Search Results (1,631)

Background/Objectives: Intraoperative hemodynamic instability during liver transplantation (LT) is common and results from cirrhosis-related circulatory dysfunction and profound hemodynamic changes during graft reperfusion. High catecholamine requirements may contribute to secondary organ injury, including myocardial damage. Terlipressin, a selective vasopressin V1 receptor agonist, has been shown to improve hemodynamic stability during LT; however, the impact of a short, targeted intraoperative infusion on cardiac biomarkers remains unclear. Methods: This retrospective single-center study included adult patients undergoing elective orthotopic liver transplantation between May 2017 and December 2025. Emergency transplantations and retransplantations were excluded. All transplant procedures were performed by a single transplant surgeon, while anesthesia care was provided by multiple teams following standardized institutional protocols. Patients receiving a fixed intraoperative dose of terlipressin (0.85 mg administered over 10 min after portal vein clamping; n = 61) were compared with a control group not receiving terlipressin (n = 44). The primary outcome was the vasoactive-inotropic score (VIS), assessed intraoperatively and during the first three postoperative days. Secondary outcomes included postoperative high-sensitivity troponin I (Hs-TnI) concentrations measured on the day of surgery and on postoperative days 1 and 3. Results: Baseline demographic and clinical characteristics, including liver disease severity and baseline Hs-TnI, were comparable between groups. VIS values were significantly lower in the terlipressin group on the day of transplantation (14.3 ± 2.4 vs. 37.0 ± 5.0, p < 0.001) and on postoperative day 1 (10.4 ± 2.2 vs. 17.3 ± 3.4, p < 0.05). Differences were no longer significant on postoperative days 2 and 3. Postoperative Hs-TnI concentrations were significantly lower in the terlipressin group at all assessed time points, including day 0 (51.5 ± 11.3 vs. 150.4 ± 29.0 ng/L, p < 0.001), postoperative day 1 (124.7 ± 28.8 vs. 275.0 ± 74.0 ng/L, p < 0.05), and day 3 (51.1 ± 18.4 vs. 167.2 ± 54.2 ng/L, p < 0.05). Conclusions: In this retrospective cohort, intraoperative terlipressin administration was associated with lower perioperative vasoactive requirements and reduced postoperative troponin release. These findings suggest that targeted terlipressin administration during liver transplantation may contribute to improved perioperative hemodynamic stability. Prospective randomized studies are required to confirm these observations and determine their impact on clinically relevant outcomes. Full article

Hemostatic biomaterial agents are widely used during surgery and trauma care to control bleeding, yet their effects on wound healing remain incompletely understood. This study evaluated the impact of oxidized non-regenerated cellulose (ONRC), oxidized regenerated cellulose (ORC), and a gelatin-based hemostat (GELA) on wound healing at 14 and 30 days in a mouse model. Full-thickness wounds were created in C57BL/6J mice (n = 192) and compared to sham controls. Tissue samples were analyzed histologically, supported by immunohistochemistry for Ki-67 and α-SMA and qPCR for VEGF, TGF-β, and FGF-2. Histology demonstrated preserved tissue architecture across groups with progressive resorption of cellulose-based materials, whereas GELA showed localized fibrous structures and enhanced extracellular matrix formation. At day 14, no significant differences were observed in proliferation, contraction, VEGF, or FGF-2 expression; however, TGF-β was significantly reduced in the ORC group. By day 30, GELA significantly increased epidermal proliferation, while contraction markers were elevated in both GELA and ORC. VEGF expression was reduced in GELA and ORC, whereas ONRC showed increased TGF-β expression. FGF-2 remained unchanged across groups. All investigated hemostatic materials were well tolerated during the early postoperative phase (up to day 14), indicating short-term biocompatibility within the scope of this model. In contrast, material-specific differences in cellular activity and growth factor expression became apparent during the later remodeling phase (day 30). These findings suggest differential effects on cellular and molecular aspects of tissue remodeling; however, no conclusions can be drawn regarding overall healing quality or clinical safety, as no quantitative macroscopic or functional outcome measures were assessed. Full article

Drug-resistant epilepsy (DRE) has a significant burden on children and their families that extends beyond seizure management. Surgery can be a curative treatment but is sometimes not an option for certain generalized epilepsies or epilepsy in an eloquent region. Neuromodulation therapies (vagus nerve stimulation–VNS, deep brain stimulation–DBS, and responsive neurostimulation–RNS) have emerged as effective palliative treatments to mitigate seizure burden. Only VNS is FDA-approved for use in certain pediatric populations for epilepsy, but all are used off-label to treat pediatric drug-resistant epilepsy. This review provides an overview of these therapies, the perioperative considerations related to their implantation, and the perioperative considerations related to managing a device in situ. Care must be taken to avoid unintentional harm to the device, the leads, and the generator. Procedures must be cognizant of possible physiological changes that can occur intraoperatively and anatomic restrictions due to lead/generator placement. Although there is still a need for more long-term safety data regarding the use of neuromodulation devices in children, the current data demonstrate good efficacy and safety thus far. More children are likely to receive these devices for treatment, and so continued training and education will be needed for health care providers to maintain device longevity and safety. Full article

Background/Objectives: An accurate preoperative assessment of prostate cancer malignancy is crucial for risk stratification and selection of the optimal treatment strategy. This study assessed the concordance of Gleason scores between MRI–TRUS fusion biopsy and radical prostatectomy specimens, and identified clinical and histopathological factors associated with post-procedural Gleason score upgrading. Methods: This retrospective analysis involved patients who underwent transperineal MRI–TRUS fusion biopsy followed by radical prostatectomy from 2020 to 2025. Concordance, upgrading, and downgrading of the Gleason score were assessed by comparing biopsy results with the final histopathological examination. Clinical parameters (age, PSA level, prostate volume, and PSA density) and histopathological features of biopsies (Gleason score and percentage of prostate lobes affected by cancer) were analyzed. Multivariate logistic regression models were stratified by PSA level (<10 ng/mL and >10 ng/mL). Results: Gleason score concordance was found in 53.1% of the 603 patients analyzed, upgrading in 29.9%, and downgrading in 17.1%. Higher Gleason scores on biopsy were independently associated with a lower risk of upgrading in the entire cohort and in both PSA subgroups. Larger tumor extent on biopsy was associated with a lower risk of upgrading, with heterogeneous dependencies between prostate lobes. The other clinical parameters showed no independent association with upgrading. Conclusions: Gleason score upgrading remains common after radical prostatectomy. The risk of this progression is primarily related to the histopathological features of the biopsy rather than to baseline clinical parameters, reflecting the limitations of biopsy as a sampling method and the biological heterogeneity of prostate cancer. Full article

Background: Kleefstra syndrome (KS) is a rare neurodevelopmental disorder caused by haploinsufficiency of EHMT1; it is characterized by global developmental delay, intellectual disability, hypotonia, distinctive facial features, and variable congenital anomalies. Autistic features, behavioral abnormalities and severe speech impairment are frequently reported. However, molecularly confirmed cases of KS from Africa remain extremely limited, largely due to restricted access to genomic diagnostic infrastructures. Methods: We describe a 15-month-old patient from Rwanda presenting with neonatal hypotonia, global developmental delay, short stature, and characteristic dysmorphic facial features. Comprehensive clinical evaluation was performed, followed by trio-based exome sequencing to identify the underlying genetic cause of this neurodevelopmental disorder. Results: Exome sequencing identified a de novo heterozygous frameshift variant in EHMT1 (NM_024757.5: c.2871dup; p. Phe958Leufs*219), confirming the diagnosis of KS. Conclusions: This report presents the first molecularly confirmed case of KS in Rwanda. It highlights additional clinical features like bilateral 5th toe clinodactyly, short stature and absence of obesity in KS. There is a need to further delineate the study of EHMT1 and investigate the natural history of KS across different populations for optimal patient management and to reduce diagnostic odyssey. The diagnostic utility of exome sequencing for neurodevelopmental disorders needs to be strengthened, with strong emphasis on expanding genomic medicine to help diagnose rare diseases in resource-limited settings. Full article

Growing evidence suggests that chronic kidney disease (CKD) profoundly disrupts gut microbiome and its activity. This study explores how CKD affects colon microbial metabolism, focusing on (1) the representativeness of fecal metabolomics, (2) saccharolytic and proteolytic fermentation metabolites, and (3) the gut microbiome’s role in the partitioning of tryptophan in its metabolic pathways. Tryptophan’s main metabolic pathways include the indolic and the kynurenine pathways, which lead, respectively, to the formation of indoxyl sulfate and kynurenine, both contributing to uremic toxicity. Using a rat model of CKD, we evaluated whether fecal concentrations of microbial compounds, on which most studies are based, reflect the colonic concentrations in contact with the gut mucosa. Thus, we quantified the concentration and content of amino acids, indole, p-cresol, and also short-chain fatty acids, in different colon sections. We demonstrated that CKD promotes increased proteolytic fermentation and an augmented tryptophan partitioning into both the indolic and kynurenine pathways. Depletion of the indolic pathway obtained upon antibiotic treatment leads to a further enhancement of the kynurenine pathway. Full article

Background/Objectives: Previous studies have compared nutritional deficiency parameters in patients with venous leg ulcers (VLUs) to healthy individuals or those with unrelated conditions. This single-center study assessed blood levels of factors involved in ulcer healing and compared patients with VLUs to those with chronic venous insufficiency without ulcers. Methods: A total of 24 patients were included: 17 with VLUs formed the study group, and 7 with lower-limb venous insufficiency without ulcers served as controls. Disease severity was assessed using the CEAP classification, and all participants underwent ankle–brachial index (ABI) measurement. Venous blood samples were analyzed for selected vitamins, proteins, ions, protein electrophoresis, and amino acid profiles. Results: Strong correlations were identified (r > 0.5 or r < −0.5), some of which were statistically significant. Positive associations in the study group included BMI with waist circumference (r = 0.85, p < 0.05), tyrosine with proline (r = 0.84, p < 0.05), and valine with leucine (r = 0.82, p < 0.05). Negative correlations included albumin with folic acid (r = −0.73, p < 0.05), albumin with vitamin B6 (r = −0.71, p < 0.05), and folic acid with waist circumference (r = −0.65, p < 0.05). No significant differences in blood concentrations were observed between groups. Conclusions: Statistically significant correlations were observed between selected biochemical parameters, including albumin and alpha-1 globulins, as well as amino acid and vitamin concentrations, in both patients with VLUs and controls with chronic venous insufficiency without ulcers. Larger studies are needed to confirm these findings and clarify their relevance to venous leg ulcers. Full article

Background/Objectives: Gasdermin D (GSDMD) is a critical mediator of pyroptosis—an inflammatory form of programmed cell death increasingly implicated in tumor biology. Our objective was to evaluate the utility of GSDMD as a diagnostic and prognostic biomarker and to investigate its association with tumor burden and hematological parameters. Methods: We analyzed GSDMD expression levels in patients with adult-type diffuse gliomas compared to healthy controls and assessed correlations with tumor size, histological grade, hematological markers, and survival outcomes. Data was complemented by transcriptomic analysis from The Cancer Genome Atlas (TCGA). Diagnostic performance was assessed using ROC curve analysis. Results: GSDMD expression was significantly elevated in adult-type diffuse glioma patients and increased with tumor grade, suggesting an association with disease severity. A positive correlation was observed between GSDMD level and tumor size (R = 0.332; p = 0.01). ROC analysis showed moderate classification ability (AUC = 0.657) with high specificity (96%), supporting its diagnostic potential. Survival analysis showed that higher GSDMD expression was associated with reduced disease-specific survival. GSDMD also correlated positively with the erythrocyte parameter mean corpuscular hemoglobin (MCH, R = 0.34, p = 0.016) and negatively with the systemic inflammatory marker C-reactive protein (CRP, R = −0.32; p = 0.042). TCGA data showed no significant sex-related differences in GSDMD expression. Baseline characteristics such as age, BMI, and coagulation parameters were matched between patients and controls. Conclusions: GSDMD is significantly associated with astrocytoma severity, tumor size, and inflammatory status, with elevated expression indicating a worse prognosis. Its correlation with tumor grade, survival and high specificity in distinguishing patients from healthy individuals, underlines its promise as a clinically relevant, non-sex-specific biomarker for diagnosis and monitoring. Full article

The application of plain bearings has become very famous in planetary gear stages in recent years. To improve load-carrying capacity, this study investigates a design method for axial profiling in which a sixth-order polynomial is iteratively derived from the curve of local minimum film thickness for each axial grid position. Two load cases with specific bearing loads of 12.0 MPa and 6.0 MPa at 0.5 m/s are considered for profile design. Calculation results and computational effort of strategies assuming rigid or elastic geometries during the optimization are compared. Results indicate that the consideration of deformation is already necessary in the design phase and a maximization of minimum film thickness leads to much higher load-carrying capacity than the minimization of the maximum film pressure. Furthermore, the impact of the lube oil pocket position on oil flow rate is experimentally and theoretically investigated to identify the optimization potential of this parameter. Results show that the oil flow varies by the factor of three if the lube oil pocket is shifted incrementally over an angular span of 180° outside the load zone. The results and possible extensions are critically discussed under the consideration of practically relevant restrictions in mechanically highly loaded planetary gearboxes. Full article

Background/Objectives: Atraumatic electrode array insertion should be targeted in cochlear implantation. Robotic insertion is used in many centers worldwide. Our objective was to evaluate manual electrode placement and robot-assisted placement using RobOtol^® on human temporal bones (TBs), in terms of endocochlear trauma and completion of insertion. Methods: Sixteen TBs originating from eight bodies were implanted with Medel-FLEX24 electrodes through the round window. The right TB was implanted manually, while the left TB of the same body was implanted using RobOtol^® for electrode insertion. Results were analyzed through micro-computed tomography imaging. No statistical analysis was used, given the small sample size; a descriptive interpretation of micro-CT scans was rather preferred. Results: In the “manual group”, there were two cases (25%) of insertion trauma: elevation of basilar membrane at basal turn (Eshraghi-stage-1). In the “robotic group”, there were two cases (25%) of insertion trauma: one case of elevation of basilar membrane at the middle turn (Eshraghi-stage-1) and one case of dislocation of all electrodes in scala vestibuli (Eshraghi-stage-3). There were six cases (75%) of incomplete insertion in the “manual group” and four cases (50%) of incomplete insertion in the “robotic group”. Conclusions: Both techniques of electrode placement yielded fairly similar results, in terms of endocochlear trauma and completion of insertion. New larger-scale cadaveric and clinical studies are needed to determine the possible benefit of robot-assisted electrode insertion in cochlear implantation. Full article

Background and objectives: Ischemic priapism is a rare but serious adverse effect of trazodone, associated with a high risk of long-term sexual dysfunction. While its urological consequences are well described, psychiatric and psychosocial outcomes remain insufficiently explored. This study assessed psychiatric and sexual sequelae following trazodone-associated ischemic priapism and compared clinical characteristics with trazodone-treated patients without priapism. Materials and Methods: In this single-center observational study, 268 adult patients receiving trazodone were analyzed, including 17 patients with ischemic priapism and 251 controls. Data on episode duration and urological management were collected. Psychiatric status and sexual functioning were evaluated through structured clinician-led interviews informed by validated psychometric frameworks during hospitalization and at 1-, 3-, and 6-month follow-up. Nonparametric analyses and Spearman rank correlations were applied. Results: Patients with priapism were significantly older than controls (44.1 ± 5.1 vs. 39.0 ± 4.4 years; p < 0.0001), while trazodone dose distribution did not differ between groups. The mean episode duration was 26.5 ± 16 h (median 24 h). Older age and longer ischemic duration were independently associated with increased treatment intensity, whereas trazodone dose was not. Persistent depressive and anxiety symptoms and impaired sexual functioning were observed in a subset of patients during follow-up. Conclusions: Trazodone-associated ischemic priapism is not only an acute urological emergency but may also lead to sustained psychiatric and sexual sequelae. Interdisciplinary follow-up should be considered to address long-term psychosocial outcomes. Full article

Clusters of acute flaccid paralysis (AFP) caused by oral vaccine-derived poliovirus (VDPV) in 2022 and sporadic outbreaks in New York and Gaza highlight the ongoing risk of polio, alongside the persistent global threat posed by wild-type poliovirus. This study aims to develop and validate a quantitative reverse transcription PCR (RT-qPCR) panel that employs different primer–probe sets to simultaneously detect vaccine and wild-type poliovirus (WPV) in wastewater. Using an inactivated poliovirus vaccine (IPV) and engineered DNA fragments (eDNAf), the qPCR master mix (MM) performance, assay specificity, sensitivity (limit of detection, LOD), and recovery from IPV-spiked wastewater were evaluated. Compared with two-step RT-qPCR and qScript MM, one-step RT-qPCR with TaqMan MM improved sensitivity for the following polioviruses (PV): Sabin 1 in IPV and the eDNAf of Sabin 1, 2, and 3; WPV1 and WPV3; and poliovirus type 2 (any serotype 2). The LOD for Sabin 1 in IPV was 2.49 copies/PCR, while LODs for eDNAf of polio targets ranged from 1.06 to 3.12 copies/PCR. Sabin 1 recovery from IPV-spiked wastewater ranged from 10.26% to 57.27%. The RT-qPCR panel for poliovirus exhibited good specificity and sensitivity, with moderate viral recovery, enabling rapid implementation of wastewater monitoring for PV as needed. Full article

Colostrum is the primary source of nutrients for newborn piglets, significantly influencing their growth, health and survival. This study examines the relationship between sow litter weight gain and the fatty acid composition of colostrum, including crude protein, lactose, calculated gross energy and total solids. The n-6:n-3 fatty acid ratio was higher in low-performing sows (p < 0.05), suggesting that a lower ratio, associated with higher n-3 fatty acid content, may positively impact litter weight gain. Specific fatty acids such as myristic acid (C14:0), pentadecanoic acid (C15:0), palmitic acid (C16:0), palmitoleic acid (C16:1), margaric acid (C17:0), elaidic acid (C18:1n9t), linoleic acid (C18:2n6c), α-linolenic acid (C18:3n3), behenic acid (C22:0), docosadienoic acid (C22:2) and eicosapentaenoic acid (C20:5n3) were also found in lower concentrations in the colostrum of low-performing sows (p < 0.05). The study suggests that the content of n-3 fatty acids and perhaps the n-6:n-3 ratio of the colostrum and the content of some special fatty acids could serve as a selection criterion for improving litter performance in the future. Full article

Background: Transport exclusion and difficult access to educational institutions pose a significant problem for maintaining daily routines, sleep patterns and eating habits and are a potential cause of gastroenterological disorders. This study aims to demonstrate the possible associations between transport difficulties and selected gastrointestinal symptoms. Methods: A cross-sectional anonymous online survey was conducted among 650 students aged 15–20 years from urban and rural areas. Data on place of residence, commuting time, wake-up time, breakfast habits, and gastrointestinal symptoms were analyzed by chi-square tests, nonparametric methods, and correlation analyses. Results: The survey demonstrated the association between commutes to school and the occurrence of morning nausea, abdominal pain, and irregular meal patterns. Early wake-up times are also associated with the risk of symptoms. Transport-related factors, particularly long commuting times and early wake-up schedules, are associated with more irregular eating patterns and a higher prevalence of morning gastrointestinal symptoms in adolescents. Conclusions: Transport exclusion may represent an important, yet understudied, factor influencing adolescent health. Full article

This paper presents experimental and numerical investigations on thin-walled carbon-epoxy composite structures subjected to axial compression under varying thermal conditions. The primary objective of the study was to determine the influence of temperature on the stability, postbuckling behavior, and load-carrying capacity of the tested profiles. To achieve this, an innovative research methodology combining laboratory experiments and numerical simulations was developed, enabling a comprehensive assessment of the performance of compressed composite structures at different operating temperatures. The obtained results allowed for both qualitative and quantitative evaluation of the temperature-dependent behavior (from −20 °C to +80 °C) of thin-walled composite elements under compressive loading, offering new insights into their structural performance in thermally variable environments. The maximum percentage change in load capacity under variable thermal conditions was approximately 26.5%. At sub-zero temperatures (−20 °C), a slight effect on the load-carrying capacity of composite structures was observed, with a change in stiffness of a few percent. At increased above-zero temperatures (+80 °C), a significant change in stiffness (up to several dozen percent) was observed. The strengths of the work are a relatively extensive experimental program across several temperatures and stacking sequence composites, the use of digital image correlation to capture buckling and postbuckling deformations, and the parallel use of numerical modeling. Full article