Search Results (284)

Recurrent intrauterine adhesions (IUA) and refractory thin endometrium are associated with impaired endometrial regeneration, reduced implantation, and poor live birth outcomes. Regenerative therapy using mesenchymal stromal cells (MSCs) has shown promising results; however, factors associated with reproductive success remain unclear. In this prospective, single-centre, single-arm uncontrolled observational study, 35 women with recurrent IUA and thin endometrium (<7 mm) unresponsive to standard surgical and hormonal therapy received combined subendometrial and systemic administration of placenta-derived MSCs. The primary endpoint was live birth. Secondary endpoints included clinical pregnancy rate, time to pregnancy, endometrial thickness changes, uterine blood flow (resistance index, RI), and anti-Müllerian hormone (AMH) levels. Univariable logistic regression was performed to identify factors associated with live birth. Clinical pregnancy occurred in 13/35 patients (37.1%), and live birth was achieved in 11/35 (31.4%). Median time to pregnancy was 7 (5–8) months. Shorter duration of infertility or prior pregnancy loss (OR 1.55 per year; 95% CI 1.10–2.57), AFS stage I adhesions (OR 6.8; 95% CI 1.1–42; p = 0.04), lower baseline RI in uterine, arcuate and radial arteries, and higher baseline AMH (OR 2.59 per doubling; 95% CI 1.15–6.89) were significantly associated with live birth. Endometrial thickness increased after therapy but was not significantly associated with live birth. No severe adverse events were observed. Placenta-derived MSC therapy was followed by live birth in 31.4% of women with recurrent IUA and refractory thin endometrium. A shorter duration of reproductive disorders, less severe adhesions, lower baseline RI in uterine, arcuate and radial arteries, and higher AMH levels were associated with live birth after treatment and may help identify patients with a more favourable reproductive prognosis in future controlled studies. Full article

Background/Objectives: Magnetic resonance imaging (MRI) provides a non-invasive means for a comprehensive assessment of the effect of radiation therapy (RT) on heart function. This study aims to determine RT induced cardiotoxicity in thoracic cancer patients using cardiac MRI. Methods: Cardiac MRI was performed at baseline and at six months post-treatment in patients undergoing standard-of-care RT for lung or esophageal cancers at a single institution. Parameters included regional myocardial strain in the longitudinal, circumferential, and radial directions as well as myocardium T1, T2, and extracellular-volume (ECV) maps. Cardiac segmental doses were extracted from the RT planning scans. The relationship between changes in segmental MRI parameters at six months and segmental heart RT dose were investigated. Results: Twelve patients underwent baseline MRI and four completed the follow-up MRI. Five of the segmental strain parameters showed notable changes between baseline and six-month follow-up. Increased doses in the heart base and apex were associated with moderate-to-large and mild deteriorations, respectively, in strain for all regions. Increased doses in the mid-ventricular regions were associated with improved strain in all regions. The segmental analysis revealed that myocardial regions nurtured by the left coronary artery are more negatively affected by radiation compared to those nurtured by the right coronary artery. Conclusions: Alterations in regional tissue and strain parameters on MRI vary according to local myocardial RT dose, suggesting there may be heterogeneity of radiation sensitivity for the heart substructures and regions. Changes in segmental strain parameters may reflect post-RT cardiac remodeling, but larger confirmatory studies are required. Full article

The pulsatile modulation of arterial blood carries essential information about the cardiovascular system and cardiac function—information that can be extracted through appropriate signal-processing algorithms. As wearable technologies are increasingly integrated into everyday life, measurement methods are required to be non-invasive and compact in scale. Electrical bioimpedance (EBI) methods meet these wearability criteria well; however, they introduce uncertainties associated with the electrode–skin interface. This paper presents a targeted overview of electrode configurations for EBI-based pulse wave signal acquisition, focusing on non-invasive solutions suitable for wearable devices. Electrode configurations are examined with respect to major peripheral arteries in the human body that are accessible at the skin surface and suitable for regional impedance cardiography. The review includes a carefully selected set of references, drawing on both research literature and patent descriptions, and discusses the primary differences in how electrode configurations are presented across these sources. Full article

Background/Objectives: This study aimed to assess complications after endoscopic radial artery harvest, evaluate patient satisfaction, and assess the feasibility of a questionnaire interview. The primary aim was to assess neurological damage after endoscopic radial artery harvest (ERAH), and the secondary aim was to assess the feasibility of a newly constructed questionnaire in Danish. Methods: From June 2010 through October 2012, 108 patients underwent endoscopic radial artery harvest for coronary artery bypass grafting (CABG) at our institution. A total of 100 patients were interviewed by phone between one and two years after the operation. The interviews included questions about infection, bleeding, neurological damage, vascular perfusion of the hand, re-intervention, and general satisfaction with the procedure. Results: The described cohort was mainly male (88.9% 95% confidence interval (CI) 90.5–98.4%) with a mean age of 60.8 years (standard deviation (SD) 9.0). The self-reported incidence of postoperative antibiotic treatment was 7.0% (95% CI 3.1–14.4%), sensory deficit 18.0% (95% CI 11.3–27.2%), pain 8.0% (95% CI 3.8–15.6%), motoric deficit 4.0% (95% CI 1.3–10.5%) and cold or pale fingers 9.0% (95% CI 4.5–16.8%). At a follow-up time with a mean of 1.40 years (range 0.97–2.37 years, SD 0.36), all incisions were healed satisfactorily, 12.0% (95% CI 6.6–20.4%) reported sensory deficit, 7.0% (95% CI 3.1–14.4%) reported pain, 2.0% (95% CI 0.3–7.7%) reported motoric deficit, and none had a tendency towards cold fingers. The mean duration of antibiotic treatment was 8.7 days ± 2.3. When asked to rate the endoscopic procedure points of satisfaction from 0 (worst) to 10 (best), the mean was 9.7 ± 0.7. Conclusions: This study reports the occurrence of surgical complications immediately after ERAH, with an occurrence of self-reported neurological deficits of 18%. A questionnaire was feasible in a cohort of postoperative patients receiving radial artery harvest. Full article

Background/Objective: Continuous blood pressure (BP) monitoring is essential in clinical settings, where rapid hemodynamic changes influence patient management. While intra-arterial measurement remains the reference standard, non-invasive volume-clamp systems offer a potential alternative. We assessed the accuracy of finger-cuff-based continuous BP monitoring compared to invasive measurement in patients with pulmonary hypertension (PH). Methods: This post hoc analysis from a crossover RCT included PH patients who underwent repetitive hemodynamic assessments at rest and during exercise. The participants had simultaneous invasive BP monitoring via the radial artery and a non-invasive finger-cuff device (Finapres^® NOVA Basic). The mean blood pressure (mBP) was compared at rest, 50% of the maximal workload, and at the end of exercise using Bland–Altman and Taffé analysis. Results: In the study, 24 patients (seven female; 59 ± 14 years) contributed 385 paired mBP measurements. The invasive and non-invasive methods showed similar values at rest (96.1 ± 16.7 vs. 96.4 ± 17.2 mmHg) and during maximal exercise (106.8 ± 18.6 vs. 111.8 ± 21.6 mmHg). The overall Bland–Altman bias was 2.8 mmHg with wide limits of agreement (−39.6 to 45.3 mmHg), which remained broad across all exercise intensities. The Taffé analysis revealed a non-uniform, directionally dependent bias: the non-invasive system overestimated the mBP at low pressures and underestimated it at higher pressures. The measurement variability was substantially greater for the non-invasive method than for the invasive reference. Conclusions: In PH patients, finger-cuff-based continuous BP monitoring demonstrated acceptable group-level agreement but insufficient individual-level accuracy for clinical decision-making. Full article

Background: Chronic kidney disease (CKD) associated vascular calcification (VC) is a leading cause of cardiovascular mortality, partially driven by osteogenic transdifferentiation of vascular smooth muscle cells (VSMCs). Chaperone-mediated autophagy (CMA) is a selective lysosomal degradation cellular process. However, the precise role and mechanism of CMA in CKD-associated vascular calcification remain unknown. Methods: We studied calcified arteries from CKD patients and rats fed on a high-phosphate diet using histological and ultrastructural methods. VSMCs’ calcification was induced by a calcification medium containing high phosphate and calcium. CMA activity was measured by a KFERQ reporter and lysosomal staining. The expression of LAMP2a and HSP90AA1 was knocked down by siRNA, overexpressed by plasmid, and activated by QX77.1. Bioinformatic analysis, protein interaction studies, immunofluorescence and co-immunoprecipitation were performed to investigate the potential mechanism of CMA in VC. Results: The expression of LAMP2a was increased in human calcified radial artery tissues (n = 3, p < 0.05) and rats’ calcified aortic tissues (n = 3, p < 0.01), accompanied by lysosomal abnormalities. The activity of CMA was increased during the osteogenic transdifferentiation of VSMCs, as indicated by increased expression of RUNX2 and reduced expression of SM22α (p < 0.05). LAMP2a knockdown attenuated VSMCs’ calcification (p < 0.05), whereas pharmacological activation of CMA aggravated calcification in VSMCs (p < 0.01). Bioinformatic screening identified HSP90AA1 as a candidate involved in CMA in vascular calcification. Elevated HSP90AA1 expression was observed in human calcified radial artery tissues (n = 3, p < 0.01) and rat calcified aortic tissues (n = 3, p < 0.01), which promoted osteogenic transdifferentiation of VSMCs (p < 0.05). HSP90AA1 interacted with LAMP2a and positively regulated its expression (p < 0.01). Conclusions: These findings support an association between CMA activation and CKD vascular calcification. It suggests that HSP90AA1 facilitates vascular calcification in chronic kidney disease involving chaperone-mediated autophagy. Full article

Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are the two dominant revascularisation strategies for obstructive coronary artery disease, yet their relative roles continue to shift because they address coronary pathophysiology differently with ever-evolving techniques. PCI has advanced through iterative improvements, including balloon angioplasty, bare-metal stents, and drug-eluting stents, with contemporary outcomes increasingly driven by procedural optimisation using intracoronary imaging and physiology-guided lesion selection rather than device category alone. CABG has progressed through perioperative management, improvements in operative safety, and, critically, conduit durability. Recognition of progressive saphenous vein graft failure has underpinned a conduit-optimisation era in which the left internal mammary artery to left anterior descending artery remains the gold standard. Further, broader arterial grafting (including radial artery use, multiple arterial grafting, and selected total-arterial strategies) has been increasingly applied, albeit with deliverability and competing-risk constraints highlighted in randomised evidence. This perspective review reframes the CABG versus PCI comparison not as a binary contest, but as a context-dependent assessment in which the relative value of each strategy depends on the specific technologies, techniques, and conduits available at the time of comparison. We summarise comparative effectiveness where evidence is most consistent and where it remains sensitive to anatomy, comorbidity, and endpoint definitions. In diabetes with multivessel disease, trial data favour CABG for long-term survival and clinical outcomes despite higher stroke risk. In left main disease, outcomes depend on lesion pattern and overall complexity, with trial-era stent technology and composite endpoint definitions influencing conclusions. In ischaemic left ventricular dysfunction, a long-term survival benefit is established for CABG added to medical therapy, while multi-vessel PCI has not demonstrated comparable prognostic modification in contemporary data. We then examine hybrid coronary revascularisation as territory-specific allocation, highlighting its physiological rationale, program dependence, and limited, adequately powered randomised evidence. Finally, we outline how artificial intelligence (AI) and robotics may accelerate a precision revascularisation paradigm by standardising lesion assessment, supporting procedural planning, improving procedural reproducibility, and enabling more patient-specific selection among PCI, contemporary CABG with optimised conduits, and hybrid pathways. Full article

Background: Chronic subdural hematoma is commonly managed with surgical evacuation when significant mass effect or herniation features are present. Although middle meningeal artery embolization has emerged as an effective adjunctive therapy, evidence supporting its use as standalone treatment in patients with radiological herniation remains limited. Case Presentation: We report a 51-year-old man who presented with a three-week history of progressive headache, intermittent confusion, and mild left-sided weakness. Magnetic resonance imaging demonstrated a right-sided chronic subdural hematoma with marked cortical compression and subfalcine herniation. Despite radiological severity, the patient remained neurologically stable. After multidisciplinary discussion, middle meningeal artery embolization was performed as sole therapy via right radial access using a liquid embolic agent. Selective angiography demonstrated pathological neovascular supply from the right middle meningeal artery, which was completely obliterated following embolization without procedural complications. The post-procedural course was uneventful, with progressive clinical improvement. Follow-up non-contrast computed tomography at eight months demonstrated near-complete resolution of the hematoma with normalization of midline structures, and no surgical evacuation was required. Conclusions: Standalone middle meningeal artery embolization may represent a feasible therapeutic option in carefully selected clinically stable patients with chronic subdural hematoma and radiological herniation features, though further studies are required to define optimal selection criteria and long-term outcomes. Full article

Background/Objectives: The transradial approach is widely used for vascular access in many disciplines. Radial artery occlusion (RAO) is a frequent sequel, and hand/arm pain affects 7.8% of patients. We aimed to elucidate whether RAO or ulnar artery occlusion (UAO) causes impaired neural blood flow and, thus, if symptoms may be attributable to claudication or nerve damage. Methods: Forty healthy volunteers (73% female), with a mean age of 38 years and without clinical or sonographic signs of carpal tunnel syndrome, were included. All underwent a standardized ultrasound examination (Aplio i800 and i22LH8 linear transducer, Canon Medical Systems) of the forearm, investigating the median nerve and its intraneural blood flow as well as the vascular status of the limb. The radial and ulnar arteries were then sequentially compressed, while changes to intraneural blood flow were noted. Thereafter, the (reverse) Barbeau test and the (inverse) modified Allen Test (MAT) were performed. Results: Simulated RAO and UAO halted intraneural blood flow in 65% and 62.5% of individuals, respectively. A total of 32.5% of participants reported discomfort in the hand/arm. Absent flow during occlusion was found at a significantly higher rate in symptomatic individuals. MAT and inverse MAT were abnormal (>10 s) in 17.5% and 7.5% of patients. Barbeau and reverse Barbeau produced type D results in 15% and 20%, respectively. Conclusions: Both simulated RAO and UAO caused the cessation of intraneural blood flow of the median nerve in two-thirds of participants, and a large proportion reported symptoms. MAT and Barbeau tests did not seem to be useful in predicting impaired neural blood flow. Full article

Nicolau syndrome, also known as embolia cutis medicamentosa, is a rare iatrogenic reaction that may occur following parenteral drug administration, including inadvertent intra-arterial or periarterial injection. Its pathophysiology remains poorly understood; however, several mechanisms have been proposed, including vasospasm, embolization, cytotoxic inflammation, and secondary tissue necrosis. We report the case of a 22-year-old transgender woman who received intravenous benzathine penicillin in the left arm without a medical prescription following a reactive syphilis screening performed outside a formal healthcare setting. She subsequently developed severe pain, livedoid dermatitis, pallor, distal cyanosis, and blister formation. Radial and brachial pulses remained palpable, and Doppler ultrasonography revealed no evidence of arterial or venous thrombosis. Medical management included daily wound care, anticoagulation, corticosteroids, peripheral vasodilators, antibiotic therapy, and analgesia. The patient was hospitalized for nine days, with partial clinical improvement. However, persistent distal ischemic changes involving the second through fifth fingers raised concern for evolving necrosis and potential amputation. After counseling regarding these risks, the patient requested voluntary discharge. This case underscores the importance of safe medication administration and appropriate injection practices, particularly in low-resource settings. It also highlights the need for improved training of healthcare personnel to ensure early recognition and prompt management of Nicolau syndrome, as well as strengthened patient education to discourage self-medication and promote timely care by qualified healthcare professionals. Full article

Monitoring intracranial pressure (ICP) dynamics is critical for the management of traumatic brain injury, stroke, other neurosurgical conditions, and cerebral blood flow autoregulation; however, invasive ICP monitoring carries risks such as infection, hemorrhage, and sensor zero drift. Increasing evidence suggests that ICP waveform morphology provides clinically relevant information beyond mean ICP value alone. In this first-in-human prospective comparative clinical study, we evaluated the feasibility and accuracy of a novel, fully passive, non-invasive ICP pulse waveform monitoring system (Archimedes 02) based on the detection of eyeball mechanical movement. Fifteen intensive care unit patients (6 males, 9 females; mean age 57.1 ± 18.8 years) with clinically indicated invasive ICP monitoring or external ventricular drainage were enrolled. Three-minute monitoring sessions were performed to simultaneously acquire non-invasive ICP pulse waveforms, invasive ICP waveforms, and invasive radial artery blood pressure (ABP) waveforms. Averaged waveforms were derived for each patient and compared graphically and using correlation analysis. Non-invasive ICP pulse waves recorded with Archimedes 02 showed a strong correlation with invasive ICP waveforms ($\overline{\mathrm{R}}$ = 0.965). In contrast, correlations between non-invasive ICP and ABP waveforms ($\overline{\mathrm{R}}$ = 0.699), as well as between invasive ICP and ABP waveforms ($\overline{\mathrm{R}}$ = 0.749), were lower. These findings indicate that the non-invasive signal primarily reflects ICP dynamics rather than arterial blood pressure. This novel non-invasive ICP monitoring approach has the potential to enhance neurocritical care, particularly in settings where invasive monitoring is impractical or unavailable. Further validation in larger and more diverse patient populations is warranted. Full article

Objectives: Radial artery spasm (RAS) is a common complication of transradial coronary angiography that may adversely affect procedural success and patient comfort. This study aimed to evaluate clinical, procedural, and anthropometric factors associated with RAS in patients undergoing elective transradial coronary angiography, with a particular focus on the wrist circumference-to-body mass index (WC/BMI) ratio as a novel predictor. Methods: A total of 466 patients who underwent elective coronary angiography via the right radial artery between January 2024 and December 2024 were included. All procedures were performed using a 6 Fr introducer sheath according to a standardized protocol. Radial artery spasm was clinically defined as operator resistance during catheter manipulation accompanied by patient-reported pain or marked discomfort in the accessed arm. Wrist circumference and body mass index were measured before the procedure, and the WC/BMI ratio was calculated. Radial artery diameter was assessed using ultrasonography. Variables associated with RAS were evaluated using univariable and multivariable logistic regression analyses. Due to collinearity between WC/BMI and radial artery diameter, two separate multivariable models were constructed. Discriminative performance was assessed using receiver operating characteristic (ROC) curve analysis. Results: Radial artery spasm occurred in 51 patients (10.9%). Patients who developed RAS had significantly lower WC/BMI ratios and smaller radial artery diameters compared with those without spasm (both p ≤ 0.001). In multivariable analysis, a lower WC/BMI ratio was independently associated with an increased risk of RAS (odds ratio [OR] 0.51 per 0.1-unit increase; 95% confidence interval [CI] 0.34–0.78; p = 0.002). Similarly, smaller radial artery diameter remained an independent predictor of RAS (OR 0.83 per 0.1 mm increase; 95% CI 0.75–0.92; p < 0.001). The area under the curve (AUC) was 0.651 for WC/BMI and 0.636 for radial artery diameter. The combined model demonstrated improved discriminative ability (AUC 0.713). Conclusions: The WC/BMI ratio is a simple, practical, and readily obtainable anthropometric parameter that can predict the risk of radial artery spasm before transradial coronary angiography. When combined with radial artery diameter, it provides improved discrimination for identifying patients at higher risk of RAS. Full article

This study used a rat model of coronary artery reperfusion imaged with preclinical 7-tesla magnetic resonance imaging (7T-MRI) to evaluate cardiac function, myocardial deformation, and the impact of infarction-to-reperfusion time. Wistar rats were assigned to control (n = 6), 20 min infarction (n = 10), 30 min infarction (n = 6), and 40 min infarction (n = 6) groups. Myocardial infarction occurred in all infarction groups but not in controls. Imaging included short- and long-axis slices. Cardiac function was assessed using end-diastolic volume, end-systolic volume, and left-ventricular ejection fraction. Myocardial deformation was analyzed by circumferential strain, radial strain (RS), and longitudinal strain (LS, four-chamber and two-chamber) using feature tracking. The 30 and 40 min infarction groups showed significant reductions in cardiac function and strain compared to the controls. RS decreased significantly between the control and 20 min infarction groups (40.6 ± 4.7% and 34.0 ± 4.1%, p < 0.05). No significant LS difference was observed between 30 and 40 min. Consequently, RS detects early myocardial changes (20 min), whereas LS may reflect compensatory contractility in severe infarction. Preclinical 7T-MRI provides valuable insights into the impact of infarction duration on cardiac function and myocardial deformation. Full article

Background/Objectives: The goal of reconstructive hand surgery is to achieve both functional and aesthetic restoration. The primary aim of this study is to perform a detailed, practice-oriented evaluation of perforator-based and local flaps for soft-tissue reconstruction of the hand and digits, focusing specifically on their functional reliability, anatomical consistency, complication profile, and aesthetic integration in a real-world, high-complexity referral population. Methods: This retrospective single-center study included 37 patients with soft tissue defects of the hand that required flap coverage between September 2021 and September 2024. The study assessed patient demographics, defect characteristics, flap selection, surgical techniques, and outcomes including satisfactory soft tissue coverage, functional results and occurrence of complications. Various perforator flaps were analyzed, including the dorsal metacarpal artery flap, reverse radial forearm flap, reverse posterior interosseous artery flap, reverse homodigital and heterodigital island flaps, and the thenar flap. Results: Satisfactory soft tissue coverage was achieved in 35 out of 37 patients. One case involved partial distal flap necrosis, and another presented with Foucher flap failure. The remaining flaps demonstrated stable integration, preserved perfusion, and durable soft-tissue coverage with satisfactory contour and pliability. Functional outcomes were favorable, with restoration of joint mobility and absence of secondary deformities. Conclusions: This study supports the continued use of perforator and local flaps in upper extremity reconstruction, emphasizing the need for individualized planning to optimize the outcomes. Full article

Over the past decades, coronary revascularization has evolved dramatically with the introduction of bioresorbable scaffolds (BRSs), designed to provide temporary vessel support, elute antiproliferative drugs, and then fully resorb, ideally restoring natural vasomotion and eliminating long-term foreign-body reactions. Early enthusiasm for first-generation polymeric devices, such as the Absorb bioresorbable vascular scaffold, was tempered by increased rates of scaffold thrombosis and late adverse events, largely attributed to thick struts, suboptimal implantation techniques, and unpredictable degradation kinetics. Subsequent developments in polymeric (e.g., MeRes-100, NeoVas) and metallic magnesium-based scaffolds (e.g., Magmaris) have focused on thinner struts, improved radial strength, and refined resorption profiles. Clinical trials and meta-analyses, including ABSORB, AIDA, BIOSOLVE, and BIOSTEMI, reveal that optimized procedural strategies, especially the “PSP” approach (Prepare–Size–Post-dilate) and routine intravascular imaging, substantially reduce thrombosis and restenosis rates, aligning outcomes closer to those of contemporary drug-eluting stents (DESs). Nonetheless, challenges persist regarding inflammatory responses to degradation by-products, mechanical fragility in complex lesions, and patient selection. Ongoing innovations include hybrid polymer–metal designs, stimuli-responsive drug coatings, and AI-assisted imaging for precision implantation. While early-generation BRSs demonstrated both promise and pitfalls, next-generation platforms show steady progress toward achieving the dual goals of transient scaffolding and long-term vessel restoration. The current trajectory suggests that bioresorbable technology, supported by optimized technique and material science, may soon fulfill its original vision; offering safe, effective, and fully resorbable alternatives to permanent metallic stents in coronary artery disease. This review provides an updated synthesis of the design principles, clinical outcomes, and procedural considerations of drug-eluting bioresorbable scaffolds (BRSs). It integrates recent meta-analytic evidence and emerging insights on device mechanics, including the influence of strut thickness on radial strength and the potential role of non-invasive imaging in pre-implantation planning. Special focus is given to magnesium-based scaffolds and future directions in patient selection and implantation strategy. Full article