Search Results (57)

Introduction: Chronic wounds and pathologic scars remain a persistent challenge in plastic surgery. Conventional treatments can be costly and inconsistent, prompting interest in regenerative approaches that utilize autologous tissue. Emulsified fat produces nanofat through mechanical processing and contains adipose-derived stem cells, stromal vascular fractions, extracellular matrix proteins, cytokines and growth factors. The purpose of this systematic review is to evaluate the use of autologous nanofat for wound healing and scar management, with emphasis on preparation techniques, treatment indications, and outcomes. Methods: A comprehensive PubMed search with no date restrictions was conducted in January 2026 using MeSH terms and keywords related to nanofat and wound-healing applications. Studies were screened independently by two reviewers using the Rayyan platform. Eligible studies evaluated nanofat for wound healing in human or animal subjects; non-English articles, studies not involving nanofat, editorials, and conference abstracts were excluded. The extracted data included study characteristics, participant numbers, treatment details, indications, adjunct therapies, follow-up duration, outcomes, and complications. Studies were grouped by clinical application, with individual reports included in multiple categories when relevant. Results: The search identified 53 records, of which 22 studies met the inclusion criteria after screening. These included 20 human and two animal studies spanning randomized controlled trials (n = 3), prospective trials (n = 6), retrospective analyses (n = 6), case series (n = 4), and case reports (n = 3). Mechanical emulsification was the predominant autologous nanofat preparation method (91%), often combined with filtration or centrifugation. Clinical indications in human studies were diverse, most commonly including scar treatment (n = 14) (acne, burns, depressed, and post-surgical), followed by chronic wounds (n = 3) and reconstructive applications (n = 3). Nanofat was administered via injection in 86% of studies (n = 19), typically using fine-gauge needles or microcannulas with intradermal or subdermal placement, while three studies used non-injection approaches such as topical, membrane, or dressing-based delivery. Scar or aesthetic parameters, measured using VSS, POSAS, physician grading, photography, pigmentation analysis, or clinical appearance, were evaluated in 73% of studies (n = 16), and all reported improvement in variables such as pigmentation, pliability, thickness, texture, or overall appearance. Wound-healing endpoints were assessed in 36% (n = 8), with 100% (n = 8) demonstrating accelerated healing, improved epithelialization, or defect closure. Patient-reported outcomes, including satisfaction or quality of life, were measured in 32% (n = 7), and all showed improvement. Objective imaging modalities (e.g., 3D imaging, ultrasound, angiography, digital analysis) were used in 23% (n = 5), each confirming structural or physiologic improvement. Histologic or biomolecular analyses were performed in 27% (n = 6) and uniformly demonstrated regenerative changes, such as increased angiogenesis, collagen remodeling, or growth factor expression. Treatment was well tolerated, with 77% of studies (n = 17) reporting minimal or no complications and only transient mild adverse effects, including mild pain, bruising, erythema, and edema. Conclusions: Current evidence suggests that autologous nanofat is a promising regenerative therapy for wound healing and scar modulation. Across diverse clinical applications, nanofat has been associated with improved tissue quality, enhanced healing, and favorable patient-reported outcomes, with minimal complications. The mechanical processing of autologous tissue may also involve fewer regulatory concerns compared with more extensively manipulated cellular products. Full article

Phagocytosis and migration in macrophages share key regulators, including Rho family GTPases; however, whether phagocytic membrane extension generates a transient, whole-cell polarity that coordinates migration and spatial prioritization of engulfment remains unclear. Here, we investigated the spatiotemporal coupling between membrane extension and cell migration using opsonized microneedles, which enable controlled stimulation together with long-range membrane extension and backtracking dynamics. During single-needle stimulation, membrane extension was tightly coupled to directional migration, whereas membrane retraction showed weaker coupling. In sequential stimulation with two microneedles, ongoing phagocytosis suppressed competing membrane extension at spatially opposite locations, and a reversal in migration direction was accompanied by initiation of membrane extension toward the second needle. Third-needle experiments further revealed a polarized spatial distribution of phagocytic responsiveness across the cell surface. Consistently, uniform stimulation with multiple opsonized microbeads demonstrated sequential, one-at-a-time engulfment even under near-simultaneous target attachment. These results support a model in which phagocytic membrane extension establishes transient, whole-cell polarity that spatially gates engulfment and coordinates whole-cell migration. The microneedle manipulation platform provides a powerful approach for dissecting the spatiotemporal regulation of phagocytosis and for understanding macrophages as adaptive living micromachines integrating mechanical inputs, transient polarity formation, and sequential target processing. Full article

For structural metallic materials, performance enhancement has traditionally relied on complex adjustments of chemical composition and heat treatment processes. However, these approaches are complex, costly, and lack sustainability. Metal additive manufacturing (AM) has unique cooling characteristics, providing it with a distinctive approach. In this study, laser powder bed fusion (LPBF) technology was used to prepare high-performance 1080 carbon steel. The study selected three groups of process parameters (VED = 92.59 J/mm³) with high density (relative density > 98%) and achieved excellent mechanical properties: the ultimate tensile strength (UTS), yield strength (YS), and elongation (EL) reach 1745.4 MPa, 1455.13 MPa, and 6.77% respectively. The effects of process parameters on microstructure and mechanical properties were investigated. It is found all specimens exhibited a characteristic martensitic needle-like grain morphology without significant crystallographic texture. The microstructure displayed substantial changes as VED varied, with martensite content progressively decreasing with increasing VED. Correspondingly, as the VED increases from 92.59 J/mm³ to 225.69 J/mm³, the UTS, YS, and EL decrease by 39.0%, 36.1%, and 3.4%, respectively. This work demonstrates the feasibility of achieving high-performance metallic components by precisely controlling additive manufacturing process parameters to manipulate the microstructure of simple alloys, thereby eliminating the need for complex alloying or post-processing heat treatments. Full article

Background/Objectives: Cervical pain is defined as pain in the neck that may or may not radiate to one or both upper extremities and lasts at least one day. Headaches are within the spectrum of neck pain, defined as any painful sensation perceived in the head that can extend to the neck. They are classified as primary (migraines and tension headaches) or secondary (cervicogenic headaches) depending on their clinical presentation and associated symptoms. The objective of this review is to compare the effects of dry needling with and without spinal manipulative techniques versus the application of other physical therapy modalities. Methods: A systematic review was conducted searching articles compatible with the objectives of this study in PubMed, ScienceDirect, and Scopus databases using the search terms spinal manipulation, cervical manipulation, dry needling, headache, headaches, and migraine over the last five years and combined with the Boolean operators AND and OR. After screening, all studies underwent methodological quality assessments using the PEDro scale and qualitative synthesis for study design, patients’ characteristics, interventions, comparators, outcomes assessed and main results data. Results: Thirteen randomized clinical trials were selected. The quality of the studies is varied, with PEDro scale values ranging from six to eight. Dry needling and cervical manipulations have proven to be effective tools, compared to other interventions, in reducing pain and improving functionality in patients with headaches. Conclusions: Dry needling techniques and manipulations have shown significant effects on parameters related to pain, sensitivity, functionality, and general health in patients with headaches. However, future studies are necessary to more deeply analyze the long-term effects of both techniques. Full article

Cancer is one of the global health problems that affects millions of people every year. Biopsies are among the standard methods for detecting and confirming a cancer diagnosis. Performing this study manually poses several challenges due to tissue movement and the difficulty of precisely locating the target, as is often the case in lung biopsies. This study presents the design and implementation of an autonomous image processing algorithm included in a closed-loop controller that drives the activity of a multi-degree-of-freedom (six) robotic manipulator that performs emulated tissue biopsies. A realistic lung motion emulator, based on a two-degree-of-freedom robotic device with a photon emitter (to simulate radiopharmaceutical identification of cancerous tissue), was used to test the proposed automatic biopsy collector. Applying image processing to detect cancer tissue enables the identification of the centroid and tumor boundaries. Using the detected centroid coordinates, the reference trajectory of the end effector (biopsy needle) was automatically determined. A finite-time convergent controller was implemented to guide the robotic manipulator’s motion towards the tumor position within a specified time window. The controller was evaluated using a digital twin representation of the entire robotic system and using an experimental device working on the simulated mobile tumor emulator. Evaluation of simulated tumor detection and reference trajectory tracking effectiveness was used to validate the operation of the proposed automatic robotic lung biopsy sampler. The application of the controller allows one to track the position of the emulated tumor with a deviation of 0.52 mm and a settling time of less than 1 s. Full article

Objectives: CT-guided interventions are associated with radiation exposure, prolonged procedural time, and complications. Navigation systems (NS) have been developed to improve procedural precision and efficiency. This study aimed to evaluate the impact of NS on procedural outcomes, radiation dose, and complication rates compared with conventional freehand techniques. Materials and methods: A systematic review and meta-analysis was performed including 30 studies (11 randomized controlled trials, 19 cohort studies) published through November 2023, involving 2785 patients (1418 NS; 1367 control). Outcomes included the number of needle manipulations, procedural time, radiation dose, complication rates, technical success, and diagnostic success. Random-effects models were applied with subgroup analyses by study design, intervention type, and target organ. Risk of bias was assessed using RoB 2 and ROBINS-I, and certainty of evidence using the GRADE framework. Results: Navigation systems significantly reduced needle manipulations (mean difference [MD], −2.58; 95% CI: −3.30 to −1.85) and procedural time (MD, −8.07 min; 95% CI: −12.27 to −3.87). Radiation dose decreased by 37% (ratio of means [ROM], 0.63; 95% CI: 0.58–0.69). Complication rates were lower overall (odds ratio [OR], 0.64), with fewer chest tube insertions during lung ablations (OR, 0.58; 95% CI: 0.39–0.86). Diagnostic success improved (OR, 1.66; 95% CI: 1.01–2.73), whereas technical success was comparable (OR, 1.41; 95% CI: 0.89–2.24). Conclusions: Navigation systems significantly enhance the efficiency and safety of CT-guided interventions by reducing needle manipulations, radiation exposure, and complication rates, while improving diagnostic success. Full article

Interface interaction mechanics analysis is of great significance for robot-assisted insertion surgery in minimally invasive surgery and therapy. Previous work indicates that the accurate modeling of soft tissue puncture forces plays a crucial role in surgical planning, robotic needle insertion, and biomechanical simulation, which can give insights useful for physicians to guide and operate assisted robots. The objective of this study is to develop a dynamic multi-component force model that integrates cutting force, stiffness resistance, and frictional interaction to characterize needle–soft tissue interaction during puncture. A dynamic force model is proposed, and a lateral periodic disturbance mechanism is introduced into the simulation framework in order to enhance the robustness and realism of the model under micro-manipulation scenarios. The model has been validated using a series of controlled puncture experiments on porcine liver and renal tissues under varying insertion angles (15°, 30°, 45°) and speeds (0.5 mm/s, 1.5 mm/s, 2.5 mm/s). Corresponding finite element simulations were also conducted using ANSYS software. The agreement between simulation and experiment has been quantitatively evaluated by comparing force–depth and force–time curves, and the statistical significance of the impact of angle and speed on puncture forces has been assessed using ANOVA and Tukey’s HSD tests. Quantitative comparison demonstrated strong consistency, with the optimal case reaching a coefficient of determination (R²) value of 0.96 and Root Mean Square Error (RMSE) below 0.13 N after incorporating a 0.05 mm lateral perturbation. Statistical analysis confirmed the impact of angle and speed on puncture force responses (p < 0.05). Furthermore, comparative analysis revealed that porcine liver exhibits more consistent biomechanical behavior than renal tissue, particularly under perturbation-enhanced simulation. This study successfully establishes a dynamic multi-component force model for soft tissue puncture, validated with high fidelity against experimental data. The incorporated lateral disturbance mechanism enhanced the model’s realism. This work can provide a reliable foundation for the future design of intelligent robot-assisted puncture systems and high-fidelity simulation-based training platforms. Full article

This study developed a virtual reality (VR) simulator for training the inferior alveolar nerve block (IANB) procedure using Leap Motion-based hand tracking and the Unity engine, and evaluated its interaction performance, task-level outcomes within the simulator, and usability. Built on a 3D anatomical model, the system provides a pre-clinical practice environment for realistic syringe manipulation and visually guided needle insertion, enabling repeated rehearsal of the procedural workflow. Interaction stability was assessed using participant-level gesture recognition rates and input latency. Usability was evaluated via a questionnaire addressing ease of use, cognitive load, and perceived educational usefulness. The results indicated participant-level mean gesture recognition rates of 88.8–90.5% and mean response latencies of approximately 64–66 ms. In usability testing (n = 40), the item related to perceived procedural skill improvement received the highest score (4.25/5.0). Because this study did not include controlled comparisons with conventional training or objective measures of clinical competency transfer, the findings should be interpreted as preliminary evidence of technical feasibility and learner-perceived usefulness within a simulated setting. Controlled comparative studies using objective learning outcomes are warranted. Full article

Background: Scleral fixation of intraocular lenses (IOLs) is a valuable option in cases of aphakia or inadequate capsular support, yet conventional sutured and sutureless approaches can pose technical challenges and complication risks. The needle-guided scleral fixation technique offers a simplified, single-suture solution that enhances safety and reproducibility. Methods: In this retrospective interventional case series, 30 eyes with insufficient capsular support underwent IOL implantation using Meduri’s needle-guided single-suture technique at the G. Martino University Hospital, Messina. The surgical method employs a 24-gauge needle to guide a double-armed 10-0 polypropylene suture through the sclera for precise IOL anchorage, minimizing vitreous manipulation. Outcomes were assessed over 24 months, including best-corrected visual acuity (BCVA), IOL centration, intraocular pressure (IOP), and postoperative complications. Results: Mean BCVA improved from X to Y LogMAR at two years (p < 0.05). All IOLs remained well-centered without tilt or decentration. Mild conjunctival hyperemia occurred in 70% of cases, resolving spontaneously. No suture erosion, vitreous hemorrhage, or retinal detachment was observed. Conclusions: The needle-guided single-suture technique provides a stable, efficient, and reproducible method for posterior chamber IOL fixation in aphakic eyes lacking capsular support. Its minimal learning curve and reduced surgical complexity make it an attractive alternative to both traditional sutured and modern sutureless methods, particularly in centers without vitreoretinal expertise. Full article

This article investigates the precipitation behavior of the phases in metastable β-type titanium alloys (Ti-38644) and their significant impact on the mechanical properties. By manipulating various solid solution aging parameters, the morphology, quantity, and distribution of the αs phase can be optimized. After one hour of solid solution treatment at 760 °C, the alloy is predominantly composed of the β phase, with a higher concentration of aluminum at the grain boundaries compared to the interior of the grains. Subsequently, after ten hours of aging treatment at 450 °C and 470 °C, the needle-shaped αs phase preferentially precipitated at the grain boundaries. As the aging temperature increased to 470 °C, the area percentage of the αs phase rose from 42.36% to 57.34%, while its yield strength (σs) increased from 967 MPa at 450 °C to 1211 MPa at 470 °C. This increase in σs results from the combined effects of dislocation strengthening (${\sigma }_{\rho }$) and precipitation hardening. This article provides a comprehensive theoretical analysis of the various factors that influence σs, offering valuable theoretical support for the development of heat treatment processes for the Ti-38644 titanium alloy. Full article

Background: Ultrasound guidance is widely used to enhance injection accuracy and safety. However, ultrasound-guided procedures require complex manipulation of both probe and needle. This simultaneous manipulation while maintaining sterility necessitates specific infection prevention protocols. This scoping review aimed to systematically investigate hygiene and safety procedures reported in clinical studies of ultrasound-guided injections. Methods: Following the Joanna Briggs Institute guideline, we conducted a systematic search of four databases (two English and two Korean) from inception to November 2023. Studies describing ultrasound-guided injection procedures with skin disinfection protocols were included. The extracted procedures were categorized and analyzed according to their timing (before, during, and after injection) and purpose. Results: Among 1728 studies identified, 86 met inclusion criteria. Notable variations were found in infection prevention practices, with only 5.81% reporting probe disinfection procedures and 27.91% documenting sterile probe cover use. Skin disinfection methods also varied, with iodophors (20.93%) and alcohol-based solutions (11.63%) being most common. Of studies describing ultrasound coupling agent procedures (26.74%), less than 20% specifically mentioned using sterile transmission agents. Documentation of temporal aspects of infection prevention was limited, with most studies not addressing precise timing of disinfection procedures or post-procedure probe reprocessing protocols. Conclusions: Our findings reveal considerable variation in infection prevention practices during ultrasound-guided injections and highlight gaps in documentation of hygiene protocols. These findings suggest the need for standardized, evidence-based protocols tailored to different anatomical sites and types of injections. Further research through expert consensus and real-world implementation is needed to develop and validate comprehensive guidelines for clinical practice. Full article

The integration of artificial intelligence in interventional radiology is an emerging field with transformative potential, aiming to make a great contribution to the health domain. This overview of reviews seeks to identify prevailing themes, opportunities, challenges, and recommendations related to the process of integration. Utilizing a standardized checklist and quality control procedures, this review examines recent advancements in, and future implications of, this domain. In total, 27 review studies were selected through the systematic process. Based on the overview, the integration of artificial intelligence (AI) in interventional radiology (IR) presents significant opportunities to enhance precision, efficiency, and personalization of procedures. AI automates tasks like catheter manipulation and needle placement, improving accuracy and reducing variability. It also integrates multiple imaging modalities, optimizing treatment planning and outcomes. AI aids intra-procedural guidance with advanced needle tracking and real-time image fusion. Robotics and automation in IR are advancing, though full autonomy in AI-guided systems has not been achieved. Despite these advancements, the integration of AI in IR is complex, involving imaging systems, robotics, and other technologies. This complexity requires a comprehensive certification and integration process. The role of regulatory bodies, scientific societies, and clinicians is essential to address these challenges. Standardized guidelines, clinician education, and careful AI assessment are necessary for safe integration. The future of AI in IR depends on developing standardized guidelines for medical devices and AI applications. Collaboration between certifying bodies, scientific societies, and legislative entities, as seen in the EU AI Act, will be crucial to tackling AI-specific challenges. Focusing on transparency, data governance, human oversight, and post-market monitoring will ensure AI integration in IR proceeds with safeguards, benefiting patient outcomes and advancing the field. Full article

To address the need for improving the flexibility of flexible needles, a technique that achieves needle steering by altering the needle’s stiffness is proposed. Needle tip forces were simplified, and a deflection model was then developed based on the Timoshenko beam theory. By combining theory and simulation, the influences of the stylet diameter, extension length, and tip direction on needle bending were analyzed. The deflection of the flexible needle is proportional to the cube of the stylet extension length. The needle with a 0.4 mm stylet diameter and an 8 mm extension length produces 8.841 mm more deflection than conventional flexible needles. The extension length can effectively regulate the bending curvature of the flexible needle, thus improving the flexibility of the puncture to some extent. Full article

Background: Artificial Intelligence (AI)-driven training systems are becoming increasingly important in surgical education, particularly in the context of laparoscopic suturing. This systematic review aims to assess the impact of AI on skill acquisition, long-term retention, and clinical performance, with a specific focus on the types of machine learning (ML) techniques applied to laparoscopic suturing training and their associated advantages and limitations. Methods: A comprehensive search was conducted across multiple databases, including PubMed, IEEE Xplore, Cochrane Library, and ScienceDirect, for studies published between 2005 and 2024. Following the PRISMA guidelines, 1200 articles were initially screened, and 33 studies met the inclusion criteria. This review specifically focuses on ML techniques such as deep learning, motion capture, and video segmentation and their application in laparoscopic suturing training. The quality of the included studies was assessed, considering factors such as sample size, follow-up duration, and potential biases. Results: AI-based training systems have shown notable improvements in the laparoscopic suturing process, offering clear advantages over traditional methods. These systems enhance precision, efficiency, and long-term retention of key suturing skills. The use of personalized feedback and real-time performance tracking allows learners to gain proficiency more rapidly and ensures that skills are retained over time. These technologies are particularly beneficial for novice surgeons and provide valuable support in resource-limited settings, where access to expert instructors and advanced equipment may be scarce. Key machine learning techniques, including deep learning, motion capture, and video segmentation, have significantly improved specific suturing tasks, such as needle manipulation, insertion techniques, knot tying, and grip control, all of which are critical to mastering laparoscopic suturing. Conclusions: AI-driven training tools are reshaping laparoscopic suturing education by improving skill acquisition, providing real-time feedback, and enhancing long-term retention. Deep learning, motion capture, and video segmentation techniques have proven most effective in refining suturing tasks such as needle manipulation and knot tying. While AI offers significant advantages, limitations in accuracy, scalability, and integration remain. Further research, particularly large-scale, high-quality studies, is necessary to refine these tools and ensure their effective implementation in real-world clinical settings. Full article

Background/Objectives: The management of lymph node metastases of the central neck compartment (CNC) in differentiated thyroid carcinoma is debated. The intraoperative measurement of thyroglobulin (Tg) has gained attention in accurately detecting metastases, reducing unnecessary CNC dissections. Methods: A total of 37 patients underwent surgery. An intraoperative assay of thyroglobulin from fine needle aspiration (Tg-FNA) was performed on CNC lymph nodes, identified by blue dye injection in 15 patients (23 nodes, group A) and by palpation in 22 patients (35 nodes, group B). The Tg-FNA values were compared with histology to calculate the diagnostic accuracy. Results: In group A, the blue dye diffused widely, complicating lymph node identification: 2 were metastatic and 21 non-metastatic, with median Tg-FNA levels of 6236 ng/mL and 99.20 ng/mL, respectively. In group B, 8 were metastatic and 27 benign, with median Tg-FNA levels of 4063 ng/mL and 121 ng/mL (p < 0.0001), respectively. ROC analysis identified 500 ng/mL as a cutoff, achieving 100% sensitivity and 74% specificity in group B and 90% sensitivity and 70% specificity overall. Finally, among the non-metastatic lymph nodes, group A exhibited some cases of very high Tg-FNA values compared to group B, with lower accuracy for the cutoff, suggesting that colorant injection might lead to increased Tg-FNA levels. Conclusions: Blue dye injection showed low accuracy. Intraoperative Tg-FNA was reliable in detecting CNC metastases, although a higher cutoff is needed in this compartment compared to what has been reported for lateral lymph nodes. Lymphatic drainage and surgical manipulation might explain these findings. The careful interpretation of Tg-FNA in CNC should be adopted. Full article