Search Results (3,654)

Corneal endothelial dysfunction is a leading cause of vision impairment globally, traditionally managed through donor-dependent keratoplasty procedures. However, limitations in donor tissue availability, surgical complexity, and long-term graft survival have prompted the development of cell-based regenerative therapies. Among these, corneal endothelial cells (CECs) injection therapy has emerged as a minimally invasive alternative, offering the potential to restore endothelial function. This review provides a comprehensive analysis of recent advances in bioengineering strategies for CECs therapy, including cell sourcing from donor tissue, pluripotent stem cells, and transdifferentiated somatic cells; optimization of culture conditions and substrates; and delivery protocols that enhance cell adhesion and survival. We further examine clinical trial outcomes and propose future directions for clinical translation. The convergence of cell biology, biomaterials engineering, and translational medicine positions CECs injection therapy as a transformative solution to corneal blindness. Full article

Background/Objectives: Minimally invasive direct coronary artery bypass (MIDCAB) surgery, performed through a left minithoracotomy, has emerged as an alternative to conventional coronary artery bypass grafting (CABG), which requires a full sternotomy. This procedure is ideal for patients with isolated proximal left anterior descending (LAD) artery disease or high surgical risk. The aim of this study was to assess the long-term clinical outcomes of MIDCAB performed at a single center with stratification by revascularization strategy. Methods: A total of 480 patients who underwent off-pump MIDCAB between 2012 and 2024 at a single center were retrospectively analyzed and categorized into three distinct groups: complete revascularization (MIDCAB-CR), hybrid coronary revascularization (MIDCAB-HCR) and incomplete revascularization (MIDCAB-IR). Short- and long-term outcomes, including mortality, major adverse cardiac and cerebral events (MACCE) and LITA–LAD graft patency were evaluated. Median follow-up was 3.39 years. Results: In-hospital mortality was 1.4%. At a median follow-up duration of 3.39 years, the overall LITA–LAD graft patency was 94.4% with 5- and 10-year survival rates of 78% and 60%, respectively. MIDCAB-CR and MIDCAB-HCR groups showed comparable long-term survival and freedom from MACCE, both significantly better than those observed in the MIDCAB-IR groups. Conclusions: These findings support the safety and durability of MIDCAB as an effective revascularization strategy, especially when performed as complete or hybrid revascularization. Incomplete revascularization may be considered in selected high-risk patients but is associated with worse outcomes. Full article

Background: The rising prevalence of gastric, biliary, and pancreatic surgeries has led to an increasing population of patients with surgically altered anatomy (SAA). In this setting, conventional endoscopic retrograde cholangiopancreatography (ERCP) is often limited by anatomical barriers, resulting in high rates of technical failure and complications. While device-assisted enteroscopy (DAE) has expanded therapeutic possibilities, its efficacy remains modest in complex reconstructions. Methods: This review analyzed recent literature from PubMed, Embase, and Scopus up to April 2025, focusing on diagnostic and therapeutic roles of endoscopic ultrasound (EUS) in SAA. Particular attention was given to cases where standard endoscopic, percutaneous, or surgical techniques failed and to studies comparing EUS-guided approaches with alternative modalities. Results: EUS has transitioned from a primarily diagnostic modality to a versatile therapeutic platform in SAA. Techniques such as EUS-guided rendezvous, antegrade drainage, and hepaticogastrostomy have shown technical and clinical success rates exceeding 80–90%, often comparable or superior to interventional radiology, while reducing the need for external drains. Innovative procedures, including EUS-directed transgastric ERCP (EDGE) and EUS-directed enteroenteric bypass (EDEE), have transformed the management of Roux-en-Y gastric bypass and bilioenteric anastomoses, providing durable and reusable access for repeated interventions. Despite these advances, EUS-guided interventions remain technically demanding, requiring advanced endoscopic and radiologic skills, specialized devices, and are best performed in tertiary referral centers. Conclusions: EUS has redefined the treatment paradigm of biliopancreatic diseases in patients with SAA, increasingly emerging as the preferred minimally invasive approach when conventional techniques fail. Future developments will focus on dedicated devices, standardized guidelines, and structured training programs to optimize outcomes. Multidisciplinary collaboration and centralization in high-volume centers remain essential to ensure safety, efficacy, and reproducibility. Full article

Although sustainability has become a central concern in project management research, its integration into enterprise risk practices in construction remains limited. This study investigates the complex set of barriers preventing effective implementation of Sustainable Enterprise Risk Management (SERM) within the construction industry of the United Arab Emirates (UAE). SERM focuses on maintaining the system’s long-term effectiveness, adaptability, and resilience. As projects across the region expand in scale and complexity, the need for resilient and sustainability-aligned risk practices has become increasingly urgent. To address this gap, a structured four-stage methodology was adopted. A Systematic Literature Review identified 28 potential barriers, which were refined through a Delphi process to 16 validated barriers. Interpretive Structural Modeling (ISM) and MICMAC analysis were then used to explore their hierarchical relationships and mutual influence. The ISM–MICMAC results showed that weak governance and limited organizational awareness reinforce communication and procedural challenges, while technology-related constraints remain highly dependent within the hierarchy. The sixteen barriers were categorized under four dimensions: leadership, culture, resources, and technology to clarify their structural relationships and dominant influence levels. Among these, the lack of senior management commitment (C01) emerged as the most influential barrier, exerting the strongest driving power (16) and lowest dependence (1), positioning it as the root cause affecting the rest. These findings highlight the need for leadership-driven strategies to embed long-term sustainability within organizational risk governance. The study offers practical direction for policymakers, contractors, and project leaders seeking to strengthen resilience and sustainable risk practices in the UAE construction sector. Full article

The indications for biliary drainage in cases of pancreatic head tumors with biliary obstruction are well established. ERCP with stent placement has long been the gold standard technique, outperforming surgery or percutaneous drainage. However, in cases of distal malignant biliary obstruction, ERCP becomes more complex, increasing the risk of complications. The advent of therapeutic endoscopic ultrasound (EUS), particularly EUS–choledochoduodenostomy (EUS-CDS) and EUS–hepaticogastrostomy (EUS-HGS), has transformed the management of distal malignant biliary obstruction in the case of pancreatic cancer. EUS-CDS creates communication between the duodenum and the common bile duct. Lumen-apposing metal stents (LAMSs) simplify the procedure, offering high technical and clinical success rates and making the technique easier to perform. Nevertheless, long-term dysfunction rates remain high, necessitating careful definition of procedural indications. EUS-HGS, a more complex technique, connects dilated left bile ducts to the stomach and requires advanced expertise; it is associated with a higher rate of complications. However, its clinical efficacy and technical success are comparable to those of EUS-CDS, and it is the preferred technique in cases of duodenal obstruction or altered anatomy. European and American guidelines currently position EUS-guided biliary drainage (EUS-BD) as a second-line approach after ERCP failure or when ERCP is not feasible, but there is a growing trend toward earlier use. Other techniques are emerging, such as EUS-guided gallbladder drainage (EUS-GBD) and combining EUS-HGS with antegrade stenting, offering valuable alternatives when conventional techniques fail or are inaccessible. Full article

Giant cell arteritis (GCA) and Takayasu arteritis (TAK) are forms of primary large vessel vasculitis (LVV) affecting the aorta and its major branches. Timely diagnosis and accurate monitoring are essential to prevent irreversible damage. Current assessment strategies rely heavily on symptoms, physical examination, and inflammatory markers, which lack sensitivity and specificity, particularly in patients treated with IL-6 inhibitors. This narrative review provides a comprehensive overview of the role of imaging in monitoring LVV. Ultrasound, magnetic resonance imaging, and positron emission tomography better reflect disease activity and treatment response compared to conventional clinical and laboratory measures. Notably, emerging imaging-based tools such as the OMERACT GCA Ultrasound Score, the Takayasu Ultrasound Index, and the TAK Integrated Disease Activity Index (TAIDAI) are promising treat-to-target instruments. While computed tomography is primarily used to assess structural damage, conventional angiography now plays a more limited role, mainly reserved for procedural planning and haemodynamic evaluation. A key challenge remains: interpreting persistent vascular abnormalities, which may indicate active disease, vascular remodelling, or irreversible damage. Standardisation of imaging protocols and interpretation is needed, alongside further research on the prognostic value of imaging for relapse risk. This review supports a multimodal, patient-tailored approach in which imaging is central to the long-term management of LVV. Full article

The growing demand for improved interruption performance characteristics in emerging aircraft high-voltage direct current (HVDC) electrical networks motivates the rapid development of solid-state power controllers (SSPCs). This article presents a comprehensive design procedure for a 270 V 300 A SSPC utilizing discrete SiC cascode devices. Due to the high fault current and limited power of single switches, parallel SiC FETs are essential for interrupting high fault currents in SSPCs. Consequently, the challenge of current balancing among parallel devices is addressed in this paper by adopting a passive current balancing strategy based on an irregular-shaped busbar. Furthermore, considering the voltage spikes arising from the power loop parasitic inductance and TVS characteristics during fault interruption, an RC-TVS-based transient voltage mitigation circuit is proposed to suppress these peak voltages. Moreover, thermal models for overload and short-circuit conditions were developed to optimize the thermal management system to ensure reliable operation of the SSPC. Finally, a prototype of 270 V/300 A SSPC has been built to validate the key characteristics of the proposed high power SSPC. Full article

Arthroscopic shoulder surgery has undergone significant evolution over the past decades, particularly in the materials used for suture anchors. The transition from metallic to bioabsorbable polymer anchors has revolutionized soft tissue-to-bone repair procedures, offering distinct advantages in terms of biocompatibility, imaging compatibility, and reduced complications. This comprehensive review examines the current state-of-the-art in anchor polymers used in arthroscopic shoulder surgery and their biocomposite formulations. Additionally, we explore the role of biostable polymers and emerging technologies in anchor design. The review synthesizes clinical outcomes, degradation kinetics, biocompatibility profiles, and mechanical properties of various anchor polymer systems. We also discuss the challenges associated with each material type, including osteolysis, cyst formation, premature degradation, and osseointegration. Recent advances in biocomposite anchors demonstrate promising solutions to address these limitations, offering controlled degradation rates and enhanced osteoconductivity. This review provides clinicians and researchers with a comprehensive understanding of anchor polymer technologies, their clinical applications, and future directions in arthroscopic shoulder surgery. Nevertheless, potential publication bias and heterogeneity among studies should be considered when interpreting comparative data. Full article

Microplastics (MPs) are emerging airborne pollutants that can migrate through various environmental pathways, with air representing one of the most critical exposure routes. Their occurrence within suspended particulate matter (PM)—a major atmospheric pollutant associated with respiratory, cardiovascular, and neurological diseases—further amplifies the risks posed by air pollution. The main sources of airborne MPs include tire and road wear, degradation of larger plastic debris, and wind-driven resuspension from soil and landfills. This review provides a comprehensive synthesis of current knowledge on airborne MPs, integrating methodological and toxicological perspectives. It summarizes sampling and separation procedures (filtration, chemical digestion, density separation) and analytical techniques for qualitative and quantitative identification. Particular emphasis is placed on the toxicological implications of MPs, including oxidative stress, inflammatory responses, and potential carcinogenicity, as revealed by in vitro and mechanistic studies. In light of the absence of standardized methodologies, this work highlights the urgent need for harmonized protocols linking environmental monitoring with biological toxicity assessment. By combining information on analytical workflows and cellular responses, this review serves as a key reference for developing environmentally relevant experimental designs and evaluating health risks associated with airborne microplastics. It therefore bridges the gap between environmental analysis and toxicological research, outlining future priorities for methodological standardization and risk assessment. Full article

Pancreaticobiliary endoscopy, encompassing endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP), and digital single-operator cholangioscopy (DSOC), is essential for diagnosing and managing pancreatic and biliary diseases. However, these procedures are limited by operator dependency, variable diagnostic accuracy, and technical complexity. Artificial intelligence (AI), particularly through machine learning (ML) and deep learning (DL), has emerged as a promising tool to address these challenges. Early studies show that AI can enhance lesion detection, improve differentiation of pancreatic masses, classify cystic lesions, and aid in diagnosing malignant biliary strictures. AI has also been used to predict post-ERCP pancreatitis risk and reduce radiation exposure during ERCP. Despite this promise, current AI models are largely experimental—limited by small, single-center datasets, lack of external validation, and no FDA-approved systems for these indications. Major barriers include inconsistent data acquisition, limited interoperability across hardware platforms, and integration into real-time workflows. Future progress depends on multicenter data sharing, standardized imaging protocols, interpretable AI design, and regulatory pathways for model deployment and updates. AI can be developed as a valuable partner to endoscopists, enhancing diagnostic accuracy, reducing complications, and supporting more efficient, personalized care in pancreaticobiliary endoscopy. Full article

Background/Objectives: Primary cleft lip repair is a procedure to restore lip function and harmonious nasolabial appearance. However, the actual effects on nasolabial appearance have been insufficiently investigated. The aim of this study was therefore to critically review surgical results using well-validated objective and subjective methods and standardised outcome measures. Methods: A total of 26 non-syndromic patients with unilateral cleft lip +/− cleft palate were assessed retrospectively. Uniform 2D photographs of the nasolabial region were objectively analysed using SymNose software. The Cleft Aesthetic Rating Scale was employed for the subjective evaluation by a total of 255 observers with different backgrounds and experience levels in cleft surgery. Results: Significant positive correlation was identified between objective measurement of upper lip asymmetry and subjective assessment (p = 0.02). Furthermore, a significant difference emerged in the assessment of the nasolabial region depending on the rater’s professional background (p < 0.001). A major discrepancy was observed between the rating of maxillofacial consultants and those of laypersons and patients affected by cleft lip +/− cleft palate. Conclusions: The evaluation of attractiveness depends significantly on the professional background of the observer. The more interaction people have with individuals after cleft lip repair, the less they consider the aesthetics conspicuous. Achieving the highest possible postoperative nasolabial symmetry should be a main objective in primary cleft lip repair. Full article

The management of antithrombotic agents in patients undergoing urgent gastrointestinal (GI) endoscopy presents a common and complex clinical challenge. The use of anticoagulants and antiplatelet therapies, especially in older patients with significant comorbidities, has increased substantially in recent decades due to the rising prevalence of cardiovascular and thromboembolic diseases. Balancing the risk of ongoing hemorrhage against the potentially life-threatening consequences of thrombosis remains a delicate and critical clinical decision. This review provides a practical, evidence-based approach to the periprocedural management of antithrombotic therapy in urgent endoscopy, particularly in the context of acute GI bleeding. We summarize the indications, pharmacokinetics, and reversal strategies for commonly used agents, including warfarin, direct oral anticoagulants (DOACs), low-molecular-weight heparin, aspirin, and P2Y12 inhibitors. Risk stratification is discussed in detail, considering both the urgency and bleeding risk of endoscopic procedures, as well as the thromboembolic risk associated with temporary drug interruption. Special considerations are given to high-risk patients, such as those with recent coronary stents, mechanical heart valves, or atrial fibrillation with elevated stroke risk scores. Close consultation and collaboration with other specialties, including cardiology and hematology, is often essential to optimize patient outcomes. Recommendations based on real-world clinical experience alongside formal guideline directives aim to support safe and timely endoscopic intervention without compromising systemic thrombotic protection, especially in emergent situations. Full article

Cardiovascular diseases remain the leading cause of death worldwide and are often managed through invasive surgical procedures such as heart transplantation, ventricular assist device implantation, coronary artery bypass grafting, and stent placement. However, significant unmet medical needs persist in this field. The development of pharmaceutical agents using non-invasive delivery strategies is therefore of critical importance. Current treatments often target peripheral tissues or organs—such as capillary endothelial cells, vascular smooth muscle, and renal tubules—to reduce cardiac workload by lowering blood pressure. However, effective drug delivery directly to the myocardium continues to pose a significant challenge. For conditions such as congestive heart failure (CHF) and myocardial infarction (MI), targeted delivery of therapeutic agents to the heart is essential. In this perspective review, I discuss the potential and emerging strategies for non-invasive cardiac drug delivery, focusing on receptor-mediated endocytosis and transcytosis using nanoparticle-based delivery systems that have frequently been employed for targeting the brain or cancer cells although their use for cardiac delivery remains largely unexplored. Full article

Background and Objectives: Chronic migraines are a disabling neurological disorder with limited response to preventive pharmacological treatments. Greater occipital nerve (GON)-targeted radiofrequency (RF) procedures have emerged as promising interventions, yet long-term comparative data between pulsed RF (PRF) and continuous-lesion RF (LesionRF) remain scarce. This study evaluated the 12-month efficacy and safety of PRF versus LesionRF. Materials and Methods: A single-center cohort of 211 patients with chronic migraine diagnosed by ICHD-3 criteria (PRF = 107; LesionRF = 104) was analyzed. All patients had a positive diagnostic block and ≥12 months of follow-up. Interventions were performed under ultrasound guidance with standardized protocols (PRF: 42 °C, 4 min, 45 V; LesionRF: 80 °C, 90 s). The primary outcome was a change in monthly migraine days (MMD), while secondary outcomes included responder rates (≥50% MMD reduction), pain intensity (VAS), functional outcomes (HIT-6, MIDAS), quality of life (SF-36, EQ-5D), medication use, retreatment, and complications. Results: Both groups improved, but LesionRF showed greater benefit. At 12 months, LesionRF achieved a larger MMD reduction (−4.8 days vs. PRF, p < 0.001), higher responder rates (83% vs. 65%, p = 0.01), and greater VAS decreases (−1.6, p < 0.001). Functional and quality-of-life scores improved more with LesionRF, with MIDAS reductions surpassing MCID and responder rates meeting PASS. Retreatment was less frequent with LesionRF (8% vs. 19%; HR 2.15, p = 0.037), and two LesionRF patients (1.9%) developed hematomas that resolved conservatively. Conclusions: Compared with PRF, LesionRF provided more sustained and clinically meaningful benefits for chronic migraines. Both approaches appeared to be safe, though confirmation in larger randomized trials is warranted. Full article

Fuchs endothelial corneal dystrophy (FECD) is the leading cause of endothelial failure requiring keratoplasty in industrialised nations. Descemet membrane endothelial keratoplasty (DMEK) has become the gold-standard surgical therapy, yet it is constrained by limited donor tissue and a steep learning curve. This narrative review summarises current and emerging therapeutic strategies for FECD. We describe conventional endothelial keratoplasty and its outcomes, tissue-sparing procedures such as descemetorhexis without endothelial keratoplasty (DWEK) and quarter-DMEK, regenerative approaches including cultured endothelial cell injection and synthetic corneal substitutes, and adjunctive innovations ranging from Rho-associated kinase inhibitors to artificial intelligence-assisted diagnostics. Challenges surrounding donor shortages, variable clinical outcomes, regulatory hurdles and cost are critically appraised. We conclude by outlining future directions that are likely to combine advanced surgical techniques with cell-based and biomaterial solutions to deliver accessible, long-term restoration of vision for patients with FECD. Full article