Search Results (367)

Diagnosing hypermobility disorders and Ehlers-Danlos syndrome (EDS) in children is challenging due to overlapping features with generalized joint hypermobility (GJH) and the lack of biomarkers. Background/Objectives: This study aims to describe the clinical and genetic features of pediatric EDS patients and identify key comorbidities and correlations. Methods: This is a single-center observational study of patients under 18 diagnosed with suspicion of EDS (2018–2024) at a tertiary pediatric hospital. Diagnoses were made using 2017 criteria. Results: Forty-one patients (46% female; mean age 11.1 ± 2.8 years) were included. Based on 2017 criteria, 61% had hypermobile EDS (hEDS)/hypermobility spectrum disorder (HSD), 22% classical EDS, 7.3% vascular, and 9.7% other subtypes. Musculoskeletal (90.2%), cutaneous (68.3%), and psychiatric (56.1%) symptoms were most frequent. Significant associations included older age with psychiatric symptoms (p = 0.029), Beighton score with dislocations (p = 0.026), and less atrophic scarring in hEDS (p < 0.008). Genetic testing (73% performed) confirmed pathogenic variants (11 novel) in EDS with a known molecular cause. Conclusions: This study proposes a clinically guided approach and diagnostic algorithm for youth hypermobility, emphasizing precision medicine principles, while highlighting the urgent need for further research to identify hEDS biomarkers. Full article

Background/Objectives: This study aimed to evaluate myocardial scar burden and distribution, as well as other nuclear imaging parameters, in predicting cardiac resynchronization therapy (CRT) responses and long-term outcomes in patients selected for CRT with ischemic HF etiology. Methods: Seventy-one patients were prospectively included. They all had NYHA class II/III despite optimal medical therapy, LVEF ≤ 35%, wide QRS complexes, and ischemic HF etiology. All were indicated for de novo CRT implantation and underwent a SPECT MPI viability test prior to CRT implantation. Two-dimensional echocardiography was performed one day before CRT implantation and 6 months after the intervention. The follow-up examination was conducted six months after the CRT implantation and, after 5 years, patients underwent a telephone follow-up to assess survival. Results: Most patients (85%) were male, with an average age of 66.26 ± 9.25 yrs. SPECT MPI revealed large myocardial scars (44.53 ± 20.94%) with high summed rest scores (SRSs) of 25.02 ± 11.29 and low EFs of 26.67 ± 7.71%. At the 6-month follow-up, after the CRT implantation, the NYHA class significantly changed and 35% of the patients were classified as CRT responders. The only difference between responders and non-responders was in the SRS and myocardial scar size (p < 0.001). A scar size of 19.5% was an optimal cutoff for the prediction of CRT response (AUC 0.853, Sn 85% and 1-sp 94%). Conclusions: SPECT MPI parameters are valuable in predicting responses and long-term survival in patients with CRT. Patients with myocardial scars of less than 19.5% may be suited to CRT and experience better cardiovascular survival. Full article

Current treatment strategies for partial tendon tears often lack the capacity to promote true tissue regeneration and improve long-term clinical outcomes. This study tested the hypothesis that treatment of a partial defect in the rabbit common calcaneus tendon (CCT) with uncultured, unmodified, autologous, adipose-derived regenerative cells (UA-ADRCs) enables regenerative healing without scar formation. A full-thickness, 3 mm defect was produced in the midsubstance of the right gastrocnemius tendon, a component of the CCT, in adult female New Zealand white rabbits. Animals received either an injection of 28.3 × 10⁶ UA-ADRCs in 0.5 mL Ringer’s lactated solution (RLS) or saline, or RLS or saline alone as sham treatment. Tendons were analyzed 4 or 12 weeks post-treatment using histology, immunohistochemistry and non-destructive biomechanical testing. UA-ADRC-treated tendons showed newly formed connective tissue consistent with tendon regeneration, whereas sham-treated tendons developed scar tissue. Biomechanical testing showed significantly higher percent relaxation in UA-ADRC-treated tendons compared to sham controls (p < 0.05), indicating greater viscoelasticity characteristic of healthy or well-integrated tissue. Together, these findings suggest that UA-ADRC therapy may provide a regenerative, structure-modifying treatment for partial tendon tears. Full article

In this study, solid particle erosion tests were conducted to evaluate the resistance of AISI 4340 (EN24) and 8620 alloy steels against silicon carbide (SiC). These steels were selected due to their high hardness, yield strength (σ_y), ultimate tensile strength (σ_uts) and elongation (%), which are significant parameters, influencing wear resistance. An erosion rig based on the ASTM G76-95 standard was used to perform the testing. Tests were carried out using different impact angles, 30°, 45°, 60° and 90°, with a particle velocity of 24 ± 2 m/s. The abrasive flow rate was 0.7 ± 0.5 g/min and the temperature was between 35 °C and 40 °C. Characterization techniques such as SEM were employed to identify the chemical composition of AISI 4340 and AISI 8620 steels and optical microscopy to determine the morphology of SiC abrasive particles. In addition, the SiC particle size was between 350 and 450 µm; it was determined by the particle size distribution technique. SEM micrographs were obtained to classify the wear mechanisms, characterized by micro-cutting, micro-ploughing, grooves, pitting actions and embedded particles on the surface at 30° and 90°. The results showed that AISI 8620 steel exhibited higher erosion resistance than AISI 4340 steel. Finally, AFM was used to evaluate the roughness variations before and after erosion tests, specifically in the central zone of the wear scars at 30° and 90° for both materials. Full article

Burn wound infections remain a major clinical challenge due to delayed healing, scarring, and the risk of sepsis, especially when complicated by multidrug-resistant (MDR) Gram-negative pathogens and biofilm formation. Acellular dermal matrices (ADMs) are widely used in reconstructive and burn surgery, yet they lack intrinsic antimicrobial activity, necessitating their combination with topical agents. Background/Objectives: This study investigates the antimicrobial and cytocompatibility profiles of ADMs impregnated with various antimicrobial agents, using in vitro planktonic and biofilm burn wound models. While the incorporation of antimicrobials into scaffolds has been previously explored, this study is, to our knowledge, the first to directly compare seven clinically relevant antimicrobial agents after they were impregnated into an ADM in a standardized in vitro model. Methods: Seven topical antimicrobials were tested against MDR Pseudomonas aeruginosa and Acinetobacter baumannii from burn patients. Results: The ADM with 1% acetic acid (AA) showed superior antimicrobial activity, achieving > 7 log₁₀ reductions in planktonic assays and complete inhibition of P. aeruginosa biofilms. In NIH 3T3 fibroblast cytotoxicity assays, the 1% AA ADM maintained cell viability at control levels, indicating excellent biocompatibility. Compared with agents such as Betadine^®, Octenilin^®, and colistin, which showed cytotoxicity, and Prontosan^®, which showed low efficacy, 1% AA uniquely combined potent antibacterial effects with minimal toxicity. Conclusions: Among the seven antimicrobial agents impregnated into ADMs, 1% AA demonstrated a unique efficacy and safety profile, supporting its potential for clinical application in integrated wound dressings and implantable biomaterials for infection control in burn care. Full article

To promote the optimization of the anti-friction and anti-wear behavior of lightweight TiAl alloys, γ-TiAl-10 wt.% Ag self-lubricating composites were fabricated, and their mechanical and tribological properties were tested. The results showed that the silver in TiAl-10 wt.% Ag slightly reduced its mechanical properties compared with those of pure TiAl alloys. A silver-enriched lubrication film formed on a wear scar, which was helpful in improving the friction and wear behavior. It was found that a large amount of silver gathered at a wear scar, gradually spread out under the action of the sliding friction force, and then increased the silver distribution areas on the wear scar, leading to the good formation of a silver-rich film. Furthermore, an identification model was established to calculate the specific area η of the silver film. A quantitative relationship indicated that an increase in the Ag distribution area improved the tribological behavior of γ-TiAl-10 wt.% Ag. When the specific area η of a silver-rich film was maintained at 44–51%, the small friction coefficient (almost 0.28) and wear rate (about 2.25 × 10⁻⁴ mm³·N⁻¹·m⁻¹) were well stabilized. This provides a new research method to improve the tribological performance of TiAl-Ag samples. Full article

Ferritic stainless steels (FSSs) have attracted considerable attention due to their excellent corrosion resistance and significantly lower cost compared with nickel-bearing austenitic stainless steels. However, the high-temperature wear behavior of additively manufactured FSS 430 has not yet been thoroughly investigated. This study aims to examine the microstructural characteristics and wear properties of laser powder directed energy deposition (LP-DED) FSS 430 fabricated under varying laser powers and hatch distances. Wear testing was conducted at 25 °C and 300 °C after subjecting the samples to solution heat treating at 815 °C and 980 °C for 1 h, followed by forced fan cooling. For comparison, an AISI 430 commercial plate was also tested under the same test conditions. The microstructural evolution and worn surfaces were analyzed using SEM-EDS and EBSD techniques. The wear performance was evaluated based on the friction coefficients and cross-sectional profiles of wear tracks, including wear volume, maximum depth, and scar width. The average friction coefficients (AFCs) of the samples solution heat treated at 980 °C were higher than those treated at 815 °C. Additionally, the AFCs increased with hatch distance at both testing temperatures. A strong correlation was observed between Rockwell hardness and wear resistance, indicating that higher hardness generally results in improved wear performance. Full article

The development of multifunctional lubricant additives is critical for enhancing the performance and longevity of internal combustion engines. This study investigates the influence of oil additive, containing an atomic metal conditioner (AMC), a two-dimensional sliding agent, and a patented revitalizer on lubricating properties of engine oil 5W-30 and on surface wear characteristics. The experimental testing involved comparative tribological evaluation using the 4-ball test. Pure commercial engine oil (PEO) 5W-30 and oil mixed with the revitalizer additive (OMA) were used. The changes in friction torque (FTq), temperature, and wear scars were analyzed. FTq evolution showed a distinct behavior across the different test cases: PEO exhibited fluctuating FTq in the initial minute and thereafter, but its value was lower, and the wear scars were smaller compared to OMA. Long-duration tests revealed that OMA resulted in significantly larger wear scars, large FTq values, and less variations emerging later in the test. When switching from PEO (1 h) to OMA (1 h) mid-test, the wear increased compared to 2 h PEO. Across all conditions, oil temperature had a strong relationship with FTq. Although some frictional improvements were observed, no definitive evidence of revitalizer-induced surface regeneration was detected, suggesting adhesive wear remained predominant under the studied conditions. Full article

Background/Objectives: The aim of this study is to identify markers and develop a multifactorial model for characterizing extensive scar tissue after revascularization in patients with myocardial infarction (MI). Methods: A total of 123 patients with MI were examined. The patients underwent contrast-enhanced cardiac magnetic resonance imaging (MRI) with a 1.5 Tesla GE SIGNA Voyager (GE HealthCare, Chicago, IL, USA) on the 7th–10th days from the onset of the disease. At the first stage, we performed a comparative analysis and built a multifactorial model based on the examination results of 92 (75%) patients enrolled from April 2021 to October 2023. These patients formed the group used for model development, or the “modeling group”. The mass of the scar was calculated, including relative to the left ventricular (LV) myocardium mass (M_scar/LVMM, in %). Results: The first subgroup consisted of 36 (39%) patients with a large scar, denoted as “LS” (M_scar/LVMM > 20%). The second subgroup included 56 (61%) patients with a smaller scar, referred to as “SS” (M_scar/LVMM ≤ 20%). Logistic regression was used to identify independent factors affecting scar tissue size. A multifactorial model was created. This model predicts M_scar/LVMM > 20% on MRI. It uses readily available clinical parameters: high-sensitivity troponin I (HscTn I) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, and LV relative wall thickness (RWT). We tested the multifactorial model on the “modeling group” (n = 31). The sensitivity was 63.6% and the specificity was 85.7%. Conclusions: These indicates the feasibility of its application in clinical practice. Full article

Background: Urethral stricture disease involves fibrotic scarring that narrows the urethral lumen and can occur at any site. Sonourethrography (SUG) is increasingly used because it depicts both luminal anatomy and periurethral fibrosis, yet little is known about patient or lesion features that influence its diagnostic performance. Methods: We conducted a prospective single-center study of 170 men who underwent SUG before anterior urethroplasty between May 2016 and May 2021. Anthropometric data, comorbidities, and detailed ultrasonographic measurements were recorded and compared with intra-operative findings, which served as the reference standard. Accuracy was analyzed with Wald chi-square testing and Spearman correlation. Results: SUG length estimates matched intra-operative measurements in 139/170 strictures (81.8%). Length accuracy was higher in patients ≥ 60 years (89.2% vs. 77.0%, p = 0.03) and in those with type 2 diabetes (92.3% vs. 80.9%, p = 0.02) in conditions associated with pronounced spongiofibrosis that enhances echo contrast. Among stricture-specific factors, proximal location (63.6% vs. 84.5%, p = 0.01) and complete luminal occlusion (68.8% vs. 84.8%, p = 0.02) reduced precision, largely because deeper anatomy and absent saline flow hinder acoustic delineation. The Chiou ultrasonographic grade was the strongest determinant of performance; higher grades yielded clearer margins and better length estimation (p < 0.001). Conclusions: SUG is a reliable bedside technique for assessing anterior urethral strictures, but its accuracy varies with age, diabetes status, stricture site, degree of occlusion, and fibrosis grade. Recognizing these determinants allows clinicians to judge when SUG alone is sufficient and when complementary imaging or heightened caution is warranted. The findings support tailored imaging protocols and underscore the need for multi-center studies that include operators with diverse experience to confirm generalisability. Full article

Background/Objectives: Tl-201 myocardial perfusion single-photon emission computed tomography (MPS) is a minimally invasive test for patients with suspected coronary artery disease (CAD). While its predictive and prognostic values are well established, diagnostic performance varies. A recent meta-analysis reported that the sensitivity and specificity of MPS range from 48.8 to 100% and 46.7 to 94.7%, respectively, reflecting discordance between CAG. Little is known, however, about the influence of patients’ characteristics and CAD risk factors on the diagnostic performance of MPS. This study aims to evaluate these factors in relation to MPS performance. Methods: We screened 4817 consecutive patients referred to our Nuclear Medicine Department in 2015 for Tl-201 MPS. Patients with clinically suspected ischemic heart disease who underwent CAG within 60 days post-MPS were included in the present analysis. The percentage of agreement/disagreement between the MPS-abnormal/normal and CAG-positive/negative groups was evaluated. Additionally, patient characteristics, CAD risk factors, co-morbidities, and single-photon emission computed tomography (SPECT) image-derived parameters were compared among the patients. Results: Among 635 patients with abnormal MPS, 583 had coronary stenosis. For the 52 without stenosis, causes included non-obstructive CAD (34.6%), prior infarction with scarring (32.7%), and imaging artifacts (32.7%). Significant stenosis was associated with older age, male sex, diabetes, dyslipidemia, CKD, and prior PCI, while hypertension and higher BMI were more common in insignificant CAD. Among 104 patients with normal MPS, 79 had stenosis, mainly in the LAD. Clinical risk factors were more prevalent in patients with any degree of stenosis. Conclusions: In patients with an abnormal MPS, the incorporation of visual interpretation, parameters, and CAD risk factors increases specificity and helps differentiate obstructive from non-obstructive CAD. Full article

Short- and long-term hand function was evaluated in adult patients with deep dermal and full-thickness hand burns after treatment with enzymatic debridement (NexoBrid^® MediWound Ltd., Yavne, Israel), assessing the results at discharge and 3, 6, and 12 months post-burn. This prospective cohort study was performed in the Burn Center in Beverwijk between March 2017 and December 2019. Hand function was assessed using Modified Kapandji Index scores, the Jebsen-Taylor Hand Function Test, and range of motion; scar quality using the Patient and Observer Scar Assessment Scale version 2.0; and quality of life using the Quick Disability Arm Shoulder Hand Questionnaire and the Canadian Occupational Performance Measure. Ten patients (14 hand burns) were included. The need for a skin graft after NexoBrid^® was 86%, and 50% needed additional surgical excision before skin grafting. Digits 3 and 4 achieved near-to-normal total active motion, and at least 50% of the hands achieved a normal range within the Jebsen-Taylor Hand Function Test in four items at 12 months post-burn. Scar quality and quality of life improved significantly over time. The present study can be considered as a proof-of-concept study for future clinical trials on enzymatic debridement for hand burns. Full article

As acne scars remain challenging to treat, this study compared the safety and efficacy of two laser modalities for acne scar treatment. Between 2022 and 2024, 88 patients were treated for acne scars using either the Hybrid platform with the ProScan applicator, which delivers fractional ablative carbon dioxide (CO₂) 10,600 nm and non-ablative 1570 nm wavelengths in a dual mode, or the Pixel CO₂ laser with the LiteScan applicator, which delivers a fractional ablative CO₂ 10,600 nm wavelength alone. Clinical efficacy was assessed using the Echelle d’Evaluation Clinique des Cicatrices D’Acne (ECCA) scale. Both groups showed significant improvements in ECCA scores post-treatment (p < 0.001, Wilcoxon signed-rank test). However, the percentage change in scores from baseline to post-treatment did not differ significantly between the groups (p > 0.05, Wilcoxon rank-sum test). Adverse effects were mild and transient, resolving within a few days, with no significant differences between the groups (p > 0.05, chi-squared test). Both laser modalities demonstrated high efficacy and safety in treating acne scars, with significant post-treatment improvement in scar severity. Full article

Background/Objectives: Acne vulgaris is a chronic skin infection characterized by high sebum secretion, keratosis around hair follicles, inflammation, and imbalance in androgen levels. Acne vulgaris causes permanent scars or skin pigmentation in cases of improper treatment. Oral or topical isotretinoin, contraceptives, and antibiotics are used to treat acne. Minocycline is one of the widely used tetracyclines for this purpose; it inhibits the synthesis of proteins in bacterial ribosomes. Commonly, minocycline is prescribed daily for several months for acne vulgaris. Systemic minocycline is highly distributed into body fluids, and it is associated with several side effects and antibiotic resistance. Additionally, minocycline is highly metabolized in the liver, leading to reduced bioavailability upon systemic delivery. This study aims to develop and characterize minocycline nanocrystals for targeted skin delivery and evaluate their antimicrobial efficacy in treating acne vulgaris. Methods: Minocycline nanocrystals were synthesized using milling or solvent evaporation techniques. Nanocrystals were characterized in terms of particle size, particle distribution index (PDI), zeta potential, and morphology. The antibacterial efficacy against Propionibacterium acne, Staphylococcus aureus, and Staphylococcus epidermidis was evaluated using a minimum inhibitory concentration assay (MIC) and agar well diffusion test in comparison to coarse minocycline. Results: Minocycline nanocrystals had a particle size of 147.4 ± 7.8 nm and 0.27 ± 0.017 of PDI. The nanocrystals exhibited a loading efficiency of 86.19 ± 16.7%. Antimicrobial testing showed no significant difference in activity between minocycline and its nanoparticle formulation. In terms of skin deposition, the nanocrystals were able to deliver minocycline topically to rat skin significantly more than free minocycline. The nanocrystal solution deposited 554.56 ± 24.13 μg of minocycline into rat skin, whereas free minocycline solution deposited 373.99 ± 23.32 μg. Conclusions: Minocycline nanocrystals represent a promising strategy for targeted skin delivery in the treatment of acne vulgaris, potentially reducing systemic side effects and antibiotic resistance and improving patient outcomes. Full article

Background and Objectives: The transoral endoscopic thyroidectomy-vestibular approach (TOETVA) and parathyroidectomy-vestibular approach (TOEPVA) are scar-free alternatives to conventional surgery but are classified as clean-contaminated due to the oral incision, raising concerns about surgical site infections (SSIs). This study evaluates whether perioperative antibiotic prophylaxis (pABX) alone is sufficient compared to extended antibiotic prophylaxis (eABX) in preventing SSIs in TOET/PVA, particularly considering the surgical learning curve. Materials and Methods: A retrospective study analyzed 162 patients undergoing TOET/PVA at a single center from January 2018 to June 2024. Patients were divided into two groups: 82 received eABX (intravenous cefazolin preoperatively plus 7 days of oral amoxicillin/clavulanate), and 80 received pABX alone (intravenous cefazolin). The inclusion criteria included complete postoperative hemogram and C-reactive protein (CRP) records; exclusions comprised other surgical approaches or missing data. Outcomes included postoperative white blood cell (WBC) count, CRP levels, and complications (seroma, cellulitis, and flap perforation), defined using Centers for Disease Control and Prevention (CDC) guidelines. The statistical analysis comprised t-tests, chi-square tests, and logistic regression, adjusting for confounders like age and sex. Results: The postoperative WBC and CRP levels were significantly higher in the pABX group (p = 0.001), but all values remained within the laboratory normal limits. Complications were observed in 14 patients: seroma in 11, cellulitis in 2, and flap perforation in 1. Complications occurred more frequently in the eABX group but without statistical significance (p = 0.103). The duration of surgery was longer in the eABX group (117.93 ± 52.35 vs. 72.44 ± 22.54 min, p = 0.001) and was an independent predictor of complications (OR = 1.018, 95% CI: 1.006–1.031, p = 0.004). Conclusions: Perioperative antibiotic prophylaxis alone does not increase the risk of SSIs compared to extended prophylaxis in TOETVA. However, eABX may be prudent during the learning curve due to longer operative times and higher complication risks. Future prospective, randomized trials are needed to standardize prophylaxis regimens. Full article