Search Results (122)

The work of anesthesiologists–intensivists, critical care specialists, and medical emergency teams is multifaceted and complex, with airway management representing a cornerstone and a common denominator of many procedures and interventions. Tracheal intubation has represented and still represents today the gold standard for airway control. This narrative review, conducted through a comprehensive search of PubMed/MEDLINE, EMBASE, and the Cochrane Library from database inception to December 2025 and supplemented by manual reference searches and retrieval of key historical sources, aims to trace the evolution of laryngoscopy for airway management and tracheal intubation—from its nineteenth-century origins to the current state of the art—while simultaneously addressing the clinical, educational, and safety implications of this evolution. Laryngoscopy evolution progressed in parallel with technological development and innovation, resulting in the expansion of clinical possibilities and in the improvement of patient safety. The evolution of laryngoscopy essentially took place between the late 1800s and the first half of the 1900s, culminating in the widespread adoption of the Macintosh laryngoscope. Almost 50 years later, a pivotal turning point occurred around the 2000s with the introduction of videolaryngoscopes. Along this path, the devices that succeeded one another introduced new problems, driving the search for new solutions. At present, tracheal intubation with videolaryngoscopy has achieved success and safety standards substantially superior to those of the early days of the technique. In this review we retrace the historical milestones of laryngoscopy, analyze the problems that emerged over time with various devices and the solutions adopted, examine the evolution of videolaryngoscopes and the impact of these devices on both technical and non-technical skills, discuss the ongoing debate surrounding their routine use (universal videolaryngoscopy) and the selection of optimal adjunct devices, and outline the emerging role of artificial intelligence in improving success rates and facilitating the learning curve. This journey, after 150 years of evolution, has reached a high level of maturity in terms of safety and efficacy. Full article

To address prevalent industrial challenges, including the high cost of fabricating microstructures via photolithography and 3D printing, impurity residues easily generated by conventional physical/chemical pore-forming techniques, and the limited sensitivity of regular capacitive sensors, this paper innovatively proposes an integrated low-temperature in situ gas foaming strategy using ammonium bicarbonate for the fabrication of porous TPU-based ionic gels. Relying on the complete gaseous decomposition property of ammonium bicarbonate upon heating, a three-dimensionally interconnected continuous porous network is spontaneously constructed inside the polymer matrix. Thermoplastic polyurethane (TPU) is selected as the continuous polymer phase, and [EMIM][TFSI] imidazolium ionic liquid is blended as the ion source to synthesize composite ionic gel substrates. A PDMS composite slurry filled with graphene is employed to prepare flexible substrates, followed by low-temperature oxygen plasma surface modification to introduce polar functional groups such as hydroxyl and carboxyl onto electrode surfaces. A standard sandwich-structured ionic pressure sensor with the configuration of “top modified electrode—porous ionic gel dielectric layer—bottom modified electrode” is finally assembled. The porous framework and modified electrodes constitute a dual synergistic enhancement system: the porous structure markedly reduces the equivalent elastic modulus of the gel and improves its compressive deformation capacity; polar-modified electrodes optimize the interfacial compatibility between electrodes and gels, shorten ion migration paths and lower interfacial contact resistance. Systematic calibration of multiple batches of parallel samples reveals that the as-fabricated sensor achieves a high sensitivity of 25.3 kPa⁻¹ across the full measuring range from 0 to 1000 kPa with a linear fitting coefficient R² = 0.992. The loading response time and unloading recovery time of the device are 60 ms and 80 ms respectively, with a performance degradation of less than 3% after 1000 consecutive loading–unloading cycles, featuring low hysteresis error and excellent signal repeatability. Multi-scenario in vivo wearable tests on human subjects verify that the device can precisely capture subtle fluctuations of radial artery pulse and periodic laryngeal deformation during swallowing, distinguish characteristic waveform patterns of various English words according to differences in vocal cord vibration, and accurately detect bending motions when attached to finger joints. The entire fabrication process adopts common chemical raw materials and standard laboratory equipment without expensive micro-nano processing facilities, featuring convenient raw material procurement and high process fault tolerance, which enables large-area coating-based mass production. This work delivers a novel technical route for the low-cost large-scale production of high-performance ionic flexible sensors and bears significant industrialization reference value for applications in wearable medical monitoring, bionic robotic electronic skin, flexible human–machine interactive touch panels and other related fields. Full article

Designing an optimal digital pathology workspace is essential to ensure diagnostic accuracy and safeguard the long-term well-being of pathologists. While digital pathology improves reproducibility, facilitates multidisciplinary collaboration, and supports data-driven precision medicine, its clinical effectiveness depends not only on computational performance but also on the physical and ergonomic environment in which pathologists operate. Inadequate workstation design may impair visual perception, increase cognitive and musculoskeletal strain, and potentially affect diagnostic consistency. Moreover, the progressive integration of artificial intelligence (AI) into routine diagnostics introduces additional requirements related to display performance, visualization interfaces, and human–machine interaction. Despite the rapid global adoption of digital pathology systems, standardized recommendations addressing ergonomic, environmental, and technological aspects of the digital workspace remain limited. In this work, we propose a clinically oriented framework for the design of digital pathology workspaces suitable for AI-assisted diagnostics. Key elements include the selection and calibration of medical-grade displays, ergonomic furniture and input devices, optimized ambient lighting conditions, and institutional quality assurance procedures. Emerging developments, such as intelligent ergonomic monitoring, advanced visualization interfaces, and adaptive AI-assisted workflows, may further support safe, sustainable, and high-performance digital diagnostic environments. Full article

Polymers are increasingly used as structural materials in medical devices due to their lightweight, chemical resistance, and electrical insulation properties. High-density polyethylene (HDPE) is widely applied; however, the fabrication of large or thick components often requires extrusion welding. Since joint performance directly affects structural reliability, controlling welding quality is essential. In this study, the effects of preheating conditions on the mechanical performance of HDPE extrusion-welded joints were systematically investigated. Preheating temperature and hot-air movement speed were selected as key variables, and their influence on tensile, flexural, and elongation properties was evaluated experimentally. The results provide insight into the role of preheating in weld quality and offer guidance for process optimization in medical device applications. Full article

Hypertension is a leading risk factor for cardiovascular morbidity and mortality. Despite the availability of effective medications and lifestyle interventions, blood pressure control rates remain poor globally, and the prevalence of hypertension continues to rise. In 2023, the US Food and Drug Administration approved renal denervation—a catheter-based procedure that ablates the renal sympathetic nerves—as an adjunctive treatment for patients with uncontrolled or resistant hypertension, defined as blood pressure above goal despite the use of at least three antihypertensive medications, including a diuretic at maximally tolerated doses. Both radiofrequency and ultrasound-based devices are approved for this procedure. However, individual patient responses vary, and further research is needed to clarify long-term efficacy, safety, and optimal patient selection. The number of trained proceduralists and access to facilities is increasing, but multidisciplinary teams and shared decision-making are recommended to ensure appropriate referrals and patient education. In this review, we discuss the pathophysiology of hypertension and approaches to treatment, review the history of renal denervation and the data on which FDA approval was based, detail the safety profile of commercially available devices, and provide a practical, team-based approach to appropriate patient selection. Full article

The advent of robotic surgery has revolutionized multiple medical fields, notably in urology, gynecology, and both general and cardiovascular surgery. This article aims to explore the journey of robotic-assisted surgery (multi/single-port) in abdomen and pelvic surgeries, tracing its historical roots, examining its current landscape, and considering the potential future impact. A comprehensive review of the literature was conducted through PubMed/MEDLINE, utilizing keywords such as “robotic surgical systems,” “robotic surgery devices,” and “robotics AND urology.” Reference lists from selected articles were also explored to ensure a broad scope of understanding. The focus was on robotic systems designed for laparoscopic urological surgeries, all of which have been granted regulatory approval for clinical use. The historical trajectory of robotic surgery is traced back to the late 1980s with early systems like the Probot^®, preceding the transformative introduction of the daVinci^® system in the early 2000s. In addition to daVinci^®, the article introduces newer robotic platforms, including Senhance^®, Revo-I^®, Versius^®, Avatera^®, Hinotori^®, Edge^®, Shurui and HugoTM RAS, which are emerging as serious competitors. While daVinci^® has been the dominant force in robotic surgery for over a decade, these new systems are making significant strides with innovative designs, enhanced precision, and improved cost-efficiency. The growing competition among these platforms promises to expand their potential applications, increase accessibility, and optimize surgical outcomes across various specialties. Furthermore, as new technologies continue to evolve, there is a clear need for more extensive clinical trials and real-world data to assess their long-term impact on surgical practices, healthcare delivery, and patient outcomes. It remains to be seen how these advanced systems will integrate into healthcare infrastructures and their ultimate role in shaping the future of minimally invasive surgery. Full article

Background/Objectives: Nipple-sparing mastectomy with immediate reconstruction is a preferred option for selected patients undergoing prophylactic or therapeutic mastectomy. Optimizing postoperative wound care is essential to support healing, preserve the nipple–areola complex, and prevent delays in oncologic treatments. This retrospective observational study aimed to evaluate the clinical outcomes associated with the use of the NovoX^® Cup medical device in post-NSM surgical wound management, assessing clinical–surgical outcomes and quality of life (QoL). Methods: We conducted a retrospective observational study on 54 patients who underwent NSM with immediate reconstruction at AOUI Verona between January 2025 and January 2026; Novox^® Cup was applied intraoperatively and changed every 48 h according to protocol. Surgeon-reported outcomes were assessed by the skin flap viability scale and the complications by Clavien–Dindo classification. Patient-reported outcomes were assessed via the Wound-QoL17 questionnaire at 7, 30, and 90 days. Clinical outcomes were supported by photographic documentation. Results: Mean age was 51.5 years; BMI averaged 23.9 kg/m². Local complications occurred in 30.4% of cases (infections 12%, dehiscence 10%, seromas 4%). Mean healing time was 15 days, with 87.4% of patients having drains removed by day 14. One patient required surgical revision, and one (1.8%) experienced delayed adjuvant therapy. Wound-QoL17 responses showed minimal discomfort and high satisfaction. Clinical evaluation revealed favorable wound appearance and preserved NAC perfusion within 48 h. Conclusions: Novox^® Cup appears effective in supporting wound healing and NAC preservation after NSM, with high patient satisfaction and minimal treatment delays. Its integration into postoperative care may enhance outcomes and maintain oncologic timelines. Full article

Urinary stone disease is common, recurrent, and increasingly managed through imaging-driven pathways, yet standard-dose CT of the kidneys, ureters, and bladder (CT KUB) raises concerns about cumulative radiation exposure and the limited use of quantitative imaging information for risk stratification. This review synthesizes contemporary evidence on dose-optimized CT, advanced spectral technologies, and artificial intelligence (AI)-enabled analytics that are reshaping diagnosis, treatment selection, and triage. This review summarizes data supporting low-dose and ultra-low-dose CT protocols that preserve diagnostic accuracy while substantially reducing dose, and discusses how dual-energy CT, photon-counting CT, and radiomics facilitate noninvasive stone characterization and extraction of imaging biomarkers beyond size and location. It also reviews AI approaches for automated detection, segmentation, and volumetric quantification across CT, KUB, and ultrasounds, highlighting their potential to standardize stone-burden metrics. It further examines predictive models, including logistic regression, nomograms, and machine learning, for perioperative infectious complications, emergency department admission or intervention, procedure success, and long-term recurrence, and outlines reporting and validation frameworks and implementation considerations, including software as a medical device regulation and human oversight. In contrast to prior reviews that consider imaging and AI separately, this review integrates dose reduction, spectral characterization, and AI-driven analytics within real-world clinical pathways to distinguish established clinical applications from those that remain investigational. Integrating advanced CT and AI outputs into well-validated prediction models embedded in real-world workflows may enable safer imaging, more consistent triage, and more personalized follow-up for urinary stone disease. Full article

Background: The aim of this study was to evaluate treatment satisfaction and decision regret in patients undergoing minimally invasive surgical therapies (MISTs) for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Materials and Methods: We analyzed prospectively collected data from consecutive patients undergoing MISTs across five Italian primary care urology centers. All patients underwent a comprehensive clinical assessment, including detailed medical history and physical examination. Preoperative, perioperative, and postoperative variables were recorded. Decision regret was assessed using validated questionnaires, with significant regret defined as a score >25%. Results: A total of 155 patients were included, with a median age of 64 years (IQR 58–66) and a median IPSS of 23 (IQR 18–26). Among them, 90 patients (51%) underwent Aquablation, 21 (12%) received a temporary implantable nitinol device (iTIND), 26 (15%) underwent water vapor thermal therapy (WVTT), and 37 (21%) were treated with prostatic urethral lift (PUL). The overall median decision regret score was 0 (IQR 0–15), with 23 patients (15%) reporting significant regret (>25%). Higher regret rates were observed in patients treated with PUL and WVTT compared to those undergoing iTIND and Aquablation. None of the evaluated variables—including age, BMI, prostate volume, preoperative Qmax, or preoperative IPSS—were significantly associated with treatment regret. However, although not reaching statistical significance, a prostate volume >60 cc was associated with higher regret in patients undergoing WVTT (OR = 3.33) and PUL (OR = 4.2). Conclusions: Among patients undergoing MISTs, treatment regret is not negligible and appears higher when patient selection is suboptimal. Larger studies are warranted to better identify predictors of decision regret and optimize patient selection for these procedures. Full article

Carotid artery stenosis remains a major cause of ischemic stroke worldwide, and its management continues to evolve in parallel with advances in surgical, endovascular, and medical therapies. Carotid endarterectomy (CEA) was established as the standard of care for symptomatic high-grade stenosis following landmark randomized trials, while carotid artery stenting (CAS) subsequently emerged as a less invasive alternative for appropriately selected patients. This review aims to summarize the historical evolution of carotid artery stenting, critically appraise evidence from major clinical trials comparing CAS and CEA, and examine contemporary practice patterns in the era of intensive medical therapy. A comprehensive review of randomized trials, registries, guideline statements, and recent literature was performed to synthesize current evidence regarding procedural outcomes, patient selection, and emerging technologies, including transcarotid artery revascularization (TCAR). Large, randomized trials have demonstrated comparable long-term composite outcomes between CAS and CEA in selected patients, although peri-procedural risk profiles differ, with higher stroke risk observed after CAS and higher myocardial infarction rates after CEA. Technological advancements in embolic protection devices, stent platforms, and alternative access strategies have further refined endovascular approaches. Concurrently, improvements in intensive medical therapy—including lipid-lowering, antiplatelet therapy, blood pressure control, smoking cessation, and lifestyle modification—have substantially reduced overall stroke risk, particularly in asymptomatic patients. In the contemporary era, optimal stroke prevention requires individualized, multidisciplinary decision-making that integrates symptom status, anatomical complexity, comorbid conditions, procedural expertise, and sustained long-term vascular risk factor management following revascularization. Full article

Degenerative mitral stenosis (MS) secondary to extensive mitral annular calcification (MAC) represents a growing clinical challenge in an aging population. These patients are often elderly, frail, and harbor a significant burden of comorbidities, rendering conventional mitral valve surgery prohibitively high-risk. While transcatheter mitral valve replacement (TMVR) has emerged as a potential alternative, the current evidence is only derived from single-arm observational registries. Therefore, the transition toward randomized controlled trials to define optimal patient selection and long-term prosthetic durability is necessary. This review examines the current landscape of TMVR for degenerative MS, focusing on the role of multimodal pre-procedural planning, procedural technique, and prevention of the principal complications. The integration of echocardiography and multi-slice computed tomography (MSCT) is essential for evaluating anatomical feasibility, particularly in predicting neo left ventricle outflow tract (neo-LVOT) obstruction, the primary determinant of procedural mortality. However, it is limited due to the absence of standardized protocol. We are showing the outcomes of off-label balloon-expandable aortic prostheses and dedicated TMVR system, which are the only two devices which data in patients with MS are available. Despite high technical success rates in specialized centers, complications, including paravalvular leak, valve thrombosis, and device migration, remain more prevalent than in aortic interventions. We present some tips and tricks to prevent and manage adverse events. TMVR represents a transformative frontier for inoperable patients with severe MAC. However, its routine clinical adoption requires further refinement of dedicated technologies and standardized imaging protocols to improve safety and bridge the gap between palliative medical therapy and definitive intervention. Full article

Biocompatible thin films are essential for advancing biomedical devices, as they enhance integration with biological tissues, improve device longevity, and reduce complications. The rapid evolution of both medical needs and materials science has led to a diverse array of deposition techniques, each offering unique advantages and challenges for tailoring surface properties without compromising the bulk characteristics of implants and sensors. While laser-based methods—such as pulsed laser deposition (PLD) and Matrix-Assisted Pulsed Laser Evaporation (MAPLE)—are renowned for their precision, ability to preserve complex material stoichiometry, and suitability for low-temperature processing, the broader landscape includes several other important approaches. Physical Vapor Deposition (PVD) techniques, including magnetron sputtering and pulsed electron deposition, are widely used for their ability to create uniform, adherent coatings with controlled thickness and composition, making them suitable for both hard and soft biomedical substrates. Chemical Vapor Deposition (CVD) and its plasma-enhanced variant (PECVD) offer conformal coatings and excellent control over film chemistry, which is particularly valuable for functional polymer and ceramic films. Other methods, such as sol–gel processing, ion beam deposition, and electrophoretic deposition, provide additional flexibility in terms of coating composition, adhesion, and processing temperature, allowing for the fabrication of films with tailored mechanical, chemical, and biological properties. Despite these advances, the field faces ongoing challenges in optimizing film properties for specific clinical applications, ensuring reproducibility, and scaling up production for widespread use. The necessity of this review lies in its comprehensive comparison of laser-based techniques with alternative deposition methods, providing critical insights into their respective strengths, limitations, and suitability for different biomedical scenarios. By synthesizing recent developments and highlighting current gaps, this review aims to guide researchers and clinicians in selecting the most appropriate thin-film deposition strategies to meet the evolving demands of next-generation biomedical devices. Full article

Circular economy (CE) decouples value creation from virgin resource use and waste in the medical device sector, which faces stringent patient-safety, quality, and regulatory obligations. Green Additive Manufacturing (AM) offers a precise, digitally driven route to implement CE through dematerialization, on-demand localized production, topology optimization, and material circularity. In this study, a comprehensive CE framework is tailored to medical device manufacturing that integrates eco-design, material circularity, remanufacturing, and regulatory compliance across the product life cycle. Methods include an International Organization for Standardization (ISO) 14040/44-aligned life cycle assessment, process energy metering, sterilization-compatibility studies, mechanical/biocompatibility verification to relevant standards, and a techno-economic/circularity analysis with Monte Carlo uncertainty quantification. Three case studies are explored using bio-based PA11 (selective laser sintering), recycled polyethylene terephthalate glycol (fused deposition modeling), and low-volatile organic carbon biocompatible photopolymer (stereolithography): (1) a patient-specific wrist orthosis, (2) a dental surgical guide, and (3) a single-use catheter Y-connector. Results indicate 38–68% reductions in embodied greenhouse-gas emissions, 22–54% energy savings per functional unit, and up to 80% mass recapture through in-process powder/runner reuse while maintaining clinical performance and regulatory conformity. Design-for-circularity patterns (DfC) were created for DfDisassembly, DfSter, DfTraceability, DfUpgrade, and DfPowder-Loop and provide a governance architecture combining ISO 13485 QMS, ISO 10993 biological evaluation, the European Union’s Medical Device Regulation (Regulation (EU) 2017/745), and the United States Food and Drug Administration’s guidance on Additive Manufactured (3D-printed) medical devices, guidance with unique device identification for closed-loop returns. The paper concludes with an Industry 5.0 roadmap for hospital-proximate micro-factories, materials passports, and digital product passports enabling verified circular flows at scale. Full article

3D-printed hand exoskeletons are important because they enable the creation of affordable, lightweight, and highly customizable assistive and rehabilitation devices tailored to individual patient needs. Their rapid production and design flexibility accelerate innovation, improve access to therapies, and accelerate functional recovery for people with hand impairments. This article discusses the development of a hand exoskeleton using advanced additive manufacturing. It highlights how Industry 4.0 principles such as digital design, automation, and smart manufacturing enable precise prototyping and efficient use of materials. Moving on to Industry 5.0, the study highlights the role of human–machine collaboration, where customization and ergonomics are prioritized to ensure user comfort and rehabilitation effectiveness. The integration of AI-based generative design and digital twins (DTs) is explored as a path to Industry 6.0, where adaptive and self-optimizing systems support continuous improvement. The perspective of personal experience provides insight into practical challenges, including material selection, printing accuracy, and wearability. The results show how technological optimization can be used to reduce costs, improves efficiency and sustainability, and accelerates the personalization of medical devices. The article shows how evolving industrial paradigms are driving the design, manufacture, and refinement of 3D-printed hand exoskeletons, combining technological innovation with human-centered outcomes. Full article

This paper proposes an efficient and automated smart healthcare communication framework that integrates a two-level filtering scheme with a multi-objective Genetic Algorithm (GA) to enhance the reliability, timeliness, and energy efficiency of Internet of Medical Things (IoMT) systems. In the first stage, physiological signals collected from heterogeneous sensors (e.g., blood pressure, glucose level, ECG, patient movement, and ambient temperature) were pre-processed using an adaptive least-mean-square (LMS) filter to suppress noise and motion artifacts, thereby improving signal quality prior to analysis. In the second stage, a GA-based optimization engine selects optimal routing paths and transmission parameters by jointly considering end-to-end delay, Signal-to-Noise Ratio (SNR), energy consumption, and packet loss ratio (PLR). The two-level filtering strategy, i.e., LMS, ensures that only denoised and high-priority records are forwarded for more processing, enabling timely delivery for supporting the downstream clinical network by optimizing the communication. The proposed mechanism is evaluated via extensive simulations involving 30–100 devices and multiple generations and is benchmarked against two existing smart healthcare schemes. The results demonstrate that the integrated GA and filtering approach significantly reduces end-to-end delay by 10%, as well as communication latency and energy consumption, while improving the packet delivery ratio by approximately 15%, as well as throughput, SNR, and overall Quality of Service (QoS) by up to 98%. These findings indicate that the proposed framework provides a scalable and intelligent communication backbone for early disease detection, continuous monitoring, and timely intervention in smart healthcare environments. Full article