Search Results (85)

This study aimed to assess the extent of vitamin B₁ and B₆ vitamer loss during a single peritoneal dialysis (PD) session using a combination of chromatographic techniques and chemometric analysis. Dialysis effluent samples were collected from 41 PD patients (22 on continuous ambulatory peritoneal dialysis (CAPD) and 19 on automated peritoneal dialysis (APD)) during a standardised peritoneal equilibration test. Concentrations of thiamine monophosphate, thiamine diphosphate (ThDP), pyridoxine, pyridoxal (PL), and pyridoxamine were determined using high-performance liquid chromatography with a fluorescence detector. The analytical method was validated in terms of sensitivity, linearity, accuracy, and recovery. Multiple regression analysis was employed to identify potential clinical and demographic predictors of vitamin washout. All vitamers except pyridoxal 5-phosphate (PLP) were detectable in dialysis effluents. ThDP exhibited the greatest loss among the B₁ forms (ca. 0.05–0.57 mg/24 h), while PL exhibited the most significant loss among the B₆ forms (ca. 0.01–0.19 mg/24 h). Vitamin losses varied depending on the dialysis modality (continuous ambulatory peritoneal dialysis, or CAPD, versus automated peritoneal dialysis, or APD) and the peritoneal transport category. Regression analysis identified body weight, haemoglobin, and haematocrit as independent predictors of ThDP washout (R² = 0.58). No statistically robust models were established for the other vitamers. Even short medical procedures (such as single PD) can result in measurable losses of water-soluble vitamins, particularly ThDP and PL. The results emphasise the importance of personalised vitamin supplementation for PD patients and suggest that body composition and haematological parameters significantly influence the loss of thiamine. Full article

This update is aimed at various specialists who deal with fractures, such as emergency physicians, general practitioners, orthopedists, and sports medicine physicians. The Global Burden of Disease 2019 Fracture Collaborators estimated the worldwide incidence to be at 178 million, i.e., 2.2 fractures per 1000 people per year. Traditionally, X-rays are the first choice for suspected fractures. However, many fractures can also be detected or excluded with ultrasound. This option is especially attractive when available at the “point of care,”, i.e., at the patient’s bedside in the ambulatory or emergency setting. Point-of-care ultrasound provides clinicians with a simple, cost-effective imaging tool without radiation and complex infrastructure. The evidence suggests that ultrasound has high diagnostic sensitivity and can reliably rule out many fractures with a high degree of certainty. When applied correctly, it could potentially save millions of radiographs and, in some cases, even compete with the accuracy of X-rays and CT scans. These findings suggest a potential paradigm shift. This update discusses the advantages of ultrasound, its examination technique, sonoanatomy of fractures, and relevant indication groups, including its application for analgesia through nerve, fascia, and fascial plane blocks. Ultrasound’s diagnostic value supports its integration into routine fracture assessment, particularly in emergency and ambulatory care settings Full article

Background/Objectives: Accurate and timely triage is essential for optimizing clinical outcomes and resource allocation in emergency departments (EDs). The Peripheral Perfusion Index (PPI), a non-invasive and objective parameter derived from pulse oximetry, may offer added value in early risk stratification. This study aimed to analyze the correlation between the PPI measured at triage and at Emergency Severity Index (ESI) levels, as well as to determine if the PPI may function as a predictive tool to facilitate early risk identification before patient disposition. Methods: In this prospective cross-sectional study, adult ambulatory patients presenting to a tertiary care ED were enrolled. At triage, PPI and standard vital signs were recorded, and patients were classified using the five-level ESI system. The diagnostic performance of PPI and ESI in predicting ED discharge was assessed using receiver operating characteristic (ROC) curve analysis, with comparative evaluation performed via DeLong’s test. Results: Lower PPI values were consistently associated with higher ESI acuity levels and more intensive care requirements. Patients who were discharged had significantly higher median PPI values (4.0) compared to those admitted to wards (2.1) or intensive care units (1.9). PPI also distinguished survivors from non-survivors (median PPI: 3.60 vs. 1.15). ROC analysis showed that the PPI demonstrated a good discriminative capacity for forecasting ED discharge, equal to the efficacy of ESI (AUC: 0.926 vs. 0.903; p < 0.001). Conclusions: The PPI could improve post-triage risk classification and enhance current triage techniques like ESI, especially in cases of unclear or borderline presentations, but further validation in prospective trials is required. Full article

Atrial fibrillation (AF) is a type of cardiac arrhythmia with a worldwide prevalence of more than 37 million among the adult population. This elusive disease is a major risk factor for ischemic stroke, along with increased rates of significant morbidity and eventual mortality. It is clinically diagnosed using medical-grade electrocardiogram (ECG) sensors in ambulatory settings. The recent emergence of consumer-grade wearables equipped with photoplethysmography (PPG) sensors has exhibited considerable promise for non-intrusive continuous monitoring in free-living conditions. However, the scarcity of large-scale public PPG datasets acquired from wearable devices hinders the development of intelligent automatic AF detection algorithms unaffected by motion artifacts, saturated ambient noise, inter- and intra-subject differences, or limited training data. In this work, we present a deep learning framework that leverages convolutional layers with a bidirectional long short-term memory (CNN-BiLSTM) network and an attention mechanism for effectively classifying raw AF rhythms from normal sinus rhythms (NSR). We derive and feed heart rate variability (HRV) and pulse rate variability (PRV) features as auxiliary inputs to the framework for robustness. A larger teacher model is trained using the MIT-BIH Arrhythmia ECG dataset. Through transfer learning (TL), its learned representation is adapted to a compressed student model (32x smaller) variant by using knowledge distillation (KD) for classifying AF with the UMass and MIMIC-III datasets of PPG signals. This results in the student model yielding average improvements in accuracy, sensitivity, F1 score, and Matthews correlation coefficient of 2.0%, 15.05%, 11.7%, and 9.85%, respectively, across both PPG datasets. Additionally, we employ Gradient-weighted Class Activation Mapping (Grad-CAM) to confer a notion of interpretability to the model decisions. We conclude that through a combination of techniques such as TL and KD, i.e., pre-trained initialization, we can utilize learned ECG concepts for scarcer PPG scenarios. This can reduce resource usage and enable deployment on edge devices. Full article

Early assessment of respiratory mechanics is crucial for early-stage diagnosing and managing lung diseases, leading to greater patient outcomes. Traditional methods like spirometry are limited in continuous monitoring and patient compliance as they require forced maneuvers with significant patient cooperation, which may not be available in fragile individuals. The Forced Oscillation Technique (FOT) is a non-invasive measurement method, only based on the tidal breathing at rest from the patient for a limited time period. The proposed solution integrates low-frequency FOT with continuous monitoring using Equivital (EQV) sensors to enhance respiratory mechanics information with heart rate variability. Data were collected over a two-hour period from six healthy volunteers, measuring respiratory impedance every 7 min and continuously recording physiological parameters. The best-fitting fractional-order models for impedance data were identified using genetic algorithms. This study also explores the correlation between impedance model parameters and EQV data, discussing the potential of AI tools for forecasting respiratory properties. Our findings indicate that combined monitoring techniques and AI analysis provides additional complementary information, subsequently aiding the improved evaluation of respiratory function and tissue mechanics. The proposed protocol allows for ambulatory assessment and can be easily performed in normal breathing conditions. Full article

Anderson–Fabry disease (AFD) is a rare X-linked lysosomal storage disorder characterized by the accumulation of globotriaosylceramide, leading to multi-organ involvement and significant morbidity. Cardiovascular manifestations, particularly arrhythmias, are common and pose a considerable risk to affected individuals. This overview examines current approaches to arrhythmic risk stratification in AFD, focusing on the identification, assessment, and management of cardiac arrhythmias associated with the disease. We explore advancements in diagnostic techniques, including echocardiography, cardiac MRI, and ambulatory ECG monitoring, to enhance the detection of arrhythmogenic substrate. Furthermore, we discuss the role of genetic and biochemical markers in predicting arrhythmic risk and the implications for personalized treatment strategies. Current therapeutic interventions, including enzyme replacement therapy and antiarrhythmic medications, are reviewed in the context of their efficacy and limitations. Finally, we highlight ongoing research and future directions with the aim of improving arrhythmic risk assessment and management in AFD. This overview underscores the need for a multidisciplinary approach to optimize care and outcomes for patients with AFD. Full article

Background/Objectives: In Europe, the prevalence of AF is expected to increase 2.5-fold over the next 50 years with a lifetime risk of 1 in 3–5 individuals after the age of 55 years and a 34% rise in AF-related strokes. The PREFATE project investigates evidence gaps in the early detection of atrial fibrillation in high-risk populations within primary care. This study aims to estimate the prevalence of device-detected atrial fibrillation (DDAF) and assess the feasibility and impact of systematic screening in routine primary care. Methods: The prospective cohort study (NCT 05772806) included 149 patients aged 65–85 years, identified as high-risk for AF. Participants underwent 14 days of cardiac rhythm monitoring using the Fibricheck^® app (CE certificate number BE16/819942412), alongside evaluations with standard ECG and transthoracic echocardiography. The primary endpoint was a new AF diagnosis confirmed by ECG or Holter monitoring. Statistical analyses examined relationships between AF and clinical, echocardiographic, and biomarker variables. Results: A total of 18 cases (12.08%) were identified as positive for possible DDAF using FibriCheck^® and 13 new cases of AF were diagnosed during follow-up, with a 71.4-fold higher probability of confirming AF in FibriCheck^®-positive individuals than in FibriCheck^®-negative individuals, resulting in a post-test odds of 87.7%. Significant echocardiographic markers of AF included reduced left atrial strain (<26%) and left atrial ejection fraction (<50%). MVP ECG risk scores ≥ 4 strongly predicted new AF diagnoses. However, inconsistencies in monitoring outcomes and limitations in current guidelines, particularly regarding AF burden, were observed. Conclusions: The study underscores the feasibility and utility of AF screening in primary care but identifies critical gaps in diagnostic criteria, anticoagulation thresholds, and guideline recommendations. Full article

Background/Objectives: Argemone platyceras Link & Otto, an endemic plant of Mexico, is widely distributed in the central area of the country, mainly in the states of Tlaxcala, Puebla, and the State of Mexico. Ethnobotanical studies in different communities of these states have demonstrated that it is primarily used to treat diabetes and mental illnesses, such as “los nervios” (nerves) and “el ansia” (anxiety); these terms are used in traditional medicine, but it is accepted that they refer to anxiety disorders. This study aimed to validate the traditional use of aerial parts of A. platyceras Link & Otto in treating these illnesses. Methods: a standardized acidic method to obtain alkaloids was used to obtain an extract (AlkExt), which was tested in adult male Swiss Webster mice in the tail suspension (TST) and forced swimming (FST) tests. Results: AlkExt was analyzed using mass spectrometry techniques (DI-ESI and UHPLC-MS) to detect 2,3′,4,5′-Tetramethoxystilbene (m/z 301.14, 3%), scoulerine (m/z 328.16, 19.8%), tetrahydro-columbamine (m/z 342.17, 28.8%), 8-(hydroxymethyl)-2,10-dimethoxy-6,8,13,13a-tetrahydro-5H-isoquinolino[2,1-b]isoquinoline-1,11-diol (m/z 358.17, 22.8%), and glaucine (m/z 356.19, 11.1%); these were assayed in a single oral administration of AlkExt, which caused robust anxiolytic- and antidepressant-like effects without affecting the spontaneous ambulatory activity of the mice. Conclusions: The easy and standardized AlkExt analyzed in pharmaceuticals assays in this study strongly suggest its therapeutic potential to treat the comorbidity of anxiety and depression disorders and support further investigations in people with these diseases. Full article

Purpose: To assess the long-term outcomes of combined penetrating keratoplasty (PKP) and pars plana vitrectomy (PPV). Methods: A retrospective review of eyes that underwent combined surgery followed for 12 months or longer. Demographic data, indications for surgery, and pre-/post-surgical eye examinations were retrieved. Results: Thirteen consecutive eyes (13 patients) were enrolled. The mean age was 51.5 ± 20.5 years, and the mean follow-up time was 67 ± 36.9 months. All cases had severe corneal opacity. Indications for surgery included retinal detachment (76.9%), dropped lens (7.7%), dropped intraocular lens (7.7%), and endophthalmitis with corneal abscess (7.7%). Visual acuity improved in 46.1% of the cases, though in most cases visual acuity remained low, and decreased in 23% of the cases. In 23% of the cases (3 eyes), ambulatory vision was achieved for more than 12 months and in 15.4% for three years. Silicone oil tamponade was used in all cases of retinal detachment (10 eyes). Of these eyes, at the final follow-up, four eyes were attached, two eyes were partially attached, and corneal opacity prevented retinal visualization in three eyes. One eye was eviscerated and one eye developed phthisis. Postoperatively, 61.5% of the cases underwent repeated PKP for graft decompensation. At the final visit, graft failure was observed in 75% of the cases. Conclusions: The long-term follow-up of eyes that underwent combined PKP and PPV supports this technique in complex cases for eye and vision preservation. The main problem after combined surgery is the long-term survival of the corneal graft which may require repeated PKP surgeries. With this approach, in 23% of the cases, ambulatory vision was maintained for more than 12 months. Full article

Background: Femoroacetabular impingement (FAI) is a condition caused by abnormal contact between the femur head and the acetabulum, which damages the labrum and articular cartilage. While the prevalence and the type of impingement may vary across human groups, the variability among populations with short height or with a high prevalence of overweight has not yet been explored. Latin American studies have rarely been conducted in reference to this condition, including the Mayan and mestizo populations from the Yucatan Peninsula. Objective: We aimed to describe the prevalence of morphological changes in femoroacetabular impingement by measuring radiological angles in abdominopelvic tomography studies in a sample of patients from a population with short height. Methods: In this prospective study, patients with programmed abdominopelvic tomography unrelated to femoroacetabular impingement but with consistent symptoms were included. Among the 98 patients, the overall prevalence of unrelated femoroacetabular impingement was 47%, and the pincer-type was the most frequent. The cam-type occurred more frequently among individuals with taller stature compared to their peers. Alpha and Wiberg angles predicted cam- and pincer-type, respectively, with over 0.95 area under the curve values in ROC analyses. The inter-rater agreement in the study was >91%. Conclusions: In a patient population from Yucatan, Mexico, attending ambulatory consultations unrelated to femoroacetabular impingement, an overall morphological changes prevalence of 47% was observed. Angle measurements using tomographic techniques can be used to predict cam- and pincer-type femoroacetabular impingement. Average stature was observed to be shorter in patients with cam-type femoroacetabular impingement, but body mass index did not vary between groups. Full article

Background: While cardiac rehabilitation (CR) primarily focuses on restoring physical strength, preventing relapse, and reducing rehospitalization rates, psychological interventions play a complementary role by supporting mental health, which is crucial for patients’ long-term adherence and overall recovery. The effectiveness of psychological interventions in CR is debated, and while technologies like virtual reality (VR) therapy show promise, they have limitations for patients with coronary artery disease (CAD). Therefore, this study examines non-sleep deep rest (NSDR) relaxation, a novel and easily implementable technique, and compares its impact on depression, anxiety, and stress with VR therapy and standard care. Methods: Forty-five CAD patients undergoing CR in ambulatory conditions were divided into three groups: the NSDR group, which received eight sessions of NSDR relaxation as part of their rehabilitation; the VR group, which received eight sessions of VR therapy as part of their rehabilitation; and the control group, which received standard care including Schultz Autogenic Training (SAT). The outcomes were measured using the Hospital Anxiety and Depression Scale (HADS) and the Perception of Stress Questionnaire (PSQ). Results: Both NSDR relaxation and VR therapy were effective in reducing the HADS total score, anxiety levels, the PSQ general score, and emotional tension. No significant differences were observed between the two treatment approaches. However, SAT was found to be insufficient for effectively improving the mental state of cardiac patients. Conclusions: This study suggests that NSDR relaxation is an effective psychotherapeutic intervention in CR. NSDR and VR therapy showed similar benefits, offering promising alternatives to traditional methods. Integrating these techniques could enhance patient outcomes and adherence in CR. Further research is needed to refine these interventions and optimize their clinical application. Full article

Hypokinesia triggers oxidative stress and accelerates the turnover of the glutathione system via the γ-glutamyl cycle. Our study aimed to identify the regulatory checkpoints controlling intracellular glutathione levels. We measured the intermediate substrates of the γ-glutamyl cycle in erythrocytes from 19 healthy young male volunteers before and during a 10-day experimental bed rest. Additionally, we tracked changes in glutathione levels and specific metabolite ratios up to 21 days of bed rest. Using gas chromatography-mass spectrometry and the internal standard technique, we observed a 9 ± 9% decrease in glutathione levels during the first 5 days of bed rest, followed by an 11 ± 9% increase from the 5th to the 10th day, nearly returning to baseline ambulatory levels. The cysteinyl-glycine-to-glutathione ratio, reflecting γ-glutamyl cyclotransferase activity (a key enzyme in glutathione breakdown), rose by 14 ± 22% in the first 5 days and then fell by 10 ± 14% over the subsequent 5 days, again approaching baseline levels. Additionally, the γ-glutamyl cysteine-to-cysteine ratio, indicative of γ-glutamyl cysteine synthetase activity (crucial for glutathione synthesis), increased by 12 ± 30% on day 5 and by 29 ± 41% on day 10 of bed rest. The results observed on day 21 of bed rest confirm those seen on day 10. By calculating the ratio of product concentration to precursor concentration, we assessed the efficiency of these key enzymes in glutathione turnover. These results were corroborated by directly measuring glutathione synthesis and degradation rates in vivo using stable isotope techniques. Our findings reveal significant changes in glutathione kinetics during the initial days of bed rest and identify potential therapeutic targets for maintaining glutathione levels. Full article

Reconstruction of the abductor mechanism remains a primary challenge with contemporary proximal femoral replacement (PFR) surgery. Previously, techniques such as trochanteric preservation or direct repair to the implant have been described; however, these strategies are limited in their ability to tension the repair and reattach other muscles of the hip girdle. The aim of this study was to evaluate the outcomes of patients undergoing oncologic PFR using a novel technique of mesh augmentation for soft tissue repair. Methods: We reviewed 18 (mean age 64 years; 8 female: 10 male) consecutive patients undergoing PFR with Marlex mesh augmentation between 2018 and 2023 at a single institution. The most common indication was metastatic disease (n = 13). The mean follow-up in the 14 surviving patients was 27 months (range 12–34). Results: All patients were ambulatory at final follow-up. There were no post-operative dislocations, infections, or wound issues. At the final follow-up, the mean total MSTS score was 77%. Conclusion: Mesh augmentation of PFRs allowed for adequate soft tissue tensioning and muscular attachment to the body of the implant. In our series, this technique was durable, with no dislocations and no mesh-related complications. In summary, mesh augmentation of PFRs may be considered during reconstruction for oncologic indications. Full article

Tissue hysteresivity is an important marker for determining the onset and progression of respiratory diseases, calculated from forced oscillation lung function test data. This study aims to reduce the number and duration of required measurements by combining multivariate data from various sensing devices. We propose using the Forced Oscillation Technique (FOT) lung function test in both a low-frequency prototype and the commercial RESMON device, combined with continuous monitoring from the Equivital (EQV) LifeMonitor and processed by artificial intelligence (AI) algorithms. While AI and deep learning have been employed in various aspects of respiratory system analysis, such as predicting lung tissue displacement and respiratory failure, the prediction or forecasting of tissue hysteresivity remains largely unexplored in the literature. In this work, the Long Short-Term Memory (LSTM) model is used in two ways: (1) to estimate the hysteresivity coefficient $\eta$ using heart rate (HR) data collected continuously by the EQV sensor, and (2) to forecast $\eta$ values by first predicting the heart rate from electrocardiogram (ECG) data. Our methodology involves a rigorous two-hour measurement protocol, with synchronized data collection from the EQV, FOT, and RESMON devices. Our results demonstrate that LSTM networks can accurately estimate the tissue hysteresivity parameter $\eta$, achieving an $R^2$ of 0.851 and a mean squared error (MSE) of 0.296 for estimation, and forecast $\eta$ with an $R^2$ of 0.883 and an MSE of 0.528, while significantly reducing the number of required measurements by a factor of three (i.e., from ten to three) for the patient. We conclude that our novel approach minimizes patient effort by reducing the measurement time and the overall ambulatory time and costs while highlighting the potential of artificial intelligence methods in respiratory monitoring. Full article

Intramedullary nailing insertion from the proximal-to-distal femur is frequently performed for impending and complete pathological femur fractures due to osteolytic metastases. After nailing through cancer-laden bone, residual chemotherapy- and/or radiation-resistant tumor may progress. Progression of osteolysis risks future nail failure or pathological fractures. This study assesses the incidence of cancer progression following intramedullary nailing in a femur-only cohort and describes a percutaneous rod-retaining salvage technique. A single-institution, retrospective study was conducted to identify adult patients who underwent intramedullary nailing for femoral osteolytic lesions for complete or impending nail failure from 2016 to 2023. Progression was defined as enlargement of the pre-existing lesion and/or appearance of new lesions on radiographs. Surgical outcomes were assessed with a combined pain and functional score. A total of 113 patients (median age 66.8 years (IQR = 16.4); median follow-up 6.0 months (IQR = 14.5)) underwent intramedullary nailing. Sixteen patients (14.2%) exhibited post-nailing cancer progression. Pre- and postoperative radiation and chemotherapy did not decrease the odds of cancer progression. Three patients underwent initial open surgical salvage consisting of proximal femur replacement arthroplasty, and six patients did not receive salvage due to poor surgical candidacy or patient choice. Seven patients (median follow-up 10.7 months (IQR = 12.9)) received percutaneous salvage. In this group, pain and functional scores improved by 4.0 points (p = 0.0078) at two-week postoperative follow-up and 2.0 points (p = 0.0312) at the most recent follow-up (mean follow-up 13.0 ± 9.4 months). All three nonambulatory patients became ambulatory, and six patients were able to ambulate independently without walking aids. No major complications were reported 30 days postoperatively. Progression of femoral osteolytic metastases may occur following intramedullary nailing. Continued monitoring of the entire femur is needed to maintain improved functional status and to prevent catastrophic progression of pre-existing lesions or appearance of new lesions. In patients with more proximal metastases only, the customary practice of bringing a long nail from the proximal femur to distal metaphysis should be reconsidered. Furthermore, there is concern of mechanical transport of cancer cells during guide wire insertion, reaming, and rod insertion through cancer laden bone to cancer free distal bone. Full article