Search Results (102)

Background: Rotator cuff tears, a prevalent pathology with significant functional impact, primarily find their therapeutic approach in arthroscopic repair. The long-term success of this intervention is modulated by various factors, among which shoulder morphology stands out. In this context, the critical shoulder angle (CSA) has gained relevance as a potential predictor of postoperative prognosis. Objectives: To determine if the CSA influences the need for reoperation after retears and functional outcomes following the arthroscopic repair of chronic rotator cuff tears. Methods: A retrospective cohort study has been conducted, which includes 74 patients (between 47 and 86 years old, mean age of 58.85 ± 2.21 years) who underwent arthroscopic shoulder surgery for the repair of chronic rotator cuff tears by the traumatology service of a tertiary level hospital in the period between 2009 and 2022, to study variables such as the appearance of complications, reoperation, and functional outcomes. Results: Patients with a CSA greater than 40° represent 56.75% (n = 42). Functional improvement was achieved in 59.52%, in contrast to 40.48% of patients who did not obtain significant functional improvement (OR = 1.470; 95% CI = 1.009–2.141). The reoperation rate in this group was 21.4% (n = 9) (OR = 1.562; 95% CI = 1.085–2.249). Conclusions: This study provides statistically significant evidence that a high CSA (>40°) behaves as a risk factor for the reoperation rate and poorer functional outcomes after the arthroscopic repair of chronic rotator cuff tears. Full article

Background: Sugaya type III rotator cuff re-tears are characterized by preserved tendon continuity with reduced thickness and are often associated with persistent pain and functional impairment. Bioinductive collagen implants may enhance tendon healing, but clinical evidence in this population remains limited. This study aimed to evaluate the clinical and radiologic outcomes of arthroscopic repair with bioinductive collagen implant augmentation in patients with Sugaya type III re-tears. Methods: This retrospective case series (Level IV) included 15 patients (mean age 61.7 years) with MRI-confirmed Sugaya type III re-tears. An a priori power analysis based on a large effect size (Cohen’s d = 0.80) indicated that a sample size of 15 would provide 80% power to detect clinically meaningful changes in the primary endpoint. Clinical outcomes were assessed preoperatively and at 6 and 12 months postoperatively using VAS, ASES, SANE, and WORC scores. MRI was used to evaluate changes in supraspinatus tendon thickness. Non-parametric statistical analysis with Bonferroni correction was applied. Results: The median VAS pain score improved from 6.5 (IQR, 6.0–7.0) preoperatively to 2.8 (IQR, 2.0–3.5) at 6 months and to 2.1 (IQR, 1.5–2.8) at 12 months (adjusted p < 0.001). The median ASES score increased from 45.0 (IQR, 39.0–51.0) to 78.0 (IQR, 72.0–85.0), with a median improvement of 33 points. SANE and WORC scores also showed significant improvements. Supraspinatus tendon thickness increased from 4.8 mm (IQR, 3.7–5.7) to 6.9 mm (IQR, 5.4–8.3) at 12 months (adjusted p < 0.001). No graft failure was observed on follow-up MRI. Conclusions: Arthroscopic repair with bioinductive collagen implant augmentation may be associated with short-term improvements in pain, function, and tendon thickness in patients with Sugaya type III re-tears. Given the small sample size and lack of a control group, these findings should be interpreted cautiously, and further prospective comparative studies are needed. Full article

Background: An aorto-right ventricular fistula (ARVF) secondary to membranous septum rupture is an exceptionally rare complication after surgical aortic valve replacement (SAVR). While sutureless prostheses such as the Perceval valve have gained wide acceptance due to reduced cross-clamp times and procedural simplification, the reported adverse events predominantly include conduction disturbances and paravalvular leaks. Structural septal disruption remains sparsely described. We report a case of an early ARVF after Perceval implantation and review the pathophysiological and procedural mechanisms implicated in septal injury following sutureless and transcatheter aortic valve interventions. Case Description: A 66-year-old woman with severe bicuspid aortic valve stenosis underwent SAVR via a median sternotomy using a Perceval XL prosthesis after meticulous annular decalcification and sizing. Immediate intraoperative transesophageal echocardiography (TEE) confirmed optimal seating without any paravalvular regurgitation. Within 24 h, the patient developed a complete atrioventricular block followed by cardiogenic shock. A repeat TEE revealed a large ARVF with significant left-to-right shunt. Emergent re-exploration identified a membranous septum tear. The Perceval prosthesis was explanted, the defect was closed with a reinforced patch repair, and a 27 mm Inspiris Resilia bioprosthesis was implanted. Peripheral veno-arterial ECMO support was required temporarily. The patient recovered and remained free of prosthetic dysfunction at the two-year follow-up. Discussion: Membranous septum rupture after AVR has an estimated incidence of 0.4–1.5% in TAVR cohorts but is virtually unreported with Perceval valves. The mechanisms are thought to be chronic radial stress from oversized or malpositioned prostheses. Case reports with TAVR devices emphasize oversizing as a risk factor. Predictive factors for septal injury in sutureless AVR mirror those for conduction disturbances: valve oversizing, shallow infra-annular septal length, heavy calcification, and prior valve surgery. Preventive measures, such as strict sizing protocols, the avoidance of balloon dilation, and optimized implantation depth, have reduced conduction complications and may mitigate septal trauma. The treatment choice, whether percutaneous or surgical closure, depends on hemodynamic stability, defect size and anatomy, and operative risk. Conclusions: Early ARVF after Perceval implantation is exceedingly rare but potentially catastrophic. Strict adherence to sizing principles, awareness of septal anatomy, and prompt management, percutaneous in selected stable cases or surgical in acute large defects, are essential to optimize outcomes in sutureless AVR. Full article

Corneal neovascularization (CNV) in dogs causes chronic ocular surface inflammation, which may disrupt tear film stability and meibomian gland function. As bevacizumab inhibits abnormal vessel growth and affects tear composition, it may benefit dogs with ocular surface disorders. The aim of this pilot study was to evaluate the effects of bevacizumab eye drops on the ocular surface in dogs with chronic CNV. Fourteen eyes from nine client-owned dogs were included. Dogs received either preserved (B_BAC-group) or unpreserved (B-group) 0.25% bevacizumab eye drops twice daily for 28 days. Re-examinations occurred one week after treatment initiation, at the end of treatment, and three months later. An ocular surface analyzer was used to assess tear composition and meibomian glands via interferometry, tear meniscus height, and meibography. Ocular and systemic toxicities were monitored, and clinical signs were scored. Serum VEGF levels were measured via ELISA before and after treatment. No statistically significant changes in intraocular pressure, tear production, or systemic VEGF levels were observed. Statistically significant improvements were noted in conjunctival hyperemia and chemosis in both groups, ocular discharge in the B_BAC-group, and fluorescein uptake in the B-group. Both formulations were safe and well tolerated. These preliminary findings suggest that topical bevacizumab may have potential benefits for CNV and ocular surface disorders in dogs, although larger studies are needed. Full article

Background/Objectives: Rotator cuff repair (RCR) is a common orthopedic procedure, with healing outcomes strongly influenced by patient-specific factors such as tissue quality, tear characteristics, and biological healing potential. Bioinductive collagen implants have shown great results in enhancing tendon healing and reducing retear rate. This study aimed to evaluate the clinical and imaging outcomes of RCR augmented with a xeno-derived collagen membrane over 24 months and to assess complications or implant failures. Methods: Patients underwent arthroscopic RCR using anchors (single or double-row) with additional xeno-derived matrix augmentation. The study included patients older than 40 years with full-thickness supraspinatus and/or infraspinatus tendon tears (DeOrio–Cofield grade 3–4) who were candidates for arthroscopic rotator cuff repair and provided informed consent. Clinical outcomes were assessed using the Constant–Murley Score (CMS), Disabilities of the Arm, Shoulder and Hand score (DASH), and Visual Analogue Score (VAS) at baseline, 3, 6, 12, and 24 months. MRI was performed preoperatively and at 24 months to assess tendon thickness. Results: All scores improved significantly. CMS increased from 16.3 ± 4.1 to 82.9 ± 5.8, VAS decreased from 7.8 ± 1.0 to 1.5 ± 0.8, and DASH improved from 70.3 ± 6.4 to 12.4 ± 4.5 (p < 0.05). Tendon thickness in the supraspinatus (T3) increased from 4.2 ± 0.9 mm to 6.8 ± 1.2 mm (p < 0.05). Retear rate was 7.55%, with no major complications. Conclusions: The bioinductive collagen implant showed notable results in improving tendon thickness, healing, and excellent clinical outcomes in RCR, without membrane-related complications. The study was designed as a prospective single-arm case series without a control group and that was the main limitation; The absence of adverse reactions in this cohort further supports the favorable safety profile of this implant in the present study population. Full article

In this study, the potential for re-mixing and re-vulcanizing waste natural rubber glove (WNRG) material by using it as the primary matrix was investigated. Alternative types of vulcanization systems, namely, sulfur, phenolic resin, and peroxide, were employed. The results unequivocally demonstrated that residual vulcanizing agents contained in the WNRG were not sufficient to cause crosslinking reactions without re-mixing with vulcanizing agents. Among the various vulcanization approaches, sulfur produced the greatest properties, whereas phenolic resin gave moderate performance. The WNRG vulcanized with sulfur demonstrated the highest crosslink density, tear strength, tensile strength, hardness, and strain-induced crystallization ability among the tested alternatives. The tensile strength of WNRG vulcanized with sulfur was approximately 16.23 MPa, which was 31.7% and 51.1% greater than the WNRG vulcanizates made with phenolic resin and peroxide, respectively. Because of its highest crosslink density, the WNRG vulcanizate with sulfur also offers the greatest storage modulus among the tested cases. The results clearly suggest that the WNRG can potentially be re-compounded, re-vulcanized, and used as the primary matrix. WNRG could be used as a matrix at an industrial scale, to minimize the environmental issues and increase the added value from waste gloves. The findings provide practical guidance for recycling waste rubber gloves in industrial applications, which would be a more sustainable solution for solving the problems associated with WNRG. Full article

Background/Objectives: The optimal surgical timing for rotator cuff tears (RCTs) remains controversial, particularly regarding how tear etiology influences the final functional recovery. This study aimed to compare the clinical outcomes of early versus delayed arthroscopic repair stratified by etiology, providing evidence for etiology-specific surgical timing. Methods: A retrospective cohort study was conducted on 183 patients who underwent arthroscopic rotator cuff repair for isolated full-thickness supraspinatus tears. Patients were stratified into traumatic (n = 74) and degenerative (n = 109) groups based on etiology. They were further divided into early-repair and delayed-repair subgroups based on symptom duration (traumatic cut-off: 3 months; degenerative cut-off: 6 months). Clinical outcomes were assessed preoperatively and at the final follow-up using the Visual Analog Scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) score, and range of motion. Complications, including retear rates and stiffness, were recorded. Results: In the traumatic group, early repair yielded significantly better postoperative pain relief (VAS) and higher functional scores (ASES and UCLA) compared to delayed repair. Notably, the delayed traumatic group exhibited a significantly higher retear rate compared to the early group (16.7% vs. 2.6%; p = 0.039). Conversely, in the degenerative group, comparisons between early and delayed repair revealed no significant differences in the final functional scores, pain levels, or complication rates (p > 0.05). Conclusions: Surgical timing significantly impacts outcomes in traumatic RCTs, where early repair is critical to optimize functional recovery and minimize retear risks. In contrast, delayed arthroscopic repair for degenerative tears yielded comparable outcomes to early repair, suggesting that an initial trial of conservative management is safe and does not compromise final surgical outcomes. Full article

Maintaining the structural integrity of conveyor belts is essential for safe and reliable mining operations. However, these belts are susceptible to longitudinal tearing and surface degradation from material impact, fatigue, and deformation. Many computer vision-based inspection methods are inefficient and unreliable in harsh mining environments characterized by dust and variable lighting. This study introduces a smartphone-driven defect detection system for the cost-effective, geometric inspection of conveyor belt surfaces. Using Apple’s iPhone 12 Pro Max (Apple Inc., Cupertino, CA, USA), the system captures 3D point cloud data from a moving belt with induced damage via the integrated TrueDepth camera. A key innovation is a 3D-to-2D projection pipeline that converts point cloud data into structured representations compatible with standard 2D Convolutional Neural Networks (CNNs). We then propose a hybrid deep learning and machine learning model, where features extracted by pre-trained CNNs (VGG16, ResNet50, InceptionV3, Xception) are classified by ensemble methods (Random Forest, XGBoost, LightGBM). The proposed system achieves high detection accuracy exceeding 0.97 F1 score in the case of all proposed model implementations with TrueDepth F1 score over 0.05 higher than RGB approach. Applied cost-effective smartphone-based sensing platform proved to support near-real-time maintenance decisions. Laboratory results demonstrate the method’s reliability, with measurement errors for defect dimensions within 3 mm. This approach shows significant potential to improve conveyor belt management, reduce maintenance costs, and enhance operational safety. Full article

Background: Animal models are essential for translating diagnostic and therapeutic strategies into clinical practice and offer valuable insights into the pathophysiology of diseases such as aortic dissection. This study presents a novel acute in vivo large animal model of Stanford type A aortic dissection, combining open surgical access with endovascular techniques to leverage the advantages of both. The model aims to reproducibly simulate acute dissections in swine, providing a standardized platform for evaluating diagnostics, disease mechanisms, and treatment strategies. Methods: Six pigs underwent a standardized protocol to induce aortic dissection. Arterial pressure was monitored via femoral and carotid catheterization. A conventional sternotomy was performed, followed by tangential cross-clamping of the ascending aorta and a controlled incision proximal to the brachiocephalic trunk. The intima and the media were separated using a guidewire and catheter-based technique to create a false lumen. A re-entry tear was also established to allow for controlled intraluminal access. Animals were monitored for 12 h post-intervention, with serial blood sampling. At the end of the experiment, the animals were euthanized and the aortas harvested for macroscopic and histological analysis. Results: In all 6 animals, the placement of arterial catheters in femoral and carotid arteries, as well as the sternotomy, was established without any complications. The dissection model was successfully created in 5 out of 6 animals by clinical signs such as adventitial hematoma, macroscopic wall separation and/or decreased femoral blood pressure. One animal experienced complete aortic perforation. Five animals completed the full observation period of 12 h. Conclusion: A standardized, reproducible, and robust large animal model of acute Stanford type A aortic dissection using a hybrid approach was developed. This model closely simulates the clinical and pathological features of human aortic dissection, making it a valuable tool for preclinical research in diagnostics, pathophysiology, and treatment development. Full article

Purpose: This study investigates the association between obstructive sleep apnea (OSA), dry eye disease (DED), and glaucoma, focusing on the impact of positive airway pressure (PAP) usage and air leakage. Methods: This retrospective cross-sectional study included 57 adults with polysomnography-confirmed OSA between 2010 and 2023. Participants were grouped into PAP users (PAP+, n = 40) and non-users (PAP−, n = 17). Ocular assessments included tear film break-up time, Schirmer’s test, Oxford staining, meibomian gland evaluation, intraocular pressure, cup-to-disc (C/D) ratio, and retinal nerve fiber layer thickness. PAP device data (usage duration and air leak rate) and OSA severity metrics were recorded. Group comparisons used chi-square and Student’s t-test, and regression analyses identified associations between PAP leakage and ocular parameters. Results: Among the 57 OSA patients, PAP users showed a trend toward a higher risk of glaucoma (OR = 0.83) and DED (OR = 0.69) compared to non-users, but neither trend was statistically significant. PAP users had significantly more severe OSA, including longer N1 sleep stage (p = 0.0005), higher apnea-hypopnea index (AHI, p = 0.0001), and poorer oxygenation. PAP leakage: 95% (mean = 25.84 L/min) exceeded the 24 L/min threshold specified in ResMed’s clinical guidelines, suggesting suboptimal therapy. Higher PAP leak was significantly associated with a lower Schirmer’s test value (p = 0.031) and a higher C/D ratio (p = 0.040) on regression analysis. However, no significant differences were found in ophthalmic parameters between PAP+ and PAP− groups. Conclusions: Suboptimal PAP therapy as mask leakage or nocturnal hemodynamic changes may worsen evaporative dry eye and affect intraocular pressure. Our findings highlight the association between PAP mask leakage and reduced tear production, and suggest that OSA-related optic nerve stress may persist unless both hypoxia and nocturnal IOP fluctuations are properly managed. However, due to the relatively small sample size and retrospective cross-sectional design, future prospective studies with larger cohorts are needed to confirm these associations. Full article

Background/Objectives: Bioinductive bovine collagen implants (BCI) have been introduced to enhance tendon biology and promote tissue regeneration in rotator cuff (RC) repairs. This study aimed to assess the clinical and radiological outcomes of arthroscopic posterosuperior rotator cuff (psRC) repair with BCI augmentation in full-thickness tears at increased risk of retear. Methods: This case series analyzed 30 patients with psRC tears who were classified as being at high risk of failure according to a predefined set of parameters, including patient history, radiological findings and intraoperative assessments, and the presence of psRC retears. All patients subsequently underwent arthroscopic psRC repair with BCI augmentation, compromising 21 primary and 9 secondary repairs. Clinical outcomes were assessed using Subjective Shoulder Value (SSV), American Shoulder and Elbow Surgeons (ASES) shoulder score, and Constant score at 6 and 12 months postoperatively. Tendon integrity was assessed using the Sugaya classification. Results: At 12 months, magnetic resonance imaging revealed complete tendon healing in 56.7%, partial healing in 16.7%, and insufficient healing in 26.7%. Significant improvements in SSV (45.3 to 83.5), ASES (40.6 to 77.8), and Constant score (36.6 to 71.7) were observed at 12 months postoperatively, with all outcome measures exceeding their respective minimally clinically important differences. Two patients (6.7%) developed secondary shoulder stiffness, and 1 patient (3.3%) required revision surgery for bicipital groove pain. Conclusions: Augmentation with a BCI in arthroscopic repair of high-risk psRC tears demonstrate promising short-term results. Patients achieve significant improvements in pain and shoulder function, accompanied by satisfactory tendon healing on MRI. Full article

This paper provides an overview of artificial intelligence (AI) applications in ophthalmology, with a focus on diagnosing dry eye disease (DED). We aim to synthesize studies that explicitly compare AI-based diagnostic models with clinical tests employed by ophthalmologists, examine results obtained using similar imaging modalities, and identify recurring limitations to propose recommendations for future work. We conducted a systematic literature search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across four databases: Google Scholar, PubMed, ScienceDirect, and the Cochrane Library. We targeted studies published between 2020 and 2025 and applied predefined inclusion criteria to select 30 original peer-reviewed articles. We then analyzed each study based on the AI models used, development strategies, diagnostic performance, correlation with clinical parameters, and reported limitations. The imaging modalities covered include videokeratography, smartphone-based imaging, tear film interferometry, anterior segment optical coherence tomography, infrared meibography, in vivo confocal microscopy, and slit-lamp photography. Across modalities, deep learning models (e.g., U-shaped Convolutional Network (U-Net), Residual Network (ResNet), Densely Connected Convolutional Network (DenseNet), Generative Adversarial Networks (GANs), transformers) demonstrated promising performance, often matching or surpassing clinical assessments, with reported accuracies ranging from 82% to 99%. However, few studies performed external validations or addressed inter-expert variability. The findings confirm AI’s potential in DED diagnosis, but emphasize gaps in data diversity, clinical use, and reproducibility. It offers practical recommendations for future research to bridge these gaps and support AI deployment in routine eye care. Full article

Background and Objectives: Corneal cross-linking (CXL) is the standard treatment for progressive keratoconus, but delayed epithelial healing remains a concern, increasing infection risk and patient discomfort. Studies suggest that insulin may promote corneal epithelial cell migration and proliferation, potentially accelerating wound healing. Its benefit has been observed in neurotrophic keratitis and diabetic epithelial defects, and it may offer similar effects post-CXL. Our objective is to evaluate the effect of topical insulin on epithelial healing after CXL in a small case series. Materials and Methods: Eight patients undergoing CXL for keratoconus were divided into two groups (n = 4 each). The insulin group received topical insulin eye drops (1 IU/mL in Systane^®) five times daily, in addition to standard postoperative care. The control group received Systane^® alone with the same regimen. Daily follow-up included slit-lamp exam, anterior segment OCT, and photodocumentation until epithelial defect closure. Results: Baseline parameters (central corneal thickness, keratoconus stage, Schirmer test, tear break up test) were comparable. While not statistically significant, the insulin group showed numerically smaller epithelial defects on day 2, suggesting a possible trend toward faster healing. By day 3, re-epithelialization was complete in all patients. Pain decreased over time in both groups without significant differences. No adverse effects were noted. Conclusions: Topical insulin may modestly accelerate epithelial healing after CXL, as suggested by smaller defects on day 2 in the insulin group. Although results were not statistically significant, the trend warrants further investigation in larger studies. Full article

The Apuseni-Banat-Timok-Srednogorie Metallogenic Belt is one of the most important polymetallic metallogenic belts in the western segment of the Tethys, where numerous porphyry-type, skarn-type, and epithermal deposits are developed. However, scholars have noted a lack of systematic chronological and geochemical studies of andesites within this belt. Furthermore, the metallodynamic mechanisms controlling mineralization—such as oceanic plate exhumation and plate tearing—remain controversial. To complement the available research, this study focuses on andesites from the Čukaru Peki area in Serbia and integrates zircon U-Pb dating, molybdenite Re-Os isotopic analysis, and whole-rock geochemical analysis. The results reveal that plagioclase andesitic breccia and fine-grained plagioclase amphibole andesite were emplaced during the Late Cretaceous. Consistently, the molybdenite isochron age (81.46 ± 0.60 Ma, MSWD = 1.30) constrains the mineralization event to the same period. Both rock types exhibit geochemical signatures typical of island arc volcanic rocks, characterized by high SiO₂ contents and low Al₂O₃, MgO, and TiO₂ contents, as well as pronounced fractionation between light and heavy rare earth elements (LREEs and HREEs). The magma source is the mantle wedge metasomatized by fluid-rich melts derived from the dehydration of the subducted oceanic crust. Additionally, the primary magma produced by partial melting of this metasomatized mantle wedge assimilated and was contaminated by continental crustal material predating the Vardar Ocean’s closure during its ascent. Our findings suggest that the regional andesites are products of the exhumation of the Vardar Ocean. This study aims to provide a theoretical foundation for mineral exploration in the Timok ore cluster and, simultaneously, support the identification of ore prospecting targets in andesite alteration zones. Full article

Background and Objectives: Corneal ulcers in patients with lagophthalmos due to facial nerve palsy pose a significant therapeutic challenge. Topical insulin has emerged as a promising adjuvant therapy for enhancing corneal re-epithelialization. The aim of this study is to evaluate the efficacy of insulin drops compared with lipid-based artificial tears, and to compare the corneal healing rate in achieving complete epithelialization within 30 days in diabetic patients. Materials and Methods: This retrospective case–control study included 32 patients with facial nerve palsy and lagophthalmos who developed an exposed corneal ulcer, of whom 20 received topical insulin and 12 received lipid-based artificial tears. The primary outcome was complete epithelialization at day 30. Additional variables included age, sex, and baseline defect characteristics. Results: By day 30, complete epithelialization was achieved in 18 of 20 patients (90%) in the insulin group compared with 5 of 12 (41.7%) in the control group. Binary logistic regression analysis confirmed significantly higher odds of healing with insulin treatment (OR = 10.8; 95% CI 1.8–63.9). No systemic adverse events or signs of hypoglycemia were observed. Conclusions: Topical insulin significantly accelerates corneal epithelialization in patients with facial nerve palsy and exposed ulcers, offering safe and effective adjuvant therapy for a high-risk population. Despite promising results, the study’s limitations—including small sample size, single-center design, and retrospective nature—highlight the need for larger, multicenter prospective studies to confirm efficacy, optimize dosing, and further evaluate long-term safety. Full article