Search Results (328)

Background/Objectives: Rates of degenerative spinal pathology are increasing, driving interest in minimally invasive surgical (MIS) techniques that facilitate faster recovery. Full endoscopic lumbar discectomy (FELD) and biportal endoscopic lumbar discectomy (BELD) offer reduced tissue disruption, but comparative outcomes versus non-endoscopic MIS and optimal patient selection remain unclear. This systematic review examines pre-operative characteristics and post-operative outcomes of endoscopic lumbar microdiscectomy (ELMD) compared to MIS and open techniques. Methods: A PRISMA-guided search of PubMed, Embase, Scopus, and hand searches through 31 September 2024 identified studies on lumbar spinal surgery using endoscopic techniques, restricted to level 1a/b and 2a evidence. Articles were subgrouped by surgery type, with this analysis focusing on ELMD. Data extraction included risk-of-bias assessment, and meta-analysis was performed using multivariate mixed-effects regression. Pre-operative patient characteristics and post-operative outcomes for endoscopic lumbar microdiscectomy (ELMD) were directly compared to both open microdiscectomy and minimally invasive non-endoscopic microdiscectomy (MIS) techniques. Within the ELMD cohort, we further analyzed differences between full endoscopic (FELD) and biportal endoscopic (BELD) approaches, as well as between transforaminal and interlaminar access routes. Results: Of 6891 articles, 5469 unique titles/abstracts were screened, yielding 87 studies (3238 patients) for final synthesis. Compared to open microdiscectomy, ELMD patients were more often male, younger, of lower BMI, and had more comorbidities. They typically presented with shorter symptom duration and predominant radiculopathy. ELMD was performed most at L3–L4 and L4–L5. Post-operatively, ELMD patients had significantly lower VAS Leg Pain scores at 1 day and 1 year and reduced recurrence rates. ELMD was associated with lower recurrence rates and correspondingly lower revision surgery rates, with dural tears and wound infections trending lower compared to open surgery. Compared to non-endoscopic MIS, pre- and post-operative characteristics were similar. BELD patients more often had longer symptom duration, motor weakness, and hyporeflexia than FELD patients. Conclusions: ELMD patients demonstrate favorable pain relief and reduced recurrence versus open surgery, with outcomes comparable to MIS. These findings support ELMD as a less invasive alternative within the MIS spectrum. Full article

Acute pancreatitis (AP) is the most common cause of gastrointestinal-related hospitalizations in the United States, with gallstone disease and alcohol as the leading etiologies. Management is determined by disease severity, classified as interstitial edematous pancreatitis or necrotizing pancreatitis, with severity further stratified based on local complications and systemic organ dysfunction. Regardless of etiology, initial treatment involves aggressive intravenous fluid resuscitation with Lactated Ringer’s solution, pain and nausea control, early oral feeding in 24 to 48 h, and etiology-directed interventions when indicated. In gallstone pancreatitis, early endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is indicated in the presence of concomitant cholangitis or persistent biliary obstruction, with subsequent laparoscopic cholecystectomy as standard of care for stone clearance. The role of interventional therapy in uncomplicated AP is limited in the acute phase, except for biliary decompression or enteral feeding support with nasojejunal tube placement. However, in severe AP with complications, interventional radiology (IR) and endoscopic approaches play a pivotal role. IR facilitates early percutaneous drainage of symptomatic, acute fluid collections and infected necrosis, particularly in non-endoscopically accessible retroperitoneal or dependent collections, improving outcomes with a step-up approach. IR-guided angiographic embolization is the preferred modality for hemorrhagic complications, including pseudoaneurysms. In the delayed phase, walled-off necrosis (WON) and pancreatic pseudocysts are managed with endoscopic ultrasound (EUS)-guided drainage, with direct endoscopic necrosectomy (DEN) reserved for infected necrosis. Dual-modality drainage (DMD), combining percutaneous and endoscopic drainage, is increasingly utilized in extensive or complex collections, reflecting a collaborative effort between gastroenterology and interventional radiology comparable to that which exists between IR and surgery in institutions that perform video assisted retroperitoneal debridement (VARD). Peripancreatic fluid collections may fistulize into adjacent structures, including the stomach, small intestine, or colon, requiring transpapillary stenting with or without additional closure of the gut leak with over-the-scope clips (OTSC) or suturing devices. Additionally, endoscopic management of pancreatic duct disruptions with transpapillary or transmural stenting plays a key role in cases of disconnected pancreatic duct syndrome (DPDS). Comparative outcomes across interventional techniques—including retroperitoneal, laparoscopic, open surgery, and endoscopic drainage—highlight a shift toward minimally invasive approaches, with decreased morbidity and reduced hospital stay. The integration of endoscopic and interventional radiology-guided techniques has transformed the management of AP complications and multidisciplinary collaboration is essential for optimal patient outcomes. Full article

Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure for treating severe aortic stenosis, where optimal vascular access route selection is critical to reduce complications. It requires careful selection of the iliac artery with the most favourable anatomy, specifically, one with the largest diameters and no segments narrower than 5 $\mathrm{m}$$\mathrm{m}$. This process is time-consuming when carried out manually. We present an active learning-based segmentation framework for contrast-enhanced Cardiac Magnetic Resonance (CMR) data, guided by probabilistic uncertainty and pseudo-labelling, enabling efficient segmentation with minimal manual annotation. The segmentations are then fed into an automated pipeline for diameter quantification, achieving a Dice score of $0.912$ and a mean absolute percentage error (MAPE) of 4.92%. An ablation study using pre- and post-contrast CMR showed superior performance with post-contrast data only. Overall, the pipeline provides accurate segmentation and detailed diameter profiles of the aorto-iliac route, helping the assessment of the access route. Full article

Background/Objectives: Sentinel lymph node (SLN) mapping has become a standard approach in the surgical staging of early-stage endometrial cancer, aiming to reduce the morbidity associated with full lymphadenectomy while preserving diagnostic accuracy. Vaginal Natural Orifice Transluminal Endoscopic Surgery (V-NOTES) represents a novel, minimally invasive approach for SLN mapping that may offer specific benefits in terms of access, cosmetics, and recovery, particularly in select patient populations. Methods: A comprehensive literature search was conducted in the main databases for studies evaluating the use of V-NOTES for sentinel lymph node mapping in patients with endometrial cancer. Results: Of the 12 included studies, three were observational cohort studies, while the remaining were case reports and series. The mean patient age was 59.6 years, with a majority being overweight or obese. V-NOTES was performed using both transperitoneal and retroperitoneal approaches, with indocyanine green (ICG) being the most used tracer. The overall mean SLN detection rate was 98.19%, with a bilateral detection rate of 93.7%. The average operative time was 155 min, the mean blood loss was 72.03 mL, and the average hospital stay was 2.4 days. The complication rate was low (3.9%), with no conversions to laparotomy reported. Conclusions: V-NOTES appears to be a feasible and safe alternative for SLN mapping in early-stage endometrial cancer, with high detection rates and favourable perioperative outcomes. However, due to the limited number of comparative studies and small sample sizes, further prospective research is needed to establish its efficacy relative to traditional minimally invasive techniques and to determine the optimal patient selection criteria. Full article

Background: Transplant ureteral stricture (TUS) reconstruction remains a significant challenge in renal transplantation, particularly when conventional access to the transplant ureter and renal pelvis is not feasible. This report presents two rare and complex surgical reconstructions: a combined calico-vesicostomy and uretero-calycostomy in one patient, and an ileo-calycostomy in another. Both cases involved patients with prior failed minimally invasive interventions and complex anatomy that precluded standard repairs. Case presentation: A hybrid surgical approach incorporating open reconstruction with fluoroscopic and endoscopic guidance was used to access the renal calyces directly, enabling successful re-establishment of urinary tract continuity. The first patient underwent dual reconstruction with native ureteral reimplantation to the middle calyx and a simultaneous calycovesicostomy, bladder to the It lower pole calyx. The second patient, with prior ileal conduit urinary diversion, underwent ileocalycostomy—anastomosing the ileal conduit to the middle calyx. Both reconstructions were performed using modified partial nephrectomies to preserve nephron mass. Long-term follow-up (34 and 40 months) demonstrated excellent graft function and minimal complications. Conclusions: These cases represent the first reported long-term outcomes of calycovesicostomy and ileocalycostomy in transplant ureteral reconstruction and reinforce the utility of calyceal access in complex TUSs. These cases highlight rare but viable surgical options in complex scenarios of transplant ureteral strictures. Hence, a multidisciplinary approach and meticulous preoperative planning are essential to optimize outcomes in these challenging scenarios. Full article

Alzheimer’s disease (AD) is a progressive neurodegenerative condition representing the most common cause of dementia and currently affects millions of people worldwide. The clinical presentation includes memory impairment, cognitive decline, and neuropsychiatric symptoms, reflecting pathological hallmarks such as β-amyloid (Aβ) plaques, neurofibrillary tangles, synaptic dysfunction, and neuroinflammation. Despite being the gold standard for detecting amyloid and tau pathologies in vivo, cerebrospinal fluid (CSF) biomarkers and positron emission tomography (PET) imaging are not widely used in the clinical setting because of invasiveness, high costs, and restricted accessibility. Recent advances in blood-based biomarkers offer a promising and minimally invasive tool for early detection, diagnosis, and monitoring of AD. Ultra-sensitive analytical platforms, including single-molecule arrays (Simoa) and immunoprecipitation-mass spectrometry, now enable reliable quantification of plasma Aβ isoforms, phosphorylated tau variants (p-Tau181, p-Tau217, p-Tau231), neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP). In addition, blood biomarkers reflecting oxidative stress, neuroinflammation, synaptic disruption and metabolic dysfunction are under active investigation. This narrative review synthesizes current evidence on blood-based biomarkers in AD, emphasizing their biological relevance, diagnostic accuracy, and clinical applications. Finally, we highlight forthcoming challenges, such as standardization, and future directions, including the use of artificial intelligence in precision medicine. Full article

For monitoring animal adaptation when facing environmental challenges, and more specifically when addressing the impacts of global warming—particularly responses to heat stress and short-term fluctuations in osmotic regulations in the different organs influencing animal physiology—there is an increasing demand for digital tools to understand and monitor a range of biomarkers. Microneedle arrays (MNAs) have recently emerged as promising devices minimally invasively penetrating human skin to access dermal interstitial fluid (ISF) to monitor deviations in physiology and consequences on health. The ISF is a blood filtrate where the concentrations of ions, low molecular weight metabolites (<70 kDa), hormones, and drugs, often closely correlate with those in blood. However, anatomical skin differences between human and farm animals, especially large animals, as well as divergent tolerances of such devices among species with behavior specificities, motivate new MNA designs. We addressed technological challenges to design higher microneedles for farm animal (pigs and cattle) measurements. We designed microneedle arrays composed of 37 microneedles, each 2.8 mm in height, using dextran-methacrylate, a photo-crosslinked biocompatible biopolymer-based hydrogel. The arrays were characterized geometrically and mechanically. Their abilities to perforate pig and cow skin were demonstrated through histological analysis. The MNAs successfully absorbed approximately 10 µL of fluid within 3 h of application. Full article

Zenker’s diverticulum (ZD) is an esophageal condition that results in an outpouching of the mucosal layer through a weakened area in the hypopharyngeal wall. This condition can cause symptoms like dysphagia, regurgitation, and aspiration, impacting patients’ quality of life. Historically, open surgery was the primary treatment. Although effective, this method is associated with longer recovery times and risks such as infections, nerve damage, and prolonged hospitalization. Rigid endoscopic stapling emerged as a less invasive alternative, offering high success rates for patients with favorable anatomy. Zenker’s peroral endoscopic myotomy (Z-POEM), adapted from treatments for achalasia, represents the latest advancement in ZD management. It involves creating a submucosal tunnel and precisely dividing the cricopharyngeus muscle. Z-POEM is minimally invasive and often provides quick relief with a high success rate of around 92%, while enabling outpatient treatment or brief hospital stays. However, it requires specialized expertise, and long-term data on recurrence rates are still emerging. This review discusses the evolution of these treatment modalities through comprehensive searches of PubMed, MEDLINE, and ScienceDirect databases. Studies reporting on treatment outcomes, complication rates, operative times, and clinical success associated with open surgery, rigid endoscopic stapling, and Z-POEM were included, with emphasis on meta-analyses, multicenter studies, and large case series highlighting Z-POEM’s comparable success to open surgery and increased patient tolerance. Open surgery achieves long-term symptom resolution rates of 90–95% but is associated with higher complication rates (up to 30%) and prolonged recovery times. Rigid endoscopic stapling offers symptom relief in approximately 90% of cases, with lower morbidity and shorter hospital stays (1–2 days), though anatomical limitations restrict its use. Z-POEM has demonstrated clinical success rates of 85.5–93%, with major complications reported in 4.8–5% of cases and recurrence rates as low as 1.4% at one-year follow-up in larger diverticula. Z-POEM’s minimally invasive nature and suitability for high-risk patients make it increasingly preferred in specialized centers. Management of Zenker’s diverticulum has evolved significantly, with endoscopic techniques, particularly Z-POEM, offering comparable success to open surgery but with fewer complications and faster recovery. Ongoing advances in endoscopic equipment and technique, along with emerging data on long-term outcomes, are likely to further refine treatment algorithms for ZD, especially for elderly and high-risk populations. Future directions in ZD management include ongoing research to enhance the safety and efficacy of endoscopic techniques, with new technologies on the horizon that could further improve outcomes and accessibility. Full article

Background/Objectives: Aging is linked to a loss of muscle mass and strength, which increases the risk of falls, disability, and lower quality of life. Identifying individuals at risk of sarcopenia, cachexia, or malnutrition is important. In settings with limited access to advanced diagnostics, simple anthropometric measurements can serve as practical alternatives. This study aimed to evaluate simple, quick, and non-invasive anthropometric measurements as indicators of muscle mass in older adults, based on body composition analysis (BIA). Methods: The study included 361 patients admitted to a geriatric ward. Standardized protocols were used to measure anthropometric and body composition parameters, including bioelectrical impedance analysis (BIA). Various body composition indices were calculated, such as body mass index (BMI), body adiposity index (BAI), waist-to-hip ratio (WHR), visceral adiposity index (VAI), fat-free mass index (FFMI), and fat mass index (FMI). Results: Strong positive correlations were found between body mass and muscle mass in both women and men. Among anthropometric measures, calf circumference showed the strongest correlation with muscle mass (R = 0.798 in women; R = 0.744 in men, p < 0.001). Other indices, including BMI (R = 0.733 in women; R = 0.606 in men, p < 0.001), FFMI (R = 0.697 in women; R = 0.721 in men, p < 0.001), and FMI (R = 0.600 in women; R = 0.354 in men, p < 0.001), were also positively correlated with muscle mass. Conclusions: Calf circumference is a simple, quick, and non-invasive measure that can effectively estimate muscle mass in older adults. Although other anthropometric parameters, such as body mass, BMI, FMI, and FFMI, also showed positive correlations with muscle mass, calf circumference appears to be the most practical, as it requires minimal equipment, little time, and limited preparation. This makes it particularly useful for routine assessments in primary care and long-term care settings, where access to advanced diagnostic tools like BIA or DXA is limited. These findings support the use of simple anthropometric measurements as cost-effective and easily accessible alternatives for estimating muscle mass in older adults. Further research is needed to determine appropriate cut-off points for specific populations and sexes. Full article

Background/Objectives: Breast cancer (BC) is the most prevalent cancer worldwide, with approximately 40% of early-stage BC patients developing recurrence despite initial treatments. Current diagnostic methods, such as mammography and solid tissue biopsies, face limitations in sensitivity, accessibility, and the ability to characterize tumor heterogeneity or monitor systemic disease progression. Methods: To address these gaps, this study investigates a fully automated analysis workflow using data derived from fluorescent Whole-Slide Imaging (fWSI) for detecting and classifying rare cells (circulating tumor and tumor microenvironment cells) in peripheral blood samples. Our methodology integrates supervised machine learning algorithms for rare event detection, immunofluorescence-based classification, and statistical quantification of cellular features. Results: Using a fWSI dataset of 534 cancer and non-cancer peripheral blood samples, the automated model demonstrated high concordance with manual annotation, achieving up to 98.9% accuracy and a precision-sensitivity AUC of 83.2%. Morphometric analysis of rare cells identified significant differences between normal donors, early-stage BC, and late-stage BC cohorts, with distinct clusters emerging in late-stage BC. Conclusions: These findings highlight the potential of liquid biopsy and algorithmic approaches for improving BC diagnostics and staging, offering a scalable, minimally invasive solution to enhance clinical decision-making. Future work aims to refine the automated framework to minimize errors and improve the robustness across diverse cohorts. Full article

Lung cancer (LC), with non-small-cell lung cancer (NSCLC) as its predominant subtype, remains the leading cause of cancer-related mortality worldwide. While immune checkpoint inhibitors (ICIs) have redefined the therapeutic paradigm in advanced NSCLC, durable responses are confined to a limited subset of patients. A major clinical challenge persists: the inability to accurately predict which patients will derive meaningful benefit, which will exhibit primary resistance, and which are at risk for severe immune-related toxicities. The imperative to individualize ICI therapy necessitates robust, dynamic, and accessible biomarkers. Liquid biopsy has emerged as a transformative, minimally invasive tool that enables real-time molecular and immunologic profiling. Through analysis of circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), exosomes, and peripheral blood immune components, liquid biopsy offers a window into both tumor intrinsic and host-related determinants of ICI response. These biomarkers not only hold promise for identifying predictive signatures—such as tumor mutational burden, neoantigen landscape, or immune activation states—but also for uncovering mechanisms of acquired resistance and guiding treatment adaptation. Beyond immunotherapy, liquid biopsy plays an increasingly central role in the landscape of targeted therapies, allowing early detection of actionable driver mutations and resistance mechanisms (e.g., EGFR T790M, MET amplification, and ALK fusion variants). Importantly, serial sampling via liquid biopsy facilitates longitudinal disease monitoring and timely therapeutic intervention without the need for repeated tissue biopsies. By guiding therapy selection, monitoring response, and detecting resistance early, liquid biopsy has the potential to significantly improve outcomes in NSCLC. Full article

A revolutionary non-invasive method for the thorough evaluation of coronary artery disease (CAD) is fractional flow reserve (FFR) obtained from coronary computed tomography angiography (CCTA). Computed tomography-derived FFR (FFR_CT) assesses both the anatomical and functional significance of coronary lesions simultaneously by utilizing sophisticated computational models, including computational fluid dynamics, machine learning (ML), and Artificial Intelligence (AI) methods. The technological development, validation research, clinical uses, and real-world constraints of FFR_CT are compiled in this review. Large multicenter trials and registries consistently show that FFR_CT is a reliable gatekeeper to invasive coronary angiography (ICA) and increases diagnostic accuracy significantly when compared to coronary Computed Tomography Angiography (CTA) alone, especially in patients with intermediate-risk anatomy. Additionally, FFR_CT has demonstrated benefits in populations with in-stent restenosis (ISR) and in virtual procedural planning. Notwithstanding its advantages, the technique still requires high-quality imaging, and its practical application is constrained by expenses, processing requirements, and image distortions. Continuous developments in automation and deep learning should improve accessibility, effectiveness, and workflow integration in clinical settings. FFR_CT is expected to become more and more important in the individualized treatment of CAD by minimizing unnecessary invasive procedures and improving patient selection for revascularization. Full article

Background: Spontaneous intracerebral hemorrhage (ICH) has the highest case fatality of all stroke types, yet recent epidemiological and outcome data from Central and Eastern Europe remain limited. Methods: We retrospectively analyzed prospectively collected data for 601 consecutive adults with primary ICH admitted to Sibiu County Clinical Emergency Hospital, Romania (2017–2023). Demographics, Glasgow Coma Scale (GCS), CT-derived hematoma volume (ABC/2), anatomical site, intraventricular extension (IVH), treatment, comorbidities, and in-hospital death were reported with exact counts and percentages; no imputation was performed. Results: Mean age was 68.4 ± 12.9 years, and 59.7% were male. Mean hematoma volume was 30.4 mL, and 23.0% exceeded 30 mL. IVH occurred in 40.1% and doubled mortality (50.6% vs. 16.7%). Overall case fatality was 29.6% and climbed to 74.5% for brain-stem bleeds. Men, although younger than women (66.0 vs. 71.9 years), died more often (35.4% vs. 21.1%; risk ratio 1.67, 95% CI 1.26–2.21). Systemic hazards amplified death risk: Oral anticoagulation, 44.2%; chronic alcohol misuse, 51.4%; thrombocytopenia, 41.0%; chronic kidney disease, 42.3%. Conservative management (74.9%) yielded 27.8% mortality overall and ≤15 for small-to-mid lobar or capsulo-lenticular bleeds; lobar surgery matched this (13.4%) only in large clots. Thalamic evacuation was futile (82.3% mortality), and cerebellar decompression performed late still carried 54.5% mortality versus 16.6% medically. Multivariable analysis confirmed that low GCS, IVH, large hematoma volume, thrombocytopenia, and chronic alcohol use independently predicted in-hospital mortality. Limitations: This retrospective study lacked post-discharge functional outcome data (e.g., mRS at 90 days). Conclusions: This study presents the largest Romanian single-center ICH cohort, establishing national benchmarks and underscoring modifiable risk factors. Early ICH lethality aligns with Western data but is amplified by exposures such as alcohol misuse, anticoagulation, thrombocytopenia, and CKD. Priorities include preventive strategies, timely surgical access, wider adoption of minimally invasive techniques, and development of a prospective regional registry. Full article

Background: Rib fractures are among the most common thoracic injuries following blunt trauma and are associated with significant morbidity, particularly in elderly and polytrauma populations. Historically managed non-operatively, recent advances have redefined the role of surgical stabilization of rib fractures (SSRF) in improving patient outcomes. The objective of this narrative review is to evaluate current evidence surrounding the management of rib fractures, with a focus on indications for SSRF, surgical techniques, special populations, and future directions in care. Methods: A narrative review of the literature was conducted, incorporating relevant randomized controlled trials, cohort studies, clinical guidelines, and expert consensus statements. Emphasis was placed on patient selection criteria, surgical strategies, multimodal analgesia, and emerging technologies. Results: SSRF has demonstrated benefits in short- and long-term outcomes, including improved pain control, reduced ventilator dependence, shorter ICU and hospital stays, and better functional recovery. These outcomes are most evident in patients with flail chest, severe displacement, or failure of conservative therapy. Minimally invasive techniques and 3D-printed implants represent promising innovations. Despite growing evidence, SSRF remains underutilized due to variability in institutional protocols and access to trained personnel. Conclusions: The management of rib fractures continues to evolve with increasing support for surgical intervention in select patients. Wider implementation of SSRF, guided by standardized protocols and advanced technologies, may improve outcomes and reduce complications in this high-risk trauma population. Full article

Aortic valve diseases affect a significant percentage of the population, and with the extension of survival expectancy, they are expected to increase furthermore. Surgical treatment of aortic valve diseases mainly includes valve replacement and, rarely, its repair. The technology of both surgical and transcatheter valves is evolving, and new prosthetic valves with improved characteristics are available, e.g., longer lifespan, faster implantation, better hemodynamic performance with better effective orifice area, suitable for small aortic annuli, etc. Minimally invasive surgical techniques are constantly evolving and spreading. New access sites are used for transcatheter valve implantation. The Heart Team determines the most appropriate intervention for each patient based on their anatomical and clinical profiles, aiming to optimize long-term outcomes. Full article