International braz j urol : official journal of the Brazilian Society of UrologyEduardo Fagundes Muricy, Jahel Alves Estrela Lopes, Emanoel Nascimento Santos, Lucas Teixeira Aguiar Batista, Ubirajara Barroso
PURPOSE: Metoidioplasty is used in transmasculine gender-affirming surgery; however, limited neophallus length and girth remain significant challenges (1-4). We describe a combined technique using Total Corpora Mobilization (TCM) for elongation and a Martius flap for girth enhancement (5-9). MATERIALS AND METHODS: Fifteen transgender men underwent first-stage metoidioplasty with TCM and Martius flap between 2023 and 2026. The vestibular plate and urethra were mobilized, followed by circumferential clitoral degloving and suspensory ligament division. A pubic periosteal incision was made, and subperiosteal dissection was performed using bipolar cautery while preserving a portion of the periosteum attached to the corpora cavernosa. The urethra was further mobilized and the triangular ligament was divided, followed by lateral dissection of both corpora cavernosa and complete release from the crura. An oral mucosa graft was used to create the urethral plate. The preserved periosteum was fixed to the dorsal tunica albuginea, and a vascularized Martius flap harvested from the labia majora was secured over the corpora for girth augmentation. Scrotal flaps provided wound coverage. RESULTS: The index patient achieved a neophallus length of 6.4 cm, representing a 1.9 cm gain over the preoperative stretched clitoral length. Median length gain was 3.7 cm, and mean circumference increase was 1.6 cm. Glans perfusion and tactile sensitivity were preserved in all patients, with no vascular or sensory complications recorded. CONCLUSIONS: Combined TCM and Martius flap metoidioplasty is feasible and reproducible. By achieving corporal release beyond previously described techniques, TCM may meaningfully enhance neophallus projection while preserving perfusion and sensation. Larger cohorts and longer follow-up are required to confirm the durability and functional outcomes of this approach.
Methods in molecular biology (Clifton, N.J.)David J Delgado Diaz, Katherine M Nelson, Vonetta L Edwards, Ian J Glomski, Filipa Ribeiro, Patrik M Bavoil, Alison K Criss, Jacques Ravel, Jason P Gleghorn, I…
Chlamydia trachomatis is an obligate intracellular bacterium that infects the columnar epithelium of the human endocervix. While conventional two-dimensional cell cultures and animal models have been instrumental in advancing our understanding of C. trachomatis biology, they are limited in capturing the multicellularity, architecture, and physiological microenvironment of the human cervix. This chapter describes the use of a three-dimensional (3D) microphysiologic model to study Chlamydia trachomatis infection. The model is inexpensively made without specialized equipment and is designed to recreate the epithelial-stromal interface. We outline procedures for coculturing cervical epithelial cells and fibroblasts, infecting epithelial cells with fluorescently labeled C. trachomatis, monitoring infection progression via fluorescent microscopy, and quantifying infectious progeny. The complete developmental cycle of C. trachomatis within this model provides a robust and accessible platform to investigate C. trachomatis-specific host-pathogen interactions, immune responses, and the influence of diverse physiological and environmental stimuli within a relevant cervical context.
Methods in molecular biology (Clifton, N.J.)Crucitti Dalila, Pacifico Davide
Culturing and maintaining Botrytis cinerea in vitro is essential for advancing research on fungal biology, host-pathogen interactions, and plant disease management. Reliable culture methods provide the basis for reproducible experiments, ensuring stable growth and long-term preservation of isolates. This chapter details standardized procedures for establishing fungal colonies on agar and broth media, including Universal Beer Agar, Potato Dextrose Agar, and Czapek-Dox Agar, as well as specialized formulations such as Carrot Agar and Honey Peptone Agar. Protocols for short-term maintenance on agar slants and long-term storage in glycerol at -80°C are described to ensure strain viability over time. Critical variables affecting fungal growth, such as temperature, light, pH, and medium composition, are also discussed, providing guidance for optimizing culture conditions. Together, these methods serve as practical tools for laboratories aiming to maintain pure B. cinerea cultures for physiological, genetic, and pathological studies.
Methods in molecular biology (Clifton, N.J.)Suzana Ferreira-Dias, Natália M Osório, Carla Tecelão
In this chapter, some examples of laboratory protocols to produce nutritional structured lipids, namely human milk fat substitutes, dietetic triacylglycerols, and interesterified fat blends with improved functional and rheological properties, catalyzed by either immobilized commercial or noncommercial lipase preparations, are presented. The use of crude oils instead of refined counterparts to reduce oil purification costs is also addressed. In addition to batch synthesis, the continuous production in packed- or fluidized-bed bioreactors is addressed, as well as the evaluation of operational stability of the biocatalysts used (either in batch reuses or in continuous mode).
Microfluidic tools enable manipulation of microliter-scale volumes within a stable microenvironment. Microfluidics has been widely adopted in various biological fields for, among other applications, controlled delivery of sensory, chemical, and mechanical stimuli to the observed organisms. In this chapter, we describe the design and usage of a custom-made double-layered PDMS microfluidic device, named BUGchip, developed for the purpose of studying plant root growth and metabolic responses in rapidly changing conditions with a high time-scale resolution. We demonstrate the utility of this device by a showcase experiment with a hyperosmotic treatment of Brachypodium distachyon roots, in which changes in growth rate and relative pH across the root surface in response to the treatment can be observed within minutes.
Methods in molecular biology (Clifton, N.J.)Marianna Cosentino, Desiree Genovese, Antonio Musarò
The development of three-dimensional (3D) tissue constructs that accurately replicate the morphology and function of native tissues is critical for advancing tissue engineering and regenerative medicine. Two primary strategies are currently employed: scaffold-based and scaffold-free approaches. Both aim to reproduce a biomimetic microenvironment that supports cell-cell and cell-matrix interactions, enabling the formation of functional tissues. To circumvent the immunological and toxicological limitations related to the use of exogenous scaffold materials, scaffold-free tissue engineering has emerged as a promising alternative. This method utilizes multicellular aggregates that fuse into cohesive structures while naturally producing extracellular matrix (ECM). Harnessing the intrinsic capacity of cells to self-organize and assemble into sheets enhances cell-cell connectivity and promotes spontaneous ECM remodeling, facilitating the formation of scaffold-free tissues. This study outlines the methodology for generating a 3D skeletal muscle tissue in vitro without the use of scaffolds. Here, we describe key analytical techniques, including flow cytometry, immunofluorescence, and histological staining, used to evaluate tissue functionality in physiological and pathological contexts. The proposed protocols enable the creation of a mouse skeletal muscle model suitable for drug screening and testing, considering its advantages and limitations. Furthermore, the integration of patient-derived biopsies or induced pluripotent stem cells (iPSCs) establishes a basis for personalized therapeutic applications in clinical settings.
Methods in molecular biology (Clifton, N.J.)Nadia Guajardo
This chapter of the book details the experimental methodology for obtaining a 5-hydroxymethyl furfural (HMF) ester through enzymatic catalysis. The esterification reaction consists of obtaining 5-acetyl-hydroxymethylfurfural from HMF and ethyl acetate catalyzed by the lipase CALB from immobilized Candida antarctica (Novozym 435®). Esterification is carried out in a batch and continuously packed-bed reactor. The operating conditions in batch mode are 35°C, 100 mM HMF, 0.02 g of biocatalyst, and 5 mL of reaction volume. In continuous mode, the reaction was carried out using a stainless-steel column of 0.4 cm internal diameter and 12.6 cm long, packed with 0.5 g of biocatalyst. The operating conditions are 35°C, 100 mM HMF, and flows of 0.02, 0.05, and 0.1 mL/min. Continuous esterification stands out over the batch mode for its simplicity of operation and high productivity.
Journal of foot and ankle researchTaeseok Choi, Sangbin Lee, Wansuk Choi, Seoyoon Heo
OBJECTIVE: To systematically review the evidence for orthotic interventions on pain, balance, and plantar pressure distribution in individuals with flexible flatfoot. METHODS: Randomized and nonrandomized controlled trials of orthotic interventions for flexible flatfoot were included. Primary outcomes were pain, balance, and plantar pressure. MEDLINE via PubMed, EMBASE via Elsevier, and the Cochrane Library were searched from inception to October 16, 2025. All effect sizes were independently recomputed, and pooling required two or more compatible datasets. RESULTS: Eight studies with 382 participants were included: six randomized controlled trials, one nonrandomized controlled trial, and one within-subject repeated-measures study. No domain met the pooling condition, so all previously reported summary estimates and heterogeneity statistics are withdrawn. Pain against a comparator without arch support rested on Yurt et al. (n = 67): g = -1.02 [95% CI: -1.54, -0.49] on the trial's designated primary outcome, a 100 mm visual analog scale, but g = -0.28 on its Foot Function Index total. In Elsayed et al. (n = 40) both arms wore the same orthosis, so g = -0.97 [-1.62, -0.33] estimates added exercise, not the device. Balance rested on Yalfani et al. (n = 30): g = -0.86 [-1.59, -0.13]. In Khodaei et al. (n = 19), plantar load was redistributed rather than reduced, moving from the heel and lesser metatarsals (g = -1.93 to -1.09) to the medial midfoot (+1.76). Taspinar et al. were withdrawn as arithmetically irreproducible. CONCLUSIONS: Every domain rests on a single small study, so no general efficacy claim is supportable. The most defensible finding is mechanical: load shifts from the heel and lesser metatarsals to the medial midfoot, as a medial arch support is designed to do. The pain estimate is not robust to instrument choice within its own trial. GRADE certainty is very low for every outcome; certainty for plantar pressure began at low because the contributing study did not randomize allocation. The two nonrandomized studies were additionally appraised with ROBINS-I, at critical and serious risk, respectively. Adequately powered randomized trials with a defined comparator and a pre-specified primary outcome are required.
Pakistan journal of pharmaceutical sciencesWeifeng Meng, Lingfei Fu, Hui Huang
BACKGROUND: Budesonide suspension is a first-line inhaled corticosteroid for elderly patients with inflammatory airway diseases, but existing research lacks targeted safety data for the very elderly (≥80 years), systematic analysis of adverse reaction (ADR) temporal distribution and quantitative evidence for modifiable clinical risk factors. OBJECTIVE: To investigate the safety profile, ADR temporal patterns and independent modifiable risk factors of nebulized budesonide suspension in elderly patients, with a focus on ≥80 years. METHODS: A retrospective analysis of 128 elderly patients (39 ≥80 years) treated with budesonide suspension (2 ml:1 mg) from January 2023 to June 2025 was conducted. ADRs were identified via medical record cross-check and verified by an expert team, with causality assessed using the WHO-UMC system. ADR incidence, type and temporal distribution were observed; univariate and multivariate logistic regression analyses were used to screen independent risk factors. RESULTS: The overall incidence of mild ADRs was 17.97%, with local ADRs (78.26%, predominantly oropharyngeal candidiasis) and systemic ADRs (21.74%). ADRs peaked at 8-14 days (39.13%). Age ≥80 years (OR=3.245, p=0.030), treatment duration >14 days (OR=2.897, p=0.048) and inadequate mouth rinsing (OR=4.126, p=0.008) were independent risk factors. ADR incidence was higher in patients with ≥3 underlying diseases (25.00% vs. 11.76%). CONCLUSION: Nebulized budesonide suspension is well tolerated in elderly patients, with no severe ADRs. This study clarifies temporal patterns of ADRs and identifies inadequate mouth rinsing as a key modifiable risk factor, providing targeted safety data for the very elderly. Standardized mouth rinsing and short-course medication are recommended for high-risk groups to reduce ADR risk. Notably, this study is limited by its single-center, retrospective design, which may introduce selection and information bias and the findings require validation in prospective multi-center studies with larger sample sizes.
Pain practice : the official journal of World Institute of PainYonghyun Yoon, King Hei Stanley Lam, Daniel Chiung-Jui Su, Teinny Suryadi, Anwar Suhaimi
BACKGROUND: Chest tube thoracostomy may cause iatrogenic nerve injury, resulting in persistent pain and functional impairment. Long thoracic nerve (LTN) palsy after chest tube placement has been described, but concurrent involvement of the LTN and the lateral cutaneous branch of an intercostal nerve (LCIN) appears to be rarely reported. We describe a patient with persistent post-thoracostomy chest wall pain and scapular winging in whom musculoskeletal ultrasonography identified entrapment of both nerves. CASE PRESENTATION: A 43-year-old man presented with severe left shoulder and chest wall pain 6 months after chest tube placement for traumatic hemopneumothorax. Examination demonstrated focal tenderness, dysesthesia, and mechanical allodynia at the chest tube scar, along with medial/inferior scapular winging during serratus anterior provocative testing. Shoulder range of motion was full on examination; however, forward flexion beyond 15° markedly aggravated pain, resulting in pain-related reluctance to move the shoulder. Manual muscle testing was 4+/5 before treatment because pain limited force generation. Musculoskeletal ultrasound demonstrated focal abnormality of the LTN where it pierced the axillary fascia over the sixth rib, with loss of fascicular definition and reduced glide, and tethering/thickening of the LCIN within scar tissue at the prior tube insertion site. Symptom reproduction with sonopalpation supported the clinical relevance of both findings. INTERVENTION AND RESULTS: Ultrasound-guided hydrodissection using 5% dextrose in water was performed around both nerves. A total of approximately 40 mL of 5% dextrose in water was used, with 20 mL administered per nerve. Immediately after the first procedure, pain improved from NRS 9/10 to 2/10, with marked reduction in pain during shoulder movement, including forward flexion. The patient subsequently underwent 5 treatment sessions at 2-week intervals over 10 weeks. During follow-up, manual muscle testing improved to 5/5 without pain, scapular winging was no longer evident on provocative testing, and the Shoulder Pain and Disability Index improved from pain/disability scores of 25/15 to 6/4. At the sixth follow-up visit, pain and function were satisfactory, and the patient elected continued monitoring without further intervention. At 1-year follow-up, treatment efficacy remained sustained without recurrence. CONCLUSION: In patients with persistent shoulder or chest wall pain after chest tube thoracostomy, iatrogenic peripheral nerve entrapment should be considered. This case highlights the value of a focused neuromuscular examination and musculoskeletal ultrasound for identifying concurrent motor and sensory nerve involvement and suggests that ultrasound-guided hydrodissection may be a useful minimally invasive treatment. Because electrodiagnostic studies were not performed, the findings are most consistent with entrapment/neurapraxia with dynamic tethering rather than electrodiagnostically proven axonal palsy.
NMR in biomedicineMing Lu, Xiaoyu Jiang, Yajun Ma, Yurui Qian, Congyu Liao, Yang Yang, John C Gore, Xinqiang Yan
This work develops and validates a practical method for quantifying the transmit-power threshold at which passive detuning of inductively coupled wireless resonators becomes reliable in MRI. All experiments were performed using phantoms. A near/far spatial signal ratio is computed from a series of gradient-echo (GRE) images acquired at different nominal flip angles. This ratio reveals ineffective detuning as a characteristic L-shaped curve whose inflection point marks the detuning threshold. The method was validated experimentally with wireless resonators incorporating different numbers of crossed diode pairs, at multiple static field strengths (3 and 7T), and with different scanner vendors. At 3T, the method produced consistent B 1 + thresholds across Philips and GE scanners despite their different flip-angle thresholds. The proposed method provides a practical, straightforward tool for acceptance testing and quality assurance of wireless resonator safety in both clinical and research MRI settings.
Oral and maxillofacial surgery clinics of North AmericaOreste Iocca, Ghayoour Mir, Imraan Jan, Guglielmo Ramieri, Rabie M Shanti
Specific considerations must be made in the treatment course of oral cavity carcinoma (OCC). Given the role of oral cavity in important functions such as speaking, eating, and esthetics, the choice of the optimal reconstructive option is of utmost importance. For small residual defects local flaps provide an acceptable solution, while for larger defects the adoption of the more complex revascularized free flaps is considered the gold standard. Another challenge is the management of recurrent OCC, which is characterized by a dismal prognosis. In this case, surgery is the first treatment option, when feasible, sometimes integrated with radiotherapy or chemotherapy.
Sexual healthKudzai Hlahla, Moni Neradilek, Morgan Garcia, Felix Mhlanga, Thesla Palanee-Phillips, Krishnaveni Reddy, Nishanta Singh, Carolyne A Akello, Samantha Siva, Leil…
BACKGROUND: Access to novel HIV prevention technologies often raise concerns of risk compensation. This analysis examined changes in the sexual behaviors of MTN 020/ASPIRE participants, a placebo controlled randomized control trial, who subsequently enrolled in MTN-025/HOPE, an open-label extension using the dapivirine vaginal ring. METHODS: Both studies enrolled healthy, sexually active, HIV-negative women from Malawi, South Africa, Uganda and Zimbabwe. Longitudinal data on participants' sexual behaviors, specifically sex with a nonprimary partner (past 3 months), and use of male or female condoms at the last vaginal sex act were compared between ASPIRE and HOPE. Conditional and mixed ordinal logistic regression models evaluated associations between study and sexual behaviors at enrollment, and quarterly over the first 12 months. RESULTS: Of the 2629 individuals enrolled in ASPIRE, 1456 (55%) participated in HOPE. At enrollment, the proportion of participants who reported sex with a nonprimary partner and condom use at last vaginal sex act did not differ by study. Across all quarterly follow-up visits, sex with a nonprimary partner was more common in HOPE (13.9-18.7%) than ASPIRE (10.7-12.6%); adjusted OR 1.47, 95% CI 1.24-1.75, P < 0.001. There was no difference in condom use at the last vaginal act across all quarterly follow-up visits between ASPIRE (36.5-42.7%) and HOPE (43.6-46.7%); adjusted OR 1.05, 95% CI 0.94-1.18. CONCLUSION: More women reported sex with nonprimary partners in HOPE, with little change in condom use over time between the two studies. Understanding behavior changes during PrEP use allows for tailored, holistic reproductive health programming.
INTRODUCTION: Uncorrected refractive error (URE) is a primary cause of visual impairment (VI). Although URE causes VI and increases the risk of amblyopia in school-going children, no studies have examined barriers to uptake of refractive eye-care services among secondary school students in Uganda. This study reports the perceived reasons for the poor uptake of refractive eye care services among students at two secondary schools in Kampala, Uganda. METHODS: A cross-sectional study was conducted in two secondary schools in Kampala between March 2019 and April 2019. Students' presenting distance visual acuities (DVA) were measured. Participants with a DVA worse than 6/9 were reassessed using a pinhole. Those not using spectacles or contact lenses who had pinhole-improvable reduced distance visual acuity suggestive of uncorrected refractive error were administered a structured questionnaire. Descriptive statistics were used to analyze the data. Chi-square tests were performed to assess the association between sex and the proportion of screened students with pinhole-improvable, reduced distance visual acuity suggestive of uncorrected refractive error. RESULTS: 407 students were screened for refractive errors. In total, 10.81% (44/407, 95% CI:8.15% to 14.20%) of screened students had pinhole-improvable reduced distance visual acuity suggestive of uncorrected refractive error (URE). Perceived barriers towards refractive eye-care use reported included fear of surgery (52.27%, 95% CI: 37.94% to 66.25%), unawareness of the available eye care services (50.00%, 95% CI: 35.83% to 64.17%) and not feeling comfortable with the indigenous practitioner to whom they had access (19/44,43.18%, 95% CI: 29.68% to 57.78%). Financial limitations were stated as an important barrier by 20.00% (5/25, 20.00%, 95% CI:95% CI: 8.86% to 39.13%) of participants who stated the most important barrier. CONCLUSION: Among students who participated in screening at two secondary schools, a small subgroup had pinhole-improvable reduced distance visual acuity suggestive of an uncorrected refractive component. Exploratory questionnaire responses identified possible barriers related to awareness, perceptions of treatment, access, cost, and family or social influences. These findings require confirmation using refraction-based case definitions, probability sampling, and a culturally adapted and validated adolescent questionnaire.
Journal of applied clinical medical physicsMichael Silosky
BACKGROUND: Quantification of low activity samples using gamma counters is a common technique when investigating the biodistribution of experimental radiopharmaceuticals. Several human and pre-clinical trials have investigated 89Zr labeled compounds, utilizing gamma counter to quantify activity in blood or animal samples. While the performance of gamma counters has been investigated for other positron emitting radionuclides, the more complex spectrum, including a 909 keV gamma emission, and low positron fraction of 89Zr may reduce both counting efficiency while increasing the severity of count rate losses. PURPOSE: The purpose of this study is to evaluate both the counting efficiency and the effect of count rate losses on the quantitation of activity for 89Zr using NaI(Tl) gamma counters. METHODS: Sources of known activity (initially 78.3 kBq) were measured in a gamma counter as they decayed over approximately 15 days. Observed count rates were fit with a paralyzable detector model for two separate energy windows, 511 keV ± 10% and 909 keV ± 10%, as well as their sum. Counting efficiency in the absence of losses as well as the effective deadtime for each dataset were calculated. RESULTS: Count rates for each energy window were well fit with a paralyzable model with R2 > 0.999. Counting efficiency (mean ± 95% confidence interval) was 10.07% ± 0.07%, 17.38% ± 0.13%, and 27.46% ± 0.16% for the 511 keV, 909 keV, and summed energy windows respectively. Effective dead time (mean, 95% confidence interval) was 14.31 µs, (13.30 µs-15.30 µs), 7.11 µs (6.68 µs-7.55 µs), and 4.77 µs (4.48 µs-5.06 µs) for the 511 keV, 909 keV, and summed energy windows respectively. CONCLUSION: Counting efficiency and count rate performance for 89Zr are poorer than for other positron emitting radionuclides. Count rate losses follow the paralyzable model and are correctible.
Pakistan journal of pharmaceutical sciencesPeipei Li, Tuo He, Jiajia Pan, Jie Yang, Jiwen Peng
BACKGROUND: Adenomyosis is commonly associated with dysmenorrhea and heavy menstrual bleeding. Although the levonorgestrel-releasing intrauterine system (Mirena, LNG-IUS) is recommended as a first-line conservative treatment, device displacement or expulsion remains a major limitation, especially in patients with enlarged uteri or deep uterine cavities. OBJECTIVES: To evaluate the clinical efficacy and safety of the Indomethacin-GyneFix IUD (GyneFix IUD) combined with LNG-IUS in patients with adenomyosis and to assess whether uterine cavity depth influences device stability. METHODS: In this single-center prospective randomized controlled trial, 270 patients with adenomyosis were randomly assigned in a 1:1:1 ratio to the GyneFix IUD + LNG-IUS group, the ring IUD + LNG-IUS group, or the LNG-IUS-alone group (90 patients each). The primary endpoint was the rate of device displacement/expulsion at 6 months. Secondary endpoints included changes in visual analogue scale (VAS) scores, pictorial blood loss assessment chart (PBAC) scores, uterine volume, hemoglobin (Hb), serum CA125, adverse events and patient acceptance. Subgroup analysis was performed according to uterine cavity depth (≤ 9cm vs. >9 cm). RESULTS: At 6 months, the displacement/expulsion rate was significantly lower in the GyneFix IUD + LNG-IUS group (2.22%) than in the ring IUD + LNG-IUS group (10.00%) and the LNG-IUS-alone group (18.89%) (χ2=13.468, P<0.001). All three groups showed significant improvement in dysmenorrhea, menstrual blood loss, Hb and CA125 compared with baseline, without significant between-group differences (all P>0.05). Adverse event rates were comparable among groups (all P>0.05). Patient willingness to choose the same treatment again (95.12%) and willingness to recommend it (90.24%) were significantly higher in the GyneFix IUD + LNG-IUS group. In patients with uterine cavity depth >9 cm, the stability advantage of this strategy was more pronounced. CONCLUSION: GyneFix IUD combined with LNG-IUS significantly reduces device displacement/expulsion in adenomyosis, particularly in patients with deeper uterine cavities, while maintaining comparable symptom relief and safety. It may represent a more stable and acceptable long-term conservative treatment option.
Journal of applied clinical medical physicsOfformata E Osunkwor, Alois Ndlovu, Roland F Teboh
BACKGROUND: Respiratory motion introduces significant geometric uncertainty in Stereotactic Body Radiotherapy (SBRT) for thoracic and abdominal tumors. Deep Inspiration Breath-Hold (DIBH) mitigates this, but the surface signal alone may not reflect internal target position, supporting the need for real-time internal-anatomy verification during delivery. PURPOSE: To commission a Surface-Guided Radiation Therapy (SGRT) system and validate an integrated SGRT + Image-Guided Radiation Therapy (IGRT) + triggered kV imaging (SITI) workflow for DIBH SBRT. MATERIALS & METHODS: The LAP LUNA 3D SGRT system was commissioned per AAPM TG-302 using phantom-based assessment of static and dynamic localization accuracy, reproducibility, and latency. An end-to-end test using a dynamic phantom validated the SITI workflow. Point dose was measured with an ion chamber under four scenarios: SGRT-only delivery, full SITI delivery, and SITI with induced 1 and 2 mm uncorrected 3D shifts. RESULTS: Static localization accuracy was better than 0.5 mm / 0.3°, with reproducibility within 0.2 mm / 0.1°. Dynamic testing confirmed sub-millimeter spatial accuracy and a 31.6 ms latency, well below the AAPM TG-302 100 ms tolerance. The 1 and 2 mm uncorrected shifts produced point-dose reductions of 0.9% and 2.2% relative to the SITI reference, consistent with the ∼1%/mm local dose gradient. Both shifts were clearly visualized on triggered kV images, confirming detection of sub-tolerance residual displacements undetected by surface guidance alone. CONCLUSIONS: The LAP LUNA 3D system meets the technical requirements for SBRT. The SITI workflow is technically feasible and provides real-time visualization of internal target position during delivery, offering a robust motion-management strategy for DIBH SBRT of mobile thoracic and abdominal targets.
GliaJens Wagner, Henrike Antony, Cornelia Hoyer, Kristiina Lundgrén, Rabah Soliymani, Sophie Crux, Lena Justus, Kevin Keppler, Julia Steffen, Christian Kurts, Dani…
Microglia are innate immune cells of the central nervous system (CNS). They extend their processes and migrate toward injuries in vivo. However, how the fractalkine receptor (CX3CR1) influences microglial migration remains unknown. Label-free proteomic profiling predicted changes in Ras homology family (RHO)-signaling activity that hint at dysregulated cytoskeleton signaling in Cx3cr1-deficient murine cortex tissue. To further investigate microglial migration, we carried out two-photon in vivo imaging at 4-h intervals for 72 h after a laser lesion in the cortex. Cx3cr1-deficient microglia showed enhanced migration toward the lesion. Additionally, the length and velocity of microglial fine processes extending toward the lesion were increased in Cx3cr1-deficient microglia. Migration remained unchanged in Ccr2-deficient mice, indicating that monocyte-derived macrophages/microglia did not contribute to microglia accumulation around the lesion. These results demonstrate that CX3CR1 modulates microglia migration toward laser-induced CNS injury. Manipulating microglia migration via the CX3CR1 signaling axis is therefore a potential target for the treatment of CNS injury.
Journal of biomedical materials research. Part AYifan Wu, Minghao Xu, Xixi Wang, Chijia Wang, Zhihong Wang, Jing Liu
The high incidence of cardiovascular diseases has led to an increasing demand for small-diameter vascular grafts. Polycaprolactone (PCL) is a commonly used synthetic polymer material in the construction of vascular grafts. However, PCL alone has limited bioactivity, which may affect its blood-contacting and tissue responses when used in small-diameter vascular grafts. Fish swim bladder-derived extracellular matrix (FSB-ECM) contains bioactive components such as collagen and has been investigated as a cardiovascular biomaterial, although its mechanical properties are limited. In this study, fish swim bladder-derived dECM was incorporated into PCL by electrospinning to fabricate a series of small-diameter vascular grafts. The study first confirmed that dECM was successfully loaded onto PCL fibers and significantly improved the hydrophilicity and degradation performance of the material. Based on the in vitro and ex vivo evaluations, the 15% PCL-dECM (3:7) formulation was selected for further in vivo testing because it showed a favorable balance of mechanical properties and hemocompatibility, including low platelet activation. Subsequent in vivo evaluation in a rat abdominal artery implantation model demonstrated that this dECM-modified graft achieved a 100% patency rate. Furthermore, it exhibited significant anti-inflammatory effects and was conducive to the organized deposition of extracellular matrix components, such as collagen and elastic fibers. This work successfully developed a novel small-diameter vascular graft that possesses both excellent bioactivity and mechanical properties. Our findings offer a promising strategy and a solid experimental foundation, supporting the future clinical translation of small-diameter vascular grafts.
The Australian & New Zealand journal of obstetrics & gynaecologyHarrison Odgers, Rhonda Farrell
BACKGROUND: Endometrial cancer is the most common gynaecological malignancy in Australia. Patients diagnosed in their reproductive window may desire a fertility-sparing approach, opposed to standard surgical care. International guidelines on fertility-sparing management exist; however, these highlight the lack of high-level evidence to support the recommendations. There are no Australian-specific guidelines or registries, leading to uncertainty as to how patients are managed locally. AIM: To survey clinicians in Australia regarding fertility-sparing management of endometrial cancer, to identify areas of consensus and variation, barriers to care and research priorities. MATERIALS AND METHODS: A 47-item online survey was distributed to clinicians who manage patients with endometrial cancer in Australia between November 2024 and January 2025. Responses were analysed descriptively. RESULTS: Of 70 eligible clinicians, 56% responded. There was agreement on appropriate candidate selection for FIGO grade 1 disease with absent/focal myoinvasion, use of hysteroscopy for diagnosis, and preference for levonorgestrel intra-uterine device as initial therapy. Opinions were divided on management of patients with Lynch syndrome or more extensive myoinvasion, the diagnostic utility of endometrial pipelle, and treatment of recurrences. POLE mutation testing and hysteroscopic resection were uncommon practices. Most respondents referred patients to fertility specialists, while other members of the multi-disciplinary team were less frequently utilised. The most frequent research priorities were weight-loss strategies (31%) and molecular profiling (27%). CONCLUSIONS: Clinicians in Australia have common approaches to diagnosis and first-line therapy, but there is variation in patient selection, surveillance and engagement with a multi-disciplinary team. These discrepancies highlight the potential benefits of local guidelines and further research.
Physiotherapy research international : the journal for researchers and clinicians in physical therapyAlbert Anand Udhaya Kumar, Vinodhkumar Ramalingam, Venkadesan Rajendran
BACKGROUND AND PURPOSE: The mechanistic rationale for treating the foot in anterior knee pain (AKP) is well established in the biomechanics literature; however, translating it into a clinically actionable evidence-supported rehabilitation protocol has proven difficult. This investigation pursued two aims: to characterize the functional and biomechanical differences between patients with AKP with and without pronated foot posture, and to compare the short-term effectiveness of two foot-targeted physiotherapy regimens, manual therapy with augmented low-dye taping (MT + ALDT) and neuromuscular training with ALDT (NMT + ALDT), against routine physiotherapy care. METHODS: A sequential two-phase design was employed in the outpatient physiotherapy department of Mediclinic Al Noor Hospital, Abu Dhabi, UAE. Phase 1 was a prospective case-control study (n = 50; pronated foot, n = 30; neutral/supinated, n = 20). Phase 2 was a single-blind parallel-group RCT that randomized 31 participants with confirmed pronation 1:1:1 to MT + ALDT (n = 11), NMT + ALDT (n = 10), or routine physiotherapy (n = 10) across 12 sessions in 4 weeks. Four outcomes were assessed at baseline and post-intervention: NPRS, Kujala AKPS, FPI-6, and DVI. RESULTS: Phase 1 revealed a 33.7-point AKPS gap between pronated and neutral/supinated participants (50.20 vs. 83.90; p < 0.001, Mann-Whitney U) and a significant FPI-6-DVI association (χ2 = 4.22, p = 0.04). In Phase 2, ANCOVA confirmed that both foot-targeted regimens significantly outperformed routine care on all four outcomes (all p < 0.001), with MT + ALDT demonstrating the greatest improvements. Effect sizes were large (η2 = 0.646-0.958; 95% CIs reported in Results) and are treated as preliminary estimates warranting cautious interpretation given the small sample and single-center setting. DISCUSSION: Foot pronation was strongly associated with impaired patellofemoral function, although the cross-sectional design of Phase 1 precluded causal inference. Both foot-targeted regimens outperformed routine care, and MT + ALDT demonstrated a stronger clinical profile. The equivalent biomechanical outcomes across both experimental arms were consistent with a contribution from ALDT, but its independent role could not be isolated without a taping-isolated comparator arm. These preliminary single-center findings support further investigation of foot posture assessment and distal intervention in AKP pending confirmation in adequately powered multicenter trials. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05917080.
MicrobiologyOpenLiam A O'Callaghan, Matthew Olsen, Caleb Kam, Matthew Linnanne, Adrian Goldsworthy
Agar plate photography is widely used to document microbial growth, but images captured under routine laboratory lighting are often affected by glare, reflections, shadows, and uneven illumination, which may compromise both visual interpretation and computational analysis. This proof-of-concept study developed and evaluated a low-cost, three-dimensional (3D)-printed lightbox for standardized smartphone-based agar plate imaging. Image characteristics were assessed across five uncultured agar media under traditional and lightbox conditions using Fiji/ImageJ. Machine learning-assisted analysis was then performed on cultured horse blood agar plates using QuPath. Separate Random Trees pixel classifiers were developed for traditional and lightbox images to distinguish colonies from background agar and noncolony artifacts. A semiautomated QuPath-assisted workflow was also compared with manual colony counts across 14 growth-positive horse blood agar plates. Lightbox imaging reduced reflective artifact, improved illumination consistency, and enhanced visualization of colony margins and hemolysis-associated changes. Traditional-lighting images produced more artifact-related classifier detections, including glare, reflections, and uncolonized agar being detected as colony-like regions. In the exploratory colony-count comparison, semiautomated QuPath-assisted counts showed close agreement with manual reference counts (Pearson r = 0.999; mean absolute error = 2.4 colonies per plate). These findings demonstrate that a low-cost, 3D-printed lightbox can improve the quality and standardization of smartphone-based agar plate images and support more interpretable machine learning-assisted analysis. Further validation using larger independent data sets, additional organisms, media types, and imaging devices is required.
Medullary bone transport is a valuable technique to perform distraction osteogenesis with all-internal components. This technique has notable advantages over other techniques which rely on external pins, wires, and frames. Preoperative templating and surgical planning are critical to the success of this procedure to ensure that movement of the segment across the defect can be performed based on the specifications of the nail. The case of a young patient with a 67 mm diaphyseal tibial defect after an open tibial shaft fracture who had successful reconstruction with a medullary bone transport nail is presented.
Clinical and experimental dental researchMohammadreza Nakhaei, Hossein Dashti, Arsalan Shahri, Mahsa Rahmani, Ali Kazemian, Saeid Sabzevari, Masih Rezaee
OBJECTIVES: To quantify the occlusal adjustment required for two-unit, implant-supported polymethyl-methacrylate (PMMA) crowns with either digital or conventional impression techniques, using full-arch and half-arch workflows. MATERIAL AND METHODS: An acrylic maxillary-mandibular model carrying two bone-level implant analogs (sites 46-47) was mounted on a semi-adjustable articulator. Twenty impressions were made (n = 5 per group): digital full-arch, digital half-arch, conventional full-arch, and conventional half-arch. PMMA crowns were designed using computer-aided design (CAD) software, milled, and surface-scanned before adjustment. Occlusal contacts were refined on the articulator with 21 µm film while recording adjustment time. Pre- and post-adjustment scans were superimposed and analyzed using three-dimensional surface analysis software to quantify mean material reduction (µm). Data were analyzed with one-way ANOVA and independent-samples t-tests (α = 0.05). RESULTS: Digital workflows required significantly less occlusal reduction (146 ± 35 µm vs. 226 ± 35 µm; p = 0.035) and shorter adjustment times (144 ± 36 s vs. 385 ± 36 s; p < 0.001) than conventional, with no effect of arch span (full vs. half; p > 0.05). Within protocols, the digital half-arch group showed the smallest adjustment (127 ± 37 µm) and fastest finishing (98 ± 33 s), whereas the conventional half-arch group required the longest time (456 ± 21 s). CONCLUSION: Fully digital impressions reduce both the amount of occlusal adjustment and the chairside time needed to seat implant-supported crowns compared with conventional silicone impressions. Reducing the scan to a half-arch does not compromise occlusal precision, making the digital half-arch workflow an efficient alternative for posterior, free-end implant restorations. CLINICAL RELEVANCE: In implant posterior PMMA crowns, the impact of impression/workflow choice on occlusal adjustment is unclear. This in-vitro study measured occlusal reduction and chairside time across digital versus conventional and full- versus half-arch workflows. Digital, especially half-arch, required less adjustment and shorter time. Clinically, a digital half-arch approach may streamline delivery and reduce unnecessary material removal, pending confirmation in patient-based settings.
Journal for specialists in pediatric nursing : JSPNAnna Stålberg, Johanna Granhagen Jungner, Cecilia Bartholdson, Henrik Hjelmgren
PURPOSE: To describe children's experiences of using extended reality (XR) distraction, namely virtual reality (VR) and augmented reality (AR), during needle-related procedures. DESIGN AND METHODS: An exploratory, prospective convergent parallel mixed-methods design was employed. Self-reported measures and structured observations conducted in accordance with a predefined protocol were combined with semi-structured interviews. Data were presented using descriptive statistics and synthesized through thematic analysis. RESULTS: Observations were conducted during 29 venipunctures in children using XR distraction. A majority of the children (90%) reported positive experiences with the use of XR distraction. Numerical Rating Scale pain scores (0-10) were low in both groups, with a mean of 1.26 (SD 1.16) for VR and 1.77 (SD 1.79) for AR. Most procedures (62%) were carried out as planned. No child declined the use of the device. Physical restraint was not observed; however, supportive holding was used in 10% of procedures. Four themes were identified through the interviews: Emotional support and comfort, The artificial world becomes reality, A diversified experience, and Usability aspects influencing user experience. CONCLUSION: When appropriately implemented, XR distraction may reduce pain and anxiety among children during needle-related procedures. However, it is not universally effective, underscoring the importance of a child-centered approach that allows children to select their preferred distraction method. Further research is required to determine optimal implementation strategies, assess cost-effectiveness, and clarify the role of XR distraction in delivering high-quality pediatric care during needle-related procedures. PRACTICE IMPLICATIONS: The demonstrated benefits of XR distraction during needle-related procedures may encourage healthcare professionals to incorporate such tools into clinical practice. Nevertheless, the findings also emphasize the importance of adopting a child-centered approach, recognizing that XR distraction is not suitable for all children.
Journal of orthopaedic traumaBrett D Crist, Mark A Lee
Nonunions with bone defects create technical challenges for fracture healing. All-internal bone transport with an intramedullary nail offers benefits over the other bone segment transport options including being simpler for the patients, avoiding the associated soft tissue issues that externally based implants or techniques and minimizing residual deformity by maintaining the anatomical axis along the intramedullary nail. This article reviews preoperative planning, technical tricks and specific techniques for internal bone transport, including the corticotomy, distraction, docking site and regenerate management, and the available literature.
Scandinavian cardiovascular journal : SCJMatilde Winther-Jensen, Berit Thornvig Philbert, Marie L Laursen, Jesper Kjaergaard, Tommi B Lindhardt, Jacob E Møller, Emilie Gregers, Louise Linde, Jens Broc…
INTRODUCTION: In patients who survive out-of-hospital cardiac arrest (OHCA), guidelines for implantation of an implantable cardioverter-defibrillator (ICD) are not unequivocal. METHODS: Patients resuscitated from OHCA of cardiac cause, without a reversible cause and an expected survival >1 year, were identified (year 2007-2011). Patients with acute coronary syndrome (ACS) and primary arrhythmia were compared with respect to: (1) incidence of early ICD-implantation prior to hospital discharge, (2) first shock- and anti-tachycardia (ATP) therapy up to 5 years, and (3) 5-year mortality rate assessed by Cox-regression analyses. RESULTS: ACS patients (n = 256) less often had an ICD implanted compared to primary arrhythmia patients (n = 258) (30% vs. 82%). Cumulative 5-year incidence of appropriate ICD-therapy did not differ (ATP; ACS: 28% vs. primary arrhythmia: 27%, shock; ACS: 22% vs. primary arrhythmia: 29%). Crude 5-year mortality was lower in ICD patients; ACS: No ICD: 22% vs. ICD: 13%; primary arrhythmia: No ICD; 66% vs. ICD: 16%. No difference in mortality between patients was noted (adjusted hazard ratio (HRACS): 0.91, 95% CI: 0.50-1.67). ICD implantation was independently associated with lower 5-year mortality risk in both patient groups after adjusting for cause of arrest, age > 65 years, left ventricular ejection fraction (LVEF) ≤35%, sex, and successful revascularization (in ACS only) (HRACS: 0.35, CI: 0.17-0.73, HRPA: 0.15, CI: 0.08-0.27). CONCLUSIONS: Cumulative incidences of appropriate therapy did not differ according to cause of arrest. Implantation of an early ICD after OHCA was significantly and independently associated with a lower 5-year mortality risk in both ACS and primary arrhythmia patients.
BACKGROUND: Central venous occlusion (CVO) is a severe complication in hemodialysis patients with tunneled cuffed catheters (TCC), leading to catheter dysfunction and poor outcomes. Optimal treatment remains controversial. METHODS: This retrospective study included 123 hemodialysis patients with TCC dysfunction and CVO between February 2017 and December 2025. Patients underwent either exchange of the existing catheter or placement of a new catheter at a different venous site, with or without concurrent balloon angioplasty or stenting. RESULTS: The cohort had a mean age of 61.02 ± 13.66 years, 29.2% male, with mean hemodialysis vintage of 7.86 years. Brachiocephalic vein occlusion was the most common lesion (74.8%), followed by superior vena cava occlusion (63.4%). Median catheter survival was 735 days. Recurrent dysfunction requiring reintervention occurred in 39.0% of patients (median time 255 days). Atrial thrombus (17.8%) and fibrin sheath (38.2%) were significantly associated with shorter catheter survival (p < 0.05). Most patients had reduced right ventricular basal diameter (98.0%) and increased left ventricular mass index (40.9%). CONCLUSIONS: Catheter exchange and endovascular treatment for central venous occlusion are safe and effective. Percutaneous superior vena cava puncture provides a valuable salvage option for this complex population, supporting durable long-term vascular access. Thrombosis and fibrin sheath predict poorer catheter survival.
International journal of medical informaticsLuca Marconi, Martina Vignali, Matteo Di Marino, Federico Cabitza
BACKGROUND: AI-enabled medical software is increasingly used across clinical care. The European Database on Medical Devices (EUDAMED) is intended to support transparency, but the public traceability of AI functionality remains uncertain. OBJECTIVE: To assess AI traceability in EUDAMED software-device records and to characterize devices supported by explicit device-specific AI evidence. METHODS: We conducted a cross-sectional study of EUDAMED software records available through 31 December 2025. Consolidation yielded 1546 device-level records from 2858 raw records. EUDAMED-only AI coding was independently replicated, with agreement measured before adjudication. AI identification then used device-specific external public evidence, including official regulatory documentation, manufacturer materials, and scientific sources where applicable. RESULTS: Overall, 386/1546 devices (25.0%) met the explicit device-specific AI criterion. Only 28 (1.81% of all devices; 7.3% of AI-identified devices) contained qualifying AI evidence directly in EUDAMED, whereas 358 (23.2% of all devices; 92.7% of AI-identified devices) required external sources. EUDAMED-only coding showed 98.12% agreement (Cohen's κ=0.318). Class IIa predominated among AI-identified devices (254/386, 65.8%); diagnosis and medical data interpretation accounted for 234/386 (60.6%). CONCLUSION: In this pre-mandatory-use snapshot, EUDAMED alone substantially underrepresents publicly substantiated AI functionality among the software-device records examined. Structured AI metadata, explicit provenance, and lifecycle reporting could improve transparency and regulatory oversight.
Scandinavian journal of primary health careHasse Melbye, Carl Edvard Rudebeck, Hans Pasterkamp
AI-assisted digital stethoscopes can classify heart and lung sounds with accuracy comparable to or exceeding that of the average clinician and help the physician in the diagnostic process. With this essay we want to discuss benefits and downsides of this new technology. Will proficiency in auscultation, which brings joy and pride to many stethoscope users, be suffering when interpretation of chest sounds is taken over by AI? And how will recommendations from AI in the diagnostic process influence decision making and the patient-doctor relationship? A tendency toward deskilling of auscultation proficiency can be counteracted when AI-assisted interpretation is used as a reflective tool, comparing machine output against clinical perception to sharpen diagnostic acuity. This concept of a collaboration of humans and AI will be important with regard to keeping AI-algorithms trustworthy. We still need more research on heart and lung sounds, to gain a detailed understanding of the clinical significance of various sound characteristics. The smart stethoscope will be useful for this research. Better knowledge will benefit not only algorithm development but also clinicians using traditional stethoscopes. The traditional stethoscope will probably prevail as the main instruments for chest auscultation in foreseeable future. Smart stethoscopes may become useful tools in the education of their users.
Annals of medicineSenlin Cai, Xiaofen Hu, Yuqian Wei, Ting Zheng, Shengyuan Xie, Huifen Lin, Xiaobin Pan
BACKGROUND: The bispectral index (BIS) was derived primarily from propofol data, and whether its thresholds apply to remimazolam is uncertain. We compared BIS between the two agents at matched sedation depths and examined early cognitive recovery. METHODS: In this prospective, randomized, double-blind, two-period crossover trial, 16 healthy volunteers (American Society of Anesthesiologists physical status I) received remimazolam and propofol in random order, ≥ 7 days apart. Each agent was titrated to moderate (Modified Observer's Assessment of Alertness/Sedation [MOAA/S] 3) and deep (MOAA/S 1) sedation. The confirmatory outcome was mean BIS at deep sedation. All other outcomes were exploratory: BIS at moderate sedation and at loss of the eyelash reflex, emergence time, and cognitive recovery at 30 and 120 min. RESULTS: At deep sedation, mean BIS was higher with remimazolam (57.6 ± 7.5) than with propofol (46.5 ± 7.9; adjusted difference 11.1 units; 95% CI, 7.3 to 14.8; p < 0.001). In exploratory analyses, BIS was also higher at moderate sedation and at loss of the eyelash reflex (both p < 0.001), and emergence time did not differ (p = 0.606). At 30 min, processing speedand executive function recovered faster after remimazolam (p = 0.012 and p < 0.001), whereas verbal memory did not differ between agents. All domains converged by 120 min. Adverse events were uncommon, and the trial was not powered to compare them. CONCLUSION: At clinically matched sedation depths, remimazolam produced higher BIS values than propofol. Spectral data were not recorded, so the basis of this offset is undetermined, and the cognitive findings were exploratory. Whether this offset warrants agent-specific reference values requires validation in clinical populations.
BACKGROUND: Reliable tracking of short- and long-term blood pressure (BP) changes is a prerequisite for clinical adoption of cuffless BP devices. This study evaluated the 6-week stability of BP estimation by CSEM's wearable photoplethysmography (PPG)-based cuffless BP monitor and its ability to track BP changes in hypertensive patients compared with a validated oscillometric device (Microlife WatchBP Home A). METHODS: In this feasibility method-comparison study, 30 hypertensive patients attended four visits over 6 weeks. At each visit, BP was estimated as the median of 5-7 consecutive measurements obtained with the cuff-based (Cuff BP) and cuffless (PPG BP) devices. Between-visit systolic and diastolic BP changes (ΔSBP, ΔDBP) were compared between devices. Concordance rate (CR), defined as the percentage of significant BP changes (ΔSBP >15 mmHg, ΔDBP >10 mmHg) showing the same direction with both devices, was also assessed. RESULTS: Thirty participants (18 women; age 54 ± 17 years; BMI 29.2 ± 5.5 kg/m²) were included. Differences between devices were 0.2 ± 12.8 mmHg for ΔSBP and -0.1 ± 7.4 mmHg for ΔDBP. No temporal drift in differences between Cuff ΔBP and PPG ΔBP was observed over 6 weeks. CR for significant BP changes was 83% for SBP and 86% for DBP. CONCLUSION: CSEM's wearable cuffless BP monitor provided stable BP estimation and concordant BP tracking during antihypertensive therapy. Interpretation is tempered by substantial variability of the oscillometric reference device. If confirmed in larger studies against a gold-standard reference, these findings could support the clinical acceptance of wearable cuffless BP monitoring.
Brain impairment : a multidisciplinary journal of the Australian Society for the Study of Brain ImpairmentZhen Yang, Shangang Zhang, Du Wang, Mengmei Guan, Linru Qiao
BACKGROUND: Motor imagery-based brain-computer Interface (MI-BCI) utilises electroencephalographic signals from imagined limb movements for control commands, enabling real-time interaction with external devices. Clinical trials suggest its potential for upper limb recovery post-stroke. This study aims to systematically evaluate the effectiveness of MI-BCI on upper limb motor function in patients with post-stroke hemiplegia. METHODS: A comprehensive search was conducted across PubMed, Cochrane Library, Web of Science and Embase through March 2026 for randomised controlled trials assessing MI-BCI effects on upper limb motor impairments post-stroke. A systematic review and meta-analysis were performed. RESULTS: The analysis included 27 studies for systematic review, with meta-analyses encompassing 24 studies involving 846 participants. MI-BCI training showed statistically significant improvements in measures of isolated limb movement and fine motor control, specifically the Fugl-Meyer Assessment for Upper Extremity (s.m.d. 0.31, 95% CI: 0.18-0.45; I² = 17%) and the Wolf Motor Function Test (s.m.d. 0.45, 95% CI: 0.24-0.66; I² = 39%). CONCLUSIONS: MI-BCI training can improve upper limb motor function, particularly for isolated movements and fine motor control, in stroke patients. Its effects on complex functional activities, activities of daily living and spasticity were not significant in the current evidence. Due to heterogeneity in control conditions (including sham interventions) across studies, the current evidence does not support definitive conclusions regarding its superiority over standardised traditional rehabilitation.
BACKGROUND: Secure defect closure is critical in endoscopic full-thickness resection (EFTR). The through-the-scope twin clip (TTS-TC) is designed to overcome the shallow tissue grasping of titanium clips, facilitating deeper tissue apposition. This study evaluated the safety, clinical effectiveness, postoperative hospital stay, and hospitalization costs of the TTS-TC in gastric EFTR defect closure. METHODS: We retrospectively analyzed 121 patients with gastric lesions who underwent EFTR between June 2023 and June 2025. Patients were stratified into the TTS-TC group (n = 36) and the 10-mm titanium clip group (n = 85) based on the closure method. We compared procedure time, number of clips used, postoperative length of stay, incidence of intraoperative and postoperative adverse events, and hospitalization costs. RESULTS: Both groups achieved definitive closure without major adverse events. Although the TTS-TC was preferred for larger and anatomically demanding lesions, subgroup analysis of defects >15 mm revealed that the TTS-TC group required significantly fewer clips and had a shorter median procedure time, with no statistically significant differences in postoperative length of stay or hospitalization costs. Multivariable regression analysis showed that the TTS-TC was independently associated with fewer clips used (p < 0.001), alongside a trend toward a shorter procedure time (p = 0.058). CONCLUSIONS: In this retrospective observational comparison, the TTS-TC appears to be a safe and feasible option for closing gastric wall defects during EFTR, and demonstrates potential utility in managing selected large or anatomically challenging defects.
BACKGROUND: A refractory catheter-related infection in patients receiving peritoneal dialysis (PD) represents a major challenge that may require catheter removal and reinsertion. We assessed the effect of a tunnel reconstruction operation on refractory infection in a single center. METHODS: We retrospectively collected data from 10 PD patients who, after inadequate responses to treatment with culture-based antibiotic therapy, underwent a tunnel reconstruction operation designed to resolve a refractory catheter-related infection without requiring transition to hemodialysis. The patients were followed for 3-41 months, and outcomes at months 3 and 12 were analyzed. RESULTS: Tunnel reconstruction surgery was performed in 10 patients, including 7 with exit-site infection and 3 with tunnel infection. No patients developed catheter-related infection, catheter dysfunction, or postoperative complications after 3 months of postoperative follow-up. During the 12-month postoperative follow-up period, there were no catheter-related infections among 7 patients (3 patients were not followed for 12 months). However, 2 patients developed an exit-site infection episode at 33 and 41 months after tunnel reconstruction surgery, respectively. No incidents of PD connector hypersensitivity or catheter leakage occurred during the follow-up period. CONCLUSION: Tunnel reconstruction operation may be a promising salvage option that requires prospective validation in PD patients with refractory catheter-related infections.
Computer methods and programs in biomedicineBohan J Li, Nicholas C Dorn, Andras Lasso, Matthew A Jolley, Jeffrey A Feinstein, Doug L James, Alison L Marsden
BACKGROUND AND OBJECTIVE: Stenting is among the most common transcatheter interventions for congenital heart disease (CHD). Patient-specific computational fluid dynamics (CFD) simulations can predict hemodynamic outcomes of intervention scenarios but require post-operative vascular geometries that reflect stent-induced shape changes, which existing tools either model inadequately or require extensive time or manual effort to generate. We present SDFStent, a signed distance function (SDF) based mesh deformation method for virtual stenting that operates in real time, maintains mesh integrity, and preserves junction geometry. METHODS: The stent is modeled as a pipe surface composed of piecewise-capsule SDFs joined by a smooth-minimum operator. Mesh vertices near the expanding SDF surface are displaced along the SDF gradient with a compactly supported fall-off function and an alpha blending mask. SDFStent was benchmarked against three existing approaches and validated on a proof-of-concept cohort of three tetralogy of Fallot (ToF) and three coarctation of the aorta (CoA) patients using rigid-wall steady-state CFD simulations against clinical catheterization measurements. RESULTS: Against a prescribed diameter of 6.0 mm, the method produced a mean stented diameter of 5.92 ± 0.08 mm in 1.5 s, over 100× faster than the best stenting-specific comparator. All output meshes were watertight and self-intersection-free. CFD-simulated post-operative pressure drops agreed with clinical measurements within 4 mmHg (mean error 2 mmHg). CONCLUSIONS: SDFStent produces simulation-ready post-stent models that match prescribed stent dimensions at interactive speeds, from pre-operative anatomy and catheterization data alone. The implementation is open-source and available in 3D Slicer. Its scriptable architecture enables automated generation of large synthetic cohorts for data-driven surrogate modeling.
Scandinavian cardiovascular journal : SCJTroels Thim, Henrik Nissen, Phillip Freeman, Jordi Sanchez Dahl, Evald Høj Christiansen, Michala Norsell, Ashkan Eftekhari, Bjarne Linde Nørgaard, Christian Al…
Background. Transcatheter aortic valve implantation (TAVI) is most extensively documented for the treatment of aortic stenosis in patients with tricuspid valves. To compare the 30-day and 1-year outcomes after TAVI in patients with tricuspid, bicuspid and bioprosthetic valves who participated in the COMPARE-TAVI 1 trial. Methods. In COMPARE-TAVI 1, all-comer patients treated with transfemoral TAVI were randomized to treatment with one of two balloon-expandable valves. In this study, these patients were divided into three groups based on valve anatomy. 30-day and 1-year outcomes among patients with bicuspid and bioprosthetic valves (surgical or transcatheter) were compared with outcomes among patients with tricuspid valves. Results. Patients with tricuspid valves (N = 892, median 82 years) were slightly older than patients with bicuspid (N = 98, median 78 years) and bioprosthetic (N = 40, median 80 years) valves. Procedural outcomes were similar. There were no differences in death or bleeding at 30 days, nor in death, myocardial infarction, percutaneous revascularization, or endocarditis at 1 year. Stroke was more frequent among patients with bicuspid valves at 30 days (n = 7), while new pacemaker was less frequent among patients with bioprosthetic valves at 30 days (n = 0). The need for reoperation was more frequent among patients with bicuspid valves (n = 3). Conclusions. In this observational study performed within the COMPARE-TAVI 1 cohort, patients with tricuspid, bicuspid or bioprosthetic valves had similar outcomes. No patients with bioprosthetic valves had a new pacemaker within 30 days after TAVI. Clinical trial registration. ClinicalTrials.gov: NCT04443023.
Biomaterials advancesPeter Trosan, Franziska Frost, Jessica Hoerner, Jana Schaetzel, Thomas Eickner, Marcus Himmler, Susanne Staehlke, Volkmar Senz, Andreas Götz, Niels Grabow, Sab…
Descemet's Membrane Endothelial Keratoplasty (DMEK) is one of the most common therapies to re-establish visual acuity caused by corneal endothelial cell loss. Donor tissue shortages become increasingly relevant. Therefore, the main objective of this study was the evaluation of potential fiber substitute materials suitable for DMEK. Six electrospun biomaterials (three degradable: poly-l-lactide (PLLA), PLLA plus lecithin and tetraethylammonium chloride (PLLA+), polydioxanone (PDO); three non-degradable: polyurethanes (TSPEU, TSPCU), thermoplastic elastomer (TPC-ET) were examined regarding their structure, transparency, cell viability, metabolic cell activity, and endothelial phenotypic markers. Cell behavior was assessed on plasma-activated as well as on non-activated biomaterials to distinguish a possible influence of cold plasma activation. All biomaterials were suitable scaffolds for endothelial cells (HCEC) in varying degrees. No significant differences could be found between plasma-activated and non-activated scaffolds. PLLA+ ranked highest in total cell number. All biomaterials were comparable regarding cell toxicity, with high levels of cell viability. qPCR analysis revealed higher expression of genes responsible for HCEC's proliferation and morphology cultured on TSPEU, PLLA, and PLLA+. In summary, PLLA and PLLA+ showed the highest number of cells with high viability and cell proliferation whilst preserving their phenotype. In addition, PLLA and PLLA+ ranked highest in light transmission, which makes them promising candidates as artificial DMEK replacements.
Biomaterials advancesAnabela Veiga, João B Costa, Viviana P Ribeiro, Glenn Leung, David L Kaplan, Ana L Oliveira
Three-dimensional (3D) bioprinting requires inks and bioinks that combine appropriate processing and mechanical properties with a biologically supportive environment capable of sustaining cell viability and proliferation. Silk-based biomaterials have attracted considerable attention in biofabrication due to their tunable properties, processability, and structural similarity to extracellular matrix components. While most silk-based inks/bioinks rely primarily on silk fibroin (SF) for structural integrity, the use of silk sericin (SS) as a cell-supportive component remains comparatively underexplored in bioprinting. As a hydrophilic protein, SS has been associated with favorable cell responses, including cell adhesion and proliferation. Additionally, SS has been reported to support cell growth in culture media, or to replace fetal bovine serum (FBS). These characteristics have motivated the exploration of sericin in formulations intended for cell encapsulation Furthermore, as a by-product of the silk industry, SS is a sustainable protein source, providing an environmental dimension to its biomedical use. In the current study, we combined both silk proteins to develop a proof-of-concept bilayer silk-based printed construct. SS-based hydrogels were formulated with gelatin and glycerol to encapsulate human dermal fibroblasts (HDFs), while SF-based ink was incorporated into the 3D printing process as a structurally supportive biomaterial. The inks/bioinks were processed using extrusion-based 3D bioprinting and subsequently crosslinked through an enzymatic horseradish peroxidase/hydrogen peroxide (HRP/H₂O₂) system to stabilize the hydrogel network. These structures supported HDF viability and proliferation under the tested in vitro conditions. Overall, these results highlight the potential of silk proteins as a proof-of-concept 3D bioprinting platform that combines a SF-based structural support ink with a sericin-containing cell-laden bioink in which HDF viability and proliferation were supported under the tested in vitro conditions.
Cryogels have emerged as promising biomimetic scaffolds for extracellular matrix emulation in bone tissue engineering (BTE). In this study, we investigated how hydroxyapatite (HA) incorporation influences the physicochemical, mechanical, and biological performance of cryogels based on methacryloyl derivatives of type A gelatin, type B gelatin, and chondroitin sulfate (GelMAA, GelMAB, and CSMA, respectively). HA-enriched cryogels were fabricated through a one-pot cryogelation process in which HA particles were dispersed within the polymer solutions prior to crosslinking, without the use of additional dispersing agents. Scaffolds incorporating either commercial spheroidal HA or ultrasound-synthesized needle-to-plate HA were compared with non-mineralized counterparts as well as with each other, to evaluate the effect of the mineral phase on the resulting cryogels properties. The different polymer matrices exhibited distinct capacities to stabilize and homogeneously incorporate HA. Negatively charged polymers (GelMAB and CSMA) enabled HA incorporation up to 10% w/w, whereas GelMAA efficiently incorporated only 2.5% w/w. However, increasing mineral content did not result in improved mechanical properties or biological performance, suggesting that alterations in cryogel pore architecture and interconnectivity outweighed the benefits of higher mineral loading. Biological evaluation revealed limited cell response in CSMA-based cryogels, while GelMA-based systems supported cell adhesion and viability, with GelMAA yielding marginally more favorable outcomes. Furthermore, HA crystal morphology had only a minor influence on scaffold performance, including osteoinductive potential. Overall, the results indicate that the composition of the polymer matrix plays a more critical role than HA loading or crystal morphology in determining the functional performance of mineralized cryogels for BTE.