Search Results (2,507)

Background and Objectives: Non-invasive biomarkers reflecting neurodegeneration are increasingly important in multiple sclerosis (MS). Optical coherence tomography (OCT) provides quantitative measures of retinal structure, most commonly peripapillary retinal nerve fiber layer (pRNFL) thickness. However, the potential clinical relevance of optic nerve head morphology, including cup-to-disc ratio (CDR), remains insufficiently explored. We investigated associations between OCT-derived parameters, subjective visual vertical (SVV), and disability in MS. Materials and Methods: In this retrospective study, 100 patients with MS were included. OCT parameters (pRNFL thickness and area-based CDR) were analyzed at baseline and follow-up. Clinical disability was assessed using the Expanded Disability Status Scale (EDSS). Detailed optic neuritis history was not consistently available in the retrospective clinical records and therefore could not be systematically accounted for in the analyses. SVV was evaluated in 37 patients using a virtual reality–based protocol. Associations were assessed using Spearman correlation and linear regression analyses. Multivariable regression models were adjusted for age, sex, and follow-up duration. Results: pRNFL thickness was not associated with baseline EDSS (rho = −0.06, p = 0.55) or annualized EDSS change. Baseline CDR correlated with both baseline EDSS (rho = 0.30, p = 0.0065) and follow-up EDSS (rho = 0.46, p < 0.0001). In univariable regression analysis, baseline CDR was associated with follow-up EDSS (B = 3.33, R² = 0.23, p < 0.0001), remaining significant after adjustment for age, sex, and follow-up duration (B = 2.59, 95% CI 1.26–3.92, p = 0.0002). No significant associations were observed between OCT parameters and SVV measures. Conclusions: Higher CDR values, but not pRNFL thickness, were associated with disability measures in this exploratory MS cohort. However, these findings should be interpreted cautiously because optic neuritis history could not be systematically accounted for and physiological optic disc variability may substantially influence CDR measurements. Full article

Background: Unstable pelvic ring injuries often require surgical stabilization to restore pelvic ring integrity. The anterior subcutaneous internal fixator, or pelvic INFIX, has emerged as an alternative to external fixation and open anterior fixation. This study evaluated the functional, radiographic, and complication-related outcomes of INFIX fixation for unstable anterior pelvic ring injuries. Methods: We retrospectively reviewed 21 adult patients treated with anterior pelvic INFIX for unstable anterior pelvic ring fractures, with or without posterior fixation, at a Level 1 Trauma Center between 2017 and 2024. Fractures were classified according to the AO/OTA system. Functional outcomes were assessed using the Iowa Pelvic Score and Short Form-12 questionnaire. Radiographic outcomes were evaluated according to Tornetta and Matta criteria. Complications were recorded throughout follow-up. The INFIX device was routinely removed 6 months postoperatively. Results: The cohort included 15 males and six females, with a mean age of 42.5 ± 11.1 years. Mean Injury Severity Score was 25.3 ± 9.6, and mean follow-up after implant removal was 31 (IQR 28–34) months. The mean Iowa Pelvic Score was 80.2 ± 7.4, indicating an overall good functional outcome. Mean SF-12 physical and mental scores were 49.2 ± 3.5 and 48.3 ± 7.9, respectively. Radiographic outcomes were excellent in eight patients, good in 11, and fair in two. Complications included postoperative hemorrhage, implant loosening, heterotopic ossification, and three cases of lateral femoral cutaneous nerve (LFCN) injury. Conclusions: INFIX fixation appears to be a reliable minimally invasive option for unstable anterior pelvic ring injuries, providing satisfactory mid-term functional and radiographic outcomes with an acceptable complication profile. Full article

Background/Objectives: The Leiden University Medical Center (LUMC) and the Medical University of Vienna (MUV) both implemented video recording and review in their neonatal intensive care unit (NICU). The two centers initiated collaborative, multicenter video review sessions to facilitate international knowledge exchange. Methods: In this exploratory, descriptive study, collaborative video review sessions were organized with the interprofessional NICU staff of the LUMC and the MUV. We aimed to describe our experience with organizing these sessions and to report procedural variations, and document lessons learned that led to new perspectives on care. Results: We conducted five sessions using recordings of different patients undergoing intubation, less invasive surfactant administration, umbilical, central-catheter insertion and physiologically based cord clamping after birth. The videos were selected to ensure technical and clinical comparability. Sessions were attended by a mean of eight providers per center. A total of 19 relevant differences were described, of which seven (37%) prompted changes in practice or new insights for one or both centers. Finally, we developed a roadmap for organizing multicenter video review sessions. Conclusions: This study shows that multicenter video review may represent a feasible and innovative educational approach for identifying practice variations and fostering cross-institutional clinical refinement. Full article

With the rapid aging of the global population, constipation has become a major gastrointestinal concern among elderly individuals. Bowel sounds provide a non-invasive acoustic signal for assessing gastrointestinal function, but their automatic analysis remains challenging due to sparsity and non-stationarity. This study proposes a two-stage bowel sound analysis framework based on continuous abdominal recordings. First, a Convolutional Neural Network-MAMBA (CNN-MAMBA) model was used for salient bowel sound detection. Second, a patient-level constipation classification model was developed using multi-view spectral representations and a Convolutional Neural Network-Conformer-Multiple Instance Learning (CNN-Conformer-MIL) architecture. On a held-out test set, the detection model achieved an accuracy of 0.87, an F1-score of 0.78, and a ROC-AUC of 0.93. For patient-level classification under binary Bristol Stool Form Scale (BSFS) grouping, five-fold cross-validation yielded a mean accuracy of 0.665 and an F1-score of 0.755. All BSFS labels were annotated by clinical physicians and temporally aligned with bowel sound recording. Given the modest improvement and cross-validation variability, the patient-level results should be interpreted as preliminary feasibility evidence. These findings suggest that bowel sound analysis may serve as an auxiliary screening or longitudinal monitoring tool rather than a stand-alone diagnostic system. Full article

Non-invasive fetal electrocardiogram (FECG) extraction from maternal abdominal ECG (AECG) is crucial for prenatal monitoring but remains challenging due to strong interference from maternal ECG (MECG), baseline drift, and noise. We propose an FECG extraction method based on minimal channel attention (MCA) and flow matching (FM), learning a deterministic mapping from AECG to FECG via a probabilistic path. To balance the preservation of physiological signals and separation of interference, we employ bridge variance scheduling for the diffusion process. Target matching loss is introduced to regress the FECG directly, enhancing training stability and waveform fidelity. For feature selection, a minimal channel attention module with global average pooling and a single linear layer is embedded after feature extraction, capturing cross-channel dependencies with minimal parameters. Enhanced residual connections are incorporated to retain underlying features and optimize gradient flow in deep networks. Experiments on two public datasets (ADDB and BDDB) with a leave-one-out cross-validation strategy show that our method achieves average Pearson correlation coefficients (PCCs) of 0.94 ± 0.050 on ADDB and 0.91 ± 0.122 on BDDB, demonstrating robust performance across diverse real-world recording conditions. The method balances high accuracy with efficient feature extraction, offering a reliable solution for non-invasive fetal heart health monitoring. Full article

Background/Objectives: Perioperative chemo-immunotherapy (CHT-IO) has emerged as a standard treatment strategy for resectable stage II–IIIB NSCLC. However, data regarding surgical feasibility, mini-invasive surgery rates, perioperative outcomes, and postoperative complications in real-world single-center experiences remain limited. Methods: A retrospective single-center analysis was performed including consecutive patients with locally advanced NSCLC treated with perioperative chemo-immunotherapy between March 2024 and March 2026. Patients received platinum-based chemotherapy combined with pembrolizumab or durvalumab, followed by surgical resection with curative intent. Surgical, pathological, and postoperative outcomes were analyzed. Results: Thirty patients received neoadjuvant CHT-IO, of which 25 (83.3%) underwent surgical resection. Reasons for failure to proceed to surgery included treatment-related toxicity or deterioration in performance status (n = 3), disease progression (n = 1), and patient refusal (n = 1). Lobectomy was the most performed procedure (64%), while a minimally invasive approach (uniportal VATS) was adopted in 44% of cases. Moderate-to-severe pleural adhesions (64%) and hilar fibrosis (60%) were observed intraoperatively. Despite these technical challenges, conversion to thoracotomy was required in only one case (4%), no intraoperative complications occurred, and complete (R0) resection was achieved in 96% of patients. Pathological complete response and major pathological response were observed in 36% and 52% of cases, respectively. Postoperative complications occurred in 56% of patients, although most were Clavien–Dindo grade I–II. The presence of comorbidities was the only factor associated with an increased risk of postoperative complications (OR 10.00, 95% CI 0.99–100.46; p = 0.05). Median length of hospital stay was 5.65 ± 2.04 days. One postoperative death due to septic complications was recorded. Conclusions: In this real-world monocentric experience, the combination of perioperative CH-ICIs and surgical resection (including mini-invasive approach) was safe and feasible in patients with locally advanced NSCLC. High rates of complete (R0) resection and encouraging pathological responses were observed, consistent with outcomes reported in randomized trials. Although surgery was overall frequently technically demanding, these changes did not appear to compromise perioperative safety or oncological radicality, even when minimally invasive approaches were adopted. Larger studies with longer follow-up are needed to better define long-term oncological outcomes. Full article

Acoustic survey provides a measurement-based approach for investigating heritage spaces in which architectural morphology, environmental conditions, and sound-related practices are physically interrelated. This study applies a portable and non-invasive survey protocol to the medieval cave sanctuary of San Michele di Mezzo, located in Fisciano, Southern Italy. The site consists of stratified natural and built spaces, including a lower cave, an upper cave, and a later upper church, and represents a relevant case study for assessing the acoustic behaviour of small, irregular, and fragile cultural heritage environments. The experimental procedure combined calibrated microphone recordings, time-domain signal inspection, third-octave-band analysis, and impulse-response-derived room-acoustic indicators, including reverberation, clarity, and definition parameters. Under the adopted source–receiver configurations, the results show acoustic differentiation among the lower cave, upper cave, and later church. The caves exhibit shorter decay times than the church over most frequency bands, while clarity and definition indicators reveal a frequency-dependent behaviour that does not support a general claim of the acoustic superiority of one space over another. Comparative data from other cave and cave-like environments further contextualize the measured response of San Michele di Mezzo. The findings do not imply intentional acoustic design; rather, in the measured configuration, they show that, under the chosen conditions, the long-lasting devotional centrality of the lower cave is compatible with an acoustic response that does not contradict spoken or sung devotional use. More broadly, the study contributes to applied acoustics by demonstrating that low-invasive field surveys can provide reproducible acoustic indicators for heritage interpretation, conservation-oriented documentation, and the investigation of intangible sound-related dimensions of cultural heritage. Full article

Photoplethysmography (PPG) is a widely used non-invasive optical technique for assessing cardiovascular dynamics and related hemodynamic processes. However, conventional noise-reduction methods can alter signal timing and distort waveform morphology, thereby affecting the identification of physiologically relevant events. Here, we propose a frequency-domain Gaussian filtering framework for selectively extracting harmonics from PPG signals. The method combines a Gaussian band-reject filter centered at 0 Hz to suppress the dominant DC component, reduce the non-pulsatile baseline, and attenuate low-frequency contributions associated with slow modulation processes. Symmetric Gaussian bandpass filters are then applied to isolate harmonic components, with the number of retained bands adapted to the requirements of a given application. As a proof of concept, the framework was applied to both a simulated PPG waveform and an experimental PPG recording. Because of the symmetric zero-phase properties of the filters, the temporal alignment of key PPG events, including the systolic peak, diastolic decay, and dicrotic notch, can be preserved while phase distortion is avoided. Reconstruction from filtered harmonics further suggests that low-order harmonics retain much of the observable waveform structure in the signals analyzed. Overall, this harmonic-based Gaussian filtering provides a promising framework for analysis of PPG signals and motivates further investigation of its potential for extracting physiologically related information from harmonic components, such as bedside monitoring. Full article

Electroretinography (ERG) is a non-invasive technique used to assess retinal function via electrical responses to light stimuli. We established baseline ERG parameters and a standardized recording protocol for collared scops owls (Otus lettia). Twelve eyes of six owls were evaluated. In addition to the pre-release assessment, ocular reflex tests and basic ophthalmic examinations were performed before the induction of anesthesia. Routine radiographic and hematological examinations were performed under general anesthesia, followed by ERG recordings. Under scotopic –20 dB conditions, the a-wave amplitude was 1.78 ± 0.53 μV (implicit time: 37.83 ± 5.52 ms), and the b-wave was 41.59 ± 10.71 μV (100.88 ± 10.9 ms). For scotopic 0 dB mixed responses, the a-wave amplitude was 27.98 ± 5.9 μV (27.64 ± 2.71 ms), and that of the b-wave was 175.51 ± 13.82 μV (97.02 ± 7.01 ms). Under photopic conditions, the a-wave and b-wave amplitudes were 2.88 ± 2.06 μV (28.67 ± 2.77 ms) and 25.53 ± 10.61 μV (77.78 ± 16.18 ms). To the best of our knowledge, this is the first study to establish species-specific baseline ERG parameters for collared scops owls. These findings provide a valuable tool for assessing retinal function in raptors and may serve as a baseline framework for ERG evaluation in other avian species. Full article

The introduction of minimally invasive surgery (MIS) marked a turning point in the history of medicine, driving one of the sharpest declines in surgical mortality and morbidity ever recorded—saving millions of lives and sparing an estimated one billion patients the suffering once inherent to large-incision surgery. Within a single generation, this once highly contested surgical innovation became the global standard of care, transforming surgical practice across disciplines and on a global scale. By every measure of public health, these outcomes place modern minimally invasive and robotic-assisted surgery as among the most consequential life-saving advances in modern medical history. This review examines the clinical impact and global dissemination of MIS, tracing its evolution from Camran Nezhat’s pioneering expansion of laparoscopy beyond diagnostics to complex therapeutic procedures across surgical disciplines. Drawing on decades of evidence across gynecology, general surgery, and urology, we show that MIS is associated with substantial reductions in perioperative mortality, major complications, blood loss, infections, thromboembolic events, postoperative pain, and length of hospital stay, while maintaining oncologic equivalence and improving functional and quality-of-life outcomes. Beyond these technical advances, MIS catalyzed a broader reimagining of surgery itself, challenging long-standing norms rooted in large-incision approaches and shifting the field toward precision, organ preservation, and pathology-directed intervention. These changes were accompanied by parallel advances in multiple domains, including in imaging, intraoperative visualization technologies, surgical anatomy, instrumentation, and nerve- and organ-sparing techniques—developments that collectively established the foundation for contemporary minimally invasive and robotic-assisted surgery. Collectively, these advances have contributed to the prevention of an estimated 10–20 million surgery-related deaths that would likely have occurred under the large-incision approaches of the past. Full article

Background/Objectives: Establishing laparoscopic access remains a critical and complication-prone step in minimally invasive surgery. Previous work has shown that proximal vibroacoustic sensing can identify peritoneal puncture events in porcine cadavers. The present pilot study evaluated whether these findings translate to human anatomy under controlled, ex vivo conditions. Methods: A vibroacoustic sensing prototype was proximally attached to a standard Veress needle during 14 insertions into a fresh human body donor (within 48 h post-mortem). An endoscope was introduced laterally to provide visual ground truth of peritoneal entry. Vibroacoustic signals were recorded at the proximal end of the instrument. Time–frequency analyses, transient excitation detection, and statistical comparisons were performed to assess whether (1) peritoneal puncture can be identified in the vibroacoustic signal, (2) signal phases and dynamics correspond to those previously observed in porcine cadavers, and (3) peritoneal punctures can be statistically differentiated from non-peritoneal events. Results: All 14 peritoneal punctures were identifiable in the vibroacoustic signal under the experimental conditions. Characteristic signal phases previously described in porcine tissue, including transient excitation associated with cavity entry, were consistently reproduced with comparable temporal and spectral profiles. Statistical analyses demonstrated group-level differences between peritoneal and non-peritoneal events, and the peritoneal puncture was the highest-energy event of its insertion in 13 of 14 cases (92.9%). Conclusions: Under the controlled ex vivo conditions of this single-donor pilot study, vibroacoustic sensing was feasible for identifying peritoneal puncture in human tissue and reproduced signal dynamics observed in porcine models. To our knowledge, this is the first demonstration of the proximal vibroacoustic sensing concept on a human body donor and the first cross-species replication of the previously reported puncture phase structure, establishing an important translational stepping stone between animal cadaver studies and in vivo investigations. The study demonstrates feasibility rather than clinical reliability: the single-donor design and the retrospective annotation framework limit generalizability. Prospective validation in living patients, across multiple subjects and operators, is required before clinical deployment. Full article

Human cervical cancer and pre-cancer research relies on datasets scattered across modality-specific archives, imaging repositories, benchmark platforms, trial registries, and controlled-access catalogs. This fragmentation—combined with heterogeneous metadata, ambiguous use of “cervical” terminology, and inconsistent indexing of pre-cancer and screening/triage resources—limits reproducible discovery, access planning, and cross-modal benchmarking. We present the Cervical Cancer Dataset Catalog (CCDCAT), a machine-readable, versioned dataset of datasets that enumerates host-specific dataset-instance records anchored to stable identifiers and resolvable landing records within an explicitly declared discoverable source universe (U_v1.0) and a frozen discovery/labeling lexicon (Q_v1.0). The CCDCAT spans invasive cervical cancer, pre-cancer/dysplasia, and cervix-focused screening and triage phenotypes, and it covers molecular omics, imaging and microscopy (including cervix photography, cytology, and digital pathology), trial registry records, benchmark resources, and controlled-access catalogs represented as metadata with explicit access pathways. Eligibility and labels are assigned conservatively from source-provided metadata; when evidence is insufficient, the CCDCAT abstains rather than infers. In the initial release (CCDCAT-U_v1.0; v0.1), we enumerate 14 eligible dataset instances across 11 host systems within a declared universe of 21 sources. Releases include manuscript-ready tables and interoperable artifacts (schema, controlled vocabularies, provenance logs, abstention ledgers, and a queryable database), enabling reproducible filtering, linkage, and auditable reuse planning. Full article

Background/Objectives: Acceleration of orthodontic tooth movement remains a major challenge in clinical orthodontics. Evidence suggests that increased local blood flow around the alveolar bone is key to bone remodeling and potentially reflects early biological responses associated with accelerated orthodontics. This study aimed to investigate the effects of non-invasive physical stimuli on gingival microcirculation. Methods: Eight healthy adult male volunteers were included in the analysis. Gingival blood flow was assessed using laser Doppler flowmetry under the following conditions: no-stimulation condition (None) and four types of stimuli: thermal stimulation (THM), electric field stimulation (ELF), vibration stimulation (VIB), and far-infrared stimulation (FIR). Gingival blood flow was recorded before and after each stimulation, and the rate of change was calculated. Statistical analysis was performed using a linear mixed-effects model with Type III ANOVA (Satterthwaite approximation), followed by Dunnett-adjusted comparisons. Results: A statistically significant difference was observed between stimulation conditions (p = 0.0087). VIB significantly increased gingival blood flow compared with the no-stimulation condition (p = 0.0041), whereas ELF showed a trend toward increased blood flow (p = 0.0936); THM and FIR showed no statistically significant effects. Conclusions: The findings of this study suggest that non-invasive physical stimuli, particularly vibration stimulation, can enhance gingival microcirculation. Although tooth movement was not directly evaluated, the observed hemodynamic changes may represent short-term physiological responses to non-invasive physical stimulation. Full article

Deltas are highly susceptible to biological invasions because of strong hydrological connectivity, frequent disturbance, and intense human use. Here, we synthesise coordinated monitoring observations and literature evidence on invasive alien plant species (IAS) recorded in four Black Sea riparian protected areas located across five countries, surveyed under the IASON/IASON+ initiatives (Danube Delta, Nestos Delta and Lake Vistonida, Kızılırmak Delta, Chorokhi Delta and Kolkheti National Park). Across the study sites, 17 IAS were documented, mainly represented by taxa native to North America and characterised by high propagule production and/or strong vegetative regeneration. Woody riparian invaders (e.g., Amorpha fruticosa, Robinia pseudoacacia, Acer negundo, Gleditsia triacanthos and Ailanthus altissima) exploited nutrient-rich floodplain soils and disturbances. In contrast, annual weeds (e.g., Ambrosia artemisiifolia, Sicyos angulatus and Xanthium orientale) remained associated with disturbed habitat edges. Aquatic dominance was confined to the Danube Delta, where Elodea nuttallii and Elodea canadensis formed dense submerged stands. Species were assigned to broad range expansion categories (slowly, moderately and rapidly spreading species) based on project observations and supporting records. We discuss shared invasion syndromes linked to reproductive and dispersal traits and outline management implications for Black Sea deltas, emphasising pathway prevention, early detection and rapid response for localised taxa, and sustained control combined with restoration for dominant invaders. Full article

The management of European mountain landscapes is increasingly threatened by rural abandonment and escalating environmental risks. This study investigates an innovative Stewardship–Renewable Energy Communities model for the Central Apennines, exploring how post-seismic public reconstruction can serve as a financial engine for territorial maintenance. Utilizing Open Data Sisma administrative records and Photovoltaic Geographical Information System irradiation metrics, this research assesses the solar potential of 18 municipalities within the Sibillini seismic crater. To ensure a reliable baseline, a Building Suitability Coefficient was introduced as a conservative proxy for the public reconstruction sector. Results indicate that the implementation of a distributed network of 6.5 MWp across 325 public nodes, with a specific yield of 1390 kWh/kWp on the entire area, could generate 9 GWh/year. This translates to approximately EUR 1.08 million in annual revenue from energy incentives and sharing. This economic surplus provides a Stewardship Capacity sufficient to fund the active maintenance of 789.77 hectares per year through Nature-Based Solutions, based on a regional rate of 1200 EUR/ha. The novelty of this study lies in bridging post-disaster energy policy with landscape resilience, demonstrating that distributed rooftop solar portfolios represent a non-invasive, self-funding mechanism. By leveraging the reconstructed public stock, mountain territories can transition from passive neglect to active, energy-backed stewardship, offering a reproducible template for high-value cultural landscapes. Full article