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.
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.
Pain practice : the official journal of World Institute of PainTigran Kesayan, Vida Motamedi, Jessica Hanflink, Patrick Assi, Salam Kassis
BACKGROUND: Surgical site infections (SSI) associated with spinal cord stimulation (SCS) implants pose risks of morbidity, mortality, and increased healthcare costs. Immunocompromised patients are especially vulnerable due to impaired immune responses, delaying diagnosis and increasing complications. Current guidelines recommend SCS explantation for deep or inadequately treated superficial SSI, though the role of capsulectomy remains underexplored despite its use in other fields like plastic surgery and cardiology. CASE PRESENTATION: We present two cases of immunocompromised patients with SSI treated with SCS explantation and capsulectomy. Case 1 involved a 64-year-old woman with ulcerative colitis and psoriatic arthritis treated with immunosuppressive agents who developed fever and myalgia and had normal imaging. Despite treatment with a course of antibiotics, she developed granulation tissue at the midline incision which tracked to the lead anchors. Explantation revealed necrotic tissue, and capsulectomy of the implanted pulse generator pocket and around lead anchors was performed. Staphylococcus schleiferi, likely linked to pet exposure, was identified. Case 2 involved a 52-year-old woman with postlaminectomy syndrome and rheumatoid arthritis on immunosuppressants, who presented with erythema and wound dehiscence weeks post-implant. Explantation and capsulectomy were performed to remove fibrotic tissue potentially harboring biofilm. MRSA infection was identified. Targeted antibiotics facilitated recovery in both cases. CONCLUSION: These cases suggest capsulectomy during SCS explantation may mitigate complications, particularly in immunocompromised patients. Current guidelines recommend capsule debridement but do not routinely address capsulectomy; its use may improve infection resolution in high-risk populations, perhaps by eliminating biofilm associated with the capsule.
Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, IncQin Qian, Ling Yin
BACKGROUND: The ECG "Spiked Helmet Sign," with diffuse concave ST-segment elevation and a J-point spike, typically suggests acute pericarditis. However, after LVAD implantation, it may herald a localized pericardial hematoma and impending tamponade. CASE PRESENTATION: A 68-year-old male with end-stage ischemic cardiomyopathy underwent LVAD placement. Hours postoperatively, ECG showed this sign with QTc prolongation (578 ms). Bedside echocardiography revealed a 6-mm localized pericardial/mediastinal hematoma. Troponin I peaked on day 1 and fell. Conservative management was successful. CONCLUSION: Recognition of this ECG sign after LVAD surgery should prompt immediate echocardiography to detect pericardial complications.
Extraction-string ureteral stents facilitate non-cystoscopic removal after ureteroscopy, but concerns remain regarding postoperative infection and accidental dislodgement. We evaluated whether extraction-string stents were associated with postoperative infection after flexible ureteroscopic lithotripsy (fURSL) in a cohort restricted to procedures with the distal Double-J (D-J) stent portion positioned within the bladder. This retrospective observational study included 102 procedures in 92 unique patients: 58 extraction-string and 44 conventional non-string procedures. Postoperative infection was defined as fever > 38 °C or a positive postoperative urine culture during the stent-indwelling period. Propensity scores incorporated age, sex, positive preoperative urine culture, preoperative pyuria, and procedure laterality. Stabilized inverse probability of treatment weights were truncated at the 1st and 99th percentiles; effective sample size was 85.38. Crude postoperative infection occurred in 8/58 (13.8%) extraction-string and 6/44 (13.6%) non-string procedures. After weighting, estimated infection rates were 13.6% and 8.8%, respectively (OR 1.64, 95% CI 0.50-5.44; P = 0.416). Fever, positive postoperative urine culture, postoperative pyuria, and postoperative day 1 pain did not differ significantly. Sensitivity analyses accounting for repeated procedures and propensity-model specification were consistent with the primary analysis. Extraction-string stent use was not significantly associated with postoperative infection after fURSL; however, the limited number of events and wide confidence intervals preclude exclusion of a clinically meaningful difference.
Archives of orthopaedic and trauma surgeryJames D Dimitroff, Conor Smith, Stefan Hanish, Lasun O Oladeji, Will Bezold, Clayton W Nuelle, Matthew J Smith
PURPOSE: To determine whether suture shape (flat-tape vs. round-wire) influences biomechanical performance at the suture-anchor-bone interface in interference-fit anchors used for rotator cuff and glenoid labrum repair. METHODS: Four matched pairs of human cadaveric shoulders were used for the glenoid model, with six anchor sites per glenoid. Five matched pairs of cadaveric humeri were used for the rotator cuff model, with three anchor sites per humerus. Each model tested multiple suture-anchor constructs under cyclic loading followed by load-to-failure. Biomechanical outcomes included cyclic displacement, yield characteristics, ultimate failure strength, stiffness, and force at fixed displacements. A linear mixed-effects model was used to compare suture types, with suture type and anchor position as fixed effects and specimen as a random effect. RESULTS: In the glenoid/labrum model, there were no significant differences among suture types in cyclic displacement (cycles 1, 50, or 100; p = 0.376, 0.101, 0.109), displacement at yield (p = 0.406), yield force (p = 0.880), force at 1 mm (p = 0.264) or 5 mm (p = 0.085), or ultimate failure strength (p = 0.204). Stiffness (p = 0.050) and force at 2 mm displacement (p = 0.033) differed at the overall model level, however, no significant pairwise differences were observed. In the humerus/rotator cuff model, displacement at cycle 50 (p = 0.022) and cycle 100 (p = 0.019) differed overall, although post hoc comparisons were not significant. Ultimate strength (p = 0.037), yield force (p = 0.012), and stiffness (p = 0.005) differed among groups, with post hoc analysis showing greater ultimate strength, yield force, and stiffness for 2-mm FiberTape compared with 2-mm XbraidTT. No other pairwise comparisons were significant. CONCLUSION: Suture shape did not meaningfully influence interference-fit fixation properties in the glenoid and humeral models evaluated in this study. Tape-type and round-type sutures demonstrated comparable biomechanical performance at the suture-anchor interface within the tested constructs. LEVEL OF EVIDENCE: Controlled Laboratory Study.
INTRODUCTION: Endoscopic retrograde cholangiopancreatography (ERCP) is the standard treatment for common bile duct stones. Although complete stone removal can be achieved in most cases, post-ERCP cholangitis still occurs in a subset of patients, even in the absence of preprocedural cholangitis. Temporary prophylactic biliary stenting after complete stone extraction may reduce post-ERCP cholangitis by preventing transient biliary obstruction caused by papillary oedema, impaired bile drainage or residual biliary sludge. However, evidence supporting this strategy is currently limited to retrospective studies. The STEP-ERCP study is designed to test the hypothesis that short-term prophylactic biliary stenting after complete removal of common bile duct stones reduces the incidence of post-ERCP cholangitis compared with no biliary stenting. METHODS AND ANALYSIS: The STEP-ERCP study is a multicentre, prospective, open-label, randomised controlled superiority trial. Adult patients undergoing ERCP for common bile duct stones without evidence of acute cholangitis at the time of ERCP and achieving complete stone clearance will be enrolled. Participants will be randomly assigned in a 1:1 ratio to prophylactic biliary stenting using a spontaneous dislodgement biliary stent or no stenting. Randomisation will be stratified by participating institution and maximum stone diameter (<10 mm vs ≥10 mm). The primary endpoint is the incidence of post-ERCP cholangitis within 7 days after ERCP, diagnosed using modified Tokyo Guidelines 2018 criteria adapted for post-ERCP conditions. Secondary endpoints include cholangitis severity, time to cholangitis onset, therapeutic antibiotic use, repeat ERCP or biliary drainage, ERCP-related adverse events and revisit or readmission within 30 days after ERCP. A total of 186 participants will be enrolled. ETHICS AND DISSEMINATION: The study will be conducted in accordance with the Declaration of Helsinki and the Ethical Guidelines for Medical and Health Research Involving Human Subjects in Japan.The study protocol was approved by the Institutional Review Board of Yokohama City University Hospital on 11 May 2026. Additional approval will be obtained from participating institutions before study initiation.Written informed consent will be obtained from all participants.Study findings will be disseminated through peer-reviewed publications and scientific conferences. TRIAL REGISTRATION NUMBER: jRCT1032260128.
Clinical oral investigationsBeyza Arslandaş Dinçtürk, Ceren Başerdem, Cemile Kedici Alp, Pekka K Vallittu, Mine Betül Üçtaşli, Sufyan Garoushi, Lippo Lassila
OBJECTIVES: Minimally invasive occlusal veneers fabricated from ceramic and resin-based materials have gained increasing popularity in recent years. The aim of this study was to evaluate the effect of different CAD/CAM materials and restoration thicknesses on the immediate load-bearing capacity of occlusal veneers. MATERIALS AND METHODS: A total of 100 human mandibular molars were prepared for occlusal veneers with a 1-mm circumferential rounded chamfer finish line. A preparation height of 1.5 mm extending from the preparation margin to the occlusal plane was created. The teeth were divided into 10 groups (n = 10), and occlusal veneers were fabricated in two different thicknesses (0.6 and 1.5 mm) using four CAD/CAM block materials: lithium disilicate glass ceramic (IPS e.max), nanoceramic composite (Lava Ultimate and Cerasmart 270), hybrid ceramic (Enamic), and an experimental short fiber-reinforced composite (SFRC CAD). The tested thickness of 0.6 mm is below the minimum thickness recommended by all manufacturers. Restorations were designed using Cerec software. After adhesive cementation, all specimens were stored in water at 37 °C for 2 days, followed by quasi-static loading testing. Data were analyzed using 2-way ANOVA (´restorative material´ and ´restoration thickness`) and Tukey's post hoc test (α <0.05). RESULTS: The two-way ANOVA demonstrated significant main effects of both restorative material and restoration thickness on fracture load (p < 0.001), whereas the material-thickness interaction was not significant (p = 0.200). SFRC CAD exhibited the highest fracture load (SFRC 0.6 mm = 2560.2 ± 424.5N and SFRC 1.5 mm = 2799.0 ± 655.9N) while IPS e.max (IPS e.max 0.6 mm = 1224.2 ± 363.4N and IPS e.max 1.5 mm = 1799.9 ± 436.8N) showed the lowest. Increasing restoration thickness from 0.6 mm to 1.5 mm significantly resulted in higher fracture load regardless of the restorative material. CONCLUSION: Both restorative material and restoration thickness play important roles in the mechanical performance of occlusal veneers. Among the evaluated CAD/CAM materials, the experimental short fiber-reinforced composite demonstrated the highest load-bearing capacity, whereas ceramic and resin-based CAD/CAM materials showed lower values. However, the higher incidence of catastrophic failures involving both restoration and tooth structure in the SFRC CAD groups indicates that fracture load alone should not be considered the only factor for material selection. These findings suggest that ultrathin occlusal veneers may have potential for minimally invasive restorative applications; however, their long-term clinical performance and failure behavior should be further investigated before clinical recommendations can be established. CLINICAL RELEVANCE: Occlusal veneers with a thickness of 0.6 mm, minimum thickness recommended by manufacturers, exhibited promising immediate load-bearing capacity, supporting their potential use in minimally invasive restorative. Furthermore, the experimental short fiber-reinforced composite CAD/CAM material demonstrated superior load-bearing capacity compared with the other CAD/CAM materials evaluated in this study.
INTRODUCTION: The implantation of cardiac implantable electronic devices (CIEDs) has become an important treatment for various types of arrhythmias and severe heart failure, effectively improving patient prognosis and increasing survival rates. However, patients after CIED implantation need to go through a process of coexisting with and adapting to the internal electronic device. This may result in limitations in daily activities, discomfort and lifestyle changes, which can easily lead to negative emotions and psychosocial maladjustment in the patients, seriously affecting their physical and mental rehabilitation and prognosis. This study aims to explore the trajectory of psychosocial adaptation and its influencing factors among patients after CIED implantation and to gain an in-depth understanding of their process of physical and psychological adjustment. Drawing on the research findings and existing literature, this study will develop an intervention programme to improve psychosocial adaptation among patients after CIED implantation, thereby providing a theoretical and practical basis for future clinical interventions in this population. METHODS AND ANALYSIS: This study focuses on patients who have undergone CIED implantation. A mixed-methods approach will be adopted, combining a cross-sectional survey, a prospective longitudinal quantitative design and a qualitative design. (1) Quantitative study: The Basic Information Questionnaire, Chinese version of Self-report Psychosocial Adjustment to Illness Scale, Chinese version of Medical Coping Modes Questionnaire, Chinese version of Acceptance of Illness Scale, Chinese version of Multidimensional Scale of Perceived Social Support, Self-efficacy for Managing Chronic Disease and Health Literacy Management Scale will be administered to patients after CIED implantation to explore the latent categories, associated factors and longitudinal trajectories of psychosocial adaptation. Statistical analysis will be conducted using Statistical analysis was performed using IBM SPSS Statistics version 26 (SPSS 26) and Mplus software. (2) Qualitative study: Based on descriptive phenomenology, semi-structured interviews will be conducted with patients after CIED implantation to gain an in-depth understanding of their life experiences of psychosocial adaptation, as well as their process of physical and psychological adjustment. The data will be analysed using the Colaizzi 7-step method of phenomenological analysis, supported by NVivo software for data organisation and coding. (3) Development of the intervention programme: Based on the literature review and theoretical framework, and integrating findings from both the quantitative and qualitative phases, an intervention programme for improving the psychosocial adaptation among patients after CIED implantation will be initially developed. The Delphi method will be used to evaluate and revise the initially developed intervention programme. A pilot test will subsequently be conducted to further refine the programme. ETHICS AND DISSEMINATION: This research plan has been approved by the Ethics Committee of the First People's Hospital of Foshan (Approval Number: LSY-2025-019). Data collection is authorised by the Ethics Committee of the First People's Hospital of Foshan. The results of this study will be published in relevant peer-reviewed journals. TRIAL REGISTRATION NUMBER: ChiCTR2600124496.
NeuroinformaticsWojciech Chmiel, Piotr Szwed, Joanna Kwiecień, Michał Turek, Stanisław Jȩdrusik, Dariusz Pałka, Mikołaj Waśniewski, Piotr Kadłuczka, Damian Gumiela, Andrzej Ze…
Precise visualization of vascular structures is crucial for planning and performing stent-assisted interventions in cerebral aneurysms. Traditional 2D imaging frequently lacks sufficient spatial information, which restricts clinicians' ability to evaluate vessel morphology, branching patterns, and how stents would interact with the vessel wall. This paper introduces an integrated visual support platform that unites workflow-driven medical image processing, numerical simulation of stent deployment, and augmented reality (AR) visualization via Microsoft HoloLens. The platform features a configurable workflow engine to handle medical data processing covering: vessel segmentation, medial-axis computation, mesh creation, and region-of-interest definition, followed by interactive simulation of stent expansion using computationally efficient approximation techniques. The resulting 3D models of the vasculature and stent are displayed in a dedicated AR environment that supports gesture-based interaction, real-time stent adjustment, and immersive navigation inside the vessels. This system provides intraoperative decision support by enabling clinicians to analyze stent placement, aneurysm coverage, and possible geometric limitations, and it also supports replay of simulations for training and educational purposes. The work shows that integrating 3D imaging, numerical modeling of stent-vessel interactions, and augmented reality can markedly improve precision, safety, and situational awareness in neurointerventional procedures.
European journal of orthopaedic surgery & traumatology : orthopedie traumatologieAlexa Zimmermann, Johanna Thiele, Christian Prangenberg, Jonas Roos, Davide Cucchi, Sebastian Scheidt, Kristian Welle, Lisa Fiona Roder
PURPOSE: Kirschner wires (K-wires) are widely used for fracture fixation in paediatric trauma surgery. Although infectious complications are uncommon, they remain clinically relevant. Subcutaneous burial of K-wires has been proposed to reduce the risk of infection, but robust data from large paediatric cohorts remain limited. This study aimed to evaluate infectious and non-infectious complications following routine use of buried K-wires in children. METHODS: In this retrospective cohort study, paediatric patients (≤ 18 years) who underwent fracture fixation with routinely buried K-wires at a Level I trauma centre between January 2005 and November 2025 were included. Only patients with complete follow-up, including radiographic assessment and wire removal at the study institution, were analysed. The primary outcome was postoperative infection related to K-wire fixation. Secondary outcomes included non-infectious wound complications, reoperations, and fracture healing. RESULTS: A total of 634 patients with a mean age of 10.2 ± 4.2 years were included; 96.8% sustained upper-extremity fractures. One superficial infection occurred (0.16%; 95% CI 0.00-0.88%), with no cases of deep infection or osteomyelitis. Secondary skin perforation without infection was observed in 8.36%, and minor wound-healing disturbances in 0.32%. No infection-related reoperations were required, and all fractures healed radiographically. CONCLUSIONS: Routine subcutaneous burial of K-wires in paediatric fracture fixation was associated with an exceptionally low rate of infectious complications and no cases of osteomyelitis in this large retrospective cohort. However, secondary skin perforation occurred in 8.36% of patients, and planned wire removal under anaesthesia represents an additional procedural burden. Given the predominance of upper-extremity fractures and the absence of an exposed-wire control group, these findings should be interpreted within the studied population and do not establish superiority over exposed K-wires.
European journal of orthopaedic surgery & traumatology : orthopedie traumatologieBenyamin Dadpey, Kevin Zhu, Noah Sward, Allen Dao, William Kent
PURPOSE: To compare the rate of distal interlocking screw backout between inlay-design and non-inlay design retrograde intramedullary femoral nails in the treatment of distal femur fractures. METHODS: Adults with AO/OTA 33 distal femur fractures treated with a retrograde ultra-high molecular weight polyethylene (UHMWPE) inlay-design nail (RFNA; DePuy Synthes) or a non-inlay design nail (T2 SCN; Stryker) between January 2015 and June 2025 at a single Level I academic trauma center with a minimum follow-up of 3 months were retrospectively reviewed. The primary outcome was distal interlocking screw backout. Secondary outcomes included time to backout diagnosis, backout distance, and rate of symptomatic screw removal. All outcomes were compared between the inlay-design and the non-inlay design cohorts. RESULTS: A total of 134 patients were included: 76 in the inlay cohort and 58 in the non-inlay cohort. The inlay cohort demonstrated a significantly lower rate of distal interlocking screw backout compared to the non-inlay cohort (5.3% vs. 19.0%; RR 0.28, 95% CI 0.09-0.83; p = 0.02), corresponding to a 72.2% relative risk reduction. Time to backout diagnosis and backout distance did not differ significantly between designs. The rate of symptomatic screw removal was significantly lower in the inlay cohort (1.3% vs. 10.3%; p = 0.04). The distal transverse screw was the most common screw with backout in both cohorts. CONCLUSION: The ultra-high molecular weight polyethylene (UHMWPE) inlay at the distal interlocking interface of a retrograde femoral nail was associated with significantly lower rates of distal interlocking screw backout and symptomatic screw removal. When backout did occur, polyethylene inlay did not impact time to diagnosis and backout distance.
Medical engineering & physicsPimpet Sratong-On, Onanong Sukjai, Sawanya Suwannawong, Hui Lin Foo, Kaylen Lim, Chuen Kum Lee, Kazuhiko Sasaki
Rigid limb surrogates transfer full mechanical loads directly to the prosthetic socket during structural testing, causing premature distal failure and underestimating of actual load capacity. In contrast, soft-compliant surrogates buffer applied loads and enables realistic structural deformation. This study investigates: (i) the influence of rigid Plaster of Paris (PoP) versus biofidelic hyperelastic silicone surrogates on the structural load capacity of 3D-printed transfemoral prosthetic sockets; and (ii) orientation-dependent structural deformation and failure behaviors arising from asymmetric transfemoral anatomy. Sockets encapsulated with PoP and silicone surrogates were evaluated under ((ISO 10328:2016) 2016 Prosthetics-Structural testing of lower-limb prostheses-Requirements and test methods (International Organization for Standardization)) static loading (Condition II) at two loading alignments: toe-off and toe-towards-lateral (90° laterally rotated) configurations. Initial testing with 3D-printed bespoke commercial (BC) connectors induced premature distal connector failure; however, under toe-towards-lateral loading, socket/silicone assemblies exhibited a 4.47-fold greater displacement and a 72.46% higher ultimate force than socket/PoP assemblies. Sockets with an enlarged BC connector encapsulated in the silicone surrogate showed distinct force-displacement hysteresis loops under toe-towards-lateral loading, indicating energy dissipation. Crucially, enlarging the BC connector shifted the failure site from interlayer delamination at the distal end under toe-off to trans-layer fracture across the lateral socket wall. Conversely, socket/PoP assemblies consistently failed at the enlarged BC distal connector regardless of loading orientation. Finite element analysis confirmed non-compliant, uniform contact pressure in socket/PoP assemblies, whereas the silicone surrogate produced compliant pressure gradients. Loading orientation significantly affected the structural deformation (p< 0.05) of socket/silicone assemblies: toe-towards-lateral loading induced two-fold greater deformation and an 18.95% higher ultimate force than under toe-off loading due to the thicker lateral silicone resulting from asymmetric limb geometry. These findings demonstrate that a biofidelic hyperelastic surrogate buffers stress and redistributes contact pressure similar to biological soft tissue, establishing a more accurate pre-clinical framework for evaluating 3D-printed prosthetic socket strength.
BMJ case reportsRavi Jineshkumar Jain, Aman Kumar Jasuja, Sanjay Dhangar
A man in his early 40s presented with acute right flank pain, vomiting and dysuria. Ultrasonography demonstrated an obstructing right upper ureteric calculus with a contralateral renal calculus. CT urography revealed fine, serpiginous contrast-opacified tubular channels extending from the right renal pelvis into the retroperitoneum without evidence of urinoma. Delayed excretory phase imaging demonstrated convergence towards the para-aortic region, consistent with pyelolymphatic backflow rather than collecting system rupture. The imaging pattern reflected markedly elevated intrarenal pressure and prompted urgent decompression. The patient underwent bilateral ureteric stenting followed by definitive endourological management with complete symptomatic resolution. Early recognition of this radiological entity prevents misdiagnosis and guides appropriate pressure-relieving intervention.
Objective.To overcome the limitations of optical access caused by opaque electrodes in multimodal neural interfaces used in large-animal models, and to enable scalable, high-density electrophysiology with unobstructed optical imaging and optogenetic stimulation.Approach.In this work, we redesigned our previously demonstrated multimodal cortical surface array, the Smart Dura, by incorporating transparent indium tin oxide (ITO) electrodes. ITO provides good electrical conductivity, while providing high levels of transparency. We discuss the design, microfabrication, benchtop characterization andin vivodemonstration of transparent Smart Dura for multimodal brain interfacing.In vivoexperiments were designed to show the feasibility of simultaneous electrophysiological recording with localized functional optical imaging through transparent Smart Dura in response to visual stimulation.Main results.The implementation of ITO electrodes increased the effective optical access of Smart Dura to 100%, eliminating obstruction from traditional metal electrodes. Bench-top characterization confirmed the electrical and optical performance of the transparent electrodes.In vivoresults demonstrate direct visual access underneath the ITO electrodes for optical recording and perturbation with co-located simultaneous high-fidelity electrophysiological recording, validating the multimodal capabilities of the transparent Smart Dura.Significance.The transparent Smart Dura design removes major barriers to optically integrated, high-density electrophysiology in large-animal models and the number and density of ITO electrodes on Smart Dura can be increased without compromising the optical access. This platform advances multimodal neural interfacing in non-human primates and provides unique opportunities to study brain function in health and disease and design therapeutics that can readily translate to humans.
Lasers in medical scienceIoana Duncea, Cristina Muresan, Oana Almasan, Smaranda Buduru, Cecilia Bacali
This literature review examines the advancements in laser technology that have enhanced the veneer debonding process, offering insights into the proper implementation of these techniques in clinical practice with emphasis on laser parameters, debonding efficiency, thermal effects, and preservation of tooth structure. A systematic literature search was conducted on PubMed,Web of Science, Scopus and Cochrane Library. The review was structured according to the PICO framework. The search was performed independently by two reviewers on laser-assisted debonding of ceramic veneers using Er:YAG or Er,Cr:YSGG lasers.Based on a comprehensive evaluation of existing studies, the review presents different types of prosthetic restorations, materials, and laser parameters, and how they interact with each other. The benefits of laser precision, including improved control, workflow efficiency, fewer procedural steps, and reduced tissue impact, are emphasised to help dental practitioners enhance the standard of care in veneer debonding. Across the twenty nine studies that were obtained, laser debonding facilitated removal while pulpal temperature increases remained below commonly cited critical values. Both Er:YAG and Er,Cr:YSGG systems demonstrated effective veneer removal. Thinner veneers nedeed less irradiation time and lower energy. Limited enamel alterations occured when appropriate parameters were used. Current studies suggest that Er:YAG and Er, Cr: YSGG lasers offer clinical advantages in terms of efficiency, safety, and patient comfort. Studies demonstrate that optimized laser settings reduce debonding time and minimize the risk of thermal damage to underlying tooth structure and surrounding tissues. Debonding efficiency was influenced by veneer thickness, ceramic type, cement composition, laser power, pulse duration and cooling protocols Er:YAG and Er,Cr:YSGG lasers are promising tools for ceramic veneer debonding. However, results obtained in these studies cannot be directly associated to patient-centered issuses, further standardized clinical studies are required before definitive clinical recommendations can be made.
World journal of urologyEva Fong, Michael Keane, Sum Sum Lo, Giovanni Losco, Hazel Ecclestone
OBJECTIVES: To examine trends in surgical management of female stress urinary incontinence (SUI) from 2010 to 2025 including the impact of the mesh pause of August 2023 and national credentialing of surgeons. METHODS: This retrospective cohort study used the Health New Zealand National Minimum Dataset (hospital events, NMDS). This includes all publicly funded hospital events from 2010-2025 for female stress urinary incontinence procedures being: mesh slings, fascial slings, Colposuspension and periurethral bulking agents. RESULTS: There was significant and sustained decline in female SUI procedures beginning in 2013 to 2022. There was also a shift in procedural types with mesh slings being the predominant procedure before 2020 and periurethral bulking agents increasing from 2017. Following the mesh pause, there was no change in overall SUI activity prior to and after the pause. However, there was shift in the predominant procedures from mesh slings to periurethral bulking agents. In younger age groups the fall in sling procedures and increase in bulking was more marked. In the context of surgeon credentialing which began in 2022 through till october 2025, we found 64% of Colposuspensions and 22% of fascial slings were performed at a hospital without a New Zealand framework credentialled surgeon. Due to NMDS database being hospital/procedural based, we assigned credentialing at hospital level which may overestimate the availability of credentialled expertise at the hospital level. CONCLUSION: Between 2010 to 2025, there has been a sustained decline in female SUI procedures in New Zealand public hospitals. This decline began in 2013, nine years before the mesh pause of 2023. There has been a significant shift in the predominant SUI procedures following the mesh pause from highly efficacious procedures, mesh slings, to periurethral bulking agents, which are less efficacious. We also found that following credentialing, a significant proportion of procedures were performed in hospitals without a credentialed surgeon.
Neurosurgical reviewRaphael Bastianon Santiago, Esteban Quiceno, Mohamed A R Soliman, Jacob D Greisman, Isabelle G Stockman, Hannon W Levy, Rehman Ali Baig, Asham Khan, Alexander …
OBJECTIVE: Although cervical pedicle screws (CPS) improve outcomes in trauma and deformity surgery, existing morphometric studies have not been systematically consolidated. This systematic review aims to pool available data to characterize subaxial cervical pedicle dimensions and insertion angles across geographically diverse populations and evaluate population-level anatomical variation relevant to cervical pedicle screw planning. METHODS: PubMed, Embase, and Google Scholar were searched to identify anatomical studies published between database inception and August 1, 2024 that reported computed tomography (CT) measurements obtained from at least 10 patients who underwent CPS placement or from at least 10 cadaveric specimens. Five measurements in these studies were analyzed: pedicle width (PW), pedicle height, mean screw length, pedicle transverse angle (PTA), and the difference between the widest and narrowest PTA along the subaxial cervical spine. Pooled means were analyzed for all subaxial vertebrae from patients in the different geographic regions identified during our literature search. RESULTS: Forty-eight articles comprising 4014 patients from 18 countries in East Asia, Southern Asia, Southeast Asia, the Middle East, the USA, Europe, and East Africa were included. Statistically significant differences in PW were observed across geographic groups at the C3, C5, C6, and C7 vertebral levels, with the largest mean pedicle dimensions found in East Asian populations and the smallest in South Asian populations. Additionally, PW was consistently greater in men than women at all levels. PTA was significantly different between subgroups at C7, where the sharpest PTA was recorded in the East Asia subgroup (p < 0.05). CONCLUSION: This study identified population-level differences in cervical pedicle morphology across geographic regions that may inform individualized preoperative planning. Future studies correlating morphometric variation with surgical outcomes are needed.
World journal of urologyNikolaos Pyrgidis, Patrick Engelmann, Daniel Puhr-Westerheide, Benedikt Ebner, Marc Kidess, Marie Semmler, Patrick Keller, Christian Stief, Gerald Bastian Schu…
BACKGROUND: Ureteral stenting in patients with bladder cancer involving the ureteral orifice may increase the rate of metachronous upper tract urothelial carcinoma (UTUC). Nevertheless, evidence on the matter is scarce and often contradictory. MATERIALS AND METHODS: We performed an observational study comparing ureteral stenting versus no stenting with respect to the risk of developing metachronous UTUC in patients who underwent transurethral resection of bladder tumors (TURBT) involving the ureteral orifice between January 2015 and December 2024. We performed time-to-event analyses to estimate hazard ratios (HRs) along with their corresponding 95% confidence intervals (CIs). RESULTS: We included 151 patients with a median age of 73 years. 37 (25%) underwent ureteral stenting during TURBT. Patients undergoing stenting had higher BMI (p = 0.014), more aggressive tumors (p = 0.003), underwent prior intravesical therapy more often (p = 0.008), higher preoperative creatinine values (p = 0.007), and longer hospitalization duration (p = 0.002) compared to those who did not undergo stenting. After a median follow-up of 25 months, 8 patients developed metachronous UTUC (2 in the stenting group and 6 in the non-stenting group). Ureteral stenting was not associated with statistically significantly higher rates of metachronous UTUC (HR: 1.2, 95%CI: 0.31-5.6, p > 0.9). During follow-up, 49 (33%) patients developed recurrence in the bladder, 43 (28%) underwent cystectomy, and 24 (16%) died. The HRs did not significantly differ between the two groups. CONCLUSIONS: The present study did not demonstrate an increased risk of metachronous UTUC after stenting during TURBT with urothelial cancer involving the ureteral orifice. Moreover, stenting was not statistically significantly associated with increased recurrences in the urinary bladder, higher cystectomy rates, or worse mortality.
Archives of orthopaedic and trauma surgeryAlice Montagna, Luca Andriollo, Virginia Cinelli, Marina Marescalchi, Luca Matascioli, Francesco Benazzo, Stefano Marco Paolo Rossi
BACKGROUND: Robotic-assisted technologies and evolving implant designs have been introduced in unicompartmental knee arthroplasty (UKA) to improve the accuracy and reproducibility of component positioning. However, the relative contribution of robotic assistance compared with conventional instrumentation to radiographic outcomes in experienced, high-volume centers remains unclear. METHODS: This retrospective comparative study included 96 consecutive medial UKAs performed at a single high-volume institution. Patients were stratified into three groups: Journey I UKA implanted with NAVIO imageless robotic assistance (n = 38), Journey II Uni UKA implanted using conventional instrumentation (n = 27), and Journey II UK UKA implanted with CORI imageless robotic assistance (n = 31). Standardized standing long-leg weight-bearing radiographs were obtained preoperatively and postoperatively. Radiographic evaluation included hip-knee-ankle (HKA) angle, femoral component coronal angle (FCCA), tibial component coronal angle (TCCA), and sagittal alignment parameters. Tibial coronal alignment was interpreted according to the Cartier metaphyseal alignment philosophy. Intergroup comparisons were performed using appropriate statistical tests. RESULTS: Baseline demographic characteristics and preoperative radiographic parameters were comparable among the three groups (all p > 0.05). Postoperative mean HKA was 177.1° ± 2.1° in the Journey I NAVIO group, 177.3° ± 2.5° in the Journey II Uni conventional group, and 177.7° ± 2.2° in the Journey II UK CORI group, with no statistically significant differences (p = 0.56). Femoral and tibial component coronal alignment, including TCCA, showed no significant intergroup differences. All cases across the three cohorts were within predefined safe zones for HKA, FCCA, and TCCA. Sagittal alignment parameters were also comparable between groups. CONCLUSION: In a high-volume center adopting a consistent alignment philosophy, medial UKA achieves equivalent and highly accurate radiographic outcomes regardless of robotic assistance or conventional instrumentation.
The journal of adhesive dentistryOliver Bailey, Frank Pfefferkorn, Thomas Attin, Roland Frankenberger, Bas Loomans, Anne-Katrin Lührs, Nicola Scotti, Diana Wolff, Reinhard Hickel, Niek Opdam
PURPOSE: There is confusion over the indications, techniques, and material choices for placing direct class II composite restorations among general dentists. This paper synthesizes new data on the general frequency of use of materials and techniques by experts, with a previous related paper that explored if and how experts restored specific class II cavities with varying complexities. It aimed to see if consensus on technique and material use when restoring class II cavities with composite could be pursued. These findings are used to inform an overview of various techniques and provide guidance on the management of more complex class II cavities. METHODS: An international expert group (n = 9) developed an e-questionnaire. The first part of the questionnaire, reported here, covered the general frequency of material and technique use during cavity preparation, control of the operating field, soft tissue management, matrix selection, stabilization and peripheral seal, tooth separation, composite materials, application techniques, light curing, finishing, and polishing. It was distributed to 67 international clinicians with expertise in placing direct composite restorations (September 2024). RESULTS: Response rate was 82%, with 95% of responders completing the first part of the survey. There was a wide variation in frequency of use of a broad variety of materials and techniques. CONCLUSIONS: International experts used a wide variety of materials and techniques for restoration of class II cavities with direct composite. Consensus was therefore not pursued. There are many potential techniques which can offer pragmatic solutions to directly restore complex class II cavities that are not beyond general practitioners.
MedicineYoung-Keun Lee, Ji Woong Ho, Jin Young Kim
Pediatric scaphoid nonunion is uncommon. Immobilization is initially attempted; however, it causes delays in both intervention and healing. Therefore, surgical intervention has gained broader acceptance and has been implemented in recent years. Among these, arthroscopic management has emerged as a contemporary technique. This study evaluated the clinical outcomes of pediatric scaphoid nonunion treated with arthroscopic-assisted bone grafting and Kirschner (K) wire fixation. Six pediatric patients with scaphoid nonunion treated with arthroscopic bone grafting and K-wire fixation between November 2009 and August 2021 were retrospectively reviewed. All included patients were male. Fracture locations included three distal thirds, two mid-thirds, and one proximal third. The mean time from injury to intervention was 7.83 months. Three patients underwent autogenous iliac bone grafting, and 3 received bone substitute grafts. The mean follow-up duration was 40.67 months. Bone union was evaluated using serial plain radiographs and computed tomography. Functional outcomes were assessed by comparing range of motion (ROM), grip strength, modified Mayo wrist score, quick disabilities of the arm, shoulder, and hand (DASH) score, and visual analog scale (VAS) before surgery and at the latest follow-up. Radiological assessment was performed by comparing the scapholunate (SL) and radiolunate (RL) angles preoperatively and at the last follow-up. Complete union was achieved in all patients. The mean time to radiological union was 9.83 weeks. Functional measures, including grip strength (% of normal side, 67→92), ROM (% of normal side, 77→94), average VAS score (4.17→0.83), quick DASH score (40.15→7.58), and modified Mayo wrist score (53.33→80.00), demonstrated significant improvement. Radiological analysis also demonstrated a significant improvement in the SL angle (59.83→50.92). Arthroscopic-assisted bone grafting with percutaneous K-wire fixation is an effective treatment modality for pediatric scaphoid nonunions. In addition, bone substitute grafts may serve as viable alternatives to autogenous bone grafts in pediatrics.
RATIONALE: Dislocation of the mandibular component after total temporomandibular joint replacement (TMJR) is uncommon but can be difficult to manage because manual reduction may fail, and recurrence can occur. PATIENT CONCERNS: A 25-year-old woman with bilateral condylar resorption, mandibular retrognathia, class II malocclusion, and severe obstructive sleep apnea underwent bilateral stock TMJR and concomitant orthognathic surgery. DIAGNOSES: Posterior dislocation of the left mandibular component occurred intraoperatively and was manually reduced. Posterior dislocation recurred on postoperative day 1 and again on postoperative day 37. INTERVENTIONS: After unsuccessful manual reduction, revision surgery was performed to reposition the left mandibular component. Following the recurrence on postoperative day 37, continuous class II elastic traction was applied for 22 days. OUTCOMES: Class II elastic traction restored satisfactory occlusion and mandibular position without the need for further surgery. At the 6-month follow-up, the patient maintained stable occlusion and facial profile, a maximum mouth opening of 35 mm, and stable condyle-fossa prosthesis positioning on imaging. The literature review identified 10 publications involving 57 patients with perioperative prosthesis dislocation; 64.3% of the dislocations were detected intraoperatively and 35.7% postoperatively. LESSONS: Recurrent dislocation may occur after TMJR, particularly following extensive mandibular repositioning and postoperative muscular instability. Prompt recognition, appropriate prosthesis repositioning, and postoperative elastic traction may reduce the risk of recurrence and avoid additional surgery.
Liver international : official journal of the International Association for the Study of the LiverFuquan Liu, Kan Zhang, Yu Zhang, Quanwei He, Mingming Meng, Xuemei Ma, Bing Zhu, Yifan Wu, Linjing An, Yifan Lv, Fuhuang Lin, Ke Zhang, Bowen Liu, Xiujuan Chan…
BACKGROUND/AIMS: International guidelines recommend initiating transjugular intrahepatic portosystemic shunt (TIPS) placement with an 8-mm stent. However, there is an evident lack of randomized controlled trials evaluating TIPS diameters < 8 mm in cirrhotic patients with a relatively small liver. The aim of this study was to determine whether 7 mm-covered TIPS, compared with 8-mm stents, could achieve comparable shunt function with a lower incidence of hepatic encephalopathy (HE). METHODS: In this multicenter randomized controlled trial, patients with cirrhosis and relatively small liver were randomized 1:1 to receive TIPS with a 7-mm (n = 92) or 8-mm (n = 92) covered stent to prevent variceal rebleeding. The primary endpoint was the incidence of overt HE after randomization. All-cause rebleeding, orthotopic liver transplantation (OLT)-free survival and a composite of these outcomes, were designated as secondary endpoints. RESULTS: Among the 184 enrolled patients, the predominant etiologies of liver cirrhosis were hepatitis B virus infection (56.0%) and alcohol-related liver disease (20.7%). Over a median follow-up of 26.5 months, overt HE occurred in 19 patients (20.7%) in the 7-mm group and 33 patients (35.9%) in the 8-mm group. The 2-year cumulative incidence of overt HE was significantly lower in the 7-mm group than in the 8-mm group (21.4% vs. 37.2%, p = 0.02). Stent diameter, post-TIPS portosystemic pressure gradient, pre-covert HE and MELD-Na score were identified as independent risk factors for overt HE. The rates of shunt dysfunction were statistically similar between groups (8.7% vs. 8.7%, p = 1.0), as were 2-year rebleeding rates (10.9% vs. 9.8%, p = 0.81) and OLT-free survival rates (91.3% vs. 88.0%, p = 0.82). CONCLUSIONS: A 7-mm covered TIPS demonstrated comparable shunt function to an 8-mm covered stents, with a significantly lower risk of overt HE. These findings support consideration of 7-mm TIPS stents for preventing variceal rebleeding in cirrhotic patients with a small liver who are undergoing TIPS. TRAIL REGISTRATION: ClinicalTrials.gov, NCT02541825.
NMR in biomedicineMina Medojević, Charles Handschin, Ayako Washio, Malou Lea, Laurence Dallet, Aleksandar Jakovljević, Emeline J Ribot, Olivia Kérourédan
Laser-assisted bioprinting (LAB) enables precise spatial patterning of living cells within three-dimensional constructs; however, the lack of non-destructive, standardised methods for longitudinal evaluation remains a major limitation to construct optimisation and translation. Magnetic resonance imaging (MRI) offers unique advantages for volumetric and repeated imaging due to its non-invasiveness, yet its application to complex multilayer bioprinted constructs has not been systematically assessed using quantitative workflows. In this study, we developed and evaluated an MRI-based pipeline for the longitudinal tracking and quantitative analysis of laser-assisted bioprinted cells within three-dimensional constructs of increasing architectural complexity. Iron oxide-labelled endothelial cells were bioprinted onto gelatin-based biopapers in predefined patterns and assembled into constructs composed of three, six or nine stacked layers. Constructs were monitored at 4.7 T using a high-resolution three-dimensional steady-state free precession sequence for up to 35 days, and quantitative image analysis was independently performed by three operators using the open-source 3D Slicer image computing platform. MRI enabled clear visualisation of printed patterns and multilayer architectures over time due to the signal drop induced by iron oxide particles. Quantitative analysis demonstrated high inter-operator reproducibility and revealed construct thickness-dependent differences in volume and signal-to-noise ratio. As a proof of concept, stacked bioprinted constructs were additionally visualised post-mortem in a murine calvarial defect model, enabling discrimination of individual layers and printed patterns. Together, these results establish MRI as a robust, non-destructive tool for the longitudinal evaluation of complex laser-assisted bioprinted constructs.
Journal of orthopaedic traumaAngela C Collins, Geoffrey S Marecek
Large bone defects that coexist with limb length discrepancy present a challenging problem in limb reconstruction. Historically, management has required complex circular fixation constructs, staged procedures, or separate devices to independently address each problem. However, the development of motorized intramedullary nails capable of performing both bone transport and limb lengthening with a single implant represent a paradigm shift. This review traces the evolution of internal bone transport technology from the initial foundational principles of distraction osteogenesis through first generation motorized lengthening nails and finally to newly available combination transport-lengthening implants. The biologic rational for a single-construct approach is examined, and clinical scenarios where single implant treatment is advantageous are emphasized. The mechanistic design that enables dual functionality is described, along with surgical technique principles including corticotomy, distraction protocols, and docking site management. Finally, recognized challenges specific to a combined approach are discussed and an illustrative case example is provided.
The international journal of medical robotics + computer assisted surgery : MRCASWeijun Zhang, Yaohui Huang, Xingye Li, Changsheng Li, Xingguang Duan
BACKGROUND: In spinal pedicle screw-rod fixation, rod contouring quality influences insertion ease, construct stability, and corrective effect. Conventional bending relies on surgeon experience and is limited by insufficient support, repeated adjustment, and inefficient workflow. METHODS: This study developed a tracking-based robot-assisted system for rod bending comprising an acquisition unit, software, and actuator. The system acquires screw-head coordinates, generates target rod shape, and discretises the curve into bending positions, axial rotations, and angles. RESULTS: In five in vitro experiments, five assisted-versus-manual comparisons, and twenty paired cases, planned rods showed high consistency with target curves, with mean angle, rotation, and length errors within acceptable ranges. Assisted bending improved efficiency and reduced placement errors versus manual bending; clinically, the assisted side had a shorter operation time. CONCLUSIONS: The system achieves a workflow from acquisition to rod formation, improving quantifiability, consistency, efficiency, and conformity, thus providing a pathway towards automated spinal rod shaping.
Journal of biomedical materials research. Part B, Applied biomaterialsZiqi Wang, Huan Zhou, Hongshui Wang, Xianyang Chen, Lei Yang, Chunyong Liang
Spinal cord injury (SCI) causes persistent neurological deficits because primary damage initiates dynamic secondary cascades that restrict endogenous repair. Functional biomaterials can bridge lesions, provide structural and biochemical support, guide axonal growth, and remodel the inhibitory microenvironment. However, their cues are generally static or slowly evolving and cannot match the changing pathological and electrophysiological states of injured tissue. Physical modulation complements these functions by delivering electrical, magnetic, ultrasonic, optical/photothermal, or mechanical cues that regulate neural excitability, inflammation, axonal growth, remyelination, and plasticity. Nevertheless, physical modulation alone may suffer from imprecise localization, variable tissue-level dosing, and insufficient structural support. This review examines integrated biomaterial-physical modulation strategies for SCI repair, focusing on material design, mechanisms, and translational challenges. Conductive hydrogels couple lesion support with localized electrical signaling, whereas compliant electrodes improve tissue conformity and charge delivery. Piezoelectric and magnetically responsive materials convert external inputs into localized electrical or mechanical cues. Optical/photothermal systems combine localized energy conversion with on-demand release, whereas engineered matrices link structural support to mechanotransduction. Across these strategies, biomaterials act as regenerative scaffolds and active interfaces that localize, transmit, convert, and sustain physical signals. Physical inputs dynamically regulate cellular and molecular responses within this material-supported environment. This integration couples structural reconstruction and microenvironmental regulation with spatiotemporally controlled biophysical signaling, constituting the central mechanistic basis of these integrated systems. Translation requires standardized tissue-level dosing, evaluation of degradation-dependent signal stability and biocompatibility, cross-species scaling, and validation in relevant large-animal models. Stimuli-responsive materials and closed-loop systems represent important future directions. Overall, benefit depends not on simply adding stimulation to a scaffold, but on engineering coordinated material-stimulus systems. In such systems, material design controls where, when, and how physical cues are delivered during spinal cord regeneration.
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.
Clinical and experimental dental researchMaría Baus-Domínguez, Paula Hermida-Cabrera, Javier Pascual, Fernando Vivancos-Cuadras, María-Ángeles Serrera-Figallo, José-Luis Gutiérrez-Pérez, Daniel Torres…
OBJECTIVES: Peri-implantitis is a reality that clinicians face in their daily practice. Current evidence discusses the applicability of bacteriostatic or bactericidal methods in order to minimize the colonization of bacteria, which entails controversy. In this scenario there arises a need to develop surfaces that minimize bacteria's appetite for them. METHODS: An in vitro microbiological study was conducted to assess the effect of a chlorhexidine-based bioadhesive gel on the growth and adhesion of a simplified peri-implantitis-associated microbial consortium. Grade IV titanium disks with three surface types (machined, sandblasted, and ContacTi) were incubated with the consortium under anaerobic conditions for 10 days, with and without gel treatment. Microbial viability was evaluated by colony-forming unit (CFU) counts, and biofilm structure was analyzed by scanning electron microscopy. Microbial community composition was assessed using 16S rRNA gene amplicon sequencing. RESULTS: After 10 days, gel-treated implants showed complete inhibition of cultivable microorganisms, with CFU values reduced below the detection limit on all surfaces, compared with untreated implants (p < 0.05). In untreated samples, ContacTi surfaces exhibited higher bacterial viability than machined and sandblasted surfaces. Metataxonomic analysis revealed a marked reduction in peri-implant pathogens, particularly Porphyromonas gingivalis, whose relative abundance decreased from approximately 20% in the initial inoculum to ~1% after incubation. CONCLUSIONS: The bioadhesive gel demonstrated a quantitatively significant antimicrobial effect, preventing biofilm formation on all tested implant surfaces after 10 days.
Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy SocietyHirofumi Yamazaki, Masahiro Itonaga, Ke Wan, Yasunobu Yamashita, Reiko Ashida, Masayuki Kitano
OBJECTIVES: Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is an alternative procedure for malignant biliary obstruction after failure of endoscopic retrograde cholangiopancreatography. When performing EUS-HGS, either plastic or metal stents are used, but selection often depends on the discretion of the endoscopist. We compared the efficacy and safety of plastic and metal stents during EUS-HGS. METHODS: We performed a systematic meta-analysis of all relevant articles listed by searching PubMed, Medline, and Web of Science databases. Random-effects or fixed-effects models were used to compare time to recurrent biliary obstruction (TRBO), clinical success rate, adverse event rate, rate of recurrent biliary obstruction, and re-intervention success rate after EUS-HGS with plastic and metal stents. RESULTS: This meta-analysis included six eligible studies. The TRBO of the metal stent group was significantly longer than that of the plastic stent group (hazard ratio 1.83; 95% confidence interval [CI] 1.42-2.36). The total procedure-related adverse event rate of the metal stent group was significantly higher than that of the plastic stent group (odds ratio [OR] 0.48; 95% CI 0.30-0.77). The recurrent biliary obstruction rate of the plastic stent group was significantly higher than that of the metal stent group (OR 1.75; 95% CI 1.06-2.88). No significant difference was found for the clinical success rate or re-intervention success rate. CONCLUSION: In this meta-analysis, metal stents showed longer TRBO, lower recurrent biliary obstruction rate, and higher adverse event rate than plastic stents.
The international journal of medical robotics + computer assisted surgery : MRCASYouming Deng, Qi Jiang, Jie Wang, Jiawei Tang
BACKGROUND: Accurate entry point localisation is critical for the safety of robot-assisted percutaneous interventions (RAPI). However, medical optical tracking systems for the traditional fiducial patch are cost-prohibitive. To address these challenges, this paper proposes a robust entry point and gesture localisation framework based on an inexpensive concentric fiducial patch and robust surface fitting. METHODS: We introduce an anisotropic iteratively reweighted least squares (IRLS) algorithm integrated with a Tukey biweight M-estimator, employing a deterministic soft-weighting strategy to effectively suppress gross outliers and smooth out high-frequency sensor noise. RESULTS: Experimental results demonstrate that the proposed method has high accuracy and robustness, achieving an MAE of 1.47 mm in dynamic respiratory tracking and maintains stable detection even under 60% occlusion and low-light conditions. CONCLUSIONS: The results suggest that this framework provides a reliable and low-cost solution for surgical navigation in unstructured clinical environments.
Mymensingh medical journal : MMJK M R Islam, S Chowdhury
Thoraco-lumbar burst fractures are a type of spinal injury that typically result from high-energy trauma. These fractures involve compression of the vertebral body with posterior displacement of bone fragments into the spinal canal. Treatment typically involves surgical stabilization with pedicle screw and rod instrumentation. The aim of the study was to evaluate the results of thoracolumbar burst fractures with incomplete neurological lesion stabilized by pedicle screw and rod. This was a prospective experimental study carried out at Bangladesh Medical University, Dhaka, Bangladesh from January 2019 to December 2019. A total of 15 patients with Thoraco-Lumbar Burst fracture aged over 15 years were included in the study. A detailed history of the selected patient was taken with mode of injury, time of injury, other history, then thorough general, local, neurological examination for proper assessment. Among the 15 cases, 12 cases (80.0%) were male and 3 cases (20.0%) were female. The age range of patient was from 17 55 years. Most commonly affected people were laborers 5(33.33%). Fall from height was the commonest cause of injury 11(73.30%). Most commonly level of injury was L1 07 (46.70%). Pedicle screw and rod used in all cases for long segment reconstruction above and below the involved level. According to Frankel grade preoperatively most common grade was C 10 and next common was B 5. Post operatively most was D 9 and next was E 4 and C-2. According to Denis et al pain scale most commonly 8 (53.34%) cases complain no pain and work scale most commonly 2(13.33%) cases were completely well and can perform normal work up to latest follow-up. Mean hospital stay was (13.27±3.54) days (10 20) days. Satisfactory results (excellent and good) were in 13(86.66%), fair 1(6.67%) and 1(6.67%) unsatisfactory (poor) results. The results of the study demonstrates that functional outcome of Thoraco-Lumbar burst fractures stabilization by pedicle screw and rod is an effective procedure.
Rhode Island medical journal (2013)Daniel Idoate Domench, Robin Reid, Dua Azim, Syed Ehsanullah, Aditya Sanjeevi, Aniket Rao
Factor V deficiency is a rare autosomal recessive bleeding disorder marked by impaired thrombin generation and variable bleeding risk. Perioperative management becomes particularly challenging in high-risk surgeries, such as aortic valve replacement, due to the absence of targeted replacement therapies and the limited efficacy of fresh frozen plasma (FFP) in restoring factor V levels. We report the case of a 30-year-old woman with congenital factor V deficiency (baseline activity 18%) who underwent successful mechanical aortic valve replacement and mitral valve repair for infective endocarditis. She received preoperative FFP aiming for a factor V level >20%. Her perioperative management included careful monitoring with a total of 23 units of FFP administered. Despite persistently low postoperative f levels (<20%), she experienced minimal bleeding complications, limited to transient anemia and one episode of gross hematuria requiring platelet transfusion. Outpatient follow-up revealed heterozygosity for both factor V Leiden and a prekallikrein variant, potentially explaining her relatively mild bleeding phenotype. This case highlights the disconnect that may exist between laboratory values and clinical bleeding risk, emphasizing the need for individualized perioperative planning and cautious anticoagulation management.
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.
Echocardiography (Mount Kisco, N.Y.)Esra Poyraz, Lale Dinc Asarcikli
BACKGROUND: Secundum atrial septal defect (ASD) is one of the most common congenital heart defects encountered in adults. Echocardiography plays a central role in diagnosis, assessment of haemodynamic significance, anatomical characterization, transcatheter closure planning, and follow-up. However, the frequently non-circular geometry of secundum ASD can make accurate anatomical assessment challenging, particularly with single-plane measurements. PURPOSE: This narrative review provides a practical echocardiographic approach to adult secundum ASD, emphasizing the complementary roles of transthoracic echocardiography (TTE), multiplanar two-dimensional transesophageal echocardiography (TEE), color Doppler, and three-dimensional (3D) TEE. CONTENT: TTE provides initial diagnosis and assessment of physiological consequences, including right-sided chamber remodeling, ventricular function, tricuspid regurgitation, and pulmonary pressure. Multiplanar 2D TEE enables systematic assessment of ASD size, morphology, and surrounding septal rims, while measurements obtained in different planes may reveal substantial differences and highlight the limitations of single-plane sizing. 3D TEE provides an en-face spatial representation of the interatrial septum and complements 2D measurements by defining defect geometry, rim relationships, and suitability for transcatheter closure. Haemodynamic assessment should integrate right ventricular volume overload, shunt magnitude, pulmonary vascular status, and left ventricular disease rather than defect diameter alone. Cardiovascular magnetic resonance or cardiac computed tomography may provide complementary information when echocardiography is insufficient to define pulmonary venous connections, anatomy, or haemodynamics. CONCLUSION: A systematic multimodality echocardiographic approach integrates anatomical and physiological information throughout the management of adult secundum ASD. Combining TTE, multiplanar 2D TEE, 3D TEE, and targeted advanced imaging can facilitate individualized assessment and informed transcatheter closure planning.
Clinical implant dentistry and related researchFrancesco Gianfreda, Luca Guarente, Marzia Lommi, Maria Scarpati Cioffari di Castiglione, Alberto Antonio Nativio, Carlo Raffone, Mirko Martelli, Patrizio Boll…
BACKGROUND AND OBJECTIVES: Pterygoid implants represent a graftless option for rehabilitation of patients with posterior maxillary atrophy, engaging the dense cortical bone of the pterygomaxillary complex. Despite clinical growth, a comprehensive synthesis of indications, surgical techniques, and complications is lacking. This review evaluated the prevalence of complications, implant survival rates, and marginal bone loss (MBL) associated with pterygoid implant placement. METHODS: The reporting of this review follows PRISMA 2020 guidelines. Six electronic databases (PubMed, Ovid, Scopus, WoS, CENTRAL, and Dentistry & Oral Sciences Source) were searched from 1 January 2020 to 31 December 2025. Included criteria comprised randomized and non-randomized clinical studies reporting outcomes of pterygoid implants (≥ 13 mm) in adult patients with posterior maxillary atrophy (minimum 10 implants). Risk of bias was assessed using JBI critical appraisal checklists. Proportions were pooled using the Freeman-Tukey double arcsine transformation under a random-effects model. Certainty of evidence was assessed using GRADE. RESULTS: Seventeen studies reporting 846 patients and 1915 pterygoid implants were included. The pooled survival rate was 97.9% (95% CI: 97.1%-98.6%; I2 = 0%; 14 studies) and the overall failure rate was 2.1% (95% CI: 1.4%-3.0%). Early failure rate was 0.9% (95% CI: 0.0%-3.0%; I2 = 59.5%). Late failure and MBL were summarized narratively. Certainty of evidence was low to very low. CONCLUSIONS: Pterygoid implants demonstrate excellent survival (97.9%) and low failure rates (2.1%), primarily early, supporting their reliability as a graftless solution for posterior maxillary atrophy. Complications appear infrequent though heterogeneously reported. Low evidence certainty necessitates prospective studies with standardized outcome reporting.
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 researchJae Joon Hwang, Hye-Mi Jeon, Hye-Min Ju, Sung-Hee Jeong, Yong-Woo Ahn, Soo-Min Ok
OBJECTIVES: To develop interpretable machine learning (ML) models for risk stratification of clinically meaningful anterior overbite decrease after stabilization splint therapy in temporomandibular disorder (TMD) patients, and to compare ML performance with conventional logistic regression. MATERIALS AND METHODS: This retrospective cohort included 87 TMD patients treated with stabilization splints, physical therapy, and pharmacologic therapy. Thirty-five pre-treatment cephalometric and demographic features were used. The primary outcome was overbite difference (OD = post-treatment minus pre-treatment overbite). For classification, patients were labeled as Decrease (OD < -0.5 mm; n = 37) versus Non-Decrease (OD ≥ -0.5 mm; n = 50), combining No Change and Increase due to severe imbalance in the Increase subgroup. Six classifiers (logistic regression, random forest, extreme gradient boosting (XGBoost), Light Gradient Boosting Machine, support vector machine, k-nearest neighbors) were evaluated using stratified fivefold cross-validation and leave-one-out cross-validation. Class imbalance was handled using class-weighting and the Synthetic Minority Over-sampling Technique (SMOTE) applied within the cross-validation loop. For regression, nine algorithms were tested to predict continuous OD. Model explainability was assessed using SHapley Additive exPlanations (SHAP). RESULTS: In fivefold cross-validation, XGBoost achieved the best discrimination (AUC = 0.734), outperforming logistic regression (AUC = 0.611). With SMOTE, the random forest achieved a comparable AUC (0.735) with improved sensitivity. Across regression models, cross-validated R2 values were near-zero or negative, indicating limited ability to predict the exact magnitude of overbite change from baseline variables alone. SHAP ranked pre-treatment overbite, ramus height, upper occlusal plane to SN angle, sella-to-condylion distance, and condylar positional indices among the most influential predictors for classification. CONCLUSION: Interpretable ML enables improved risk stratification for clinically meaningful anterior overbite decrease after stabilization splint therapy in TMD patients, whereas predicting the exact magnitude of overbite change remains limited using pre-treatment cephalometrics alone. These models may support individualized counseling and closer monitoring for patients at higher risk of open-bite development during splint therapy.
Journal of orthopaedic traumaDavid B Frumberg, Rajiv S Vasudevan, Elizabeth P Wellings
Bone defects are among the most challenging problems treated by limb reconstruction surgeons and orthopaedic traumatologists. Bone transport is a biological reconstruction technique which harnesses distraction osteogenesis to create new bone in critical bone defect. This technique has been successfully performed with a variety of internal and external solutions. This work introduces a newly available technology which provides a fully implantable, all-internal solution (eg, without the need for external fixation) for bone transport with the option to simultaneously address residual limb length discrepancy.