Search Results (220)

Background: Sortilin (SORT1), linked to the 1p13.3 coronary risk locus, is implicated in lipid trafficking and atherogenesis; however, clinical studies of circulating SORT1 have produced inconsistent results. We evaluated whether circulating SORT1 is associated with angiographic burden and lesion localization in patients with premature or early clinical debut coronary atherosclerosis. Methods: This single-center, cross-sectional study analyzed a dataset collected from January to May 2023. Participants were classified as coronary atherosclerosis cases if the dataset contained an age of clinical debut of clinically significant atherosclerosis (n = 101). Controls had no recorded debut age and 0% stenosis in all assessed coronary segments (n = 27). Blood was collected in clot activator tubes; serum was stored at −40 °C until analysis. SORT1 (ng/mL) was measured using an Aviscera Bioscience ELISA. Coronary stenoses were recorded as percent diameter stenosis for left main (LM), proximal/mid/distal LAD, proximal/mid/distal LCx, and proximal/mid/distal RCA. Burden metrics included the number of segments with any stenosis (>0%), the number of obstructive segments (≥50%), the number of diseased vessels, and maximum stenosis. The prespecified primary endpoint was obstructive proximal LAD stenosis (≥50%). Nonparametric tests and Spearman correlations were used. Logistic regression evaluated the association between log2-transformed SORT1 and proximal LAD obstruction, adjusted for age, sex, LDL-C, statin use, and smoking/diabetes/hypertension durations. Results: SORT1 was higher in cases than controls (8.60 [2.60–17.10] vs. 2.30 [1.25–10.65] ng/mL; p = 0.0058). Within cases, SORT1 did not correlate with global angiographic burden (any-stenosis segments: ρ = −0.066, p = 0.513; obstructive segments: ρ = −0.060, p = 0.552; diseased vessels: ρ = −0.045, p = 0.652; maximum stenosis: ρ = −0.084, p = 0.403). Obstructive proximal LAD stenosis occurred in 44/101 (43.6%) and was associated with higher SORT1 (12.25 [4.18–17.45] vs. 4.10 [2.20–11.60] ng/mL; p = 0.0093). Each doubling of SORT1 was independently associated with proximal LAD obstruction (adjusted OR 1.48, 95% CI 1.12–1.95; p = 0.005). Conclusions: In this cross-sectional cohort, circulating SORT1 was associated with obstructive proximal LAD stenosis but not with global angiographic burden metrics. These findings are hypothesis-generating and warrant validation in independent cohorts with standardized preanalytics and prospective designs to assess temporal relationships and clinical utility. Full article

Background and Objectives: De Quervain tenosynovitis (DQT) is a stenosing overuse condition of the synovial sheath of the first extensor compartment of the wrist. Open surgical release of the first dorsal compartment remains a standard intervention for DQT when conservative treatments fail. This systematic review evaluated the comparative efficacy of transverse versus longitudinal skin incisions for open release of the first dorsal compartment in DQT. Materials and Methods: Four studies with 259 patients were included in the review. Data from 17 patients were unavailable due to loss to follow-up; therefore, 243 wrists (242 patients) were included in the quantitative analysis. The transverse incision group consisted of 114 cases, and the longitudinal incision group of 129 cases. The primary outcome of the review was the incision-related incidence of injuries to adjacent anatomical structures, including injuries to the superficial branch of the radial nerve (SBRN), tendon injuries, and vein injuries. Secondary outcomes included hypertrophic scar formation, wound infection, and postoperative changes in pain severity measured using a visual analog scale (VAS). Results: Although there was a lower rate of SBRN injury in the longitudinal group (5.4% vs. 7% in the transverse group), the difference did not meet statistical significance (OR = 2.17; 95% CI, 0.39–11.99; p = 0.37; I² = 30%). Similarly, there was no significant difference in the risk of vein injury (RD = 0.06; 95% CI, −0.03 to 0.14; p = 0.21; I² = 61%), hypertrophic scar formation (OR = 1.39; 95% CI, 0.32 to 6.04; p = 0.66; I² = 35%), and wound infection (RD = 0.00; 95% CI, −0.03 to 0.03; p = 0.93; I² = 0%). Although both approaches resulted in significant pain improvement, no statistically significant difference in postoperative pain was observed between incision types, as assessed by the VAS for pain (mean difference = 0.30; 95% CI, −0.70 to 1.30; p = 0.56; I² = 43%). Conclusions: No significant differences were identified between incision techniques for DQT in terms of complication rates and postoperative pain outcomes. However, the available evidence is limited, and future high-quality trials are necessary to determine any clinically meaningful difference. Therefore, incision selection should be individualized based on surgeon preference, patient-specific anatomy, and procedural complexity. Despite the technique used, meticulous surgical technique is essential to prevent postoperative complications. Full article

Background/Objectives: Fontan pathway obstructions are a common complication during long-term follow-up after Fontan surgery. The clinical or hemodynamic benefit of percutaneous treatment of Fontan stenoses is poorly understood. In this study we analyzed the feasibility and clinical effects of percutaneous treatment of Fontan pathway obstructions. Methods: From April 2019 to December 2024 35 Fontan patients received percutaneous treatment of Fontan pathway obstructions by stent implantation. Indications for treatment included clinical signs of lower venous congestion or PLE and/or a moderate-to-severe morphologic pathway stenosis independent of clinical sequelae. Median follow-up time after the intervention was 1.5 years [IQR 0.7; 2.2]. Results: Median patient age was 20.3 years [IQR 16.3; 26.8]. Interventional success was defined as a significant increase in median indexed Fontan conduit cross sectional area and was achieved in all patients by expanding from 98.4 mm²/m² [IQR 80.7; 115.5] to 145.1 mm²/m² [IQR 134.8; 167.0, p < 0.001]. In symptomatic patients, a significant clinical improvement was detected 6 months after the intervention including an amelioration of physical capacity assessed by NYHA classification (p = 0.039) and cardiopulmonary exercise testing (VO_2peak; p = 0.025). Global assessment of Fontan-associated liver disease (FALD) showed improvement during follow-up (p = 0.035). No peri- or postprocedural complications occurred. Conclusions: Percutaneous treatment of Fontan pathway obstruction has a high interventional success rate with a significant increase in indexed cross-sectional area. During follow-up, improvement of patients’ clinical condition and global signs of FALD were observed. The impact of percutaneous Fontan pathway obstruction relief on reversing or delaying the progression of FALD requires further investigation. Full article

Background/Objectives: Physiological assessment of borderline coronary lesions is recommended by current guidelines for revascularization decision-making. The aim of our study was to assess the prognostic utility of physiological indices and determine whether their predictive value differs between patients with and without diabetes (DM). Methods: A physiological assessment was conducted in 381 patients with borderline coronary artery disease. The study cohort was divided according to the presence or absence of DM, and all individuals were followed over a four-year period. Results: Of the 381 patients, 154 (40.4%) had DM. Patients with DM had a higher BMI (30.1 kg/m² vs. 27.8 kg/m², p < 0.0001) and a lower left ventricular ejection fraction at the time of enrollment (50% vs. 55%, p = 0.0414) compared to the non-diabetic group. Patients diagnosed with DM had significantly more positive FFR results for ischemia, regardless of the assessed vessel, positive non-hyperemic evaluation of LAD and more PCI procedures, including PCI of the LAD. The mortality rate in FU among diabetics was 23.4%, while in patients without diabetes, it was 16.8%; (p = 0.1081). The clinical profile of deceased patients was largely comparable between groups. In patients with diabetes, the non-hyperemic physiological assessment by RFR/iFR (OR 0.68, 95%CI: 0.49–0.96; p = 0.0261) as well as iFR alone (OR 0.55, 95%CI: 0.32–0.97; p = 0.0388) was strongly correlated with the risk of death. In contrast to patients with DM, in the non-DM group, the non-hyperemic assessment using RFR (OR 0.37, 95%CI: 0.18–0.78; p = 0.0085) proved to be a significant prognostic factor. Conclusions: Non-hyperemic physiological indices (RFR/iFR) demonstrated a strong prognostic value in both diabetic and non-diabetic populations. Higher RFR/iFR values were consistently associated with a reduced risk of death. In the group of patients with DM, the iFR value may be considered a significant prognostic factor for long-term mortality. In the group without DM, the RFR assessment is such a factor. Full article

Objectives: To assess the diagnostic accuracy of a deep learning (DL)-based algorithm for non-invasive computation of fractional flow reserve (FFR-CT) from coronary computed tomography angiography (CCTA) and to evaluate the model’s ability to automatically assign cardiovascular risk categories according to the Coronary Artery Disease–Reporting and Data System (CAD-RADS). Materials and Methods: Sixty patients with suspected coronary artery disease who underwent both CCTA and invasive coronary angiography (ICA) were retrospectively included in this multicenter study. Curved multiplanar reconstructions derived from CCTA were analyzed by the deep learning-based model to estimate FFR-CT values and to automatically assign CAD-RADS risk categories. The diagnostic performance of the software for the identification of hemodynamically significant coronary stenoses was evaluated using ICA as the reference standard. Receiver operating characteristic (ROC) curve analysis was performed to determine the area under the curve (AUC), sensitivity, and specificity on both a per-patient and per-vessel basis. Finally, agreement between CAD-RADS risk categories assigned by the DL algorithm and those determined by an expert radiologist was assessed. Results: FFR-CT demonstrated high diagnostic accuracy, with AUC of 0.935, sensitivity of 93.2%, specificity of 93.7%, and excellent agreement with reference standard (k = 0.836) on a per-patient level. Per-vessel diagnostic performance was consistently high across all major coronary arteries, with the left anterior descending artery (LAD) showing the highest accuracy (AUC = 0.932). Automated CAD-RADS classifications generated by the software showed good agreement with those assigned by human (k = 0.765). Conclusions: The DL-based model demonstrated high diagnostic accuracy and represents a promising noninvasive approach for ischemia assessment and cardiovascular risk stratification. Full article

Epicardial adipose tissue (EAT) has previously been associated with coronary artery calcium scores, an increased burden of coronary artery disease (CAD), and features of plaque instability. These associations are likely mediated by endocrine and paracrine signaling from bioactive molecules secreted by EAT, which may contribute to coronary atherosclerosis. EAT can be non-invasively quantified on images obtained during coronary computed tomography angiography (CCTA). This study aimed to evaluate the potential association between EAT and non-calcified coronary plaques with severe stenosis using radiomic methodology. Materials and Methods: A total of 128 consecutive patients undergoing CCTA—both with and without contrast—for known or suspected CAD were retrospectively analyzed. EAT features were extracted from contrast scans. Coronary artery plaque features were evaluated using Coronary Artery Disease-Reporting and Data System (CAD-RADS). Results: EAT features showed a statistically significant positive correlation with non-calcified coronary plaques with severe grades of stenosis (CAD-RADS > 4). The Ensemble Machine Learning (EML) model combined with coronary plaque data showed a sensitivity of 1.00 and a specificity of 0.93, with a negative predictive value of 1.00 and a positive predictive value of 0.85, and an accuracy of 0.95 (95% CI: 0.9221–1) in internal validation. Conclusions: EAT may represent a novel imaging biomarker associated with the presence of actionable coronary plaques. Radiomic texture analysis of EAT could enhance the non-invasive prediction of coronary stenoses. These preliminary findings support the clinical utility of EAT evaluation via CCTA in patients with low to intermediate cardiovascular risk. Full article

Background and Objectives: Coronary computed tomography angiography (CCTA) is widely used in the diagnostic evaluation of suspected stable coronary artery disease; however, its agreement with invasive coronary angiography (ICA) remains inconsistent across different levels of analysis. The aim of this study was to evaluate the agreement between CCTA and ICA and to identify the factors associated with discrepancies. Materials and Methods: A single-centre retrospective analysis of 500 patients was performed. All patients underwent CCTA within one year prior to ICA. Coronary stenoses were evaluated at the 11-segment coronary artery, vessel, and patient levels using a ≥50% cut-off. Diagnostic agreement was assessed using the kappa coefficient, while diagnostic performance was evaluated in terms of sensitivity, specificity, positive predictive value, and negative predictive value. Factors associated with discrepancies were evaluated using a logistic regression model. Results: At the segment level, agreement between CCTA and ICA was low to moderate across 11 coronary segments (κ = 0.108–0.461). At the patient level, CCTA identified ≥50% coronary stenosis more frequently than ICA (86.2% vs. 59.4%, p < 0.001), demonstrating high sensitivity (91.3%) but low specificity (21.2%). Diagnostic discrepancies were associated with higher coronary calcium burden, and in multivariable analysis, body mass index > 25 kg/m², age < 68 years, and multiple comorbidities were independently associated with discordant findings. Conclusions: At the patient level, CCTA demonstrates high sensitivity and represents an appropriate non-invasive method for patient selection for further diagnostic evaluation. However, agreement between CCTA and invasive coronary angiography remains limited at the segment and vessel levels. Diagnostic discrepancies were significantly associated with coronary artery calcification and higher body mass index (BMI), which should be taken into consideration when interpreting CCTA findings. Full article

Accurate assessment of the functional significance of coronary artery stenoses is essential for guiding revascularization decisions and improving clinical outcomes in patients with coronary artery disease (CAD). While invasive wire-based fractional flow reserve (FFR) remains the gold standard for physiological lesion assessment, its adoption in routine clinical practice is limited by procedural complexity, patient discomfort, time consumption, and cost. These limitations have driven the development of angiography-derived FFR techniques that enable physiological evaluation without pressure wires or pharmacologic hyperaemia. Recent advances in computational modelling, artificial intelligence, and image processing have facilitated the estimation of FFR from conventional coronary angiography, including approaches that require only a single angiographic view. Single-view angiography-derived FFR methods—such as Murray law-based quantitative flow ratio (µQFR), FFR2D, Angio-iFR/FFR, sAccuFFR, and X1-FFR—aim to simplify workflow while maintaining diagnostic accuracy. Among these, µQFR has demonstrated the most consistent validation against invasive FFR across a broad range of clinical scenarios, including complex lesions, severe aortic stenosis, multivessel disease, and acute coronary syndromes. This review summarizes the principles, validation data, clinical applications, and limitations of single-view angiography-derived FFR technologies and highlights their potential to expand the adoption of physiology-guided coronary intervention. Full article

Background: Arterial stenosis produces nonlinear changes in vascular impedance that are challenging to investigate in real time using either benchtop flow phantoms or high-fidelity computational fluid dynamics (CFD) models. Objective: This study aimed to develop and evaluate a low-cost printed circuit board (PCB) analog capable of reproducing the hemodynamic effects of progressive arterial stenosis through an R–L–C mapping of vascular mechanics. Methods: A lumped-parameter (0D) electrical network was constructed in which voltage represented pressure, current represented flow, resistance modeled viscous losses, capacitance corresponded to vessel compliance, and inductance represented fluid inertance. A variable resistor simulated focal stenosis and was adjusted incrementally to represent progressive narrowing. Input U_in, output U_out, peak-to-peak V_pp, and mean V_avg voltages were recorded at a driving frequency of 50 Hz. Physiological correspondence was established using the canonical relationships. $R={\displaystyle \frac{8\mu l}{\pi r^4}}$, $L={\displaystyle \frac{pl}{\pi r^2}}$, $C={\displaystyle \frac{3\pi r^3}{2Eh}}$, where μ is blood viscosity, ρ is density, E is Young’s modulus, and h is wall thickness. A calibration constant was applied to convert measured voltage differences into pressure differences. Results: As simulated stenosis increased, the circuit exhibited a monotonic rise in U_out and V_pp, with a precise inflection beyond mid-range narrowing—consistent with the nonlinear growth in pressure loss predicted by fluid dynamic theory. Replicate measurements yielded stable, repeatable traces with no outliers under nominal test conditions. Qualitative trends matched those of surrogate 0D and CFD analyses, showing minimal changes for mild narrowing (≤25%) and a sharp increase in pressure loss for moderate to severe stenoses (≥50%). The PCB analog uses a simplified, lumped-parameter representation driven by a fixed-frequency sinusoidal excitation and therefore does not reproduce fully characterized physiological systolic–diastolic waveforms or heart–arterial coupling. In addition, the present configuration is intended for relatively straight peripheral arterial segments and is not designed to capture the complex geometry and branching of specialized vascular beds (e.g., intracranial circulation) or strongly curved elastic vessels (e.g., the thoracic aorta). Conclusions: The PCB analog successfully reproduces the characteristic hemodynamic signatures of arterial stenosis in real time and at low cost. The model provides a valuable tool for educational and research applications, offering rapid and intuitive visualization of vascular behavior. Current accuracy reflects assumptions of Newtonian, laminar, and lumped flow; future work will refine calibration, quantify uncertainty, and benchmark results against physiological measurements and full CFD simulations. Full article

The current research first investigates the flow in the fractional order of a vertical artery with atherosclerosis using a Casson-based penta-hybrid nanofluid. Gold (Au), copper (Cu), silver (Ag), magnesium oxide (MgO), and alumina (Al₂O₃) nanoparticles are dispersed in blood to make the hybrid nanofluid. It is assumed that the flow is very pulsatile. The mathematical model is constructed by using differential forms of the conservation laws of mass, momentum, energy, and irreversibility analysis. By applying the mild stenosis approximation, the governing equations are transformed into dimensionless form. To generalize the classical model to its fractional counterpart, the Caputo–Fabrizio fractional derivative (C-FFD) is employed. Closed-form solutions for the velocity and temperature fields are realized by the joint application of the Laplace and Hankel transforms. The impact of essential physical parameters on velocity, temperature, and entropy generation is displayed through figures. The physical significance of enhanced thermal characteristics is shown, emphasizing their potential relevance to thermal regulation, targeted drug delivery, and minimization of irreversible energy losses in biomedical flow systems. The velocity profile elevates with the increase in the Casson parameter, while the temperature drops as the fractional-order parameter rises. Entropy generation is observed to amplify with the increasing values of the thermodynamic parameter in question, whereas an opposite tendency is seen for the Bejan number. The Bejan number decreases as the control parameter becomes higher. The novelty of the present investigation lies in the simultaneous incorporation of Caputo–Fabrizio fractional dynamics, penta-hybrid nanoparticle suspension, and entropy generation analysis in a stenosed arterial configuration. Unlike existing fractional Casson blood flow models that primarily focus on single or hybrid nanofluids, the present framework highlights the synergistic enhancement of thermal transport and irreversibility control achieved through penta-hybrid nanoparticles, which may be relevant for advanced biomedical and targeted therapeutic applications. Full article

Background: The traditional A1-centric paradigm for trigger finger (TF) management does not fully capture heterogeneous pathology spanning isolated pulley stenosis, tendon degeneration, and impaired tendon–sheath gliding. Methods: A comprehensive literature synthesis (2010–2025) integrating anatomy, biomechanics, and ultrasound-guided interventions was performed to develop a testable, phenotype-driven framework. Results: A continuum model is proposed emphasizing (i) origin-to-insertion assessment of the flexor apparatus, (ii) pragmatic ultrasound phenotyping into pulley-dominant, tendon-dominant, and mixed patterns, and (iii) a stepwise, phenotype-matched management pathway incorporating conservative care, ultrasound-guided injection, selected adjuncts (e.g., hydrodissection, prolotherapy, ESWT) for tendon-dominant or mixed presentations, and percutaneous or open release when an A1 bottleneck is confirmed. Conclusions: This framework is presented as a hypothesis to guide standardized reporting, reliability testing, and phenotype-stratified comparative trials, rather than as a validated clinical guideline. This article proposes a novel, phenotype-driven clinical framework to address this limitation. Contemporary evidence is integrated to construct a model emphasizing (i) a whole-length, origin-to-insertion assessment of the flexor apparatus, (ii) sonographic phenotyping into pulley-dominant, tendon-dominant, and mixed patterns, and (iii) a stepwise treatment algorithm integrating conservative care, ultrasound-guided injections, ultrasound-guided percutaneous release, and selected adjunctive approaches such as hydrodissection (HD), prolotherapy (Prolo), and extracorporeal shockwave therapy (ESWT). While evidence supports individual modalities, the framework’s primary innovation lies in matching interventions to phenotype. This sonographic phenotyping system is presented not as a validated tool, but as a testable hypothesis designed to guide future validation studies. The proposed framework establishes research priorities, including standardized criteria, reliability testing, and comparative effectiveness research for phenotype-stratified management. Full article

Background/Objectives: Neurofibromatosis type 1 (NF1) is a genetic disorder characterized by various clinical manifestations, including significant neurovascular complications. This review aims to synthesize current knowledge regarding intracranial stenoses and associated vascular abnormalities in patients with NF1, emphasizing the differences between pediatric and adult populations. Methods: A narrative review was conducted, analyzing the existing literature on the epidemiology, clinical manifestations, and management of neurovascular issues related to NF1. Data were collected from a range of studies, including retrospective analyses and case series, focusing on the incidence and outcomes of intracranial vascular abnormalities. Results: The study found that intracranial vasculopathy affects between 0.4% and 6.4% of NF1 patients, with children experiencing higher rates of stenotic lesions. However, vascular issues in adults are less understood, with 3.5% of adult patients presenting vascular abnormalities. The review highlights a significant underdiagnosis of these conditions due to the lack of routine use of magnetic resonance angiography (MRA) in standard evaluations. The management of NF1-related vascular conditions, particularly in adults, remains poorly defined, particularly regarding the efficacy of antithrombotic therapies. Conclusions: The management of neurovascular complications in NF1 requires urgent attention, with a need for standardized screening protocols and further research to elucidate the natural history and optimal treatment strategies for these patients. Enhanced diagnostic practices, including routine neuroimaging, are essential to improve outcomes and reduce the risk of significant vascular events. Full article

Background: Quantitative flow ratio (QFR) is a novel technology to assess the functional significance of coronary stenoses based on standard coronary angiography, which can be alternatives to invasive fractional flow reserve (FFR) assessment. However, the evidence is limited to single-center studies and small sample sizes. This study systematically determined the diagnostic performance of QFR to diagnose functionally significant stenosis with FFR as the reference standard. Methods: A systematic review and meta-analysis of studies assessing the diagnostic performance of angiography-derived QFR systems were performed. All relevant studies from six literature databases were searched and screened according to the inclusion and exclusion criteria. The pooled sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR−), and diagnostic odds ratio (DOR), along with their 95% confidence intervals (CIs), were calculated using DerSimonian–Laird methodology. The summary receiver operating characteristic (SROC) curve and area under the curve were estimated. Meta-regression analysis was performed to identify a potential source of heterogeneity. Results: Fifty-seven studies comprising 13,215 patients and 16,125 vessels were included in the final analysis. At the vessel level, the pooled sensitivity and specificity of QFR for detecting a significant coronary stenosis were 0.826 (95% CI: 0.798–0.851) and 0.919 (95% CI: 0.902–0.933). Pooled LR+ and LR− were 10.198 (95% CI: 8.469–12.281) and 0.189 (95% CI: 0.163–0.219), with a pooled DOR of 53.968 (95% CI: 42.888–67.910). The SROC revealed an area under the curve (AUC) of 0.94 (95% CI: 0.91–0.96). The summary AUCs were 0.90 (95% CI: 0.87–0.92) for fixed-flow QFR (fQFR), 0.95 (95% CI: 0.92–0.96) for contrast-flow QFR (cQFR), 0.97 (95% CI: 0.95–0.98) for Murray law-based QFR (μQFR), and 0.91 (95% CI: 0.89–0.94) for non-specified QFR. The adjusted pooled DORs were as follows: 126.25 for μQFR, 45.49 for cQFR, 26.12 for adenosine-flow QFR (aQFR), 25.88 for fQFR, and 36.54 for non-specified QFR. Conclusions: The accuracy of angiography-derived QFR was strong to assess the functional significance of coronary stenoses with FFR as a reference. μQFR demonstrated the highest diagnostic performance among the five evaluated modes. Full article

Objectives: Due to the rarity of primary vaginal carcinoma, standardized treatment approaches are limited. Radical surgery is rare, especially in advanced stages. This report evaluates the feasibility, technical aspects and outcomes of laparoscopic en bloc resection in advanced vaginal carcinoma. Case presentation: A 67-year-old woman presented with pain and vaginal bleeding. Clinical examination revealed a stenosing vaginal tumour up to 2 cm above the introitus, extending to the urethra and right vulva. Biopsies confirmed invasive squamous cell carcinoma with VAIN/VIN III. Imaging revealed enlarged pelvic lymph nodes, but no distant metastases. Methods: The surgical procedure comprised laparoscopic en bloc resection, including bilateral pelvic lymphadenectomy, radical hysterectomy with bilateral salpingo-oophorectomy, and total vaginal excision down to the pelvic floor. Additionally, inguinal bilateral ICG-guided sentinel lymph node dissection, vulvectomy with clitoral preservation, and partial urethral resection were performed, followed by transvaginal specimen removal. Vaginal closure was achieved via combined transvaginal and laparoscopic pelvic floor reconstruction. The postoperative course was uneventful, with early recovery of urinary and bowel function. Final histology confirmed complete tumor resection with clear margins (pT3, pN0, L0, V0, Pn0, R0). Functional outcomes remained excellent, with no recurrence or functional impairment at one-year follow-up. Conclusions: Laparoscopic en bloc resection appears to be a feasible option for selected patients with locally advanced vaginal carcinoma, enabling complete tumour removal with preservation of pelvic floor function and resulting in favourable postoperative and oncological outcomes. Full article

Trigger finger (TF) is a common debilitating hand disorder that often results in pain and functional limitations. Currently accepted conservative treatments include splinting, nonsteroidal anti-inflammatory drugs, and corticosteroid injections. Recently, transfer energy capacitive and resistive (TECAR) therapy is emerging as a promising intervention for its potential to enhance microcirculation, reduce pain and inflammation, and stimulate tissue regeneration in various musculoskeletal conditions. However, its effectiveness for TF remains unclear. This study aims to compare the outcomes between TF conservative management with splinting alone, TECAR therapy alone, and the combined approach. Twenty-one fingers from 16 patients were included, with outcomes measured in terms of pain intensity, Green’s TF classification, frequency, severity and functional impact of triggering, and Quick-Disabilities of the Arm, Shoulder, and Hand. Assessments were conducted at baseline, at the fourth and eighth weeks after the initial treatment, and at one-month follow-up. Although all groups showed beneficial effects in all outcomes from baseline to the follow-up, the combined therapy group demonstrated statistically significant, quicker, and higher magnitude improvements in all clinical parameters compared to the single-treatment groups. By combining TECAR therapy with conventional splinting, TF patients may experience faster pain relief and functional recovery. Thus, integrating TECAR therapy into rehabilitation programs may represent a valuable opportunity for enhancing pain management and recovery in TF patients. Full article