Search Results (123)

Background: Peripancreatic collections (PPCs) are a frequent and severe complication of acute and chronic pancreatitis, as well as pancreatic surgery, often requiring interventions to treat and prevent infection, gastric obstruction, and other complications. Endoscopic ultrasound (EUS)-guided drainage has emerged as a minimally invasive alternative to surgical and percutaneous approaches, offering reduced morbidity and shorter recovery times. However, the effectiveness of EUS-guided drainage in post-surgical PPCs remains underexplored. Methods: This retrospective, single-center study evaluated the technical and clinical outcomes of EUS-guided drainage in patients with PPCs between October 2021 and December 2024. Patients were categorized as having post-pancreatitis or post-surgical PPCs. Technical success, clinical success, complications, recurrence rates, and the need for reintervention were assessed. Results: A total of 50 patients underwent EUS-guided drainage, including 42 (84%) with post-pancreatitis PPCs and 8 (16%) with post-surgical PPCs. The overall technical success rate was 100%, with clinical success achieved in 96% of cases. Lumen-apposing metal stents (LAMSs) were used in 84% of patients, including 7.1% as a dual-gate salvage strategy after the failure of double-pigtail drainage. The complication rate was 24%, with infection being the most common (16%). The recurrence rate was 25%, with no significant difference between post-pancreatitis and post-surgical cases. Patients with walled-off necrosis had a significantly higher reintervention rate (35%) than those with pseudocysts (18%; p = 0.042). Conclusions: EUS-guided drainage is a highly effective and safe intervention for PPCs, including complex post-surgical cases. The 100% technical success rate reinforces its reliability, even in anatomically altered post-surgical collections. While recurrence rates remain a consideration, EUS-guided drainage offers a minimally invasive alternative to surgery, with comparable outcomes in both post-pancreatitis and post-surgical patients. Future multi-center studies should focus on optimizing treatment strategies and reducing recurrence in high-risk populations. Full article

Background: Coronary heart disease (CHD) remains the most prevalent pathology within the circulatory system. Among its chronic complications, ischemic mitral valve regurgitation (IMR) is observed in approximately 15% of patients with sustained myocardial ischemia. The presence of this complex valvular defect significantly increases both overall mortality and the incidence of adverse cardiovascular events. Notably, the presence of moderate to severe mitral regurgitation in patients undergoing surgical revascularization has been shown to double the risk of death. Despite the well-established etiology of IMR, data regarding the efficacy of surgical interventions and the determinants of postoperative outcomes remain inconclusive. Methods: The objective of the present study was to evaluate both early and long-term outcomes of surgical treatment of mitral regurgitation in patients undergoing coronary artery bypass grafting (CABG) due to ischemic heart disease. Particular attention was given to the influence of the severity of regurgitation, left ventricular ejection fraction (LVEF), and the dimensions of the left atrium (LA) and left ventricle (LV) on the postoperative prognosis. An additional aim was to identify preoperative risk factors associated with increased postoperative mortality and morbidity. A retrospective analysis was conducted on 421 patients diagnosed with ischemic mitral regurgitation who underwent concomitant mitral valve surgery and CABG. Exclusion criteria included emergent and urgent procedures as well as non-ischemic etiologies of mitral valve dysfunction. Results: The study cohort comprised 34.9% women and 65.1% men, with the mean age of 65.7 years (±7.57). A substantial proportion (76.7%) of patients were aged over 60 years. More than half (51.5%) presented with severe heart failure symptoms, classified as NYHA class III or IV, while over 70% were categorized as CCS class II or III. Among the surgical procedures performed, 344 patients underwent mitral valve repair, and 77 patients required mitral valve replacement. Additionally, 119 individuals underwent concomitant tricuspid valve repair. Short-term survival was significantly affected by the presence of hypertension, prior cerebrovascular events, and chronic kidney disease. In contrast, hypertension and chronic obstructive pulmonary disease were identified as significant predictors of adverse late-term outcomes. Conclusions: Interestingly, neither the preoperative severity of mitral regurgitation nor the echocardiographic measurements of LA and LV dimensions were found to significantly influence surgical outcomes. The perioperative risk, as assessed by the EuroSCORE II (average score: 10.0%), corresponded closely with observed mortality rates following mitral valve repair (9.9%) and replacement (10.4%). Notably, the need for concomitant tricuspid valve surgery was associated with an elevated mortality rate (12.4%). Furthermore, the preoperative echocardiographic evaluation of LA regurgitation severity, as well as LA and LV dimensions, did not exhibit a statistically significant impact on either early or long-term surgical outcomes. However, a reduced LVEF was correlated with increased long-term mortality. The presence of advanced clinical symptoms and the necessity for tricuspid valve repair were independently associated with a poorer late-term prognosis. Importantly, the annual mortality rate observed in the late-term follow-up of patients who underwent surgical treatment of ischemic mitral regurgitation was lower than rates reported in the literature for patients managed conservatively. The EuroSCORE II scale proved to be a reliable and precise tool in predicting surgical risk and outcomes in this patient population. Full article

Background/Objectives: Refractory community-acquired pneumonia (r-CAP) has become a thorny issue in clinical practice, especially after the COVID-19 pandemic, even in immunocompetent patients, as conventionally defined. In this study, we aimed to identify the risk factors for immunocompetent patients with r-CAP. Methods: This was a single-center retrospective study. In total, we collected clinical data from 82 patients with r-CAP in whom the first-line antibiotic therapy failed and 82 patients with general CAP (g-CAP) who recovered with first-line antibiotics, matched at a ratio of 1:1, admitted to Beijing Shijitan Hospital, Capital Medical University, from 1 January 2022, to 31 December 2023. The differences between the two groups (clinical characteristics, peripheral blood cell count, lymphocyte subsets, and regular laboratory indicators) were analyzed using paired t, paired Wilcoxon, Chi-square, or Fisher’s exact tests, and univariate and multivariate logistics regression analyses were conducted to identify the independent risk factors. A model for predicting indicators with statistical significance was established and proved with the receiver operating characteristic (ROC) curve. Results: Warm season, a history of chronic obstructive pulmonary disease, longer time from onset to admission (T_O-A), higher percentages of CD4⁺ T, CD8⁺ T, and double-negative T (DNT) lymphocytes, as well as higher levels of C-reactive protein (CRP), low-density lipoprotein cholesterin (LDL-C), serum sodium ion (Na⁺), and free-calcium ion (FCa²⁺) were regarded as independent risk factors, while T lymphocyte percentage (T%) and total cholesterol (TC) were identified as protective factors. The combined multivariate model using all the above factors proved to be sensitive and specific (AUC = 0.8711, p < 0.0001, R² = 0.4235), and thus better than the respective univariate models. Conclusions: Increased CD4⁺ T%Lym, CD8⁺ T%Lym, and DNT%Lym, warm season, a history of COPD, longer T_O-A, and increased levers of CRP, LDL-C, Na⁺, and FCa²⁺ potentially cause CAP to be refractory, while the T lymphocyte count, namely, the overall cellular immunity, was impaired in r-CAP patients, and increased TC levels could be beneficial to pneumonia recovery. Full article

A diverse range of granitoids in the North Qilian Orogenic Belt (NQOB) offers valuable insights into the region’s tectonomagmatic evolution. In this study, we undertook a geochronological, mineralogical, geochemical, and zircon Hf isotopic analysis of granodiorites from the Yaogou area of the NQOB. Zircon U-Pb dating reveals that the Yaogou granodiorites formed during the Early–Middle Ordovician (473–460 Ma). The Yaogou granodiorites have high SiO₂ (63.3–71.1 wt.%), high Al₂O₃ (13.9–15.8 wt.%) contents, and low Zr (96–244 ppm), Nb (2.9–18 ppm), as well as low Ga/Al ratios (10,000 × Ga/Al ratios of 1.7–2.9) and FeO^T/MgO ratios (1.9–3.2), and are characterized by elevated concentrations of light rare earth elements and large-ion lithophile elements such as Rb, Th, and U, coupled with significant depletion in heavy rare earth elements and high-field-strength elements including Nb, Ta, and Ti. Additionally, the presence of negative europium anomalies further reflects geochemical signatures typical of I-type granitic rocks. The zircon grains from these rocks display negative ε_Hf(t) values (−14.6 to −10.7), with two-stage Hf model ages (T_DM2) from 2129 to 1907 Ma. These characteristics suggest that the magmatic source of the Yaogou granodiorites likely originated from the partial melting of Paleoproterozoic basement-derived crustal materials within a tectonic environment associated with subduction in the North Qilian Ocean. Integrating regional geological data, we suggest that during the Early Paleozoic, the North Qilian Oceanic slab underwent double subduction: initially southward, followed by a northward shift. Due to the deep northward subduction of the Qaidam continental crust and oceanic crust along the southern margin of the Qilian Orogenic Belt, the southward subduction of the North Qilian ocean was obstructed, triggering a reversal in subduction polarity. This reversal likely decelerated the southward subduction and initiated northward subduction, ultimately leading to the formation of the Yaogou granodiorites. These findings enhance our understanding of the complex tectonic processes that shaped the North Qilian Orogenic Belt during the Early Paleozoic, emphasizing the role of subduction dynamics and continental interactions in the region’s geological evolution. Full article

Background and aim. Acute rhinitis (AR) is a common condition in children, primarily of viral origin, causing nasal congestion, rhinorrhea, and discomfort, with a significant impact on quality of life and economic burden. Current treatments are limited to symptomatic relief, with nasal irrigation being the primary non-pharmacological intervention. This study aimed at evaluating the efficacy and safety of Elysium Naso-gola—an isotonic saline solution enriched with mullein (Verbascum thapsus), thyme (Thymus vulgaris), propolis, and long-chain polyphosphates—in reducing symptom severity and duration in pediatric AR. Methods. A randomized, double-blind, placebo-controlled pilot trial was conducted on 60 children (aged 4–14 years) with AR. Participants were randomized into two groups: the active group received Elysium Naso-gola, while the placebo group received a sterile isotonic saline solution, both administered as nasal sprays four times daily for seven days. Symptom severity was assessed at baseline (T0), day 5 (T1), and day 10 (T2) using the I-NOSE questionnaire and Visual Analog Scale (VAS). The primary outcome was symptom reduction at T1, while secondary outcomes included nasal obstruction improvement and complete symptom resolution at T2. Results. At baseline, both groups exhibited comparable symptoms severity. At T1, the active group showed a significant reduction in I-NOSE scores compared to placebo group (p < 0.05), with a marked decrease in nasal obstruction severity. VAS scores also indicated a greater improvement in nasal breathing in the active group. At T2, complete symptom resolution was achieved in 60% of patients treated with Elysium Naso-gola, compared to only 5.3% in the placebo group (p < 0.01). No adverse events were reported, and treatment adherence was high in both groups. Conclusions. The findings suggest that Elysium Naso-gola is a safe and effective non-pharmacological treatment for pediatric AR, providing faster symptom relief and higher resolution rates. Larger multicenter trials are warranted to confirm these preliminary results and further explore its role in pediatric respiratory care. Full article

With the global shift in energy structure and the advancement of the “double carbon” strategy, methanol has gained attention as a clean low-carbon fuel in the engine sector. However, the corrosion–wear coupling failure caused by acidic byproducts, such as methanoic acid and formaldehyde, generated during combustion severely limits the durability of methanol engines. In this study, we employed a systematic approach combining the construction of a corrosion liquid concentration gradient experiment with a full-load and full-speed bench test to elucidate the synergistic corrosion–wear mechanism of core friction pairs (cylinder liner, piston, and piston ring) in methanol-fueled engines. The experiment employed corrosion-resistant gray cast iron (CRGCI), high chromium cast iron (HCCI), and nodular cast iron (NCI) cylinder liners, along with F38MnVS steel and ZL109 aluminum alloy pistons. Piston rings with DLC, PVD, and CKS coatings were also tested. Corrosion kinetic analysis was conducted in a formaldehyde/methanoic acid gradient corrosion solution, with a concentration range of 0.5–2.5% for formaldehyde and 0.01–0.10% for methanoic acid, simulating the combustion products of methanol. The results showed that the corrosion depth of CRGCI was the lowest in low-concentration corrosion solutions, measuring 0.042 and 0.055 μm. The presence of microalloyed Cr/Sn/Cu within its pearlite matrix, along with the directional distribution of flake graphite, effectively inhibited the micro-cell effect. In high-concentration corrosion solutions (#3), HCCI reduced the corrosion depth by 60.7%, resulting in a measurement of 0.232 μm, attributed to the dynamic reconstruction of the Cr₂O₃-Fe₂O₃ composite passive film. Conversely, galvanic action between spherical graphite and the surrounding matrix caused significant corrosion in NCI, with a depth reaching 1.241 μm. The DLC piston coating obstructed the permeation pathway of formate ions due to its amorphous carbon structure. In corrosion solution #3, the recorded weight loss was 0.982 mg, which accounted for only 11.7% of the weight loss observed with the CKS piston coating. Following a 1500 h bench test, the combination of the HCCI cylinder liner and DLC-coated piston ring significantly reduced the wear depth. The average wear amounts at the top and bottom dead centers were 5.537 and 1.337 μm, respectively, representing a reduction of 67.7% compared with CRGCI, where the wear amounts were 17.152 and 4.244 μm. This research confirmed that the HCCI ferrite–Cr carbide matrix eliminated electrochemical heterogeneity, while the DLC piston coating inhibited abrasive wear. Together, these components reduced the wear amount at the top dead center on the push side by 80.1%. Furthermore, mismatches between the thermal expansion coefficients of the F38MnVS steel piston (12–14 × 10⁻⁶/°C) and gray cast iron (11 × 10⁻⁶/°C) resulted in a tolerance exceeding 0.105 mm in the cylinder fitting gap after 3500 h of testing. Notably, the combination of a HCCI matrix and DLC coating successfully maintained the gap within the required range of 50–95 μm. Full article

Iatrogenic ureteral strictures are uncommon but challenging to manage. We present our expertise in laparoscopic and robot-assisted laparoscopic ureteroureterostomy (LUU and RAUU) for lumbar and iliac strictures and laparoscopic ureteral reimplantation for pelvic strictures. A descriptive study was conducted on nine adult patients who underwent minimally invasive procedures. Six had lumbar or iliac ureteral strictures—five due to ureterorenoscopy and one following pancreaticoduodenectomy for pancreatic cancer. Three developed pelvic strictures after ureterorenoscopy. Preoperative evaluation included a medical history review, abdominal ultrasound, and CT scan. Success was characterized by the absence of symptoms and the lack of obstruction on follow-up imaging at one year. All procedures were technically feasible, with a median operating time of 105 min and a median hospital stay of four days. No major complications occurred. One patient experienced ureteral stricture recurrence following a laparoscopic approach for a lumbar stricture, and required a permanent double-J stent. At a median follow-up of 38 months, 88.88% of patients remained asymptomatic with preserved renal function. Our findings suggest that robotic and laparoscopic ureteral reconstruction performed by experienced surgeons at a tertiary center is a safe and effective option with a low complication rate. Full article

Chronic venous disease (CVD) is among the most common diseases in industrialized countries and has a significant socioeconomic impact. The diversity of clinical symptoms and manifestations of CVD pose major challenges in routine diagnosis and treatment. Despite the high prevalence and the huge number of venous surgical interventions performed every day, a substantial proportion of the etiopathogenesis remains unclear. There are several widely advocated and generally valid theories of “peri-capillary fibrin cuffs” and “white cell trapping hypothesis”, which consider the role of venous reflux/obstruction, inflammation, vascular remodeling, hemodynamic changes, genetic and social risk factors. There are several specific provoking factors for the development of venous reflux: incompetence of the valve system, inflammation of the vascular wall, and venous hypertension. Over the past few years, increasing scientific data has demonstrated the link between oxidative stress, endothelial dysfunction, and vascular inflammation. High levels of oxidants and persistent inflammation can cause cumulative changes in hemodynamics, resulting in permanent and irreversible damage to the microcirculation and endothelial cells. Production of reactive oxygen species and expression of inflammatory cytokines and adhesion molecules are involved in a vicious cycle of venous wall remodeling. The interaction of ROS, and in particular, the superoxide anion radical, with nitric oxide leads to a decrease in NO bioavailability, followed by the initiation of prolonged vasoconstriction and hypoxia and impairment of vascular tone. This review addresses the role of ED, oxidative, and hemodynamic stress in the CVD mediation. Based on predefined inclusion and exclusion criteria, we conducted a systematic review of published scientific articles using PubMed, PMC Europe, Scopus, WoS, MEDLINE, and Google Scholar databases in the interval from 24 April 2002 to 1 April 2025. The current review included studies (n = 197) scientific articles, including new reviews, updates, and grey literature, which were evaluated according to eligibility criteria. The selection process was performed using a standardized form according to PRISMA rules, the manual search of the databases, and a double-check to ensure transparent and complete reporting of reviews. Studies had to report quantitative assessments of the relationship between vascular endothelial dysfunction, inflammation, oxidative stress, and shear stress in a chronic venous disease. Full article

Background and Objectives: Congenital urological malformations are among the most frequent causes of pediatric chronic kidney disease. Endoscopic balloon dilation and ureteral stenting can be considered less invasive options compared to conventional surgery for primary obstructive megaureter (POM). Nevertheless, the long-term results and side effects of these methods have not yet been well documented. The purpose of this study is to analyze the effectiveness and safety of the endoscopic treatment of POM in children, with the aim of assisting clinical decision making and improving treatment plans. Materials and Methods: A retrospective longitudinal study was performed at the Pediatric Surgery Department of the “M.S. Curie” Emergency Clinical Hospital for Children in Bucharest between October 2020 and September 2024. Eleven endoscopic interventions were performed in five pediatric patients (four boys and one girl) who had six affected ureters, with a median age of 22 months. The inclusion criteria were retrovesical ureter dilation > 7 mm and no prior surgeries of the ureterovesical junction. Cases with secondary megaureters were excluded from the study. The procedures comprised HPEBD and temporary double-J (DJ) stent placement, with systematic postoperative monitoring. Success was defined as improvements in symptoms, a decrease in hydronephrosis, and the preservation of renal function. Results: A final success rate of 83.3% was achieved with endoscopic treatment. Complications were noted in 73% of cases: Clavien–Dindo Grade I (30%); Clavien–Dindo Grade II (20%); Clavien–Dindo Grade IIIb (50%). The documented complications consisted of balloon rupture, stent migration, restenosis, and febrile urinary tract infections (UTIs). Nonetheless, no major complications were observed. The postoperative monitoring showed that renal function was stable and that hydronephrosis had improved gradually. Conclusions: Endoscopic procedures offer a promising, minimally invasive treatment for POM in children with a good success rate. However, the high complication risk necessitates careful patient selection, post-surgery monitoring, and clear guidelines. Full article

Background and Objectives: This study evaluated the safety and efficacy of long-term indwelling self-expandable covered metallic stents (UVENTA; Taewoong Medical Co., Ltd., Seoul, Republic of Korea) used to manage benign and malignant ureteral strictures. Materials and Methods: We retrospectively identified and analyzed the medical records of all patients who underwent metallic stent insertion at our institution since September 2012. Additionally, we evaluated the technical and clinical success rates and complications of patients who underwent follow-up for more than 36 months. Results: A total of 25 patients underwent metallic stent insertion for ureteral obstructions at our institution. Among them, 18 underwent follow-up for more than 36 months. A total of 21 ureters (15 unilateral and 3 bilateral) were ultimately included in this study. Metallic stents were successfully placed in all ureters using a retrograde approach, with a technical success rate of 100%. The mean follow-up duration was 58.6 months (range, 36–107 months). However, the clinical success rates were 85.7% (18/21 ureters) by 12 months, 61.9% (14/21 ureters) by 24 months, and 52.4% (11/21 ureters) after 36 months. During follow-up, obstructions could not be resolved using metallic stents in eleven ureters (median time to failure, 18.4 months; range, 2−40 months); therefore, they were treated with nephrectomy (three ureters because of a nonfunctional kidney) or percutaneous nephrostomy and double J stent placement (four ureters). Major complications included the encrustation of the metallic stent, flank pain, and gross hematuria. A uretero-enteric fistula occurred in one ureter. In two patients, existing metallic stents were removed and patency was maintained. In another two patients, new metallic stents were inserted without complications. Conclusions: Benign and malignant ureteral obstructions may be treated effectively and safely with metallic stents. However, the patency rate drastically decreased and major complications occurred during long-term follow-up. Therefore, careful patient selection is necessary to achieve better results. Full article

People with HIV (PWH) have a high risk of coronary artery disease (CAD). Cytomegalovirus (CMV) co-infection is very common in PWH, but little is known about its association with CAD. We aimed to investigate if CMV IgG serostatus and concentrations are associated with CAD in PWH. From the Copenhagen Comorbidity in HIV Infection (COCOMO) Study we included PWH with coronary CT angiography (CCTA) and quantitative CMV IgG concentration measurements. We measured the stenosis grades and plaque volumes in the coronary vessels. Using multivariable regressions adjusted for traditional CAD risk factors, we investigated if CMV IgG serostatus and concentrations were associated with any atherosclerosis, obstructive CAD, or plaque volumes. We included 620 PWH of whom 586 had positive CMV serostatus, which was not associated with any atherosclerosis, obstructive CAD, or plaque volumes. A doubling of CMV IgG concentrations was associated with any atherosclerosis (OR 1.21 [95% CI: 1.06–1.39]), obstructive CAD (OR 1.31 [95% CI: 1.07–1.59]), and higher total plaque volume (1.56 [95% CI: 1.21–2.01] fold increase), but the association did not remain significant after adjustment for traditional CAD risk factors. This indicates that CMV IgG serostatus and concentrations are not independently associated with prevalent CAD in PWH. Full article

Background/Objectives: This case study presents the complex management of a neonate with concurrent posterior urethral valves (PUV) and duodenal atresia (DA), highlighting diagnostic challenges due to overlapping and atypical imaging findings. Methods: A retrospective chart review was performed with a focus on pre- and postnatal imaging and clinical findings throughout the patient’s course of care. Results: A 32-week gestational referral revealed polyhydramnios, a double-bubble sign, and hydronephrosis. DA-associated polyhydramnios masked the expected oligohydramnios and other in utero sonographic signs of PUV, complicating prenatal diagnosis. Postnatally, early urethral stenting for DA repair obscured typical PUV imaging. PUV diagnosis was confirmed by cystoscopy on day 73. Conclusions: We emphasize the importance of multidisciplinary care and appreciating diagnostic uncertainties in neonates with concurrent obstructive uropathy and intestinal obstruction. Full article

Background and Objectives: Congenital duodenal obstruction (CDO) is a very rare anomaly with an incidence of 1 in 5000–10,000 live births. Annular pancreas is one of the reasons for CDO and is defined as the pancreatic tissue encircling the duodenum. The exact cause of annular pancreas remains unclear. Materials and Methods: A retrospective study was conducted on all prenatally diagnosed cases of CDO, with the diagnoses and ethiology confirmed by surgery after birth from 1 January 2018 to 1 January 2024. The cases suspected of having CDO in their fetuses underwent ultrasound evaluations on a weekly or biweekly basis. The cohort was divided into two groups, “CDO with annular pancreas” and “CDO without annular pancreas”, in order to compare the clinical characteristics and outcomes. Results: A total of 34 cases of CDO were detected prenatally, with 30 of these cases being confirmed through postnatal surgical interventions. The underlying ethiology was duodenal atresia in 15 cases (50%), duodenal web in 2 cases (6.6%) and annular pancreas in 13 cases (43.3%). All cases had a dilated stomach and double bubble sign. Polyhydramnios was identified in all cases except for one. Three cases were terminated and intrauterine demise was observed in one case. Nine of the cases (33%) died in the postnatal period. In 19 cases (55.9%), CDO was associated with chromosomal abnormalities. Chromosomal abnormalities were significantly more common in the cases of CDO with annular pancreas (p = 0.033). Conclusions: The prenatal diagnosis of CDO is mostly based on findings of double bubble and polyhydramnios. An annular pancreas, although rare, is an important cause of neonatal duodenal obstruction. An accurate diagnosis is usually performed during a laparotomy. Given the higher rates of chromosomal abnormalities in cases of annular pancreas, it is clear that more reliable markers or imaging techniques are needed to detect the ethiology of CDO in the prenatal period. Full article

Background/Objectives: Hydrophobic microparticles are one of the most versatile structures in drug delivery and tissue engineering. These constructs offer a protective environment for hydrophobic or water-sensitive compounds (e.g., drugs, peroxides), providing an optimal solution for numerous biomedical purposes, such as drug delivery or oxygen therapeutics. The intravascular administration of hydrophobic microparticles requires a safe-to-flow particle profile, which typically corresponds to a maximum size of 5 µm—the generally accepted diameter for the thinnest blood vessels in humans. However, the production of hydrophobic microparticles below this size range remains largely unexplored. In this work, we investigate the fabrication of hydrophobic microparticles at safe-to-inject and safe-to-flow sizes (<5 µm) for intravascular administration. Methods: Polycaprolactone microparticles (PCL MPs) are produced using a double-emulsification method with tip ultrasonication, for which various production parameters (PCL molecular weight, PCL concentration, type of stabilizer, and filtration) are optimized to obtain particles at sizes below 5 µm. Results: We achieve a PCL MP size distribution of 99.8% below this size limit, and prove that these particles can flow without obstruction through a microfluidic model emulating a thin human blood capillary (4.1 µm × 3.0 µm width × heigh). Conclusions: Overall, we demonstrate that hydrophobic microparticles can be fabricated at safe-to-flow sizes using a simple and scalable setup, paving the way towards their applicability as new intravascular injectables. Full article

Background/Objectives: This study was conducted to determine whether a structured clinical pathway can help to safely implement minimally invasive surgery (MIS) as the standard approach in surgery for acute bowel obstruction (ABO). Methods: A prospective analysis was performed on consecutive patients undergoing MIS for ABO at a single center in 2021 and 2022. Prior to the study onset, a structured treatment pathway was defined to apply MIS in all patients. The rate of success in the MIS and patient-, surgeon- and outcome-specific parameters with a focus on complication and conversion rates were analyzed. Results: Compared to a historical control group, the conversion rate from MIS to open surgery (OS) nearly doubled from 20.4% to 36.4% (p = 0.14). The complication rate in converted patients was 43.8% vs. 7.15% in non-converted patients (p < 0.05). Conclusions: A structured clinical pathway, including technical standardization and preoperative decisional processes, can be used to implement MIS as a primary surgical treatment in ABO. This is accompanied by high conversion rates and a significant increase in postoperative complications in patients undergoing conversion. Individual decision-making concerning the surgical approach remains paramount to prevent complications and high conversion rates. Full article