Search Results (433)

Background and Objectives: The causes and clinical outcomes of renal perfusion abnormalities occurring after para-aortic lymphadenectomy (PANDx) for gynecologic malignancies are unknown. We investigated the potential involvement of accessory renal artery (ARA) obstruction in their development by reassessing perioperative contrast-enhanced computed tomography (CECT). Materials and Methods: This retrospective study investigated a clinical database to identify urinary contrast defects using CECT in all patients who had undergone PANDx between January 2020 and December 2024. The perfusion defects in the kidney detected by CECT were extracted by a gynecologic oncologist and evaluated by a radiologist and urologist for suspected obstruction of ARAs. Results: Postoperative renal contrast defects were observed in 3.8% (6/157) of patients. Renal parenchymal fibrosis, cortical atrophy, and parenchymal thinning were observed as universal findings in all patients showing renal contrast defects. In five of the six cases, ARAs supplying the infarcted renal segments were identified on preoperative CECT, and arterial obstruction was confirmed on postoperative imaging. The remaining case was considered to be latent pyelonephritis. All five patients underwent laparotomy, and preoperative CECT failed to detect ARAs. The median resected para-aortic lymph node was 23 nodes (range: 15–33) in five patients, showing no statistically significant difference compared to patients without perfusion abnormalities (p = 0.19). Postoperative serum creatinine levels remained stable. Conclusions: ARA obstruction appears to be a risk factor for segmental renal infarction after para-aortic lymphadenectomy in gynecological malignancies; however, the clinical impact on urinary function may be limited. Awareness of this potential complication is essential for gynecologic oncologists performing PANDx. Full article

Background: The anterior cerebral artery (ACA), a critical component of the cerebral arterial circle, exhibits substantial morphological variability. While previous studies have explored ACA morphology using cadaveric and imaging methods, a comprehensive meta-analysis incorporating the latest evidence is lacking. Methods: Following current guidelines, a systematic review and meta-analysis were performed across four major databases, supplemented by the gray literature and targeted journal searches. Ninety-nine studies, encompassing 85,316 patients, met the inclusion criteria. Statistical analyses were conducted using R, applying random effects models to estimate pooled prevalence and morphometric parameters. Results: The pooled prevalence of typical ACA morphology was 93.75%, whereas variants were noted in 6.25% of cases. The predominant variation identified was the accessory ACA (aACA) (1.99%), followed by unilateral absence of the A1 segment (1.78%), with the latter being more frequently recognized in imaging studies (p < 0.0001). Rare variants encompassed azygos ACA (azACA) (0.22%), fenestrated ACA (fACA) (0.02%), and bihemispheric ACA (bACA) (0.02%). The mean diameter and length of the A1 segment were measured at 2.10 mm and 14.24 mm, respectively. Hypoplasia of the A1 segment (<1 mm diameter) was recorded in 3.15% of cases. The influences of imaging modality, laterality, and population distribution on prevalence estimates were minimal. No significant publication bias was detected. Conclusions: Although infrequent, variants of the ACA possess significant clinical importance attributable to their correlation with aneurysm formation and the impairment of collateral circulation. The aACA and the absence of the A1 segment emerged as the most common variations. This meta-analysis presents an updated and high-quality synthesis of ACA morphology, serving as a valuable reference for clinicians and anatomists. Full article

Previous studies about the COVID-19 pandemic on STEMI patient outcomes have conflicting results. It remains unclear if this may be attributed to regional differences and/or differences during COVID-19 wave periods. Using the American Heart Association Get With The Guidelines–Coronary Artery Disease registry data, we evaluated (1) time metrics related to STEMI system goals and (2) regional variation in STEMI incidence and in-hospital mortality during pandemic wave time periods. The study included all patients 18–100 years old admitted with STEMI (n = 72,516) to 1 of 435 American Heart Association Get With The Guidelines–Coronary Artery Disease hospitals (1 October 2019–31 December 2021). Of these, 70.8% were male and 73.0% non-Hispanic White, with a median age of 63 (IQR 18) years. Compared to pre-pandemic time frames, patients with STEMI had a higher risk profile, delayed time to treatment, were treated with fibrinolytic therapy or primary PCI, and were transferred for primary PCI at similar rates, and had higher adjusted in-hospital mortality (during the second wave in the South and Midwest). Preservation of STEMI systems of care resulted in an overall lower in-hospital mortality rate than predicted, although opportunities exist to improve treatment delays. Regional differences in mortality rates require further study. Full article

Continuous blood pressure (BP) monitoring provides valuable insight into the body’s dynamic cardiovascular regulation across various physiological states such as physical activity, emotional stress, postural changes, and sleep. Continuous BP monitoring captures different variations in systolic and diastolic pressures, reflecting autonomic nervous system activity, vascular compliance, and circadian rhythms. This enables early identification of abnormal BP trends and allows for timely diagnosis and interventions to reduce the risk of cardiovascular diseases (CVDs) such as hypertension, stroke, heart failure, and chronic kidney disease as well as chronic stress or anxiety disorders. To facilitate continuous BP monitoring, we propose an AI-powered estimation framework. The proposed framework first uses an expert-driven feature engineering approach that systematically extracts physiological features from photoplethysmogram (PPG)-based arterial pulse waveforms (APWs). Extracted features include pulse rate, ascending/descending times, pulse width, slopes, intensity variations, and waveform areas. These features are fused with demographic data (age, gender, height, weight, BMI) to enhance model robustness and accuracy across diverse populations. The framework utilizes a Tab-Transformer to learn rich feature embeddings, which are then processed through an ensemble machine learning framework consisting of CatBoost, XGBoost, and LightGBM. Evaluated on a dataset of 1000 subjects, the model achieves Mean Absolute Errors (MAE) of 3.87 mmHg (SBP) and 2.50 mmHg (DBP), meeting British Hypertension Society (BHS) Grade A and Association for the Advancement of Medical Instrumentation (AAMI) standards. The proposed architecture advances non-invasive, AI-driven solutions for dynamic cardiovascular health monitoring. Full article

Background/Objectives: The inferior thyroid artery (ITA) is an essential component of the thyroid gland’s vasculature, with significant clinical and surgical implications due to its anatomical variability. This systematic review aimed to describe the prevalence of ITA anatomical variants and their association with clinical conditions or surgical implications. Methods: A comprehensive search was conducted in MEDLINE, Web of Science, Google Scholar, CINAHL, Scopus, and EMBASE on 20 November 2025. Eligibility criteria included studies reporting on the presence of ITA variants and their correlation with pathologies. Two authors independently screened the literature, extracted data, and assessed methodological quality using the AQUA and JBI tools. Results: Of the 2647 articles identified, 19 studies involving 1118 subjects/cadavers were included. Variations in ITA origin, absence, and additional arteries were reported, with the most common variant being direct origin from the subclavian artery. Clinically, these variations were associated with increased risk of intraoperative hemorrhage, potential nerve damage, and challenges in preoperative planning, particularly during thyroidectomy and other neck procedures. Conclusions: Understanding the anatomical diversity of the ITA is crucial for reducing surgical risks and improving patient outcomes. The review highlighted the need for more standardized research protocols and comprehensive data reporting to enhance the quality of evidence in this domain. Preoperative imaging and thorough anatomical assessments tailored to individual patient profiles, considering ethnic and gender-related differences, are essential for safe surgical interventions in the thyroid region. Full article

Background: Venous thromboembolism (VTE) is conventionally treated with anticoagulant therapy. In contrast, the core treatment for peripheral artery disease (PAD) is antiplatelet therapy. VTE and PAD share common risk factors and may occur in the same patient. Nonetheless, there is little evidence of the best antithrombotic regimen to use when the two conditions coexist, especially in terms of the extended prevention of major adverse cardiovascular events (MACE), major adverse limb events (MALE), and VTE recurrences. Methods: We conducted an online survey of members of the Italian Society of Angiology and Vascular Medicine (SIAPAV) to explore current prescribing habits for extended antithrombotic therapy in patients with PAD and unprovoked VTE. The survey included four clinical scenarios with variations in age, gender, bleeding risk, index VTE event, and severity of PAD. In all cases, patients had received anticoagulation for 6 months, and the key question was how to continue treatment beyond 6 months from the index VTE event. Results: A total of 174 clinicians participated to the survey. The most common choice was combining antiplatelet therapy with a direct oral anticoagulant (DOAC) at a low dose. Full-dose DOAC alone or antiplatelet therapy alone were less frequently chosen. Older age and high bleeding risk increased the preference for antiplatelet therapy alone. Conclusions: This survey highlights the marked variability in antithrombotic prescribing patterns among specialists in vascular medicine for patients with unprovoked VTE and concomitant PAD, reflecting the lack of evidence on optimal management in this specific setting. More research is needed to define the safest and most effective treatment strategies for patients with concurrent PAD and VTE. Full article

Diabetes is the world’s leading cause of renal and premature cardiovascular disease. There are marked differences between groups of patients with different ethnicities in their susceptibility to diabetes and its renal and cardiovascular complications. Novel markers of developing diabetes complications are related to disturbances in oxidative metabolism. In this cross-sectional study, we measured the arterial stiffness in patients of differing ethnicities with type 2 diabetes mellitus and assessed the relationship of their ethnicity with systemic markers of oxidative stress. Patients from black, African and Caribbean, and Asian minor ethnic groups were studied, with white patients with T2DM (n = 170) without evidence of cardiovascular disease (CVD). The vascular stiffness was measured by infrared finger-photoplethysmography. The oxidative stress burden was assessed by measuring the urinary 8-hydroxy-2′-deoxyguanosine (8-OHdG), activities of plasma glutathione peroxidase (GPx-3), superoxide dismutase (SOD) activities, and concentration of selenium. The vascular stiffness and 8-OHdG were higher in the white than in the Black patients (9.68 m/s vs. 9.26 m/s, p = 0.021 and 292.8 ng/mL vs. 200.9 ng/mL, p = 0.0027, respectively). Meanwhile, the GPx-3 and SOD activities and selenium were lower in the white than in the Black patients (283.3 U/L vs. 440.4 U/L, p < 0.0001; 37.5 U/L vs. 75.6 U/L, p = 0.0007; and 1.14 vs. 1.28 µmol/L, p = 0.0001, respectively). In regression modelling, the 8-OHdG/creatinine ratio was an independent predictor of vascular stiffness in the white patient group (β = 0.23 m/s per unit increase in ln(8-OHdG/creatinine) [95% CI, 0.03 to 0.42]; p = 0.021) but not in the Black patient group (p = 0.29). Increased vascular stiffness, lower endogenous antioxidant defense, and greater levels of oxidative damage were found in patients of white ethnicity, which could contribute to the higher incidence of CVD compared with patients from Black minor ethnic groups with diabetic renal disease. Full article

This paper presents a methodology for extracting and simulating arterial pulse waveform signals from Fabry–Perot interferometric measurements, emphasizing a practical approach for noninvasive cardiovascular assessment. A key novelty of this work is the presentation of a complete Python-based processing pipeline, which is made publicly available as open-source code on GitHub (git version 2.39.5). To the authors’ knowledge, no such repository for demodulating these specific interferometric signals to obtain a raw arterial pulse waveform previously existed. The proposed system utilizes accessible Python-based preprocessing steps, including outlier removal, Butterworth high-pass filtering, and min–max normalization, designed for robust signal quality even in settings with common physiological artifacts. Key features such as the rate of change, the Hilbert transform of the rate of change (envelope), and detected extrema guide the signal reconstruction, offering a computationally efficient pathway to reveal its periodic and phase-dependent dynamics. Visual analyses highlight amplitude variations and residual noise sources, primarily attributed to sensor bandwidth limitations and interpolation methods, considerations critical for real-world deployment. Despite these practical challenges, the reconstructed arterial pulse waveform signals provide valuable insights into arterial motion, with the methodology’s performance validated on measurements from three subjects against synchronized ECG recordings. This demonstrates the viability of Fabry–Perot sensors as a potentially cost-effective and readily implementable tool for noninvasive cardiovascular diagnostics. The results underscore the importance of precise yet practical signal processing techniques and pave the way for further improvements in interferometric sensing, bio-signal analysis, and their translation into clinical practice. Full article

Myeloproliferative neoplasms (MPNs) are clonal hematopoietic disorders characterized by excessive proliferation of one or more myeloid lineages, frequently accompanied by an elevated risk of thrombotic events. Matrix metalloproteinases (MMPs), a family of zinc-dependent endopeptidases, are implicated in numerous inflammatory and vascular pathophysiological processes. In this study, we analyzed the association between selected MMP polymorphisms, rs1799750, rs243865, rs3025058, rs3918242, and rs17576, and thrombotic risk as well as clinical characteristics in patients with MPNs. Genotyping was performed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Among the polymorphisms analyzed, a statistically significant association was identified between the MMP-9 rs3918242 CT genotype and an increased risk of arterial thrombosis (OR = 4.206, CI 1.337–13.234, p = 0.014). Moreover, rs3918242 CT was associated with thrombotic events (both arterial and venous thrombosis combined), suggesting a potential contributory role in the prothrombotic phenotype observed in MPNs (OR = 3.200, CI 1.110–9.258, p = 0.031). These findings indicate that genetic variation in MMP-9, particularly rs3918242, may serve as a predictive marker for vascular complications in MPN patients. Further studies with larger cohorts are warranted to confirm these associations and to elucidate the molecular mechanisms underlying the contribution of MMP polymorphisms to thrombosis in MPNs. Full article

Objectives: To assess the long-term survival outcomes of patients undergoing no-touch aorta, total arterial off-pump coronary artery bypass grafting (OPCAB) using a left internal mammary artery (LIMA)–radial artery (RA) Y-graft configuration. This approach was applied uniformly to all-comers undergoing isolated CABG between 2004 and 2021, irrespective of preoperative risk profile. Methods: We included all patients treated with total arterial OPCAB using the LIMA–RA Y-graft without additional concomitant procedures. Patients were stratified into five age groups (<50, 50–59, 60–69, 70–79, and >80 years). Survival at 5 years was analyzed using Kaplan–Meier curves and Cox regression analysis. Results: A total of 2174 patients were analyzed, with a median follow-up of 3266 days. In-hospital mortality was 0.6%, whereas postoperative stroke was 0.3% without residual trauma and 0.2% with residual trauma, respectively, without differences between age groups. The mean number of grafts per patient was 3.7, with no significant variation between age groups (p = 0.09). Overall, 5-year survival was 90% (n = 1767), ranging from 98% in the youngest group to 65% in the oldest (log-rank p < 0.0001). Conclusions: No-touch aorta, total arterial OPCAB using the LIMA–RA Y-graft is a safe and effective revascularization strategy for a broad spectrum of patients, including those with advanced age and comorbidities. Full article

Background/Objectives: Variations in the course of the maxillary artery (MA) relative to the lateral pterygoid muscle (LPM) pose critical challenges in surgical, anesthetic, and interventional procedures involving the infratemporal fossa (ITF). These variations can increase the risk of hemorrhage, nerve injury, or incomplete anesthesia. The present study aimed to elucidate the topographic relationship between the MA and LPM by combining high-resolution radiological imaging with a comprehensive analysis of anatomical literature. Materials and Methods: A retrospective review of 250 brain computed tomography angiographies (CTAs), totaling 500 sides, was conducted to classify the MA course as lateral (superficial), medial (deep), or intramuscular. Additionally, a systematic review and meta-analysis of 32 eligible studies—including 5938 arteries—was performed following PRISMA 2020 and Evidence-Based Anatomy (EBA) guidelines. Study quality and risk of bias were assessed using the Anatomical Quality Assurance (AQUA) tool. Results: In the imaging cohort, the MA coursed lateral to the LPM in 64.2% of sides, medial in 29.6%, and through the muscle fibers in 6.2%. A rare temporalis-traversing variant was identified in 3.0% of cases. Bilateral symmetry was observed in 77.6% of patients. Meta-analytic findings indicated a pooled prevalence of 79.6% for the lateral course, 19.9% for the medial course, and 0.01% for the intramuscular course. Cadaveric studies and Asian populations showed a higher incidence of lateral variants, while imaging-based studies more frequently detected medial and transmuscular paths. Conclusions: While the MA most often follows a lateral course relative to the LPM, clinically significant variation—including medial, intramuscular, and temporalis-traversing routes—exists. These variants complicate access during maxillofacial surgery, TMJ procedures, and regional anesthesia. Findings emphasize the importance of individualized preoperative vascular mapping to improve procedural safety and outcomes in the ITF. Full article

Background: Arterial variations in the upper limb, although infrequent, carry critical clinical implications. The presence of superficial ulnar and radial arteries, especially when originating from high levels, increases the risk of iatrogenic injury, misdiagnosis, and surgical complications. To confirm and describe, through ultrasound and anatomical dissection, the presence of a high-origin superficial ulnar artery and a superficial radial artery in a cadaver, highlighting their anatomical trajectory and clinical relevance. Methods: A cross-sectional ultrasound and anatomical study was conducted on 150 upper limbs from fresh-frozen cadavers. High-frequency ultrasound was used to scan the vasculature from the axilla to the wrist. Subsequently, dissection was performed to confirm sonographic findings. Results: One case (0.66%) of concurrent superficial ulnar artery and superficial radial artery was identified in the left arm of a 79-year-old male cadaver. The superficial ulnar artery originated from the axillary artery and coursed superficially along the forearm, anterior to the flexor muscles. The superficial radial artery emerged from the brachial artery and ran subcutaneously in the distal forearm. These arteries remained in close relation to key neural and venous structures, increasing their vulnerability to clinical error. Conclusions: The identification of high-origin superficial arteries is essential for clinical practice. Ultrasound serves as a reliable, non-invasive method for detecting such variations preoperatively. Awareness of these anomalies can prevent inadvertent vascular injuries, improve diagnostic accuracy, and inform safer surgical and anesthetic approaches in upper limb interventions. Full article

Buprenorphine has gained widespread popularity for use in rabbits, while much less is known about methadone. Our aim was to compare sedative, analgesic, and respiratory effects of methadone and buprenorphine as part of balanced anaesthesia. Forty-eight female New Zealand white rabbits undergoing calvaria defects were randomly equally assigned to receive either 0.03 mg kg⁻¹ of buprenorphine (group B) or 0.3 mg kg⁻¹ of methadone (group M) in combination with 15 mg kg⁻¹ of ketamine and 0.1 mg kg⁻¹ of dexmedetomidine SC. Fifteen minutes later, sedation was scored. A laryngeal mask was placed, and inhalational anaesthesia started. Rescue intraoperative analgesia was administered based on autonomic variations. Arterial blood gases were analysed intra- and postoperatively. Postoperative analgesia was administered if the Rabbit Grimace Scale (RbtGS) score was ≥4. The Mann–Whitney test, t-test, and relative risk followed by chi-square test were used to compare the treatment groups. Deeper sedation was observed in rabbits of group M than in those of group B. Rescue analgesia was administered intraoperatively to seven animals in group B and five in group M (p = 0.739) and postoperatively to three in group B and twelve in group M (p = 0.013). Rabbits of both groups showed short-term respiratory acidosis. RbtGS scores indicated better and longer analgesia in group B compared to group M. Full article

Background: Preconception diet and nutritional status are important determinants of reproductive and pregnancy health. As a comprehensive evaluation, this paper describes harmonization of diet data across multiple cohorts including over 50,000 participants and the differences between them. This information may be useful for developing targeted strategies to improve women’s diet prior to pregnancy for optimal prenatal health outcomes. Methods: The Preconception Period Analysis of Risks and Exposures influencing health and Development (PrePARED) consortium incorporates studies covering the preconception period and includes both couples planning pregnancy and studies covering the reproductive period but not focused on pregnancy. We harmonized data on 56,520 participants from seven cohort studies that collected data during the preconception period. We generated data on diet quality according to the International Federation of Gynecology and Obstetrics (FIGO) nutrition checklist to examine diet quality measures across the cohorts and compare estimates of diet quality across studies. Four studies used food frequency questionnaires; one used a study-specific diet history; one used two 24 h dietary recalls; and one used a short series of general diet questions. Positive responses on the six FIGO questions were tallied to calculate a total diet quality score. Results: Cohort samples varied in terms of age; socioeconomic status; race; ethnicity; and geographic region. Across the cohorts, participants met a median of three or four of the FIGO criteria for diet quality; those most commonly met were recommendations for consumption of meat and protein, while those least commonly met were recommendations for limiting consumption of processed foods and snacks. There was greater variation in meeting recommendations for the consumption of fruits and vegetables; dairy; fish; and whole grains. The percentage meeting ≤ 2 criteria ranged from 6.4% (Coronary Artery Risk Development in Young Adults) to 40.4% (Bogalusa Heart Study). Discussion: There was wide variability across preconception cohort studies in the extent to which participants met FIGO dietary guidelines. Although studies were conducted in populations that were not likely to be malnourished, it was rare for women to meet all the preconception dietary recommendations. These findings illustrate a need for strategies to promote meeting dietary guidelines prior to conception to improve health outcomes. Full article

Asthma exacerbations are acute worsening episodes in individuals with bronchial asthma, frequently necessitating emergency hospital care. Early differentiation between eosinophilic (≥150 eosinophils/mm³) and non-eosinophilic (<150 eosinophils/mm³) subtypes plays a crucial role in treatment decisions and identifying patients eligible for biologic therapies. The ExBA Study explored variations in complete blood count (CBC) parameters and derived cellular ratios—namely the neutrophil-to-lymphocyte (NLR), thrombocyte-to-lymphocyte (TLR), and eosinophil-to-leukocyte ratios (ELR)—in adults hospitalized with severe asthma exacerbations. Ninety patients were enrolled and categorized into eosinophilic (n = 38) and non-eosinophilic (n = 52) groups. Significant statistical differences were observed in the neutrophil and lymphocyte levels, as well as in all three ratios. ROC analysis highlighted the ELR as the most specific indicator of the eosinophilic phenotype (specificity 100%, AUC 0.938, cut-off 0.003), whereas the NLR and TLR showed stronger associations with the non-eosinophilic group (AUC 0.733 and 0.676). No meaningful differences emerged regarding arterial blood gas levels, length of hospital stay, treatment costs, or mortality. A notable association was found between a personal or family history of atopy and the eosinophilic subtype (p = 0.0181). This study underscores the relevance of CBC-based ratios in asthma phenotyping during exacerbation events. Full article