Search Results (3,597)

Diabetic retinopathy (DR) is a leading cause of vision loss worldwide and represents a complex neurovascular complication of diabetes mellitus driven by chronic hyperglycemia. Increasing evidence identifies oxidative stress—defined as an imbalance between reactive oxygen species (ROS) production and antioxidant defenses—as a central pathogenic mechanism linking metabolic dysregulation to retinal injury. The retina is particularly vulnerable to oxidative damage due to its high metabolic demand, elevated oxygen consumption, and abundance of polyunsaturated fatty acids. Hyperglycemia activates multiple interconnected biochemical pathways, including the polyol and hexosamine pathways, protein kinase C signaling, advanced glycation end-product formation, and lipid peroxidation, all of which converge on excessive ROS production and mitochondrial dysfunction. Growing attention has focused on oxidative stress biomarkers as tools to characterize DR severity and progression. Elevated systemic markers of lipid, protein, and DNA oxidation, together with impaired antioxidant capacity, correlate with disease stage, while oxidative biomarkers detected in aqueous and vitreous humor reflect localized retinal injury. Importantly, oxidative stress biomarkers are also associated with functional outcomes, including best-corrected visual acuity and diabetic macular edema. Integration of systemic and ocular oxidative biomarkers with clinical staging may improve risk stratification and support personalized therapeutic strategies in DR. Full article

Background: Severe lung compromise from COVID-19, ARDS, and recently AH3N2 can progress to life-threatening hypoxia. Past experience led to standardized protocols that assumed similarity to SARS-CoV. Methods: COVID-19 pathophysiology and histopathological lung biopsy photomicrographs are analyzed. Results: Pneumolysis is defined as progressive alveolar–capillary destruction resulting from SARS-CoV-2 attack on pneumocytes. In the final stages preceding pneumolysis, molecular mechanisms in the lungs include apoptosis in alveolar epithelial type I and II cells, compromising alveolar regeneration, and necrosis, resulting in leakage of intracellular contents and amplifying inflammation. Pyroptosis, driven by inflammasome activity, further disrupts alveolar integrity in ARDS. Histopathological findings include Masson bodies, alveolar-coating cells with nuclear atypia, reactive pneumocytes and reparative fibrosis, intra-alveolar hemorrhage, moderate inflammatory infiltrates and abscesses, microthrombi, hyaline membrane remnants, and emphysema. The three theoretical pathophysiological stages of progressive hypoxemia (silent hypoxemia, gasping, and death zone) are shown. Conclusions: Silent hypoxemia rapidly progresses to critical hypoxemia. This progression results from progressive pneumolysis, inflammation, immune overexpression, autoimmunity, and HAPE-type edema, leading to acute pulmonary insufficiency. Long-lasting COVID-19 can result in fibrosis and, as a compensatory mechanism, polierythrocythemia. The proposed treatment (based on tolerance to hypoxia and the hemoglobin factor) includes prompt oxygen administration, control of inflammatory and immune responses, antibiotics, rehydration, erythropoietin and platelet aggregation inhibitors. Full article

Background and Clinical Significance: Left atrial myxoma is the most common benign primary cardiac tumor and is associated with embolic and hemodynamic complications. Complete surgical excision is the treatment of choice, while postoperative cardiovascular rehabilitation is essential for functional recovery. Case Presentation: We report the case of a 75-year-old woman with arterial hypertension, dyslipidemia, and chronic venous insufficiency (Clinical–Etiological–Anatomical–Pathophysiological (CEAP) class 2), and chronic hepatitis B virus (HBV) infection who underwent surgical excision of a left atrial myxoma and was subsequently admitted three weeks postoperatively for phase II cardiovascular rehabilitation. The postoperative course was complicated by transient atrial fibrillation, peripheral edema, pleural effusion, and progressive purpuric lesions of the lower limbs. Laboratory and immunological evaluation revealed positive cryoglobulins, markedly elevated rheumatoid factor (1058 UI/mL) and IgM levels (715 mg/dL), reduced complement levels (C3, C4), normocytic normochromic anemia, microscopic hematuria, and elevated ALT (156 U/L), AST (142 U/L), total bilirubin (1.4 mg/dL), and INR (1.6), suggestive of hepatic inflammatory activity. HBV status was scheduled for evaluation through Gastroenterology referral (HBV DNA viral load, serological markers: HBsAg, HBeAg, anti-HBe), as our Cardiology Rehabilitation Clinic lacks the possibility of evaluation. After systematic exclusion of alternative etiologies, secondary cryoglobulinemic vasculitis in the context of chronic HBV infection with biochemical evidence of hepatic activity was considered the most plausible diagnosis. Conclusions: This case highlights the complexity of managing elderly patients after cardiac tumor surgery, particularly in the presence of systemic comorbidities. Early recognition of extracardiac complications and an individualized, multidisciplinary strategy are essential to optimize outcomes. Full article

Escherichia coli, Streptococcus equi subsp. zooepidemicus, Klebsiella oxytoca, and Enterococcus durans are microorganisms capable of causing severe infections, particularly in patients with underlying comorbidities or immune dysfunction. We report a rare clinical case of a 65-year-old man with advanced cardiac and hepatic disease who developed severe diarrheal syndrome followed by septic shock, rapid clinical deterioration, and death. Microbiological examination of autopsy specimens from the intestinal wall and spleen identified Escherichia coli O128 with an enterotoxigenic profile (lt+, st+, eae−), together with Streptococcus equi subsp. zooepidemicus, Klebsiella oxytoca, and Enterococcus durans. Histopathological analysis demonstrated catarrhal enteritis with fibrinous deposits, mucosal edema, vascular congestion, and inflammatory infiltration. Although the microbiological findings were partly derived from autopsy material and postmortem bacterial translocation cannot be completely excluded, the concordance between clinical presentation, laboratory findings, and morphological changes supports the presence of a clinically significant infectious process. To our knowledge, this is the first reported human case of fatal polymicrobial infection involving these four pathogens. The case highlights the potential severity of polymicrobial infections in patients with cirrhosis-associated immune dysfunction and underscores the importance of integrated microbiological and molecular diagnostics for accurate etiological assessment. Full article

Protein-losing enteropathy (PLE) is an uncommon and often underrecognized manifestation of lymphoproliferative disorders and may be difficult to diagnose when conventional gastrointestinal investigations are unrevealing. We present an 82-year-old woman with recurrent hospital admissions initially spanning six months for diarrhea, weight loss, peripheral edema, and persistent hypoalbuminemia. Initial upper gastrointestinal endoscopy was normal, and colonoscopy was deferred due to intercurrent infection. Despite extensive laboratory and radiologic evaluation, including routine biochemical testing and imaging, the etiology of PLE remained unclear. Peripheral blood flow cytometry subsequently identified a small kappa-restricted monoclonal B-cell population compatible with marginal zone lymphoma, later confirmed on bone marrow biopsy, raising suspicion for gastrointestinal involvement. Video capsule enteroscopy demonstrated diffuse erosive and ulcerative disease throughout the small intestine, providing an anatomical explanation for the patient’s protein loss. Following lymphoma-directed therapy, repeat capsule enteroscopy showed complete normalization of the small bowel mucosa. This case highlights the diagnostic value of combining peripheral blood flow cytometry and capsule endoscopy in unexplained protein-losing enteropathy, a rare and diagnostically challenging presentation of indolent lymphoma, and illustrates the role of capsule imaging in both disease localization and treatment monitoring. As a single-case report, these findings are not generalizable, and further studies are required to evaluate the broader applicability of this diagnostic approach. Full article

Background: Sutureless intrascleral intraocular lens (IOL) fixation using the Yamane technique is an option for visual rehabilitation in eyes without capsular support. The aim of this study is to report long-term visual outcomes and clinical predictors in consecutive real-world cohorts, a topic addressed by very few previous studies. Methods: This was a single-center, single-surgeon consecutive case series including 87 eyes of 85 patients who underwent Yamane SFIOL for aphakia or lens/posterior chamber IOL ectopia, with at least 12 months of follow-up. BCVA was measured using a Snellen chart and recorded in decimal notation. To identify predictors of postoperative BCVA, univariable screening was first performed, followed by a clinically driven multivariable linear mixed-effect regression. Results: Mean age was 68.2 ± 11.4 years, and 70.6% were male. Median follow-up was 26.5 months. Median BCVA improved from 0.2 ± 0.2 (range 0.001–1.0) preoperatively to 0.9 ± 0.2 (range 0.2–1.0) postoperatively (p < 0.001). Surgical indication and preoperative comorbidity burden were not linked to postoperative BCVA. In the multivariable analysis, older age (B = −0.005, p = 0.027), macular edema (B = −0.242, p = 0.035), and prior silicone oil removal (B = −0.237, p = 0.046) independently predicted lower postoperative BCVA. Conclusions: Yamane SFIOL provides significant long-term visual improvement, with outcomes mainly determined by patient age and retinal status. This study offers new data on functional outcomes and clinically relevant predictors in a consecutive real-world cohort, supporting the reliability and long-term efficacy of sutureless scleral IOL fixation. Full article

Tributyltin (TBT) is well known for inducing imposex in mollusks. Studies have shown its hepatotoxicity and immunotoxicity in laboratory animals, with macrophages playing a crucial role in maintaining hepatic homeostasis and influencing disease progression; however, no research has yet explored its effects on hepatotoxicity and immunotoxicity based on hepatic macrophages. To address this gap, weaned rats were treated with corn oil or TBT (0.5, 5, or 50 μg/kg) via oral gavage every three days for 60 days. Liver sections were then subjected to hematoxylin and eosin staining, Oil Red O staining, Sirius Red staining, immunohistochemistry, and immunofluorescence to assess the effects of TBT. Hepatic function and inflammatory state were evaluated by serum biochemistry and quantitative reverse transcription-PCR (qPCR), respectively. Histological examination indicated that TBT exposure did not increase hepatic lipid accumulation but resulted in hepatocyte edema and congestion in the 5 and 50 μg/kg groups, accompanied by progressive hepatic fibrosis. In parallel, 50 μg/kg TBT increased the number of macrophages, driven by an increase in the CD206⁺CD68⁺ subset. qPCR analysis revealed a significant decrease in the expression of pro-inflammatory cytokines (such as IL-1β and TNF-α), confirming an immunosuppressive state in the livers of rats exposed to TBT. Moreover, the significant increase in serum ALT activity further revealed hepatic injury induced by 50 μg/kg TBT. In summary, TBT exposure restructures the hepatic immune microenvironment, promoting the progression of liver fibrosis independently of fat accumulation in rats. Full article

Background: Polysubstance use, particularly the combination of opioids and stimulants, represents a growing public health concern due to its high risk of severe multisystem complications and mortality. Here, we present a case illustrating the lethal synergy of opioid–stimulant co-use. Methods: A 37-year-old male with chronic Hepatitis C and documented polysubstance use reported recent use of fentanyl, cocaine, methamphetamine, and cannabis. He presented with generalized weakness, left lower limb pain, tense edema, and anuria. Clinical assessment included monitoring of vital signs, physical examination, capillary blood gas analysis, extended laboratory panels (muscle and cardiac enzymes, electrolytes, and coagulation parameters), urinalysis, and Doppler imaging. Management over five days included intravenous hydration, diuretics, urinary alkalinization, electrolyte correction, anticoagulation, metabolic and vitamin therapy, hemodialysis, and comprehensive supportive care. Results: Laboratory evaluation revealed massive rhabdomyolysis (peak CK 161,050 U/L), severe hyperkalemia (K⁺ 8.4 mmol/L), metabolic acidosis, acute kidney injury with oligoanuria, and left-sided deep vein thrombosis. Despite intensive multidisciplinary interventions, the patient’s repeated refusal of ongoing treatment critically contributed to a fatal outcome. Conclusions: This case underscores the high mortality risk associated with opioid–stimulant co-use and the crucial impact of treatment refusal. Clinicians and public health stakeholders should recognize the rapid progression of multisystem dysfunction in polysubstance users and prioritize early, aggressive interventions combined with patient engagement strategies to mitigate fatal outcomes. Full article

Non-invasive assessment of tissue water content is clinically relevant for edema detection, fluid management, and monitoring of local inflammation. In the short-wave infrared (SWIR), water exhibits strong absorption near 1450 nm with a secondary band near 1650 nm, enabling hydration-sensitive reflectance measurements. However, many SWIR systems rely on spectrometers or high-power broadband sources, limiting translation to compact or wearable platforms. We present a compact SWIR diffuse-reflectance probe built from small-form-factor components using four discrete LEDs (1450 nm and 1650 nm) and a single photodetector to acquire spatially resolved measurements at two source–detector separations (4.5 mm and 7 mm). Probe-geometry-matched Monte Carlo simulations were used to generate lookup tables relating reduced scattering to same-wavelength spatial ratios. A diffusion-based forward model was then used to perform a calibration-anchored water-fraction consistency analysis. Eight gelatin–Intralipid phantoms spanning two scattering conditions and formulation-defined water fractions were evaluated. Spatial-ratio signatures were repeatable and monotonic with nominal water fraction, yielding a mean absolute percent error of 1.55% and a maximum absolute percent error of 3.33% under absorption-consistent conditions. These results demonstrate the feasibility of compact SWIR ratio sensing for controlled hydration changes in tissue-mimicking phantoms and provide a modeling framework for future extension to unknown or in vivo samples. Full article

Background and Clinical Significance: Decompressive hemicraniectomy (DHC) is a life-saving intervention for malignant middle cerebral artery (MCA) infarction, but postoperative secondary injury mechanisms and functional outcome remain difficult to evaluate using intracranial pressure (ICP) alone. The pressure reactivity index (PRx), calculated as the moving correlation coefficient between ICP and mean arterial pressure (MAP), provides a measure of cerebral autoregulation. The utility of PRx monitoring in ischemic stroke, especially following DHC, remains uncertain. Case Presentation: We describe two patients presenting with acute ischemic stroke in the MCA territory who underwent DHC followed by postoperative ICP and PRx monitoring. Case 1 is a 40-year-old female with a left proximal MCA occlusion initially treated with endovascular thrombectomy (EVT) who required emergent DHC due to re-occlusion. Postoperatively, ICPs remained controlled, and PRx values were favorable (<0.2), indicating preserved cerebral autoregulation. She later showed moderate neurological improvement. Case 2 was a 68-year-old female with a left proximal MCA occlusion treated with EVT who developed worsening cerebral edema and midline shift, necessitating emergent DHC. Despite adequate ICP control, PRx values remained markedly elevated (0.45 to 0.73), consistent with impaired cerebral autoregulation, and her neurologic state remained poor at discharge. Conclusions: These contrasting cases suggest that PRx may provide physiologic information not reflected by ICP metrics alone post-DHC. PRx monitoring may provide complementary physiologic insight into postoperative autoregulatory status following DHC. Further investigation is warranted to define its role in individualized post-DHC management and prognostication in malignant ischemic stroke. Full article

Background/Objectives: Photobiomodulation (PBMT) has been shown to improve tissue healing; however, the best protocol for different clinical challenges is not clearly determined. Despite the good previous outcomes of the PBMT in healing of the third molar surgical sites, the ideal protocol of PBMT was not determined. The objective of this split-mouth double-blinded randomized clinical trial was to compare the effect of photobiomodulation (PBMT) with red and infrared wavelengths combined and PBMT with only red wavelength on the healing of post-extraction alveoli of third molars. Methods: Twenty patients underwent third molar extraction. The alveoli were treated randomly in a split mouth model with: PBMT with red laser (R-PBMT) or PBMT with red and infrared laser combined (IR-R-PBMT). PBMT was applied immediately, and 3 and 7 days after surgery. Patients were clinically evaluated in relation to repair (bleeding, exudate, color, and consistency of the tissues), degree of the edema, and through the application of a VAS scale (pain, edema, bleeding, chewing, and mouth opening) in the baseline period, and 3, 7, 14, 30, and 90 days after the surgical procedure. In addition, bone tissue density and structure were measured by radiographic analysis at 7 and 90 days postoperatively. Results: Clinical analysis showed that IR-R-PBMT induce more reduction in the edema 7 days after surgery compared with the R-PBMT; however, no significant differences were noted between groups in other parameters. Conclusions: IR-R-PBMT reduces the edema after 7 days of third molar extraction compared with the R-PBMT. Registration: This study was registered with the Brazilian Registry of Clinical Trials (REBEC-RBR-103g7j28; date of registration 12 July 2023) under number U1111-1297-6962. Full article

The opportunistic pathogen Pseudomonas aeruginosa poses a serious threat to immunocompromised patients. Monosodium glutamate (MSG), a widely used flavor enhancer, has been reported to possess anti-inflammatory and antioxidant properties. However, its therapeutic potential and mechanism against Pseudomonas aeruginosa (P. aeruginosa) infection have remained unexplored. This study systematically elucidated the protective effects and molecular mechanisms of MSG against P. aeruginosa-induced acute lung injury (ALI). In a murine pneumonia model, MSG administration effectively alleviated lung pathological damage, edema, and inflammatory responses. Mechanistically, MSG exerted protection through a multifaceted strategy, including direct suppression of bacterial virulence via binding to PopB of T3SS inhibition of the TLR4/MyD88/MAPK-driven inflammatory cascade and pro-inflammatory cytokine production, enhancement of endogenous antioxidant defense (SOD, CAT), and reshaping of pulmonary macrophages from the M1 to M2 phenotype. Notably, the anti-virulence effect of MSG, achieved by binding to PopB (K_D = 3.52 × 10⁻⁶ M), presented a distinct advantage over traditional antimicrobials by potentially mitigating resistance development. Collectively, these findings indicated that MSG can alleviate ALI caused by P. aeruginosa infection. Full article

Background/Objectives: The role of pre-treatment breast magnetic resonance imaging (MRI) findings and apparent diffusion coefficient (ADC) values in predicting pathologic complete response (pCR) in breast cancer patients receiving neoadjuvant chemotherapy (NAC) has not yet been sufficiently clarified, especially in the context of molecular subtype differences. In this study, we questioned whether these imaging parameters were independent predictors of pCR. Methods: This study retrospectively explored MRI characteristics of 188 patients who underwent NAC from 2015 to 2023. The patients were divided into the pCR-positive and pCR-negative groups—the latter comprising patients with partial response (n = 61) and stable disease (n = 90)—and were classified into four molecular subtypes: Luminal A/B, HER2-enriched, and triple-negative breast cancer (TNBC). The MRI parameters included pre-chemotherapy T2-weighted signal characteristics, shape features, contrast kinetics, peritumoral edema, and ADC MIN/ADC MAX. Post-treatment ADC and ΔADC were the post-chemotherapy MRI parameters. Independent predictors were evaluated by logistic regression and discriminant performance by ROC analysis. Results: The overall pCR rate was 19.7%. In multivariate analysis, T2-weighted isointense signal (OR = 4.50), uniform tumor shape (OR = 12.83), HER2-enriched subtype (OR = 6.03), TNBC (OR = 5.15), ADC MIN (OR = 1.41), tumor size (OR = 1.28), and kinetic Type 3 pattern (OR = 3.21) were identified as independent predictors. Pre-treatment ADC MIN yielded an AUC of 0.724, while post-treatment ADC achieved 100% sensitivity and 96.7% specificity (AUC = 0.967). Conclusions: MRI morphology and ADC values may make a meaningful contribution to the prediction of pCR when evaluated in the context of molecular subtype. Post-treatment ADC demonstrated particularly strong discriminatory performance; however, external validation in multicenter cohorts is required before clinical implementation. Full article

Background: Burn injuries have both physical and psychological impacts on patients. Factors such as personal beliefs, prior experiences, and geographic, economic, or cultural barriers, as well as fear of hospitals, can contribute to delays in seeking specialized care. When combined with inadequate first aid or the inappropriate use of pharmaceutical or traditional remedies, these delays may worsen burn severity, prolong healing, and negatively affect quality of life. From a clinical perspective, delayed presentation following burn injury has been linked to burn wound progression, which increases the risk of local infection, hypertrophic scarring and prolonged functional impairment. Methods: This analytical cross-sectional study was conducted at the Clinical Emergency Hospital of Bucharest between January and September 2025. The primary objective was to characterize adult burn patients presenting more than 24 h after injury (Group A) and to describe self-reported psychosocial/behavioral characteristics and explore unadjusted patterns among delayed presenters. Data were collected from medical records and a structured questionnaire administered to delayed presenters. A secondary descriptive comparison was performed with patients presenting within 24 h (Group B) to provide contextual reference. Results: The majority of patients were male (62.2%) and of working age (18–65 years, 82.4%). Thermal burns from domestic accidents were most common (58.8%), with scalds predominating. Second-degree burns were the most frequent (60.5%), primarily affecting the upper and lower limbs. Mean total body surface area (TBSA) was low (2.86 ± 1.91%), although higher values were observed in radiation burns and closed-space accidents. More than half of the patients did not receive any first aid, while the remainder used various pharmaceutical or natural products, some of which were inappropriate for burn treatment. The main reasons for delaying specialized care were the expectation that injuries would heal spontaneously, negligence, and fear of the hospital. In contrast, escalating pain, edema, and family insistence were the primary motivators for seeking professional medical attention. Delayed presentation was associated with older burn lesions, higher burn severity and an increased likelihood of hospitalization or refusal of recommended admission. Conclusions: Burn injuries predominantly affect working-age males and most frequently arise from domestic thermal accidents. Delayed presentation and inadequate first aid are common and influenced by behavioral, social, and demographic factors. Targeted public education, improved first aid practices, and timely healthcare-seeking are essential to reduce burn severity and improve patient outcomes. Full article