Search Results (501)

Background/Objectives: Despite growing evidence on quantitative computed tomography (CT) analysis of coronary plaques and pericoronary adipose tissue (PCAT), their association with myocardial perfusion (MP) in patients with first acute myocardial infarction (AMI) with obstructive coronary artery disease (MICAD) and non-obstructive coronary arteries (MINOCA) remain unclear. The aim of this study was to assess the relationship between quantitative CT coronary plaque components and PCAT characteristics with MP, myocardial blood flow (MBF) and coronary flow reserve (CFR) obtained by dynamic single-photon emission computed tomography (SPECT) in patients with AMI. Methods: Patients with a first episode of AMI were included in the study. All patients underwent coronary CT angiography with quantitative assessment of plaque volume (PV) and burden (PB), as well as PCAT volume and attenuation. Dynamic SPECT was performed on cadmium–zinc–telluride gamma-camera for quantitative assessment of MP parameters, stress and rest MBF, and CFR. Results: A total of 31 patients (median age 62 [56–70] years) were analyzed, including MICAD (n = 21) and MINOCA (n = 10). MICAD patients had significantly higher total PV and PB, mainly due to non-calcified and fibrofatty components (p < 0.05), while low-attenuation (LAP) and calcified plaques (CP) did not differ between groups. PCAT volumes were higher in MICAD (p < 0.05), whereas PCAT attenuation showed no differences. Dynamic SPECT revealed lower stress MBF and CFR in MICAD (p < 0.05). Correlation analysis showed positive associations of PV and PB with MP summed stress and rest scores, except LAP or CP; PB was negatively associated with MBF. In addition, PCAT volume correlated negatively with stress and rest MBF and CFR, as well as PCAT attenuation correlated positively with stress-induced MP abnormalities. Conclusions: Patients with MICAD demonstrated a greater extent of atherosclerosis and larger PCAT volume compared with MINOCA. Moreover, PCAT volume demonstrated inverse associations with MBF and CFR, indicating a potential link between PCAT characteristics and microvascular dysfunction. Full article

Background/Objectives: Cerebral blood flow (CBF) and cerebral blood volume (CBV) are critical perfusion metrics in diagnosing ischemic stroke. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) enables the evaluation of these cerebral perfusion metrics; however, accurately assessing them remains challenging. This study aimed to: (1) assess CBF asymmetry by quantifying and comparing it between contralateral hemispheres (right vs. left) within the MCA, ACA, and PCA territories using paired t-tests, and describe pattern of CBV; (2) evaluate overall inter-territorial regional variations in CBF across the different cerebral arterial territories (MCA, ACA, PCA), irrespective of the hemisphere, using ANOVA; (3) determine the correlation between CBF and CBV using both Pearson’s and Spearman’s correlation analyses; and (4) assess the influence of age and gender on CBF using multiple regression analysis. Methods: A cross-sectional study of 55 ischemic stroke patients was conducted. DCE-MRI was used to measure CBF and CBV. Paired t-tests compared contralateral hemispheric CBF in MCA, PCA, and ACA, one-way ANOVA assessed overall inter-territorial CBF variations, correlation analyses (Pearson/Spearman) evaluated the CBF-CBV relationship, and linear regression modeled demographic effects. Results: Significant contralateral asymmetries in CBF were observed for each cerebral pair of cerebral arteries using a paired t-test, with descriptive asymmetries noted in CBV. Separately, ANOVA revealed significant overall variability in CBF between the different cerebral arteries, irrespective of hemisphere. A strong positive correlation was found between CBF and CBV (Pearson r = 0.976; Spearman r = 0.928), with multiple regression analysis identifying age and gender as significant predictors of CBF. Conclusions: This study highlights hemispheric asymmetry and inter-territorial variation, the impact of age, and gender on CBF. DCE-MRI provides perfusion metrics that can guide individualized stroke treatment, offering valuable insights for therapeutic planning, particularly in resource-limited settings. Full article

Background/Objective: Timely identification of bloodstream pathogens is critical for sepsis management; however, PCR inhibitors such as sodium polyanetholesulfonate (SPS) in blood culture broth compromise nucleic acid recovery and long read sequencing. We assessed whether coupling a benzyl alcohol SPS-removal step to the fully automated LabTurbo AIO extractor improves Oxford Nanopore-based pathogen detection. Methods: Thirteen positive blood culture broths were pre-treated with benzyl alcohol and divided: half volumes were purified on the LabTurbo AIO; paired aliquots underwent manual QIAamp extraction. DNA purity was evaluated by NanoDrop and Qubit. Barcoded libraries were sequenced on MinION R9.4.1 flow cells for 6 h. Results: Automated eluates showed a median A₂₆₀/A₂₈₀ of 1.92 and A₂₆₀/A₂₃₀ of 1.96, versus 1.80 and 1.48 for manual extracts. The automated workflow generated 1.69 × 10⁶ total reads compared with 3.9 × 10⁵ reads for manual extraction. The median N50 read length increased from 5.9 kb to 8.7 kb, and the median proportion of reads classified to species increased from 62% to 84%. The hands-on time was <5 min and the sample-to-answer turnaround was <8 h, compared with >9 h and 90 min for the manual protocol, respectively. Conclusions: Benzyl alcohol SPS removal integrated into the LabTurbo AIO extractor yielded purer, longer, and higher read counts, enhancing nanopore sequencing depth and accuracy while compressing diagnostic turnaround to a single working day. This represents a practical advance for rapid blood culture pathogen identification in critical care settings. Full article

Introduction: Controlled (c-) and uncontrolled (u-) DCDs are two entirely different types of donors, mainly because the duration of ischemic and reperfusion injury differs between them. We hypothesized that normothermic regional perfusion (NRP) management and performance (as indicated by the dynamic changes in blood flow and lactate) might be different in uDCDs and in cDCDs. Methods: We assessed 99 DCD donors that were consecutively evaluated by the Tuscany Regional Transplant Center from 2020 to 2024 (multi-center investigation), focusing on the comparison between NRP performance and management in uDCDs (n = 44) vs. cDCDs (n = 45). Results: NRP duration was significantly higher in uDCDs compared to cDCDs (p = 0.001). During NRP, we observed no changes in lactate values in uDCDs and cDCDs, a significant increase in transaminases, and a progressive reduction in NRP blood flow rates despite the administration of more fluids. Throughout the entire NRP duration, pH values were significantly lower and glucose levels were higher in uDCDs compared to cDCDs, even though a higher dosage of bicarbonate and insulin units were administered in uDCDs. Conclusions: In our series, we documented that NRP performance and management differed in uDCDs compared to cDCDs. This phenomenon may be mainly related to the different duration of the ischemic injury between these two types of donors. During NRP, uncontrolled DCDs showed a more severe metabolic derangement, which was only partially reversable by a more aggressive treatment (higher fluid volumes, insulin and bicarbonate dosages). Our results strongly suggest that there is likely space for optimization of NRP management in DCDs. Further research should address this issue, considering the disparity between the supply of organs and increasing transplantation needs. Full article

Background/Objectives: Adnexal masses are commonly encountered in the routine practice of gynecologists, and transvaginal ultrasonography is the preferred imaging modality for assessing the masses in size and complexity. There has been a notable lack of focus on comparative studies concerning benign adnexal tumors. This study aimed to define and compare the specific morphological and vascular characteristics of ovarian mature cystic teratomas (MCTs) and endometriomas using transvaginal ultrasound and Doppler analysis. Methods: This retrospective analysis included 93 patients who underwent surgical intervention for benign adnexal masses at the Obstetrics and Gynecology Clinic Narodni Front from 1 January 2020 to 1 January 2022. Morphological parameters included the appearance of tumors, the largest diameter, volume, capsule thickness, and the presence of fluid in the pouch of Douglas. Hemodynamic parameters included the localization and quantity of blood vessels within the mass, Resistance Index (RI), peak systolic velocity (Vmax), and end-diastolic velocity (Vmin) within detectable tumor vessels. Flow was also assessed in the uterine arteries, calculating the AURI (uterine artery RI) on both the tumor and contralateral sides. Results: There were 46 patients with ovarian mature cystic teratomas, as well as 46 patients with endometriomas; 1 patient presented with both tumors. There were significant differences in ultrasonographic morphological appearance between the two groups. MCTs most frequently presented as multilocular solid cysts (51.0%) or unilocular solid cysts with hyperechoic content (20.4%). Conversely, the majority of endometriomas were classified as unilocular cysts with ground-glass echogenicity (45.5%). A significant difference was identified in the RI of intracystic vessels and the RI of the ipsilateral uterine artery (AURI). Endometriomas presented elevated RI values (0.57 vs. 0.54, p = 0.04) and reduced AURI (0.81 vs. 0.83, p = 0.02) compared to teratomas. Conclusions: These findings confirm that specific morphological and Doppler parameters, particularly the RI and AURI, can assist in distinguishing between endometriomas and mature cystic teratomas. This suggests a potential role for Doppler analysis in improving diagnostic precision for common benign adnexal tumors in clinical practice. Full article

Introduction: Leukoaraiosis (LA) or white matter disease is a significant component of vascular dementia. There is a large overlap noted between normal-pressure hydrocephalus (NPH) and LA. A previously reported lumped parameter modelling study of NPH led to novel findings in this disease. Given the overlap between LA and NPH, the purpose of the current study is to perform a lumped parameter study into LA to see if the vascular pathophysiology is similar to NPH. Methods: A lumped parameter model originally developed to study normal-pressure hydrocephalus was extended to investigate LA. The model was constrained by the known cerebral blood flow and cerebral blood volumes found in LA, as derived from the literature. Results: Similar to NPH, in LA, the model predicted a balanced increase in arterial and venous outflow resistance, with the resulting ischemia affecting the white matter rather than the grey matter. However, unlike NPH, in LA, the findings are irreversible, most likely due to structural venous wall changes. Conclusions: The model suggests that the vascular physiology of LA maybe similar to NPH. A common pathophysiology is discussed based on a pulsation-induced increase in the venous outflow resistance. Full article

Background/Objectives: Spontaneous intracranial hypotension (SIH), caused by spinal cerebrospinal fluid (CSF) leakage, commonly presents with orthostatic headache and CSF hypovolemia. While CSF dynamics in the cerebral aqueduct are well studied, alterations in spinal CSF flow remain less defined. We aimed to quantitatively assess spinal CSF flow at C2 using phase-contrast (PC) MRI enhanced by artificial intelligence (AI) and to evaluate its utility for diagnosing SIH and predicting responses to epidural blood patch (EBP). Methods: We enrolled 31 patients with MRI-confirmed SIH and 26 age- and sex-matched healthy volunteers (HVs). All participants underwent ECG-gated cine PC-MRI at the C2 level and whole-spine MR myelography. AI-based segmentation using YOLOv4 and a pulsatility-based algorithm was used to extract quantitative CSF flow metrics. Between-group comparisons were analyzed using Mann–Whitney U tests, and receiver operating characteristic (ROC) analysis was used to evaluate diagnostic and predictive performance. Results: Compared to HVs, SIH patients showed significantly reduced CSF flow parameters across all metrics, including upward/downward mean flow, peak flow, total flow per cycle, and absolute stroke volume (all p < 0.001). ROC analysis revealed excellent diagnostic accuracy for multiple parameters, particularly downward peak flow (AUC = 0.844) and summation of peak flow (AUC = 0.841). Importantly, baseline CSF flow metrics significantly distinguished patients who required one versus multiple epidural blood patches (EBPs) (all p < 0.001). ROC analysis demonstrated that several parameters achieved near-perfect to perfect accuracy in predicting EBP success, with AUCs up to 1.0 and 100% sensitivity/specificity. Conclusions: AI-enhanced PC-MRI enables the robust, quantitative evaluation of spinal CSF dynamics in SIH. These flow metrics not only differentiate SIH patients from healthy individuals but also predict response to EBP treatment with high accuracy. Quantitative CSF flow analysis may support both diagnosis and personalized treatment planning in SIH. Full article

This study aims to demonstrate whether immunization against inhibin could alters testicular echotexture (TE), hemodynamics (resistance and pulstalilty index [RI and PI], testicular blood flow volume [TBFV]), and semen picture. Senile male camels were immunized actively against inhibin alpha subunit (immunized males; n = 5; subcutaneous route; 1 mL) or non immunized (control males; n = 5). The injection was four times with four weeks intervals. Semen was collected by electroejaculator once per week. Blood sampling, ultrasonography, and hormonal assaying was performed once per week. The levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), testosterone (T), and nitric oxide (NO) were calculated. Regarding control camels, the FSH levels were elevated (p < 0.01) in immunized males weeks 6–9 in August. Both E2 and NO were increased in the same group at weeks 7–11 with the highest level in week 10 for E2 (17.01 ± 0.11 pg/mL) in September and in week 9 for NO (44.66 ± 0.15 µmol/L). The Doppler indices RI and PI were declined (p < 0.01) in immunized camels in weeks 7–11, while the TBFV was elevated (p < 0.01). A marked elevation (p < 0.05) in testicular volume was noticed in the immunized group with a decline in the TE in week 9. The sperm cell concentration and viability were elevated (p < 0.01) in the immunized group. In conclusion, the active immunization against inhibin in senile camels shows a positive effect via improvement of testicular hemodynamics, flow volume, testicular volume, FSH, E2, NO, and sperm cell concentration with viability %, and alterations in both Doppler indices with the TE. Full article

Background: Heated tobacco products (HTPs) are marketed as reduced-harm alternatives to conventional cigarettes (CCs) and are increasingly used by young adults and occasional smokers. However, their acute nicotine delivery and user experience remain insufficiently studied in occasional smokers without established cigarette or nicotine dependence. Additives such as menthol—known to reduce sensory irritation and facilitate inhalation—may further influence initiation and product appeal, particularly in naïve users. Methods: In a crossover study with three separate study days, n = 15 occasional smokers without established cigarette or nicotine dependence consumed a mentholated HTP (mHTP), a non-mentholated HTP (nmHTP), and a conventional cigarette (CC) under ad libitum conditions during a 30 min observation. We measured plasma nicotine concentrations, smoking topography, cardiovascular parameters, and subjective effects (mCEQ). Results: Nicotine pharmacokinetics (Cmax, AUC) were comparable across products (Cmax 7.8–8.5 ng/mL; AUC 2.3–2.8 ng·min/mL [geometric means]; no significant differences), even though participants had no prior experience with HTPs. Compared to CCs, HTPs were associated with longer puff durations (2.09 s mHTP/2.00 s nmHTP vs. 1.78 s CC), higher puff volumes (mean: 68.06/68.16 vs. 43.76 mL; total: 949.80/897.73 vs. 522.41 mL), and greater flow rates (mean 37.49/38.25 vs. 27.68 mL/s; peak 63.24/63.69 vs. 44.38 mL/s). Subjective effects did not differ significantly between products (mCEQ subscale examples: satisfaction 3.00–3.33/7; reward 2.81–3.31/7; craving reduction 5.07–5.60/7). Cardiovascular parameters such as heart rate or systolic blood pressure showed with no between-product differences (HR p = 0.518; SBP p = 0.109) and no differences in their change over time between products (HR p = 0.807; SBP p = 0.734). No differences were observed between mHTP and nmHTP. Conclusion: HTPs can deliver nicotine and evoke user experiences similar to CCs, even in non-dependent users. The more intensive inhalation behavior observed with HTPs may reflect compensatory use and merits further investigation. Although no menthol-specific effects were observed, methodological constraints may have limited their detectability. Full article

Background/Objectives: Delayed cerebral ischemia (DCI) after an aneurysmal subarachnoid hemorrhage (aSAH) often presents with bilateral vasospasm and cortical spreading depolarizations. Computer tomography perfusion (CTP) is the prevailing screening method for detecting early changes in the cerebral blood flow. Commonly used CTP thresholds include an rCBF < 30% for the core volume and a Tmax > 6 s for hypoperfused tissue detection in acute ischemic stroke. These stroke algorithm computing thresholds compared to the contralateral hemisphere may or may not apply to detect tissue at risk of DCI. We aimed to quantify the volumetric agreement of three different stroke algorithms compared to the final infarct volumes as the standard. Methods: Furthermore, 123 CTP datasets of 75 patients with aSAH suspicious of DCI were processed using Intellispace Portal (ISP), Cercare Threshold, and Cercare Artificial Intelligence (AI) to calculate the tissue-at-risk (hypoperfused) and non-viable tissue (core) volumes. CT infarct volumes in plain CTs were segmented in the follow-up study by using a 3D slicer. Results: The calculated core volumes corresponded best to the final infarct volumes if DCI-related treatment was performed subsequently. Additional postprocessing improved the calculation of core volumes but overestimated the tissue at risk of hypoperfusion in DCI. Whereas the accuracy of tissue-at-risk prediction accelerated without treatment, underlining the importance of intra-arterial spasmolysis and induced hypertension in the prevention of DCI. Conclusions: Cercare AI and ISP revealed a sensitivity of 100% each, with a serious low specificity of <5% that was independent of treatment. Overall, the Cercare Threshold, applying the commonly used stroke thresholds, performed the best in predicting tissue at risk of hypoperfusion in DCI. Full article

The interaction between the left ventricle (LV) and aorta is critical for cardiovascular performance, particularly under pathophysiological conditions. However, how changes in LV mechanics, including preload and afterload, affect aortic function via LV–aorta interactions remains poorly understood due to the challenges associated with varying loading conditions in vivo. To overcome these limitations, the effects of varying LV preload or afterload on LV and aortic functions via LV–aorta interactions are quantified using ex vivo beating rat heart experiments in this study. In five healthy rat hearts under retrograde Langendorff and antegrade working heart perfusion, LV pressure, volume, aortic pressure, and aortic blood flow were measured. Key findings include the following: (1) under Langendorff perfusion, aortic flow increased linearly with LV developed pressure (DP), with a slope of 4.04 mmHg·min/mL; under working heart constant-pressure perfusion (2) a 12.4% increase in afterload decreased aortic flow by 58.8%, indicating that elevated aortic pressure significantly impedes aortic flow; (3) a 10.4% increase in preload enhanced aortic flow by 44.2%, driven primarily by an increase in LV DP that promoted forward flow. These results suggest that aortic pressure predominantly influences aortic flow under varying afterload conditions, whereas LV DP plays the dominant role in regulating aortic flow under different preload conditions. These findings demonstrate that the heart’s loading conditions strongly impact aortic blood flow. Specifically, elevated LV afterload can severely limit forward blood flow, while increased LV filling with increased LV preload can enhance blood flow, highlighting the importance of managing both afterload and preload in conditions such as hypertension and heart failure with preserved ejection fraction. This pilot study also established the feasibility of experimental platforms for coronary and ventricular function analysis. Full article

Background: Regional cerebral blood flow (rCBF) is a putative biomarker for neuropsychiatric disorders, including major depressive disorder (MDD). Methods: Here, we show that rCBF can be predicted from resting-state functional MRI (rsfMRI) at the voxel level while correcting for partial volume averaging (PVA) artifacts. Cortical patterns of MDD-related CBF differences decoded from rsfMRI using a PVA-corrected approach showed excellent agreement with CBF measured using single-photon emission computed tomography (SPECT) and arterial spin labeling (ASL). A support vector machine algorithm was trained to decode cortical voxel-wise CBF from temporal and power-spectral features of voxel-level rsfMRI time series while accounting for PVA. Three datasets, Amish Connectome Project (N = 300; 179 M/121 F, both rsfMRI and ASL data), UK Biobank (N = 8396; 3097 M/5319 F, rsfMRI data), and Amen Clinics Inc. datasets (N = 372: N = 183 M/189 F, SPECT data), were used. Results: PVA-corrected CBF values predicted from rsfMRI showed significant correlation with the whole-brain (r = 0.54, p = 2 × 10⁻⁵) and 31 out of 34 regional (r = 0.33 to 0.59, p < 1.1 × 10⁻³) rCBF measures from 3D ASL. PVA-corrected rCBF values showed significant regional deficits in the UKBB MDD group (Cohen’s d = −0.30 to −0.56, p < 10⁻²⁸), with the strongest effect sizes observed in the frontal and cingulate areas. The regional deficit pattern of MDD-related hypoperfusion showed excellent agreement with CBF deficits observed in the SPECT data (r = 0.74, p = 4.9 × 10⁻⁷). Consistent with previous findings, this new method suggests that perfusion signals can be predicted using voxel-wise rsfMRI signals. Conclusions: CBF values computed from widely available rsfMRI can be used to study the impact of neuropsychiatric disorders such as MDD on cerebral neurophysiology. Full article

Background: Large vessel occlusion (LVO) strokes account for a significant proportion of ischemic strokes and are often cardioembolic in origin, particularly following atrial fibrillation (AF) with thrombus formation in the left atrial appendage (LAA). Although direct oral anticoagulation (DOAC) therapy reduces stroke risk in AF, anatomical and flow-related factors may still allow thrombi to form and persist, revealing the limitations of anticoagulation in high-risk patients. Examining structural and hemodynamic factors contributing to thrombus persistence is essential for optimizing patient management. Methods: We retrospectively analyzed 169 AF patients with LVO stroke who underwent cardiac CT (cCT) during acute stroke assessment. Patients were categorized based on the presence or absence of persistent LAA thrombi and further stratified by DOAC status. LAA volume, blood stasis and left ventricular (LV) diameter were measured. Thrombi were assessed using Hounsfield Unit (HU) analysis to evaluate potential differences in thrombus composition. Logistic regression analysis was performed to identify independent predictors of thrombus persistence with adjustment for DOAC therapy. Results: Persistent LAA thrombi were identified in 23 patients (13.6%). Patients with thrombi had significantly higher rates of stasis (p = 0.004), larger left ventricular diameters (p = 0.0019) and higher LAA volumes (p = 0.004). When adjusted for DOAC therapy, larger LAA volume (OR 1.05, p = 0.011), presence of LAA stasis (OR 6.14, p = 0.013) and increased LV diameter (OR 1.06, p = 0.006) were independent predictors of thrombus persistence. Thrombus size and HU values did not differ significantly between DOAC and non-DOAC groups. Notably, 30.4% of patients with persistent thrombi were on adequate DOAC therapy. Conclusions: LAA volume, stasis and LV enlargement predict thrombus persistence in the LAA of AF patients with LVO stroke, even under adequate DOAC therapy. These findings highlight the potential need for alternative antithrombotic strategies, including interventional LAA occlusion, and warrant further investigation into individualized stroke prevention in high-risk AF populations. Full article

Aging is a complex biological process marked by progressive physiological decline with increasing vulnerability to diseases such as cardiovascular disorders, neurodegenerative conditions, and metabolic syndromes. Identifying reliable biomarkers of aging is essential for assessing biological age, predicting health outcomes, and guiding interventions to promote healthy aging. Among various candidate biomarkers, red blood cells (RBCs) offer a unique and accessible window into the aging process due to their abundance, finite lifespan, and responsiveness to systemic changes. This review examines the potential of RBCs as biomarkers of aging by exploring their age-associated morphological, functional, and biochemical alterations. Age-related reduction in key haematological parameters such as RBC count, haemoglobin concentration, and haematocrit, and increases in mean cell volume (MCV) and red cell distribution width (RDW), reflect underlying shifts in erythropoiesis and cellular turnover. Functional changes include reduced oxygen-carrying capacity, decreased deformability, diminished ATP release, and increased RBC aggregation, all of which may impair both macrocirculatory and microcirculatory flow and tissue oxygenation. Biochemically, aging RBCs exhibit altered membrane lipid and protein composition, reduced membrane fluidity, and diminished antioxidant and enzymatic activity, contributing to cellular senescence and clearance. Despite these promising indicators, challenges persist in establishing RBC parameters as definitive biomarkers of aging. Inter-individual and intra-individual variability and storage-related artifacts complicate their use. In conclusion, RBCs present a compelling, though currently underutilized, avenue for aging biomarker research. Further longitudinal validation and mechanistic research are essential to support the clinical utility of RBC parameters as biomarkers of aging. Full article

Platelet-rich plasma (PRP) is widely used in regenerative medicine, yet clinical outcomes remain inconsistent. While traditional strategies have focused on platelet concentration and activation methods, emerging evidence suggests that the biological age of platelets, especially platelet senescence, may be a critical but overlooked factor influencing therapeutic efficacy. Senescent platelets display reduced granule content, impaired responsiveness, and heightened pro-inflammatory behavior, all of which can compromise tissue repair and regeneration. This review explores the mechanisms underlying platelet aging, including oxidative stress, mitochondrial dysfunction, and systemic inflammation, and examines how these factors influence PRP performance across diverse clinical contexts. We discuss the functional consequences of platelet senescence, the impact of comorbidities and aging on PRP quality, and current tools to assess platelet functionality, such as HLA-I–based flow cytometry. In addition, we present strategies for pre-procedural optimization, advanced processing techniques, and adjunctive therapies aimed at enhancing platelet quality. Finally, we challenge the prevailing emphasis on high-volume blood collection, highlighting the limitations of quantity-focused protocols and advocating for a shift toward biologically precise, function-driven regenerative interventions. Recognizing and addressing platelet senescence is a key step toward unlocking the full therapeutic potential of PRP-based interventions. Full article