Search Results (5,160)

Background: Surgery and the perioperative management for periampullary carcinomas are translated from the more frequent ductal adenocarcinoma of the pancreatic head (hPDAC). After implementation of the pathological circumferential resection margin (CRM), true margin negativity dropped dramatically for hPDAC patients. The frequent infiltration of the mesopancreas (MP) is a causative factor for incomplete resection. It remains unknown if the oncological relevance of the MP remains exclusive for the hPDAC or if it can be translated into the operative management for periampullary carcinomas as well. Material and methods: Patients who received oncological pancreatoduodenectomies (PD) for dCCAs and ACs from 2015 to 2025 at our department were included in this study (n =100). The MP status was retrieved from the histopathological reporting. Results: MP infiltration was evident in 36.4% and 62.2% of the AC and dCCA patients respectively (p = 0.015). Across both tumour entities, mesopancreatic involvement emerged as a marker of significantly worse overall survival (AC: p = 0.002; dCCA: p = 0.013). Conclusion: Distal cholangiocarcinomas presented with a frequent infiltration into the mesopancreas. A positive infiltration status of the MP significantly correlated with incomplete resection status in ampullary carcinoma. In addition, MP infiltration proved to be an adverse prognostic factor for overall survival in periampullary carcinoma patients, underscoring its potential role in perioperative staging and its possible relevance for surgical decision-making. This is the first study revealing insights into the infiltrative prevalence of the MP in periampullary carcinomas. Mesopancreatic involvement may not be exclusive to pancreatic cancer and warrants further investigation in other periampullary malignancies. Full article

Spontaneous coronary artery dissection (SCAD) is an important non-atherosclerotic cause of acute coronary syndrome, predominantly affecting younger women without traditional cardiovascular risk factors. In hemodynamically stable patients, accumulating evidence supports a conservative management strategy owing to the high rate of spontaneous vessel healing, while technically challenging invasive interventions should be reserved for selected high-risk cases. Despite growing evidence regarding acute management, recurrent SCAD and other adverse cardiovascular events have been reported during follow-up, underscoring the need for surveillance. However, optimal strategies for post-acute follow-up and for assessing the appropriateness of treatment decisions remain insufficiently established. This review focuses on clinical decision-making in the management of SCAD, with particular emphasis on follow-up assessment. We summarize the existing evidence regarding indications for conservative versus invasive treatment and discuss the clinical rationale for longitudinal imaging surveillance. Special attention is given to the role of non-invasive follow-up using coronary computed tomography angiography, including confirmation of vessel healing, evaluation of residual intramural hematoma, and assessment of distal coronary flow. Given the heterogeneity of SCAD and the risk of recurrence, individualized treatment decisions and structured follow-up strategies are essential to optimize management, avoid unnecessary invasive procedures, and support care and risk stratification in patients with SCAD. Full article

Peripheral artery disease (PAD) involves atherosclerotic obstruction of the leg arteries and impairs function and structure of lower-limb tissues. Although traditionally regarded as a large-artery (macrovascular) disorder, PAD includes significant microvascular disease in the affected musculature, together leading to impaired leg perfusion. Monitoring muscle oxygenation during exercise provides an indirect index of limb perfusion and exercise capacity, and tracking its kinetics with near-infrared spectroscopy (NIRS; a portable, non-invasive technique measuring real-time tissue oxygen saturation) helps elucidate mechanisms underlying walking limitations in PAD. We systematically searched PubMed, Web of Science, and the Cochrane Library (1985–2025) for studies employing NIRS to monitor muscle oxygenation in PAD patients before, during, and after exercise. Of 628 articles screened, 11 met the inclusion criteria. NIRS demonstrated reliability and validity for monitoring muscle oxygenation in PAD. During walking, PAD patients showed a much steeper decline in muscle oxygenation and delayed recovery to baseline. Resting muscle oxygenation did not differ between patients with PAD and controls. These dynamics reveal the pathophysiological interplay in which proximal/macrovascular and distal/microvascular disease limit oxygen delivery and utilization in skeletal muscle. Accordingly, NIRS offers a sensitive, non-invasive tool to evaluate macro- and microvascular disease burden and monitor therapeutic response in PAD. Full article

Wilson’s disease (WD) is an autosomal recessive disorder of copper metabolism caused by ATP7B mutations, characterized by hepatic copper accumulation and multisystem involvement. Several rare inherited and acquired conditions can closely mimic WD, posing diagnostic challenges and the risk of inappropriate therapy. By examining neuroimaging patterns and distinguishing between diagnostic criteria, this narrative review provides a comprehensive synthesis of WD-mimicking disorders, emphasizing their molecular mechanisms, clinical phenotypes, and biochemical features. WD-mimicking disorders encompass ATP7A-related neurodegenerations (Menkes disease, occipital horn syndrome, X-linked distal hereditary motor neuropathy), MEDNIK syndrome, Huppke–Brendel syndrome, aceruloplasminemia, congenital disorders of glycosylation, primary familial intrahepatic cholestasis type 3, and acquired copper deficiency syndromes. Mechanisms include systemic copper deficiency, impaired intracellular trafficking, defective ceruloplasmin biosynthesis, secondary hepatic copper accumulation, and abnormal glycosylation. Clinical features range from neurodevelopmental delay, movement disorders, and hepatic dysfunction to dermatologic, hematologic, and connective-tissue abnormalities. Biochemical profiles may overlap with WD, particularly low serum ceruloplasmin and total copper, altered urinary copper excretion, and elevated hepatic copper in some disorders. Neuroimaging and genetic testing provide critical discriminative value. Management is largely supportive, with disease-specific therapies available in selected conditions, such as subcutaneous copper in Menkes disease or monosaccharide supplementation in certain congenital disorders of glycosylation subtypes. Accurate differentiation between WD and WD-mimicking disorders requires careful integration of clinical, biochemical, imaging, and molecular data. Recognition of distinctive features and understanding underlying pathophysiology are essential to avoid misdiagnosis and inappropriate anti-copper therapy, optimize management, and improve patient outcomes. Full article

Background/Objectives: Bronchogenic cysts are rare congenital cystic lesions caused by congenital bronchopulmonary dysplasia; incidental discovery during preoperative investigations or unrelated procedures raises operative management questions. We report successful concurrent resection during laparoscopic Nissen fundoplication. Methods/Case presentation: During elective laparoscopic Nissen fundoplication, a cystic lesion adjacent to the distal oesophagus, previously identified on preoperative imaging, was encountered. Laparoscopic enucleation was performed without compromising the integrity of the gastrointestinal tract or the cyst wall, and the 360° fundoplication was then completed. The specimen was sent for histopathology. Results: Resection was completed without conversion. Histology showed a glandular epithelial lining without features of malignancy, consistent with a bronchogenic cyst. The patient recovered uneventfully with resolution of reflux symptoms. Conclusions: Distal oesophageal bronchogenic cysts accessible via the hiatus can be safely enucleated during laparoscopic Nissen fundoplication in experienced hands, allowing definitive treatment in a single operation. Careful dissection, assessment of gastrointestinal patency and integrity, and histopathological confirmation are essential. Full article

Background and Clinical Significance: Dupuytren’s disease (DD) typically affects the palmar fascia and proximal digital structures, with distal interphalangeal joint (DIPJ) involvement considered rare. True extension of DD into the volar pulp has not been previously documented. Distal lesions may be misdiagnosed as neoplastic or inflammatory masses, and optimal management of isolated distal cords remains uncertain. We present the first histologically confirmed case of DD extending beyond the DIPJ into the volar pulp, accompanied by a systematic review of reported DIPJ-dominant DD. Case Presentation: A 30-year-old right-hand-dominant male presented with a two-year history of progressive flexion deformity of the little finger. Examination demonstrated a 90° proximal interphalangeal joint and 55° DIPJ contracture. Ultrasound and MRI showed a well-circumscribed soft-tissue lesion along the radial middle phalanx but did not suggest DD. Open exploration via an ulnar digital approach revealed a discrete DD cord extending distally beyond the DIPJ into the volar pulp, closely associated with the ulnar neurovascular bundle. Limited fasciectomy achieved full correction without neurovascular compromise. Histopathology confirmed classic DD. At the twelve-month follow-up, the patient maintained full extension and function with no recurrence. Conclusions: This study reports the first confirmed case of DD extending into the volar pulp and highlights that atypical distal DD can occur even in young patients. Imaging may fail to identify DD in uncommon sites, reinforcing the importance of clinical suspicion. Limited fasciectomy remains safe and effective in the distal phalanx. Recognition of this phenotype or histopathological examination may improve diagnostic accuracy and guide tailored operative planning. Full article

Equine swimming is increasingly used for injury prevention and rehabilitation, but objective analysis of movement during swimming remains limited compared to land-based locomotion. Spatiotemporal parameters are essential for evaluating therapeutic outcomes, yet capturing these parameters is technically challenging due to difficulties in observing limb motion in water. Inertial sensors, already widely applied in equine science, offer a promising solution for measuring swimming kinematics objectively. The objective of this study was to evaluate the reliability of inertial sensors placed on equine distal limbs in detecting key spatiotemporal events during swimming by comparing it with video-based detection made by veterinarians. For the duration of the hindlimb swimming cycle, 24 data values were analysed and showed an “excellent” agreement, with an intraclass correlation coefficient = 0.96, 95% CI: 0.904–0.983, and Bland–Altmann analysis showed an upper limit of agreement of 50 ms (95% CI: 70 ms, 30 ms) and lower one of −60 ms (95% CI: −40 ms, −80 ms). The estimates of the “swimming” duty factor of the hindlimb (n = 24) demonstrated “moderate” to “excellent” with intraclass correlation of 0.82 (95% CI: 0.625–0.920) and limits of agreement of 4.39% (95% CI: 6.21%, 2.53%) and −5.28% (95% CI: −3.42%, −7.14%). The results of the forelimb were mixed, suggesting that the cycle duration and “swimming” duty factor parameters determined for this limb should be used with caution. Overall, the findings confirm that inertial sensors, particularly on the hindlimbs, provide reliable spatiotemporal measurements and are well suited for studying equine swimming. Full article

Hereditary renal tubulopathies are rare monogenic disorders caused by defects in tubular transport mechanisms that impair the handling of electrolytes, water, and acid–base balance along the nephron. While each tubulopathy is individually uncommon, their collective burden is clinically relevant, as these disorders can severely affect quality of life and predispose to nephrolithiasis, dehydration episodes, and progression to chronic kidney disease. Advances in molecular genetics have identified more than 70 genes involved in renal tubular physiology; however, a substantial proportion of these cases remain genetically unresolved, and marked phenotypic heterogeneity complicates diagnosis and management. This narrative review provides an integrated overview of the main transport systems operating in the different tubular segments of the nephron—proximal tubule, thick ascending limb of the loop of Henle, distal convoluted tubule and collecting duct—summarizing the tubulopathies associated with each segment and discussing in greater detail representative inherited disorders that illustrate the clinical consequences of their dysfunction. We highlight current diagnostic challenges and limitations of existing therapeutic strategies and discuss novel diagnostic approaches as well as emerging treatment options. Improved genetic diagnosis, validation of candidate biomarkers, and the development of novel therapeutic strategies will be essential to advance precision medicine and improve outcomes for patients with inherited renal tubulopathies. Full article

A V-set Ig domain-containing 4 (VSIG4), known for complement receptor, has been involved in the profibrotic pathway in chronic kidney disease including diabetic kidney disease. However, its relationship with renal aging has not been examined longitudinally. This study aims to elucidate the role of VSIG4 in the aging process of kidneys, particularly in diabetes. Male db/m and db/db mice were followed from 8 to 38 weeks. Urinary albumin and VSIG4 levels were assessed using 6 h timed urine collections and ELISA. The intrarenal expression of VSIG4 and klotho were analyzed through immunohistochemical stating. In db/db mice, urinary albumin levels were significantly higher from 8 weeks onward compared to db/m mice. These levels increased progressively with age, peaking at 38 weeks. Similarly, urinary VSIG4 levels showed a significant initial increase in db/db mice, followed by a consistent rise with age. Interestingly, both urinary albumin and VSIG4 levels in db/m mice showed a sudden surge at 38 weeks. Urinary VSIG4 levels showed a strong correlation with urinary albumin levels (r = 0.867, p < 0.001). Intrarenal VSIG4 expression increased with age, appearing earlier and more predominantly in diabetic mice, and was predominantly localized to distal tubular segments, while klotho expression progressively declined. These findings indicate that VSIG4 expression changes with renal aging and that diabetes is associated with earlier activation of this process. Urinary VSIG4 reflects aging-related kidney changes rather than diabetic injury alone. Full article

Sodium glucose-1 cotransporter (SGLT1) is a low-capacity, high-affinity glucose transporter expressed in the proximal renal tubule. It is also expressed in different human tissues and, primarily, in the brush border of the small intestine. At this level, SGLT1 inhibition results in an increase in glucose supply to the distal intestine with a reduction in intestinal pH and a consequent alteration of the intestinal microbiota. Specifically, SGLT1 inhibitors (SGLT1is) lead to an intensification of the production of short-chain fatty acids (SCFAs) and an enhancement of the incretin pathway. Potential mechanisms by which SGLT1is could reduce the occurrence of stroke and myocardial infarction may therefore involve the anti-inflammatory, anti-fibrotic and anti-atherosclerotic effects associated with an increased production of endogenous glucagon-like peptide-1 (GLP-1). Full article

Background: Blood flow restriction (BFR) resistance exercise has emerged as a training methodology capable of inducing muscular adaptations comparable to traditional high-load training despite substantially lower mechanical loads. While low-load BFR protocols (20–50% 1RM) are well-established, emerging evidence supports applications across the full loading spectrum, including moderate-to-high loads (>50–90% 1RM), contralateral training effects, and proximal–distal adaptations. In this second installment of the Blood Flow Restriction in Athletic Populations series, we review current evidence on BFR resistance exercise in athletic populations, with emphasis on morphological, neuromuscular, and functional adaptations across diverse application contexts. Methods: A narrative review of research examining BFR resistance exercise in trained and athletic populations was conducted via a PubMed/MEDLINE search. Search terms: (“blood flow restriction” OR “BFR” OR “occlusion training” OR “KAATSU”) AND (“resistance training” OR “resistance exercise” OR “strength training”) AND (“athletes” OR “athletic” OR “trained” OR “elite” OR “sport”) AND (“cross-education” OR “contralateral” OR “cross transfer” OR “proximal” OR “distal”). Studies investigating low-load (20–50% 1RM) and moderate-to-high load (>50% 1RM) protocols, contralateral cross-education effects, and proximal–distal adaptations were evaluated. Primary outcomes included muscle hypertrophy, strength, power, and sport-specific performance measures. Results: Low-load BFR resistance exercise has been shown to produce significant improvements in muscle hypertrophy and strength gains over 4–12 week interventions compared to low-load control conditions. Moderate-to-high load BFR enhanced barbell velocity and power output, particularly at loads > 80% 1RM with intermittent inflation protocols. Contralateral and cross-transfer effects of BFR training demonstrate variable efficacy across muscle groups, with the most consistent evidence supporting cross-transfer enhancement of training adaptations when BFR is applied to one body region while exercising another. Proximal BFR application induced adaptations in both proximal and distal musculature, suggesting systemic mechanisms beyond local vascular restriction. Conclusions: BFR resistance exercise represents a versatile training modality producing meaningful morphological and neuromuscular adaptations across the loading spectrum. Contralateral and proximal–distal effects expand practical applications for injury rehabilitation and targeted adaptation. These findings support BFR integration within periodized training programs when mechanical load management is prioritized. Full article

Background: Supplementing aquafeeds with emulsifiers can enhance lipid utilization, yet the physiological effects of lysolecithin, derived from enzymatic lecithin conversion, remain under-explored. Objectives: This study examined the effects of lysolecithin supplementation on hepatopancreatic transcriptome and gut microbiota in largemouth bass (Micropterus salmoides) fed stearin-based high-lipid diets. Methods: Two diets were formulated: a control containing 130 g kg⁻¹ stearin fish oil (SO), and in the experimental diet (SL), 3.1 g kg⁻¹ rapeseed oil was replaced with 3.1 g kg⁻¹ lysolecithin oil. Each diet was fed to three replicate groups for 56 days. Hepatopancreas and distal intestine were sampled for transcriptome profiling, and gut microbiota were characterized at 28 and 56 days. Results: Lysolecithin supplementation resulted in 424 differentially expressed genes compared with the control (322 up- and 102 downregulated). KEGG enrichment indicated major effects on lipid metabolic processes, notably activation of the PI3K-AKT signaling pathway, enhanced adipocyte lipolysis, and modulation of adipocytokine signaling, suggesting improved insulin sensitivity and lipid mobilization. Histological analysis showed mild distal intestinal inflammation in the SO group. Gut microbiota composition shifted over time; lysolecithin increased the relative abundance of Cetobacterium and reduced potential opportunistic taxa compared with the control. Conclusions: Overall, dietary inclusion of lysolecithin improved lipid utilization in largemouth bass, likely by enhancing lipid metabolism and promoting beneficial gut microbial profiles. These findings support lysolecithin as a promising feed additive for optimizing high-lipid aquafeeds. Full article

Background: Acute type A aortic dissection (ATAAD) is a life-threatening condition that may be complicated by malperfusion, particularly in patients with prior aortic interventions such as Thoracic Endovascular Aortic Repair (TEVAR). Management becomes increasingly complex when the dissection involves supra-aortic branches and compromises previously placed stents. Methods: We report the case of a 58-year-old male presenting with ATAAD and left lower limb paralysis, with a history of prior TEVAR. Imaging demonstrated an entry tear in the ascending aorta with extension into the distal left main and supra-aortic branches, resulting in a dissection flap obstructing the proximal end of the TEVAR stent. The patient underwent emergency surgical intervention including a Bentall procedure, coronary artery bypass grafting (CABG), and deployment of a small Ascyrus Medical Dissection Stent (AMDS) distally within the TEVAR stent. Pre-operatively, the patient had severe lower limb ischemia due to near-complete obstruction of distal flow. Results: Following surgical intervention, there was restoration of true lumen perfusion with resolution of malperfusion. The patient was successfully weaned from cardiopulmonary bypass, extubated on post-operative day 4, and discharged on day 7 with stable hemodynamics and intact bilateral lower limb perfusion. Post-operative computed tomography (CT) demonstrated a well-seated AMDS with no evidence of ongoing false lumen perfusion. At 30-day follow-up, there was no clinical or biochemical evidence of organ malperfusion. Conclusions: The use of an AMDS deployed within a pre-existing TEVAR stent may represent an effective strategy for managing complex ATAAD with malperfusion, particularly in cases requiring combined surgical interventions. Full article

Background/Objectives: A floating hip injury, defined as an ipsilateral fracture of the pelvis or acetabulum combined with a femoral fracture, represents a rare and devastating musculoskeletal injury resulting from high-energy trauma. Although Müller type A floating hip injuries comprising an acetabular fracture with an ipsilateral femoral fracture are recognized for their clinical complexity, the long-term prognostic factors influencing functional outcomes remain poorly elucidated. This study aimed to identify independent prognostic factors associated with unsatisfactory long-term functional outcomes in patients with Müller type A floating hip injuries. Methods: A retrospective study was performed on 68 consecutive patients with Müller type A floating hip injuries who underwent surgical fixation at a single tertiary trauma center, with a minimum follow-up period of 5 years. Functional outcomes were assessed using the Majeed score, and patients were dichotomized into satisfactory (n = 48; 70.6%) and unsatisfactory (n = 20; 29.4%) outcome groups. Acetabular fractures were classified according to the Judet–Letournel system, and femoral fractures were classified by fracture level (proximal, shaft, or distal). Radiological outcomes were evaluated using Matta’s radiological grading system. Demographic, injury-specific, and treatment-related variables were compared between groups using the Mann–Whitney U test and chi-square test with Bonferroni correction. A multivariate binary logistic regression model was constructed to determine independent predictors of unsatisfactory outcomes. Results: The mean age was 37.15 ± 12.07 years, with a male predominance (67.6%). The predominant mechanism of injury was pedestrian struck by vehicle (54.4%), followed by motor vehicle collision (27.9%) and fall from height (17.6%); collectively, high-energy vehicular trauma accounted for 82.3% of cases. In the univariate analysis, transverse with posterior wall acetabular fracture pattern (p = 0.001), proximal femur fracture level (p = 0.001), associated lower extremity fractures (p = 0.001), nerve damage (p = 0.001), higher body mass index (BMI) (p = 0.001), and lower Matta’s radiological scores (p = 0.001) were significantly associated with unsatisfactory outcomes. Three independent predictors emerged in the multivariate logistic regression: BMI (OR = 1.50; 95% CI: 1.05–2.15; p = 0.025), the presence of associated lower extremity fractures (OR = 29.02; 95% CI: 2.83–297.67; p = 0.005), and Matta’s radiological score (OR = 0.06; 95% CI: 0.01–0.56; p = 0.014). The model yielded internal discriminatory metrics within the acceptable range (overall accuracy 89.7%, sensitivity 95.8%, specificity 75.0%, Nagelkerke R² = 0.757); however, given the limited events-per-variable ratio (~6.7) and the wide confidence intervals observed for some predictors, these internal performance estimates are likely optimistic due to potential overfitting, and the findings should be interpreted as exploratory pending external validation. Conclusions: Elevated BMI, the presence of associated ipsilateral lower extremity fractures, and poor quality of acetabular reduction, assessed via Matta’s radiological criteria, are independent determinants of unsatisfactory long-term functional outcomes in Müller type A floating hip injuries. These findings underscore the critical importance of achieving anatomical reduction in the acetabulum and highlight the compounding effect of additional ipsilateral limb injuries on patient prognosis. Full article

Background and Clinical Significance: Revascularization of the circumflex territory remains technically challenging because of its anatomical position and the frequent need for distal branch grafting. Case presentation: We report the case of a 76-year-old man in whom the proximal circumflex trunk was used as the target for an in situ right internal thoracic artery routed through the transverse sinus during combined coronary and ascending aortic surgery. This approach allowed antegrade perfusion of the circumflex territory while avoiding multiple distal anastomoses. In this selected anatomical setting, the technique proved feasible and was associated with excellent intraoperative flow and 1-year radiological patency. Conclusions: Direct grafting of the circumflex trunk is not a new concept, but this case revisits it using a contemporary total arterial revascularization strategy. This approach may represent a useful adjunctive option in carefully selected patients with favorable circumflex anatomy. Full article