transcatheter valve was implanted. Postoperative imaging confirmed optimal valve function and vascular integrity without complications. This case highlights the role of IVL as an innovative adjunctive technique enabling TF-TAVI in patients with challenging vascular anatomy, thereby expanding treatment options for high-risk individuals with severe AS. Full article

Background: Sturge–Weber syndrome (SWS) typically presents with a port-wine stain on the face, accompanied by leptomeningeal capillary malformations and ocular vascular anomalies. The aim of our study was to evaluate retinal vascular density and vessel diameter to better characterize the presence of vascular alterations. Methods: 15 patients diagnosed with Sturge–Weber syndrome and 15 healthy controls underwent comprehensive ophthalmologic evaluation, Optical Coherence Tomography (OCT) and Optical Coherence Tomography Angiography (OCTA), to evaluate the microvascular architecture of the retina and choroid. Results: Analysis of the processed images revealed a significant increase (p < 0.05 *) in the density of the deep capillary plexus in patients with SWS compared to healthy controls. Vascular diameter was found to be increased overall in several retinal vascular plexuses in SWS patients compared to controls, reaching statistical significance (p < 0.05 *) in the deep vascular complex. Conclusions: The findings from our analysis highlight the potential role of OCTA in predicting the progression or worsening of ocular diseases over time. The introduction of new assessment parameters offers additional perspectives in evaluating ocular health. Since this examination allows for the detection of changes in the morphology and density of blood vessels as revealed by OCTA, these changes can be correlated with disease progression and the effectiveness of therapies. Full article

Background: Duplex ultrasonography (DUS) of the extracranial arteries is essential for the primary and secondary prevention of ischemic stroke and the diagnosis of other cerebrovascular pathologies. The aim of the Italian Society for Vascular Investigation (SIDV) is to provide a standardised approach for the ultrasound evaluation of extracranial arterial disease. Methods: A multidisciplinary SIDV expert panel conducted a comprehensive literature search and performed a narrative review of the recent medical literature; the updated operative procedures were subsequently developed through a consensus-driven process that included dedicated meetings and national congress sessions for discussion and validation. Results: This document outlines a comprehensive approach to the ultrasound evaluation of extracranial arteries, detailing techniques such as Brightness Mode (B-mode), Colour Doppler, Power Doppler, contrast-enhanced ultrasound (CEUS), micro-vascular flow imaging (MVFI), and Three-Dimensional (3D) ultrasound. The text provides an in-depth discussion of clinical indications, technical protocols, plaque characterisation, stenosis quantification, and hemodynamic criteria. Emerging technologies are also examined for their potential to improve cerebrovascular risk stratification. Conclusions: The updated SIDV operative procedures for the ultrasound evaluation of extracranial cerebrovascular disease are intended to serve as a valuable reference for clinicians and vascular laboratories. Full article

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is prevalent in adolescents with obesity and is linked to insulin resistance and cardiovascular disease (CVD). Pancreas steatosis might be associated with MASLD and early CVD. Imaging-based analyses of these associations have not been studied extensively in children. Objectives: To assess the reproducibility of liver and pancreatic steatosis and volume measurement on MRI in adolescents with obesity and MASLD and their association with homeostatic model assessment of insulin resistance (HOMA-IR) and subclinical vascular changes on ultrasound. Methods: This is an observational study on adolescents with MASLD and obesity. Hepatic and pancreatic steatosis, volume, and abdominal fat were assessed using magnetic resonance spectroscopy and proton density fat fraction. Reproducibility of these measurements was performed. Vascular markers included non-invasive vascular elastography (NIVE), carotid artery intima-media thickness (IMT), and pericardial fat thickness. Fasting blood tests measured the HOMA-IR. Bivariate correlation and simple linear regression were performed using SPSS. Results: We obtained 23 participants aged 12 to 17 years (78.3% male). Measurements were reproducible [ICC 0.807–0.998]. Liver steatosis was positively correlated with HOMA-IR (p = 0.015). Pancreas steatosis was positively correlated with HOMA-IR (p = 0.02), IMT/diameter (p = 0.002), and pericardial fat (p = 0.03). Liver steatosis was not significantly correlated with pancreas steatosis nor vascular markers. There were negative associations between NIVE metrics and visceral abdominal fat (p = 0.009) and intraperitoneal fat (p = 0.047). Conclusions: Liver and pancreas steatosis measurements on MRI are reproducible. In this exploratory study, adolescents with obesity and MASLD, pancreas steatosis, and pancreas volume show association with subclinical CVD markers. Visceral and intraperitoneal abdominal fat show association with increased vascular stiffness, suggesting a potential role of imaging-based cardiovascular risk assessment in this population if validated. These preliminary findings require validation in larger, diverse prospective cohorts. Full article

Background: Primary spinal gliomas are rare in the pediatric population. Separately, FGFR1 genomic aberrations are also uncommon in spinal cord tumors. We report a case of a previously well adolescent who presented with progressive symptoms secondary to an intramedullary tumor with unique radiological and molecular characteristics. Case Presentation: A previously well 17-year-old male presented with worsening mid-back pain associated with lower limb long-tract signs. Magnetic resonance imaging (MRI) of his neuro-axis reported a long-segment intramedullary lesion with enhancing foci and a multi-septate syrinx containing hemorrhagic components from C4 to T12. The largest enhancement focus was centered at T7. Additional MRI sequences observed no intracranial involvement or vascular anomaly. He underwent an emergent laminoplasty and excision of the thoracic lesion. Intraoperative findings demonstrated a soft, grayish intramedullary tumor associated with extensive hematomyelia that had multiple septations. Active fenestration of the latter revealed blood products in various stages of resolution. Postoperatively, the patient recovered well, with neurological improvement. Final histology reported a circumscribed low-grade glial neoplasm. Further molecular interrogation via next-generation sequencing panels showed FGFR1 p.K656E and V561M alterations. The unique features of this case are presented and discussed in corroboration with a focused literature review. Conclusions: We highlight an interesting case of an intramedullary tumor with unusual radiological and pathological findings. Emphasis is on the importance of tissue sampling in corroboration with genomic investigations to guide clinical management. Full article

Background: Spontaneous retroperitoneal hematomas constitute a rare clinical entity, yet their incidence has markedly increased during the SARS-CoV-2 pandemic. The pathophysiological substrate is incompletely elucidated, being influenced by anticoagulant therapy, vascular inflammatory alterations induced by SARS-CoV-2 infection, and comorbidities in critically ill patients that exacerbate hemorrhagic risk. Methods: We performed a comprehensive literature review of published case reports and case series on spontaneous retroperitoneal hematomas in COVID-19 patients, complemented by our institutional experience, in order to synthesize current diagnostic and therapeutic approaches. Results: Available evidence indicates that most cases occur in anticoagulated patients, with clinical manifestations often limited to nonspecific abdominal or lumbar pain. Diagnosis relies primarily on contrast-enhanced CT imaging. Reported therapeutic strategies include conservative management, endovascular embolization, and surgical intervention, with outcomes ranging from complete recovery to fatal progression, particularly in elderly and comorbid individuals. Conclusions: Spontaneous retroperitoneal hematomas in the setting of SARS-CoV-2 infection represent a diagnostic and therapeutic challenge associated with considerable morbidity and mortality. Early recognition, prompt imaging, and individualized multidisciplinary management are essential, while further research is needed to clarify incidence, risk factors, and preventive strategies. Full article

The aorta, once viewed as a passive conduit, is now recognized as an active organ crucial for hemodynamic regulation and vascular homeostasis. Thoracic aortic aneurysms (TAAs), particularly those involving the ascending aorta, often remain silent until life-threatening complications such as dissection or rupture occur. Current management primarily relies on aortic diameter criteria, yet up to 60% of type A dissections occur at sizes below the 5.5 cm surgical threshold, revealing the limitations of this approach. This narrative review summarizes recent advances in understanding ascending aortic aneurysms, including insights into their genetic and degenerative mechanisms, the role of novel morphological and hemodynamic markers, and the potential of advanced imaging techniques. It also explores evolving surgical strategies, from conventional open repair, still the gold standard, to minimally invasive and investigational endovascular approaches. By integrating biological, morphological, and clinical factors, emerging strategies aim to move beyond diameter alone toward more personalized risk assessment. This paradigm shift may improve early detection, optimize surgical timing, and ultimately enhance outcomes for patients with ascending aortic aneurysms. Full article

Background: Excessive scarring remains a frequent complication in plastic surgery, yet standardized preventive strategies are lacking. Type I collagen-based biomaterials may support regenerative processes and improve scar outcomes. Methods: This case series includes six female patients (ages 24–52) undergoing wound management after trauma and procedures including blepharoplasty, abdominoplasty, and revision mammaplasty. Native collagen type I (7% or 15%) was injected along wound margins or into hypertrophic scars at 3–4 week intervals. Outcomes were assessed through patient-reported symptoms and Antera 3D imaging (vascularity, pigmentation, surface topography). Results: Patients reported reduced tightness, pruritus, and scar stiffness after initial sessions. Antera 3D imaging showed decreased vascular and pigment indices, and a reduction in surface elevation over follow-up (up to 14 months). No adverse effects such as atrophy or infection were observed. Conclusions: Native type I collagen was well tolerated and may be a useful adjunct for wound healing and scar modulation following plastic surgery. Full article

Human herpesvirus-8 (HHV-8)-associated multicentric Castleman disease (MCD) is a rare lymphoproliferative disorder with systemic and cutaneous manifestations that can be diagnostically challenging, especially in immunocompromised patients. We report the case of a 68-year-old man with HIV and biopsy-proven Kaposi sarcoma (KS), who developed progressive fevers, night sweats, weight loss, and fatigue, accompanied by diffuse lymphadenopathy, splenomegaly, and new erythematous and hyperpigmented lesions shortly after intravenous immunoglobulin therapy for Guillain–Barré syndrome. A laboratory evaluation revealed that the patient had elevated total protein and polyclonal hypergammaglobulinemia, without monoclonality. Imaging demonstrated widespread lymphadenopathy and splenomegaly. A core lymph node biopsy showed polytypic plasmacytosis, but was non-diagnostic. Given the ongoing symptoms, an excisional biopsy was performed, revealing regressed germinal centers with increased interfollicular vascularity, mantle zone “onion skinning,” and HHV-8 LANA-1 nuclear positivity, establishing the diagnosis of HHV-8-associated MCD. Rituximab monotherapy was initiated, resulting in clinical improvement, resolution of the constitutional symptoms, and stabilization of ascites. This case highlights the importance of maintaining a high index of suspicion for MCD in patients with KS who develop new systemic or cutaneous findings, the limitations of a core biopsy, and the value of a timely excisional biopsy in guiding diagnosis and treatment. Full article

Background: Lower limb amputation (LLA), due to non-traumatic causes such as vascular diseases and diabetes, significantly impacts patients’ physical, psychological, and social well-being. While multidisciplinary rehabilitation programs commonly address physical and functional recovery, psychological and subjective experiences related to limb loss remain less explored. Thus, this preliminary study aimed to investigate the psychological and behavioral adaptation processes in patients undergoing rehabilitation following lower limb amputation. Methods: A preliminary observational study with a mixed-method approach based on quantitative and qualitative data triangulation was conducted. This approach involves integrating multiple data sources and methodologies—in this case, quantitative psychometric measures and qualitative interviews via the prospective of amputees and those who use prostheses—to enhance the validity and depth of the research findings. Results: Fourteen inpatient amputees and fourteen inpatient prosthesis users (years: 66.6 ± 2.5 for amputee and 61.5 ± 1.9 for prosthesis users, male amputees: 85.7%, male prosthesis users: 100%) of a research hospital in the North of Italy were assessed using validated psychometric tools (GAD-7, PHQ-9, PID-5-BF, BIS, ASonA) alongside semi-structured interviews analyzed through the Interpretive Description approach. Key themes highlighted illness acceptance, prosthesis adaptation, body image, medication and behavioral adherence, anxiety, depression, quality of life, denial, optimism, and social support. Overall, anxiety–depressive symptomatology tended to decrease with the prosthesis, and pharmacological and behavioral adherence improved, as did the disease acceptance. Body image was fairly preserved in all patients despite some fears of others’ judgment with respect to the prosthesis. Interestingly, there was poor agreement between quantitative and qualitative data in both the amputee’ and prosthesis users’ groups: while the former returned a partial and neutral picture, a more multifaceted picture emerged from the interviews collected. Conclusions: These findings underline the importance of integrating quantitative psychometric evaluations with qualitative methods to comprehensively understand patients’ adaptive experiences. Such combined insights are essential to inform tailored psychological interventions throughout the rehabilitation journey. Full article

Background: Endothelial cells (EC), crucial components of the vascular system, are adaptable cells that maintain homeostasis and respond to pathological events through structural and functional plasticity. Hepatocyte growth factor (HGF) is a multifunctional cytokine that has been demonstrated to have protective and disruptive influence on the blood barrier function. In endothelial biology, its role is also poorly characterized. The present study explores the impact of supraphysiological concentrations of HGF on mouse brain endothelial cells (MBECs), scrutinizing how it alters their integrity and morphology. Methods: Two groups of MBECs—control (CTR) and experimental (EXP)—were analyzed at two time points: early passage (p5) and late passage (p41). The EXP-groups (p5 and p41) were treated with HGF at a concentration of 4 µL/mL. Cellular morphology was assessed with brightfield microscopy; protein expression and localization of the tight junction marker (ZO-1) and the endothelial marker (Factor VII related antigen/von Willebrand factor, vWf) were analyzed using Western blotting, immunocytochemistry, and confocal microscopy. Intercellular barrier function was estimated via Transendothelial Electric Resistance (TEER) and Transendothelial Dextran Permeability (TEDP) assays. Results: Microscopical analysis demonstrated a change in the morphology of the MBECs from a longitudinal, spindle-like shape to a rounded, more spheroid, cobblestone-like morphology under high-dose HGF treatment. Western blotting revealed a progressive decrease of ZO-1 expression in the EXP-groups. The expression of vWf did not show significant differences. Qualitative immunocytochemical staining: vWf showed consistent expression across all groups. ZO-1 displayed a punctate, well-defined membrane and cytoplasmic localization pattern in the CTR-groups at p5 and p41. In contrast, the p5 EXP-group demonstrated a shift to a more diffuse cytoplasmic pattern. At p41, the EXP-group displayed a markedly reduced ZO-1 signal with no clear-cut membrane localization. Confocal analysis: ZO-1: punctate membrane-associated localization in CTR-groups at p5 and 41. The EXP-groups at p5 and p41 confirmed the diffuse cytoplasmic ZO-1 distribution. Phalloidin: well-organized actin cytoskeleton in CTR-groups, but rearrangement and stress fiber disorganization in the EXP-groups, especially at p41. The merged images confirmed reduced co-localization of ZO-1 with actin structures. Barrier function: TEER values dropped significantly in HGF-treated cells. TEDP to small and medium molecular weight dextran increased markedly under HGF treatment. Conclusions: Our data demonstrate that supraphysiological doses of HGF in an in vitro MBEC-barrier-like model disrupt TJ organization, leading to morphological changes and functional weakening of the MBEC-barrier-like structure, as shown by uncoupling between ZO-1/F-actin cytoskeleton, reduced TEER, and increased size-selective paracellular permeability (TEDP). Full article

Background/Objectives: Biological aging phenotypes in coronary artery disease (CAD) include coronary atherosclerosis, vascular aging, and endothelial dysfunction. The aim of the present study was to investigate the potential links between aging phenotypes, regulatory immune cells, and features of the thymus in patients with CAD. Methods: A single-center, cross-sectional, comparative study was conducted. Patients were stratified according to the severity of coronary atherosclerosis: patients with a Gensini score ≥ 65 points and patients with a Gensini score < 65 points. Peripheral blood and thymus biopsy were obtained. Imaging flow cytometry, ELISA, and immunohistochemical analysis were used for analysis. Results: Thymic morphology ranged from total fatty involution to a preserved structure of the thymus (20–80% area in 31% of obtained samples) but was not associated with the severity of atherosclerosis. Meanwhile, patients with a Gensini score ≥ 65 had impaired thymus cellular composition compared to patients with a Gensini score < 65 points; increased frequency of CD8+ T lymphocytes and NK cells; and decreased frequency of CD4 + CD8+ T lymphocytes. In peripheral blood, the main determinants of a Gensini score ≥ 65 points were low absolute counts of eMDSCs and CD25^low Tregs with FoxP3 nuclear translocation, while advanced vascular aging was associated with elevated eMDSC absolute counts. Advanced coronary atherosclerosis was also associated with decreased numbers of endothelial progenitor cells in circulation. Conclusions: Thymus dysfunction accompanies CAD progression and is manifested in changes in cellular composition rather than morphology. In CAD patients, MDSC and Treg lymphocytes are equally involved in the progression of coronary atherosclerosis, which is aggravated by the decreased regulatory potential of the endothelium. Vascular aging represents a distinct phenotype of biological aging in CAD patients, characterized by the expansion of eMDSCs. Full article