Search Results (2,055)

Background and Objectives: Lower limb defects often present significant reconstructive challenges due to limited soft tissue availability and exposure of critical structures. Perforator-based flaps offer reliable solutions, with minimal donor site morbidity. This study aimed to evaluate the efficacy of infrared thermography (IRT) in preoperative planning and postoperative monitoring of perforator-based flaps, assessing its accuracy in identifying perforators, predicting complications, and optimizing outcomes. Materials and Methods: A prospective observational study was conducted on 76 patients undergoing lower limb reconstruction with fascio-cutaneous perforator flaps between 2022 and 2024. Perforator mapping was performed concurrently with IRT and Doppler ultrasonography (D-US), with intraoperative confirmation. Flap design variables and systemic parameters were recorded. Postoperative monitoring employed thermal imaging on days 1 and 7. Outcomes were correlated with thermal, anatomical, and systemic factors using statistical analyses, including t-tests and Pearson correlation. Results: IRT showed high sensitivity (97.4%) and positive predictive value (96.8%) for perforator detection. A total of nine minor complications occurred, predominantly in patients with diabetes mellitus and/or elevated glycemia (p = 0.05). Larger flap-to-defect ratios (A/C and B/C) correlated with increased complications in propeller flaps, while smaller ratios posed risks for V-Y and Keystone flaps. Thermal analysis indicated significantly lower flap temperatures and greater temperature gradients in flaps with complications by postoperative day 7 (p < 0.05). CRP levels correlated with glycemia and white blood cell counts, highlighting systemic inflammation’s impact on outcomes. Conclusions: IRT proves to be a reliable, non-invasive method for perforator localization and flap monitoring, enhancing surgical planning and early complication detection. Combined with D-US, it improves perforator selection and perfusion assessment. Thermographic parameters, systemic factors, and flap design metrics collectively predict flap viability. Integration of IRT into surgical workflows offers a cost-effective tool for optimizing reconstructive outcomes in lower limb surgery. Full article

Background: Neonatal jaundice is common and can cause severe hyperbilirubinemia if untreated. The early identification of at-risk newborns is challenging despite the existing guidelines. Objective: This study aimed to identify the key maternal and neonatal risk factors for jaundice requiring phototherapy using machine learning. Methods: In this study hospital, phototherapy was administered following the American Academy of Pediatrics (AAP) guidelines when a neonate’s transcutaneous bilirubin level was in the high-risk zone. To identify the risk factors for phototherapy, we retrospectively analyzed the electronic medical records of 8242 neonates admitted between 2017 and 2022. Predictive models were trained using maternal and neonatal data. XGBoost showed the best performance (AUROC = 0.911). SHAP values interpreted the model. Results: Mode of delivery, neonatal feeding indicators (including daily formula intake and breastfeeding frequency), maternal BMI, and maternal white blood cell count were strong predictors. Cesarean delivery and lower birth weight were linked to treatment need. Conclusions: Machine learning models using perinatal data accurately predict the risk of neonatal jaundice requiring phototherapy, potentially aiding early clinical decisions and improving outcomes. Full article

Background: Reliable platelet (PLT) measurement is crucial for the accurate diagnosis of thrombocytopenia. Several methods exist for automated PLT counting, including the impedance method (PLT-I), as well as optical and fluorescence methods (PLT-F). The impedance method is cost-effective but susceptible to interference from small red blood cells and schistocytes. In contrast, fluorescent assessment offers higher specificity but is more expensive, as it requires additional dyes and detectors. Hybrid platelet counting (PLT-H) combines impedance with measurements from the leukocyte differentiation channel and is available without additional cost. Aim: The aim of this study was to evaluate the accuracy of hybrid PLT counting in anemic samples. Methods: In this retrospective study, PLT counts from 583 unselected anemic samples were analyzed using two different analyzers: the Sysmex XN3500, equipped with fluorescent PLT-F technology, and the Mindray BC6200, which uses both impedance (PLT-I) and hybrid (PLT-H) technologies. Agreement between PLT-I and PLT-F, as well as between PLT-H and PLT-F, was assessed using Bland–Altman plots. Correlation between the methods was evaluated using the Pearson correlation coefficient. Results: The hybrid method demonstrated better accuracy in PLT counting compared to the impedance method. Correlation between PLT-H and PLT-F was excellent, ranging from 0.991 to 0.999. In thrombocytopenic samples (PLT < 50 G/L), the hybrid method also provided more reliable PLT counts than the impedance method, reducing the number of falsely elevated PLT results by nearly fivefold. Conclusions: Hybrid platelet counting yields more accurate results than the impedance method in anemic samples and shows excellent correlation with the fluorescence method. Full article

Background: The prevalence of cardiogenic shock (CS) resulting from the progression of heart failure (PHF) is increasing and remains associated with high mortality. This study aimed to compare the clinical characteristics and outcomes of patients who developed CS due to PHF versus those whose CS was caused by other aetiologies (non-PHF). Methods: We retrospectively analysed 280 patients admitted to a Polish tertiary care centre between January 2021 and April 2024. The cohort was divided into two groups: PHF (n = 84, 30%) and non-PHF (n = 196, 70%). Results: Compared to the non-PHF group, PHF patients more frequently had chronic kidney disease (30% vs. 15%, p < 0.01), and significant valvular disease (30% vs. 13%, p < 0.01). PHF patients exhibited significantly lower white blood cell counts (9.4 [6.9–16.4] vs. 13.3 [10.4–17.6], p < 0.01) and troponin T levels (188 [61–1392] vs. 10,921 [809–45,792], p < 0.01). In-hospital mortality was significantly lower among PHF patients (52% vs. 65%, p = 0.04). Although the overall use of mechanical circulatory support (MCS) did not differ between groups, significant differences in the types of MCS applied were observed (p < 0.01). Additionally, PHF patients underwent fewer coronary revascularisation procedures (15% vs. 70%, p < 0.01). Conclusions: Patients with PHF-related CS exhibit distinct clinical profiles and may experience lower in-hospital mortality when appropriately diagnosed and treated with a personalised approach. Further prospective, multicentre studies are warranted to optimize the management of this growing subgroup of CS patients. Full article

Dietary tannin supplementation represents a potential strategy to modulate rumen fermentation and enhance lactation performance in dairy cows, though responses remain inconsistent. A 21-day feeding trial was conducted to evaluate the effect of chestnut tannin (CNT) extract on the enteric methane emissions (EME), blood metabolites, and milk production traits in mid-lactation dairy cows. Thirty-six Holstein cows were allocated to three homogeneous treatment groups: control (CNT₀, 0 g/d CNT), CNT₄₀ (40 g/d CNT), and CNT₈₀ (80 g/d CNT). Measurements of EME, dry matter intake (DMI), milk yield (MY), and blood and milk parameters were carried out pre- and post-21-day supplementation period. Compared with the no-additive group, the CNT extract reduced methane production, methane yield, and methane intensity in CNT₄₀ and CNT₈₀ (p < 0.001). CNT₄₀ and CNT₈₀ cows exhibited lower blood urea nitrogen (p = 0.019 and p = 0.002) and elevated serum insulin (p = 0.003 and p < 0.001) and growth hormone concentrations (p = 0.046 and p = 0.034), coinciding with reduced aspartate aminotransferase (p = 0.016 and p = 0.045), and lactate dehydrogenase (p = 0.011 and p = 0.008) activities compared to control. However, CNT₈₀ had higher circulating NEFA and BHBA than CNT₀ (p = 0.003 and p = 0.004) and CNT₄₀ (p = 0.035 and p = 0.019). The blood glucose, albumin, and total bilirubin concentrations were not affected. MY and fat- and protein-corrected milk (FPCM), MY/DMI, and FPCM/DMI were higher in both CNT₄₀ (p = 0.004, p = 0.003, p = 0.014, p = 0.010) and CNT₈₀ (p = 0.002, p = 0.003, p = 0.008, p = 0.013) cows compared with controls. Feeding CNT₈₀ resulted in higher protein content (p = 0.015) but lower fat percentage in milk (p = 0.004) compared to CNT₀. Milk urea nitrogen and somatic cell counts were significantly lower in both CNT₄₀ (p < 0.001, p = 0.009) and CNT₈₀ (p < 0.001 for both) compared to CNT₀, while milk lactose did not differ between treatments. These findings demonstrate that chestnut tannin extract effectively mitigates EME while enhancing lactation performance in mid-lactation dairy cows. Full article

Sepsis is a serious public health problem. sTREM-1 is a marker of inflammatory and infectious processes that has the potential to become a useful tool for predicting the evolution of sepsis. A prediction model for sepsis was constructed by combining sTREM-1, CRP, and a leukogram via a Bayesian network. A translational study carried out with 32 children with congenital heart disease who had undergone surgical correction at a public referral hospital in Northeast Brazil. In the postoperative period, the mean value of sTREM-1 was greater among patients diagnosed with sepsis than among those not diagnosed with sepsis (394.58 pg/mL versus 239.93 pg/mL, p < 0.001). Analysis of the ROC curve for sTREM-1 and sepsis revealed that the area under the curve was 0.761, with a 95% CI (0.587–0.935) and p = 0.013. With the Bayesian model, we found that a 100% probability of sepsis was related to postoperative blood concentrations of CRP above 71 mg/dL, a leukogram above 14,000 cells/μL, and sTREM-1 concentrations above the cutoff point (283.53 pg/mL). The proposed model using the Bayesian network approach with the combination of CRP, leukocyte count, and postoperative sTREM-1 showed promise for the diagnosis of sepsis. Full article

Recombinant vesicular stomatitis virus (rVSV) is a promising viral vaccine vector for addressing the COVID-19 pandemic. Inducing mucosal immunity via the intranasal route is an ideal strategy for rVSV-based vaccines, but it requires extremely stringent safety standards. In this study, we constructed two rVSV variants with amino acid mutations in their M protein: rVSV-M2 with M33A/M51R mutations and rVSV-M4 with M33A/M51R/V221F/S226R mutations, and developed COVID-19 vaccines based on these attenuated vectors. By comparing viral replication capacity, intranasal immunization, intracranial injection, and blood cell counts, we demonstrated that the M protein mutation variants exhibit significant attenuation effects both in vitro and in vivo. Moreover, preliminary investigations into the mechanisms of virus attenuation revealed that these attenuated viruses can induce a stronger type I interferon response while reducing inflammation compared to the wild-type rVSV. We developed three candidate vaccines against SARS-CoV-2 using the wildtype VSV backbone with either wild-type M (rVSV-JN.1) and two M mutant variants (rVSV-M2-JN.1 and rVSV-M4-JN.1). Our results confirmed that rVSV-M2-JN.1 and rVSV-M4-JN.1 retain strong immunogenicity while enhancing safety in hamsters. In summary, the rVSV variants with M protein mutations represent promising candidate vectors for mucosal vaccines and warrant further investigation. Full article

Background and Objectives: Surgical site infections (SSIs) are a frequent complication after lower extremity fracture surgery, yet tools for individualized risk prediction remain limited. This study aimed to develop and internally validate a nomogram for individualized SSI risk prediction based on perioperative clinical parameters. Materials and Methods: This retrospective cohort study included adults who underwent lower extremity fracture surgery between 2022 and 2025 at a tertiary care center. Thirty candidate predictors were evaluated. Feature selection was performed using six strategies, and the final model was developed with logistic regression based on bootstrap inclusion frequency. Model performance was assessed by area under the curve, calibration slope, Brier score, sensitivity, and specificity. Results: Among 638 patients undergoing lower extremity fracture surgery, 76 (11.9%) developed SSIs. Of six feature selection strategies compared, bootstrap inclusion frequency identified seven predictors: red blood cell count, preoperative C-reactive protein, chronic kidney disease, operative time, chronic obstructive pulmonary disease, body mass index, and blood transfusion. The final model demonstrated an AUROC of 0.924 (95% CI, 0.876–0.973), a calibration slope of 1.03, and a Brier score of 0.0602. Sensitivity was 86.2% (95% CI, 69.4–94.5) and specificity was 89.5% (95% CI, 83.8–93.3). Chronic kidney disease (OR, 88.75; 95% CI, 5.51–1428.80) and blood transfusion (OR, 85.07; 95% CI, 11.69–619.09) were the strongest predictors of infection. Conclusions: The developed nomogram demonstrates strong predictive performance and may support personalized SSI risk assessment in patients undergoing lower extremity fracture surgery. Full article

Considering the high plasticity of FoxP3⁺ regulatory T (Treg) cells and Interleukin (IL)-17-producing Th17 cells, we hypothesized that a Th17 inflammatory milieu may impair the functional properties of Treg cells in chronic inflammatory arthritides. Therefore, a cross-sectional explorative analysis was set up in patients with psoriatic arthritis (PsoA), rheumatoid arthritis, or spondyloarthritis to investigate the features of Th17 and Treg cells. T cell subpopulation counts, FOXP3 mRNA expression, CpG methylation of the FOXP3 gene, and the suppressive capacity of isolated Treg cells were determined. Ex vivo analysis of PsoA-derived peripheral blood lymphocytes showed a Th17-mediated inflammation. It was accompanied by demethylation of the FOXP3 promotor and Treg-specific demethylated region (TSDR) in Treg cells which, however, resulted neither in elevated FOXP3 mRNA expression nor in increased suppressive Treg cell capacity. To clarify this conundrum, in vitro stimulation of isolated Treg cells with Th17-inducing cytokines (IL-1β, IL-6, IL-23, TGFβ), recombinant IL-17, or the anti-IL-17A antibody secukinumab was performed, demonstrating that cell culture conditions polarizing towards Th17, but not IL-17 itself, impair the suppressive function of Treg cells, accompanied by diminished FOXP3 mRNA expression due to hypermethylation of the FOXP3 promotor and TSDR. This potential causal relationship between Th17 inflammation and impaired Treg cell function requires attention regarding the development of immunomodulatory therapies. Full article

Background and Objectives: Acute appendicitis is a common surgical emergency, and while appendectomy typically results in good outcomes, post-operative complications, like intra-abdominal abscesses, can occur. Traditional biomarkers, such as white blood cells count and C-reactive protein, often lack the accuracy needed for early detection. Procalcitonin is emerging as a potential marker for predicting post-operative infections. This pilot study evaluates the role of kinetics of procalcitonin, measured via point-of-care testing, in predicting abscess formation in patients with non-complicated appendicitis. Materials and Methods: The study involved 33 patients undergoing appendectomy for non-complicated acute appendicitis. The levels of procalcitonin were measured at four time points: pre-operatively (T0), post-operatively (T1), on the first post-operative day (T2), and at discharge (T3). The primary outcome was the development of post-operative abscesses, confirmed by imaging or intervention. Results: Four patients (12%) developed abscesses. The levels of procalcitonin were significantly higher in the abscess group at all time points compared to the non-abscess group (p < 0.05). The levels of procalcitonin in the abscess group plateaued after an initial post-operative decline, while levels steadily decreased in the non-abscess group. Conclusions: Procalcitonin, particularly its kinetic profile, may serve as a valuable early marker for predicting post-operative abscess formation. Point-of-care testing for procalcitonin can enable timely intervention, improving outcomes. Kinetics of procalcitonin show promise as a predictor for post-operative abscesses after appendectomy, though larger studies are needed to confirm these findings. Full article

The objective of this study was to evaluate the effects of feeding a combination of chicory–plantain silage and supplementing Se yeast on the response of early-lactating ewes to induce subclinical mastitis. Polypay ewes (n = 32) were fed either chicory–plantain silage or grass silage and supplemented with 3.6 mg Se yeast/ewe/day for approximately 2 months prior to the infusion of S. uberis into both mammary glands (i.e., intramammary infection or IMI). The ewes had a typical subclinical mastitis response with an 8-fold increase in milk somatic cell count within 24 h post-IMI, a decrease in milk yield, and changes in all milk components measured. The ewes experienced a mild systemic inflammation post-IMI as determined by an increase in rectal temperature and decrease in feed and water intake and, in blood, by an increase in the concentration of ceruloplasmin, haptoglobin, and myeloperoxidase and a decrease in paraoxonase, Zn, advanced oxidation protein products, and hematocrit with no effect on pro-inflammatory cytokines. No effect of silage type, likely due to a low concentration of secondary compounds, or Se supplementation was detected in response to IMI. In summary, the subclinical mastitis model used was effective in mounting an inflammatory response, although this was mild; however, feeding chicory–plantain silage with a low concentration of secondary compounds and supplementing Se yeast had no significant effect on the response of ewes to mammary infection. Full article

Background: While timely blood transfusion is critical for restoring oxygen-carrying capacity after coronary artery bypass grafting (CABG), allogeneic blood product transfusions are independently associated with increased long-term mortality, necessitating a risk-stratified approach to balance oxygen delivery against immunological complications and infection risks. Methods: We retrospectively analyzed 3376 patients undergoing isolated CABG between 2005 and 2023 at a single tertiary center. Patients who died during their perioperative hospital stay within 30 days were excluded. Transfusion burden was assessed both as the absolute number of blood product units (packed red blood cells, platelet transfusion, fresh frozen plasma) and as a percentage of calculated patient blood volume. The primary outcome was all-cause mortality at 5 years. Flexible Cox regression with penalized smoothing splines, adjusted for EuroSCORE II, was used to model dose–response relationships. Results: From our cohort of 3376 patients, a total of 137 patients (4.05%) received >10 units of packed red blood cells (PRBC) perioperatively. These patients were older (median 71 vs. 68 years, p < 0.001), more often female (29% vs. 15%, p < 0.001), and had higher preoperative risk (EuroSCORE II: 2.53 vs. 1.41, p < 0.001). After 5 years, mortality was 42% in the massive transfusion group versus 10% in controls. Spline regression revealed an exponential increase in mortality with transfused units: 14 units yielded a 1.5-fold higher hazard of death (HR 1.46, 95% CI 1.31–1.64), rising to HR 2.71 (95% CI 2.12–3.47) at 30 units. When transfusion was indexed to blood volume, this relationship became linear and more tightly correlated with mortality, with lower maximum hazard ratios and narrower confidence intervals. Conclusions: Indexing transfusion burden to the percentage of patient blood volume replaced provides a more accurate and clinically actionable predictor of 5-year mortality after CABG than absolute unit counts. Our findings support a shift toward individualized, volume-based transfusion strategies to optimize patient outcomes and resource stewardship in a time of limited availability of blood products. Full article

Atopic dermatitis (AD) is a common chronic inflammatory skin disorder characterized by immune dysregulation and skin barrier impairment. This study evaluated the anti-inflammatory and immunomodulatory effects of Camellia japonica extract in a 2,4-dinitrochlorobenzene (DNCB)-induced AD mouse model using SKH-1 hairless mice. Topical application of Camellia japonica extract for four weeks significantly alleviated AD-like symptoms by reducing epidermal thickness, mast cell infiltration, and overall skin inflammation. Hematological analysis revealed a marked decrease in total white blood cell (WBC) and neutrophil counts. Furthermore, the Camellia japonica extract significantly decreased oxidative stress, as evidenced by reduced serum reactive oxygen species (ROS) and nitric oxide (NO) levels, while enhancing the activity of antioxidant enzymes such as catalase. Importantly, allergic response markers including serum immunoglobulin E (IgE), histamine, and thymic stromal lymphopoietin (TSLP), were also downregulated. At the molecular level, Camellia japonica extract suppressed the expression of key pro-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1β, and T helper 2 (Th2)-type cytokines such as IL-4 and IL-5, while slightly upregulating the anti-inflammatory cytokine IL-10. Collectively, these findings suggest that Camellia japonica extract effectively modulates immune responses, suppresses allergic responses, attenuates oxidative stress, and promotes skin barrier recovery. Therefore, application of Camellia japonica extract holds the promising effect as a natural therapeutic agent for the prevention and treatment of AD-like skin conditions. Full article

Objective: The interactions between the central nervous system (CNS) and the immune system suggest that immune mechanisms may be effective in the pathogenesis of epilepsy and epileptic seizures. Although studies on the natural immune response and epilepsy are continuing, it is not yet clear whether the interaction of the current immune system is due to epilepsy itself or antiepileptic drugs (AEDs), since epileptic patients also use AEDs There are a limited number of studies that have reported an increased incidence of upper respiratory tract infections (URTIs) in patients during levetiracetam (LEV) treatment. Therefore, we aimed to report our experience regarding the effect of LEV monotherapy on the complete blood count (CBC), immunoglobulin (Ig) levels, and lymphocyte subgroups in the interictal period in children and adolescents with epilepsy. Methods: This study enrolled 31 children who presented with epilepsy and underwent LEV monotherapy for at least one year (patient group) and 43 healthy children (control group). The CBC parameters (hemoglobin (hb), lymphocytes, leukocytes, neutrophils, and platelets), Ig levels (IgA, IgM, IgG, and IgE), and lymphocyte subsets (CD3, CD4, CD8, CD4/CD8 ratio, CD19, CD56, NKT cells, and Treg cells) were measured and compared between the two groups. The patients were also investigated regarding the frequency and types of infections that they experienced in the first month and first year of the study, and these data were compared between the patient group and the control group. In addition, the same parameters and the frequency of infection were compared among the patient subgroups (focal and generalized seizures). Results: The results of the present study indicate that there were no significant differences in the CBC parameters, lymphocyte subsets, or Ig levels between the patient group and the control group. The comparison among the patient subgroups was similar; however, the CD4/CD8 ratio was lower in the patient subgroup with focal seizures. In addition, there were no significant differences in the frequency or type of infections experienced one month and one year of the study between the patient group and the control group, and likewise for the patient subgroups (focal and generalized seizures). Conclusions: The present study demonstrated that LEV monotherapy did not increase the incidence of infection, and there were no significant effects on the CBC or on the humoral or cellular immune system in epileptic children. These findings also suggest that the CD4/CD8 ratio among lymphocyte subgroups is lower in patients with focal seizures. However, the epilepsy subgroups had a relatively small sample size; therefore, further prospective studies involving a larger patient population are needed to establish the association between LEV monotherapy and lymphocyte subgroups in patients with epilepsy. Full article

Background/Objectives: Erysipelas is an acute bacterial skin infection, particularly affecting the lower limbs, with a tendency to recur. Despite its clinical importance, data on demographic and epidemiological risk factors, as well as factors influencing hospitalization, remain limited. This study aimed to analyze the epidemiological and clinical characteristics of patients hospitalized with primary and recurrent erysipelas, focusing on risk factors contributing to disease onset, recurrence, and prolonged hospitalization. Methods: A retrospective single-center analysis was conducted on 239 patients hospitalized for erysipelas at the Department of Dermatology, Pediatric Dermatology, and Oncology at the Medical University of Lodz. Data collected included demographics, lesion location, laboratory markers, comorbidities, and hospitalization outcomes. Statistical analyses were performed to assess associations between risk factors, disease recurrence, and hospitalization duration. Results: The majority of erysipelas cases (85.4%) involved the lower limbs, with a higher prevalence in men. Upper extremities were mostly affected in women, especially those who had undergone breast cancer surgery. Recurrent erysipelas accounted for 75.7% of cases. Most patients (89.1%) had at least one comorbidity, with hypertension, diabetes type 2 (DM2), and obesity being the most common. Higher white blood cell (WBC) count, obesity, atrial fibrillation (AF), and the need for enoxaparin administration were independently associated with prolonged hospitalization. Dyslipidemia was significantly associated with erysipelas recurrence (p < 0.05). Conclusions: Both primary and recurrent erysipelas are associated with specific risk factors. Recurrent erysipelas may be linked to components of metabolic syndrome, particularly obesity and dyslipidemia, which emerged as a significant risk factor in this study. Hospitalization length may be prolonged by inflammation markers (WBC and CRP) and comorbidities such as AF, obesity, or the need for enoxaparin in patients with elevated thrombosis risk. Further multicenter studies with larger cohorts are needed to assess the impact of demographics, biomarkers, metabolic disorders, and treatment strategies on erysipelas recurrence and outcomes. Awareness of these risk factors is essential for effective prevention, management, and recurrence reduction. Full article