Search Results (1,827)

Accurate displacement field measurement by holographic interferometry requires robust analysis of high-density fringe patterns, which is hindered by speckle noise inherent in any interferogram, no matter how perfect. Conventional skeletonization methods, such as edge detection algorithms and active contour models, often fail under these conditions, producing fragmented and unreliable fringe contours. This paper presents a novel skeletonization procedure that simultaneously addresses three fundamental challenges: (1) topology preservation—by representing the fringe family within a physics-informed, finite-dimensional parametric subspace (e.g., Fourier-based contours), ensuring global smoothness, connectivity, and correct nesting of each fringe; (2) extreme noise robustness—through a robust strip integration functional that replaces noisy point sampling with Gaussian-weighted intensity averaging across a narrow strip, effectively suppressing speckle while yielding a smooth objective function suitable for gradient-based optimization; and (3) sub-pixel accuracy without phase extraction—leveraging continuous bicubic interpolation within a recursive quasi-optimization framework that exploits fringe similarity for precise and stable contour localization. The method’s performance is quantitatively validated on synthetic interferograms with controlled noise, demonstrating significantly lower error compared to baseline techniques. Practical utility is confirmed by successful processing of a real interferogram of a bent plate containing over 100 fringes, enabling precise displacement field reconstruction that closely matches independent theoretical modeling. The proposed procedure provides a reliable tool for processing challenging interferograms where traditional methods fail to deliver satisfactory results. Full article

Background and Clinical Significance: The Ozaki procedure offers excellent hemodynamics and mid-term durability, but infective endocarditis (IE), although rare, remains its most serious complication and frequently requires complex redo surgery. Sutureless valve technology, particularly the Perceval bioprosthesis, has shown value in high-risk endocarditis due to reduced annular manipulation and rapid deployment. Case Presentation: We describe the first reported case of Perceval sutureless valve implantation as a bail-out strategy for IE after a prior Ozaki procedure. A 68-year-old male previously treated with Ozaki reconstruction and LIMA-LAD bypass presented with septic and cardiogenic shock caused by Streptococcus bovis endocarditis, two years after the first surgery. TOE revealed torrential aortic regurgitation from destruction of the anterior neocuspid and large vegetations. Despite a EuroSCORE II of 89.5%, emergent redo surgery was undertaken. Redo sternotomy revealed extensive leaflet destruction and a sub-annular abscess involving two sinuses. Following radical debridement and annular reconstruction, a medium Perceval valve was implanted due to severe tissue fragility. The prosthesis seated securely with no paravalvular leakage. Conclusions: This case demonstrates that the Perceval sutureless valve can be an effective bailout option for post-Ozaki infective endocarditis, particularly when annular integrity is compromised, and conventional sutured prostheses are high risk. The combination of rapid deployment and minimal annular stress may expand therapeutic possibilities in complex redo aortic surgery. Full article

Vascularised composite allotransplantation (VCA) has an evolving role in the reconstruction of complex functional and aesthetic deficits non-amenable to autologous or implant-based reconstructive modalities. International applications of VCA span upper extremity, face, abdominal wall, uterus, and penile transplantation, with more than 300 procedures performed worldwide. Among these, abdominal wall transplantation has uniquely contributed to the development of the sentinel skin flap (SSF) concept, in which solid organ transplant patients undergo simultaneous transplantation of a solid organ and a donor-derived vascularised skin flap, with the skin component of the SSF being trialled internationally as a means of monitoring for rejection within the solid organ allograft. Despite growing clinical success, VCA continues to face substantial barriers to wider adoption. Acute rejection remains highly prevalent, affecting up to 89% of recipients, with significant morbidity linked to intensive systemic immunosuppression. Challenges are further amplified by the unique immunological heterogeneity of composite grafts, ethical concerns surrounding identity-linked tissues, and the lack of standardised outcomes reporting across VCA subtypes. Advances in machine perfusion technologies and emerging cellular and biomaterial-based immunomodulation strategies show promise in reducing immunosuppression burden and improving graft longevity. This review outlines the current state of VCA, including clinical applications, outcomes, and mechanistic insights from pre-clinical studies, while highlighting key ethical considerations and evolving regulatory frameworks. Future progress will depend on standardised reporting systems, improved donor–recipient matching, better understanding of ischemia–reperfusion injury, and the development of next-generation immunosuppressive/immuno-modulatory therapies. Collectively, these innovations position VCA as a rapidly advancing field with significant potential to redefine reconstructive and transplant surgery. Full article

This paper analyses the role of landscape as a fundamental dimension of post-earthquake recovery in the inland areas of Central Italy, arguing that reconstruction must be understood not only as the repair of damaged buildings but as a broader territorial process affecting identity, spatial organization, and long-term settlement trajectories. In this sense, post-earthquake recovery is also interpreted as a strategic opportunity to reinforce coast–inland relationships, acknowledging the structural interdependence between inland Apennine areas and coastal urban systems. Drawing on insights from applied research conducted in the L’Aquila 2009 crater and on the conceptual framework developed within the PRIN TRIALS project, the paper discusses how seismic events accelerate pre-existing territorial dynamics and produce enduring transformations, particularly in the proximity landscapes surrounding historic centres. Rather than presenting empirical findings, the contribution offers a theoretical and operational framework aimed at integrating landscape considerations into reconstruction processes. It outlines key concepts such as landscape quality, transformative resilience, and permanent temporariness; reviews critical normative aspects linked to emergency procedures; and proposes a set of landscape-oriented guidelines and criteria for the contextual integration of reconstruction projects. These include landscape quality objectives, multiscalar readings of identity values, and operational tools such as visual-impact assessment, Project Reference Context analysis, and principles for managing transformations in peri-urban and historic environments. Overall, the paper argues that adopting a landscape-based perspective can strengthen territorial cohesion, support the sustainable redevelopment of historic centres and their surroundings, and embed post-earthquake reconstruction within broader coast–inland territorial strategies aimed at long-term resilience and balanced regional development in Apennine communities. Full article

Background: Congenital split foot/hand is a rare limb anomaly. Although various surgical techniques have been described, detailed gross anatomical studies of soft tissue adaptation, particularly in the foot, are extremely rare. This study presents a detailed anatomical description of a case of severe bilateral split foot. Methods: A comprehensive dissection was performed on the lower limb of a 64-year-old male donor with bilateral split foot/hand. Results: Radiographic evaluation classified the deformity as Blauth type IV, characterized by the absence of the lateral cuneiform bone and severe hypoplasia/aplasia of the second and third metatarsals. Significant changes were revealed in the musculotendinous apparatus. The key finding was a unique tendon loop passing through the central cleft, formed by the tendon of the extensor digitorum longus and connecting with the tendons of the flexor digitorum longus and flexor hallucis longus. Conclusions: This study presents the first detailed macroscopic anatomical description of split foot, demonstrating that this congenital anomaly involves complex, structured tendon and muscle adaptations that extend beyond skeletal deficiencies alone. The discovery of a persistent tendon loop—previously reported only once in split hand—indicates asynchronous development of skeletal and soft tissue structures. These findings should be taken into account for surgical planning, emphasizing the need to identify and manage such abnormal soft tissue structures during reconstructive procedures. Full article

Three-dimensional (3D) reconstruction of ultrasound (US) images represents a novel advancement that has been extensively explored over the past three decades. This technique enables endoscopists to perform more detailed and enhanced visualizations of anatomical structures, which is not feasible using traditional ultrasound methods. The reconstructed images also facilitate navigation during endoscopy-guided procedures, such as fine-needle aspiration. Furthermore, augmented reality (AR) algorithms can overlay the reconstructed images with real-time anatomical images, thereby enhancing clinician performance during these procedures. Current evidence suggests that 3D ultrasound reconstruction has already been widely implemented in various clinical imaging studies. However, its application for generating procedural guidance and augmented reality overlays remains in the early research stages and has not yet achieved widespread adoption. Existing pre-clinical evidence suggests that 3D reconstruction has significant potential to enhance clinician performance in various ultrasound-guided procedures. Full article

This study introduces a novel framework for defining screw trajectory that utilizes PointNet—a deep neural network trained on lumbar vertebrae point clouds—to improve the manual surgical planning procedures. The conventional architecture of PointNet was modified to accommodate various vertebral orientations and predict six values, which were reconstructed into two control points that define a linear trajectory. A custom loss function was designed to align the predicted trajectory with the ground-truth trajectory. The neural networks were trained on 4284 point clouds of vertebrae, and 28 unseen point clouds were used to evaluate the model’s performance based on translational error, angular error, and clinical accuracy. For the left pedicle, the mean translational errors were 1.5 ± 0.8 mm at the entry point and 2.3 ± 1.2 mm at the target point. For the right pedicle, the mean translational errors were 1.5 ± 0.7 mm at the entry point and 2.3 ± 1.0 mm at the target point. The mean angular error was 3.5 ± 2.3° for the left pedicle and 3.9 ± 1.7° for the right pedicle. Clinically, the network generated 52 out of 56 trajectories without medial-cortical violations of the spinal canal. The trained neural network demonstrated promising technical and clinical accuracy, generating feasible screw trajectories across various vertebral orientations. Integrating a spinal segmentation network with the proposed framework could enable fully automated surgical planning in the future. Full article

Background/Objectives: Targeted muscle reinnervation and regenerative peripheral nerve interface procedures have emerged as effective techniques for reducing post-amputation pain and preventing symptomatic neuroma formation. However, the optimal timing of these procedures remains debated. This study aims to compare complication and reoperation rates between acute and delayed advanced nerve interface procedures in lower-extremity amputees. Methods: A retrospective cohort study was conducted including 74 patients who underwent acute or delayed targeted muscle reinnervation and/or regenerative peripheral nerve interface procedures between 2019 and 2025 at a tertiary academic medical center. Procedures performed concurrently with amputation or during early-stage reconstruction were classified as acute, whereas procedures performed more than one month after amputation were classified as delayed interventions. The primary outcome was postoperative surgical complications occurring within one year. Mann–Whitney U and chi-square tests were used for group comparisons. Univariable and multivariable logistic regression analyses were performed to identify factors associated with surgical complications, adjusting for potential confounders. A p-value < 0.05 was considered statistically significant. Results: Of 80 limbs, 47 (58.8%) underwent acute and 33 (41.3%) underwent delayed procedures. One-year complication rates were 23.4% in the acute group, and 12.1% in the delayed group, with wound-related complications predominantly occurring in patients undergoing amputation for infection or vascular disease. Unexpected reoperation rates were 19.1% for acute and 12.1% for delayed interventions. On univariable and multivariable analyses, early procedures demonstrated higher odds of surgical complications. However, these associations did not reach statistical significance and were limited by baseline differences in patient comorbidity and etiology. Conclusions: Early advanced nerve interface procedures were performed in more medically complex patients and were associated with higher observed rates of surgical complications, whereas delayed procedures were associated with a higher incidence of recurrent symptomatic neuromas. These findings underscore the importance of patient selection, etiology of amputation, and surgical context, rather than timing alone, when determining the optimal approach to nerve interface reconstruction following lower-extremity amputation. Full article

Background/Objectives: Gunshot wounds in living patients present significant challenges from both a clinical and a forensic perspective. Understanding the exact trajectory of a bullet is crucial not only for guiding treatment but also for providing reliable documentation in legal settings. This work introduces a practical diagnostic workflow that combines OsiriX (V. 14.1.1), a DICOM viewer with advanced 3D tools, with Autodesk Maya, a modeling platform used to recreate the external shooting scene. Methods: CT scans obtained with multidetector systems were analyzed in OsiriX using a structured, seven-step process that included multiplanar reconstructions, 3D renderings, and region-of-interest tracking. The reconstructed trajectories were then exported to Maya, where they were integrated into a virtual model of the shooting scene to correlate internal findings with the incident’s external dynamics. Results: The workflow allowed precise identification of entry and exit points, reliable reconstruction of bullet paths, and effective 3D visualization. While OsiriX provided detailed information for clinical and radiological purposes, the use of Maya enabled simulation of the external scene, improving forensic interpretation and courtroom presentation. The procedure proved reproducible across cases and compatible with emergency timelines. Conclusions: The combined use of OsiriX and Maya offers a reproducible and informative method for analyzing gunshot wounds in living patients. This approach not only supports surgical and diagnostic decisions but also enhances the forensic value of radiological data by linking internal trajectories to external shooting dynamics. Its integration into trauma imaging protocols and forensic workflows could represent a significant step toward standardized ballistic documentation. Full article

Replantation of an amputated finger is a complex microsurgical procedure that is rarely attempted in low-resource settings due to limited infrastructure and expertise. We report a case of complete amputation of a finger in rural Kenya that was successfully replanted during a humanitarian surgical mission. A 28-year-old man sustained a severe crush avulsion agricultural machine injury resulting in the amputation of all ten digits; only one digit was deemed suitable for replantation. The replantation was performed under loupe and microscope magnification by a visiting specialist team in collaboration with local staff. Intraoperatively, bony fixation with Kirschner wires, extensor and flexor digitorum profundus tendon repair, arterial and venous anastomoses, and neurorrhaphy of the digital nerve were achieved. Postoperatively, the finger survived with adequate perfusion. At one-month follow-up, the replanted finger was viable with progressing wound healing and early joint motion; further rehabilitation was arranged to maximize functional recovery. This case, which is, to our knowledge, one of the first documented digital replantations in East Africa, illustrates that successful microsurgical limb salvage is feasible in a non-specialized hospital setting. Our experience underscores that, with proper planning, training, and teamwork, advanced reconstructive procedures like finger replantation can be safely carried out even in resource-constrained hospitals, offering patients in low-income regions outcomes previously achievable only in high-resource centers. Full article

Aesthetic Medicine is advanced as an integrated, evidence-based framework for patient-centered care that unites physical, psychological, social, and aesthetic dimensions of health. Drawing on Clinical Health Psychology, the paper introduces Aesthetic Health Psychology as a specialization that embeds psychological theory, assessment, and intervention within aesthetic medicine and surgery, emphasizing interdisciplinary collaboration rather than professional mistrust. The paper argues that integrating Aesthetic Health Psychology into aesthetic medicine can enhance ethical practice, improve patient-reported outcomes, and support equity-focused implementation across diverse procedures and settings. It further suggests a practical framework for implementation. Three interrelated models are proposed: the Aesthetic Biopsychosocial Model, which conceptualizes aesthetics as a distinct health domain alongside biological, psychological, and social factors; the Aesthetic Health Care Process Model, which structures care as a five-stage journey supported by systematic screening for body dysmorphic disorder and the routine use of patient-reported outcome measures; and the Aesthetic Health Systems Model, which situates aesthetic care within institutional, policy, and cultural contexts. Idealized but clinically grounded vignettes from elective cosmetic, reconstructive, and gender-affirming settings illustrate how these models address non-linear trajectories of adaptation, evolving expectations, complications, and stigma. These concepts jointly define both the motivation for Aesthetic Health Psychology and its practical implications, from the use of brief, selective aesthetic screening during primary health care visits to the design of equity-focused implementation strategies across aesthetic procedures and settings. Full article

Walkability for non-motorized users is crucial for fostering inclusive, healthy, and sustainable communities. By prioritizing modern human-centered design principles, social equality is promoted for all categories of users, regardless of physical abilities or socio-economic status. Despite the importance of this indicator, a series of inconsistencies that produce inadequate and inaccessible urban space can still be observed in cities. The aim of this paper is to present the methodology for the calculation of the walkability index at the local level. This new methodological procedure considers walkability for pedestrians, with a special focus on people with reduced mobility. Based on specifically defined criteria, initial calculations were performed and integrated into the dynamic walkability index (DWI). One of the main advantages of this index is that it includes the dynamic component of the share of different categories of users in the total sample, which enables simple time modification without repeating the entire procedure. The developed methodology can be used as a tool for ranking existing street segments according to the urgency of reconstruction, while on the other hand promoting equality and inclusion of all categories of users in decision-making processes, thus creating more comfortable and safer environments. Full article

Autologous fat grafting is the main surgical technique for soft tissue reconstruction. However, its clinical use with more extended volumes is limited by repeated procedures due to the little possibility of banking tissue, donor-site morbidity and unpredictable graft resorption rates. To overcome these problems, adipose tissue engineering has focused on developing injectable scaffolds. Most of them are hydrogels that closely mimic the biological, structural and mechanical characteristics of native adipose tissue. This review provides an overview of current injectable scaffolds designed to restore soft tissue volume defects, emphasizing their translational potential and future directions. Natural injectable scaffolds exhibit excellent biocompatibility but degrade rapidly and lack mechanical strength. Synthetic injectable scaffolds provide tunable elasticity and degradation rates but require biofunctionalization to support cell adhesion and tissue integration. Adipose extracellular matrix-derived injectable scaffolds are fabricated by decellularization of adipose tissue. Accordingly, they combine bio-mimetic structure with intrinsic biological cues that stimulate host-driven adipogenesis and angiogenesis, thus representing a translatable “off-the-shelf” alternative to autologous fat grafting. However, despite this broad spectrum of available injectable scaffolds, the establishment of clinically reliable soft tissue substitutes capable of supporting large-volume and long-lasting soft tissue reconstruction still remains an open challenge. Full article

Background and Objectives: Access to anterior cruciate ligament reconstruction (ACLR) varies substantially across health systems, yet national-level data from Eastern Europe remain limited. This study provides the first nationwide, regionally stratified assessment of ACLR activity in Romania, examining geographic variation, socioeconomic and workforce determinants, and inequality. Materials and Methods: We conducted a retrospective cross-sectional analysis of all ACLRs reported in the national administrative hospital database (2017–2023), supplemented with demographic, GDP, and workforce statistics. Outomes included incidence per 100,000 population, private-sector share, and sex distribution. Regional differences were tested using Kruskal–Wallis and Dunn post hoc comparisons. Predictors of ACLR incidence and private-sector utilization were identified through multivariable Poisson and logistic models. Inequality metrics (Gini coefficients, P90/P10 ratios) and sensitivity analyses excluding Bucharest–Ilfov were also performed. Results: A total of 11, 080 ACLRs were recorded. Incidence varied markedly across regions, from a median of 40.0 per 100,000 in Bucharest–Ilfov to <1–3 per 100,000 in the South, South-East, and South-West (p < 0.001). Higher GDP per capita correlated with incidence (ρ = 0.36) and explained 45% of its variance. Private-sector involvement ranged from <5% in Bucharest–Ilfov and the South to 80–100% in the Centre, North-West, and South-East. In adjusted Poisson models, GDP, surgeon availability, and private-sector share were strong independent predictors of incidence (all p < 0.001). Private-sector access was primarily determined by the proportion of private orthopedic surgeons (OR 21.03). National inequality was extreme (Gini 0.842–0.752; P90/P10 > 10⁹), reflecting the concentration of procedures within a small number of counties. Results were consistent across sensitivity analyses. Conclusions: ACLR in Romania displays severe territorial inequities driven by socioeconomic development, workforce distribution, and uneven private-sector capacity. Targeted regional investment and coordinated workforce strategies are necessary to improve equitable access to surgical care. Full article

This paper presents a simple experimental method for evaluating a superconducting quantum processor through two-qubit quantum state tomography and generalized GHZ-state benchmarking. The goal is to provide an accessible procedure for assessing hardware fidelity and entanglement capability. The method was demonstrated using IBM’s 127-qubit ibm_brisbane device, where each Bell state was prepared and reconstructed from 10,000 shots, and the resulting fidelities were compared to Qiskit Aer simulations. The method further examines multi-qubit GHZ states to gauge scalability. The main advantages are its simplicity, reproducibility on free IBM Quantum hardware, and its suitability for entry-level experimentation and performance evaluation. Full article