Search Results (840)

Background and Objectives: The erector spinae plane block (ESPB) is an emerging regional anesthesia technique that has demonstrated effectiveness in reducing postoperative pain and opioid consumption following laparoscopic cholecystectomy (LC). However, the optimal timing of ESPB whether administered preoperatively or postoperatively remains uncertain, particularly regarding its influence on intraoperative hemodynamic stability and procedural feasibility. This study aimed to compare the analgesic efficacy, intraoperative hemodynamic profiles, and procedural advantages of preoperative versus postoperative ESPB in patients undergoing elective LC. Materials and Methods: In this prospective, randomized, and single-blind clinical trial, 80 ASA I–II adult patients scheduled for elective LC were randomly assigned to receive bilateral ESPB either before anesthesia induction (Group 1) or immediately after surgery but prior to extubation (Group 2). All patients received standardized general anesthesia. The primary outcome was postoperative pain measured by the numeric rating scale (NRS) at 2 h postoperatively. Secondary outcomes included NRS scores at other time points (0, 4, 6, 12, and 24 h), intraoperative and postoperative hemodynamic parameters, cumulative 24 h rescue analgesic consumption, patient satisfaction scores, and adverse events. Results: Both groups experienced significant reductions in postoperative NRS scores, with no statistically significant differences between groups in pain intensity or tramadol consumption. However, the preoperative ESPB group exhibited significantly more stable intraoperative blood pressure readings, particularly at 30 and 60 min after incision and at extubation. No ESPB-related complications occurred in either group. Patient satisfaction levels were comparable across groups. Conclusions: Preoperative and postoperative ESPBs offer comparable analgesic efficacy and opioid sparing effects in LC. However, preoperative ESPB provides enhanced intraoperative hemodynamic stability and avoids the logistical challenges of performing blocks under anesthesia, including repositioning related risks. These findings suggest that preoperative ESPB may be considered for integration into enhanced recovery after surgery (ERAS) protocols for minimally invasive biliary surgery, pending further large-scale multicenter trials. Full article

Background and Objectives: Circadian fluctuations in blood pressure, particularly the non-dipping pattern characterized by the absence of a nocturnal decline, are associated with an increased risk of microvascular complications. The retina, as a highly sensitive microvascular tissue, offers a valuable window into systemic hemodynamic alterations. However, the literature lacks detailed structural analyses that evaluate all retinal regions by segmenting nighttime into specific time intervals. Notably, the early morning period (04:00–08:00), during which stress hormones such as cortisol and catecholamines rise physiologically, leads to increased blood pressure that may significantly affect retinal microcirculation. This prospective study aims to assess retinal microvascular structures in dipper and non-dipper individuals using structural optical coherence tomography and to investigate their relationship with blood pressure parameters by dividing nighttime into distinct time segments. Materials and Methods: A total of 60 participants were classified as dipper (n = 26) or non-dipper (n = 34) based on 24 h ambulatory blood pressure monitoring results. Structural optical coherence tomography was used to evaluate superficial and deep capillary plexus densities in the foveal, parafoveal, and perifoveal regions, along with the area and perimeter of the foveal avascular zone (FAZ) and flow density (FD). Blood pressure values, including systolic, diastolic, mean arterial, and pulse pressure, were recorded during two nighttime intervals (00:00–04:00 and 04:00–08:00), and correlations with retinal parameters were analyzed. Results: No significant differences were observed in retinal microvascular parameters between the dipper and non-dipper groups. Deep capillary densities, particularly in the parafoveal and perifoveal regions, showed significant positive correlations with serum total protein, albumin, and very low-density lipoprotein (VLDL) levels. Furthermore, systolic and mean arterial pressures measured during the 04:00–08:00 interval demonstrated significant positive correlations with deep retinal vascular densities. The FAZ perimeter was negatively correlated with pulse pressure variability, while FD showed a negative correlation with mean arterial pressure variability. Conclusions: This prospective study is among the first to investigate the effects of circadian blood pressure patterns on retinal microvascular structures by segmenting nighttime into specific intervals and employing comprehensive structural optical coherence tomography across the entire retina. The findings suggest that retinal microvascular structure may be associated with fluctuations in blood pressure. Analyses of blood pressure measurements between 04:00 and 08:00 may offer supplementary insights into the evaluation of retinal microvascular structure. Full article

Hemodynamic monitoring is fundamental in the management of critically ill patients with acute circulatory failure. The invasiveness of conventional devices, however, often limits their applicability in the emergency department (ED). Recent advances have introduced non-invasive modalities (including echocardiography, bioreactance, and plethysmography) that extend the use of hemodynamic assessment beyond the intensive care unit. Among various available techniques, bedside ultrasound (Point-of-Care Ultrasound, POCUS) emerges as a particularly versatile tool for rapid and comprehensive assessment of cardiac function and volume status. When integrated with continuous technologies such as bioreactance or pulse contour analysis, it allows for the adoption of more dynamic and personalized fluid management strategies. Currently, a multimodal and patient-centered approach represents the most effective paradigm for non-invasive hemodynamic evaluation in the emergency setting. This strategy enhances diagnostic accuracy and enables timely interventions guided by pathophysiological principles. Despite the inherent limitations of each technique, their integration provides emergency physicians with real-time information, with potential benefits on clinical outcomes and resource utilization. This review aims to outline the pathophysiological rationale for adopting non-invasive monitoring in the ED and to critically evaluate the advantages and limitations of each technique, providing emergency physicians with a concise framework to guide clinical practice. Full article

Major depressive disorder (MDD) is a prevalent and disabling condition. Transcranial direct current stimulation (tDCS) may improve symptoms by modulating neuroplastic and inflammatory mechanisms. This randomized, double-blind, placebo-controlled trial will recruit adult outpatients with MDD showing residual symptoms despite at least four weeks of stable SSRI treatment. Participants will be randomized to active or sham add-on tDCS while continuing their antidepressant regimen. The intervention will consist of 15 sessions over 3 weeks, targeting the left dorsolateral prefrontal cortex (anode F3, cathode F4) at 2 mA for 30 min per session. The primary outcome is the reduction of depressive symptoms measured by the Hamilton Depression Rating Scale-17 (HDRS), with remission defined as HDRS-17 ≤ 7. Secondary outcomes include cognitive performance (attention, executive functioning, memory), serum biomarkers (BDNF, VEGF, NGF, NRG1, angiogenin, IGF1, IL-6, TNF-α), cortical excitability assessed by transcranial magnetic stimulation (motor threshold, silent period, intracortical inhibition/facilitation), and cerebral hemodynamics by transcranial Doppler sonography (blood flow velocity, pulsatility, resistivity). Assessments will occur at baseline, post-treatment, and 3- and 6-month follow-ups. This trial aims to evaluate the efficacy of adjunctive tDCS in MDD with residual symptoms and its biological correlates, bridging clinical improvement with electrophysiological and neurovascular mechanisms. Full article

The phase shift (PS) between spontaneous slow oscillations of cerebral and systemic hemodynamics reliably reflects the state of cerebral autoregulation (CA). However, CA measurements are performed retrospectively after studying the signals from the analysis sensors. At the same time, CA-oriented therapy is becoming increasingly important with the receipt of data on the state of CA in real time, especially in intensive care units. We offer a hardware and software complex for transcranial Dopplerography, which uses a non-invasive method and allows for continuous measurement of cerebral blood flow to assess the rate of CA in real time. The hardware and software complex uses sensors to measure the PS between spontaneous slow oscillations of blood flow velocity (BFV) in the middle cerebral arteries (MCAs) and systemic arterial pressure (BP) in the Mayer wave range and performs wavelet analysis of sensor signals. An examination of 30 volunteers, with an average age of 28 ± 8 years, and 15 patients, with an average age of 57 ± 16 years, with various neurovascular pathologies confirms the feasibility of using the developed hardware and software complex for continuous monitoring of PS in real time to study the mechanisms of cerebral blood flow regulation. Full article

Wharton’s jelly (WJ), the mucoid connective tissue of the umbilical cord, provides essential protection to the umbilical vessels against mechanical stress. While research into WJ-derived stem cells for regenerative medicine has surged, the clinical significance of its in utero pathologies remains less explored. This review synthesizes the current literature on the pathophysiology of WJ abnormalities and their direct impact on fetal and neonatal outcomes. Pathologies are broadly categorized as quantitative (absence/reduction or excess/edema) and structural (pseudocysts, mucoid degeneration). A reduction or segmental absence of WJ critically compromises cord integrity, leading to vascular compression and is a direct cause of stillbirth, fetal growth restriction (FGR), and intrapartum distress. Conversely, excessive WJ or edema is associated with maternal diabetes and fetal hydrops and can also impair hemodynamics. Umbilical cord pseudocysts, arising from focal WJ degeneration, are significant markers for severe chromosomal abnormalities, particularly Trisomy 18 and 13, and other structural defects, especially when persistent or multiple. Sonographic measurement of WJ area shows promise as a surrogate for placental function, with decreased area correlating with placental pathology and FGR. However, significant diagnostic challenges persist, particularly the prenatal detection of segmental WJ absence, a “silent” pathology often discovered only after a catastrophic event. This review highlights the critical role of WJ integrity in determining perinatal outcomes and underscores the urgent need for improved diagnostic modalities and standardized management protocols to mitigate associated risks. Full article

Background: Familial Mediterranean Fever (FMF) is a chronic autoinflammatory disorder that is characterized by increased arterial stiffness and subtle cardiovascular dysfunction. Colchicine remains the mainstay of treatment and may provide vascular benefits that extend beyond its anti-inflammatory effects. However, the association between colchicine therapy and ventriculoarterial coupling (VAC), a hemodynamic marker of cardiovascular efficiency, has not been previously studied. Methods: In this cross-sectional study, 97 patients with FMF receiving colchicine therapy for at least one year and 81 colchicine-naive individuals without FMF were consecutively enrolled from a tertiary rheumatology outpatient clinic. The VAC was evaluated using the Chen method, calculated as the ratio of arterial elastance (Ea) to end-systolic elastance (Es), based on echocardiographic measurements and noninvasive brachial blood pressure. Correlation analyses and stepwise multivariate linear regression analyses were performed to identify independent predictors of VAC. Results: Patients with FMF demonstrated significantly lower VAC values compared to controls (1.23 ± 0.34 vs. 1.40 ± 0.57; p = 0.001). The colchicine dose was inversely correlated with VAC (r = −0.243; p = 0.001) and remained an independent predictor in multivariate analysis (β = −0.186, p = 0.018). Beta-blocker use was positively associated with VAC (β = 0.194, p = 0.014), whereas female sex showed a borderline inverse association. Conclusions: Colchicine use in patients with FMF was associated with more favorable VAC in a dose-dependent manner. These findings suggest that colchicine may exert cardiovascular effects beyond the control of inflammation. VAC may be a useful noninvasive marker for assessing vascular–ventricular interactions in FMF. Full article

Intraventricular hemorrhage (IVH) is a common complication of prematurity and continues to represent a considerable threat due to its association with significant short- and long-term morbidity and mortality. Despite the advances in neonatal care, the prevalence of IVH, particularly in the extremely preterm neonates, remains high. Therefore, it is imperative to recognize and implement in clinical practice preventive strategies, non-pharmacological or pharmacological, to reduce IVH effectively. The aim of this narrative review is to provide an overview of novel and debatable preventive measures for IVH that are promising for clinical use and could potentially improve outcomes for very preterm neonates. IVH prevention bundles (IVHPBs) consist of strategies that aim to minimize hemodynamic and cerebral perfusion fluctuations, which are a crucial component of IVH pathogenesis. Early postnatal prophylactic indomethacin, erythropoietin, and insulin-growth factor-1 administration have shown encouraging results on IVH prevention; however, the literature is still inconclusive. Stem-cell-based interventions represent novel and promising techniques with the potential to contribute to the prevention of IVH. The prevention of IVH remains a field of investigation, and there is a requirement for conclusive evidence and recommendations. The necessity for further large-scale prospective studies is therefore evident. Full article

Current fractional flow reserve computed tomography (FFR_CT) methods use static imaging, potentially missing critical hemodynamic changes during the cardiac cycle. We developed a novel dynamic FFR_CT framework using 4D-CTA data to capture temporal coronary dynamics throughout the complete cardiac cycle. Our automated pipeline integrates 4D-CTA processing, temporally weighted geometric modeling, and patient-specific boundary conditions derived from actual flow measurements. Preliminary validation in three patients (four vessels) showed that dynamic FFRCT values (0.720, 0.797, 0.811, and 0.952) closely matched invasive FFR measurements (0.70, 0.78, 0.78, and 0.94) with improved accuracy compared to conventional static methods. The dynamic approach successfully captured physiologically relevant hemodynamic variations, addressing inter-patient variability limitations of standardized approaches. This study establishes the clinical feasibility of dynamic FFR_CT computation, potentially improving non-invasive coronary stenosis assessment for clinical decision-making and treatment planning. Full article

Background/Objectives: The YSK olfactory function (YOF) test is a culturally adapted psychophysical tool that assesses threshold, discrimination, and identification. This study evaluated whether functional near-infrared spectroscopy (fNIRS) synchronized with routine YOF testing, combined with machine learning, can predict YOF subdomain performance in healthy adults, providing an objective neural correlate to complement behavioral testing. Methods: In this prospective diagnostic-accuracy (feasibility/validation) study in healthy adults with algorithm development, 100 healthy adults completed the YOF test while undergoing prefrontal/orbitofrontal fNIRS during odor blocks. Feature sets from ΔHbO/ΔHbR included time-domain descriptors, complexity (Lempel–Ziv), and information-theoretic measures (mutual information); the identification task used a hybrid attention–CNN. Separate models were developed for threshold (binary classification), discrimination (binary classification), and identification (binary classification). Performance was summarized with accuracy, area under the curve (AUC), F1-score, and (where applicable) sensitivity/specificity, using participant-level cross-validation. Results: The threshold classifier achieved accuracy 0.86, AUC 0.86, and F1 0.86, indicating strong discrimination of correct vs. incorrect threshold responses. The discrimination model yielded accuracy 0.75, AUC 0.76, and F1 0.75. The identification model (attention–convolutional neural network [CNN]) achieved accuracy 0.88, sensitivity 0.86, specificity 0.91, and F1 0.88. Feature-attribution (e.g., SHapley Additive exPlanations [SHAP]) provided interpretable links between fNIRS features and task performance for threshold and discrimination. Conclusions: Olfactory-evoked fNIRS signals can accurately predict YOF subdomain performance in healthy adults, supporting the feasibility of non-invasive, portable, near–real-time olfactory monitoring. These findings are preliminary and not generalizable to clinical populations; external validation in diverse cohorts is warranted. The approach clarifies the scientific essence of the method by (i) aligning psychophysical outcomes with objective hemodynamic signatures and (ii) introducing a feature-rich modeling pipeline (ΔHbO/ΔHbR + Lempel–Ziv complexity/mutual information; attention–CNN) that advances prior work. Full article

Background and Objectives: Anesthesia type may influence early hemodynamics post-transcatheter aortic valve implantation (TAVI), but sex-based differences in anesthetic response remain underexamined. We aimed to assess whether male and female patients exhibit differential responses to general anesthesia (GA) versus monitored anesthesia care (MAC) during TAVI, with particular attention to post-procedural transvalvular gradient changes. Methods: We conducted a single-center retrospective cohort study of 693 patients who underwent TAVI between 2011 and 2023 with complete echocardiographic and anesthesia data. Patients were categorized into four groups by sex and anesthesia type: GA-Male, MAC-Male, GA-Female, and MAC-Female. Hemodynamic, anesthetic, echocardiographic characteristics, and 6-month outcomes were compared. Results: Significant differences were observed across the four sex-anesthesia groups in several hemodynamic and echocardiographic measures. Initial analyses showed that female patients had significantly higher 24 h post-TAVI transvalvular mean gradient delta values compared to males, and among MAC patients, females also had higher 30-day mean gradients. However, secondary analyses revealed that valve size differed significantly between groups and was a key driver of these hemodynamic differences. After adjusting for valve size in a multivariable regression model, gradient differences between groups were no longer statistically significant. Net fluid balance and vasopressor use were more strongly associated with anesthesia type than sex, with GA groups requiring greater support. No significant differences in 6-month cardiovascular outcomes were observed. Conclusions: Early post-TAVI transvalvular gradient changes appeared to be primarily influenced by valve size rather than sex or anesthesia type alone. These findings suggest previously observed sex-based differences may reflect underlying disparities in valve sizing, highlighting need for further prospective studies assessing the independent contributions of sex, anesthesia modality, and valve size on early valve performance/long-term outcomes. Full article

Background/Objective: Identifying fluid-responsive patients is essential in managing hemodynamic instability. Traditional static measures like central venous pressure (CVP) are often unreliable. Prior studies suggest that cardiac ultrasound (US), particularly carotid Doppler point-of-care ultrasound (POCUS), may correlate with pulmonary artery catheter (PAC)-derived cardiac output (CO), offering a noninvasive tool to assess fluid responsiveness. We aimed to evaluate the correlation between carotid ultrasound (US) parameters and pulmonary artery catheter (PAC) derived measurements in post cardiac surgery patients. Methods: We conducted a prospective cohort study on 50 postcardiac surgery patients from 2019 to 2022 in a single cardiothoracic ICU. Carotid US and PAC CO measurements were obtained at four intervals: pre- and post-passive leg raise (fluid challenge) on ICU admission, and one hour later. Fluid responsiveness was defined as a ≥10% increase in carotid blood flow, ≥7 ms increase in corrected flow time (FTc), or ≥10% change in respiratory peak carotid systolic velocity (ΔCDPV). Pearson’s correlation and linear regression were used to assess associations between carotid US and PAC changes. Agreement in fluid responsiveness categorization (≥10% CO change) was evaluated using weighted Cohen’s kappa. Significance was set at α = 0.05. Results: No significant correlation was found between changes in carotid US parameters and the PAC cardiac index (CI) at baseline or one hour for ΔCDPV, FTc, or carotid blood flow. A moderate correlation was observed between carotid blood flow and FTc at one hour (r = 0.41, p = 0.005). Regression and sensitivity analyses showed no significant associations. Conclusions: The carotid US parameters did not correlate with PAC-derived CO after passive leg raise. Further studies are needed to validate carotid POCUS in this setting. Full article

The present study aimed to investigate sex differences in the hemodynamic response of the cerebral cortex during interactive and passive tasks using functional near-infrared spectroscopy fNIRS. Ninety-seven healthy adults (63 women, 34 men) participated in the study. Participants performed two tasks: an interactive motor game and a passive hand movement, and activation was measured in five cortical regions. Statistically significant differences in the amplitude of the hemodynamic response of oxygenated haemoglobin ΔHbO levels were observed, particularly in the parietal cortex, where men showed higher activation levels. The differences remained significant in the parietal, prefrontal, left hemisphere, and visual cortex. The differences were more pronounced in the passive task, which may indicate different processing strategies in women and men. Although no significant group differences were found in the latency time of maximum reaction t_max, men tended to have longer times in the visual cortex. Additionally, a moderate positive correlation between ΔHbO and t_max was observed among men, particularly in the prefrontal cortex. These results highlight the importance of considering biological sex in neuroimaging studies and suggest directions for further analysis. Full article

Background: Previous research from our group demonstrated that novel hemodynamic indices can predict 3–5-year mortality risk in myocardial infarction survivors. Building on these findings, we assessed the long-term prognostic value of these markers over a 10-year follow-up period. Methods: We conducted a prospective study involving 569 consecutive acute coronary syndrome (ACS) patients admitted within 12 h of symptom onset, all presenting with >50% coronary artery stenosis. Hemodynamic indices were assessed using echocardiography to measure ejection fraction (EF), global longitudinal peak systolic strain (GLPSS), and ventricular–arterial coupling (VA coupling). Excess aortic pressure (excess_PTI) was evaluated via radial tonometry, while local arterial stiffness was assessed by pulse wave velocity (PWV) through carotid ultrasonography. The primary outcome was all-cause mortality over a 10-year follow-up period. Results: Over a median follow-up of 3249 days, 172 patients reached the primary endpoint (death). Deceased individuals were older and exhibited lower EF, impaired VA coupling, higher excess_PTI, and a lower PWV/GLPSS index compared to survivors. In multivariate Cox proportional hazards analysis, EF, VA coupling, excess_PTI, and PWV/GLPSS index were independently associated with all-cause mortality over a 10-year follow-up period. Conclusions: This study highlights the significant long-term prognostic value of novel hemodynamic indices, including VA coupling, PWV/GLPSS index, and excess_PTI, in predicting 10-year all-cause mortality in ACS patients. Full article

Introduction: Non-surgical biopsy is recommended for diagnosing solid pulmonary nodules measuring >8 mm when the probability of malignancy is low to moderate. However, currently available biopsy methods do not have a sufficient diagnostic yield for nodule size <20 mm. Previous work has shown that one-lung flooding (OLF) enables complete lung sonography and good demarcation of lung nodules. Therefore, here, we report the first experiences with ultrasound-guided transthoracic core needle biopsy (USgTTcNB) under OLF for the histological diagnosis of small pulmonary nodules. Methods: In two patients with small pulmonary nodules, a transbronchial/thoracic biopsy was not indicated due to the size and location of the nodules. Following nodule detection under OLF, the USgTTcNB was performed. The biopsy cylinder was immediately examined via the frozen section procedure. After liquid draining and re-ventilation, the patients were extubated in the operation room and monitored in the intermediate care unit. Results: In both patients, a histological diagnosis was achieved. In the case of malignancy, the patient underwent lobectomy during the same session. In the case of a benign diagnosis, a futile operation was avoided. In case two, a small apical pneumothorax occurred. The hemodynamic values during and after the intervention were in the normal range. Lung function on day 2 after the intervention increased compared with that before the intervention. Conclusions: USgTTcNB under OLF is feasible and enables a histological confirmation of small pulmonary nodules. Nevertheless, this new promising technique should be evaluated in a study with a larger cohort. Full article