Search Results (121)

In precision oncology research, achieving joint modeling of tumor grading and treatment response, together with interpretable mechanism analysis, based on multimodal medical imaging and clinical data remains a challenging and critical problem. From a sensing perspective, these imaging and clinical data can be regarded as heterogeneous sensor-derived signals acquired by medical imaging sensors and clinical monitoring systems, providing continuous and structured observations of tumor characteristics and patient states. Existing approaches typically rely on invasive pathological grading, while grading prediction and treatment response modeling are often conducted independently. Moreover, multimodal fusion procedures generally lack explicit structural constraints, which limits their practical utility in clinical decision-making. To address these issues, a grade-guided multimodal collaborative modeling framework was proposed. Built upon mature deep learning models, including 3D ResNet-18, MLP, and CNN–Transformer, tumor grading was incorporated as a weakly supervised prior into the processes of multimodal feature fusion and treatment response modeling, thereby enabling an integrated solution for non-invasive grading prediction, treatment response subtype discovery, and intrinsic mechanism interpretation. Through a grade-guided feature fusion mechanism, discriminative information that is highly correlated with tumor malignancy and treatment sensitivity is emphasized in the multimodal joint representation, while irrelevant features are suppressed to prevent interference with model learning. Within a unified framework, grading prediction and grade-conditioned treatment response modeling are jointly realized. Experimental results on real-world clinical datasets demonstrate that the proposed method achieved an accuracy of $84.6\%$ and a kappa coefficient of $0.81$ in the tumor-grading prediction task, indicating a high level of consistency with pathological grading. In the treatment response prediction task, the proposed model attained an AUC of $0.85$, a precision of $0.81$, and a recall of $0.79$, significantly outperforming single-modality models, conventional early-fusion models, and multimodal CNN–Transformer models without grading constraints. In addition, treatment-sensitive and treatment-resistant subtypes identified under grading conditions exhibited stable and significant stratification differences in clustering consistency and survival analysis, validating the potential value of the proposed approach for clinical risk assessment and individualized treatment decision-making. Full article

Various recurring medical events encourage innovative patient well-being through connected health strategies based on an elegant digital environment that prioritizes safety, comfort, and beneficial outcomes for both patients and medical staff. This narrative review article aims to investigate and highlight the potential of advanced, reliable, high-precision, and secure medical observation and intervention missions. These involve a smart digital environment integrating smart materials combined with smart digital monitoring. These medical implications concern robotic surgery and drug delivery through image-assisted implantation, as well as wearable observation and assistive tools. The former requires high-precision motion and positioning strategies, while the latter enables sensing, diagnosis, monitoring, and central task assistance. Both advocate minimally invasive or noninvasive procedures and precise supervision through autonomously controlled processes with staff participation. The article analyzes the requirements and evolution of medical interventions, robotic actuation technologies for positioning actuated and self-moving instances, monitoring of image-assisted robotic procedures using digital twins and augmented digital tools, and wearable medical detection and assistance devices. A discussion including future research perspectives and conclusions complete the article. The different themes addressed in the proposed paper, although self-sufficient, are supported by examples of the literature, allowing a deeper understanding. Full article

Multimodal imaging plays a central role in optimizing the evaluation and management of myocardial ischemia by leveraging the complementary strengths of echocardiography, cardiac magnetic resonance imaging (CMR), single photon emission computed tomography (SPECT), positron emission tomography (PET), and invasive coronary angiography (ICA). Noninvasive functional imaging is typically recommended for patients with intermediate to high pre-test probability of coronary artery disease, while coronary computed tomography angiography (CCTA) is preferred for low to intermediate risk. Stress echocardiography is valuable for detecting wall motion abnormalities and is particularly effective in multivessel or left main disease, where perfusion techniques may miss balanced ischemia. CMR offers high spatial resolution and quantitative assessment of myocardial blood flow (MBF), while SPECT and PET quantify ischemic burden, with PET providing superior accuracy for MBF and microvascular disease. ICA remains the gold standard for defining the presence, location, and severity of epicardial coronary stenosis. It is indicated when noninvasive imaging reveals high-risk features, when symptoms are refractory to medical therapy, or when noninvasive results are inconclusive. While ICA offers high spatial resolution, it alone cannot assess the hemodynamic significance of intermediate lesions, nor the coronary microvasculature. Adjunctive invasive hemodynamic and provocative coronary testing (e.g., Fractional Flow Reserve—FFR, invasive Coronary Flow Reserve—CFR, Index of Microcirculatory Resistance—IMR, acetylcholine test) provide essential insights, especially in ischemia with nonobstructive coronary arteries. Given its procedural risks, ICA should be reserved for cases where it will impact management. Intravascular imaging may be used to further characterize lesions. In summary, modality selection should be individualized based on patient characteristics, comorbidities, contraindications, and the need for anatomical versus physiological data. Integrating noninvasive and invasive modalities provides a comprehensive, patient-centered approach to ischemia evaluation. Full article

Introduction: The scope and accessibility of prenatal testing have significantly expanded in recent years, reaching a broader population of pregnant women. Advances in non-invasive diagnostic methods support informed decision-making and help reduce the need for invasive procedures. Objective: The objective was to evaluate pregnant women’s knowledge regarding prenatal testing and assess the quality of information provided by healthcare professionals, including the frequency of screening and invasive procedures. Materials and Methods: A total of 310 obstetric patients from maternity wards in two hospitals in northern Poland completed a survey addressing prenatal tests, sources of information, and the quality of guidance received from medical staff. Results: Nearly 75% of respondents demonstrated adequate knowledge of the purpose, indications, and scope of prenatal testing. Physicians were identified as the primary source of information. Approximately 50% correctly indicated the recommended number of ultrasound examinations during pregnancy. No correlation was observed between knowledge of prenatal testing and a history of delivering a child with health complications. The combined first-trimester test was performed in 48.6% of cases, NIPT in 11.6%, and invasive testing in 1.8% of the study group. Conclusions: Public awareness of prenatal testing in Poland remains insufficient. With the introduction of partially reimbursed tests in 2024, we recommend strengthening educational efforts through social campaigns and targeted training for healthcare professionals. Full article

Background: Upper gastrointestinal bleeding (UGIB) is a common medical emergency associated with significant morbidity, mortality, and healthcare costs. Many patients undergo early endoscopy despite the absence of active bleeding. PillSense is a novel Food and Drug Administration (FDA)-cleared ingestible capsule that rapidly detects the presence of blood in the upper GI tract and may optimize triage decisions. Methods: We conducted a retrospective study evaluating the impact of PillSense on the management of suspected UGIB in an academic center. The primary outcome was the association between capsule results and clinical decision-making, including endoscopy deferral, prioritization, outpatient scheduling, and airway protection. Secondary outcomes included transfusion requirements, time-to-endoscopy, endoscopic intervention, and 30-day adverse events. Results: A total of 28 patients (mean age 64.4 ± 17.9 years, 82.7% male) were included. Compared with negative results, positive results were associated with higher transfusion requirements (median 3 (IQR 3–6) vs. 2 (IQR 1–3.25) units; p = 0.041) and shorter time-to-endoscopy (median 0.2 (IQR 0.01–1) vs. 2 (IQR 1–15.5) days; p = 0.017). In high-risk for sedated endoscopy patients, negative results were associated with EGD deferral in 53.8%, with no subsequent adverse events within 30 days. Endoscopic intervention was performed in 62.5% of positive-result patients versus 9.5% of negative-result patients. Conclusions: The PillSense results were associated with differences in triage and management of high-risk patients with suspected UGIB. Its rapid, accurate, and non-invasive results may reduce unnecessary urgent endoscopy procedures, improve resource utilization, and enhance patient safety, particularly in the highest-risk populations. Full article

Objective: The current study aimed to develop predictive models based on noninvasive clinical parameters to facilitate the early identification and stratification of patients with suspected bladder outlet dysfunction (BOD), thereby reducing the need for invasive diagnostic procedures. Materials and Methods: This retrospective study included 307 male patients with lower urinary tract symptoms (LUTS) refractory to medical therapy who were enrolled between January 2001 and May 2022. To assess the predictive performance of the model in an independent cohort, the dataset was randomly divided into the training set (70%) for model development and the test set (30%) for external validation. A two-stage modeling approach was adopted: Stage 1 involved detecting BOD, and stage 2 focused on identifying specific BOD subtypes. Backward stepwise logistic regression was conducted for model derivation, with internal validation performed using 5-fold cross-validation repeated 20 times. Clinical nomograms and a clinical decision-making framework were constructed based on the final modeling results. Results: In stage 1, the derived BOD model for detecting suspected BOD incorporated maximum flow rate, voided volume, intravesical prostatic protrusion (IPP), and prostatic urethral angle (PUA) as predictors. In stage 2, the derived benign prostatic obstruction (BPO) model included post-void residual (PVR), total prostate volume (TPV), and IPP as predictors. We also constructed nomogram to broadly screening BOD by the combination of maximum flow rate, voided volume, IPP, and PUA, a total score of ≥107 yielded the probability of 0.78 to identify BOD of 0.78. Subsequently, by combining PVR, TPV, and IPP, a total score of ≥39 yielded the probability of 0.35 to discriminate BPO. However, the BOD model (0.47) had a relatively low specificity, and the BPO model (0.58) had a lower sensitivity. Thus, these findings should be considered when applying the models in clinical practice. Conclusions: The results of this study revealed that using the clinical non-invasive parameters to create models can only yield a low sensitivity and low specificity for identifying BPO and the other BOD subtype. In patients with LUTS and small to moderate prostate volume, invasive video urodynamic study is still necessary when invasive treatment modality is recommended. Full article

Background: Tremor-dominant Parkinson’s disease (TDPD) is the most common subtype of PD. Tremor is difficult to treat and less than 50% of patients respond to dopaminergic medications. Magnetic resonance guided focused ultrasound (MRgFUS) thalamotomy is an incisionless noninvasive method for treating pharmacoresistant tremor in PD patients, but its effect on progression of PD is unknown. In this study, we investigate the efficacy of MRgFUS thalamotomy on progression of motor and non-motor symptoms, using a levodopa equivalent daily dose (LEDD) requirement. Methods: A total of 21 PD patients with ineffective tremor correction by medical therapy underwent MRgFUS thalamotomy. Assessments of motor and non-motor symptoms, adverse events (AE), changes in LEDD, and evolution of FUS (focused ultrasound) lesion were performed on the day before surgery, and then 2 days, as well as 3, 6, and 12 months, after the procedure. Results: On the 2nd day after FUS thalamotomy, 11 patients were tremor-free and, in 10 patients, tremor decreased by 80–90% with a concomitant reduction in hypokinesia and rigidity. By the end of the 12th month, 5 patients remained tremor-free; in 11 patients, mild/moderate tremor re-emerged; and in 5 patients, there was a relapse of severe tremor. Quality of life (QoL) and activities of daily living (ADL) improved significantly at 3 months and remained stable thereafter. Cognitive function improved in patients with baseline MoCA score < 26 points at 3 months after FUS. Anxiety progressed between baseline and end of follow-up. By the end of the follow-up period, LEDD was lowered or stable in 9 patients. Four patients had persistent mild AE. Conclusions: This open label study suggests a beneficial effect of MRgFUS in reducing tremor, hypokinesia, and rigidity and improving QoL, ADL, and cognitive function in TDPD patients in the short term, although long-term data needs to be collected in further studies. Full article

Background/Objectives: Non-invasive ventilation (NIV) is a highly effective and safe treatment for hypercapnic acute respiratory failure (ARF). This study aimed to identify and examine the content and recommendations within local health guidance documents (LHGDs) that facilitate ward-based implementation of NIV for the treatment of ARF in adults in Australian health services. Methods: A scoping review was conducted on 26 May 2023, updated on 11 January 2024 and 16 September 2025 to identify public health services NIV LHGDs. Data were extracted and analysed regarding NIV initiation, monitoring, maintenance and weaning, and management of clinical deterioration. Results: Twenty-two LHGDs were included, of which only six (27.3%) referenced international NIV guidelines. Most LHGDs (n = 17, 77.3%) required an arterial blood gas (ABG) measurement before NIV initiation, with eight (36.4%) specifying PaCO₂ > 45 mmHg and pH < 7.35 as a basis to consider NIV initiation. Most (n = 13, 59.1%) specified a target SpO₂ range to monitor NIV, but recommendations varied. NIV implementation recommendations general wards (n = 12, 54.5%) were most common, followed by respiratory wards (n = 5, 22.7%) and respiratory care units (n = 4, 18.2%). Most LHGDs did not specify criteria for medical review (n = 13, 59.1%), clinical escalation (n = 13, 59.1%) or palliation care (n = 13, 59.1%), and weaning guidance was rarely specified (n = 7, 31.8%). Conclusions: There was substantial variation in the structure and content of LHGDs for ward-based NIV across Australian hospitals, including inconsistencies in initiation, monitoring, weaning, and detection of patient deterioration. Variation and limited alignment with major clinical guidelines may impact care quality and safety. Full article

This review explores the transformative potential of graphene-based, non-invasive biochemical sensors in the context of real-time health monitoring and personalised medicine. Traditional diagnostic methods often involve invasive procedures that can be uncomfortable, pose risks, and limit the frequency of monitoring. In contrast, wearable sensors incorporating graphene offer a compelling alternative by enabling continuous, real-time tracking of physiological and biochemical signals with minimal intrusion. Graphene’s exceptional electrical conductivity, mechanical flexibility, biocompatibility, and high surface-area-to-volume ratio make it ideally suited for integration into skin-conformal sensor platforms. These properties not only enhance sensitivity and signal fidelity but also promote user comfort and long-term wearability, critical factors for the adoption of wearable health technologies. The discussion evaluates current developments in the design and deployment of graphene-based biosensors, with particular attention given to their role in managing chronic conditions, supporting preventative healthcare, and facilitating decentralised diagnostics. By bridging materials science and biomedical engineering, this review positions graphene as a key enabler in the shift towards more proactive, patient-centred healthcare models. The text also identifies ongoing challenges and future directions in sensor design, aiming to inform researchers working at the intersection of advanced materials and medical technology. Full article

Cardiovascular diseases remain the leading cause of death worldwide and are often managed through invasive surgical procedures such as heart transplantation, ventricular assist device implantation, coronary artery bypass grafting, and stent placement. However, significant unmet medical needs persist in this field. The development of pharmaceutical agents using non-invasive delivery strategies is therefore of critical importance. Current treatments often target peripheral tissues or organs—such as capillary endothelial cells, vascular smooth muscle, and renal tubules—to reduce cardiac workload by lowering blood pressure. However, effective drug delivery directly to the myocardium continues to pose a significant challenge. For conditions such as congestive heart failure (CHF) and myocardial infarction (MI), targeted delivery of therapeutic agents to the heart is essential. In this perspective review, I discuss the potential and emerging strategies for non-invasive cardiac drug delivery, focusing on receptor-mediated endocytosis and transcytosis using nanoparticle-based delivery systems that have frequently been employed for targeting the brain or cancer cells although their use for cardiac delivery remains largely unexplored. Full article

Background and Clinical Significance: Granulomatous reactions are rare but clinically significant complications of aesthetic procedures involving dermal fillers, particularly in individuals with underlying immune dysregulation. These reactions present diagnostic and therapeutic challenges, especially when associated with undiagnosed or latent autoimmune diseases. This case illustrates the interaction between filler composition, immune status, and the risk of delayed inflammatory responses, underscoring the need for thorough patient evaluation and individualized management strategies. Case Presentation: A 49-year-old woman developed delayed-onset subcutaneous nodules following midface augmentation with two filler types: a monophasic, cross-linked hyaluronic acid gel (concentration 20 mg/mL, 1.0 mL per side) injected into the deep malar fat pads, and a calcium hydroxyapatite suspension (30% CaHA microspheres in a carboxymethylcellulose carrier, 0.5 mL per side) placed in the subdermal plane along the zygomatic arch. The procedure was performed in a single session using a 22 G blunt cannula, with no immediate adverse events. High-resolution ultrasound demonstrated hypoechoic inflammatory nodules without systemic symptoms. A retrospective review of her medical history revealed a latent, previously undisclosed diagnosis of granulomatosis with polyangiitis (GPA). The immune-adjuvant properties of calcium hydroxyapatite likely triggered a localized pro-inflammatory response in this predisposed patient. A conservative, staged, non-invasive therapeutic protocol—saline infiltration, intradermal polynucleotide injections, and manual lymphatic drainage—achieved complete clinical and radiological resolution without systemic immunosuppression or surgical intervention. Conclusions: This case highlights the critical importance of pre-procedural immunological assessment in aesthetic medicine. Subclinical autoimmune conditions may predispose patients to delayed granulomatous reactions after filler injections. An individualized, conservative management strategy can effectively resolve such complications while minimizing the risks associated with aggressive treatment. Greater awareness of immune-mediated responses to dermal fillers is essential to ensure patient safety and optimize clinical outcomes. Full article

Background: Accurate differentiation of Parkinson’s disease (PD) from healthy aging is crucial for timely intervention and effective management. Postural sway abnormalities are prominent motor features of PD. Quantitative stabilometry and machine learning (ML) offer a promising avenue for developing objective markers to support the diagnostic process. This study aimed to develop and validate high-performance ML models to classify individuals with PD and age-matched healthy older adults (HOAs) using a comprehensive set of stabilometric parameters. Methods: Thirty-seven HOAs (mean age 70 ± 6.8 years) and 26 individuals with idiopathic PD (Hoehn and Yahr stages 2–3, on medication; mean age 66 years ± 2.9 years), all aged 60–80 years, participated. Stabilometric data were collected using a force platform during quiet stance under eyes-open (EO) and eyes-closed (EC) conditions, from which 34 parameters reflecting the time- and frequency-domain characteristics of center-of-pressure (COP) sway were extracted. After data preprocessing, including mean imputation for missing values and feature scaling, three ML classifiers (Random Forest, Gradient Boosting, and Support Vector Machine) were hyperparameter-tuned using GridSearchCV with three-fold cross-validation. An ensemble voting classifier (soft voting) was constructed from these tuned models. Model performance was rigorously evaluated using 15 iterations of stratified train–test splits (70% train and 30% test) and an additional bootstrap procedure of 1000 iterations to derive reliable 95% confidence intervals (CIs). Results: Our optimized ensemble voting classifier achieved excellent discriminative power, distinguishing PD from HOAs with a mean accuracy of 0.91 (95% CI: 0.81–1.00) and a mean Area Under the ROC Curve (AUC ROC) of 0.97 (95% CI: 0.92–1.00). Importantly, feature analysis revealed that anteroposterior sway velocity with eyes open (V-AP) and total sway path with eyes closed (TOD_EC, calculated using COP displacement vectors from its mean position) are the most robust and non-invasive biomarkers for differentiating the groups. Conclusions: An ensemble ML approach leveraging stabilometric features provides a highly accurate, non-invasive method to distinguish PD from healthy aging and may augment clinical assessment and monitoring. Full article

Background/Objectives: This pilot study aimed to evaluate stress levels in pediatric patients classified as definitely negative according to the Frankl scale by measuring salivary cortisol concentrations. Additionally, the study assessed the impact of Midazolam premedication on stress reduction during dental procedures. Methods. Children and adolescents attending the Pediatric Dentistry Master’s program at the Catholic University of Valencia participated in the study. Salivary cortisol levels were measured before and after dental treatments, differentiating between invasive and non-invasive procedures. Patients were divided into two groups: those receiving Midazolam premedication and those who did not. Results. Findings showed a significant increase in cortisol levels following invasive dental treatments (0.991), whereas non-invasive treatments (0.992) did not lead to notable changes (p < 0.001). Patients premedicated with Midazolam exhibited significantly lower post-treatment cortisol levels compared to those who did not receive the medication (p < 0.05). Conclusions. These preliminary findings suggest that Midazolam-based management in children with definitely negative behavior may be associated with reduced physiological stress responses. As a pilot study with a limited sample and inherent group-allocation bias, the results should be interpreted with caution. The methodology proved feasible and supports the use of salivary cortisol in future, larger-scale studies designed to disentangle behavioral and pharmacological effects. Full article

Background and Purpose: Undescended testes (UDT) is recognized as the most prevalent anomaly of the male genitalia and presents a significant risk factor for long-term complications, including infertility and testicular cancer. Currently, there is no consensus on the necessity of imaging in the management of UDT, nor is there agreement on which imaging modality is preferred or to what extent these tests offer real added value in the clinical setting. This review aims to evaluate the various imaging options available in the management of cryptorchidism, discussing their utility, advantages, and disadvantages compared to exploratory laparoscopy. Methods: We conducted a PubMed search using the following search terms: [“undescended testis”] OR [(“cryptorchidism”) OR (“diagnostic imaging”)] OR [(“Ultrasound”), OR (“CT scan”) OR (“MRI”)] AND [“laparoscopy”]. We analyzed 90 full articles, excluding irrelevant ones, and, in total, 18 publications were included in this review. Results: Ultrasound (US) is the most commonly used technique due to its non-invasive nature and absence of ionizing radiation. It is particularly beneficial in cases of non-palpable UDT. However, its main limitation lies in the difficulty in accurately locating UDT, especially when they are situated outside the inguinal region. Computed tomography (CT) scans serve as a crucial diagnostic tool, particularly for testes located below the internal inguinal ring. While CT exhibits comparable accuracy in detecting UDT, the need for sedation or general anesthesia, along with the costs and potential risks of secondary malignancy due to radiation exposure, does not favor its routine use. Magnetic resonance imaging (MRI) offers higher sensitivity than US and does not utilize ionizing radiation or intravascular contrast agents. It allows for the generation of multiplanar images, thereby providing improved tissue characterization. However, limitations include prolonged scan durations, the potential for motion artifacts during imaging, the need for sedation, and higher costs. Laparoscopy has been shown to provide better accuracy, offering both diagnostic and therapeutic benefits, particularly in cases of non-palpable UDT. It is widely regarded as the gold standard in achieving clear diagnostic and definitive therapeutic procedures and has demonstrated its utility in determining the anatomical position of intra-abdominal testes, owing to its magnification capabilities and minimally invasive approach. Conclusions: Achieving a correct and comprehensive diagnosis of cryptorchidism requires the medical team to decide on the appropriate imaging studies, as these will not significantly influence or alter the therapeutic decision-making process. It is unlikely that medical practice will eliminate imaging studies before a surgical decision is made in the near future. Therefore, a multidisciplinary approach that includes clinical examination, imaging, and diagnostic laparoscopy remains essential for the accurate management of UDT. Full article

Introduction: The objective of the present work is to assess the efficacy of photobiomodulation (PBM) with respect to pain, inflammation, and healing after tooth extractions as compared with a sham treatment. Method: A single-blinded, randomized clinical study conducted in a private dental clinic in Murcia, it included 124 patients who needed a tooth extraction, excluding those with medical conditions that could affect healing (such as non-controlled diabetes, immunosuppression, or hemorrhagic disorders). Group I (Experimental): extraction and PBM session with a diode laser (power: 0.5 W, energy 15 J/cm² for 10–30 s at 1 mm from the tissue). Group II (Sham treatment): tooth extraction and application of inactive PBM. Results: Pain and inflammation decreased similarly in both groups over time. Anxiety decreased in both groups without significant differences (p = 0.776; p = 0.246). There was no evidence that the treatment or location of the extraction had an influence on healing. Suturing the socket increased the likelihood of good healing (p = 0.048), while long procedures reduced it (p = 0.040). Conclusions: PBM is a non-invasive and safe therapy. This study did not show significant differences with respect to the sham treatment. More research is needed with a standardized methodology to better assess its efficacy. Full article