Search Results (4,402)

Background: The T-hook is a recently introduced device for ab interno trabeculotomy, first reported in 2022. This study compared the one-year surgical outcomes of Kahook Dual Blade (K group)- and T-hook (T group)-assisted trabeculotomy combined with phacoemulsification in patients with primary open-angle glaucoma (POAG). Methods: This retrospective study included patients with POAG who underwent 180° ab interno trabeculotomy combined with phacoemulsification at our institution between June 2018 and September 2024 and were followed for at least 12 months. Changes in intraocular pressure (IOP), mean IOP reduction rate, number of antiglaucoma medications, postoperative complications (hyphema and transient IOP spikes), and cumulative surgical success rates were evaluated. Results: A total of 45 patients (61 eyes) were included, comprising 29 patients (42 eyes) in the K group and 16 patients (19 eyes) in the T group. A transient increase in IOP at one week postoperatively observed in the K group (p < 0.0001); however, both groups demonstrated significant IOP reduction from baseline after 1 month (p < 0.05). The mean IOP reduction rate at 12 months did not differ significantly between groups (p = 0.0720, ANCOVA). The number of antiglaucoma medications significantly decreased at all postoperative time points in both groups compared with baseline (p < 0.05). Kaplan–Meier survival analysis revealed no significant difference in cumulative surgical success rates between groups (p = 0.6217). The incidence of hyphema was comparable between groups (p = 1.00), whereas transient IOP spikes occurred significantly more frequently in the K group (p = 0.0057). Conclusions: While both procedures demonstrated comparable intraocular pressure-lowering efficacy, T-hook-assisted trabeculotomy was associated with fewer transient postoperative IOP spikes during the early postoperative period in this cohort. Full article

For more than seventy years, mathematics—particularly the calculus sequence—has defined both the rigor and the exclusivity of engineering education in the United States. While this structure was historically instrumental in professionalizing engineering, it has also produced unintended consequences: restricted access, misalignment with contemporary engineering practice, and persistent inequities in participation and degree attainment. This commentary argues that mathematics must be reimagined not as a barrier or filter, but as a gateway that enables engineering learning, persistence, and innovation. Building on The Engineering Mindset Report and decades of research in engineering education, learning sciences, and curricular reform, we examine how mathematics became a gatekeeping mechanism, assess its current impacts, and propose a framework for redesigning engineering mathematics around context, modularity, technology, and equity. We advocate for accessible, flexible, and technology-enabled pathways that emphasize modeling, data analysis, and conceptual understanding over procedural endurance. Such an approach has the potential to broaden participation, improve student success, and better align engineering education with the realities of 21st-century professional practice. Full article

Learning management systems (LMS) are essential for sustainable teaching and learning procedures due to the growing integration of digital technologies in higher education. Despite the widespread adoption of platforms such as Moodle, limited research has examined the students’ behavioral engagement and their subjective learning experiences. Addressing this gap, this study investigates the relationship between learning analytics indicators and academic performance, and how students’ experiences influence their participation in online learning environments. It adopted a convergent parallel design. Quantitative data were collected from the Moodle-based BirDeHa platform, drawing on learning analytics logs of 137 pre-service teachers enrolled in various programs within a faculty of education. Key indicators included frequency of material downloads, system usage, video engagement, and quiz performance. Qualitative data were collected via focus group interviews with nine participants. The results revealed a clear relationship between students’ interaction patterns within the LMS and their academic performance. Indicators of active engagement, particularly time spent on the platform and frequency of interaction with course materials, emerged as strong predictors of academic success. Qualitative findings further indicate that students perceive the LMS as flexible, inclusive, and supportive of their learning needs. Overall, this study underlines the importance of integrating data-driven insights with student-centered perspectives to achieve a comprehensive understanding of online learning environments and to inform effective design. The findings contribute to the sustainability of digital learning environments by providing behavioral indicators that can inform data-driven instructional design. Full article

Background: Anesthetizing frail patients for hip surgery is challenging; spinal (SA) and general anesthesia (GA) often cause hemodynamic instability. Traditional nerve blocks provide analgesia but rarely complete surgical anesthesia without motor block. We evaluate the clinical feasibility of the SAFE (Subarachnoid-alternative Anaesthesia For Endoprosthesis) protocol—combining Anterior Pericapsular Nerve Group (A-PENG), POsterior pericapsular Nerve Group (PONG), and Local Infiltration Analgesia (LIA) under intravenous sedation—as a primary anesthetic preserving motor function and avoiding SA/GA. Methods: This single-center retrospective series analyzed patients undergoing elective or trauma-related hip surgery using the SAFE protocol between September 2022 and April 2026. The primary outcome was success rate (completion without SA/GA conversion). Secondary outcomes included procedural timings, recovery room (RR) transit, and motor preservation. Variables are reported as medians [IQR]. Results: We included 48 patients (median age 83.5 years [IQR: 68.7–87.2]; 66.7% female) undergoing hip hemiarthroplasty (n = 28) or total hip arthroplasty (n = 20). The success rate was 100%, without SA/GA conversion or advanced airway management. Median anesthetic preparation and surgical durations were 55 [IQR: 50–76.2] and 85 min [IQR: 74–110], respectively. RR transit times (recorded for 35 patients) were brief (40 min [IQR: 34.0–67.5]). Crucially, lower-limb motor capacity was preserved in 100% of cases. The technique also proved opioid-sparing, substantially reducing postoperative opioid consumption. Conclusions: The SAFE protocol is a clinically feasible primary anesthetic strategy for hip surgery. By preserving motor function and enabling rapid fast-tracking, it aligns with ERAS pathways, offering a promising alternative to conventional anesthesia for elective and frail trauma patients. Randomized controlled trials are warranted to validate these outcomes. Full article

Objective: To evaluate the impact of a systematic, multi-component ultra-low-dose imaging protocol on radiation and contrast exposure during endovascular aortic repair (EVAR) across diverse anatomical complexities. Methods: In this retrospective cohort study, 331 consecutive EVAR procedures at a tertiary vascular center were analyzed. Patients treated with an integrated ultra-low-dose protocol (Group A, n = 228) incorporating 2D/3D fusion navigation, low-frame-rate fluoroscopy (3.75 frames/s), restricted digital subtraction angiography (DSA), structured collimation, and routine CO₂ angiography were compared with historical controls treated with a standard low-dose protocol (Group B, n = 103) where the frame rate was the same and CO₂ was only used for fusion registration. Primary endpoint was total dose-area product (DAP). Secondary endpoints included component DAP values, fluoroscopy time, contrast volume, and technical success. Results: Group A demonstrated a 71% reduction in median total DAP (57.9 vs. 199.3 Gy·cm², p < 0.001), driven primarily by an 79% reduction in DSA-associated and 45% fluoroscopy-associated radiation. Contrast volume decreased by 20% (101 vs. 126 mL, p < 0.001) without increased fluoroscopy time (57 vs. 64 s, p = 0.278). Technical success remained comparable (86% vs. 87%, p = 0.809). Reductions were consistent across all repair types, most pronounced in infrarenal repairs with iliac-branch-devices (70% DAP reduction). Within Group A, a dose–response relationship was evident: procedures with ≥70% ultra-low-dose DSA utilization achieved 61% lower radiation than those with <70% adherence. Conclusions: A protocolized, system-level ultra-low-dose imaging workflow achieves substantial, durable reductions in radiation and contrast exposure during EVAR of varying complexity without compromising technical success. This integrated approach represents a scalable strategy for enhancing safety for patients and procedural staff alike. Full article

Background and Aims: Patients with malignancy are frequently excluded from randomized thrombectomy trials, and evidence regarding the safety and efficacy of mechanical thrombectomy (MT) in this population remains incompletely defined. We aimed to compare procedural success, functional outcomes, and mortality between acute ischemic stroke (AIS) patients with and without malignancy undergoing MT. Methods: We retrospectively analyzed 110 patients treated with MT. Patients were stratified into two groups: those with malignancy (n = 48) and those without malignancy (n = 62). Baseline demographics, vascular risk factors, procedural metrics, angiographic outcomes, and clinical outcomes including functional independence (modified Rankin Scale [mRS] 0–2), 90-day mortality and intracranial hemorrhage were compared. Results: Baseline demographics and admission stroke severity were similar between groups. Smoking was significantly more frequent in the malignancy group (25% vs. 11.3%, p < 0.001). Successful reperfusion (TICI 2b-3) was achieved in 95.8% of malignancy patients and 98.4% of controls (p = 0.51). Functional independence at 90 days was lower in the malignancy group (42.6% vs. 61.3%, p = 0.04), whereas 90-day mortality was significantly higher (44.7% vs. 19.4%, p = 0.004); this increase in mortality remained significant after multivariate analysis. There were no significant differences in rates of intracranial hemorrhage between groups (p = 0.53). Conclusions: Mechanical thrombectomy is technically effective and safe in patients with malignancy; however, long-term functional recovery and survival are significantly worse, likely reflecting the effect of cancer itself rather than procedural factors. Careful patient selection and multidisciplinary decision-making are essential in this population. Full article

Despite legislative advancements, social and reputational norms continue to govern domestic conflict’s institutional visibility. Using an explanatory sequential mixed-methods design in the United Arab Emirates, covering the period 2019–2025, this study analyzes how the transition across two successive domestic violence statutes is associated with women’s institutional trajectories. Quantitatively, 412 first-instance case files were analyzed using non-parametric tests and a CHAID decision tree. Qualitatively, interviews with women (n = 28) and institutional actors (n = 23) explain how “status flipping” occurs through counter-complaints and moral character narratives. Findings indicate that norms-based moral regulation and structural constraints (e.g., financial dependency and custody leverage) are strong correlates of escalation from case closure to formal prosecution. The CHAID model identifies structural constraints as the principal splitter in trajectory separation. Post-2024 patterns suggest an institutional lag, where implementation routines evolve more slowly than formal law. The paper contributes a model of reputation-mediated escalation and proposes procedural safeguarding to curb retaliatory cross-filing and make patterned coercive control legally legible. By situating women’s legal interactions within an interactional pathway of norms, constraints, and institutional translation, the study clarifies why “protection” can paradoxically morph into complex procedural outcomes in legally transitioning contexts. Full article

Background: In this study, we radiologically assessed potential increases in microvascularity, extracellular matrix-related changes, and tissue viscoelasticity following carboxytherapy for periorbital hyperpigmentation (POH). We also analyzed the correlation between radiological changes and clinical outcomes and explored implications for future outpatient selection, as well as the potential to predict treatment success based on radiological–clinical correlations. Materials and Methods: The present study included 78 patients (76 women and 2 men) aged over 18 years with Fitzpatrick skin types I–V and moderate-to-severe infraorbital dark circles who applied for treatment at the Dermatology Department in the Cosmetology Unit of Cerrahpaşa Medical Faculty Hospital. Each patient was given manual, pressure-controlled injections of sterile CO₂ into the upper and lower eyelids for 7 weeks, with one round of treatment per week. We conducted dermatoclinical and radiological evaluations, including measurements of epidermis–dermis thickness and SWE, musculus orbicularis oculi pars pretarsalis thickness, and cSMI vascular index percentage, as well as SOOF tissue SWE (measured in kPa). These analyses were performed on both lower eyelids before treatment and at 1 month and 6 months after treatment. Results: After treatment, VAS scores improved significantly. Grayscale ultrasonography showed significant increases in epidermis–dermis and orbicularis oculi thickness at 1 and 6 months (p < 0.05). SMI presented a significant increase in vascular index at both follow-ups (p < 0.05). SOOF SWE values increased significantly at 1 and 6 months, whereas epidermis–dermis SWE did not. Procedural pain was common, and 25 participants withdrew during the 7-week period due to discomfort. Injection depth was not confirmed by real-time imaging, and adverse events were not graded using a standardized classification system. Therefore, tolerability and procedural safety should be interpreted with caution. Conclusions: Carboxytherapy was associated with improvements in clinical outcomes and radiological parameters among patients who were able to tolerate the procedure, including increased microvascularity on SMI and changes suggestive of extracellular matrix-related alterations. These improvements were maintained at the 6-month follow-up, indicating temporal persistence of the observed findings. However, due to the absence of a control group, the results should be interpreted with caution, and further randomized controlled studies are required to confirm these findings and establish causality. Full article

Background and Objectives: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are widely performed procedures with high success rates but relevant postoperative complications. Preoperative nutritional status is a key modifiable risk factor influencing surgical outcomes. This study aimed to map and synthesize the available evidence on the association between preoperative nutritional status and postoperative complications in patients undergoing primary THA or TKA. Materials and Methods: A scoping review was conducted following PRISMA-ScR guidelines. A comprehensive search was performed in PubMed, ScienceDirect, and Scopus, with the last update conducted in April 2026. Studies published between 2015 and 2026 in English and Spanish were included. Eligibility criteria followed the PCC framework. Randomized controlled trials and observational studies were included. Risk of bias was assessed using the Newcastle–Ottawa Scale for observational studies and the Cochrane Risk of Bias tool for randomized trials. Results: A total of 1126 records were identified, and 23 studies were included, comprising 447,852 patients. Nutritional status was mainly assessed using serum biomarkers, particularly albumin, followed by anthropometric measures, combined indices, and micronutrients. Poor nutritional status, especially hypoalbuminemia, vitamin D deficiency, and low BMI, was associated with higher rates of infectious complications, prolonged hospital stay, increased readmissions and mortality, and worse functional recovery. Conclusions: Preoperative nutritional assessment is essential for perioperative risk stratification in THA and TKA. Integrating biomarkers, indices, and targeted interventions may improve outcomes and reduce postoperative complications. Full article

Background/Objectives: Military and Veteran families face unique challenges, including deployment-related difficulties and transitions, mental health issues, educational setbacks, and more. The needs of Veteran families, specifically, are often overlooked and research among this population is insufficient. In an effort to promote the well-being of children of Veterans and their families, we developed a screening tool for identifying family needs and a workflow to implement the screening tool within the Veterans Health Administration. The objective of this quality improvement initiative was to then provide those in need with appropriate referrals and connect them to timely care. Methods: The screening tool was developed with input from key stakeholders and adjusted after an initial pilot. Screens were offered to all Veterans seen at the participating sites. Veterans completed the self-report screen consisting of demographic information and items regarding household composition, the quality of relationships with family members, and the Veteran’s perceptions of difficulties experienced by family members. Descriptive statistics were conducted to summarize the data with regard to demographics, relationship difficulties, and related needs of Veteran family members. Results: Among familial relationships, Veterans reported experiencing the most difficulties with their partner/spouse as compared to other family members. Veterans self-reported that many of their children 18 years old and younger demonstrated difficulties related to learning, development, and behavioral and emotional concerns. Conclusions: More than a third of Veterans screened in this process requested further contact for consultation and referrals, and half of those were provided referrals. The development and implementation of this screening tool and referral procedure was successful in identifying needs and facilitating a connection to care that might otherwise have not occurred, bridging the gap between research and practice as it relates to Veteran family needs. Full article

Background: The primary goal of root canal treatment is the prevention and healing of apical periodontitis through the meticulous elimination of pathogenic bacteria and infected tissues. Within this framework, apical patency remains a fundamental yet debated clinical concept. Objectives: This review aims to evaluate the clinical significance of maintaining apical patency, its influence on postoperative discomfort, and the technical strategies required for predictable negotiation. Methods: We performed a comprehensive review of existing literature, including clinical studies and recent meta-analyses, focusing on the correlation between patency maneuvers and postoperative pain, the role of preoperative CBCT imaging, and the efficacy of specialized negotiation instruments and motor kinematics. While patency facilitates thorough debridement, evidence regarding its impact on postoperative pain is conflicting, with recent meta-analyses suggesting it may actually alleviate discomfort intensity. Preoperative CBCT was identified as essential for identifying complex anatomy, such as the MB2 canal. Furthermore, the use of specialized files and reciprocating motor modes enhances the predictability of glide path establishment. Conclusions: Although failure to achieve patency does not always dictate a negative outcome, it is associated with improved long-term healing. Clinicians should prioritize “Anatomical Patency”—respecting original morphology—over forceful “Operative Patency” to ensure procedural integrity and clinical success. Full article

Background: Debridement, antibiotics, and implant retention (DAIR) is the treatment of choice for early and acute hematogenous periprosthetic joint infections (PJIs), but its success rates vary widely. The primary outcome of this study was to assess 1-year implant survival and treatment failure among DAIR patients. The secondary aims were to identify the causative pathogens and potential predictors of failure. Methods: Patients treated with DAIR for PJI in a single center between 2017 and 2025 were included. Implant survival was evaluated using Kaplan–Meier analysis, and univariate analysis was performed to explore potential associations between baseline variables and treatment failure. Results: 57 patients (58 hips/knees) were included. The mean age at surgery was 67.5 ± 11.5 years, and most procedures involved the hip (93.1%, n = 54). During follow-up, 7 patients (12.06%) experienced treatment failure. Kaplan–Meier analysis demonstrated a 1-year implant survival of 87.9%, with most failures occurring in the early postoperative months. The microbiological profile was dominated by Staphylococci (51.7%, n = 14) and polymicrobial (24.1%, n = 14) species, while Gram-negative bacteria and Enterococci were less frequently identified. Culture-negative infections were observed in 17.2% of cases (n = 10). Univariate analysis identified preoperative glucose levels and BMI as significantly different between groups, although these findings should be interpreted with caution. Conclusions: DAIR achieved favorable short-term outcomes in this cohort. Failures occurred mainly early after treatment, and the microbiological spectrum was consistent with the typical epidemiology of PJI. BMI and perioperative glucose levels may represent potentially modifiable factors associated with treatment failure. Full article

Coronary artery calcification, present in 20–30% of percutaneous coronary interventions (PCI), significantly impairs procedural success. Conventional angiography detects calcification in fewer than half of affected cases, while intravascular imaging—though precise—requires lesion crossability that cannot be guaranteed in up to 20% of severely calcified lesions. Cardiac CT (CCT) addresses both constraints by providing comprehensive, three-dimensional calcium characterization before the procedure begins, independent of wire crossability. This review details how specific CCT-derived parameters translate into procedural decisions. Calcium arc, depth, density, and longitudinal distribution each carry distinct implications for device selection: superficial high-density calcium favors atherectomy, while deep concentric patterns are better addressed by intravascular lithotripsy. Validated scoring systems—including the ABCD score—enable objective pre-procedural risk stratification. For chronic total occlusions, bifurcation lesions, ostial stenoses, and very long calcified segments, CCT provides lesion-specific information that supports stepwise strategy selection, equipment preparation, and anticipation of combined modification approaches. Importantly, CCT also identifies anatomical configurations—such as left main bifurcations or tortuous calcified segments—where specific device-related risks warrant particular caution. CCT and intravascular imaging serve complementary roles: CCT defines the strategic framework before the procedure, while intravascular imaging guides real-time execution and optimization. Limitations include operator-dependent interpretation, the absence of standardized protocols for translating calcium morphology into device selection, and the need to validate established Hounsfield unit thresholds in emerging photon-counting CT systems. Prospective randomized evidence comparing CCT-guided and intravascular imaging-guided strategies remains limited but is anticipated from ongoing trials. Full article

Background: Perioperative antibiotic prophylaxis (PAP) is effective for infection prevention in implant-related surgery, with infections being the most feared complications. A total of 15% of all antibiotics in hospitals are used for surgical prophylaxis but less than 50% of them are used according to the guidelines. International guidelines recommend only a single preoperative dose for all surgical procedures. We have developed and implemented new recommendations for PAP duration in primary hip and knee arthroplasty at the University Department for Orthopaedic Surgery. Methods: The development and implementation of new recommendations regarding PAP duration were performed via the following steps: pre-interventional analysis; identification of barriers and facilitators using the Flottorp framework; analyzing the data and preparation of a tailored implementation strategy based on an educational group meeting with the development of new consented to recommendations; and dissemination; followed by postinterventional analysis of PAP duration compliance 6 months later. Results: Before the intervention, 70% of PAP was used inappropriately (longer than 24 h). The major recognized barriers were fear of prosthetic joint infection (PJI) and a lack of concern regarding global antimicrobial resistance problems. Major facilitators were a low local PJI incidence rate (0.28%), etiology of PJI and existing local experience with a single-dose regime. After implementation of new recommendations regarding the duration of PAP, the postinterventional analysis showed that 80% of PAP was used according to the new recommendations, with a significant reduction in prolonged PAP use (from 70% to 12%), leading to an important decline in antimicrobial consumption. Conclusions: Our study showed that a tailored strategy in the development and implementation of new recommendations is complex and time consuming, although necessary for successful clinical practice change. Full article

Background/Objectives: Chronic subdural hematoma (cSDH) is an increasingly prevalent neurosurgical condition in the aging population. Burr hole craniotomy (BHC) with irrigation and postoperative drainage represents the evidence-based standard of care, yet recurrence rates remain substantial. Twist drill craniostomy (TDC), a minimally invasive bedside procedure performed under local anesthesia, offers theoretical advantages for frail patients but has been largely abandoned due to concerns regarding incomplete evacuation and recurrence. This study aimed to identify the predictors of a successful TDC outcome and to compare the recurrence rates between TDC and BHC. Methods: We performed a retrospective cohort study of consecutive patients undergoing surgical treatment for radiologically confirmed cSDH at RWTH Aachen University Hospital between 2015 and 2023. Hematoma morphology was classified using an extended CT-based architecture system and grouped into homogeneous, organized, sedimented, or subacute categories. The primary endpoint was recurrence requiring surgical reintervention. Multivariable logistic regression was used to identify independent predictors of recurrence among patients discharged after definitive TDC. Propensity score matching was performed to compare recurrence rates between TDC and BHC while adjusting for baseline demographic, clinical, and radiographic differences. Results: Among 178 patients initially treated with TDC, 56 (31.5%) were discharged without conversion to BHC. Late recurrence occurred in 26 of 56 patients (46.4%) treated definitively with TDC. In multivariable analysis, homogeneous hematoma architecture was the only independent predictor of recurrence (adjusted OR 4.48, 95% CI 1.10–22.07, p = 0.037). Propensity score matching yielded 48 well-balanced pairs of TDC and BHC patients. Recurrence rates remained significantly higher after TDC compared with BHC (42.6% vs. 17.0%, p = 0.012), as confirmed by conditional logistic regression (adjusted OR 3.20, 95% CI 1.17–8.73). Conclusions: Twist drill craniostomy may provide definitive treatment in carefully selected patients but is associated with substantially higher recurrence rates than burr hole craniotomy, particularly in homogeneous hematomas. Burr hole evacuation remains the preferred standard approach, while optimized drainage protocols and architecture-guided selection may define a limited role for TDC in high-risk patients. Full article