Search Results (243)

Background/Objectives: Anxiety before ophthalmic surgery under local anesthesia may hinder patient cooperation and surgical outcomes. Nurse-led auditory interventions offer a promising non-pharmacological approach to perioperative anxiety management. This study evaluated the effectiveness of superimposed binaural beats (SBBs)—classical music layered with frequency differentials—in reducing anxiety during pterygium surgery with conjunctival autografting. Methods: In this randomized controlled trial, 111 adult patients scheduled for elective pterygium excision with conjunctival autografting under local anesthesia were allocated to one of three groups: SBBs, plain music (PM), or silence (control). A trained perioperative nurse administered all auditory interventions. The patients’ anxiety was assessed using the State–Trait Anxiety Inventory—State (STAI-S), and physiological parameters (blood pressure, heart rate, respiratory rate, and oxygen saturation) were recorded before and after surgery. Results: The SBB group showed significantly greater reductions in their STAI-S scores (p < 0.001), systolic blood pressure (p = 0.011), heart rate (p = 0.003), and respiratory rate (p = 0.009) compared to the PM and control groups. No adverse events occurred. Conclusions: SBBs are a safe, nurse-delivered auditory intervention that significantly reduces perioperative anxiety and supports physiological stability. Their integration into routine nursing care for minor ophthalmic surgeries is both feasible and beneficial. Trial Registration: This study was registered with the Thai Clinical Trials Registry (TCTR) under registration number TCTR20250125002 on 25 January 2025. Full article

Malignant mediastinal tumors are a group representing some of the most demanding oncological challenges for early, multi-level, and successful management. The timely identification of any suspicious clinical symptomatology is urgent in achieving an accurate, staged histological diagnosis, in order to follow up with an equally detailed medical therapeutic plan (interventional or not) and determine the principal goals regarding efficient overall treatment in these patients. We report a case of a 24-year-old male patient with an incident-free prior medical history. An initial chest X-ray was performed after the patient reported short-term, consistent moderate chest pain symptomatology, early work fatigue, and shortness of breath. The following imaging procedures (chest CT, PET-CT) indicated the presence of an anterior mediastinal mass (meas. ~11 cm × 10 cm × 13 cm, SUV: 8.7), applying additional pressure upon both right heart chambers. The Alpha-Fetoprotein (aFP) blood levels had exceeded at least 50 times their normal range. Two consecutive diagnostic attempts with non-specific histological results, a negative-for-malignancy fine-needle aspiration biopsy (FNA-biopsy), and an additional tumor biopsy, performed via mini anterior (R) thoracotomy with “suspicious” cellular gatherings, were performed elsewhere. After admission to our department, an (R) Video-Assisted Thoracic Surgery (VATS) was performed, along with multiple tumor biopsies and moderate pleural effusion drainage. The tumor’s measurements had increased to DMax: 16 cm × 9 cm × 13 cm, with a severe degree of atelectasis of the Right Lower Lobe parenchyma (RLL) and a pressure-displacement effect upon the Superior Vena Cava (SVC) and the (R) heart sinus, based on data from the preoperative chest MRA. The histological report indicated elements of a combined, non-seminomatous germ-cell mediastinal tumor, posthuberal-type teratoma, and embryonal carcinoma. The imminent chemotherapeutic plan included a “BEP” (Bleomycin^®/Cisplatin^®/Etoposide^®) scheme, which needed to be modified to a “VIP” (Cisplatin^®/Etoposide^®/Ifosfamide^®) scheme, due to an acute pulmonary embolism incident. While the aFP blood levels declined, even reaching normal measurements, the tumor’s size continued to increase significantly (DMax: 28 cm × 25 cm × 13 cm), with severe localized pressure effects, rapid weight loss, and a progressively worsening clinical status. Thus, an emergency surgical intervention took place via median sternotomy, extended with a complementary “T-Shaped” mini anterior (R) thoracotomy. A large, approx. 4 Kg mediastinal tumor was extracted, with additional RML and RUL “en-bloc” segmentectomy and partial mediastinal pleura decortication. The following histological results, apart from verifying the already-known posthuberal-type teratoma, indicated additional scattered small lesions of combined high-grade rabdomyosarcoma, chondrosarcoma, and osteosarcoma, as well as numerous high-grade glioblastoma cellular gatherings. No visible findings of the previously discovered non-seminomatous germ-cell and embryonal carcinoma elements were found. The patient’s postoperative status progressively improved, allowing therapeutic management to continue with six “TIP” (Cisplatin^®/Paclitaxel^®/Ifosfamide^®) sessions, currently under his regular “follow-up” from the oncological team. This report underlines the importance of early, accurate histological identification, combined with any necessary surgical intervention, diagnostic or therapeutic, as well as the appliance of any subsequent multimodality management plan. The diversity of mediastinal tumors, especially for young patients, leaves no place for complacency. Such rare examples may manifest, with equivalent, unpredictable evolution, obliging clinical physicians to stay constantly alert and not take anything for granted. Full article

Background/Objectives: Endovascular thrombectomy has become a mainstay in the treatment of acute ischemic stroke caused by large vessel occlusion. Among the multiple factors that influence outcomes, the choice of anesthetic technique—general anesthesia (GA), conscious sedation (CS), or local anesthesia (LA)—remains controversial. This narrative review aims to critically examine and synthesize current evidence comparing the efficacy and safety of different anesthetic strategies in endovascular stroke treatment. Methods: A structured search of the PubMed^® database was conducted using the terms “stroke treatment”, “endovascular stroke treatment”, “anesthesia”, “general anesthesia”, “conscious sedation”, and “local anesthesia”. The search focused on clinical trials involving human subjects published in English. Studies were included if they compared at least two anesthetic techniques during thrombectomy and reported outcomes such as neurological recovery, mortality, or complication rates. Reviews, case reports, and animal studies were excluded. Results: Several randomized controlled trials and observational studies show comparable functional outcomes between GA and CS, though CS may confer advantages in early neurological recovery and reduced complications. Local anesthesia, though less studied, may offer favorable outcomes in selected patients. General anesthesia appears to be associated with greater hemodynamic variability and a higher risk of post-procedural infections, particularly in unsuccessful interventions. Maintaining stable blood pressure and minimizing ventilation duration are crucial to improving patient prognosis. Conclusions: While both GA and CS are viable options during thrombectomy, CS and LA may provide a safer profile in selected patients by preserving hemodynamic stability and reducing infectious risk. Personalized anesthetic strategies and further high-quality trials are warranted. Full article

Amorpha fruticosa L. (Fabaceae) originates from North America and has become an aggressive invasive plant in many parts of the world. It affects the local biodiversity in many negative ways. Our previous in vivo tests of purified extract of A. fruticosa pods for antihyperglycemic activity in streptozotocin-induced diabetic spontaneously hypertensive rats (SHRs) revealed that the oral administration of purified extract of A. fruticosa (100 mg/kg) for 35 days to SHRs caused significant decreases in the systolic pressure, blood glucose levels, and MDA quantity. The aim of this experimental study is to test the glycosidase inhibition of several extracts of A. fruticosa pods. Methods: GC-MS, NMR, and a glycosidase inhibition assay were performed. Results: The results demonstrate strong inhibition of yeast alpha- and almond beta-glucosidases, rat intestinal hexosaminidase, and bovine beta-glucuronidase, but not of some other glycosidases. The activity is probably due at least in part to the presence of iminosugars and iminosugar acids. We here report on further analysis and activity assessments of A. fruticosa pods and leaves collected in Bulgaria, and for the first time discover glycosidase inhibitors, pinitol, and hydroxylated pipecolic acids in the species and more complex iminosugar-like compounds that may all contribute to antidiabetic potential. Hydroxylated pipecolic acids are probable precursors of iminosugars and common in legumes containing them. Considerable chemical variation was observed over four pod collections. Conclusions: A. fruticosa pods and leaves were found to contain a number of compounds that could contribute to the potential antihyperglycemic activities including pinitol and a complex mixture of iminosugar-related compounds derived from pipecolic acids and prolines. The pods and leaves caused potent selective inhibition of glucosidases and hexosaminidases and beta-glucuronidase. The variation between the collections might reflect the sites differing or wide phenotypic versatility allowing the success of the species as an invasive plant. Full article

Background/Objectives: Copper is an essential micronutrient required for physiological functions, but elevated serum levels impair vascular reactivity and blood pressure regulation. Given PVAT’s critical role in vascular function, this study aimed to investigate the effects of chronic copper overload on the secretory function of mesenteric PVAT, focusing on its vasoregulatory role. Methods: In the first phase, 8-week-old male Wistar rats were assigned to two groups, namely control (saline, i.p.) or copper (25.72 µg/kg/day Cu, i.p., for 30 days), corresponding to twice the recommended daily dose of copper. In the second phase, rats were divided into four groups: control (saline, i.p., water by gavage), copper (Cu, i.p., water by gavage), losartan (saline, i.p., 10 mg/kg/day losartan by gavage), or copper + losartan (Cu, i.p., 10 mg/kg/day losartan by gavage). After euthanasia, mesenteric PVAT was collected for morphometric analysis, gene and protein expression of adipokines, inflammatory molecules, and the renin–angiotensin system. Serum was used for hormone and biochemical measurements. Results: In mesenteric PVAT, chronic copper overload increased adipocyte diameter and reduced lipolysis. It also elevated the secretion of TNF-α and PAI-1 while decreasing IL-10 levels. Additionally, it upregulated the mRNA expression of MCP-1, F4/80, CD86, TLR4, arginase-1, iNOS, ACE1, and AT1R, alongside an increase in serum angiotensin II levels. When copper treatment was combined with losartan, an AT1R antagonist, adipocyte hypertrophy; TNF-α secretion; and the gene expression of TLR4, F4/80, and arginase-1 were attenuated. Conclusions: Chronic exposure to double the recommended dose of Cu disrupts the secretory function of mesenteric PVAT, promoting inflammation and altering the local RAS. These effects appear to occur, at least in part, alongside the activation of the AT1R–TLR4–angiotensin II signaling pathway, triggering the upregulation of vasoregulatory inflammatory markers. Full article

Background: Glioblastoma (GBM) is a highly aggressive primary brain tumor with limited therapeutic options, particularly due to the limited blood–brain barrier (BBB) permeability. Nanoparticle-based drug delivery systems, such as liposomes, can prolong drugs’ circulation time and enhance their accumulation within brain tumors, thereby improving therapeutic outcomes. Controlled drug release further contributes to high local drug concentrations while minimizing systemic toxicity. Oleic acid (OA), a monounsaturated fatty acid, is commonly used to enhance drug loading and increase lipid membrane fluidity. In this study, we developed liposomal formulations with optimized temozolomide (TMZ)’s loading and analyze its response to focused ultrasound (FUS). Methods: We synthetized OA-based liposomes with different lipid composition, performed physicochemical characterization (DLS, TEM) and analyzed the TMZ loading efficiency. Different FUS parameters were tested for effective OA-based liposomes destruction. Safety of selected parameters was evaluated in vivo by MRI, histological staining and RT-PCR of pro-inflammatory cytokines. Results: All the formulations exhibited comparable hydrodynamic diameters; however, OA-containing liposomes demonstrated a significantly higher TMZ encapsulation efficiency and enhanced cytotoxicity in U87 glioma cells. Moreover, it was shown that OA-liposomes were disrupted at lower acoustic pressures (5 MPa), while conventional liposomes required higher thresholds (>8 MPa). A safety analysis of FUS parameters indicated that pressures exceeding 11 MPa induced brain edema, necrotic lesions and elevated cytokine levels within 72 h post-treatment. Conclusions: These results suggest that OA-based liposomes possess favorable characteristics, with an increased sonosensitivity for the site-specific delivery of TMZ, offering a promising strategy for glioma treatment. Full article

γ-aminobutyric acid (GABA) is a four-carbon non-protein amino acid, with many regulatory effects in humans. It aids in regulating blood glucose levels and pressure and is widely recognized for its ability to promote cognitive balance through the alleviation of stress and improvements in sleep quality. The GABA content of longan pulp is higher than that of many other fruits and vegetables; however, much is still unknown about GABA’s biosynthesis in longan. In this study, we found that the GABA content of ‘Baoshi No. 1’ (BS1) pulp was significantly higher than that of ‘Chunxiang’ (CX) pulp. The GAD activity was higher in BS1 pulp than CX pulp, while there was no significant difference in the GABA-T activity. Additionally, five GAD genes were identified in longan, and an analysis of their transcriptional levels showed that only the expression level of DlGAD3 corresponded to the GABA content and GAD activity. DlGAD3 was localized in the cytoplasm, and its transient overexpression promoted an increase in the GABA content in Nicotiana benthamiana leaves. Overall, our results show that DlGAD3 is able to promote the accumulation of GABA and may play a major role in its biosynthesis in longan pulp. Full article

Heart attack is a leading cause of mortality, necessitating timely and precise diagnosis to improve patient outcomes. However, timely diagnosis remains a challenge due to the complex and nonlinear relationships between clinical indicators. Machine learning (ML) and deep learning (DL) models have the potential to predict cardiac conditions by identifying complex patterns within data, but their “black-box” nature restricts interpretability, making it challenging for healthcare professionals to comprehend the reasoning behind predictions. This lack of interpretability limits their clinical trust and adoption. The proposed approach addresses this limitation by integrating predictive modeling with Explainable AI (XAI) to ensure both accuracy and transparency in clinical decision-making. The proposed study enhances heart attack prediction using the University of California, Irvine (UCI) dataset, which includes various heart analysis parameters collected through electrocardiogram (ECG) sensors, blood pressure monitors, and biochemical analyzers. Due to class imbalance, the Synthetic Minority Over-sampling Technique (SMOTE) was applied to enhance the representation of the minority class. After preprocessing, various ML algorithms were employed, among which Artificial Neural Networks (ANN) achieved the highest performance with 96.1% accuracy, 95.7% recall, and 95.7% F1-score. To enhance the interpretability of ANN, two XAI techniques, specifically SHapley Additive Explanations (SHAP) and Local Interpretable Model-Agnostic Explanations (LIME), were utilized. This study incrementally benchmarks SMOTE, ANN, and XAI techniques such as SHAP and LIME on standardized cardiac datasets, emphasizing clinical interpretability and providing a reproducible framework for practical healthcare implementation. These techniques enable healthcare practitioners to understand the model’s decisions, identify key predictive features, and enhance clinical judgment. By bridging the gap between AI-driven performance and practical medical implementation, this work contributes to making heart attack prediction both highly accurate and interpretable, facilitating its adoption in real-world clinical settings. Full article

Background/Objectives: Glaucoma and Alzheimer’s disease (AD) are neurodegenerative conditions with vascular underpinnings. This study aimed to explore the relationship between blood pressure parameters such as mean arterial pressure (MAP), pulse pressure (PP), and cerebral perfusion pressure (CPP) and cognitive performance in patients with AD, normal-tension glaucoma (NTG), and healthy controls. We hypothesized that NTG patients, like those with mild cognitive impairment (MCI), may experience subtle cognitive changes related to vascular dysregulation. Methods: Ninety-eight participants (35 NTG, 17 AD, 46 controls) were assessed for CPP, MAP, OPP, and cognitive performance. Statistical analyses compared groups and examined correlations. Results: AD patients showed lower CPP and MAP (p < 0.001), indicating systemic vascular dysfunction, while NTG patients had higher ocular perfusion pressure (OPP) (p = 0.008), suggesting compensatory mechanisms. CPP correlated with visuospatial abilities in AD (r = 0.492, p = 0.045). MAP correlated with the Clock drawing test (CDT) scores in the NTG group (r = 0.378, p = 0.025). PP negatively correlated with cognition in AD (r = −0.527, p = 0.016 for CDT scores) and controls (r = −0.440, p = 0.002 for verbal fluency and r = −0.348, p = 0.019 for total ACE scores). Conclusions: The study highlights distinct hemodynamic profiles: systemic dysfunction in AD and localized dysregulation in NTG. These findings emphasize the role of vascular dysregulation in neurodegeneration, with implications for personalized treatment approaches targeting vascular health in neurodegenerative conditions. Full article

Pathophysiological conditions in arteries, such as stenosis or aneurysms, have a great impact on blood flow dynamics enforcing the numerical study of such pathologies. Computational fluid dynamics (CFD) could provide the means for the calculation and interpretation of pressure and velocity fields, wall stresses, and important biomedical factors in such pathologies. Additionally, most of these pathological conditions are connected with geometric vessel changes. In this study, the numerical solution of the 2D flow in a branching artery and a multiscale model of 3D flow are presented utilizing CFD. In the 3D case, a multiscale approach (3D and 0D–1D) is pursued, in which a dynamically altered velocity parabolic profile is applied at the inlet of the geometry. The obtained waveforms are derived from a 0D–1D mathematical model of the entire arterial tree. The geometries of interest are patient-specific 3D reconstructed abdominal aortic aneurysms after fenestrated (FEVAR) and branched endovascular aneurysm repair (BEVAR). Critical hemodynamic parameters such as velocity, wall shear stress, time averaged wall shear stress, and local normalized helicity are presented, evaluated, and compared. Full article

Human epidemiological studies have statistically localized a multitude of quantitative trait loci (QTLs) for blood pressure (BP). However, their potential pathogenic mechanisms causing hypertension remain mysterious. To fill this void, we utilized congenic knock-in genetics to physiologically analyze the BP effects of individual and combinational QTLs. The effect magnitude from a single QTL in vivo ranged from 33.8 to 59.8%. ‘Double’ and multiple combinations of QTLs exhibited the same BP impact as a single QTL alone. Consequently, the products of these QTLs seemed to belong to the same pathway involved in physiological BP regulations. From this, we identified a novel pathway of hypertension pathogenesis in vivo controlled by the CUE domain containing 1 protein (Cuedc1). This pathway physiologically modulates blood pressure, aldosterone production, and renal and cardiac functions. CUEDC1 originated from common mammalian ancestors, partly explaining similar blood pressures between humans and rodents on this shared mechanistic basis. A translation of CUEDC1 into diagnostic and treatment applications to humans seems individualized and mechanistic because humans and rats may utilize the same BP-regulating mechanisms involving CUEDC1. The future sustainability of post-GWAS will depend on a balanced and robust ‘ecosystem’ provided by model studies that are founded on the physiologies and mechanisms of BP regulations in vivo. Full article

Enhanced external counterpulsation (EECP) treatment has been demonstrated to be effectively vasculoprotective and anti-atherosclerotic in clinical observations and controlled trials. The diastolic blood flow augmentation induced by EECP greatly affected the local hemodynamic environment in multiple arterial segments. In this study, a porcine model of hypercholesterolaemia was developed to perform an invasive physiological measurement involving electrocardiogram, blood flow wave, and arterial pressure. Subsequently, a three-dimensional carotid bifurcation model was developed to evaluate the variations in wall shear stress (WSS) and its temporal and spatial oscillations. The results show that, compared to the pre-EECP state, EECP stimulus led to an increase of 28.7% in the common carotid artery (CCA) blood flow volume over a cardiac cycle, as well as an augmentation of 22.73% in the diastolic pressure. Meanwhile, the time-average wall shear stress (TAWSS) over the cardiac cycle increased 25.1%, while the relative residence time (RRT) declined 45.7%. These results may serve to reveal the hemodynamic mechanism of EECP treatment that contributes to its anti-atherosclerotic effects. Full article

Blood pressure (BP), interarm differences (IAD) in BP, and arterial stiffness (AS) are related to cardiovascular disease risk and are attenuated by exercise training. While active, tennis players (TP) experience bilateral differences in shear stress, and thus vascular function due to the unilateral nature of the sport. However, it is unknown if this translates into attenuated bilateral differences in peripheral blood pressure (pBP), estimated central blood pressure (cBP), and AS, which could provide insight into the local versus systemic effects of exercise training on BP in women. Purpose: to evaluate bilateral differences in pBP, cBP, and AS in Division III female college TP and healthy recreationally active (RA) age- and sex-matched controls. Methods: In a parallel design, TP (n = 10) and RA controls (n = 10) were assessed for anthropometrics, body composition, and bilateral BP measurements using oscillometric cuff technique. Results: TP and RA were well-matched for body weight, body fat percentage, and BMI (all, p > 0.69). Interaction of arm and group, and effects of arm, or group were insignificant for pSBP and pDBP (all, p > 0.137). IAD in pSBP tended lower in TP (p = 0.096, d = 0.8), but IAD in cSBP was lower (p = 0.040, d = 0.8). Augmentation pressure and index were different between arms (p = 0.02), but no interactions (group by arm) were observed (p > 0.05). Conclusions: In groups well-matched for age and body composition, TP tended to have lower BP and IAD in pSBP, but cSBP revealed ~50% lower IAD in TP. Thus, measurement site and exercise training matter when assessing arterial stiffness and interarm differences in BP. Full article

Background: Spinal anesthesia is considered the method of choice for elective cesarean sections; however, it is not without maternal–fetal risks. Materials and Methods: This study compared the effects on maternal hemodynamics of intrathecal administration of fentanyl or morphine in parturients undergoing spinal anesthesia with 0.5% hyperbaric bupivacaine, with doses varied between 7.5 and 11 mg, depending on the patient’s height. Data from a cohort of 170 parturients were analyzed. The administered doses were intrathecal morphine at 0.1 mL (100 µg, solution of 1 mg/mL) or fentanyl at 0.25 mL (25 µg, solution of 50 µg/mL). This study included 80 patients in the fentanyl (F) group and 90 in the morphine (M) group. Results: Group F showed significantly higher post-intervention systolic blood pressure values than group M (95.30 ± 12.99 mmHg vs. 90.58 ± 14.75 mmHg, p = 0.032). The incidence of vomiting was significantly less frequent in group F compared to group M (1, 1.3% vs. 10, 11.1%, p = 0.011). The total dose of ephedrine required for hypotension correction was significantly lower in the F group (12.75 ± 13.26 mg vs. 17.72 ± 16.73 mg, p = 0.035). Conclusions: The addition of fentanyl as an adjuvant alongside the local anesthetic in cesarean section is associated with enhanced hemodynamic stability compared to morphine, requiring lower doses of ephedrine and contributing to increased patient safety during elective cesarean surgery. Full article

Cornea vascularisation is a significant cause of ocular morbidity. Disease or injury often triggers the development of new blood vessels in the cornea, compromising its clarity and impairing vision. Common causes of corneal neovascularisation include infections, chemical burns, and local and systemic inflammatory disorders. Topical corticosteroid eye drops remain the standard therapy; however, extended use of corticosteroids has been known to cause side-effects including cataracts and raised intraocular pressure. As such, an alternative therapy has been actively sought. Vascular endothelial growth factor (VEGF) is a major angiogenic factor implicated in neovascularisation. The success of anti-VEGF agents in managing leaking blood vessels in neovascular age-related macular degeneration provides an opportunity to explore its use in the treatment of corneal neovascularisation. The therapeutic potential of anti-VEGF agents has been evaluated in experimental models of corneal neovascularisation and clinical trials with variable results. Here, we review the study results and discuss the development of new strategies that may improve treatment outcomes for corneal neovascularisation. Full article