Search Results (412)

The electrical ventricular storm (VES) is defined as multiple sustained ventricular arrhythmias arising in a short time, often refractory to standard antiarrhythmic treatment. The three pillars of the physiopathogenesis of the VES are autonomic dysfunction, triggers, and an altered ventricular substrate. Incessant or highly recurrent ventricular arrhythmia impacts the hemodynamic status by worsening heart failure and increasing mortality. A stepwise, team-based, and tailored therapeutic approach is required to stop ventricular arrhythmia and regain the hemodynamic and electric stability of the patient. The authors focused on describing all currently available therapeutic approaches for VES, intending to establish the best VES therapeutic approaches. This process involves considering the patient’s specific condition, responses to previous treatments, and the potential risks and benefits of each approach. The options range from adjusting antiarrhythmic therapy to reprogramming of the ICD, sedation, epidural anaesthesia, stellate ganglia anaesthetic block, and the use of ECMO or left ventricular assist devices and radiofrequency catheter ablation. Particular attention is paid to the detailed management of genetic primary arrhythmia syndromes like long-QT syndrome, catecholaminergic polymorphic ventricular tachycardia, Brugada syndrome and Wolff–Parkinson–White syndrome, early repolarisation syndrome, right ventricular arrhythmogenic dysplasia, and idiopathic ventricular fibrillation. After overcoming the acute events of VES and obtaining hemodynamic stability, the treatment should shift toward an optimal balance of heart failure therapy, controlling the substrate by revascularisation procedures and resolving other pathology-generating ventricular arrhythmias. This article provides a comprehensive overview of ESV’s current management options using the most efficient strategies known to date. Full article

Introduction: Radiomics is the extraction of non-invasive and reproducible quantitative imaging features, which may yield mineable information for clinical practice implementation. Quantification of lung function through radiomics could play a role in the management of patients with pulmonary lesions. The aim of this study is to test the capability of radiomic features to predict pulmonary function parameters, focusing on the diffusing capacity of lungs to carbon monoxide (DL_CO). Methods: Retrospective data were retrieved from electronical medical records of patients treated with Stereotactic Body Radiation Therapy (SBRT) at a single institution. Inclusion criteria were as follows: (1) SBRT treatment performed for primary early-stage non-small cell lung cancer (ES-NSCLC) or oligometastatic lung nodules, (2) availability of simulation four-dimensional computed tomography (4DCT) scan, (3) baseline spirometry data availability, (4) availability of baseline clinical data, and (5) written informed consent for the anonymized use of data. The gross tumor volume (GTV) was segmented on 4DCT reconstructed phases representing the moment of maximum inhalation and maximum exhalation (Phase 0 and Phase 50, respectively), and radiomic features were extracted from the lung parenchyma subtracting the lesion/s. An iterative algorithm was clustered based on correlation, while keeping only those most associated with baseline and post-treatment DL_CO. Three models were built to predict DL_CO abnormality: the clinical model—containing clinical information; the radiomic model—containing the radiomic score; the clinical-radiomic model—containing clinical information and the radiomic score. For the models just described, the following were constructed: Model 1 based on the features in Phase 0; Model 2 based on the features in Phase 50; Model 3 based on the difference between the two phases. The AUC was used to compare their performances. Results: A total of 98 patients met the inclusion criteria. The Charlson Comorbidity Index (CCI) scored as the clinical variable most associated with baseline DL_CO (p = 0.014), while the most associated features were mainly texture features and similar among the two phases. Clinical-radiomic models were the best at predicting both baseline and post-treatment abnormal DL_CO. In particular, the performances for the three clinical-radiomic models at predicting baseline abnormal DL_CO were AUC₁ = 0.72, AUC₂ = 0.72, and AUC₃ = 0.75, for Model 1, Model 2, and Model 3, respectively. Regarding the prediction of post-treatment abnormal DL_CO, the performances of the three clinical-radiomic models were AUC₁ = 0.91, AUC₂ = 0.91, and AUC₃ = 0.95, for Model 1, Model 2, and Model 3, respectively. Conclusions: This study demonstrates that radiomic features extracted from healthy lung parenchyma on a 4DCT scan are associated with baseline pulmonary function parameters, showing that radiomics can add a layer of information in surrogate models for lung function assessment. Preliminary results suggest the potential applicability of these models for predicting post-SBRT lung function, warranting validation in larger, prospective cohorts. Full article

To compare the clinical characteristics of inherited retinal diseases (IRDs) caused by biallelic versus monoallelic variants in the RP1, BEST1, and PROM1 genes. A total of 52 patients (26 female) with genetically confirmed IRDs were retrospectively selected from the records of the Harkness Eye Institute Clinical Coordinating Center at Columbia University Irving Medical Center. In RP1, 3 individuals with biallelic variants and 22 patients with monoallelic variants classified as pathogenic or likely pathogenic were selected. In BEST1, eight individuals with biallelic variants and nine individuals with monoallelic variants classified as either pathogenic or likely pathogenic were included. In PROM1, four individuals with biallelic variants and six patients with monoallelic variants classified as pathogenic or likely pathogenic were selected. All patients underwent multimodal retinal imaging and, when available, full-field electroretinography (ffERG). In all three genes, individuals with biallelic variants had markedly earlier disease onset and more severe phenotypes. In RP1, on SD-OCT, foveal involvement was observed in all biallelic cases (3/3, 100%) and in 4/22 (18%) monoallelic cases. In BEST1, the average age of onset in the biallelic cohort was 7.12 years, and the average age was 32.7 years in the monoallelic cohort. Four of eight (50%) patients in the biallelic group were additionally found to have widespread serous lesions outside of the central macula. This finding was not observed in the monoallelic group. Three of eight (38%) biallelic BEST1 patients had moderate reductions in their photopic flicker. All monoallelic BEST1 patients had photopic responses within the normal range. PROM1 biallelic cases showed severe functional impairment on ffERG, while most monoallelic cases retained normal responses. In the biallelic cohort, four of four (100%) of patients had severely attenuated or extinguished photopic responses. In the monoallelic PROM1 group, four of five (80%) monoallelic PROM1 patients had normal photopic responses, and P2-2 had mildly attenuated photopic responses. Individuals with biallelic variants exhibited earlier disease onset, more severe retinal degeneration, and significantly reduced retinal function compared with those with monoallelic variants. These observations highlight the role of loss-of-function mechanisms in more aggressive disease courses and underscore the importance of considering zygosity when determining prognosis and planning gene-based therapies. Full article

Recent advances in technology and pharmacologic agents have significantly improved both local and systemic therapies, making the treatment of non-small cell lung cancer (NSCLC) more effective and less invasive. However, recurrence after radical resection remains a major clinical challenge. Among the various recurrence patterns, oligo-recurrence—particularly metachronous oligo-recurrence, characterized by a limited number of metastatic lesions appearing after a disease-free interval—has gained attention due to its potential for long-term survival and even cure through local therapy. Concurrently, systemic treatments have advanced with the development of molecularly targeted therapies and immune checkpoint inhibitors. Numerous studies have demonstrated their clinical efficacy, resulting in significant improvements in patient prognosis. Therefore, selecting an appropriate treatment strategy for recurrent NSCLC involves a broad spectrum of therapeutic options, including targeted therapies, immune checkpoint inhibitors, and conventional chemotherapy. Treatment decisions are particularly complex in cases of oligo-recurrence, where local therapy is feasible, making it challenging to choose the best approach from the available options. This narrative review summarizes current evidence from retrospective and ongoing prospective trials and discusses the clinical characteristics and treatment strategies for oligo-recurrent NSCLC. Full article

Breast cancer-related lymphedema (BCRL) is a debilitating complication in breast cancer survivors, with axillary lymph node dissection (ALND) as the greatest independent risk factor. Beyond non-surgical therapies such as complete decongestive and compression therapy, there has been increased interest in immediate microsurgical reconstruction via immediate lymphatic reconstruction (ILR) anastomosing transected lymphatic vessels to a local venous recipient at the time of ALND to mitigate the risks of BCRL. This work provides a scoping review of the landscape surrounding ILR, spanning the updated literature investigating patient outcomes, current accepted best practices, and critical components of surgical techniques for a successful multidisciplinary approach. While limited by heterogeneity in the methods of lymphedema detection, a growing body of work demonstrates the protective effects of ILR. From the pioneering work by Boccardo et al. in 2009 and his introduction of Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) using an intussusception-type end-to-end microanastmosis, to the first randomized control trial by Coriddi in 2023, which importantly employed relative upper extremity volume change as an outcome measure to circumvent the confounding effects of body size and BMI, the current literature supports ILR following ALND in the prevention of BCRL. Collaboration between the oncologic breast surgeon and reconstructive microsurgeon are central to the success of ILR. Critical components for operative success include preoperative and intraoperative lymphatic mapping, preservation of suitable venous targets, availability of supermicrosurgical instruments and sutures, as well as aptitude with a variety of microsurgical anastomotic techniques. Full article

Circulating cell-free nucleic acids (NAs), in particular plasma-derived cell-free DNA, have evolved into promising clinical analytes for prenatal diagnostics, cancer analysis, and cancer surveillance and therapy monitoring. Nevertheless, salivary extracellular and extracellular vesicle (EV)-derived DNA and microRNA have recently gained attention as potential non-invasive biomarkers for a variety of diseases, including cancer, cardiovascular, autoimmune, and infectious diseases. Our goal in this study was therefore to evaluate and optimize commercially available approaches for cell-free nucleic acid isolation, focusing specifically on DNA and miRNA present in cell-free saliva or saliva-derived EVs. Along these lines, we investigated various commercially available kits, which enable parallel isolation of cell-free DNA and RNA in separate fractions from cell-free saliva and salivary EVs, respectively, and compared them to single analyte extraction kits. The efficiency of all tested nucleic acid extraction methods was determined by comparing DNA and RNA fluorescence spectroscopy measurements and quantitative PCR values obtained from a selection of different DNA- and microRNA targets. We found the Norgen Plasma/Serum RNA/DNA Purification Mini kit in combination with the miRCURY exosome isolation kit to work best in our hands and to provide the highest yields of EV-derived nucleic acids. Having tested and identified effective protocols for isolating salivary extracellular nucleic acids, we present with this comparison study, among others, a sound basis for future circulating small nucleic acid and epigenetic biomarker research aiming for early disease diagnosis, prognosis, and prediction from cell-free saliva, representing an easy-to-collect and readily available diagnostic fluid. Full article

Chronic kidney disease (CKD) is prevalent throughout the world, and peritoneal dialysis (PD) has been a growing mode of renal replacement therapy (RRT) for over four decades. Peritoneal dialysis has several advantages in cost, patient satisfaction, and quality of life, despite accounting for only one in ten patients on dialysis in the United States. In spite of some contraindications and barriers to effective PD, the vast majority of renal failure patients are candidates, especially when in a high-volume program with surgical expertise readily available. Reliable access via an intraabdominal PD catheter is paramount for managing end-stage renal disease patients. Surgical approaches for PD catheter insertion have evolved substantially alongside innovations in catheter design. Recent data suggests that the advanced laparoscopic catheter placement offers the best results and long-term survival. However, image-guided fluoroscopic insertion can be performed without general anesthesia, is highly effective, and is growing in usage. Being able to start PD urgently is vital in avoiding hemodialysis (HD) and its complications, and this is a growing theme worldwide, despite slightly higher morbidity. Infectious and mechanical complications are relatively common and are frustrating to PD patients and the physicians who care for them. Peritonitis and exit site infections require antibiotic coverage and sometimes, surgical intervention. Catheter dysfunction is a frequent mechanical issue requiring a multidisciplinary approach: medical treatment, nurse-administered flushing and clot dissolvers, interventional radiology evaluation and wire manipulation, and surgical laparoscopy for catheter salvage. Full article

(1) Background: There has been a recent growth in evidence regarding the use, value and impact of photobiomodulation therapy for individuals with fibromyalgia. However, the nature of the evidence has, to the best of the authors’ knowledge, not been presented within a scoping review. The objective of this work is to reveal the nature of the evidence, gaps in the evidence, and a map of the evidence considering photobiomodulation therapy against established policy guidelines; (2) Methods: A scoping review was undertaken considering all academic research that has examined the experiences and impact of photobiomodulation therapy on individuals with fibromyalgia; (3) Results: Our results highlight that, indeed, there is plentiful data available to address a high proportion of the concerns portrayed by the National Institute for Healthcare and Excellence. Outcome measures are wide-ranging, albeit demonstrating heterogeneity, and the results are extremely promising; (4) Conclusion: Based on the current evidence, the United Kingdom’s ‘standard of care’ for fibromyalgia needs to be ascertained, and stringent cost-effectiveness data needs to be collected and presented to governing bodies with the aim of integrating recommendations into future healthcare guidelines. Full article

Background: With the inclusion of evidence-based dentistry, numerous systematic reviews (SRs) and meta-analyses (MAs) have been conducted in endodontics with the best available scientific evidence to improve diagnosis and treatment. Objective: To synthesize the scientific evidence on the effectiveness of irrigation protocols in endodontic therapy. Methods: Following the umbrella review methodology (UR), a comprehensive literature search was conducted using scientific and grey literature databases. A quality evaluation and a descriptive analysis of the included SRs and MAs were conducted. Quantitative comparability between MAs was carried out. Results: Four descriptive SRs and nine MAs were included. Eight articles evidenced high methodological quality. Studies showed the effectiveness and efficacy depending on the study design, the findings of primary clinical trials, and factors related to the type of irrigant, concentration, volume, and irrigation systems. Variability between irrigants and protocols was observed. Follow-up periods extend from hours to years, and there were different study samples. SRs and MAs evidenced limitations regarding methodological aspects. Low overlap of the primary studies was found. Quantitative analyses indicated greater efficacy in microbial reduction and apical healing in favor of passive ultrasonic irrigation (PUI; RD −0.15; 95% CI −0.28, −0.01; p = 0.03; I2 = 60%; RD −0.09; 95% CI −0.16, −0.02; p = 0.01; I2 = 0%, respectively). Conclusions: This UR highlights the importance of root canal disinfection, emphasizing sodium hypochlorite (NaOCl) as the primary irrigant. Enhanced activation methods, such as PUI and lasers, improve irrigant efficiency, while alternatives like chlorhexidine (CHX) offer better biocompatibility. Standardized protocols and evidence-based clinical guidelines are needed. PROSPERO register: CRD42023409044. Full article

Candidemia is a significant cause of morbidity and mortality among critically ill patients. Early-onset candidemia is characterized by occurring within the first seven days after admission to the Intensive Care Unit and presents several important challenges regarding its management. Risk factors may vary among patients with early- and late-onset infection, while clinical manifestations are generally non-specific and covered by the underlying disease and co-morbidities. Diagnosis and appropriate therapy are frequently delayed, with a high risk of progression to invasive, deep-seated infections, leading to rapid clinical deterioration. Management strategies to optimize the approach for patients with early-onset candidemia include the use of both conventional and novel diagnostic techniques, the initiation of appropriate antifungal therapy, administration of an adequate dose, daily evaluation of clinical response, de-escalation treatment whenever possible, and early discontinuation. Incorporating an antifungal stewardship program in clinical practice is essential in order to achieve the best clinical outcomes. Based on a review and analysis of the available literature, this article provides a thorough update on the risk factors, clinical characteristics, diagnostic methods, and management of early-onset candidemia in adult critically ill patients. Full article

Health and wellness tourism is a rapidly expanding segment of the global tourism industry, driven by increasing consumer awareness of well-being and lifestyle enhancement. As the demand for wellness travel grows, destinations are expected to offer high standards of safety, hygiene, rehabilitation, and holistic experiences. This study aims to identify and evaluate the key attributes and determinants for developing health and wellness tourism destinations by applying the 6As Tourism Development framework: Attractions, Accessibility, Amenities, Activities, Available Packages, and Ancillary Services. A multi-criteria decision-making approach, specifically the TOPSIS, was employed to assess destination potential through a case study of Nakhon Ratchasima Province, Thailand. The results indicate that Attractions, Accessibility, and Amenities are the top three priorities for wellness tourists. Sub-criteria such as natural scenery, cultural significance, accessibility for all, safety, and accommodation quality are particularly influential. Three districts in Nakhon Ratchasima were found to exhibit distinct strengths—Pak Chong is best suited for rehabilitative tourism (e.g., aroma and water therapy), aligning with mind and nutrition wellness components; Wang Nam Khiao is ideal for ecotourism and cultural experiences, supporting environmental and nutritional dimensions; while Mueang Nakhon Ratchasima excels in sports tourism, supporting physical and nutritional well-being. The study offers practical insights for policymakers and tourism stakeholders to design sustainable, visitor-centered wellness destinations. The proposed framework supports strategic planning and resource allocation for health-focused tourism development. Full article

Laser photobiomodulation (LPMB) is a non-invasive therapy that relies on the use of low-power lasers. The literature supports the positive effect of LPBM on tissue regeneration, since it reduces the timing of the inflammatory phase, promoting the proliferative phase of the process. From a purely clinical point of view, the breadth of lasers currently available for dental use makes it difficult to identify unambiguous parameters that can guarantee the best regenerative effect. Therefore, the aim of the present systematic review is to identify the best irradiation parameters for each type of dental laser that can provide the best effects on fibroblast proliferation and differentiation. The literature was searched through the following electronic databases: Medline, Scopus, Web of Science, Springer, and Cochrane, while respecting the PRISMA 2020 guidelines. In vitro studies conducted on human fibroblast cells, drafted in English between 2004 and 2025, were included. A total of 17 papers assessing the effects of diode lasers at different wavelengths (445 nm, 635 nm, 650 nm, 660 nm, 670 nm, 685 nm, 810 nm, 830 nm, 915 nm, 940 nm), CO2 lasers (10.6 µm), and Er:YAG lasers (2940 nm) were included. What can be concluded from the present review is that, for the same wavelength, the wide variability in the results obtained from each study makes it complicated to identify unambiguous parameters for each laser device that can guarantee the best effect on fibroblast proliferation and differentiation. Full article

Background/Objectives: Anaplastic lymphoma kinase (ALK)-positive (+) anaplastic large cell lymphoma (ALCL) is known to express CD25, but its significance has not been well studied. Methods: In the present study, we identified 54 ALK+ ALCL patients with CD25 results available and investigated the significance of CD25 expression levels. Results: Forty-two (78%) cases had high CD25 expressions, whereas low CD25 expressions were found in 12 (22%) cases. Compared with ALK+ ALCL patients with CD25-high neoplasms, patients with CD25-low neoplasms were older (median: 40 years vs. 29 years, p = 0.01) and more often had thrombocytopenia (40% vs. 0%, p = 0.02). Between CD25-low and CD25-high groups, other clinical features were similar to each other (all p > 0.05). CD25-low ALK+ ALCL cases showed higher frequency of surface CD3 (100% vs. 3%, p = 0.001) and CD8 (57% vs. 14%, p = 0.03). Fourteen of 47 (30%) ALK+ ALCL patients died (median follow-up time, 33.8 months; range, 0.3–382.8 months): 5 of 9 (56%) patients with CD25-low neoplasms and 9 of 38 (24%) patients with CD25-high neoplasms. Univariate analysis showed: (1) the OS of patients with CD25-low ALK+ ALCL was shorter than that of patients with CD25-high ALK+ ALCL (median: 72.2 months vs. undefined, p = 0.02); and (2) young (<30 years) patients with high CD25 expression had the best prognosis, with a long-term OS rate of 89%. However, in multivariate analysis, low CD25 expression did not significantly impact OS. Conclusions: most cases of ALK+ ALCL highly express CD25 which is a potential target for therapy. ALK+ ALCL with low CD25 expression is associated with older patient age and increased frequency of thrombocytopenia and surface CD3 and CD8 expression. Full article

Background/Objectives: Glioblastoma (GBM) is a highly aggressive primary central nervous system tumor with a median survival of 14 months. MGMT (O6-methylguanine-DNA methyltransferase) promoter methylation status is a key biomarker as a prognostic indicator and a predictor of chemotherapy response in GBM. Patients with MGMT methylated disease progress later and survive longer (median survival rate 22 vs. 15 months, respectively) as compared to patients with MGMT unmethylated disease. Patients with GBM undergo an MRI of the brain prior to diagnosis and following surgical resection for radiation therapy planning and ongoing follow-up. There is currently no imaging biomarker for GBM. Studies have attempted to connect MGMT methylation status to MRI imaging appearance to determine if brain MRI can be leveraged to provide MGMT status information non-invasively and more expeditiously. Methods: Artificial intelligence (AI) can identify MRI features that are not distinguishable to the human eye and can be linked to MGMT status. We employed the UPenn-GBM dataset patients for whom methylation status was available (n = 146), employing a novel radiomic method grounded in hybrid feature selection and weighting to predict MGMT methylation status. Results: The best MGMT classification and feature selection result obtained resulted in a mean accuracy rate value of 81.6% utilizing 101 selected features and five-fold cross-validation. Conclusions: This compared favorably with similar studies in the literature. Validation with external datasets remains critical to enhance generalizability and propagate robust results while reducing bias. Future directions include multi-channel data integration with radiomic features and deep and ensemble learning methods to improve predictive performance. Full article

Optimized glycemic management is crucial for controlling atherosclerosis and consequent cardiovascular morbidity in patients with diabetes. Due to the continuous glucose burden from glucose-containing peritoneal dialysis (PD) solutions, PD patients with diabetes experience difficulties in glucose level regulation with glucose hypervariability and worsening dyslipidemia. Even in non-diabetic PD patients, glucose-containing PD solutions aggravate insulin resistance and cause overweight. Additionally, glucose degradation products (GDP) from glucose-based PD solutions provoke oxidative stress and complex inflammatory processes, leading to chronic deleterious and fibrotic peritoneal membrane changes. In this narrative review, we searched the literature using PubMed, MEDLINE, and Google Scholar over the last three decades to summarize the most important facts relevant to the presented issues, aiming to inform both endocrinologists and nephrologists in providing the best currently available care for people with diabetes on PD. We not only focus on adequate tailoring of insulin therapy adapted at the time of PD exchange with hypertonic glucose solution., but also emphasize the use of continuous glucose monitoring (CGM) that allows assessment of mean glucose values and time spent in normal, hypo, and hyperglycemia. However, the routine use of CGM in PD patients is limited due to high cost, and hemoglobin A1c (HbA1c) analysis is still recommended as a basic clinical tool for the assessment of glycemic control. Possible choices of antidiabetic drugs were considered given the narrowed choice due to contraindications for metformin and sulfonylurea. The other important therapeutic approach in PD patients with diabetes is using glucose-sparing PD regimens based on icodextrin and amino acid PD solutions with the addition of just one or two bags of low glucose concentration PD solution daily. This glucose-sparing approach not only reduces the glucose load and improves glycoregulation with correction of the lipid profile but also maintains the viability of the peritoneal membrane by reducing the harmful effects of GDPs. Full article