Search Results (484)

Background/Objectives: From a phenomenological perspective, the body is not merely a biological entity but the primary medium through which we experience and interpret the world. This study aimed to understand the lived body experience of advanced physiotherapy students at a university in Cali, Colombia, exploring how significant life events are embodied and expressed. Methods: A qualitative phenomenological design was employed. Twenty physiotherapy students participated in a body mapping exercise within a mental health elective. Participants graphically represented sensations, emotions, and memories on a body silhouette using colors and symbols. Data from the resulting body maps were analyzed using a thematic analysis approach via a data extraction matrix to identify patterns in symbolic, chromatic, and narrative elements. Results: The analysis revealed that students consistently inscribe both traumatic and positive life events onto their body maps, illustrating a narrative of resilience. Specific colors and body parts were symbolically charged: black and red in the heart, head, and shoulders represented pain and emotional burden, while blue and green in areas like the hands and stomach signified stability and achievement. External symbols (e.g., landscapes, bicycles) served as emotional anchors or representations of personal growth. Conclusions: Body mapping proves to be a powerful technique for accessing the embodied, often non-verbal, narratives of students. It underscores that the body functions as a living archive of experience. Integrating such methodologies into physiotherapy education can significantly enrich professional training by fostering sensitivity to corporality as a lived, relational, and cultural phenomenon, thereby strengthening future clinicians’ holistic and humanistic competencies. Full article

Against the backdrop of high digital uncertainty in the 2023 Thai General Election, this study examines how social media reshapes voting intentions through a novel hybrid framework integrating Fuzzy Rough Set Theory (FRST), Hierarchical Confirmatory Factor Analysis (CFA), and Random Forest Regression (RFR). A three-stage design—combining 23 expert opinions with survey data from 812 voters—overcomes expert ambiguity and non-linear dynamics. The findings reveal a hierarchy in digital campaigning: while Party Image (Importance = 0.3056) is the primary predictor for initial voter attention, substantive Campaign Policy (β = 0.98) remains the definitive driver of final commitment. Other perceptual constructs, including Trust, Loyalty, and Perceived Quality, function as reinforcing dimensions that validate policy claims within the digital ecosystem. This suggests a shift where traditional broadcasting is superseded by interactive digital streaming, allowing voters to scrutinize policies through replays and public comments. The model’s robustness, validated through 10-fold Random Forest Cross-Validation, demonstrates high predictive stability (Mean CV R² = 0.840) and minimal error (MAE = 0.064). This study offers a sensitive instrument for emerging democracies and provides actionable insights, showing that substantive policy remains the ultimate driver of voter choice, even when mediated through Party Image in interactive digital environments. Full article

Background: Iron deficiency (ID) is a prevalent condition in patients with cardiovascular diseases, irrespective of anemia, associated with adverse outcomes. Its incidence and prognostic value in acute coronary syndromes (ACS) are yet to be established. Current literature on the matter is scarce, and further research is necessary to confirm a clear link between ID and possible adverse outcome prediction in this group. Aims: This study aimed to evaluate the incidence and prognostic value of ID in ACS patients, and associations between iron parameters and patients’ characteristics, comorbidities, hospitalization length, laboratory results, electrocardiographic, echocardiographic assessment, and invasive coronary angiography results. Methods: We conducted an observational prospective study enrolling 214 consecutive patients after ACS. Adverse events were defined as all-cause death or non-elective rehospitalization due to cardiovascular causes. Results: ID patients constituted 46.7% of the studied cohort. ID was associated with higher NT-proBNP on admission (p = 0.03). Higher TSAT was independently associated with lower peak troponin levels (β = −0.03, standardized β = −0.15, p = 0.03). Ferritin < 100 ng/mL was paradoxically associated with shorter in-hospital stay (p = 0.03). In multivariable analysis, ID was an independent predictor of the composite endpoint (HR 1.94 [95% CI: 1.02–3.67], p = 0.04); however, no significant differences in event-free survival have been identified between ID and non-ID groups. Conclusions: ID is a common condition in ACS patients, associated with higher values of biomarkers reflecting cardiac damage, and may constitute an important predictor of adverse events after discharge. Further, larger, preferably multicenter studies are required to establish the exact association between ID and mortality among ACS patients treated with percutaneous coronary intervention. Full article

Colorectal cancer (CRC) develops gradually from precancerous adenomas and is highly curable when detected early. In Malaysia, however, most cases are diagnosed at advanced stages, leading to poorer outcomes despite the availability of screening programmes such as the immunological Faecal Occult Blood Test (iFOBT). Limited screening uptake and poor adherence contribute to delayed diagnosis. Therefore, effective non-invasive and patient-friendly screening tools are essential. Background/Objectives: This study aims to validate the diagnostic performance of the multi-target stool DNA (mt-sDNA) test. Methods: This cross-sectional validation study was conducted at the Endoscopic Center, Hospital Canselor Tuanku Muhriz (HCTM), from January 2024 to September 2025. Adults aged 18–75 years undergoing elective or emergency colonoscopy were included. Results: Among 246 patients, most were male (56.5%), Malay (65.2%), and aged 55–75 years (91.3%). CRC prevalence was 8.5%. A significant association was observed between age group and colonoscopy findings (p = 0.005), with older individuals more likely to have CRC or adenomatous lesions. Most CRC (90.4%) and advanced adenoma (84.6%) cases occurred in symptomatic patients; however, this difference did not demonstrate a significant association with colonoscopy outcomes (p = 0.069). Per rectal bleeding, constitutional symptoms, altered bowel habit, abdominal pain and constipation were significantly associated with CRC and adenomatous lesions. The mt-sDNA test showed a sensitivity of 63.2%, specificity of 85.0%, positive predictive value of 36.4%, and negative predictive value of 94.4%. Conclusions: Preliminary findings indicate that mt-sDNA demonstrates good specificity and high negative predictive value, but moderate sensitivity and low positive predictive value. Full article

Background/Objectives: Traumatic spinal fractures are common injuries, and a proportion of these cases require surgical stabilization using various operative systems. This study aimed to analyze the epidemiology of surgical site infections (SSIs) following exclusively trauma-related spinal surgery and to identify potential risk factors for their occurrence, as there is a lack of studies focusing on non-elective trauma-related spinal surgeries and SSI in the literature. Methods: This retrospective single-center analysis examined 710 patients with traumatic spinal injuries treated surgically between 2012 and 2022 at the Level I Trauma Center at the Department of Orthopedics and Trauma Surgery of the University Hospital Wiener Neustadt, Austria. To investigate SSI risk factors, comparative statistical analyses and logistic regression were used, with a level of statistical significance of α = 0.05. Results: In total, 28 cases (with an incidence of 3.94%) developed SSI, and these cases were characterized by a significantly higher body weight/BMI, longer operative times, and more stabilized segments and implanted hardware. They were also more likely to have undergone open surgery, laminectomy in combination with dorsal stabilization, intensive care treatment, or to present with neurological deficits or ankylosing spondylitis. SSIs occurred most frequently in the thoracolumbar and cervicothoracic junctions, and were predominantly caused by Staphylococcus epidermidis, Staphylococcus aureus, and Cutibacterium acnes. As independent risk factors, a higher BMI (OR = 1.188) and the use of cross-connectors (OR = 4.948) were identified, whereas other initially significant variables did not remain significant after adjustment. Conclusions: There are surgery-related and potentially modifiable variables and non-modifiable patient-related risk factors for the occurrence of SSI. Patients with SSIs stayed an average of 25.3 days in hospital and had a mortality rate of 17.9%. Full article

Background: Artificial intelligence (AI) is progressively entering perioperative medicine; however, its role in preoperative anesthetic decision-making remains insufficiently characterized. We evaluated the concordance between anesthesiologist-selected anesthetic techniques and algorithm-generated recommendations in a cohort of adult patients undergoing non-cardiac surgery. Methods: This retrospective observational study included adult patients (≥18 years) undergoing elective non-cardiac surgery between January 2024 and January 2025 at two international centers (Mexico and Italy). Clinical, demographic, and surgical variables were extracted from electronic medical records. For each case, a structured anonymized vignette was submitted to ChatGPT (version 5.0, medical configuration) to obtain an independent recommendation regarding anesthetic technique. Concordance between AI-generated and clinician-selected techniques was assessed using agreement analysis and stratified by country and surgical specialty. Results: A total of 1965 patients were analyzed. Overall concordance between ChatGPT recommendations and anesthesiologist-selected techniques was 84.6%. Agreement remained stable across centers (Mexico 84.3%; Italy 88.7%). Disagreement rates varied by surgical specialty, with the highest values observed in vascular and proctologic surgery (28.6%), followed by urology (21.1%) and thoracic surgery (18.8%). Orthopedic procedures—particularly shoulder arthroscopy—accounted for a relevant proportion of divergences, where AI frequently favored regional techniques over general anesthesia. No specialty demonstrated discordance exceeding 30%. Conclusions: AI-generated anesthetic recommendations demonstrated substantial concordance with expert clinical decision-making across heterogeneous surgical settings. These findings support the potential integration of AI within a hybrid decision-making framework, complementing—rather than replacing—anesthesiologist expertise in contemporary perioperative care. Full article

Background/Objectives: Nuclear receptor corepressors NCOR1 and NCOR2 are key regulators of transcriptional repression, chromatin remodelling, and immunometabolic signalling. While NCOR1 has already been linked to vascular biology, its relevance in abdominal aortic aneurysm (AAA) remains unclear, particularly for NCOR2. This study aimed to investigate the expression, cellular localisation, and molecular interactions of NCOR1/2 in human AAA tissue. Methods: Human AAA samples (elective and ruptured) (n = 45) and non-aneurysmal control aortas (n = 18) were obtained from our Swiss Vascular Biobank. Transcriptomic profiling was performed using ribosomal RNA-depleted RNA sequencing. Differential expression and correlation analyses were performed using DESeq2/EdgeR and Spearman rank correlation with Benjamini–Hochberg correction. Cellular localisation was assessed through immunohistochemistry (IHC). Results: Bulk transcriptomic analyses showed no significant differences in NCOR1 or NCOR2 expression between AAA and controls. IHC revealed that NCOR1 was found in endothelial cells (ECs), smooth muscle cells (SMCs), and inflammatory infiltrates, while NCOR2 was primarily associated with macrophages. Correlation analyses suggest that NCOR1 interacts with various cellular markers, proteolytic enzymes, inflammatory mediators, and epigenetic regulators, including the lncRNA MALAT1. NCOR2 showed distinct associations with remodelling enzymes, TGFB1 signalling, selective epigenetic modifiers, and lncRNA H19. Conclusions: The lack of transcriptional differences in NCOR1 and NCOR2 between AAA and controls does not exclude cell-type-specific regulation or functional relevance. The specific cellular distributions and molecular associations in human AAA imply that NCOR1 and NCOR2 play non-redundant roles in vascular remodelling, inflammation, and epigenetic regulation. Our findings highlight NCOR pathways as potential modulators of AAA pathophysiology and promising targets for future therapies. Full article

Background/Objectives: Ultra-low-profile (ULP) endografts have expanded the applicability of endovascular aneurysm repair (EVAR) in patients with challenging aortoiliac anatomy and narrow access vessels. However, direct long-term comparisons between different ULP devices remain limited. This study aimed to compare mid- to long-term outcomes of the INCRAFT and Ovation endografts in a single-center experience. Methods: This retrospective single-center study included 102 patients (45 Ovation, 57 INCRAFT) with a median follow-up exceeding 60 months. We retrospectively analyzed 102 consecutive patients undergoing elective EVAR with ULP devices between January 2011 and December 2019. Forty-five patients were treated with Ovation and 57 with INCRAFT. The primary endpoint was technical success. Secondary endpoints included survival, reintervention, endoleak, and device-related complications. Statistical comparisons were performed using Student’s t-test and Fisher’s exact test. Results: Primary technical success was achieved in all cases. The Ovation group exhibited more complex proximal neck anatomy, including greater thrombus involvement (47.4% vs. 12.7%, p < 0.001). Post-implantation syndrome occurred more frequently with INCRAFT (14% vs. 0%, p = 0.009). No significant differences were observed in endoleak, major adverse events, or total reintervention. Long-term mortality was higher in the Ovation group (37.8% vs. 15.8%, p = 0.01), although deaths were not aneurysm-related. Median follow-up exceeded 60 months in both groups. Conclusions: Both ULP endografts demonstrated favorable long-term outcomes within the limitations of a non-randomized, anatomically heterogeneous cohort. Full article

Background and Objectives: Postoperative delirium and postoperative cognitive dysfunction are common complications in older adults undergoing elective non-cardiac surgery, associated with increased morbidity and mortality, functional decline, and prolonged hospital stay. Prolonged preoperative fasting may intensify inflammatory responses and insulin resistance. Preoperative oral carbohydrate loading within ERAS protocols may modulate this response and reduce cognitive risk. Materials and Methods: A scoping review was conducted following the methodological recommendations of Arksey and O’Malley, the Joanna Briggs Institute, and PRISMA-ScR. A systematic search was performed in PubMed and Scopus for studies published up to September 2025. Randomized controlled trials and observational studies including adults ≥ 65 years undergoing elective non-cardiac surgery were included if they evaluated fasting modifications or preoperative carbohydrate loading and reported postoperative delirium or cognitive dysfunction. Results: A total of eight publications were included: four randomized controlled trials, one prospective cohort study, two cross-sectional studies, and one descriptive/correlational study. Populations included older adults undergoing elective abdominal, orthopedic, colorectal, or hip surgery, as well as hospitalized elderly surgical patients. Interventions included oral carbohydrate loading, assessment of preoperative nutritional status, and enteral versus parenteral nutrition. Only four of the eight included studies directly evaluated neurocognitive outcomes. Postoperative delirium was assessed in three studies, using the Confusion Assessment Method in two studies and the Delirium Rating Scale in one study. Postoperative cognitive dysfunction was evaluated in one study using a Mini-Mental State Examination-based cognitive assessment, while the remaining four studies did not assess neurocognitive outcomes and instead focused on metabolic, inflammatory, or perioperative well-being outcomes. Conclusions: Available evidence suggests that perioperative fasting protocols and preoperative carbohydrate loading may influence metabolic and inflammatory responses related to postoperative neurocognitive outcomes in older adults. However, evidence remains limited and heterogeneous. Findings are exploratory and hypothesis-generating, highlighting the need for well-designed trials assessing neurocognitive outcomes in geriatric surgical populations. Full article

Objectives: To investigate the early- and long-term outcomes of femoral endarterectomy (FEA) in patients undergoing hemodialysis (HD) compared with patients who were not. Methods: This single-center retrospective study evaluated 199 limbs of 163 patients (HD group, n = 50; non-HD group, n = 149) who underwent elective FEA between 2013 and 2023. Clinical outcomes were compared between the groups. The primary outcomes included early postoperative morbidity and mortality, primary patency (PP), freedom from major amputation (FFMA), overall survival (OS), and amputation-free survival (AFS). Results: Early morbidity rates were similar between the groups. However, the mortality rate was significantly higher in the HD group than in the non-HD group. There was no significant difference in the 5-year PP rate between the two groups. Furthermore, FFMA, OS, and AFS were significantly lower in the HD group than in the non-HD group. Conclusions: FEA provides acceptable patency outcomes in patients undergoing HD. However, these patients have a higher early postoperative mortality rate and experience significantly poorer limb salvage and OS than non-HD patients. These findings highlight the necessity of careful perioperative management and vigilant long-term follow-up in this high-risk patient population. Full article

With the introduction of total neoadjuvant therapy (TNT) in locally advanced rectal cancer treatment, multidisciplinary treatment options have become more diverse than before, and many challenges remain unresolved. A randomized clinical study in intermediate-risk locally advanced rectal cancer showed that neoadjuvant full-dose systemic chemotherapy with response-adapted omission of radiation therapy is non-inferior to concurrent chemoradiotherapy. Given that preoperative systemic chemotherapy provides an additional layer of local disease control, the traditional role and extent of neoadjuvant radiation therapy could be strategically re-evaluated within the TNT framework. In this context, a risk-adapted approach featuring selective reduction in elective nodal irradiation volume, particularly of the lateral pelvic lymph nodes, may offer a promising middle ground for treatment personalization. Drawing parallels from surgical practice—where total mesorectal excision is standard but lateral pelvic lymph node dissection is reserved for selected cases—this perspective advocates for similar selectivity in radiation therapy targeting, focusing on mesorectal and presacral regions while judiciously omitting lateral nodes in appropriately selected patients. This approach could maintain oncologic safety by focusing radiation therapy on limited but essential volumes. With modern intensity-modulated radiation therapy, reducing the target volume translates directly to enhanced organs-at-risk sparing, thereby mitigating radiation-induced toxicity. When combined with induction chemotherapy response assessment to refine patient selection, this approach can offer a biologically informed, personalized treatment paradigm that balances disease control with quality of life. Full article

Background/Objectives: Chronic obstructive pulmonary disease (COPD) coexists with lung cancer in 40–70% of cases and increases perioperative risk, particularly in patients with severely impaired pulmonary function. Preoperative pulmonary rehabilitation (PR) has been proposed as a perioperative optimization strategy; however, its effect on hospital length of stay (LOS) in patients with advanced COPD remains unclear. This study aimed to compare postoperative complications, intensive care unit (ICU) utilization, and hospital LOS between patients with lower and higher baseline forced expiratory volume in one second (FEV1), and to evaluate the role of preoperative PR as a risk-adaptive perioperative strategy in high-risk COPD patients undergoing lung cancer surgery. Methods: This retrospective cohort study comprises patients with spirometry-confirmed COPD and non-small cell lung cancer (NSCLC) who underwent elective lung resection at a tertiary care center between March 2019 and June 2020. Disease severity was classified using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) framework: GOLD 1–2 (FEV1 ≥ 50% predicted) and GOLD 3–4 (FEV1 < 50% predicted). Patients in the GOLD 3–4 group received a uniform 15-day hospital-based preoperative PR program prior to surgery. Primary outcomes were ICU stay, postoperative complications, and hospital LOS. Factors independently associated with prolonged hospital stay were examined using an exploratory multivariable linear regression model. Results: Among 63 patients (95.2% male; median age 64 years), those with GOLD 3–4 COPD had significantly lower baseline FEV1 values and longer COPD duration compared with the GOLD 1–2 group. Despite a higher perioperative risk profile, postoperative complication rates (28.6% overall; p = 0.237) and ICU utilization were comparable between groups. Median postoperative hospital LOS was significantly longer in patients with GOLD 3–4 COPD (15 [IQR 6] vs. 11 [IQR 4] days; p < 0.001). In the exploratory regression analysis, lower predicted FEV1 percent (p = 0.003) and older age were independently associated with prolonged hospital stay, whereas PR was not an independent determinant of LOS. Conclusions: In patients with lung cancer and severe COPD (GOLD 3–4) who received preoperative PR, postoperative complication rates and ICU utilization were comparable to those observed in patients with less severe disease. Prolonged hospital stay in the high-risk group was independently associated with lower FEV1 and older age, reflecting underlying disease severity. Prospective controlled studies stratified by COPD severity are needed to establish the independent contribution of preoperative PR in this population. Full article

Background: Port-a-catheter (PAC) placement is a common procedure in oncology that, despite local anaesthesia, can induce patient discomfort, procedural pain, and anxiety. Virtual reality hypnosis (VRH), combining immersive virtual reality with clinical hypnosis, has been proposed as a non-pharmacological adjunct to reduce peri-procedural distress. Objectives: This pilot study aimed to explore the suitability of VRH during PAC placement and its potential effects on pain, anxiety, and VRH-related experiences, while investigating psychological variables associated with VRH engagement. Methods: In this single-arm interventional monocentric prospective pilot study, twenty oncology patients undergoing first-time elective PAC placement received a VRH intervention delivered via a medical-grade head-mounted display throughout the procedure. Pain, anxiety, and VRH-related dimensions—including absorption, dissociation, automaticity, arousal, and sense of presence—were assessed pre- and post-procedure using self-reported numerical rating scales and questionnaires. Non-parametric Wilcoxon tests evaluated pre–post changes, and correlational analyses (Pearson’s and Spearman’s when necessary) explored associations between variables. Results: VRH was well tolerated by most participants, although three patients required additional pharmacological support, and four could not complete the session due to intolerance or technical issues. Anxiety scores decreased significantly following VRH, whereas pain showed a non-significant trend toward reduction. Post-procedural absorption and dissociation were positively associated with presence, and higher absorption traits were linked to greater immersive engagement and prior VR/hypnosis experience. Cybersickness was negatively associated with absorption. Older age was correlated with lower post-procedural pain, and females reported higher state anxiety. Conclusions: In this pilot, VRH was feasible, well tolerated, and associated with a significant exploratory reduction in procedural state anxiety. Given the single-arm design, these findings constitute directional evidence warranting controlled trial evaluation rather than proof of efficacy. These preliminary results support the rationale for randomised controlled trials to evaluate VRH efficacy, underlying mechanisms, and potential role as a non-pharmacological adjunct in oncology perioperative care. Full article

Background: Kartagener syndrome (KS) is a rare subset of primary ciliary dyskinesia characterized by the triad of situs viscerum inversus (SVI), chronic sinusitis, and bronchiectasis. Laparoscopic cholecystectomy (LC) in patients with SVI is technically demanding because of mirror-image anatomy, while evidence supporting the use of indocyanine green (ICG) fluorescence in this setting is scarce. Case Presentation: We report the case of a 25-year-old woman with KS and SVI totalis who underwent elective LC for symptomatic cholelithiasis. The procedure was performed using a mirror American approach with four trocars and near-infrared ICG fluorescence cholangiography. ICG enabled real-time visualization of biliary anatomy and facilitated intraoperative orientation. The procedure was completed laparoscopically without intraoperative or postoperative complications, and the postoperative course was uneventful. Methods: A non-systematic narrative review of the literature was conducted to identify reported cases of LC in patients with SVI, including cases associated with KS. Studies published between 1991 and 2025 were retrieved from PubMed, Web of Science, Scopus, and Embase. Data were descriptively summarized, focusing on surgical technique, trocar placement, and reported use of ICG fluorescence. Results: A total of 143 articles were included. Most cases involved isolated SVI, while KS was reported only in a minority of patients. The mirror American technique and four-trocar configuration were the most frequently adopted approaches. Only three cases, including the present report, described the use of ICG fluorescence during LC in patients with SVI or KS. Conclusions: LC in patients with SVI is feasible but technically demanding. ICG fluorescence may assist intraoperative biliary orientation in complex anatomical settings; however, current evidence is extremely limited and should be considered hypothesis-generating only. Full article

Inclusion and preference relations are fundamental comparison tools in intuitionistic fuzzy set (IFS) theory and play an important role in decision analysis under uncertainty. In IFS representations, the hesitation degree reflects information that is not captured by membership and non-membership values alone. This study investigates the structural relationship between hesitation and the inclusion and preference relations of IFSs. A proposed interpretation of membership and non-membership degrees is employed to provide a geometric perspective on hesitation. Within this framework, analytical relations between hesitation inequalities and preference conditions are derived. In particular, it is shown that the hesitation inequality constitutes a necessary condition for preference, whereas inclusion relations remain compatible with a wider range of hesitation configurations. The theoretical observations are illustrated using electoral datasets from the 2002 South Korean presidential election and the 2000 United States presidential election in Florida. Regional vote shares are transformed into intuitionistic fuzzy representations to analyze the distribution of hesitation across regions. The examples demonstrate how hesitation may influence the stability of preference relations while inclusion relations remain structurally preserved. Full article