Search Results (410)

Background: Floating barbed threads are commonly used for minimally invasive midface lifting and rely on mobile subcutaneous tissue for support, which may limit stability. Fixation is primarily achieved by barb engagement within the subcutaneous fat and fibrous septa of the retinacula cutis. Objectives: To describe an anatomically guided modification of the APTOS Excellence Visage Soft (PLLA/PCL) thread technique, positioning the terminal segment posterior to the zygomatic retaining ligament line with the aim to enhancing mechanical stability. This technical report presents the anatomical rationale, procedural steps, and illustrative clinical cases demonstrating feasibility. Methods: The modified technique uses a single-entry point at the superior zygomatic margin, with five threads per hemiface. After linear insertion, the cannula is rotated laterally and inferiorly to position the terminal barbs posterior to the zygomatic retaining ligament line, thereby transferring tensile load toward a more fixed anatomical structure. Representative cases were documented and are presented. Results: Illustrative cases showed immediate midface elevation with improved malar projection and softening of the nasolabial and mentolabial folds. Standardized 3D imaging and vector analysis demonstrated a superolateral pattern of soft tissue displacement along the intended vectors, consistent with the proposed fixed-anchorage concept. The procedure was well tolerated, with only mild and transient local effects observed. One illustrative case included photographic follow-up at 12 months, in which preservation of midface contour and malar projection was visually appreciable. Conclusions: Redirecting the terminal thread segment posterior to the zygomatic retaining ligament line is a feasible modification that may contribute to improved vector stability by engaging a fixed fascial structure. Observations—including one case with 12-month follow-up—support the anatomical plausibility of the approach, although controlled studies with objective endpoints are necessary to confirm long-term efficacy and reproducibility. Full article

Objectives: Diuretics are frequently used in bronchopulmonary dysplasia (BPD), yet evidence describing their short-term physiological effects remains limited. This study aimed to describe early changes in respiratory support parameters and safety outcomes following combined oral spironolactone and hydrochlorothiazide (SP/HCTZ) therapy in preterm infants with BPD. Methods: A retrospective, single-center before–after observational study was conducted. Preterm infants diagnosed with BPD who initiated SP/HCTZ therapy were included. Respiratory parameters (FiO₂, PEEP, and flow rate) and serum electrolytes were compared between Day 1 (initiation) and Day 3 of treatment. A predefined clinical response was defined as either a ≥10% reduction in FiO₂ or a step-down in respiratory support modality. Results: Fifty-six infants (mean gestational age 27.7 ± 2.3 weeks) were analyzed. After 72 h of SP/HCTZ therapy, mean FiO₂ decreased from 26.2 ± 6.3% to 22.4 ± 3.4% (p < 0.001). Significant reductions were also observed in PEEP and cannula flow rates (p = 0.004 and p = 0.003, respectively). Overall, 39 infants (69.6%) met the predefined clinical response criteria. The prevalence of hyponatremia (Na < 133 mmol/L) increased from 7.1% at baseline to 25.0% on Day 3 (p = 0.039). Conclusions: Initiation of SP/HCTZ was temporally associated with short-term reductions in respiratory support parameters; however, these findings should be interpreted as associations rather than treatment effects. Given the increased frequency of hyponatremia by Day 3, close electrolyte monitoring appears warranted during the early phase of therapy. Full article

Background: The use of HFNC (High Flow Nasal Cannula) in the management of acute respiratory failure has been fully established in clinical practice. Conversely, less data is available supporting its use in chronic hypoxemic–hypercapnic respiratory failure. The aim of the present study is to evaluate the efficacy of HFNC in chronic hypercapnic respiratory failure associated with stable COPD. Methods: In this retrospective single-center longitudinal observational study, 40 patients treated with HFNC at home followed at the COPD Clinic of Respiratory Diseases (University of Campania L. Vanvitelli Monaldi Hospital, Naples) were included. All patients are re-assessed at our clinic at T0, T3, T6 and T12 months through functional respiratory tests and blood gas analysis. Results: After 12 months, significant reductions in pCO₂ (arterial partial pressure of carbon dioxide) (from 58.5 to 48.0 mmHg) and lactates (from 1.60 to 0.90 mmol/L) were observed, and MIP and MEP improved significantly. Patients receiving HFNC flows ≥50 L/min experienced greater reductions in pCO₂ and fewer exacerbations. Multivariate analysis identified HFNC flow rate (p = 0.0046), hours of use/day (p = 0.0157), lactate levels (p = 0.0301), and FEV₁ (forced expiratory volume in 1 s) (p = 0.0491) as independent predictors of reduction in PaCO₂. Higher BMI and greater airway obstruction were associated with a reduced response. Conclusions: Treatment with HFNC represents a reasonable therapeutic choice to reduce AEs-COPD and reduce PaCO₂ and lactates in stable COPD patients. Full article

This study investigated the nutritional value of enzymolytic soybean meal (ESBM) in growing pigs through two experiments. Experiment 1 evaluated the digestible energy (DE) and metabolizable energy (ME) values using twenty-two crossbred pigs (Duroc × Landrace × Yorkshire; initial BW 36.47 ± 0.63 kg) in a replicated 11 × 3 incomplete Latin square design. The dietary treatments comprised a corn-based diet and ten test diets formulated by substituting 30% corn with ESBM. Experiment 2 evaluated standardized ileal digestibility (SID) of amino acid (AA) through a 10 × 6 incomplete Latin square design involving ten pigs (Duroc × Landrace × Yorkshire; initial BW: 21.30 ± 1.38 kg) fitted with T-cannulas. All experimental diets contained 40% ESBM as the sole source of AA and 0.2% titanium dioxide as an indigestible marker. The results revealed variations in the chemical composition of ESBM samples, with coefficients of variation (CV) exceeding 9% for all analyzed components except for gross energy (GE), which had a CV of 4.65%. The mean DE and ME were 16.46 MJ/kg DM (13.82 to 19.13 MJ/kg DM) and 15.73 MJ/kg DM (12.79 to 18.77 MJ/kg DM), respectively. The best-fit prediction equations for DE and ME were as follows: DE (MJ/kg DM) = −26.31 + (2.74 × GE) − (0.17 × CP) (R² = 0.76, p < 0.01) and ME (MJ/kg DM) = −28.45 + (2.85 × GE) − (0.19 × CP) (R² = 0.70, p = 0.01). The mean SID of Lys, Met, Thr, Trp, Val, and total AA were 81.72% (71.19 to 95.64%), 81.36% (45.59 to 95.76%), 76.19% (59.67 to 90.40%), 50.61% (15.40 to 74.13%), 81.23% (69.39 to 92.99%), and 84.29% (67.36 to 96.56%), respectively. In this study, ESBM5 exhibited higher energy content and AA digestibility, whereas ESBM8 demonstrated the lowest nutritional value. The ash content exhibited the strongest negative correlation with DE (r = −0.75; p < 0.05) and ME (r = −0.76; p < 0.05), while Trp showed the strongest positive correlation with the SID of AA. The chemical composition of ESBM can be effectively used to predict DE, ME, and SID of AA in growing pigs. Full article

Background: Extubation failure increases morbidity and mortality. Non-invasive ventilation (NIV), including high-flow nasal cannula (HFNC), can reduce reintubation rates. Current practice often involves prophylactic use of NIV post-extubation. Electrical Impedance Tomography (EIT) provides real-time monitoring of pulmonary distribution and ventilation. Recent adult studies suggest that EIT has potential in extubation failure prediction, but evidence in children is limited. Our objectives were to evaluate peri-extubation regional lung volume/distribution and to explore EIT-derived physiological changes and on post-extubation respiratory support patterns in critically ill children. Methods: A prospective observational study included intubated patients aged 1 month to 18 years in the PICU who were intubated for over 24 h. Vital signs and chest EIT were recorded pre-extubation (H0), immediately post-extubation (H1), at 30 min (H2), and at 4 h (H3). Patients were categorized by chest X-ray findings into abnormal or normal groups. Results: Among 209 ventilated patients, 54 were included. End-expiratory lung impedance (∆EELI), tidal impedance (TID), and the global inhomogeneity index (GI) demonstrated significant changes across predefined peri-extubation time points. Thirty-eight (70.4%) patients received HFNC or NIV immediately after extubation. No extubation failures occurred, precluding evaluation of extubation failure predictors. In the subgroup analyzed based on chest X-ray findings, differences in TID and ODCL were observed between patients with normal and abnormal chest X-rays immediately after extubation. Conclusions: The ∆EELI, TID, and GI demonstrated significant changes across predefined peri-extubation time points. In the absence of extubation failure events, the ability of EIT monitoring to evaluate extubation failure could not be assessed. The frequent use of prophylactic NIV support after extubation may have influenced post-extubation physiology. Full article

Cardiogenic pulmonary edema (CPE) is a life-threatening manifestation of acute heart failure characterized by rapid accumulation of fluid in the interstitial and alveolar spaces, leading to severe dyspnea, hypoxemia, and respiratory failure. The condition arises from elevated left-sided filling pressures that increase pulmonary capillary hydrostatic pressure, disrupt alveolo-capillary barrier integrity, and impair gas exchange. Neurohormonal activation further perpetuates congestion and increases myocardial workload, creating a vicious cycle of hemodynamic overload and respiratory compromise. Respiratory support is a cornerstone of management in CPE, aimed at stabilizing oxygenation, reducing the work of breathing, and facilitating ventricular unloading while definitive therapies, such as diuretics, vasodilators, inotropes, or mechanical circulatory support (MCS), address the underlying cause. Among available modalities, non-invasive ventilation (NIV) with continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) has the strongest evidence base in moderate-to-severe CPE, consistently reducing the need for intubation and providing rapid relief of dyspnea. High-flow nasal cannula (HFNC) represents an emerging alternative in patients with moderate hypoxemia or intolerance to mask ventilation, and should be considered an adjunctive option in selected patients with less severe disease or NIV intolerance, although its efficacy in severe presentations remains uncertain. Invasive mechanical ventilation is reserved for refractory cases, while extracorporeal membrane oxygenation (ECMO) and other advanced circulatory support modalities may be necessary in cardiogenic shock. Integration of respiratory strategies with hemodynamic optimization is essential, as positive pressure ventilation favorably modulates preload and afterload, synergizing with pharmacological unloading. Future directions include personalization of ventilatory strategies using advanced monitoring, novel interfaces to improve tolerability, and earlier integration of MCS. In summary, respiratory support in CPE is both a bridge and a decisive therapeutic intervention, interrupting the cycle of hypoxemia and hemodynamic deterioration. A multidisciplinary, individualized approach remains central to improving outcomes in this high-risk population. Full article

Biofilm formation by non-C. albicans Candida (NAC) species is a major factor in device-associated infections, yet few studies have examined their development under physiologically relevant conditions. This study evaluated the biofilm-forming capacity of Candida tropicalis, Candida parapsilosis sensu stricto and Candida albicans on stainless steel surfaces in the presence of artificial saliva, simulating the respiratory tract environment of tracheostomized patients. Standardized inocula were incubated for 24 h, and biofilms were assessed through quantification of viable cells, biomass, biofilm matrix production and structural characterization by scanning electron microscopy (SEM). C. tropicalis produced the most robust biofilms compared to C. albicans and C. parapsilosis stricto sensu isolates, with significantly higher biomass and biofilm matrix (p < 0.001). C. parapsilosis sensu stricto developed less dense yet structurally defined biofilm networks. SEM confirmed mature and compact biofilm architecture, especially in C. tropicalis. These results demonstrate the strong intrinsic biofilm-forming ability of NAC species on stainless steel under host-like conditions, reinforcing their capacity to persist on medical surfaces and their relevance as independent contributors to biofilm-related contamination and infection. Full article

Background/Objectives: Flexible bronchoscopy (FB) enables airway exploration and diagnosis of various respiratory pathologies, but the sedation and instrumentation required during the procedure raise oxygen demand while reducing ventilation, which can lead to hypoxemia. Conventional oxygen therapy (COT) may not adequately prevent desaturations in high-risk groups, as patients with moderate respiratory deficiency. High-flow nasal cannula (HFNC) can deliver heated, humidified oxygen at high flow rates, generating low-level positive airway pressure, improving oxygenation, reducing dead-space, and enhancing procedure tolerance. Prior studies have shown that HFNC can improve gas exchange and reduce desaturations during bronchoscopy. However, evidence remains limited for patients with moderate respiratory deficiency, who are particularly vulnerable. Evaluating the feasibility and safety of HFNC in this population is essential to guide safe procedural practice. Methods: A retrospective observational study including patients undergoing FB with HFNC support between January and May 2025. Inclusion criteria were BMI between 18 and 30; age > 18 years old; moderate respiratory dysfunction, defined by pulse oximetry, Pulmonary Functional Tests (PFTs) and Arterial Blood Gas (ABG) analysis. Exclusion criteria were intolerance/contraindication to HFNC. Procedures were performed under basic monitoring. Primary outcome was occurrence of severe hypoxemia (SpO2 < 90%). Secondary outcomes were needed for rescue maneuvers, interruption for conversion to other ventilatory strategies, and hemodynamic instability. Results: No severe desaturations were recorded, all procedures were completed without rescue maneuvers or other ventilatory strategies, and no hypoxemia occurred. Mean duration of the procedure was 9 min. Vital parameters were maintained within the normal ranges, with a mean SpO₂ during bronchoscopy of 98%. Conclusions: HFNC enables oxygenation and ventilation without adverse events in sedations for FB in patients with moderate respiratory deficiency. Full article

Background/Objectives: Reasons for long-term stays in intensive care units (ICUs) include various critical conditions, prolonged weaning with post-extubation dysphagia (PED), as well as the mere presence of a tracheal cannula. In an interprofessional QM project, medicine, nursing, physiotherapy, speech and language therapy (SLT), and occupational therapy work together to reduce the length of stay (LOS) in ICUs. SLT focuses on tracheal cannula management (TCM) and PED. The primary aim of SLT is fast and safe decannulation and thereby the reduction in LOS. Methods: Two SOPs for dealing with PED patients and for structured TCM were developed for this purpose and were both implemented in a postoperative ICU, together with a SLT staff increase. To compare the effects on the intervention group (IG, n = 54), a historical control (HC, n = 58) group was created through a retrospective data analysis. We screened all patients from ICU (n = 5605), including those with tracheostomy, and analyzed them during their ICU stay. Results: Clinically relevant results were observed for the mean time in days of tracheostomy in those who could be decannulated (HC = 43.43, IG = 23.8; d = 0.99) and, even more importantly, for LOS in days (HC = 33.41, IG = 23.8; d = 0.48). Conclusions: The integration of SLT in ICU care is feasible and helps to reduce the time to decannulation and LOS. Full article

Background: Durvalumab, a PD-L1 inhibitor used as consolidation therapy after chemoradiation in unresectable stage III non–small cell lung cancer (NSCLC), can induce immune-related adverse events, among which immune-mediated pneumonitis represents one of the most severe. Differentiating checkpoint inhibitor pneumonitis (CIP) from infectious pneumonia is challenging due to overlapping clinical and radiologic findings. Case presentation: We describe a 67-year-old woman with stage III lung adenocarcinoma treated with chemotherapy, radiotherapy, and durvalumab, who presented with progressive dyspnea and extensive bilateral ground-glass opacities on CT imaging. Laboratory tests revealed leukopenia and elevated inflammatory markers. Despite broad-spectrum antibiotic and antiviral therapy, her condition worsened, requiring high-flow nasal cannula oxygen therapy. Multiplex molecular testing on sputum identified human metapneumovirus (HMPV), while blood cultures and urinary antigens for Streptococcus pneumoniae and Legionella pneumophila were negative. A pulmonology consultation raised suspicion for severe durvalumab-induced pneumonitis exacerbated by viral infection. High-dose methylprednisolone (2 mg/kg/day) followed by a four-week taper led to gradual clinical and radiologic resolution. Durvalumab was permanently discontinued. Discussion: To our knowledge, this is the first reported case of HMPV-associated pneumonitis in a patient receiving durvalumab. This case highlights the potential synergistic interplay between viral infection and immune checkpoint blockade, resulting in severe lung injury. Comprehensive microbiologic evaluation, including molecular diagnostics, is essential to guide therapy and distinguish infectious from immune-mediated causes. Conclusions: Early recognition of mixed infectious and immune-mediated pneumonitis, and timely corticosteroid therapy are critical to achieving favorable outcomes and preventing irreversible pulmonary damage. Full article

High-flow nasal cannula (HFNC) therapy is frequently described as a positive pressure modality, yet this classification lacks mechanistic support. This critical narrative review integrates experimental, computational, and clinical evidence to examine the established physiological mechanisms underlying HFNC, with emphasis on precise terminology. The study clarifies that labeling HFNC as “positive pressure” is conceptually inaccurate, as the system delivers transient, flow-dependent pressures characteristic of open-circuit administration. Evidence is synthesized to quantify the relative contributions of nasopharyngeal dead-space clearance versus emergent pressure generation. Unlike CPAP, HFNC produces pressures ranging from 0.2 to 13.5 cmH₂O, determined by airway geometry, leak magnitude, and mouth position. Fluid dynamic modeling using Bernoulli and Darcy–Weisbach equations demonstrates oscillatory rather than sustained pressures, with magnitudes linked to nasopharyngeal Reynolds numbers (2400–6000) and turbulent energy dissipation (30–60%). Clinical efficacy persists despite variable pressures, reflecting synergistic mechanisms: inspiratory flow matching (40–50% reduction in work of breathing), dead-space clearance (CO₂ reduction, r = −0.77, p < 0.05), emergent pressure effects (10–20%), and thermal humidification (10–20%). Electrical impedance tomography reveals heterogeneous alveolar recruitment, with high-potential (54%) and low-potential (46%) phenotypes. Based on these mechanistic insights, this review proposes the term “emergent hydrodynamic pressure” to accurately describe HFNC’s transient, flow-dependent pressures. This terminology differentiates HFNC from conventional positive pressure systems and aligns language with the principles of fluid dynamics and respiratory physiology. Full article

Background: The association between oxidative stress and inflammation in obesity motivates investigation of the effects of d-limonene, gallic acid, ellagic acid, p-coumaric acid, and their mixture, which are major compounds of Callistemon citrinus, on oxidative stress and inflammation in the brains of rats fed a high-fat-sucrose diet. This study aimed to identify the specific bioactive compounds in C. citrinus leaf extract responsible for its neuroprotective effects against diet-induced oxidative stress and neuroinflammation. Methods: Forty-eight male Wistar rats were randomly divided into eight groups (n = 6). Group 1 (control) received a standard diet, while group 2 received a high-fat, high-sucrose diet (HFSD). Groups 3, 4, 5, 6, 7, and 8 were also fed HFSD supplemented with C. citrinus extract, its main compounds, and a mixture of these compounds administered once daily via oral cannula for 23 weeks. The antioxidant and pro-inflammatory enzymes, along with oxidative biomarkers, were evaluated in the brains of the rats. Results:C. citrinus leaf extract and its four main components, both separately and together, modulated the activities of catalase, superoxide dismutase, glutathione peroxidase, and paraoxonase-1. They also affected levels of reduced glutathione while decreasing the amounts of advanced oxidative protein products, malondialdehyde, and 4-hydroxynonenal. Additionally, they decreased the activities of cyclooxygenase (COX-1 and COX-2), 5-lipoxygenase, xanthine oxidase, and myeloperoxidase in the brains of rats, despite a high-fat-sucrose diet. Conclusions: These results show that the main compounds in C. citrinus leaf extract are essential for its antioxidant and anti-inflammatory effects, which help protect against oxidative stress in the brains of rats on a high-calorie diet. Full article

Intraoperative optical coherence tomography (iOCT) has emerged as a pivotal technology in anterior segment surgery, particularly in cases limited by corneal opacity, edema, or altered anatomy. By providing real-time, cross-sectional imaging, iOCT enables surgeons to visualize otherwise hidden structures and to perform critical intraocular maneuvers with greater precision and safety. Its integration into the surgical microscope allows continuous monitoring of tissue–instrument interaction, transforming traditionally “blind” procedures into image-guided interventions. This review highlights the role of iOCT in endothelial keratoplasty, deep anterior lamellar keratoplasty (DALK), management of acute corneal hydrops, synechiolysis, glaucoma drainage device implantation, and ocular trauma. In endothelial procedures, iOCT helps confirm Descemet membrane removal, graft orientation, and resolution of interface fluid. In DALK, it facilitates accurate cannula placement, stromal depth assessment, and evaluation of leucoma extension to guide surgical strategy. During hydrops management, iOCT supports precise air/gas injection and compression suture placement. Additionally, it enhances safety in synechiolysis, shunt implantation, and repair of traumatic corneal injuries. Full article

Background: Use of high-flow nasal cannula (HFNC) expanded from ICUs to internal medicine/respiratory wards during and after the COVID-19 pandemic, but safety and effectiveness in non-ICU settings remain uncertain. Methods: We performed a systematic review and meta-analysis of adults (≥18 years) initiated on HFNC in non-ICU wards. Primary outcomes were in-hospital (or 28-day) mortality and ICU transfer; where available, we compared mortality for HFNC vs. conventional oxygen therapy (COT) in do-not-intubate (DNI) cohorts. Observational studies and trials were eligible. Random-effects models synthesized proportions and risk ratios; risk of bias (ROBINS-I/RoB 2) and certainty (GRADE) were assessed. Results: Ten studies met the inclusion criteria for any-ward HFNC; subsets contributed data to pooled analyses. Across all non-ICU wards (general wards plus step-up IMCU/HDU), pooled mortality was 14.0% (95% CI 4.6–35.5; I² ≈ 92%). Pooled ICU transfer after ward/step-up HFNC start was 20.0% (95% CI 6.3–48.1; I² ≈ 97%). Restricted to internal medicine/respiratory wards, pooled mortality was 19.8% (95% CI 7.1–44.2; I² ≈ 95%) and ICU transfer 31.2% (95% CI 9.9–65.0; I² ≈ 97%). In step-up units (IMCU/HDU), ICU transfer appeared lower and less variable (22.0% [95% CI 16.5–28.8]; I² ≈ 10%), suggesting environment-dependent outcomes. In a multicenter DNI COVID-19 cohort, HFNC vs. COT showed no clear mortality difference (RR ≈ 0.90, 95% CI 0.75–1.08; adjusted OR ≈ 0.72, 95% CI 0.34–1.54). Certainty of evidence for all critical outcomes was very low due to observational design, high inconsistency, and imprecision. Conclusions: HFNC outside the ICU is feasible, but it is related to nontrivial mortality and frequent escalation—particularly on general wards—while step-up units demonstrate more reproducible trajectories. Outcomes appear strongly conditioned by care environment, staffing, monitoring, and escalation pathways. Given very low certainty and substantial heterogeneity, institutions should pair ward HFNC with protocolized reassessment and rapid response/ICU outreach, and future research should prospectively compare ward HFNC pathways against optimized COT/NIV using standardized outcomes. Full article

Hydrogen has antioxidant and anti-inflammatory properties that may attenuate perioperative stress responses. However, its clinical impact on postoperative recovery remains unclear. This randomized, double-blind, placebo-controlled trial evaluated whether perioperative hydrogen inhalation improves early recovery after hepatectomy. Sixty-eight patients undergoing elective hepatectomy were randomized (1:1) to receive 5% hydrogen gas or placebo air via nasal cannula from postoperative day (POD) 1 to POD7. The primary endpoint was the total Quality of Recovery-40 (QoR-40) score on POD3, analyzed at α = 0.2 with 80% confidence intervals in accordance with the pre-specified statistical analysis plan. Secondary and exploratory outcomes, analyzed at α = 0.05, included postoperative liver function, oxidative stress markers, and QoR-40 subdomain scores. Analyses were performed in the modified intention-to-treat population using the Mann–Whitney U test. Sixty-four patients (hydrogen, n = 31; placebo, n = 33) were analyzed. At POD3, the median QoR-40 score was 192.0 (184.0–198.0) vs. 163.0 (140.0–190.0) (p < 0.001), indicating significantly better early recovery in the hydrogen group. As supportive findings, prothrombin activity was higher with hydrogen (85.0% vs. 76.2%, p = 0.005), and QoR-40 subdomain analysis showed significantly higher emotions and physical independence scores, whereas comfort, pain, and patient support domains showed no difference. No other between-group differences were observed in biochemical parameters or urinary 8-OHdG levels. Perioperative hydrogen inhalation significantly improved early postoperative recovery after hepatectomy, primarily through psychophysical domains of well-being. These findings suggest that hydrogen may selectively enhance emotional stability and functional independence during the early recovery phase. Full article