Search Results (1,892)

Background and Clinical Significance: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide. Among its various etiologies, uterine atony accounts for approximately 70% of cases, while other causes include genital tract trauma, pathologic placentation, and intrapelvic arterial injury. Uterine artery embolization (UAE) has emerged as a preferred management option for severe PPH due to its high success rates of 89–98% and fertility preservation benefit. Despite its efficacy, UAE can lead to complications, such as pain, re-bleeding, infection, persistent vaginal discharge, ovarian insufficiency, and uterine necrosis—a rare but serious complication occurring in 1.4–2.7% of cases. Case Presentation: We present three cases of uterine necrosis following UAE from a single center (CHA Bundang Medical Center) between 2003 and 2024. All patients developed persistent high-grade fever approximately two weeks after the procedure, despite an initial response to antibiotic therapy. Imaging studies, including contrast-enhanced CT and MRI, revealed uterine ischemia and necrosis, and all patients ultimately required total hysterectomy. Conclusions: Uterine necrosis is a rare but potentially life-threatening complication of UAE that should be suspected in patients with persistent high-grade fever beyond the typical post-procedural course. Early imaging evaluation, particularly with contrast-enhanced modalities, is essential for prompt diagnosis. Timely surgical intervention, including hysterectomy, may be required to prevent severe morbidity. Full article

Ocular surface inflammation is a major disruptor of corneal epithelial homeostasis and a key driver of limbal stem cell deficiency (LSCD). Limbal stem cells (LSCs), residing within the specialized limbal niche, maintain corneal transparency through continuous epithelial renewal and by preventing conjunctival encroachment onto the corneal surface. Chronic or severe inflammatory insults—stemming from systemic autoimmune disorders, ocular surface diseases, infections, trauma, or environmental stressors—can damage both LSCs and their microenvironment, ultimately leading to limbal insufficiency. This review synthesizes current insights into the mechanisms by which inflammation impairs LSC survival, including cytokine-mediated cytotoxicity, oxidative stress, immune cell infiltration, and disruption of essential signaling pathways such as Wnt, Notch, and BMP. The distinction between LSC depletion and LSC dysfunction is highlighted, as residual stem cells may persist even in clinically advanced disease and can regenerate the corneal surface once the inflammatory milieu is corrected. Clinical manifestations, staging systems, and diagnostic markers—including p63α, ABCG2, and additional emerging molecular indicators—are summarized to support accurate assessment of LSCD severity. Current therapeutic strategies, ranging from anti-inflammatory medical management to surgical approaches such as SLET, CLET, and allogeneic transplantation, are reviewed alongside evolving regenerative and cell-based therapies. By integrating mechanistic understanding with clinical implications, this review underscores the critical interplay between inflammation and limbal niche failure and emphasizes the importance of early recognition and targeted intervention to preserve or restore LSC function. Full article

Radiomics enables quantitative medical image analysis by converting imaging data into structured, high-dimensional feature representations for predictive modeling. Despite methodological developments and encouraging retrospective results, radiomics continue to face persistent challenges related to feature instability, limited reproducibility, validation bias, and restricted clinical translation. Existing reviews largely focus on application-specific outcomes or isolated pipeline components, with limited analysis of how interdependent design choices across acquisition, preprocessing, feature engineering, modeling, and evaluation collectively affect robustness and generalizability. This survey provides an end-to-end analysis of radiomics pipelines, examining how methodological decisions at each stage influence feature stability, model reliability, and translational validity. This paper reviews radiomic feature extraction, selection, and dimensionality reduction strategies; classical machine and deep learning–based modeling approaches; and ensemble and hybrid frameworks, with emphasis on validation protocols, data leakage prevention, and statistical reliability. Clinical applications are discussed with a focus on evaluation rigor rather than reported performance metrics. The survey identifies open challenges in standardization, domain shift, and clinical deployment, and outlines future directions such as hybrid radiomics–artificial intelligence models, multimodal fusion, federated learning, and standardized benchmarking. Full article

Breast implants are among the most frequently used long-term implantable medical devices in aesthetic and reconstructive surgery. In addition to correcting anatomical deficits, they have significant psychosocial effects, influencing body image, self-esteem, and quality of life, particularly in patients undergoing postmastectomy reconstruction. This review provides a comprehensive overview of the historical development, biological interactions, material characteristics, and clinical outcomes of breast implants. Early reconstructive attempts using foreign materials and injectable substances were associated with severe complications, underscoring the need for safer technologies. The introduction of silicone gel implants in the 1960s marked a pivotal advancement, followed by the development of saline-filled devices and highly cohesive silicone gels with enhanced mechanical stability. Key surgical considerations, including incision type and implant placement plane (subglandular, submuscular, dual-plane, and subfascial), are discussed in relation to aesthetic outcomes and complication risk. Emphasis is placed on the implant–tissue interface and the foreign body response (FBR), a process involving protein adsorption, immune cell activation, fibrous capsule formation, and potential chronic inflammation. Persistent inflammatory stimulation, often associated with bacterial biofilm formation, contributes to capsular contracture, the most common long-term complication. Additional adverse events include implant rupture, silicone gel bleed, granulomatous reactions, infection, hematoma, implant malposition, and rare but clinically significant conditions such as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). The review also summarizes implant classification according to construction, filling material, shape, and surface topography, highlighting the influence of surface characteristics on host response and clinical outcomes. Advances in biomaterials, cohesive gel formulations, and surface engineering aim to enhance biocompatibility and long-term safety, supported by standardized mechanical and biological testing protocols. Full article

The Stewart–Gough Platform (SGP) is a spatial parallel manipulator offering high accuracy, rigidity, and adaptability, with applications spanning medical systems, marine engineering, agriculture, manufacturing, entertainment, aerospace, and architectural installations. This paper presents a comparative analytical and computational study of three SGP configurations: the regular SGP, with regular hexagonal base and top platforms; the Irregular-Parallel SGP, derived from the regular SGP by a novel graphical decomposition-and-modification procedure and characterized by similar symmetric hexagonal platforms with limbs preserved parallel; and the Irregular-Skewed SGP, in which the irregular hexagonal platforms of the Irregular-Parallel SGP are retained, but the limbs are connected in an inclined, alternating clockwise (or anticlockwise) topology. The Irregular–Skewed SGP is free from the constraint singularity that persists in the first two configurations and requires the shortest maximum actuator stroke. Static force analysis shows that the regular SGP and the Irregular–Parallel SGP both exhibit a rank-deficient rigidity matrix (rank = 3) across the geometric scaling range tested (radius ratios 1:2 to 1:10; inter-platform distances 100–1000 mm), whereas the Irregular-Skewed SGP achieves full rank (rank = 6) through inclined limb connectivity and is the only configuration capable of sustaining static equilibrium under the loading conditions examined. The forward kinematics of the Irregular-Parallel SGP is verified against a SolidWorks model: under a 9 mm uniform limb extension, the MATLAB and SolidWorks positions of node 7 agree to within 1.27 mm. The rotational workspace volume is equivalent across the three configurations, but the density of valid solution points within that workspace differs. The workspace within joint limits, alternating compression–tension force partition, and asymmetric stroke economy of the Irregular-Skewed SGP indicate applicability to kinetic facades and transformable interiors in architectural-robotics deployment. Full article

Exposure to blast waves without kinetic, penetrating, thermal, or toxic components causes a distinct form of traumatic brain injury, termed primary blast-induced TBI (pbTBI). Clinical manifestations of pbTBI span a wide spectrum, ranging from life-threatening intracranial hemorrhage, hyperemia, and delayed cerebral edema to mild and transient neurological symptoms without detectable structural abnormalities on routine imaging. At the mild end of the spectrum, symptoms after a single exposure may resolve quickly, yet repeated exposures—even at very low levels, termed “subconcussive”—can develop into post-concussive syndrome (PCS) or persistent post-concussive symptoms (PPCS) in a subset of individuals. Despite extensive studies, the molecular pathobiology linking primary blast exposure to delayed and sometimes chronic neurobehavioral deficits remains incompletely understood. A mechanistic framework connecting blast-wave physics to biomechanics to biological vulnerability may therefore help define exposure hazards, interpret clinical symptomatology, and guide diagnostic and therapeutic development. This review summarizes the physics of primary blast waves, the resulting biomechanical responses, and candidate biological substrates, emphasizing structures and interfaces with distinct acoustic impedances across anatomical, tissue, cellular, and molecular scales. We synthesize evidence supporting the hypothesis that the cerebral vasculature and endothelial cells represent critically vulnerable substrates of primary blast-wave injury, in part because the vascular tree constitutes the brain’s largest and most widely distributed interface between compartments with different acoustic impedances. Across experimental and human studies, endothelial stress, vascular injury, and downstream neuroinflammation emerge as convergent molecular responses to primary blast exposure. Temporal dynamics are central to understanding pbTBI because many blast-induced processes unfold in sequential phases. These observations support conceptualizing pbTBI as a condition characterized by prominent cerebrovascular injury of varying severity with secondary consequences for neuronal signaling, network function, and behavior. Within this framework, cerebrovascular and neurovascular unit (NVU) dysfunction provides a parsimonious bridge between primary blast-wave exposure and chronic symptom trajectories, where vascular pathology may offer more accessible therapeutic targets than neuronal injury. Key knowledge gaps include identifying which physical component(s) of the blast are most injurious, establishing biologically meaningful dose–response relationships at molecular and physiological levels, and defining windows of vulnerability during recovery that are relevant to repeated exposures. Addressing these gaps is essential for refining safety protocols, improving diagnostic specificity through mechanism-informed biomarkers, and developing evidence-based molecular and vascular therapeutic targets for pbTBI-associated conditions. Progress will require integrating waveform-aware dosimetry with longitudinal physiological and molecular monitoring across both preclinical and human cohorts. Such integration offers a practical path toward translating blast physics into actionable medical guidance for prevention, triage, and recovery management. Full article

Objectives: This study aimed to estimate the prevalence of Post-COVID-19 Syndrome among older adults in Indonesia, using time-based definitions of symptoms persisting beyond >4 weeks, >8 weeks, and >12 weeks. Methods: A retrospective cohort study was conducted among 329 older patients (≥60 years) hospitalized with COVID-19 in two tertiary hospitals in Jakarta from January to December 2021. Data on risk factors and persistent symptoms were collected from medical records and interviews. Results: The prevalence of Post-COVID-19 Syndrome was 31% (>4 weeks), 18.24% (>8 weeks), and 10.64% (>12 weeks). Significant predictors included frailty (OR 2.814), immobility during hospitalization (OR up to 4.767), higher number of initial symptoms (OR 2.043), constipation, instability, and sensory impairment during follow-up. Conclusions: Frailty, symptom burden, and geriatric syndromes, particularly immobility are strongly associated with Post-COVID-19 Syndrome in older adults. Clinical Implications: Early identification of frailty, geriatric syndromes (especially immobility), and high initial symptom burden is essential for risk stratification, targeted monitoring, and implementation of preventive and rehabilitative interventions to reduce long-term post-COVID-19 complications in older populations. Full article

Background: Pediatric tuberculosis (TB) remains a major global health concern, accounting for a substantial proportion of TB-related morbidity and mortality worldwide. Treatment in children is particularly challenging due to age-specific pharmacokinetics, difficulties in drug administration, poor palatability, and reliance on caregivers for adherence. Objectives: This narrative review aims to evaluate the advantages and limitations of fixed-dose combinations (FDCs) in the treatment of pediatric TB, with a focus on adherence, pharmacological considerations, clinical outcomes, and implementation challenges. Methods: A narrative review of the literature was conducted, including clinical studies, pharmacokinetic analyses, programmatic data, and international guidelines related to the use of FDCs in pediatric TB management. Results: Evidence indicates that pediatric FDCs significantly improve treatment adherence by reducing pill burden and simplifying dosing regimens. They also decrease the risk of medication errors and inadvertent monotherapy, thereby contributing to the prevention of drug resistance. The availability of dispersible, child-friendly formulations has enhanced acceptability and ease of administration. However, limitations persist, including reduced flexibility in dose individualization, challenges in identifying the causative agent in adverse drug reactions, and variable access across settings. Pharmacokinetic concerns, particularly regarding rifampicin exposure, have been addressed in newer WHO-recommended formulations. Conclusions: FDCs represent a critical advancement in pediatric TB management and are strongly supported by international guidelines. Further research is needed to optimize formulations, ensure equitable access, and evaluate long-term clinical outcomes in diverse pediatric populations. Full article

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymatic disorder of red blood cells, with particularly high prevalence in Sardinia, where it is strongly associated with favism. Public awareness remains incomplete and misconceptions persist—particularly regarding symptom onset from fava bean pollen or odors. This cross-sectional survey assessed G6PD self-reported deficiency, population knowledge, and persistence of false beliefs in Sardinia. Methods: A 16-item structured questionnaire was disseminated online (May–June 2025) to adults across diverse age groups and educational backgrounds. Results: Among 536 respondents (74.25% female; 97.39% Sardinia residents), 43.47% of respondents self-reported as G6PD-deficient, a figure substantially above the expected population estimate of 8–15% and consistent with affected-network recruitment. Moreover, 49.07% self-reported as non-deficient, and 7.46% were unaware of their status. While 99.07% correctly identified fava bean ingestion as a trigger and 74.25% identified certain medications, 62.50% incorrectly attributed hazard to pollen inhalation and 25.93% to pea consumption. Only 3.92% reported a hemolytic crisis, whereas 25.93% reported feeling unwell after smelling beans or inhaling pollen. Family and friends (49.81%) and healthcare providers (42.16%) were the primary information sources; schools (25.75%) and online resources (14.55%) were underrepresented. Overall, 90.45% perceived public information as insufficient—uniformly across G6PD strata (χ² = 0.09, p = 0.955). Exploratory analyses suggested lower perceived information adequacy among younger respondents (Cochran–Armitage Z = 2.92, p = 0.002) and, less robustly, among female respondents (χ² = 3.90, p = 0.048; borderline significance, unadjusted). Conclusions: Although recognition of fava bean ingestion as the principal dietary trigger is nearly universal, substantial gaps persist regarding non-ingestive exposures, less-recognized dietary triggers, and pharmacological risks. Perceived information insufficiency was independent of G6PD status but associated with younger age and female sex. Integrating targeted nutritional education into school curricula, primary care, and digital platforms is warranted for these priority groups and for G6PD-endemic populations worldwide. Full article

Background: Acute limb ischemia (ALI) is a vascular emergency characterized by abrupt limb hypoperfusion, ischemia–reperfusion injury, and a high risk of thromboinflammatory and organ complications. Complement activation has been implicated in endothelial dysfunction, glycocalyx injury, and ischemia–reperfusion damage, but the clinical relevance of ongoing terminal complement blockade in patients presenting with ALI remains unclear, highlighting a gap between mechanistic understanding and real-world clinical outcomes. Methods: A retrospective cohort study was performed using the TriNetX federated research network. Adult patients with ALI were identified and stratified according to ongoing treatment with the C5 inhibitors eculizumab or ravulizumab. Outcomes included ischemic stroke, venous thrombosis, pulmonary embolism, arterial embolism, thrombotic disorders, acute kidney injury (AKI), and the composite outcome major adverse cardiovascular events (MACE) within 31 days. Propensity score matching was performed for demographic characteristics, cardiovascular comorbidities, complement-associated diseases and medications. Results: After propensity score matching, 112 patients remained in each cohort. Compared with matched controls, patients receiving C5 inhibition had a significantly higher risk of venous thrombosis (27.9% vs. 13.7%; p < 0.001), AKI (18.9% vs. 9.4%; p = 0.001), MACE (50.0% vs. 35.1%; p = 0.001), and thrombotic disorders (46.7% vs. 31.3%; p = 0.001). Time-to-event analyses confirmed significantly lower event-free survival for venous thrombosis (HR 2.3), AKI (HR 2.1), MACE (HR 1.6), and thrombotic disorders (HR 1.7). No significant differences were observed for ischemic stroke, pulmonary embolism, or arterial embolism. Conclusions: In patients with ALI, ongoing treatment with eculizumab or ravulizumab was not associated with an apparent reduction in short-term thromboinflammatory or cardiovascular complications. Instead, the observed outcome pattern suggests persistent vulnerability in this clinically uncommon but increasingly relevant high-risk population, although substantial residual confounding by indication and disease severity remains likely. These findings support further investigation of complement-targeted therapy, endothelial injury, and short-term vascular outcomes in ALI, and emphasize the translational relevance of linking mechanistic insights with clinical data to inform risk stratification and management strategies in this population. Full article

Background: Out-of-hospital cardiac arrest is a major cause of mortality, and survival depends heavily on rapid defibrillation. Automated external defibrillators (AEDs) can significantly improve outcomes when used before emergency medical services (EMS) arrive, yet access to and use of these devices remain uneven across communities. This study investigates racial and geographic disparities in AED use during EMS encounters in the United States, evaluating differences across racial groups, geographic settings, cardiac arrest status, and patient acuity, irrespective of whether a bystander or EMS personnel applied the device. Methods: This descriptive study used aggregated data from the National Emergency Medical Services Information System (NEMSIS) Public Release Data Cube to compare AED use across racial, geographic, cardiac arrest, and acuity categories. AED use was defined as any documented application during the EMS encounter. Results: The dataset included 106,246 EMS encounters across six racial and ethnic groups. AEDs were applied in 16,688 encounters (15.7%), with substantial variation across demographic and geographic categories. Asian, American Indian or Alaska Native, and Black or African American patients had the highest rates of AED use, while White patients had the lowest rate despite representing the largest share of encounters. Urban areas accounted for most AED deployments, whereas suburban and frontier regions showed markedly lower use, while rural AED use was similar to urban rates. AED application was strongly associated with cardiac arrest and high patient acuity, yet racial differences persisted even within these clinically severe categories. Conclusions: AED use generally aligns with clinical indicators such as cardiac arrest and critical acuity, but meaningful racial and geographic differences were observed, reflecting descriptive patterns rather than confirmed disparities. These patterns should be interpreted cautiously, as the aggregated nature of the dataset limits the ability to determine whether differences reflect inequities, incident characteristics, or EMS system factors. These findings highlight the need for targeted strategies to expand AED access, improve device placement, and strengthen community readiness in underserved areas. Integrating AED availability into broader EMS planning and community outreach may help reduce inequities and create conditions that support improved survival outcomes. Further research using individual-level data and geospatial methods is needed to clarify the drivers of these observed differences and inform equitable prehospital care policies. Full article

Our study examines the growing role of Explainable Artificial Intelligence (XAI) in cancer medical imaging, where transparency and interpretability are essential for trustworthy clinical decision making. Using a PRISMA-guided systematic literature review, 926 records published between 2020 and 2026 were identified from major databases, with 46 studies meeting the inclusion criteria after screening and quality assessment. The review systematically analyzes XAI techniques, model architectures, evaluation approaches, interpretability mechanisms, challenges, and future research directions. The findings show that gradient-based methods, particularly Grad-CAM, dominate the field due to their ease of integration with convolutional neural networks. At the same time, complementary approaches such as LIME, SHAP, and Integrated Gradients provide additional attribution insights. Evaluation practices remain heterogeneous, with a strong reliance on qualitative visual inspection and limited standardized quantitative frameworks. XAI contributes to interpretability primarily through spatial localization, feature attribution, and clinical decision support; however, challenges persist, including instability in explanations, coarse localization, high computational cost, and limited compatibility with transformer-based models. Overall, while XAI enhances transparency in cancer imaging, its clinical reliability remains constrained by methodological and technical limitations. Future work should focus on standardized evaluation, clinician-centered validation, and the development of robust, multimodal, and architecture-aware explainability frameworks. Full article

Background/Objectives: Chronic pain represents a core global health burden and remains a leading cause of disability and reduced quality of life. Tramadol is a widely prescribed analgesic with a dual-opioid and non-opioid mechanism of action; however, safety concerns persist. This scoping review summarizes current evidence on tramadol pharmacology, dosing, and safety. Methods: A systematic literature search was conducted across main scientific databases to identify preclinical and clinical studies evaluating tramadol pharmacokinetics, safety, and dosing. Results: The same tramadol presentations have been used for several years, with a high overdose risk due to incorrect dosing measurements. Dosing pump devices represent a viable solution to improve dosing accuracy and minimize this risk. Conclusions: Tramadol drops seem like an easier administration pathway but require careful handling when taking the prescribed dose. A dosing pump in the medication bottle will improve dosing accuracy. Full article

Background and aims: Atopic dermatitis (AD) is the most common chronic inflammatory skin disease among children. Our study aimed to evaluate the prevalence of hypogammaglobulinemia among pediatric patients with AD and to characterize the clinical and laboratory findings of patients diagnosed with AD and hypogammaglobulinemia. Method: The electronic files of 1850 patients aged 0–18 years diagnosed with AD between 2020 and 2022 in the Pediatric Immunology and Allergy Clinic of Bursa Medical Faculty City Hospital were retrospectively analyzed. During this period, all patients newly diagnosed with atopic dermatitis at our clinic were systematically screened for their serum immunoglobulin (Ig) levels (IgG, IgA, and IgM) at the time of initial presentation. We included 200 AD patients with hypogammaglobulinemia. Disease severity was classified using the Scoring Atopic Dermatitis (SCORAD) index. Multivariate logistic and linear regression analyses were performed to identify independent determinants of disease severity, considering age, sex, eosinophil counts, total IgE, food allergies, and baseline immunoglobulin levels. Results: The prevalence of hypogammaglobulinemia among the 1850 screened children with AD was 10.8% (200/1850). Of the 200 patients included in this study, 128 (64%) were male, and 72 (36%) were female. The median age at first clinic presentation was 8 months (interquartile range (IQR) 25–75%: 5–16). According to the Scoring Atopic Dermatitis (SCORAD) index, AD severity was mild in 150 (75%) patients and moderate-to-severe in 50 (25%). Food allergy sensitization was present in 72 (36%) patients. Patients with moderate-to-severe AD had significantly lower IgG (300 vs. 374 mg/dL; p < 0.001; r = −0.346), IgA (10 vs. 14 mg/dL; p = 0.004), and IgM (38 vs. 51 mg/dL; p = 0.001) levels when compared with those with mild disease. Multivariate logistic regression confirmed that lower IgG was the only immunoglobulin independently associated with moderate-to-severe AD (OR = 1.97 per 100 mg/dL decrease; 95% CI: 1.15–3.39; p = 0.013), while food allergy was the strongest independent predictor of the SCORAD index (β = +11.97; p < 0.001). None of the patients received intravenous immunoglobulin (IVIG) treatment. Of the 142 patients who underwent serial serum immunoglobulin measurements, 56 (39%) achieved age-appropriate normal IgG levels, while hypogammaglobulinemia persisted in 86 (61%). Conclusions: We found a higher frequency of hypogammaglobulinemia in patients with AD in our study, as compared with previously reported rates of THI in children from the general pediatric population. Although our study showed an increase in IgG levels during the follow-up period in many patients, it emphasizes the need for long-term immunological monitoring, especially in patients with moderate-to-severe AD. Full article

Background: Documentation of admission medication is frequently insufficient, particularly in the emergency department (ED). This study analyses discrepancies between the admission medication by ED physicians and pharmaceutical medication reconciliation (PMR) at the emergency admission ward, their clinical relevance, and influence on discharge medication. Methods: In a retrospective observational study (May 2022–April 2023) on an interdisciplinary emergency admission ward, unintended medication discrepancies (UMDs) between ED admission medication and PMR, as well as prescription discrepancies (PDs) between admission medication prescribed at the emergency admission ward and PMR, were analysed. Persistence of PDs up to discharge was evaluated. Drugs associated with discrepancies were classified for clinical relevance during hospitalisation as (A) relevant for documentation and prescription, (B) relevant for documentation but irrelevant for prescription, or (C) irrelevant for documentation and prescription. Additionally, a list of high-risk drugs was established. Results: For 256 patients, a median of three (Q1–Q3 0–6.75) and five (2–8) drugs were documented as admission medication in the ED and PMR, respectively, with a median of two (1–5) UMDs per patient. For Group A drugs, the admission medication prescribed at the emergency admission ward compared to the PMR resulted in a median of one (0–3) PD per patient. Drug omission was most common (60.0 and 61.0% of UMDs and PDs, respectively). A total of 22.8% of UMDs and 23.8% of PDs concerned high-risk drugs. Of 215 PDs eligible for discharge analysis, 137 (63.7%) persisted up to the discharge letter. Conclusions: A considerable number of discrepancies were found between the admission medication in the ED and PMR. A substantial proportion of these were caused by high-risk drugs, highlighting their potential to harm patients. Discrepancies tend to persist throughout hospitalisation up to the discharge letter. Full article