Search Results (245)

Background and Objectives: Facial paralysis involves the complete or partial loss of facial movement due to damage to the facial nerve, leading to impaired voluntary muscle function and facial asymmetry. Given its significant physical and psychosocial impact, there is an urgent need to strengthen the evidence supporting non-pharmacological treatments. This umbrella review aims to compile the most reliable and current data to establish a consensus on the effectiveness of such interventions for patients with facial paralysis. Materials and Methods: This study is an umbrella review. A systematic search was conducted in PubMed, Embase, Scopus, and CINAHL (28 July 2024). The variables assessed included overall healing/recovery rate, facial disability, and facial function. Methodological quality was evaluated using the AMSTAR and ROBIS tools. Screening was performed independently by two reviewers, with a third reviewer resolving any discrepancies. Results: Five systematic reviews were included, all evaluating the impact of non-pharmacological interventions in facial paralysis. The findings suggest that acupuncture and electrical stimulation may improve recovery rates and facial function, although high heterogeneity and methodological limitations were noted in some studies. No definitive conclusions could be drawn regarding facial disability. Conclusions: The combination of electrotherapy with other complementary techniques, such as facial exercises or laser therapy, appears to be a safe and potentially effective approach for facial paralysis rehabilitation. Nonetheless, further research employing standardized protocols and higher methodological quality is necessary to establish more robust conclusions for physiotherapeutic practice. Full article

Background/Objectives: Chronic obstructive pulmonary disease (COPD) is a progressive condition whose heterogeneous endotypes, clinical manifestations, and recovery pathways complicate the identification of reliable predictors of rehabilitation outcomes. Several respiratory and functional assessments are available with no consensus on the most predictive ones. While univariate markers may miss multifactorial interactions essential for prognosis, data-driven unsupervised clustering methods can integrate complex information from different sources. This study aimed to apply unsupervised clustering to identify pre-rehabilitation characteristics predictive of discharge outcomes for COPD patients undergoing pulmonary rehabilitation. Methods: A total of 126 COPD patients undergoing pulmonary rehabilitation were included in the analysis. Three assessments were performed at admission, namely the forced oscillation technique, spirometry, and the six-minute walk test (6MWT). The outcome was the change in 6MWT distance between admission and discharge. Unsupervised clustering methods were applied to admission variables to identify subgroups associated with outcomes. Results: Among the clustering algorithms tested, k-means (with N_cl = 2) provided the optimal solution. The resulting respiratory rehabilitation index (R2I) was significantly associated with the outcome dichotomized via the minimal clinically important difference of 30 m. Patients with R2I = 1, indicating severe functional and respiratory impairments, were associated with higher post-rehabilitation functional improvement (p = 0.032). While few functional parameters of 6MWT were statistically different between the groups identified by outcome, nearly all variables in the analysis exhibited significant distribution differences among the R2I clusters. Conclusions: These findings highlight the heterogeneity of COPD and the potential of unsupervised clustering to identify distinct patient subgroups, enabling more personalized rehabilitation strategies. Full article

Intubated critically ill patients are susceptible to secretion accumulation because of compromised airway clearance. Various airway clearance interventions are employed to prevent complications arising from mucus retention. This Delphi study aims to collect global opinions in an international expert panel of ICU professionals on the usefulness of these various airway clearance interventions. A steering committee performed a literature search informing the formulation of statements. Statements are grouped into two distinct parts: (1) Humidification and Nebulization, and (2) Suctioning and Mucus mobilization techniques. For each part, a diverse panel of 30–40 experts will be selected, with concerted effort to involve experts from various medical specialties involved in airway clearance methods. Multiple choice questions (MCQs) or 7-point Likert-scale statements will be used in the iterative Delphi rounds to reach consensus on various airway clearance interventions. Rounds will continue until stability is achieved for all statements. Consensus will be deemed achieved when a choice in MCQs or a Likert-scale statement achieves ≥75% agreement or disagreement. Starting from the second round of the Delphi process, stability will be assessed using non-parametric χ² tests or Kruskal–Wallis tests. Stability will be defined by a p-value of ≥0.05. Full article

Background: The rapid shift from open to endovascular techniques in vascular surgery has significantly decreased trainee exposure to high-stakes open procedures. Simulation-based training, especially that incorporating virtual reality (VR) and artificial intelligence (AI), provides a promising way to bridge this skill gap. Objective: This narrative review aims to assess the current evidence on the integration of extended reality (XR) and AI into vascular surgeon training, focusing on technical skill development, performance evaluation, and educational results. Methods: We reviewed the literature on AI- and XR-enhanced surgical education across various specialties, focusing on validated cognitive learning theories, simulation methods, and procedure-specific training. This review covered studies on general, neurosurgical, orthopedic, and vascular procedures, along with recent systematic reviews and consensus statements. Results: VR-based training speeds up skill learning, reduces procedural mistakes, and enhances both technical and non-technical skills. AI-powered platforms provide real-time feedback, performance benchmarking, and objective skill evaluations. In vascular surgery, high-fidelity simulations have proven effective for training in carotid artery stenting, EVAR, rAAA management, and peripheral interventions. Patient-specific rehearsal, haptic feedback, and mixed-reality tools further improve realism and readiness. However, challenges like cost, data security, algorithmic bias, and the absence of long-term outcome data remain. Conclusions: XR and AI technologies are transforming vascular surgical education by providing scalable, evidence-based alternatives to traditional training methods. Future integration into curricula should focus on ethical use, thorough validation, and alignment with cognitive learning frameworks. A structured approach that combines VR, simulation, cadaver labs, and supervised practice may be the safest and most effective way to train the next generation of vascular surgeons. Full article

Background/Objective: The most effective strategy for addressing users’ prosthetic needs is a comprehensive clinical assessment that provides a holistic understanding of the individual’s symptoms, health, function, and environmental barriers and facilitators. A standardized evaluation form would provide guidance for a structured approach to comprehensive clinical assessments of people with LLA. The objective of this study was to determine a list of relevant elements to be included in prosthetic evaluation for adults with lower limb amputation. Methods: Three independent focus group discussions were conducted with prosthetists (n = 15), prosthesis users (n = 11), and decision makers (n = 4) to identify all relevant elements that should be included in the clinical assessment of prosthetic services. The final content was then determined using the Delphi technique, with 35 panelists (18 prosthetists and decision makers, and 17 prosthesis users) voting in each round. Results: A total of 91 elements were identified through the focus group, of which 78 were included through the Delphi process. The identified elements are mostly related to the physical health of the prosthesis user (e.g., mobility, pain, and medical information), while others address personal or psychosocial aspects (e.g., activities of daily living, goals, and motivation) or technical aspects (prosthesis-related). Conclusions: Through a Delphi consensus, a list of relevant elements to be included in a prosthetic evaluation was generated. These results will inform the development of a standardized clinical prosthetic assessment form. This form has the potential to improve the quality of clinical evaluations, guide interventions, and enhance the well-being of prosthetic users. Full article

Background/Objectives: Rotator cuff calcific tendinopathy (RCCT) is one of the most common causes of non-traumatic shoulder pain. To date, there is still no consensus regarding the most effective method for its treatment. Ultrasound-guided percutaneous aspiration is suggested during the reabsorption phase of calcific metaplasia. We aimed to evaluate the effectiveness of ultrasound-guided lavage for RCCT from a clinical and radiological perspective. Methods: We involved patients affected by RCCT of the supraspinatus tendon. The approach used for the calcification lavage was the one-needle technique, consisting in inserting a 16–18 G needle on a 20 mL syringe with 0.9% saline solution, in the calcific metaplasia, under ultrasound guidance, using an in-plane approach; the repetitive action of pressing and releasing the plunger was repeated until the contents of the syringe became milky, at which point the syringe was replaced with a new one, always containing saline solution. The physiotherapy treatment began 7 days after the procedure. We assessed the Numeric Rating Scale, the Gartner classification, the Disability of the Arm, Shoulder and Hand scale, the Constant–Murley shoulder score, and the passive range of motion of flexion and abduction. Results: We included 23 subjects. The analysis of the data at baseline and t1 showed a statistically significant improvement in all the functional variables (p < 0.05). This result was mainly evident for pain, with a p-value of 0.001. Conclusions: The findings of the present prospective case series study showed an improvement in the clinical and radiological outcomes after ultrasound-guided percutaneous aspiration for rotator cuff calcific tendinopathy. Full article

Background: The management of difficult airways is one of the most critical and challenging aspects of emergency and ICU care. Despite technological advances, unanticipated airway difficulty can result in serious complications, including hypoxia, brain injury, and death. This comprehensive narrative review aims to consolidate current algorithms and evidence-based strategies to guide clinicians in the assessment and management of difficult airways. Methods: A comprehensive literature review was conducted using PubMed, Embase, and Google Scholar to identify relevant studies, clinical guidelines, and expert consensus documents related to difficult airway management. The focus was placed on both pre-intubation assessment tools and intervention strategies used in various clinical contexts. Results: Airway difficulty is best anticipated through a combination of history, physical examination, and validated tools such as the Mallampati score. Several algorithms, including those from the American Society of Anesthesiologists (ASA) and the Difficult Airway Society (DAS), provide structured approaches that emphasize preoxygenation, preparedness for failed intubation, and the use of adjuncts such as video laryngoscopy, supraglottic airway devices, and awake intubation techniques. Crisis algorithms such as the Vortex approach help simplify decision-making during emergencies. It is important to have adjuncts available in cases of anticipated difficult airways, such as fiberoptic intubation, while surgical airway access is an important component of a stepwise airway management algorithm when critical scenarios are encountered. Conclusions: Effective difficult airway management requires anticipation, a structured plan, familiarity with advanced airway tools, and adherence to validated algorithms. Training in crisis resource management and multidisciplinary rehearsal of airway scenarios are essential to improving outcomes. Full article

Platinum-induced ototoxicity constitutes a significant adverse effect in pediatric oncology, frequently resulting in permanent hearing impairment with profound implications for quality of life, language acquisition, and scholastic performance. This comprehensive review critically evaluates contemporary ototoxicity monitoring practices across various pediatric oncology settings, analyzes current guideline recommendations, and formulates strategies for implementing standardized surveillance protocols. Through examination of recent literature—encompassing retrospective cohort investigations, international consensus recommendations, and functional outcome assessments—we present an integrated analysis of challenges and opportunities in managing chemotherapy-associated hearing loss among childhood cancer survivors. Our findings demonstrate marked heterogeneity in monitoring methodologies, substantial implementation obstacles, and considerable impact on survivors’ functional status across multiple domains. Particularly concerning is the persistent absence of an evidence-based consensus regarding the appropriate duration of audiological surveillance for this vulnerable population. We propose a structured framework for comprehensive ototoxicity management emphasizing prompt detection, standardized assessment techniques, and integrated long-term follow-up care to minimize the developmental consequences of platinum-induced hearing impairment. This approach addresses critical gaps in current practice while acknowledging resource limitations across diverse healthcare environments. Full article

Neurophysiological techniques, particularly somatosensory evoked potentials (SEPs) and electroencephalography (EEG), are essential tools for the functional and prognostic evaluation of patients with prolonged disorders of consciousness (DoC) in intensive neurorehabilitation settings. This narrative review critically analyzes the most relevant evidence regarding the use of SEPs and EEG in the management of post-comatose patients, highlighting the strategic role of physiatrists in integrating these assessments into individualized rehabilitation plans. A systematic search was conducted across major international databases (PubMed, Embase, Scopus, Cinahl, and DiTA) until December 2024, selecting consensus documents, official guidelines (including the 2021 ERC/ESICM guidelines), systematic reviews, observational studies, and significant Italian neurophysiological contributions. The literature supports the strong prognostic value of the bilateral presence of the N20 component in SEPs, while its early bilateral absence, particularly in post-anoxic cases, is a robust predictor of poor neurological outcomes. EEG provides complementary information, with continuous, reactive, and symmetrical patterns associated with favorable outcomes, while pathological patterns, such as burst suppression or isoelectric activity, predict a worse prognosis. Combining SEP and EEG assessments significantly improves prognostic sensitivity and specificity, especially in sedated or metabolically compromised patients. Additionally, the use of direct muscle stimulation (DMS) and nerve conduction studies enables accurate differentiation between central and peripheral impairments, which is crucial for effective rehabilitation planning. Overall, SEPs and EEG should be systematically incorporated into the evaluation and follow-up of DoC patients, and the acquisition of neurophysiological competencies by physiatrists represents a strategic priority for modern, effective, and personalized neurorehabilitation. Full article

Background: Split-thickness skin grafts (STSGs) are utilised to close wounds which cannot be closed by primary closure. Dermatome-assisted STSG harvest utilises a lubricant to control friction, which facilitates graft harvest. Many different lubricants are used during graft harvest, although little research has been conducted to identify the optimal lubricant. Furthermore, new techniques such as Meek grafting are incompatible with commonly used oil-based lubricants. Method: A literature search was conducted, following the PRISMA protocol. 173 records were screened with 6 included in this study. We also reviewed the literature on lubricants in other biotribological systems including shaving. Results: We found support for numerous lubricants, including: mineral oil, catheter gel, chlorhexidine, saline and ultrasound gel. Evidence consisted of expert opinions, and one blinded comparative review. There was no consensus on the optimal lubricant, and we did not find evidence that lubricant compatibility with Meek grafting had been assessed. Conclusions: Presently, lubrication choice in STSG harvest lacks a scientific basis, and further research is needed to design a bespoke, Meek-compatible lubricant which considers only four of Engelhardt’s characteristics (1. cost-effectiveness; 4. lubrication; 6. no side effects; 8. practicability) to be essential. This should be followed by a blinded trial of lubricants. Full article

Scoring divergent thinking (DT) tasks poses significant challenges as differences between raters affect the resulting scores. Item Response Theory (IRT) offers a statistical framework to handle differences in rater severity and discrimination. We applied the IRT framework by re-analysing an open access dataset including three scored DT tasks from 202 participants. After comparing different IRT models, we examined rater severity and discrimination parameters for individual response scoring and snapshot scoring using the best-fitting model—Graded Response Model. Secondly, we compared IRT-adjusted scores with non-adjusted average and max-scoring scores in terms of reliability and fluency confound effect. Additionally, we simulated missing data to assess the robustness of these approaches. Our results showed that IRT models can be applied to both individual response scoring and snapshot scoring. IRT-adjusted and unadjusted scores were highly correlated, indicating that, under conditions of high inter-rater agreement, rater variability in severity and discrimination does not substantially impact scores. Overall, our study confirms that IRT is a valuable statistical framework for modeling rater severity and discrimination for different DT scores, although further research is needed to clarify the conditions under which it offers the greatest practical benefit. Full article

Plant modeling uses mathematical and computational methods to simulate plant structures, physiological processes, and interactions with various environments. In precision agriculture, it enables the digital monitoring and prediction of crop growth, supporting better management and efficient resource use. Wheat, as a major global staple, is vital for food security. However, wheat stripe rust, a widespread and destructive disease, threatens yield stability. The paper proposes wheat cultivation suitability evaluation with stripe rust disease using an agriculture group consensus framework (WCSE-AGC) to tackle this issue. Assessing stripe rust severity in regions relies on wheat pathologists’ judgments based on multiple criteria, creating a multi-attribute, multi-decision-maker consensus problem. Limited regional coverage and inconsistent evaluations among wheat pathologists complicate consensus-reaching. To support wheat pathologist participation, this study employs artificial-intelligence-generated content (AIGC) techniques by using Claude 3.7 to simulate wheat pathologists’ scoring through role-playing and chain-of-thought prompting. WCSE-AGC comprises three main stages. First, a graph neural network (GNN) models trust propagation within wheat pathologists’ social networks, completing missing trust links and providing a solid foundation for weighting and clustering. This ensures reliable expert influence estimations. Second, integrating secretary bird optimization (SBO), K-means, and three-way clustering detects overlapping wheat pathologist subgroups, reducing opinion divergence and improving consensus inclusiveness and convergence. Third, a two-stage optimization balances group fairness and adjustment cost, enhancing consensus practicality and acceptance. The paper conducts experiments using publicly available real wheat stripe rust datasets from four different locations, Ethiopia, India, Turkey, and China, and validates the effectiveness and robustness of the framework through comparative and sensitivity analyses. Full article

Background: Acromioclavicular (AC) joint dislocations are frequent, especially kocsisamong young male athletes. While over 150 surgical techniques exist, consensus on optimal treatment—particularly for Rockwood type III injuries—remains elusive. This study evaluates the Lockdown procedure’s efficacy, safety, and patient satisfaction, a synthetic ligament technique for AC joint stabilization. Methods: A multicenter prospective study was conducted on 39 patients across three Hungarian hospitals (2018–2023). Outcomes included shoulder function, pain levels, and complication rates, with subgroup analysis of acute (≤3 weeks) versus chronic (>3 weeks) cases. A systematic review of nine studies (205 cases) was also performed to assess broader outcomes and complications. Results: Significant improvements were observed in functional scores (OSS, Constant, DASH, SST, ASES, Nottingham, Imitani) and pain reduction, especially in acute cases with no prior shoulder surgery. The mean patient age was 38.9 ± 12.68 years, with a 24.5-month average follow-up. OSS improvement between acute and chronic cases was 14.96 (95% CI: 6.45–23.47; p = 0.0017). Complications (30.8%) occurred in eleven patients, mainly minor infections; implant failure necessitated revision in 5.1%. The systematic review reported a 34.6% complication rate (predominantly minor complications, like asymptomatic subluxation −16%) and 5.4% implant removal due to failure. A meta-analysis was not feasible due to data heterogeneity. Conclusions: The Lockdown procedure significantly enhances shoulder function and reduces pain, particularly in acute dislocations. However, the procedure showed a moderate complication rate, underscoring the need for careful patient selection and postoperative management. Full article

Background: Recreational nasal cocaine use (RNCU) presents a significant challenge for rhinologists due to cocaine-induced midline destructive lesions (CIMDLs). This clinical consensus statement (CCS) offers guidelines for diagnosing, assessing, and managing both proven and suspected cases of CIMDL (including those without a prior RNCU history). It aims to support clinicians in addressing these complex cases effectively. Methods: An international, multidisciplinary panel of 18 specialists employed a three-round modified Delphi-method survey to evaluate statements covering CIMDL management issues such as definition, clinical evaluation and diagnosis, initial management approaches, and surgical management of complications and reconstructions. This study primarily targets otorhinolaryngologists. Results: Out of 44 evaluated statements, 20 achieved strong consensus, 20 reached consensus, 3 approached near-consensus, and 1 failed to achieve consensus. Consensus-covered areas included the definition of CIMDL, clinical evaluations, first-line management, and management of complications. However, reconstructive techniques remained a contentious topic. Conclusions: In the absence of extensive data, this CCS establishes a management framework for CIMDL, significantly bridging a knowledge gap. It highlights the need for standardized assessments, multidisciplinary cooperation, and customized follow-up care for patients with CIMDL. Considering the widespread use of cocaine, physicians should consistently consider the possibility of RNCU when encountering chronic inflammatory lesions in the sinonasal tract. Full article

Background: Gallbladder cancer (GBC) is a highly aggressive malignancy often diagnosed at an advanced stage due to its asymptomatic onset. Despite surgery being the only potentially curative option, recurrence and poor prognosis remain common, especially in advanced-stage diseases. There is limited consensus regarding the extent of lymphadenectomy, hepatic resection, and the role of adjuvant therapies. Identifying prognostic factors and optimizing treatment strategies are critical for improving outcomes. This multicenter retrospective study was conducted to evaluate the clinical and pathological predictors of survival and recurrence in GBC patients that underwent radical surgery and to assess the potential benefit of adjuvant therapies in advanced stages. Methods: This was a retrospective cohort study of GBC patients who underwent curative-intent resection for GBC between 2010 and 2022 at two tertiary medical centers in China. The baseline characteristics, surgical data, pathology, adjuvant therapy, and follow-up outcomes were analyzed. The survival outcomes were assessed using Kaplan–Meier methods and Cox regression models. Subgroup analyses were conducted to explore the impact of postoperative adjuvant chemotherapy, period of surgical treatment, and extent of resection. Multiple imputation was used to address missing data. Results: The 5-year overall survival (OS) rate was 57.4%. Independent predictors of a poorer OS included CA19-9 > 30 U/mL (HR = 1.861, p = 0.003), poor/moderate-to-poor differentiation (HR = 2.134, p = 0.004), T3–T4 stage (HR = 2.685, p = 0.001), N1–N2 stage (HR = 2.217, p = 0.002), M1 stage (HR = 2.308, p = 0.001), and a high CAN score (HR = 1.875, p = 0.009). Adjuvant chemotherapy improved the OS in the stage III–IV patients (24.8 vs. 17.3 months, p = 0.036), though the DFS improvement was not significant (p = 0.133). No survival difference was observed between the segment IVb + V resection and wedge resection in the T2b patients. The patients treated after 2017 had a better OS (p = 0.024), possibly due to improved surgical techniques and perioperative care. Conclusions: Radical surgery remains critical for GBC. Accurate staging and tailored perioperative strategies, including chemotherapy, may improve outcomes, though further prospective studies are needed to validate these findings. Full article