Search Results (662)

Background: SARS-CoV-2 infection, its late complications, and SARS-CoV-2 vaccines are known to cause pericardial effusion. We sought to investigate the influence of the COVID-19 outbreak on trends in pericardiocentesis. Methods: We performed a retrospective population study including all >18 years patients undergoing pericardiocentesis in a single tertiary hospital between January 2018 and April 2022. The effusion characteristics and patient outcomes were compared between patients admitted before and after the COVID-19 outbreak. Results: 92 patients underwent pericardiocentesis cases during the COVID-19 period compared to 65 patients during the pre-COVID-19 period (χ² = 3.07, p = 0.0796). Only 15% of the post-COVID-19 outbreak cases were related to COVID-19 infection or vaccine. In-hospital mortality was numerically higher during the post-COVID-19 group (7.7% vs. 14.4%), but this difference did not reach statistical significance (p = 0.22). The 90-day mortality was also similar between groups. Conclusions: A numerical, yet statistically insignificant increase in pericardiocentesis was observed following the COVID-19 outbreak. We assume this observation cannot be attributed solely to the virus and vaccines per se. Neglect of other chronic diseases, social distancing, and widespread availability of point-of-care ultrasound may have contributed to this observation. Full article

Background: All major international and national guidelines recommend supervised exercise therapy (SET) for intermittent claudication (IC) as a first line of treatment, with revascularisation options to be considered for those who do not respond. Revascularisation incurs complication risks and additional costs; therefore, the need to correctly identify individuals who potentially may progress to revascularisation following SET would be of benefit. This retrospective cohort study aimed to review responses and subsequent revascularisation for individuals with IC following completion of SET. Methods: Retrospective data was collated for individuals who received hospital-based SET between 2016 and 2020. Demographics, Pain Onset Distance (POD), revascularisation (pre- and post-completion of SET) and quality of life (QoL) were calculated. Results: A total of 142 individuals were included; of those, 38 had diabetes, 48 were current smokers and 42 were female. Individuals who had a ≥75% improvement in POD were less likely to need revascularisation (p < 0.019). Gender, diabetes, and age did not imply likelihood of preventing revascularisation. Those who smoked were significantly less likely to go on to further revascularisation (p < 0.05) and those who had previous revascularisation surgery (n = 25) were significantly more likely to require further revascularisation (p = 0.0071) (32% compared with 10%). A mean positive improvement (1.77%) was seen in the EQ5D5L overall health percentage score for individuals who avoided surgery. Conclusions: Individuals who saw a ≥75% in POD were statistically less likely to require revascularisation post-SET. Improvements in QoL increase the probability of avoiding revascularisation. Full article

Background: Achieving adequate margins in pelvic bone tumor resection remains difficult, as conventional navigation provides no direct three-dimensional margin feedback. We proposed an innovative dangerous region generation method based on 3D image resampling and anisotropic distance transform, integrated with computer-assisted navigation, to enhance surgical margin accuracy. This study aimed to evaluate its oncological safety, functional outcomes, and perioperative efficacy in pelvic tumor surgery. Methods: The study was conducted on 19 patients (8 males, 11 females) with primary pelvic bone tumors between May 2018 and June 2024. The age range was 19 to 66 years (mean age: 62.67 years). Histological diagnoses included chondrosarcoma (n = 6), giant cell tumor (n = 4), osteosarcoma (n = 1), chordoma (n = 2), Ewing sarcoma (n = 3), spindle cell sarcoma (n = 1), chondromyxoid fibroma (n = 1), and peripheral nerve sheath tumor (n = 1). The feasibility of the dangerous region generation method for computer-assisted pelvic tumor resection surgery was assessed by general results, oncological and functional results. Results: All patients successfully underwent surgery with a mean operative time of 252 min and average intraoperative blood loss of 1358 mL. The mean hospital stay was 22 days, and all patients completed follow-up (mean, 37 months). Two patients developed postoperative wound complications, which resolved after debridement. Adequate surgical margins were achieved in all cases. The 5-year overall survival rate was 75.6%, increasing to 80.0% among patients with wide-margin resections. At the final follow-up, the mean MSTS score among 16 limb-salvage patients was 26.6, corresponding to an average functional recovery of 88.5%. Most patients exhibited a normal gait and were able to ambulate without assistive devices. Conclusions: This dangerous region generation method, when combined with computer-assisted techniques for pelvic bone tumor resection, is feasible and can achieve favorable clinical outcomes. Full article

In Italy, access to public dental care is limited, and the characteristics of patients seeking hospital-based services are poorly described. A single-centre retrospective cross-sectional study was conducted, including all individuals attending their first appointment at the public Dental Clinic of Bari University Hospital (Southern Italy) between 1 January and 31 December 2023. Demographic and clinical variables, comorbidities, reasons for consultation, and travel distance from residence were retrieved from electronic records and analysed. Among 1361 patients (49% male; mean age 47.8 ± 23.3 years), most attended for oral surgery (35%) or oral pathology (17%), while other specialties accounted for the remaining visits. Many patients presented with multiple systemic conditions, particularly cardiovascular and metabolic diseases; however, a sizeable proportion were young, apparently healthy individuals who did not meet national eligibility criteria for publicly funded dental care. The dental clinic served a wide catchment area, including referrals from other regions. Documentation on education and behavioural risk factors was frequently incomplete. Overall, these findings show that complex oral medicine and oral surgery needs are concentrated in a small number of hospital clinics and support the expansion of Italian public dental services and improvements in routine data collection. Full article

Background/Objectives: Venovenous extracorporeal membrane oxygenation (VV ECMO) supports reversible respiratory failure when mechanical ventilation fails. Technological advances and specialized teams now enable ECMO initiation at referring centers, even for high-risk transports. This study aimed to evaluate the safety of pediatric patients on ECMO support during medical transfer, based on a single-center experience and a systematic review of the literature. Methods: A retrospective analysis was conducted on all pediatric patients supported with ECMO transferred from regional hospitals to our university hospital (January 2023–September 2025), focusing on transport-related mortality and morbidity. We also performed a systematic review of original articles (2015–2025) using the PubMed, Embase, and Cochrane databases. Results: Fourteen critically ill children with a median age of 16 months (range: 2 months to 11 years) and acute respiratory failure were transferred to our hospital’s Intensive Therapy Unit. All transported patients in the local cohort were supported with VV ECMO. Transport distances ranged from 5 to 520 km (median: 151 km). No mortality or serious adverse events occurred during transfer. Two technical issues were noted. In the systematic review, 14 articles met the inclusion criteria, reporting a total of 900 transfers, mainly primary ECMO initiations (779–86.6%). The number of ground transports was 337, which accounted for 37.4%. Adverse events were reported in 252 out of 900, which was 28%. One death during transport was reported (mortality: 1‰). Conclusions: All transports were safely performed by our experienced multidisciplinary mobile ECMO team. Both our experience and literature review confirmed low mortality in pediatric ECMO transport, despite potential life-threatening adverse events. Full article

Background and Objectives: Accurate breast tumor segmentation in dynamic contrast-enhanced MRI (DCE-MRI) is crucial for treatment planning, therapy monitoring, and quantitative studies of breast cancer response. However, deep learning models often have worse performance when applied to new hospitals because scanner hardware, acquisition protocols, and patient populations differ from those in the training data. This study investigates how such center-related domain shift affects automated breast DCE-MRI tumor segmentation on the multi-center MAMA-MIA dataset. Methods: We trained a standard 3D U-Net for primary tumor segmentation under two evaluation settings. First, we constructed a random patient-wise split that mixes cases from the three main MAMA-MIA center groups (ISPY2, DUKE, NACT) and used this as an in-distribution reference. Second, we designed a balanced leave-one-center-out cross-validation (LoCoCV) protocol in which each center is held out in turn, while training, validation, and test sets are matched in size across folds. Performance was assessed using the Dice similarity coefficient, 95th percentile Hausdorff distance (HD95), sensitivity, specificity, and related overlap measures. Results: On the mixed-center random split, the best three-channel model achieved a mean Dice of about 0.68 and a mean HD95 of about 19.7 mm on the held-out test set, indicating good volumetric overlap and boundary accuracy when training and test distributions match. Under balanced LoCoCV, the one-channel model reached a mean Dice of about 0.45 and a mean HD95 of about 41 mm on unseen centers, with similar averages for the three-channel variant. Compared with the random split baseline, Dice and sensitivity decreased, while HD95 nearly doubled, showing that boundary errors become larger and segmentations less reliable when the model is applied to new centers. Conclusions: A model that performs well on mixed-center random splits can still suffer a substantial loss of accuracy on completely unseen institutions. The balanced LoCoCV design makes this out-of-distribution penalty visible by separating center-related effects from sample size effects. These findings highlight the need for robust multi-center training strategies and explicit cross-center validation before deploying breast DCE-MRI segmentation models in clinical practice. Full article

Controlling pre-analytical conditions for medical biology tests, particularly during transport, is crucial for complying with the ISO 15189 standard and ensuring high-quality medical services. The use of drones, also known as unmanned aerial vehicles, to transport clinical samples is growing in scale, but requires prior validation to verify that there is no negative impact on the test results provided to doctors. This study aimed to establish a secure, high-quality solution for transporting biological samples by drone in a coastal region of France. The 80 km routes passed over several densely populated urban areas, with take-off and landing points within hospital grounds. The analytical and clinical impact of this mode of transport was compared according to two protocols: an interventional clinical trial on 30 volunteers compared to the reference transport by car, and an observational study on samples from 126 hospitalized patients compared to no transport. The system enabled samples to be transported without damage by maintaining freezing, refrigerated, and room temperatures throughout the flight, without any significant gain in travel time. Analytical variations were observed for sodium, folate, GGT, and platelet levels, with no clinical impact on the interpretation of the results. There is a risk of time-dependent alterations of blood glucose measurements in heparin tubes, which can be corrected by using fluoride tubes. This demonstrated the feasibility and security of transporting biological samples over long distances in line with the ISO 15189 standard. Controlling transport times remains crucial to assessing the quality of analyses. It is imperative to devise contingency plans for backup solutions to ensure the continuity of transportation in the event of inclement weather. Full article

Background/Objectives: Cardiac rehabilitation (CR) is known to improve clinical outcomes in cardiovascular disease, yet its benefits in patients with implantable cardioverter-defibrillators (ICD) are not well established. This meta-analysis evaluated the impact of CR on functional capacity and safety in ICD recipients. Methods: A systematic search of PubMed, Scopus, and Cochrane Library was performed to identify randomized controlled trials (RCT) involving adults who underwent ICD implantation and were assigned to either CR or standard care. The primary outcome was the change in peak oxygen uptake (peak VO₂) from the baseline to the final follow-up. Random-effects models were applied, and subgroup analyses were conducted based on follow-up duration, supervision type, baseline peak VO₂, and ischemic vs. non-ischemic etiology. Results: Seven RCTs involving 1461 participants (784 CR; 677 control) met the inclusion criteria. CR was associated with a significant improvement peak VO₂ compared with usual care, expressed as the mean difference (MD) in change from the baseline to the last follow-up (MD 2 mL·kg⁻¹·min⁻¹; 95% CI 1.02–2.81; I² = 65.7%), with consistent effects across all subgroups. Quality of life improved in the CR group (MD 6.46; 95% CI 2.25–10.67; I² = 0%). A non-significant trend toward increased 6MWT distance was observed. CR did not increase adverse events, including ICD shocks, hospitalizations, or cardiac deaths. Conclusions: CR safely enhances exercise capacity and quality of life in ICD recipients without increasing arrhythmic events or mortality. Larger standardized trials are warranted to optimize CR delivery in this population. Full article

This article offers an interdisciplinary ethnolinguistic and sociolinguistic reading of Karl Steinmetz’s early twentieth-century travel accounts from the northern Albanian highlands and links them to contemporary Albanian youth’s attitudes toward tradition. Through close analysis of his depictions of space, social organisation and oral practice, the study examines how tower, household, clan, honour, blood, revenge, hospitality and priest are lexically and discursively encoded as “word-concepts” structuring local worldviews. Methodologically, it combines textual analysis with a questionnaire administered to respondents aged 15–17 and 18–21 about the relevance of traditions today. The findings show that Steinmetz’s materials provide an early, systematic corpus on Northern Gheg Albanian, where linguistic variation is closely linked to customary law and collective identity; contemporary youth still value honour, hospitality, family solidarity and “besa”, while distancing themselves from the normative force of the Kanun and reinterpreting traditional codes in more individualised, rights-oriented terms. The article argues that Steinmetz’s work remains a crucial resource for understanding the diachronic interplay of language, culture and identity in northern Albania and for analysing how cultural models are transformed among younger generations. Full article

(1) Background: In hospitals, mattresses are often relocated for cleaning or patient transfer, leading to mismatches between actual and recorded bed locations. Manual updates are time-consuming and error-prone, requiring an automatic localization system that is cost-effective and easy to deploy to ensure traceability and reduce nursing workload. (2) Purpose: This study presents a pragmatic, large-scale implementation and validation of a BLE-based localization system using RSSI measurements. The goal was to achieve reliable room-level identification of smart mattresses by leveraging existing hospital infrastructure. (3) Results: The system showed stable signals in the complex hospital environment, with a 12.04 dBm mean gap between primary and secondary rooms, accurately detecting mattress movements and restoring location confidence. Nurses reported easier operation, reduced manual checks, and improved accuracy, though occasional mismatches occurred when receivers were offline. (4) Conclusions: The RSSI-based system demonstrates a feasible and scalable model for real-world asset tracking. Future upgrades include receiver health monitoring, watchdog restarts, and enhanced user training to improve reliability and usability. (5) Method: RSSI–distance relationships were characterized under different partition conditions to determine parameters for room differentiation. To evaluate real-world scalability, a field validation involving 266 mattresses in 101 rooms over 42 h tested performance, along with relocation tests and nurse feedback. Full article

The closure of rural maternity units in hospitals across the United States contributes to health inequities; however, little is known about the effects of reopening maternity services in this context. We conducted a mixed-methods study to characterize labor and delivery outcomes and patient experiences associated with the reopening of a rural Level 1 Maternity Care Center (MCC) at a critical access hospital. We compared clinical outcomes and distance to care for patients who gave birth at the rural MCC in the three years after its opening with outcomes from a similar low-risk and geographically located sample who gave birth at a large suburban academic medical center in the same hospital system in the three years before the MCC reopened. We also conducted in-depth interviews with patients who gave birth at the MCC. Labor and delivery outcomes were similar across both groups, with significantly more care provided by family physicians and midwives and lower neonatal intensive care unit use at the MCC. The opening of the MCC halved the distance patients traveled to give birth, and patients reported high rates of satisfaction. Rural maternity care centers can improve access to quality care closer to home using a resource-appropriate model. Full article

Background: Chronic obstructive pulmonary disease (COPD) increasingly strains European health systems amid population ageing. Digital health interventions (DHIs) can reduce hospitalizations and support self-management, yet older patients hesitate to adopt them. Tailored interventions require understanding patient profiles. This study aimed to identify clusters by intention to use DHIs. Methods: Between July 2024 and February 2025, 232 COPD patients (mean age 65; 61% female) across seven European countries completed surveys covering sociodemographic and Unified Theory of Technology Acceptance (UTAUT) constructs. Intention to use DHIs was categorized as positive, neutral, or negative. Weighted UTAUT scores were clustered using Gower distance and Partitioning Around Medoids. Associations were visualized with multiple correspondence analysis and heat maps; differences were tested with the chi-square test. Results: Intention to adopt DHIs varied across countries, with the highest in the Netherlands. Two clusters emerged. Cluster 1, the ‘balanced hesitant’ group (n = 104), showed mixed intentions (38% positive, 40% neutral, 21% negative). Barriers included low performance expectancy and limited digital skills (both p < 0.05). Cluster 2, the ‘enthusiastic’ group (n = 128), demonstrated strong adoption intentions, with 84% positive intention. Enablers included low effort expectancy and complex disease (p < 0.01). Across both clusters, performance expectancy predicted intention. Conclusions: Digital health adoption among COPD patients is shaped by psychosocial and digital skill profiles. Hesitant users benefit from expectation-based information about DHIs, digital literacy training and peer support. Enthusiasts require ease of integration. Performance expectancy is a consistent driver of adoption, whereas country-specific factors should guide strategies. Full article

Background: SGLT2 inhibitors are key therapies in heart failure (HF), but their combined multidomain effects have not been analyzed together. Methods: We conducted a PROSPERO-registered (CRD420251235850) systematic review and meta-analysis of all randomized controlled trials (RCTs) comparing SGLT2i (dapagliflozin, empagliflozin, canagliflozin, sotagliflozin) with placebo in adults with HF, regardless of ejection fraction or diabetes status. We searched PubMed/MEDLINE, Embase, Cochrane CENTRAL, and Web of Science through 1 February 2025. Outcomes were grouped into four domains: (1) clinical events, (2) symptoms/health status (Kansas City Cardiomyopathy Questionnaire, KCCQ), (3) functional capacity (6 min walk distance, peak VO₂), and (4) cardiac remodeling/energetics (cardiac MRI, 31P-MRS). We used random-effects models with Hartung–Knapp adjustment and assessed heterogeneity by I² and prediction intervals. Results: Eleven RCTs with 23,812 patients (HFrEF, HFmrEF, HFpEF, and acute or recently decompensated HF) were included. SGLT2i lowered the risk of cardiovascular death or first HF hospitalization by 23% (HR 0.77, 95% CI 0.72–0.82; p < 0.0001; I² = 28%; prediction interval 0.68–0.87), with similar effects across ejection fraction, diabetes status, and presentation type. All-cause and cardiovascular mortality dropped by 12% (HR 0.88, 95% CI 0.81–0.96) and 14% (HR 0.86, 95% CI 0.78–0.95), respectively. SGLT2i improved KCCQ—Clinical Summary Score by 4.6 points (95% CI 3.4–5.8; p < 0.0001) and increased the odds of a ≥5-point improvement (OR 1.49, 95% CI 1.32–1.68; NNT = 12). Six-minute walk distance increased by 21.8 m (95% CI 9.4–34.2; p = 0.001), and mechanistic trials showed significant reverse remodeling (ΔLVEDV −19.8 mL, ΔLVEF +6.1%; both p < 0.001). No improvement was observed in myocardial PCr/ATP ratio. Safety was favorable, with no excess ketoacidosis or severe hypoglycemia. Conclusions: This multidomain synthesis demonstrates that SGLT2 inhibitors provide consistent, robust reductions in mortality and hospitalizations, while also delivering early, clinically meaningful improvements across multiple patient-centered domains. These results establish SGLT2i as a foundational component of contemporary HF management. Full article

Background: Carbapenem-resistant Escherichia coli (CREC) producing OXA-48-like carbapenemase was first detected in Hungary in 2022. The aim of the present study was to characterize such strains isolated in 2022–2025 in Baranya County, Hungary. Methods: Antibiotic susceptibility and the whole-genome sequence (WGS) of E. coli isolates, identified as OXA-48-like carbapenemase producers using the CARBA-5 NG test, were established. The transferability of bla_OXA-48-like plasmids was tested by conjugation. Results: Of the 6722 non-repeat E. coli isolates, 6 produced an OXA-48-like carbapenemase. They exhibited variable resistance to ertapenem and were susceptible to imipenem and meropenem. WGS revealed that all OXA-48-like producer E. coli belonged to high-risk clones: two clonally related OXA-181-producer E. coli ST405 were isolated in Hospital A, three OXA-244-producing E. coli ST38 (two identical via cgMLST from Hospital B), and an OXA-48-producing E. coli ST69. The bla_OXA-48 and bla_OXA-244 genes were chromosomally located, while bla_OXA-181 was on a non-conjugative IncFIB-IncFIC plasmid. So far, the bla_OXA-181-bearing plasmid of this incompatibility type has only been described in Ghana, but all bla_OXA-48-like gene-carrying transposons in this study have already been identified in Europe and other continents. The E. coli ST38 isolates, showing close association based on core genome SNP distances to European and Qatari strains, belonged to Cluster A and harbored bla_CTX-M-27. All but the E. coli ST69 isolate had cephalosporinase gene(s). Conclusions: This study describes small-scale intra-hospital transfers of OXA-48-like carbapenemase-producer E. coli. Interestingly, E. coli ST405 of Hungary carried bla_OXA-181 on an IncFIB-IncFIC plasmid, which has only been reported from Africa so far. Full article

Access to specialist veterinary oncology services may be influenced by geographic, demographic, and patient-related factors. Understanding travel burden is important for identifying potential barriers to care and designing more equitable service delivery models. This study quantified the distance travelled by owners seeking specialist oncology care at a UK veterinary teaching hospital and examined whether species, age, breed, and insurance status were associated with travel patterns. A retrospective review was conducted of all dogs and cats presenting to the Oncology Service at the Hospital for Small Animals, University of Edinburgh, between 1 December 2018 and 31 October 2025. Owner postcodes were used to calculate distances from residence to the hospital. Distances were compared across species (dog vs. cat), breed (pure-breed vs. mixed-breed), age (<7 vs. ≥7 years), and insurance status (insured vs. uninsured). A total of 3074 cases were included. In univariate analysis, dogs travelled significantly further than cats (p < 0.001), pure-breed animals travelled significantly further than mixed-breed animals (p < 0.001), and younger animals travelled significantly further than older animals (p = 0.002). In multivariate analysis, species, age, and insurance status were significant, with dogs (p < 0.001), younger animals (p = 0.012), and uninsured animals (p = 0.008) travelling further. These findings highlight potential geographic inequities in access to specialist care and underscore the need for alternative service-delivery strategies to improve accessibility, particularly for cats and younger animals. Full article