Search Results (117)

Background: This study presents an innovative approach to cardiovascular disease (CVD) risk prediction based on a comprehensive analysis of clinical, immunological and biochemical markers using mathematical modelling and machine learning methods. Baseline data include indices of humoral and cellular immunity (CD59, CD16, IL-10, CD14, CD19, CD8, CD4, etc.), cytokines and markers of cardiovascular disease, inflammatory markers (TNF, GM-CSF, CRP), growth and angiogenesis factors (VEGF, PGF), proteins involved in apoptosis and cytotoxicity (perforin, CD95), as well as indices of liver function, kidney function, oxidative stress and heart failure (albumin, cystatin C, N-terminal pro B-type natriuretic peptide (NT-proBNP), superoxide dismutase (SOD), C-reactive protein (CRP), cholinesterase (ChE), cholesterol, and glomerular filtration rate (GFR)). Clinical and behavioural risk factors were also considered: arterial hypertension (AH), previous myocardial infarction (PICS), aortocoronary bypass surgery (CABG) and/or stenting, coronary heart disease (CHD), atrial fibrillation (AF), atrioventricular block (AB block), and diabetes mellitus (DM), as well as lifestyle (smoking, alcohol consumption, physical activity level), education, and body mass index (BMI). Methods: The study included 52 patients aged 65 years and older. Based on the clinical, biochemical and immunological data obtained, a model for predicting the risk of premature cardiovascular aging was developed using mathematical modelling and machine learning methods. The aim of the study was to develop a predictive model allowing for the early detection of predisposition to the development of CVDs and their complications. Numerical methods of mathematical modelling, including Runge–Kutta, Adams–Bashforth and backward-directed Euler methods, were used to solve the prediction problem, which made it possible to describe the dynamics of changes in biomarkers and patients’ condition over time with high accuracy. Results: HLA-DR (50%), CD14 (41%) and CD16 (38%) showed the highest association with aging processes. BMI was correlated with placental growth factor (37%). The glomerular filtration rate was positively associated with physical activity (47%), whereas SOD activity was negatively correlated with it (48%), reflecting a decline in antioxidant defence. Conclusions: The obtained results allow for improving the accuracy of cardiovascular risk prediction, and form personalised recommendations for the prevention and correction of its development. Full article

Background/Objectives: Robot-assisted radical cystectomy (RARC) has become the primary approach for treating bladder cancer, replacing the traditional open procedure. The robotic approach, when combined with ureterocutaneostomy (UCS), offers significant advantages for octogenarians, who are at increased risk for perioperative complications. Methods: This observational, prospective, multicenter analysis is based on data from the Italian Radical Cystectomy Registry (RIC), collected from January 2017 to June 2020 across 28 major urological centers in Italy. We analyzed consecutive male and female patients undergoing radical cystectomy (RC) and urinary diversion via the open, laparoscopic, or robot-assisted technique. Inclusion criteria: patients aged 80 years or older, with a WHO Performance Status (PS) of 2–3, an American Society of Anesthesiologist score ≥3, a Charlson Comorbidity Index (CCI) ≥ 4, and a glomerular filtration rate (GFR) <60 mL/min. Results: A total of 128 consecutive patients were included: 41 underwent RARC with UCS (Group 1), 65 open RC (ORC) with UCS (Group 2), and 22 laparoscopic RC (LRC) with UCS (Group 3). The cystectomy operative time was longer in robotic surgeries, while the lymph node dissection time was shorter. RARC with UCS showed statistically significant advantages in terms of lower median estimated blood loss (EBL), transfusion rate, and length of hospital stay (LOS) compared to open and laparoscopic procedures. Intra- and postoperative complications were also lower in the RARC groups. Conclusions: Robotic cystectomy in high-volume referral centers (≥20 cystectomies per year) provides the best outcome for fragile patients. Beyond addressing the baseline pathology, RARC with UCS may represent a leading option, offering oncological control while reducing complications in this vulnerable age group. Full article

Intraoperative cell salvage (ICS) is a blood conservation technique utilized in major surgery, yet its application in oncologic procedures remains debated. Concerns persist about the theoretical risk of metastasis through reinfusion of tumor cells, despite the established disadvantages of allogeneic blood transfusion (ABT), such as transfusion-related reactions and immunosuppression. In this review, we discuss the historical development of ICS, the technical processes of ICS including leukocyte depletion filtration and irradiation, and experimental and clinical data regarding its safety and efficacy. In vitro studies suggest that tumor cells undergo significant structural alterations during ICS processing, and additional filtration further reduces cell load, although complete removal is not always achieved. Observational studies of predominantly moderate quality, aggregated in multiple systematic reviews, consistently report no increased recurrence rates or reduced disease-free and overall survival in patients receiving ICS. Accordingly, national and international guidelines endorse the use of ICS during oncologic surgery. Although high-quality data—preferably from randomized controlled trials—are lacking, and certainty of available evidence from observational studies is low, ICS appears to be effective and safe. The broader adoption of its use during oncologic surgery may be warranted to minimize reliance on ABT and its associated risks. Full article

Background: Robotic surgical systems offer enhanced precision, motion scaling, tremor filtration, and visualization, making them highly suitable for the complex anatomical demands of plastic and reconstructive surgery. While widely implemented in other specialties, their integration in plastic surgery remains limited. This systematic review evaluates the clinical applications, outcomes, and limitations of robotic-assisted techniques in plastic and reconstructive procedures. Methods: Following PRISMA guidelines, a systematic search was conducted across PubMed, Embase, Scopus, and Web of Science for studies published between January 1980 and March 2025. Clinical studies reporting robotic applications in plastic surgery were included, while cadaveric, animal, and non-English studies were excluded. Data extraction and quality assessment were performed using Covidence and validated tools including the CARE checklist, NOS, GRADE, and SYRCLE. A total of 1428 studies were screened, and 31 met the inclusion criteria. Results: Robotic systems were primarily applied in microsurgery (n = 16), breast reconstruction (n = 8), and craniofacial/aesthetic surgery (n = 7). Common platforms included the Symani Surgical System, Da Vinci systems, and ARTAS. Robotic-assisted approaches improved precision, aesthetic outcomes, flap survival, and patient satisfaction, particularly in procedures involving lymphaticovenous anastomosis and nipple-sparing mastectomy. However, challenges included steep learning curves, longer operative times, high equipment costs, and the lack of haptic feedback. Quality assessment rated all studies as moderate. Conclusions: Robotic-assisted surgery demonstrates considerable potential in enhancing plastic and reconstructive outcomes. As systems become more compact, cost-effective, and integrated with AI and biomimetic technologies, their broader adoption is anticipated. Further high-quality studies are needed to optimize these systems and support widespread clinical implementation. Full article

Background and Objectives: Partial nephrectomy (PN) is the preferred option for treating localized cT1 renal cell carcinoma (RCC), as it preserves renal function in most patients and offers non-inferior oncological outcomes compared to radical nephrectomy. In this study, we aimed to construct a predictive model for estimating the glomerular filtration rate (GFR) at one year after PN in patients with RCC, using various machine learning techniques. Methods: Retrospective data were collected from two academic centers, covering surgeries performed between 2010 and 2022. GFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration 2021 (CKD-EPI) formula. Univariable linear regression (LR) was used to identify significant clinical predictors of 1-year postoperative GFR, followed by multivariable LR. The dataset was split into training and testing cohorts in a 70:30 ratio. Internal validation was performed on the test cohort, and various machine learning methods, including artificial neural networks (ANNs), support vector machines (SVMs), random forests (RFs), and XGBoost, were compared. Results: Among 615 patients treated with PN, 415 had complete follow-up GFR data and were included in the analysis. Only 8.7% of patients experienced significant GFR loss (>30% decrease) at 1 year. Multivariable LR identified baseline GFR (Estimate: 0.76, p < 0.001), tumor diameter on imaging (Estimate: −1.65, p = 0.005), and Charlson Comorbidity Index (Estimate: −1.95, p < 0.001) as independent predictors of 1-year GFR (R² = 0.67). A 10-fold cross-validation of the multivariable model yielded an R² of 0.68. In the testing cohort, ANN, SVM, RF, and XGBoost did not outperform the LR model, with R² values of 0.68, 0.66, 0.64, and 0.55, respectively. Conclusions: Preoperative factors, including baseline GFR, tumor size on imaging, and Charlson Comorbidity Index, are effective predictors of GFR at 1 year following PN. Our study demonstrates that a conventional LR model based on preoperative variables provides acceptable accuracy for predicting GFR after PN and is not inferior to more complex machine learning techniques. Full article

Background/Objectives: Patients with advanced heart failure (HF) often suffer from impaired kidney function. Based on the pathophysiology of types I and II of cardiorenal syndrome, heart transplantation (Htx) may restore renal function. The aim of this study was to identify predictors of improvement in kidney function after HTx. Methods: Htx patients from a tertiary hospital were retrospectively divided into three groups—improvement (n = 24), deterioration (n = 31) and no significant change in eGFR (n = 45)—based on changes in their mean estimated glomerular filtration rate (eGFR) within the first three postoperative months, compared to the last three preoperative months. The threshold for eGFR improvement was defined as a ≥20% increase, while deterioration was defined as a ≥20% decrease. The no significant change group was defined as any change falling between these two values. Results: The median age of analyzed cohort was 54 (45–63) years, and 82% were male. Preoperatively, the improvement group was more frequently treated with inotropes or vasopressors and had significantly higher blood urea and total bilirubin levels before Htx. In the multivariate analysis, total bilirubin before Htx (OR 1.66; 95% CI; 1.24–2.69; p = 0.002) and no need for RRT early after Htx (OR 0.46; 95% CI 0.24–0.88; p = 0.02) were independent predictors of improved kidney function in the first three months after HTx. Conclusions: The improvement in renal function after HTx is uncommon. It could be expected in patients suffering from more severe forms of HF, with impaired kidney and liver function but who did not need RRT after the surgery. Full article

Filtration surgery is highly effective in lowering intraocular pressure; however, it is associated with a higher risk of severe complications. Visual dysfunction may persist in relatively uneventful cases because of induced astigmatism or worsening optical aberrations. Therefore, for early- to moderate-stage glaucoma, an increasing number of surgeons are prioritizing surgical safety and preserving postoperative visual function by opting for minimally invasive glaucoma surgery (MIGS). Among the various MIGS techniques, canal-opening surgery—targeting aqueous outflow through the Schlemm’s canal (Schlemm’s canal-based MIGS, CB-MIGS)—has gained increasing popularity. Unlike filtration surgery, CB-MIGS does not require creating an aqueous outflow pathway between the intraocular and extraocular spaces. Consequently, it is considered a minimally invasive procedure with a reduced risk of severe complications and is increasingly being chosen for suitable cases. Although this surgical technique has limitations in lowering intraocular pressure, it avoids the manipulation of the conjunctiva or sclera and is primarily performed through a small corneal incision. Therefore, a minimal impact on induced astigmatism or postoperative refractive changes is expected. However, few reviews comprehensively summarize postoperative changes in visual function. Therefore, this study reviews the literature on visual function after CB-MIGS, focusing on changes in best-corrected visual acuity (BCVA), refraction, astigmatism, and the effectiveness of visual field preservation to assess the extent of these postoperative changes. Hyphema is the primary cause of early postoperative vision loss and is often transient in cases in which other complications would have led to visual impairment. Severe complications that threaten vision are rare. Additionally, compared with filtration surgery, postoperative visual recovery tends to be faster, and the degree of induced astigmatism is comparable to that of standalone cataract surgery. When combined with cataract surgery, the refractive error is at the same level as that of cataract surgery alone. However, in some cases, mild hyperopic shifts may occur because of axial length shortening, depending on the extent of intraocular pressure reduction. This possibility has been highlighted in several studies. Regarding the effectiveness of slowing the progression of visual field defects, most studies have focused on short- to medium-term postoperative outcomes. Many of these studies have reported the sufficient suppression of progression rates. However, studies with large sample sizes and long-term prospective designs are limited. To establish more robust evidence, future research should focus on conducting larger-scale, long-term investigations. Full article

Background/Objectives: Primary open-angle glaucoma (POAG) is an anterior optic neuropathy that can lead to irreversible vision loss if untreated. Prostaglandin analogues are the first-line treatment, but new drug classes, such as rho kinase (ROCK) inhibitors, are being explored. This review evaluates the efficacy and safety of ROCK inhibitors in treating POAG based on completed trials, comparing results with available natural history data and identifying areas for further research. Methods: A systematic database search was conducted in Ovid MEDLINE and Ovid Embase on 5 April 2022 using the following keywords: ‘glaucoma’, ‘rho kinase inhibitor’, ‘rho-kinase inhibitor’, ‘rock inhibitor’, ‘ripasudil’, ‘netarsudil’, and ‘fasudil’. Abstracts were screened for relevant studies and results summarized in tables. Results: The analysis of trials conducted for ROCK inhibitors reveals that they are a safe and efficacious drug to treat POAG, demonstrating non-inferiority to existing medical treatments. Comparison of data to natural history studies was inconclusive due to the lack of natural history studies and their limitations. The results showed ROCK inhibitors to be effective when combined with existing medical treatments. However, questions remain regarding the optimal dosage, patient selection, and cost-effectiveness. Outcome measures for future trials should be expanded to include additional methods of monitoring disease progression as well as patient quality-of-life. Conclusions: ROCK inhibitors have emerged with a favorable safety profile, efficaciously attenuating intraocular pressure. To elucidate their long-term therapeutic value and safety comprehensively, further independent, large-scale, prospective randomized controlled trials are warranted. Such studies are pivotal to augment our understanding of this emergent medication class. Full article

Filtration bleb (FB) fibrosis represents the primary risk factor for glaucoma filtration surgery (GFS) failure. We reviewed the most recent literature on post-GFS fibrosis in humans, focusing on novel molecular pathways and antifibrotic treatments. Three main literature searches were conducted. First, we performed a narrative review of two models of extra-ocular fibrosis, idiopathic pulmonary fibrosis and skin fibrosis, to improve the comprehension of ocular fibrosis. Second, we conducted a systematic review of failed FB features in the PubMed, Embase, and Cochrane Library databases. Selected studies were screened based on the functional state and morphological features of FB. Third, we carried out a narrative review of novel potential antifibrotic molecules. In the systematic review, 11 studies met the criteria for analysis. Immunohistochemistry and genomics deemed SPARC and transglutaminases to be important for tissue remodeling and attributed pivotal roles to TGFβ and M2c macrophages in promoting FB fibrosis. Four major mechanisms were identified in the FB failure process: inflammation, fibroblast proliferation and myofibroblast conversion, vascularization, and tissue remodeling. On this basis, an updated model of FB fibrosis was described. Among the pharmacological options, particular attention was given to nintedanib, pirfenidone, and rapamycin, which are used in skin and pulmonary fibrosis, since their promising effects are demonstrated in experimental models of FB fibrosis. Based on the most recent literature, modern patho-physiological models of FB fibrosis should consider TGFβ and M2c macrophages as pivotal players and favorite targets for therapy, while research on antifibrotic strategies should clinically investigate medications utilized in the management of extra-ocular fibrosis. Full article

Introduction: To report the role of prostaglandin-associated periorbitopathy (PAP) severity on the surgical efficacy of Ahmed Glaucoma Valve (AGV) implantation. Subjects and Methods: Retrospective observational case series. Participants were the consecutive 102 eyes from 102 Japanese subjects (55 males, 47 females; mean age ± standard deviation, 74.9 ± 7.8 years) who underwent AGV implantation for primary open-angle glaucoma (POAG), completed full postoperative visits for 12 months, and had information on PAP severity graded by the Shimane University PAP Grading System (SU-PAP). Data were collected via medical chart review. Comparison of surgical success rates among groups stratified by SU-PAP grades (grades 0–3) using survival curve analysis. Failure was defined based on additional glaucoma surgery, IOP reduction in less than 20%, postoperative IOP exceeding 18 mmHg (definition A) or 15 mmHg (definition B), or postoperative visual acuity reduced to no light perception. Results: At 12 months postoperatively, the success rates for grades 0, 1, 2, and 3 were 47%, 43%, 42%, and 73%, respectively, for definition A (p = 0.35) and 35%, 26%, 19%, and 27%, respectively, for definition B (p = 0.64, log-rank test). For definition A, younger age was associated with surgical failure (Hazard ratio = 0.97/year, p = 0.049, Wald test), while no other factors, including gender, preoperative IOP, medications, refractive error, history of conjunctival manipulation procedures, or SU-PAP grade, were associated with surgical failure. For definition B, no factors were found to influence surgical outcomes. Conclusions: The preoperative severity of PAP might not affect the postoperative outcomes of AGV. Given that the success rate of trabeculectomy is influenced by PAP severity, in cases with severe PAP, physicians are advised to consider long-tube shunt surgery as an initial filtration procedure or as a rescue procedure when filtration surgery is unsuccessful. Full article

Objectives: We evaluated the 3-year effectiveness and safety of XEN45, combined or not with phacoemulsification, in patients from the Italian XEN-Glaucoma Treatment Registry. Methods: Data from glaucoma patients who underwent XEN45 alone or combined with phacoemulsification were analyzed. Changes in intraocular pressure (IOP) and the number of ocular hypotensive medications (OHMs) were tested with repeated measures ANOVA in last observation carried forward (LOCF) and per-protocol (PP) analyses. Complete and qualified success (IOP < 18 mmHg and ≥20% IOP reduction from baseline, without or with OHMs) at 36 months and pre- and intraoperative factors predicting surgery failure were explored using survival analysis and Cox proportional-hazard models. Complications rates were evaluated to assess safety. Results: The analysis included 239 eyes (239 patients): 144 (60.2%) in the XEN alone and 95 (39.8%) in the XEN+Phaco groups. Overall success was achieved in 164 (68.1%) eyes [113 (68.9%) complete and 51 (31.1%) qualified], without significant differences in success (p = 0.07) and survival rates (p = 0.46) between groups. At the 36th month, the baseline IOP decreased from a median (IQR) of 23.0 (20.0–26.0) to 15.0 (12.0–17.5) mmHg (p < 0.01), with an overall 34.1 ± 20.1% IOP reduction. The mean ± SD number of OHMs decreased from the baseline of 2.7 ± 0.9 to 0.9 ± 1.1 at month 36 (p < 0.01). PP and LOCF analyses were comparable. Neither pre- nor intraoperative factors were significantly predictive of surgery failure. In 91 (38.1%) and 57 (23.8%) of the eyes, at least one postoperative complication occurred early (<month 1) and late (≥month 1) during follow-up, respectively, without sequelae. During follow-up, 68 (28.5%) eyes needed at least one needling. Conclusions: At 3 years, XEN45, combined or not with phacoemulsification, effectively and safely reduced IOP and OHMs need. Full article

Glaucoma is the leading cause of irreversible blindness globally, with the commonest subtype being primary open angle glaucoma (POAG). POAG is characterised by an increase in intraocular pressure (IOP), optic nerve damage and irreversible visual field loss. People of African descent (AD) are significantly more susceptible to POAG when compared to people of European descent (ED), and the reasons for this are complex and multifaceted. The vast level of genetic diversity in AD populations has allowed, through genome-wide association studies (GWAS), for the identification of several single nucleotide polymorphisms (SNPs) as well as differences in mitochondrial haplogroups, which could explain the pathophysiology underlying the increased susceptibility of AD populations to POAG. The altered expression of genes such as MYOC as well as the expression of inflammatory mediators influencing reactive astrocytes have also been implicated. There are also several differences in morphology between AD and ED eyes which must be considered, including differences in central corneal thickness (CCT) and corneal hysteresis (CH) as well as variation in properties of optic discs. The link between all the aforementioned factors and the increased prevalence of POAG in AD populations will be explored in this review. Full article

Weight regain (WR) after bariatric surgery, particularly sleeve gastrectomy, is a significant challenge, often driven by a combination of metabolic, behavioral, and lifestyle factors. Non-surgical interventions to manage WR are critical, given the increased risks and reduced efficacy of revisional surgeries. In this context, very low-calorie ketogenic diets (VLCKDs) have gained attention for their potential to promote weight loss and improve body composition in individuals struggling with WR. This study assessed the safety and efficacy of a VLCKD in 11 patients who experienced WR following sleeve gastrectomy. Over an 8-week period, patients demonstrated a significant average weight loss of 6.3% (p = 0.005), along with improvements in body composition, including reductions in body fat percentage (p = 0.003) and waist circumference (p = 0.003). Metabolic markers, such as insulin resistance (HOMA-IR), also improved significantly (p = 0.041). Although a decrease in the glomerular filtration rate was observed (p = 0.007), this finding is unlikely to be clinically relevant over the short term. Importantly, no major adverse events were reported, with only mild constipation observed. These results suggest that VLCKDs may be a promising non-surgical approach for managing WR post-bariatric surgery, though further studies are needed to assess long-term effects, especially on renal function. Full article

Background and Hypothesis: Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD) are significant risks for kidney cancer (KC) patients undergoing partial (PN) or radical nephrectomy (RN) and for living kidney donors (LKD). This study compares AKI and CKD incidence in these groups with a pre-operative glomerular filtration rate (GFR) over 60 mL/min/1.73 m². Methods: This study included 465 KC patients with cT1-2N0M0 kidney mass and 256 LKD who underwent nephrectomy at four Italian institutions from 2014 to 2021. Data on demographics, comorbidities, and therapies were analyzed. Serum creatinine and estimated GFR (eGFR) were measured before and after surgery. Outcomes were AKI (per KDIGO guidelines) and CKD stage progression. Analyses included descriptive statistics, ANOVA, logistic regression, and Kaplan–Meier survival. Results: Among 721 patients, significant age and gender differences were noted. Hypertension (41%) and diabetes (7.1%) were prevalent in RN and PN groups. Post-surgery AKI was more common in donors (84%), while CKD stage progression varied by surgery type (CKD stage G3 after 60 months: RN 48.91%, PN 18.22%, LKD 26.56%). Age, pre-surgery CKD, and surgery type predicted CKD progression. Limitations include retrospective design and bias. Conclusions: Both LKD and KC patients face similar AKI and CKD risks. Surgery type significantly influences AKI and CKD incidence, highlighting the importance of approach. Full article

Acute kidney injury (AKI) is a severe and prevalent syndrome, primarily observed in intensive care units (ICUs) and perioperative settings. The discovery of a new biomarker for kidney function and injury, capable of overcoming the limitations of traditional markers, has the potential to improve the diagnosis and management of AKI. Proenkephalin A 119–159 (PENK) has emerged as a novel biomarker for AKI and has been validated in various clinical settings. It has demonstrated a faster response to AKI compared to creatinine and has been shown to predict successful weaning from renal replacement therapy in the ICU. PENK has also shown promise as an AKI biomarker in perioperative patients. Additionally, PENK has been proven to be effective in estimating mortality and morbidity in patients undergoing cardiac surgery, and those with traumatic brain injury or ischemic stroke. Incorporating PENK into a novel estimation of the glomerular filtration rate, referred to as the PENK-Crea equation, has yielded promising results. Full article