Search Results (80)

Atrial fibrillation remains the most frequent sustained arrhythmia, particularly in the elderly population, and is associated with increased risks of stroke, heart failure, and reduced quality of life. While catheter ablation is widely used for rhythm control, its efficacy is limited in persistent and long-standing atrial fibrillation. Over the past two decades, minimally invasive surgical strategies have emerged as effective alternatives, aiming to replicate the success of the Cox-Maze procedure while reducing surgical trauma. This overview critically summarizes the current minimally invasive techniques available for atrial fibrillation treatment, including mini-thoracotomy ablation, thoracoscopic ablation, and hybrid procedures such as the convergent approach. These methods offer the potential for durable sinus rhythm restoration by enabling direct visualization, transmural lesion creation, and left atrial appendage exclusion, with lower perioperative morbidity compared to traditional open surgery. The choice of energy source plays a key role in lesion efficacy and safety. Particular attention is given to the technical steps of each procedure, patient selection criteria, and the role of left atrial appendage closure in stroke prevention. Hybrid strategies, which combine epicardial surgical ablation with endocardial catheter-based procedures, have shown encouraging outcomes in patients with refractory or long-standing atrial fibrillation. Despite the steep learning curve, minimally invasive techniques provide significant benefits in terms of recovery time, reduced hospital stay, and fewer complications. As evidence continues to evolve, these approaches represent a key advancement in the surgical management of atrial fibrillation, deserving integration into contemporary treatment algorithms and multidisciplinary heart team planning. Full article

We present a miniaturized, inexpensive, and user-friendly microfluidic platform to support biological applications. The system integrates a mini-incubator providing controlled environmental conditions and housing a microfluidic device for long-term cell culture experiments. The incubator is designed to be compatible with standard inverted optical microscopes and Raman spectrometers, allowing for the non-invasive imaging and spectroscopic analysis of cell cultures in vitro. The microfluidic device, which reproduces a dynamic environment, was optimized to sustain a passive, gravity-driven flow of medium, eliminating the need for an external pumping system and reducing mechanical stress on the cells. The platform was tested using Raman analysis and adherent tumoral cells to assess proliferation prior and subsequent to hydrogen peroxide treatment for oxidative stress induction. The results demonstrated a successful adhesion of cells onto the substrate and their proliferation. Furthermore, the platform is suitable for carrying out optical monitoring of cultures and Raman analysis. In fact, it was possible to discriminate spectra deriving from control and hydrogen peroxide-treated cells in terms of DNA backbone and cellular membrane modification effects provoked by reactive oxygen species (ROS) activity. The 800–1100 cm⁻¹ band highlights the destructive effects of ROS on the DNA backbone’s structure, as its rupture modifies its vibration; moreover, unpaired nucleotides are increased in treated sample, as shown in the 1154–1185 cm⁻¹ band. Protein synthesis deterioration, led by DNA structure damage, is highlighted in the 1257–1341 cm⁻¹, 1440–1450 cm⁻¹, and 1640–1670 cm⁻¹ bands. Furthermore, membrane damage is emphasized in changes in the 1270, 1301, and 1738 cm⁻¹ frequencies, as phospholipid synthesis is accelerated in an attempt to compensate for the membrane damage brought about by the ROS attack. This study highlights the potential use of this platform as an alternative to conventional culturing and analysis procedures, considering that cell culturing, optical imaging, and Raman spectroscopy can be performed simultaneously on living cells with minimal cellular stress and without the need for labeling or fixation. Full article

Background: Dental eruption pathways could be influenced by several factors, both general and local, with different prevalence and morbidity. This study aims to report our experience of pediatric impacted teeth due to local factors, with the exclusion of the third molars, illustrating their prevalence, diagnostic and therapeutic pathways, and treatment outcomes. Methods: The inclusion criteria were minor age (<18 years) and the presence of impacted teeth due to a local cause, excluding wisdom teeth. The complete diagnostic and therapeutic procedures and their outcomes were described. The relationship between the treatment and the outcomes was assessed with a chi-square test. Results: One hundred twelve patients with a single impaction were included in the study. The local causes of single impaction were: 63 odontogenic cysts (57%), 24 supernumerary teeth (21%), 17 odontogenic tumors (15%), and eight primary bone lesions (7%). During the follow-up period, 83 teeth erupted spontaneously 12–36 months following surgery (74%), 12 were extracted during surgery (11%), and 17 needed orthodontic traction to achieve their aesthetic and functional position (15%). The relationship between mini-invasive surgery and spontaneous eruption was significant (p < 0.00001). Conclusions: Within the limitations of this study, mini-invasive surgical treatment preceded by a correct diagnosis may lead to a spontaneous eruption of permanent teeth, avoiding further orthodontic intervention and premature loss of permanent teeth. Full article

Background and Objectives: Anterior open-bite malocclusion remains a challenging orthodontic condition where achieving a positive overbite necessitates precise control of incisor extrusion and molar intrusion. With recent advances in clear aligner therapy—improved materials, attachment techniques and digital treatment planning—the potential for non-invasive treatment has increased. This scoping review systematically maps the evidence on the efficacy of clear aligners in treating anterior open bite among adult patients, outlines treatment protocols and highlights gaps in the literature. Materials and Methods: A systematic search was conducted in PubMed/Medline, Embase/ScienceDirect and Clarivate/Web of Science for literature published in English between January 2000 and December 2024. Studies involving adult patients treated with clear aligners (predominantly Invisalign^®) were included. A two-step screening process was applied, and data were charted according to pre-specified criteria. The review adheres to the PRISMA-ScR checklist guidelines. Results: From an initial pool of 802 articles, 30 met the inclusion criteria following duplicate removal and full-text screening. The evidence suggests that clear aligners can achieve measurable incisor extrusion and posterior intrusion when appropriate auxiliary techniques (e.g., attachments and mini screws) are used. However, digital treatment planning software may overestimate movement predictions, necessitating iterative refinement phases. Patient compliance, clinician expertise and technological limitations are key factors influencing outcomes. Conclusions: Clear aligner therapy represents a promising alternative to fixed appliances for anterior open-bite correction in adults, although challenges remain in achieving precise vertical control. Further high-quality randomized controlled trials and standardized outcome measures are needed to confirm long-term stability and efficacy. Full article

Immunotherapy has revolutionized cancer treatment; however, the availability of cost-effective blood-based biomarkers for prognostic and predictive factors of immune treatment in patients with solid tumors remains limited. Due to low cost and easy accessibility, blood-based biomarkers should constitute an essential component of studies to optimize and monitor immunotherapy. Currently available markers that can be measured in peripheral blood include total monocyte count, myeloid-derived suppressor cells (MDSCs), regulatory T cells (Tregs), relative eosinophil count, cytokine levels (such as IL-6, IL-8, and IL-10), lactate dehydrogenase (LDH), C-reactive protein (CRP), soluble forms of CTLA-4 and PD-1 or PD-L1, as well as circulating tumor DNA (ctDNA). In our mini-review, we discuss the latest evidence indicating that routinely accessible peripheral blood parameters—such as the neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), and rheological parameters, which so far have been rarely considered for such an application, may be used as non-invasive biomarkers in cancer immunotherapy. Rheological parameters such as whole blood viscosity are influenced by several factors, such as hematocrit, aggregability and deformability of erythrocytes, and plasma viscosity, which is largely dependent on plasma proteins. Especially in cases where the set of symptoms indicates a high probability of hyperviscosity syndrome, blood rheological tests can lead to early diagnosis and treatment. Both biochemical and rheological parameters are prone to become novel and future standards for assessing immunotherapy among patients with solid tumors. Full article

Background and Objectives: The aim of this study was to compare the short- and long-term effectiveness of ultrasound-guided percutaneous release (CTR-US) and mini-open surgery in the treatment of carpal tunnel syndrome (CTS). Materials and Methods: A retrospective analysis was conducted on 172 patients who underwent surgical treatment for CTS between 2015 and 2020. The patients were divided into two groups: those who underwent CTR-US (Group A, n = 66) and those treated with mini-open surgery (Group B, n = 106). All patients were evaluated using the Boston Carpal Tunnel Questionnaire (BCTQ) and the Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) scores before surgery and at 3 months, 6 months, 1 year, 2 years, and 5 years postoperatively. Electrophysiological and ultrasound findings were also compared. Statistical analyses were performed using t-tests, Mann–Whitney U tests, and Chi-square tests, with significance set at p < 0.05. Results: A total of 172 patients who met the study criteria were included. Among the participants, 112 were women and 60 were men. The mean age was calculated as 61 years for female patients and 54 years for male patients. No significant differences were found between the groups in terms of age, gender, laterality, and disease duration. Both groups demonstrated significant improvements in BCTQ and QDASH scores at all postoperative time points compared to preoperative scores (p < 0.001). The CTR-US group showed advantages in shorter treatment duration (p < 0.001), lower cost (p < 0.05), and faster recovery time. Electrophysiological evaluations revealed faster improvements in distal motor latency (DML) and sensory conduction velocity (SCV) in the CTR-US group (p < 0.05). Ultrasound assessments indicated that both methods achieved effective release of the transverse carpal ligament. No significant differences were observed between the groups in long-term questionnaire scores. Conclusion: CTR-US offers advantages such as shorter treatment duration, lower cost, and faster recovery due to its minimally invasive nature. Consistent with the literature, CTR-US provided faster recovery and improved patient comfort. However, mini-open surgery remains a reliable alternative with long-term symptom control and low complication rates. Our study found that both methods are effective, but CTR-US stands out for its esthetic and functional advantages. Full article

Background: Interventional physiatry is a branch of medicine that uses minimally invasive ultrasound-guided techniques for diagnosis and treatment in the musculoskeletal system. The aim of this scoping review is to investigate the sterilisation techniques used and the rate of infection with ultrasound-guided injections. Methods: PubMed was searched up to 30 September 2024 using the following search terms (“Ultrasound, Interventional”[mesh]) AND “Injections, Intra-Articular”[mesh]; “Ultrasound-guided intra-articular injection”. The inclusion criteria were randomised clinical trials, written in English, involving US-guided mini-invaexercissive procedures. Results: The search identified a total of 256 potentially relevant publications. After screening for duplication, inclusion, and exclusion criteria, 105 articles were eligible for data extraction. In 51 studies, the method of skin disinfection was not specified, 18 RCT reported a ’sterile condition’, 9 studies used povidone–iodine solution, 5 used alcohol, and 2 used chlorhexidine 0.5%. In 64 trials, the method of probe preparation was not specified, 11 trials described the use of sterile gel, 10 trials reported the use of a probe cover, sterile pad, or barrier, and 2 trials reported the use of chlorhexidine 0.5%; 41 studies reported mild adverse events and 4 serious adverse events. Conclusions: Taken together, the findings of this scoping review did not show a clear relationship between current sterilisation protocols and the prevention of the microbial contamination of the probes or the patient’s skin. The variation in protocols highlights the need for standardised guidelines and more rigorous studies to accurately determine the most effective disinfection practices. Full article

Background/Objectives: Contemporary dentistry aims to preserve healthy tissues and perform minimally invasive procedures. The availability of ever-improving equipment allows practitioners to follow this conceptual innovation. This approach is also used in endodontics, as new types of access cavities seem to be gaining popularity, allegedly reducing tissue destruction and loss of mechanical resistance of the treated teeth. Methods: We performed a comprehensive review of the available literature on the subject, focusing on in vitro studies accessible through major search engines and limiting the search to English-language articles published between 2010 and 2024. Results: Our analysis showed that the realization of reduced access cavities seems to preserve the mechanical resistance of the treated teeth, may compromise disinfection, and respects the original root canal path and the quality of obturation. In addition, these procedures appear to increase instrument deformation, fracture susceptibility, and treatment time: Mini-invasive cavities have many limitations and should only be used in situations where there is a high likelihood of success, where there are few difficulties and where sufficient material is available. However, with appropriate case selection, these new approaches can be used and should improve the prognosis of endodontically treated teeth. Full article

Background/Objectives: Heart failure (HF) with reduced ejection fraction remains a significant global health challenge despite advances in medical therapy. Cardiac contractility modulation (CCM) is a promising treatment for symptomatic HF patients who are ineligible for cardiac resynchronization therapy (CRT). Non-invasive methods to assess the acute hemodynamic effects of CCM are critical to optimize care and guide treatment. This study aimed to evaluate the acute impact of CCM on stroke volume (SV) and total peripheral resistance index (TPRI) using the non-invasive bioimpedance-based system (NICaS^®). Methods: Eight HF patients (median age: 64.6 years, median left ejection fraction (LVEF): 34.5%) underwent implantation of the Optimizer Smart Mini CCM device. Hemodynamic parameters, including SV and TPRI, were measured using NICaS^® at baseline (pre-implantation) and at 1 week, 1 month, and 3 months post-implantation. Measurements were repeated eight times per session and analyzed using non-parametric statistical tests, including the Kruskal–Wallis test, Mann–Whitney test, and Kolmogorov–Smirnov test. Results: Median SV increased significantly from 40.02 mL (interquartile range (IQR): 32.62–78.16 mL) at baseline to 69.83 mL (IQR: 58.63–86.36 mL) at 3 months (p < 0.0001). Median TPRI decreased significantly from 2537 dn s/cm⁵ m² (IQR: 1807–3084 dn s/cm⁵ m²) to 1307 dn s/cm⁵ m² (IQR: 1119–1665 dn s/cm⁵ m²) over the same period (p < 0.0001). CCM therapy significantly improved SV and reduced TPRI in HF patients within three months of implantation. Conclusions: NICaS^® provided a reliable, non-invasive tool for monitoring these acute hemodynamic changes, supporting its use in clinical practice. Full article

Background/Objectives: Alzheimer’s disease (AD) is characterized by progressive brain atrophy marked by cognitive decline and memory loss, which significantly affect patients’ quality of life. Transcranial ultrasound stimulation (TUS) is a potential physical treatment for AD patients. However, the specific brain regions stimulated by TUS and its therapeutic effects remain unclear. Methods: In this study, magnetic resonance imaging (MRI) and FreeSurfer segmentation were employed to assess alterations in the brain volume of AD patients after TUS. Results: Our findings revealed significant volume increases in the corpus callosum (CC) and lateral orbitofrontal cortex (lOFC) in the TUS group. Moreover, the volumetric changes in the CC were strongly correlated with improvements in the Mini-Mental State Examination score, which is a widely used measure of cognitive function of AD patients. Conclusions: TUS has the potential to alleviate disease progression and offers a non-invasive therapeutic approach to the improvement of cognitive function in AD patients. Full article

This review aims to explore the evolution, techniques, and outcomes of minimally invasive spine surgery (MISS) within the field of neurosurgery. We sought to address the increasing burden of spine degeneration in a rapidly aging population and the need for optimizing surgical management. This review explores various techniques in MISS, drawing upon evidence from retrospective studies, case series, systematic reviews, and technological advancements in neurosurgical spine treatment. Various approaches, including endonasal cervical, transoral cervical, transcervical, mini-open/percutaneous, tubular, and endoscopic techniques, provide alternatives for current approaches to a range of spinal pathologies. The main findings of this review highlight potential advantages of MISS over traditional open surgery, including reduced complications, shorter hospital stays, and improved patient outcomes. Our research underscores the importance of adopting MISS techniques to optimize patient care in neurosurgical spine treatment. Full article

Gastric cancer (GC) is a malignant tumor of the gastrointestinal tract associated with high mortality rates and accounting for approximately 1 million new cases diagnosed annually. Surgery, particularly radical gastrectomy, remains the primary treatment; however, there are currently no specific approaches to better distinguish malignant from healthy tissue or to differentiate between metastatic and non-metastatic lymph nodes. As a result, surgeons have to remove all lymph nodes indiscriminately, increasing intraoperative risks for patients and prolonging hospital stay. Near-infrared fluorescence imaging with indocyanine green (ICG) can provide real-time visualization of the surgical field using both conventional laparoscopy and robotic mini-invasive precision surgery platforms. However, its application shows some limits, as ICG is a non-targeted contrast agent. Several studies are now investigating the potential efficacy of fluorescent targeted agents that could selectively bind to the tumor tissue, offering a valuable tool for metastatic mapping during robotic gastrectomy. This review aims to summarize the key fluorescent agents that have been developed to recognize GC markers, as well as those targeting the tumor microenvironment (TME) and metabolic features. These agents hold great potential as valuable tools for enhancing precision surgery in robotic gastrectomy procedures improving the clinical recovery of GC patients. Full article

Background/Objectives: The ageing population has heightened interest in the prognostic role of geriatric conditions, notably frailty syndrome (FS) and cognitive impairment (CI). Evidence indicates a significant link between cardiovascular disease, FS, and CI. However, limited research has explored the impact of impaired functional and cognitive performance on outcomes in acute coronary syndrome (ACS) patients. This study aimed to evaluate the effect of coexisting FS and CI (FSxCI) on early and 6-month complications in older adults with ACS. Methods: This study included 196 ACS patients (119 men) aged 65 and over (mean = 74.7 years), with 90.8% undergoing invasive treatment (PCI in 81.6%, CABG in 9.2%). FS and CI were assessed on the third hospital day using the Tilburg Frailty Indicator (TFI) and Mini Mental State Examination (MMSE). Early (in-hospital) complications included major bleeding, ventricular arrhythmia (VT), conduction disturbances, cardiac arrest, stent thrombosis, acute heart failure (Killip–Kimball class III/IV), stroke, prolonged stay, and in-hospital death. Six-month follow-up recorded major adverse cardiovascular and cerebrovascular events (MACCEs). Results: Patients with FSxCI (n = 107, 54.6%) were older and had higher hypertension prevalence and lower nicotine dependence. FSxCI patients faced over twice the risk of prolonged hospital stays (OR 2.39; p = 0.01) and nearly three times the risk of early complications (OR 2.73; p < 0.001). At 6 months, FSxCI tripled the risk of MACCEs (OR 2.8; p = 0.007). Kaplan–Meier analysis confirmed a worse 6-month prognosis for FSxCI patients. Conclusions: Elderly patients with ACS and concomitant FSxCI had significantly higher rates of early (in-hospital) and 6-month complications. FSxCI was associated with a worse 6-month prognosis. This highlights its significance for clinical decision-making, as identifying FSxCI in ACS patients can help prioritize high-risk individuals for tailored interventions, optimize resource allocation, and improve outcomes. Full article

Background: Dental implants are commonly employed to address edentulism, while orthodontic treatments often incorporate mini-screws to enhance tooth movement and provide stable anchorage. Both procedures are integral to modern dental practice and frequently interact in comprehensive care scenarios. While oral health professionals routinely assess patients’ medical histories before procedures, undiagnosed coagulopathies, such as Von Willebrand Disease (VWD), can present significant challenges when invasive procedures are carried out, such as the insertion of implants or mini-implants. Case description: This case report discusses the surgical placement of dental implants and orthodontic mini-screws in a patient with previously undiagnosed VWD, underscoring the potential complications and the importance of recognizing bleeding disorders in clinical practice, and provides some advice on the management of patients with previously undiagnosed VWD after/during surgical procedures. Conclusions: To prevent the risk of excessive bleeding, before surgery, all patients should be screened through precise questions on bleeding history. Full article

Background: Mini dental implants (MDIs) are alternatives to support an overdenture when a standard diameter implant cannot be placed due to lack of bone volume. They reduce the need for invasive bone grafting and lower the barrier for treatment. Aim: This prospective study reports on implant and patient-centered outcomes of flaplessly placed, early loaded MDIs supporting horseshoe-shaped maxillary overdentures after 7 years of function. Materials and Methods: Patients with a CBCT-confirmed thin alveolar crest received 5–6 one-piece MDIs using mentally guided flapless surgery. The conventional denture was relined and MDIs were provisionally loaded within one week. After 6 months the non-splinted MDIs were actively loaded with a horseshoe overdenture. Implant and prosthetic survival, peri-implant health (PPD and BoP) and patient-related outcomes using OHIP-14 and Subjective Masticatory Evaluation were assessed after 7 years. Results: 185 MDIs were placed in 14 females and 17 males. During provisional loading, 32 MDIs were lost, and 17 replacements were required in 16 patients. In total, 170 out of 202 totally placed MDIs were supporting 29 overdentures after 6 months. Cumulative implant failure increased from 15.8% at the moment of active loading to 34.7% at 7 years. After 7 years, 76% of the initially placed overdentures remained functional, mean PPD was 3.48 (SD 0.86), BoP was 0.20 (SD 0.40) and peri-implantitis incidence was 0.9%. The total OHIP-14 was reduced from 21.3/56 (SD: 13.1) preoperatively to 15.6/56 (SD 12.8) at provisional loading (p > 0.1) and 7.3/56 (SD 6.7) at final loading (p = 0.006), and it remained unchanged up to 7 years at 6.57/56 (SD: 8.92) (p > 0.5). Conclusions: Maxillary MDIs provide an acceptable treatment option in patients with deficient bone volume that cannot or refuse to be treated with bone grafting. Despite one third of the MDIs being lost, remaining MDIs had good peri-implant health, prosthetic success was 71% and Oral Health Related Quality of Life was beyond expectations. Full article