Search Results (96)

Background: Digital technologies offer innovative opportunities for recovering and maintaining intellectual and mental health. The use of a multitask approach that combines motor component with various cognitive tasks in a virtual environment can optimize cognitive and physical functions and improve the quality of life of cardiac surgery patients. This study aimed to localize current sources of theta and alpha power in patients who have undergone virtual multitask training (VMT) and a control group in the early postoperative period of coronary artery bypass grafting (CABG). Methods: A total of 100 male CABG patients (mean age, 62.7 ± 7.62 years) were allocated to the VMT group (n = 50) or to the control group (n = 50). EEG was recorded in the eyes-closed resting state at baseline (2–3 days before CABG) and after VMT course or approximately 11–12 days after CABG (the control group). Power EEG analysis was conducted and frequency-domain standardized low-resolution tomography (sLORETA) was used to assess the effect of VMT on brain activity. Results: After VMT, patients demonstrated a significantly higher density of alpha-rhythm (7–9 Hz) current sources (t > −4.18; p < 0.026) in Brodmann area 30, parahippocampal, and limbic system structures compared to preoperative data. In contrast, the control group had a marked elevation in the density of theta-rhythm (3–5 Hz) current sources (t > −3.98; p < 0.017) in parieto-occipital areas in comparison to preoperative values. Conclusions: Virtual reality-based multitask training stimulated brain regions associated with spatial orientation and memory encoding. The findings of this study highlight the importance of neural mechanisms underlying the effectiveness of multitask interventions and will be useful for designing and conducting future studies involving VR multitask training. Full article

Background: The incidence of anterior cruciate ligament ruptures in football has experienced a marked increase in recent years, affecting both professional and amateur players. This injury is characterised by being highly disabling, causing the player to withdraw from the field of play for prolonged periods and there is no clear consensus on how to carry out the different phases of rehabilitation, which poses a major challenge for health professionals. Case presentation: This study followed a semi-professional player who suffered an anterior cruciate ligament tear following two forced valgus actions without direct contact in the same match. Outcome and follow-up: The patient underwent surgery using an autologous hamstring graft. He followed a progressive rehabilitation programme consisting of one preoperative phase and six phases after the operation. After a 12-month follow-up, with exercises aimed at perfecting step-by-step basic and specific physical skills, the player showed a complete functional recovery, achieving the desired parameters. Conclusions: This case highlights the importance of structured rehabilitation adapted to the specific needs of the football player through an approach with coherent progressions, which considers the muscle chains that determine the movements performed on the football pitch. Full article

Background and Objectives: Idiopathic normal-pressure hydrocephalus (NPH) is a treatable, but diagnostically challenging condition in the elderly marked by gait disturbance, cognitive decline, and urinary incontinence. Ventriculoperitoneal (VP) shunting is effective, but the prognostic significance of symptom duration before surgery remains unclear. This systematic review evaluates symptom duration in NPH patients with postoperative outcomes. Methods: A systematic search of PubMed, Scopus, and Embase was conducted per PRISMA guidelines. Studies were included if they assessed clinical or radiological outcomes of VP shunting in adult NPH patients, reported symptom duration, and had a follow-up of at least one month. Clinical outcomes (MMSE, TUG, NPH score) were qualitatively analyzed due to study heterogeneity. Results: Twenty-four studies comprising 1169 patients were included (mean age: 72.45 years; mean symptom duration: 33.04 months). Most studies reported clinical improvement after VP shunting. However, few directly evaluated the effect of symptom duration, yielding inconsistent findings: some suggested better outcomes with shorter symptom duration, while others found no clear correlation. Larger studies often lacked conclusive data, and no randomized controlled trials were identified. Conclusions: VP shunting remains an effective intervention for NPH; however, evidence supporting the predictive value of preoperative symptom length is inconclusive. This review highlights the need for standardized diagnostic protocols and larger prospective studies to clarify this association and optimize surgical timing. Full article

Introduction: Postoperative delirium (POD) remains a major complication in geriatric surgical care, with poorly understood molecular mechanisms. Emerging evidence links cardiac surgery to elevated markers of neurologic injury, even in cognitively intact individuals. While neuroinflammation is the prevailing model, a more detailed characterization of the systemic inflammatory and metabolic response to surgery may offer deeper insights into POD pathogenesis. Methods: We used the 7K SomaLogic proteomic platform to analyze preoperative and postoperative day-one serum samples from 78 patients undergoing cardiac surgery with cardiopulmonary bypass. We compared proteomic profiles within individuals (pre- vs. post-surgery) and between those who developed POD and those who did not. Functional analyses were performed to identify relevant biological pathways. A composite metabo-inflammatory score (MIF) was derived to quantify systemic derangement. We modeled the association between POD and age, sex, baseline cognition, and MIF score. Results: Cardiac surgery with CPB was associated with marked inflammatory responses across all subjects, including increased IL-6, CRP, and serum amyloid A. Compared to controls, POD cases showed greater metabo-inflammatory shifts from baseline (average logFC = 2.56, p < 0.001). Lower baseline cognitive scores (OR = 0.74, p = 0.019) and higher MIF scores (OR = 1.03, p = 0.013) were independently associated with increased POD risk. Conclusions: Cardiac surgery with CPB elicits a significant metabo-inflammatory response in all patients. However, those who develop POD exhibit disproportionately greater dysregulation. Full article

Preoperative facial markings are critical to surgical precision and aesthetic outcomes in plastic surgery, yet remain operator-dependent and variably documented. Generative artificial intelligence (AI), particularly large multimodal models, offers potential for the automated illustration of surgical plans. This study compares the performances of ChatGPT-4o and Gemini Advanced in generating standardised preoperative markings for aesthetic facial procedures. Methods: Six text prompts describing common facial aesthetic surgeries were developed using established marking protocols. Each prompt was submitted once to ChatGPT-4o and Gemini Advanced, yielding twelve illustrations. Three board-certified plastic surgeons independently evaluated the images using a five-domain Likert scale assessing incision clarity, anatomical accuracy, template conformity, clinical usefulness, and overall graphic quality. A composite score out of 25 was calculated. Data were analysed using paired t-tests, and interrater reliability was assessed with intraclass correlation coefficients. Results: ChatGPT-4o significantly outperformed Gemini Advanced in composite scores (mean 18.0 ± 1.4 vs. 13.9 ± 1.6, p = 0.001, Cohen’s d = 1.69). Superior performance was noted across all domains, particularly in clarity (mean difference 0.83, p = 0.002) and graphic quality (mean difference 0.90, p = 0.001). Interrater reliability was good (ICC = 0.82). Discussion: ChatGPT-4o demonstrated higher fidelity in translating surgical prompts into anatomically appropriate, clinically useful illustrations. However, neither system achieved the precision required for clinical implementation without revision. These models may serve as adjuncts in education and preliminary planning. Future work should explore model fine-tuning, surgeon-guided generation, and performance in reconstructive procedures. Full article

Objectives: This study aims to assess the clinical efficacy of micro-fragmented adipose tissue (MFAT) therapy over three years in patients with KOA and to determine whether short-term improvements at three months can forecast long-term outcomes. Methods: A retrospective, observational study was conducted on 335 patients diagnosed with KOA who received a single MFAT injection. The patients were followed up at 3 months, 6 months, 1 year, 2 years, and 3 years, with assessments using the Visual Analog Scale (VAS), Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Score (KOOS). Statistical analysis was performed to assess the differences in preoperative and postoperative scores (VAS, OKS, WOMAC, KOOS) to evaluate the predictive role of 3-month score changes on long-term clinical outcomes. Results: All measured scores (VAS, OKS, WOMAC, KOOS) showed significant improvement at 3 months, with sustained improvements through 3 years (p < 0.001). Early score changes at 3 months were significantly associated with improved clinical outcomes at 1, 2, and 3 years (p < 0.05). Logistic regression confirmed early post-treatment improvements as independent predictors of long-term benefit, except for the VAS score at 3 years (p = 0.098). A comparative analysis between completers and dropouts showed no baseline differences; however, significant outcome differences emerged at later follow-up points. Due to insufficient data at the 3-year mark among dropouts, statistical comparisons were not possible for that time point. Conclusions: MFAT treatment was associated with consistent symptomatic improvement in patients with KOA, and early clinical response at 3 months served as a reliable predictor of long-term pain and function outcomes. While this study focused on patient-reported symptom relief and not structural regeneration, the results support MFAT as a minimally invasive option for symptom management. Early post-treatment response may serve as a useful tool for clinicians to predict long-term therapeutic success and personalize treatment strategies for KOA patients. Full article

Tetralogy of Fallot (ToF) with pulmonary atresia (PA) and complete right ventricular outflow tract obstruction (RVOTO) represents one of the most critical forms of congenital heart disease in neonates. These cases require complex and timely interventions to ensure survival and optimize long-term outcomes. While surgical correction offers a favorable prognosis, the period from birth to surgery is often marked by significant hemodynamic, respiratory and nutritional challenges, particularly in neonatal intensive care units (NICUs). This study aims to outline a structured, physiology-guided approach to the preoperative management of neonates with ToF and complete RVOTO, emphasizing stabilization strategies, hemodynamic support, ventilatory management and nutritional optimization. We performed a focused literature review of practices in neonatal ToF management and illustrated our experience through two case reports highlighting divergent outcomes in infants with the same anatomical diagnosis. The management strategies covered include delivery room stabilization, the use of prostaglandins, mechanical ventilation techniques, nutritional interventions and the timing of surgical intervention. A phased, physiology-guided management strategy is the key to the successful preoperative treatment of ToF with pulmonary atresia. Optimizing hemodynamics, ensuring adequate pulmonary blood flow and supporting nutritional needs are the main drivers for growth and may reduce the time from diagnosis to surgical correction. Full article

Objectives: Cervical degenerative disc disease (CDD) significantly compromises patients’ quality of life through the induction of radiculopathy and myelopathy. This study endeavored to compare the clinical and radiological outcomes of anterior cervical discectomy and fusion (ACDF) in patients presenting with single-, two-, and three-level CDD. Methods: A retrospective analysis was conducted on 94 patients who underwent ACDF between December 2018 and December 2023. Patients were categorized into single-level (n = 36), two-level (n = 40), and three-level (n = 18) CDD groups. Preoperative and postoperative radiological (X-ray, MRI) and clinical (Japanese Orthopedic Association [JOA], Visual Analog Scale [VAS]) data were rigorously analyzed. Results: Statistically significant improvements in postoperative JOA and VAS scores were observed across all cohorts. Notably, the three-level CDD group exhibited a significantly lower JOA improvement rate compared to the single-level group (p = 0.040). All groups demonstrated a marked increase in cervical lordosis and disc height postoperatively (p < 0.05). Patients undergoing three-level ACDF presented with lower JOA scores than those undergoing single- or two-level procedures. Logistic regression analysis identified that the preservation of the disc height significantly correlated with a higher likelihood of achieving a greater JOA improvement. Conclusions: ACDF is established as a safe and efficacious surgical intervention for patients with single-, two-, and three-level CDD. The implementation of hybrid prostheses appears to be instrumental in maintaining lordosis in multilevel ACDF. Three-level ACDF is associated with diminished JOA improvement rates compared to single-level ACDF. Further longitudinal, multicenter investigations are warranted to validate these findings. Full article

Background/Objectives: Elevated expression of human epididymis protein 4 (HE4) has been observed in breast cancer and is associated with cancer progression; however, its role in ductal carcinoma in situ (DCIS) remains unclear. This study aimed to evaluate HE4 levels in serum and tissue from patients with DCIS and their correlation with clinicopathological features. Methods: Preoperative serum HE4 levels were measured in 59 DCIS patients. HE4 mRNA and protein expression in DCIS and adjacent normal tissues were assessed using RNAscope in situ hybridization and immunohistochemistry, respectively. An additional independent tissue microarray of 41 DCIS cases was also analyzed for HE4 expression in tumor tissue only. Furthermore, the BreastMark database was applied to assess the prognostic significance of HE4 expression in a larger cohort of breast cancer. Results: Serum HE4 levels (mean ± SD: 39.4 ± 11.9 pmol/L) were within the normal range and showed no significant correlation with clinicopathological parameters except menopausal status. HE4 expression was significantly higher in DCIS tissues compared to adjacent normal tissues, with a positive correlation between mRNA and protein levels (r = 0.771, p < 0.001). High HE4 mRNA and protein expression was associated with ER positivity, HER2 negativity, low stromal tumor-infiltrating lymphocyte density, and HR+/HER2− subtypes, but was not predictive of DCIS recurrence. In breast cancer patients, high HE4 expression was significantly correlated with improved survival outcomes. Conclusions: Although serum HE4 is not elevated in DCIS, high HE4 expression in tissue is associated with favorable clinicopathological features. These findings highlight the need for further investigation into the potential prognostic role of HE4. Full article

Background: Tibiotalocalcaneal (TTC) arthrodesis using talar allografts has emerged as a viable surgical option for managing complex hindfoot pathologies, including post-traumatic avascular necrosis (AVN), infection-related complications, and failed total ankle replacement (TAR). These conditions present significant therapeutic challenges due to extensive bone loss and joint instability. Previous reports have focused on TTC arthrodesis using talar allografts, highlighting its potential to provide enhanced structural support. This study aims to further evaluate the efficacy and safety of this surgical approach by assessing union, clinical outcomes, and complications in a diverse patient population. Methods: This retrospective study reviewed 11 patients who underwent TTC arthrodesis with talar allograft between January 2020 and November 2022. The study cohort included patients with post-traumatic AVN, infection-related complications, and failed TAR. Preoperative and postoperative evaluations included X-rays, computed tomography scans, and functional outcome scores such as the Visual Analog Scale (VAS) and the Foot and Ankle Outcome Score (FAOS). Results: This study included 11 patients who underwent surgical treatment between January 2020 and November 2022, with a minimum follow-up of 24 months and a mean follow-up of 33.45 months (range, 24–50 months). Successful arthrodesis was observed in nine patients, yielding a success rate of 82%. Significant improvements in functional outcomes were noted, including marked reductions in pain and enhanced activity levels, as evaluated by VAS and FAOS scores. Two patients demonstrated radiographic nonunion (one tibiotalar, one subtalar), but both remained asymptomatic and did not require revision surgery. No other complications such as infection, wound issues, or thromboembolism were observed. Immediate postoperative radiographs confirmed appropriate allograft alignment and placement. Conclusions: TTC arthrodesis using structural talar allografts may be a viable and safe option for managing severe hindfoot pathology, potentially resulting in satisfactory fusion rates and clinical outcomes. Full article

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide, underscoring the urgent need for novel therapeutic targets and strategies. The kinase MARK4 (MAP (microtubule-associated proteins)/microtubule affinity-regulating kinase 4) regulates microtubule-associated proteins pivotal for cell polarity, protein stability, and intracellular signaling. Animal models of heart failure revealed elevated MARK4 levels, which correlated with impaired cardiac contractility. However, the involvement of MARK4 and its potential as a molecular drug target has not yet been explored in the myocardium of cardiovascular patients. We investigated the MARK4 mRNA expression in human myocardial biopsies of 152 high-risk cardiovascular patients undergoing cardiac surgery. Comprehensive echocardiography as well as testing for sleep-disordered breathing (SDB), a critical comorbidity in heart failure, were assessed preoperatively. We observed a substantial upregulation of myocardial MARK4 expression in patients with impaired cardiac contractility, resulting in an inverse correlation with the left ventricular ejection fraction. Myocardial MARK4 expression also correlated with echocardiographic E/e’, a central parameter of diastolic dysfunction. Mechanistically, our analyses revealed that MARK4 expression increases in SDB and under hypoxic conditions, as evidenced by significant correlations between myocardial MARK4 expression and factors like mean oxygen saturation, time with oxygen saturation below 90%, and the oxygen desaturation index. Multivariable regression analysis revealed that both left ventricular ejection fraction and mean oxygen saturation were independently associated with dysregulated MARK4 levels, even when controlling for important clinical covariables as potential confounders. Taken together, our findings demonstrate that MARK4 expression is highly increased in the myocardium of cardiovascular high-risk patients, suggesting it is a potential molecular target against cardiovascular diseases. Full article

Background/Objectives: Reported patient results after total hip arthroplasty (THA) have been described as a function of surgical approach. Such results have commonly been subjective. Though self-reported outcomes are of value and often utilized, inclusion of functional performance measures represents an objective measure to compare THA techniques. Methods: Patients that underwent primary THA surgery at our institution were grouped by surgical approach (Direct Anterior vs Posterior). Patient data were collected pre-operatively, as well as post-operatively at three and twelve months. Hip Dysfunction and Osteoarthritis Outcome Score (HOOS JR) was utilized, and function was assessed with the timed up and go test (TUGT), 4-m walk test (4MWT), and 30 s sit-to-stand (30STS) test. Unpaired T tests were used to compare mean results and differences between the groups. Results: Functional outcome scores were improved to a similar degree for both surgical approach groups at all the time points post-operatively. At 3 months, the TUGT was improved by 2.33 s for the posterior group, the 30STS was increased by 2.71 repetitions, and the 4MWT was increased by 1.23 s; the anterior group had 2.66 s, 2.49 repetition, and 1.18 s improvements in the three functional tests, respectively. At 12 months, the posterior group had improvements of 2.86 s, 3.99 repetition, and 1.19 s, while the anterior group had improvements of 3.15 s, 3.83 repetition, and 1.23 s, respectively. No clinical and statistical significant differences in surgical approach were noted in these measures. In contrast, the anterior group showed a statistically significant but not clinically significant improvement in self-reported HOOS JR scores compared to the posterior group at the 3-month post-operative mark (p = 0.045). Conclusions: This study suggests both anterior and posterior surgical approaches to total hip arthroplasty yield equivalent functional results at 3 months and one year post-operatively, while the anterior approach demonstrates more improved patient satisfaction than the posterior approach at the 3-month post-operative assessment. Full article

Background: The direct superior approach (DSA), a muscle-sparing technique derived from the posterior approach (PA), has received little attention despite its potential advantages. This study compared the impact of the DSA and PA on patient-reported pain and postoperative opioid consumption with medical and surgical complications. Methods: We reviewed 451 primary total hip arthroplasties for osteonecrosis of the femoral head and osteoarthritis between January 2016 and December 2022, which were categorized as DSA or PA. Demographic data, including age, sex, preoperative opioid usage, smoking status, chronic alcoholism, and underlying diseases, were collected. Propensity score matching balanced the DSA and PA groups. The maximum and minimum pain score on the postoperative day (POD) and total opioid consumption were compared between the two groups. Inflammation-related serum markers, medical and surgical complications, and the length of hospital stay were also analyzed. Results: After matching, 139 patients were included in each group. Patients with the DSA reported a lower average maximum pain on POD #1 and #4 and a lower average minimum pain on POD #1, #2, and #4. The DSA group showed a significant reduction in opioid consumption. In addition, the DSA led to a significant reduction in C-reactive protein (CRP) on POD #5, 14, and 28 after the index surgery compared to the PA. Postoperative delirium (3.6 vs. 9.4%, p = 0.05) and length of stay (5.4 vs. 8.4 days, p < 0.001) were significantly different between the two groups. No significant differences were observed in chronic opioid use, medical complications, or other surgical complications. Conclusions: The DSA was associated with lower patient-reported pain and a marked reduction in opioid consumption, delirium, and length of hospital stay. Full article

The operative field and exposure in minimally invasive cardiac surgery (MICS) are limited. Meticulous preoperative planning and intraoperative visualization are crucial. We present our initial experience with HoloLens^® 2 as an intraoperative guide during MICS procedures: aortic valve replacement (AVR) via right anterior small thoracotomy, coronary artery bypass graft surgery (CABG) via left anterior small thoracotomy (LAST), and pulmonary valve replacement (PVR) via LAST. Three-dimensional (3D) segmentations were performed using the patient’s computer tomography (CT) data subsequently rendered into a 3D hologram on the HoloLens^® 2. The holographic image was then superimposed on the patient lying on the operating table, using the xiphoid and the clavicle as landmarks, and was used as a real-time anatomical image guide for the surgery. The incision site marking made using HoloLens^® 2 differed by one intercostal space from the marking made using a conventional surgeon’s mental reconstructed image from the patient’s preoperative imaging and was found to be a more appropriate site of entry into the chest for the structure of interest. The transparent visor of the HoloLens^® 2 provided unobstructed views of the operating field. A mixed reality (MR) device could contribute to preoperative surgical planning and intraoperative real-time image guidance, which facilitates the understanding of anatomical relationships. MR has the potential to improve surgical precision, decrease risk, and enhance patient safety. Full article

Background: Determining the optimal resection line for an organ that cannot be palpated is crucial, but challenging, in minimally invasive gastrointestinal (GI) surgery. Therefore, there is an urgent need to establish the most effective method for tumor localization. We hypothesize that our novel near-infrared (NIR) fluorescence detection system will enable the highly accurate detection of fluorescent clips marking GI cancer. Methods: Twenty-five patients with gastric cancer, esophagogastric junctional cancer, or esophageal cancer will be enrolled. NIR fluorescent clips will be placed endoscopically around the tumor on the day before surgery. Patients in whom clip dislodgement is confirmed by preoperative abdominal radiography will be excluded. The clips will be placed before the transection of the organ, and those on the surgical specimen will be observed after transection using both the novel NIR fluorescence detection system and an existing NIR fluorescence imaging system. The detection rate and time, the fluorescence intensity, surgical margins, and adverse events will be evaluated. This study has been registered in the Japan Registry of Clinical Trials, with the code jRCTs012240043. (Expected) Results: As the novel fluorescence detection system allows for higher-sensitivity detection by analyzing the spectral characteristics of fluorescence and measuring the peak values, we anticipate that this new system will detect the fluorescent clips with high accuracy. Conclusions: This study aims to establish a novel tumor-marking method using fluorescent clips and a new detection system that can be easily applied in various medical facilities. Full article