Search Results (262)

Background/Objectives: Acute-on-chronic liver failure (ACLF) is a severe syndrome in chronic liver disease (CLD) patients, characterized by multi-organ failure and high mortality. Living donor liver transplantation (LDLT) is vital in donor-scarce areas. This study compares baseline characteristics, perioperative complications, and long-term survival between ACLF and non-ACLF patients, emphasizing etiology, ACLF grading, and graft factors. Methods: Data from a prospective registry of 591 adult LDLT recipients (2019–2023) were analyzed. ACLF was defined by EASL-CLIF (multi-organ failure, grades 1–3) and APASL (jaundice/coagulopathy with complications) criteria, evaluated at initial assessment and within 24 h pre-LDLT. Results: ACLF patients (n = 101, 17.1%) showed higher MELD-Na (27 vs. 20, p < 0.001), bilirubin (6.84 vs. 1.75 mg/dL, p < 0.001), creatinine (108 vs. 70.5 μmol/L, p < 0.001), metabolic/genetic etiologies (9.9% vs. 2.8%, p = 0.001), and chronic kidney disease (23.7% vs. 8.1%, p < 0.001), and lower HCC rates (11.8% vs. 29.6%, p < 0.001). GRWR was marginally lower in ACLF patients (0.59 vs. 0.66, p = 0.10). The ACLF group had elevated infection (27.7% vs. 10.4%, p < 0.001), bleeding (14.9% vs. 6.3%, p = 0.004), and biliary complications (15.8% vs. 7.8%, p = 0.010), with longer ICU (5 vs. 3 days, p < 0.001) and hospital stays (33.66 vs. 20.7 days, p = 0.036). Five-year overall survival was reduced in ACLF patients (log-rank p = 0.001), worsening with grade (EASL-CLIF grade 3: 55% vs. 81% for no ACLF, p = 0.002). Graft survival was also lower (75% vs. 85%, p = 0.02). Multivariable analysis identified chronic kidney disease as an independent mortality predictor (HR 2.09, 95% CI 1.11–3.95, p = 0.023). Conclusions: LDLT for ACLF involves higher perioperative risks and poorer long-term survival than non-ACLF patients, with outcomes deteriorating by ACLF grade. Chronic kidney disease independently predicts mortality. Timely LDLT is essential in donor-limited regions. Full article

Background: Coronary artery bypass grafting is the optimal revascularization strategy for patients with complex multivessel coronary artery disease. However, saphenous vein grafts are associated with high failure rates and donor site morbidity. Off-the-shelf tissue-engineered vascular grafts offer a potential solution for patients lacking suitable autologous vessels. Here, we report the first successful clinical implant of an acellular Tissue-Engineered Vessel (TEV) for coronary artery bypass grafting in Europe. Methods: A 73-year-old male with two-vessel disease and no suitable autologous vein underwent on-pump coronary artery bypass grafting using the left internal mammary artery to the left anterior descending artery and a 4 mm TEV to the right coronary artery. Results: Implant procedure followed standard surgical techniques, sutures and duration. The conduit handling was comparable to native vessels. Intraoperative flow measurements demonstrated excellent graft performance (TEV: 110 mL/min, Pulsatility Index 1.0). Postoperative recovery was uneventful. One-month computed tomography coronary angiography confirmed graft patency. Discussion: This case demonstrates the feasibility of using a bioengineered conduit for coronary revascularization in patients without suitable autologous grafts. If these findings are confirmed in larger trials, bioengineered vessels could expand surgical revascularization to patients without suitable autologous conduits and fundamentally alter conduit selection strategy in CABG. Conclusions: This first-in-Europe clinical implant demonstrates that an off-the-shelf acellular tissue-engineered vessel can meet the procedural, hemodynamics, and patency requirements of coronary artery bypass. These proof-of-concept results support progression to prospective multi-center evaluation. Full article

Background/Objectives: Hemodialysis (HD) is a life-sustaining treatment for an increasing number of patients around the globe. The options for vascular access (VA) in HD are arteriovenous fistulas (AVFs), arteriovenous grafts (AVGs), and central venous catheters (CVCs). AVFs are historically associated with better long-term outcomes. Recently, international guidelines have shifted to a more individualized approach driven by evidence that patient-specific factors influence the success of AVF creation. The initial “Vienna ACTS NOW” study revealed significant inter-center variability in CVC prevalence in Vienna. This two-year follow-up aimed to document the continuing variability in CVC-based HD management and to monitor the clinical outcomes and cost associated with an attempted conversion to AVF/G. Methods: This multi-center cohort study collected data (March 2023 to March 2025) on 153 CVC-based HD patients from six Viennese institutions. Primary endpoints included VA-related events and patency; the secondary endpoint was overall mortality. Costs were calculated using the Austrian Catalogue for Medical Services (MEL). Results: Overall, 28 (18.3%) out of 153 patients underwent AVF/G surgery, and 20 (71.4%) achieved successful cannulation. A total of 12 surgical and 14 endovascular interventions were performed to either support VA maturation or maintain patency. The median hospital admission was 3 days for VA creation and 4 days for later interventions. VA creation in patients that did not require later interventions cost 3130.44 € per patient, and it cost 11,893.02 € in patients that did. The proportion of AVF/G creation attempts varied from 0% to 40.9% between centers. Patients who underwent VA-creating surgery had a better rate of survival after two years compared to patients who did not undergo VA-creating surgery. (86.2% vs. 63.3% p < 0.02). Overall, 6.3% of deaths were related to VA management. Conclusions: Patient-specific characteristics and the capability of the healthcare system to timely detect and treat CKD might influence the outcome of patients. The proportion of CVC- and AVF/G-based HD might therefore be associated with the level of access patients have to the healthcare system and the efficiency of the care network. Our own data point towards a difference in CVC use between different centers in Vienna, not solely driven by patient characteristics, but by locally available resources and differences in policies. Full article

Background/Objectives: Radiotherapy following mastectomy induces persistent structural alterations in the chest wall, including fibrosis, extracellular matrix disorganization, and vascular changes that compromise reconstructive outcomes. Although autologous fat grafting is widely used to improve tissue quality in irradiated breasts, direct human histological evidence remains limited. The aim of this prospective pilot study was to evaluate intra-patient histological remodeling in irradiated postmastectomy breast tissue before and 4 months after autologous fat grafting using paired core needle biopsies. This study should be considered a hypothesis-generating histological pilot study. Methods: Five female patients with prior mastectomy and adjuvant radiotherapy underwent Tru-Cut core needle biopsy of irradiated chest wall tissue before lipofilling and at approximately four months (range between 3 and 12 months) post-procedure. Specimens were processed using formalin fixation, paraffin embedding, and hematoxylin and eosin staining. Histological assessment focused on collagen density, stromal organization, vascular structures, inflammatory infiltrate, and adipocyte integration. Comparative intra-patient analysis was performed descriptively. Results: Baseline biopsies demonstrated consistent post-radiation alterations, including collagen compaction, stromal disorganization, perivascular fibrosis, and variable inflammatory infiltrate. Post-lipofilling specimens showed heterogeneous remodeling characterized by focal collagen fiber insertion between adipocytes, areas of immature connective tissue formation, and variable preservation of adipose architecture. The extent and pattern of remodeling differed among patients. Inflammatory activity decreased or remained mild in most cases. Conclusions: Autologous fat grafting in irradiated postmastectomy tissue is associated with measurable histological remodeling. Structural adaptation appears heterogeneous and patient-specific, suggesting a dynamic multi-stage process rather than uniform regeneration. Further studies incorporating quantitative and molecular analyses are required to clarify the mechanisms underlying these changes. Full article

Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are the two dominant revascularisation strategies for obstructive coronary artery disease, yet their relative roles continue to shift because they address coronary pathophysiology differently with ever-evolving techniques. PCI has advanced through iterative improvements, including balloon angioplasty, bare-metal stents, and drug-eluting stents, with contemporary outcomes increasingly driven by procedural optimisation using intracoronary imaging and physiology-guided lesion selection rather than device category alone. CABG has progressed through perioperative management, improvements in operative safety, and, critically, conduit durability. Recognition of progressive saphenous vein graft failure has underpinned a conduit-optimisation era in which the left internal mammary artery to left anterior descending artery remains the gold standard. Further, broader arterial grafting (including radial artery use, multiple arterial grafting, and selected total-arterial strategies) has been increasingly applied, albeit with deliverability and competing-risk constraints highlighted in randomised evidence. This perspective review reframes the CABG versus PCI comparison not as a binary contest, but as a context-dependent assessment in which the relative value of each strategy depends on the specific technologies, techniques, and conduits available at the time of comparison. We summarise comparative effectiveness where evidence is most consistent and where it remains sensitive to anatomy, comorbidity, and endpoint definitions. In diabetes with multivessel disease, trial data favour CABG for long-term survival and clinical outcomes despite higher stroke risk. In left main disease, outcomes depend on lesion pattern and overall complexity, with trial-era stent technology and composite endpoint definitions influencing conclusions. In ischaemic left ventricular dysfunction, a long-term survival benefit is established for CABG added to medical therapy, while multi-vessel PCI has not demonstrated comparable prognostic modification in contemporary data. We then examine hybrid coronary revascularisation as territory-specific allocation, highlighting its physiological rationale, program dependence, and limited, adequately powered randomised evidence. Finally, we outline how artificial intelligence (AI) and robotics may accelerate a precision revascularisation paradigm by standardising lesion assessment, supporting procedural planning, improving procedural reproducibility, and enabling more patient-specific selection among PCI, contemporary CABG with optimised conduits, and hybrid pathways. Full article

Background and Objectives: Renal transplantation is the optimal treatment for end-stage renal disease, yet long-term allograft survival remains threatened by immune-mediated injury and chronic nephropathy. Conventional monitoring using serum creatinine and protocol biopsy suffers from limited sensitivity for early, subclinical injury. Liquid biopsy-based biomarkers offer a non-invasive alternative. Materials and Methods: We conducted a systematic narrative review of studies published between January 2010 and December 2024, identified through PubMed, Scopus, and Web of Science. Results: Extracellular vesicles carry injury-specific molecular cargo reflecting the biological state of tubular, glomerular, and endothelial cells; urinary EV CXCL9 protein and exosomal CD3ε mRNA have demonstrated AUC values of 0.81–0.88 for the detection of T-cell-mediated rejection. Donor-derived cell-free DNA quantifies global graft cell death; the FDA-cleared AlloSure assay achieves an AUC of 0.74 and NPV of 84% at the validated ≥1.0% threshold established in the DART trial. Donor-specific antibodies—particularly complement-fixing C1q-positive DSAs—confer markedly inferior 5-year graft survival compared with DSA-negative recipients (54% versus 93%). Multi-biomarker panels integrating all three modalities yield AUCs of 0.88–0.94 and NPVs of 91–95%. Conclusions: The integration of EV, ddcfDNA, and DSA monitoring into a unified surveillance framework offers a clinically meaningful advance over creatinine-based monitoring. Prospective randomized trials confirming improvement in long-term allograft survival will be the critical next step. Full article

Motor vehicle encroachment into non-motorized lanes is a common but hard-to-verify violation in urban intersections, especially when monitored from unmanned aerial vehicles (UAVs) or high-mounted overhead views. Existing rule-based solutions built on horizontal bounding boxes and center-point/line-crossing criteria are sensitive to perspective distortion, occlusion, and frame-to-frame jitter, resulting in unstable decisions and low evidential value. This paper presents a cascaded UAV-view system that closes the loop from perception to evidence output through detection–segmentation–recognition–decision. First, we adopt a two-stage detection cascade: a lightweight vehicle detector localizes vehicles using axis-aligned bounding boxes, and a dedicated YOLOv5n-based oriented bounding box (OBB) license plate detector, constructed via architecture grafting and weight transfer, is then applied within each vehicle region of interest (ROI) to localize rotated license plates under large pose variation and small-target conditions. Second, a U-Net lane region segmentation module provides pixel-level spatial constraints to define an enforceable lane occupancy region. Third, a perspective rectification step is integrated with the PP-OCRv4 optical character recognition (OCR) framework to improve license plate recognition reliability for tilted plates. Finally, an area ratio criterion and an N-frame temporal counter are used to suppress transient misdetections and stabilize alarms. On a representative 100-sample controlled encroachment benchmark, the proposed system improves detection accuracy from 67.0% to 92.0% and reduces the false positive rate from 32.35% to 5.88% compared with a baseline horizontal bounding box (HBB)-based rule. The system outputs both violation alarms and license plate evidence, supporting practical deployment for multi-view traffic governance. Full article

Background/Objectives: The aim of this study is to evaluate whether preoperative intra-articular corticosteroid injections (CSIs) are associated with an increased risk of reoperation following matrix-associated or autologous chondrocyte implantation (MACI/ACI). Secondary aims included comparing reoperation-free survival, patient-reported outcomes (PROMs), and patient acceptable symptom state (PASS) achievement. Methods: A retrospective cohort study was conducted on adults undergoing primary MACI/ACI between 2011 and 2023 at a single academic institution. Patients with documented CSI status and ≥2 years of follow-up were included. Exclusion criteria were prior MACI/ACI, osteochondral allograft transplantation, multi-ligament reconstruction, or inadequate follow-up. Propensity score matching (2:1, no steroid/steroid) based on age, sex, BMI, laterality, procedure type, and prior surgery yielded 138 matched patients (92 no steroid, 48 steroid). The primary outcome was ipsilateral reoperation, analyzed as a binary outcome, with Kaplan–Meier reoperation-free survival and restricted mean survival time (RMST). PROMs and PASS achievement were also assessed. Statistical significance was set at p < 0.05. Results: Baseline characteristics and follow-up (6.55 ± 3.74 vs. 6.73 ± 3.99 years; p = 0.80) were similar. Graft failure rates were identical (4.3% each; p = 1.00). Reoperation occurred in 21.7% of patients without CSI and 23.9% with CSI (p = 0.83). CSI was not associated with reoperation (adjusted OR 2.28; 95% CI 0.54–9.95; p = 0.26). No significant difference in reoperation-free survival or PROMs was observed. Conclusions: Preoperative intra-articular corticosteroid injections were not associated with increased reoperation risk, inferior reoperation-free survival, or worse functional outcomes following MACI/ACI. Full article

Type A aortic dissection represents one of the most life-threatening cardiovascular emergencies, with management strategies evolving toward hybrid and endovascular approaches, particularly in high-risk patients. The Ascyrus Medical Dissection Stent (AMDS) is an emerging adjunctive technology designed to promote true lumen expansion and facilitate favorable aortic remodeling during open repair of acute Type A dissection. We present the first reported case of AMDS deployment in secondary Type A dissection following prior thoracic endovascular aortic repair (TEVAR). An 83-year-old female with extensive aortic history—including TEVAR in 2012 for intramural hematoma with chimney stenting to the left subclavian artery and carotid–subclavian bypass in 2013—developed acute Type A dissection extending into the existing stent graft in 2024. Emergency surgical intervention included ascending aortic replacement, aortic arch repair with AMDS implantation, aortic valve resuspension, and left atrial appendage resection under cardiopulmonary bypass and hypothermic circulatory arrest. Postoperative imaging confirmed appropriate AMDS positioning, false lumen exclusion, and preservation of prior endograft integrity. The patient tolerated the procedure well and was discharged in stable condition with favorable early follow-up outcomes. This case demonstrates the potential role of hybrid surgical strategies and adjunctive endovascular devices in managing complex, multi-stage aortic disease. Full article

Three-dimensional (3D) bioprinting provides new options for airway reconstruction by enabling the fabrication of customizable, biodegradable scaffolds designed to support in situ tissue regeneration. Building on our established large-animal platform, in which two cm bioprinted tracheal grafts combined with refined surgical techniques and adjunctive laser intervention have achieved long-term survival exceeding three months, the present study aims to explore long-segment (≥four cm) tracheal transplantation. We evaluated the fabrication feasibility and regeneration patterns of extrusion-based 3D bioprinted polycaprolactone (PCL) tracheal grafts in a porcine model. The grafts were implanted via end-to-end anastomosis with adjunctive mechanical stabilization and followed by serial bronchoscopic surveillance, gross examination, and histological analysis. The two cm PCL tracheal grafts achieved reproducible survival exceeding three months when combined with refined surgical techniques, structured postoperative airway management, and optimized wound coverage. Histological analysis revealed multi-lineage tissue formation—including cartilage, muscle, glands, and epithelium—was observed. Cartilage regeneration followed a staged maturation process, compared to epithelial regeneration, although continuous by 12 weeks, remained developmentally immature. A single long-segment transplantation was explored in a single preliminary case, providing an initial technical observation of feasibility; however, definitive conclusions regarding long-term survival or regeneration cannot be drawn. These findings further characterize regenerative responses in a large-animal model and highlight critical translational barriers—fabrication constraints, airway biomechanics, and delayed epithelial maturation—that require systematic investigation before long-segment tracheal reconstruction can advance toward clinical application. Full article

Due to the non-polar and chemically inert nature of carbon fiber surfaces, the interfacial bonding strength between carbon fibers and norbornene-polyimide (PI-NA) resin matrix is relatively weak. To address this issue, this study constructed a composite coating on the carbon fiber surface and proposed a novel method to build robust interfaces based on multiple interfacial interactions, thereby effectively enhancing the interfacial properties between carbon fibers and PI-NA resin. Inspired by mussel adhesive proteins, this study established a multi-level synergistic interfacial reinforcement system by sequentially constructing a C-PEI@OPDA coating, in situ growing zinc oxide nanorods (ZW) arrays, and grafting 3-mercaptopropyltrimethoxysilane (MPS) onto carbon fiber surfaces. The C-PEI@OPDA coating, rich in amino (–NH₂) and hydroxyl groups (–OH), enhanced adhesion to carbon fibers and adsorbed Zn²⁺ via coordination interactions to provide nucleation sites for ZW growth. Meanwhile, the active hydrogen in the coating promoted the crosslinking of PI-NA resin, thereby increasing the resin crosslinking density in the interfacial region. The vertically aligned ZW significantly increased surface roughness, enhanced mechanical interlocking effects, and provided secondary reaction sites for MPS grafting. The thiol groups (–SH) in MPS formed covalent bonds with PI-NA resin through thiol-ene click reactions, further strengthening interfacial bonding. The results showed that the ILSS, IFSS, and flexural strength of C-PEI@OPDA/ZW/MPS modified carbon fiber composites reached 75.15 MPa, 102.93 MPa, and 1735.56 MPa, representing improvements of 39.09%, 48.79%, and 31.16%, respectively. This study effectively enhanced the carbon fiber-reinforced polymer composites interfacial bonding strength through the synergistic effects of hydrogen bonding, mechanical interlocking, chemical bonding, and increased resin crosslinking density. Full article

Background and Clinical Significance: Heat-press injuries of the hand can cause deceptively deep, progressive tissue damage, and dorsal multi-digit involvement carries a high risk of joint stiffness and scar contracture. Case Presentation: A 58-year-old left-hand-dominant woman sustained a dorsal heat-press injury affecting the left index to small fingers; we performed staged reconstruction with tangential debridement and artificial dermis placement (Day 9) followed by full-thickness skin grafting (FTSG) from the right infraclavicular region (Day 23), with supervised rehabilitation from Day 15 and active ROM resumed on postoperative day (POD) 6 after FTSG. Conclusions: At long-term follow-up (POD 821 after FTSG; ≈2.2 years), the reconstructed digits showed no hypertrophic scarring and achieved full finger motion with full fist formation; serial joint-specific active ROM tracking may enhance interpretability and comparability of outcomes in this uncommon but functionally critical injury pattern. Full article

Background/Objectives: Large osteochondral lesions of the talus (OLT) pose a major challenge because their size and depth often exceed the indications for bone marrow stimulation, and durable biological repair remains difficult to achieve. However, evidence for autologous osteochondral transplantation (AOT) in extensive talar defects is still limited. Methods: In this retrospective cohort, 40 consecutive patients ≥ 14 years with ICRS grade III–IV lesions of the talar dome were treated with AOT at a tertiary referral center. One to three overlapping cylindrical osteochondral grafts (mean diameter 0.9 cm) were harvested from non-weight-bearing regions of the ipsilateral patellofemoral groove using a water-cooled diamond trephine system and implanted press-fit into the talar dome. Donor sites were refilled with autologous iliac crest bone cylinders and hydroxyapatite substitute. Pain (Numeric Rating Scale, NRS) and function (AOFAS Ankle–Hindfoot Score) were recorded preoperatively and at 3, 6, 9, and 12 months, and changes over time were analyzed using generalized estimating equations. Results: Mean defect size was 137.4 ± 31.9 mm², and 82.5% of lesions were ICRS grade III. NRS pain improved from 5.69 ± 2.52 preoperatively to 0.53 ± 0.98 at 12 months (p < 0.001). AOFAS score increased from 63.79 ± 2.55 to 97.36 ± 2.49 (p < 0.001). Age and graft location significantly influenced postoperative pain, whereas graft size and sex did not. No infections, graft failures, conversions to arthrodesis or arthroplasty, or clinically relevant donor-site symptoms occurred. Conclusions: Multi-plug AOT using a diamond trephine system provides substantial and durable pain relief and functional improvement in patients with large OLT, with low complication and donor-site morbidity rates. These findings support AOT as a joint-preserving option for extensive talar defects and justify further prospective, comparative studies with long-term follow-up. Full article

Maxillofacial skeletal reconstruction presents significant challenges due to anatomical complexity, functional requirements, and aesthetic demands. Traditional materials such as titanium and autogenous bone grafts have limitations, prompting interest in Polyetheretherketone (PEEK), a versatile thermoplastic polymer with advantages like biocompatibility, radiolucency, and elasticity similar to human bone. This multi-year case series evaluates the clinical outcomes of PEEK implants used in 56 cases on 53 patients for maxillofacial reconstruction, primarily for trauma (44 patients) and deformity (9 patients). PEEK implants were applied to various facial regions including the orbit, zygoma, mandible, and maxilla. The majority of surgeries utilised virtual surgical planning. Patient-specific implants were fabricated using 3D imaging technologies, allowing customisation for optimal fit and functionality. The mean patient age was 37 years with a split of 37 to 16 females. Some complications were noted such as infection and paraesthesia. However, the majority of patients experienced positive outcomes. The findings support PEEK implants as a safe, effective, and adaptable material for maxillofacial surgery, with potential for further advancements in material properties and surgical technologies to improve long-term outcomes. Full article