Search Results (358)

Objectives: To investigate the efficacy of femtosecond laser-assisted cataract surgery (FLACS) with the FEMTO LDV Z8 laser system in comparison to manual conventional cataract surgery (CCS). Background: Preservation of corneal endothelial integrity remains one of the most critical determinants of long-term visual quality after cataract surgery. The introduction of low-energy femtosecond laser systems has raised expectations for safer and more efficient procedures, particularity in cases with denser cataracts. Methods: This is a prospective, randomized study. Here, 38 eyes in the FLACS group and 40 in the CCS group were included. The changes in central corneal thickness (CCT), endothelial cell density (ECD), and best-corrected visual acuity (BCVA) were analyzed. In addition, the effective phacoemulsification time (EPT), the total phacoemulsification time (PT), and the intraoperative time (IT) were evaluated as a function of cataract grade. The total follow-up period was six weeks. Results: On postoperative day 1, BCVA improved significantly faster in the FLACS group (0.91 ± 0.14) compared with the CCS group (0.70 ± 0.17; p < 0.05). FLACS also demonstrated a significantly shorter EPT (1.01 ± 0.91 s) than CCS (1.61 ± 1.70 s; p < 0.05). No significant differences were observed between groups regarding postoperative ECD or CCT at any time point. No intraoperative or postoperative complications occurred. Conclusions: Low-energy FLACS achieved comparable endothelial safety to CCS, while providing significantly faster early visual recovery and reduced ultrasound energy use. These finding support the clinical value of FLACS in patients with moderate to dense cataracts. Full article

Outpatient neurosurgical oncology has expanded with advances in anesthesia, imaging, and minimally invasive techniques, enabling safe same-day discharge for selected patients undergoing procedures such as stereotactic biopsy and craniotomy. In this review, we find that across multiple international series, same-day discharge rates in several studies ranging from 85 to 95%, with low complication (3–6%) and readmission rates when structured pathways, including standardized selection criteria, enhanced recovery protocols, and routine 4-h postoperative CT imaging, are used. Studies on economic analyses demonstrate substantial cost savings driven by reduced inpatient bed utilization, with no increase in adverse events. Key challenges identified include medicolegal concerns amongst physicians, patient education, and limitations in organization adoption. Telemedicine and remote monitoring are increasingly incorporated to streamline preoperative evaluation and postoperative follow-up, improving access and continuity of care. Emerging technologies such as laser interstitial thermal therapy and focused ultrasound may further expand the outpatient neuro-oncology repertoire. Overall, current evidence supports outpatient neurosurgical oncology as a safe, efficient, and patient-centered model when applied with structured clinical pathways and patient selection. Full article

Objectives: The Eight-chop technique is a mechanically based nuclear segmentation method designed to improve surgical efficiency and reduce intraocular tissue stress during phacoemulsification. Early postoperative aqueous flare serves as an objective indicator of surgical invasiveness, whereas corneal endothelial cell density (CECD) loss represents a structural measure of endothelial injury. Although both parameters are clinically important, their relationship has not been systematically investigated in the context of this newer mechanical fragmentation approach. Methods: This prospective observational study included 118 eyes from 70 non-diabetic patients undergoing uncomplicated Eight-chop phacoemulsification. Aqueous flare was measured preoperatively and at postoperative Day 1, Day 7, Week 7, and Week 19 using laser flare photometry. CECD was evaluated preoperatively and at Weeks 7 and 19. Changes over time were analyzed using paired t-tests. Linear mixed-effects models (random intercept = patient ID) were constructed to assess predictors of CECD loss and postoperative intraocular pressure (IOP) reduction. Explanatory variables included Day 1 flare, age, preoperative CECD, nucleus hardness (Emery-Little grade), cumulative dissipated energy (CDE), and irrigation fluid volume. Results: Postoperative flare increased significantly at all time points (all p < 0.001), peaking on Day 7 (16.7 ± 9.21 photon counts/ms). CECD loss was extremely small, averaging 1.38% at Week 7 and 1.46% at Week 19. In mixed-effects models, Day 1 flare was not associated with CECD loss at Week 7 (p = 0.35) or Week 19 (p = 0.85). Significant predictors of CECD loss included Emery-Little grade (p = 0.004 at Week 7; p = 0.025 at Week 19), with borderline contributions from CDE and irrigation volume. IOP decreased significantly at Weeks 7 and 19; however, Day 1 flare did not predict IOP reduction. Conclusions: Eight-chop phacoemulsification produced uniformly low postoperative inflammation and exceptionally small corneal endothelial cell loss. Early postoperative flare did not predict CECD loss, suggesting that the Eight-chop technique provides a highly standardized, low-invasiveness surgical environment. These findings suggest that the Eight-chop technique lowers ultrasound energy requirements and may help reduce corneal endothelial stress relative to standard phacoemulsification. Full article

Zein (ZP) is the major storage protein of corn (maize). It is safe, biodegradable, edible, and characterized by unique self-assembly properties. These properties were exploited to prepare ZP microcapsules filled with soybean oil (SO) by ultrasound-assisted emulsification of oil-in-water (o/w) dispersions under optimal experimental conditions. The morphology and stability of o/w ZP/SO microcapsules were investigated by optical spectroscopy (electronic circular dichroism and fluorescence) and dynamic light scattering, as well as bright-field, laser confocal fluorescence, and scanning electron microscopies. The results showed that ZP formed a stable protein shell protecting the inner oily phase from diffusion of the confined compounds. It was also found that ZP/SO microcapsules, stored under suitable conditions, could be redissolved in water, maintaining their spherical morphology. Proof-of-principle studies on the inclusion and release of curcumin, a very active anti-inflammatory and nutraceutical substance, from ZP/SO microcapsules under temperature and pH stimuli are also reported. Full article

Focused ultrasound (FU) technology is extensively employed in clinical applications such as tumor ablation, Parkinson’s disease treatment, and neuropathic pain management. The safety and efficacy of FU therapy critically depend on the accurate quantification of the acoustic field, particularly the high-pressure distribution in focal region. To address the limitations of existing acoustic measurement techniques—including invasiveness, inability to measure high sound pressure, and system complexity—this study proposes a non-invasive method termed Laser Deflection Acoustic Field Quantification (LDAQ), based on the laser deflection principle. An experimental system was constructed utilizing the acousto-optic deflection effect, which incorporates precision displacement control, rotational scanning, and synchronized triggering. Through tomographic scanning, laser deflection images of the acoustic field were acquired at multiple orientations. An inversion algorithm using Radon transforms was proposed to reconstruct the refractive index gradient distributions from the variations of light intensity and spot displacement. An adaptive weighted fusion strategy was then employed to map these optical signals to the sound pressure field. To validate the LDAQ technique, an acoustic field generated by an FU transducer operating at 0.84 MHz was measured. The reconstructed results were compared with both hydrophone measurements and numerical simulations. The findings demonstrated high consistency among all three results within the focal zone. Full-field analysis yielded a root mean square error (RMSE) of 0.1102 between LDAQ and simulation, and an RMSE of 0.1422 between LDAQ and hydrophone measurements. These results confirm that LDAQ enables non-invasive and high-precision quantification of megapascal-level focused acoustic fields, offering a reliable methodology for acoustic field characterization to support FU treatment optimization and device standardization. Full article

Photoacoustic (PA) velocimetry offers a promising solution to the limitations of conventional techniques for measuring blood flow velocity. Given its moderate penetration depth and high spatial resolution, PA imaging is considered suitable for measuring low-velocity blood flow in capillaries located at moderate depths. High-resolution measurements based on PA signals from individual blood cells can be achieved using a high-frequency transducer. However, high-frequency signals attenuate rapidly within biological tissue, restricting the measurable depth. Consequently, low-frequency transducers are required for deeper measurements. To date, PA flow velocimetry employing low-frequency transducers remains insufficiently explored. In this study, we investigated the effect of the concentration of particles that mimic blood cells within vessels under low-concentration conditions. The performance of flow velocity measurement was evaluated using an ultrasonic transducer (UST) with a center frequency of 10 MHz. The volume fraction of particles in the solution was systematically varied, and the spatially averaged flow velocity was assessed using two different distinct analysis methods. One method employed a time-shift approach based on cross-correlation analysis. Flow velocity was estimated from PA signal redpairs generated by particles dispersed in the fluid, using consecutive pulsed laser irradiations at fixed time intervals. The other method employed a pulsed Doppler method in the frequency domain, widely applied in ultrasound Doppler measurements. In this method, flow velocity redwas estimated from the Doppler-shifted frequency between the transmitted and received signals of the UST. For the initial analysis, numerical simulations were performed, followed by experiments based on displacement measurements equivalent to velocity measurements. The target was a capillary tube filled with an aqueous solution containing particles at different concentration levels. The time–domain method tended to underestimate flow velocity as particle concentration increased, whereas the pulsed Doppler method yielded estimates consistent with theoretical values, demonstrating its potential for measurements at high concentrations. Full article

Background: To evaluate the short-term effects of a dietary supplement containing curcumin, bromelain, glucosamine, chondroitin sulphate, sodium hyaluronate, type II collagen, and vitamin C on symptomatic vitreous floaters (SVFs) following Nd:YAG laser capsulotomy. Methods: Forty eyes with SVFs on the first postoperative day were randomized into a control group (standard topical therapy, n = 20) and a treatment group (oral supplement plus standard therapy, n = 20). Outcomes included best-corrected visual acuity (BCVA), contrast sensitivity (CS), and subjective scores from a non-standardized questionnaire on floater perception (QS1), interference with daily activities (QS2), and foreign body sensation (QS3). Objective evaluation was performed using two novel ultrasound-based methods: mean number of vitreous peaks (MVP) from A-scans and mean grey intensity (MGI) from B-scan images processed with ImageJ. Results: At 2 months, the treatment group showed greater improvement in CS (Δ = 0.26 LogCS, CI, 0.14–0.38; p < 0.01), QS1 (Δ = 1.10; 95% CI, 0.60–1.60; p < 0.01), QS2 (Δ = 0.90; 95% CI, 0.40–1.40; p < 0.01), QS3 (Δ = 0.90; 95% CI, 0.44–1.36; p < 0.01), MVP (Δ = 1.10; 95% CI, 0.60–1.60; p < 0.01), and MGI (Δ = 12.89 units; 95% CI, 7.84–17.93; p < 0.01). BCVA was comparable between groups (p = 0.478). Conclusions: Short-term dietary supplementation with vitreous-specific nutrients is well tolerated and associated with improvements in reducing SVFs and foreign body sensations after Nd:YAG capsulotomy and may represent a promising non-invasive therapeutic option. Full article

Facial asymmetry significantly affects aesthetic appearance, essential functions such as mastication and speech, and psychological well-being. While traditional surgical interventions effectively address significant facial asymmetry, they are often associated with considerable morbidity, prolonged recovery periods, and potential complications. Consequently, interest in minimally invasive, non-surgical techniques has substantially increased, driven by advantages including reduced downtime, rapid recovery, and immediate aesthetic results. This narrative review critically evaluates contemporary non-surgical techniques for correcting facial asymmetry, focusing specifically on dermal fillers, collagen stimulators (polydioxanone powder), polydioxanone thread lifting, energy-based non-invasive devices (radiofrequency, ultrasound, and laser therapies), and extracorporeal shockwave therapy. The review is based on a structured literature search of PubMed/MEDLINE, Embase, and Google Scholar up to October 2025, focusing on human clinical studies and review articles on non-surgical correction of facial asymmetry and related facial contouring. We provide a detailed analysis of each treatment modality’s underlying mechanisms, clinical efficacy, advantages, limitations, and safety profiles. Current evidence suggests that these non-surgical methods effectively enhance facial symmetry by offering immediate visible improvements and progressive enhancements through natural collagen regeneration, thereby significantly improving patient satisfaction and overall quality of life. Clinicians are encouraged to incorporate these versatile, minimally invasive interventions into clinical practice, carefully tailoring treatments according to individual patient characteristics and specific aesthetic goals. Further research should aim to refine existing treatment protocols, evaluate long-term efficacy and safety, and establish standardized guidelines to optimize outcomes in facial asymmetry correction. Full article

Background and Objectives. Bilateral knee osteoarthritis (KOA) in older patients compromises mobility and quality of life. Gait analysis provides objective, reproducible measures of physical performance. This study evaluated the integration of gait analysis for longitudinal monitoring and personalized rehabilitation, while ultrasound was performed only at baseline for characterization and did not inform adjustments to the interventions. Materials and Methods. We conducted a 6-week, randomized, parallel-group clinical trial including 130 participants aged ≥65 years. Patients were randomized to a Study Group (SG, n = 64) receiving 10 sessions of a comprehensive rehabilitation program (conventional measures plus gait training) or a Control Group (CG, n = 66) receiving 10 sessions of conventional rehabilitation (electrotherapy with magnetodiaflux, TENS, therapeutic ultrasound, low-intensity laser, plus standard kinesitherapy). Interventions were delivered daily, 5 days/week, over 2 consecutive weeks. Gait outcomes (BTS G-WALK/G-SENSOR 2) included TUG, Symmetry Index, 6MWD, and cadence; functional outcomes included VAS pain, WOMAC, and Lequesne Index. Quadriceps morphology was assessed sonographically, and a height-normalized quadriceps thickness index (QHNI) was calculated. Results. Of 130 randomized, 112 completed (93.3%). Compared with control, the intervention produced significant, clinically meaningful improvements: 6MWD increased by approximately 59 m, cadence by ~9 steps/min; TUG improved by ~2.6 s; gait symmetry by ~4–5 points; VAS pain decreased by ~1.7 points; WOMAC total by ~8.5 points; and Lequesne Index by ~2 points (all p < 0.001). QHNI showed no significant association with anthropometrics and performance measures, indicating limited value as a linear predictor at baseline; nonlinear models or subgroup analyses may be warranted. Conclusions. Both neuromuscular-focused rehabilitation and the conventional program improved gait and clinical outcomes. Integrating gait analysis with ultrasound evaluation enables comprehensive monitoring and supports personalized interventions to reduce joint loading and optimize gait mechanics in older patients with bilateral KOA. Full article

This study investigates the potential of an undervalued cephalopod species, Eledone moschata, for producing a freeze-dried protein concentrate via acid solubilisation and isoelectric precipitation. Although nutritionally rich, the processing route significantly affected the aggregation state of the recovered proteins, as demonstrated by differential scanning calorimetry (DSC) and SDS–PAGE electrophoresis. We systematically examined pretreatments of the lyophilised protein concentrate (PC) by dispersing it across a pH range (2–10) and applying ultrasonication (US), characterising the resulting aggregates in terms of protein solubility, surface hydrophobicity, dynamic light scattering (DLS), and ζ-potential. Subsequently, ultrasound-treated protein dispersions at different pH values were used to produce protein–quercetin nanoparticles (PQ), which were analysed for particle size (DLS), yield, and quercetin entrapment efficiency. PQ dispersions at pH 2, 4, and 7 were evaluated as stabilising agents in US-treated sunflower oil emulsions containing 10% oil and were characterised by rheological properties, microstructure, and DLS particle sizing. Confocal laser scanning microscopy (CLSM) revealed that nanoparticles at pH 2 produced small, uniformly distributed fat droplets with a particle diameter of 1.5 μm. This study provides insights into how processing conditions modulate the structural and interfacial behaviour of cephalopod proteins and highlights their potential application in designing low-fat, fluid emulsions for innovative food formulations. Full article

Chronic musculoskeletal pain (CMP) is the leading global cause of disability and a major contributor to healthcare burden. Its pathogenesis reflects regenerative failure, driven by extracellular matrix (ECM) fibrosis, calcific deposition, mitochondrial dysfunction, and neuroimmune sensitization. Conventional pharmacological therapies such as NSAIDs, corticosteroids, and opioids offer only transient symptomatic relief while exposing patients to systemic complications. In contrast, energy-based, drug-free regenerative interventions directly address underlying pathology and restore physiological function. This Perspective synthesizes recent evidence (2020–2025) on three modalities that together form a regenerative triad: extracorporeal shockwave therapy (ESWT), high-intensity laser therapy (HILT), and ultrasound-guided mechanical needling with sterile water injection (SWI). ESWT promotes mechanotransduction, angiogenesis, and ECM remodeling; HILT enhances mitochondrial bioenergetics and downregulates inflammatory pathways; and SWI disrupts fibrosis and calcification while restoring neurovascular dynamics. Evidence from randomized controlled trials and meta-analyses supports moderate-to-high certainty (GRADE B–A–) for ESWT and HILT. SWI, initially supported by large observational cohorts and comparative studies, is now reinforced by a randomized comparative trial and meta-analyses of lavage effects, justifying an upgrade from moderate (B) to moderate-to-high certainty (B–A–). Risk of bias assessment using Cochrane RoB 2.0 and the Newcastle–Ottawa Scale (NOS) indicates overall low-to-moderate concerns across modalities. Together, these interventions integrate mechanistic biology with translational rehabilitation practice. This Perspective outlines their mechanistic foundations, clinical evidence, and alignment with the WHO decade of healthy ageing, offering a drug-free, mechanism-based framework for sustainable CMP management. Full article

The global rise in obesity presents significant challenges for reconstructive surgery. Effective postoperative monitoring of tissue flap vitality is essential for successful outcomes, but obesity introduces complexities that can hinder accurate assessments. This article examines the specific challenges associated with monitoring tissue flap viability in individuals with obesity, focusing on how obesity-related physiological changes affect the effectiveness of various monitoring techniques. We explore alterations in subcutaneous adipose tissue—such as thickness, density, and volume—as well as changes in vessel structure, blood pressure, glucose levels, lactate levels, and tissue perfusion. These factors can impact the accuracy and reliability of monitoring methods. A deep understanding of these challenges is crucial for determining the suitability of different monitoring systems for patients with obesity undergoing flap reconstruction. Based on a review of clinical experience, we assess the usability of widely used monitoring devices, including ultrasound Doppler, near-infrared spectroscopy, and laser Doppler flowmetry, in patients with obesity. Non-conventional techniques such as glucose and lactate measurements, thermography, and fluorescence angiography are also investigated. This article aims to provide a comprehensive overview of the relationship between obesity and tissue flap monitoring, ultimately helping to select the most appropriate and effective methods for this patient population. By considering these factors, surgeons in cooperation with engineers can optimize postoperative care and enhance the likelihood of successful flap reconstruction. Full article

Thyroid nodules, prevalent in 2% to 65% of the general population depending on diagnostic methodology, represent a significant clinical concern despite a low malignancy rate, typically 1% to 5%. A substantial proportion of thyroid cancers are small, indolent lesions, allowing for conservative management with favorable prognoses. Nodule detection commonly occurs via palpation, clinical examination, or incidental radiological findings. Established risk factors include advanced age, female gender, obesity, metabolic syndrome, and estrogen dominance. Despite conservative management potential, a considerable number of thyroid nodules in Europe are unnecessarily referred for surgery, incurring unfavorable risk-to-benefit ratios and increased costs. Minimally invasive techniques (MITs), encompassing ethanol and thermal ablation modalities (e.g., laser, radiofrequency, microwave), offer outpatient, nonsurgical management for symptomatic or cosmetically concerning thyroid lesions. These procedures, performed under ultrasound guidance without general anesthesia, are associated with low complication rates. MITs effectively achieve substantial and sustained nodule volume reduction (57–77% at 5 years), correlating with improved local symptoms. Thermal ablation (TA) is particularly favored for solid thyroid lesions due to its precise and predictable tissue destruction. Optimal TA balances near-complete nodule eradication to prevent recurrence with careful preservation of adjacent anatomical structures to minimize complications. Radiofrequency ablation (RFA) is widely adopted, while microwave ablation (MWA) presents a promising alternative addressing RFA limitations. Percutaneous laser ablation (LA), an early image-guided thyroid ablation technique, remains a viable option for benign, hyperfunctioning, and malignant thyroid pathologies. This review comprehensively evaluates RFA, MWA, and LA for thyroid nodule treatment, assessing current evidence regarding their efficacy, safety, comparative outcomes, side effects, and outlining future research directions. Full article

Introduction: The introduction of radial-firing laser fibers has minimized catheter-to-vein distance during endovenous laser ablation (EVLA) for the great saphenous vein (GSV) and anterior saphenous veins (ASVs). This study investigates flush endovenous laser ablation (fEVLA) effectiveness in addressing chronic superficial venous insufficiency (CVI). Materials and methods: This single-center retrospective study analyzed consecutive fEVLA cases with duplex ultrasound follow-up at 1, 4, and 12 weeks. The primary endpoint was clinically significant endovenous heat-induced thrombosis (classes III–IV). Results: Three hundred and twelve patients were recruited (405 affected limbs, 369 GSV, and 36 ASV). CEAP classifications were stratified as follows: C2 in 6.1%, C3 in 34.2%, C4 in 44%, C5 in 2.7%, and C6 in 12.7% of cases. Perforator ligation, phlebectomy, or foam sclerotherapy were carried out in conjunction with EVLA. fEVLA was feasible in all cases. The success rate was 96.78%, defined as EHIT classes 1 and 2, and assessed by ultrasound one week postoperatively. Clinically significant EHIT (2.5% class 3 and 0.2% class 4) was managed with 15 mg rivaroxaban twice daily for 21 days. Follow-up at 4 weeks revealed complete resolution of all EHIT 3–4 cases. No cases of pulmonary embolism or deep vein thrombosis were observed during the study or follow-up period. Conclusions: fEVLA is a safe treatment for superficial CVI across various CEAP classes, and with prompt detection, the minimal complication rate can be completely resolved. Full article

Background/Objectives: Benign prostatic hyperplasia (BPH) is a prevalent condition in aging men and a major cause of lower urinary tract symptoms (LUTSs). While traditional treatments such as transurethral resection of the prostate (TURP) are effective, they are associated with notable morbidity. Ultrasound-guided transperineal laser ablation (TPLA) has emerged as a minimally invasive alternative. This study aimed to assess the 12-month efficacy, safety, and functional outcomes of TPLA in patients with LUTS secondary to BPH. Methods: This was a single-center, retrospective observational cohort study including 53 patients with moderate-to-severe LUTS due to BPH who underwent TPLA between November 2021 and May 2024. Baseline and follow-up assessments were conducted at 1, 3, 6, and 12 months, including IPSS, Qmax, PVR, prostate volume (MRI), QoL, IIEF-5, and MSHQ-ED/Bother scores. The procedure was performed under local anesthesia using the EchoLaser™ system, and ablation was guided via real-time transrectal ultrasonography. Results: Statistically significant improvements were observed in IPSS (median decrease from 30 to 13), Qmax (5.5 to 13.0 mL/s), and PVR (200 to 85 mL). Prostate and adenoma volumes decreased by 41.2% and 58.3%, respectively. Quality of life scores improved, and erectile function remained stable. Ejaculatory function improved significantly based on MSHQ-ED and MSHQ-Bother scores. No major complications or conversions to surgery occurred. Conclusions: TPLA appears to be a safe, effective, and minimally invasive treatment modality for LUTS caused by BPH. It offers sustained symptomatic relief, prostate volume reduction, and preservation of sexual function, making it a promising alternative for patients unfit or unwilling to undergo invasive surgery. Full article