Search Results (78)

Background: Acute renal colic, most often caused by ureteral stones, is a common cause of emergency admissions. While non-contrast computed tomography (CT) is the diagnostic gold standard, its use is limited by radiation exposure, cost, and accessibility. Growth Differentiation Factor-15 (GDF-15) is a stress-induced cytokine elevated in various acute pathologies. This study investigated the diagnostic and predictive value of serum and urine GDF-15 in patients with acute renal colic due to ureteral stones. Methods: In this prospective observational study (January 2024–March 2025), 76 patients presenting with sudden-onset flank pain were enrolled. A total of 41 patients with radiologically confirmed ureteral stones formed the stone-positive group, and 35 patients without urinary pathology served as controls. Serum and urine GDF-15 levels were measured by ELISA, along with routine laboratory tests. CT was used to assess stone characteristics, hydronephrosis grade, and ureteral wall thickness. Group comparisons were performed using the Mann–Whitney U test, correlations with Spearman’s test, and diagnostic performance with ROC analysis. Results: Both serum and urine GDF-15 levels were significantly higher in stone-positive patients (p < 0.001). Urine GDF-15 demonstrated excellent diagnostic accuracy (AUC = 0.986; sensitivity = 92.7%; specificity = 91.4), while serum GDF-15 showed moderate performance (AUC = 0.767). GDF-15 levels showed modest positive correlations with CRP and were numerically higher in patients with ureteral wall thickness > 1 mm and proximal stones. No significant association was found with spontaneous stone passage (p > 0.05). Conclusions: Urine GDF-15 shows promising diagnostic accuracy for ureteral stones and may serve as a non-invasive adjunctive tool when imaging is limited. While associated with inflammation and stone location, it did not predict spontaneous stone passage. These findings support its potential as a clinical biomarker, though further large-scale validation is required. Full article

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used in the treatment of type 2 diabetes and obesity due to their metabolic effects. Emerging evidence suggests they may also have neuroprotective effects, indicating their potential as disease-modifying therapies in neurodegenerative disorders such as Alzheimer’s disease (AD) and Parkinson’s disease (PD). Preclinical studies in animal models have demonstrated that GLP-1RAs can reduce neuroinflammation, oxidative stress, neuronal apoptosis, and pathological protein aggregation, while enhancing glucose metabolism and mitochondrial function. This narrative review analyzed results from human clinical trials evaluating GLP-1RAs in AD and PD, based on a search of four databases (Web of Science, Medline, Embase, and Clinical Trials). The analysis included eleven studies. In AD, clinical trials suggest that GLP-1RAs such as liraglutide and semaglutide may enhance brain glucose metabolism, facilitate glucose transport across the blood–brain barrier, and benefit neuronal networks. However, most studies did not demonstrate improvements in cognitive functions or radiological markers. Short-term clinical trials of GLP-1RAs, including exenatide and lixisenatide, demonstrated promising effects on motor and selected non-motor symptoms in patients with PD, but their disease-modifying effects remain unproven. GLP-1RAs showed a favorable safety profile. Despite promising findings, small study populations, heterogeneous protocols, and short observation periods limit definitive conclusions. Further larger, long-term studies are needed, particularly to clarify the risk–benefit balance, weight control, and long-term outcomes. Full article

Microneedle array-based drug delivery offers a minimally invasive and safe approach for breaching the skin barrier, enabling localized and targeted treatment—an advantage particularly valuable in chronic condition management, such as rheumatoid arthritis (RA). RA presents a multifaceted pathophysiology, often necessitating long-term pharmacological management. However, conventional oral administration may lead to systemic drug distribution, increasing the likelihood of adverse effects, and ultimately undermining therapeutic efficacy. In this study, a hollow microneedle array was employed for effective delivery of Tofacitinib and the antioxidant N-acetylcysteine (NAC). A comprehensive evaluation was conducted across multiple levels, in which inflammation and cartilage degradation were assessed histologically using hematoxylin-eosin (H&E) and Safranin O–Fast Green staining. Radiologically, micro-computed tomography (micro-CT) was employed to visualize bone structure alterations. On the molecular level, enzyme-linked immunosorbent assay (ELISA) was used to quantify inflammatory cytokines and oxidative stress markers. Furthermore, differentially expressed genes and enriched signaling pathways were identified through transcriptomic profiling pre- and post-treatment. And the potential regulatory targets and mechanistic insights into the therapeutic response were elucidated through correlation analyses between gene expression profiles and pathological indicators. This study provides a mechanistic and computational basis for precision targeted therapy, validates the efficacy and safety of microneedle delivery in a rheumatoid arthritis (RA) model, and demonstrates its potential application in local drug delivery strategies. Full article

Background/Objectives: Spinal fusion with static fixation—surgically joining two or more vertebrae to eliminate motion—is commonly employed to treat degenerative spinal disease. However, the rigidity imposed by static constructs and the increased load on the adjacent segments frequently result in complications such as disc or facet degeneration, spinal stenosis (SS), and segmental instability. This study investigates the effectiveness of pedicle-based dynamic stabilization using the Dynesys system, particularly in a dynamic-transitional optima (DTO) hybrid configuration, in mitigating adjacent segment disease (ASD) and improving clinical outcomes. In this work, we analyzed the mechanical performance and intermediate-term clinical effects of the DTO hybrid lumbar device, focusing on how the load-sharing properties of the Dynesys cord–spacer stabilizers may contribute to junctional complications in individuals with diverse grades of intervertebral disc degeneration. Study Design/Setting: We designed a combined biomechanical finite element (FE) and experimental analysis to predict the clinical outcomes. Patient Sample: Among 115 patients with lumbar SS enrolled for analysis, 31 patients (mean age: 68.5 ± 7.5 years), with or without grade I spondylolisthesis (18/13), underwent a two-level DTO hybrid procedure—L4–L5 static fixation and L3–L4 dynamic stabilization—with minimal decompression to preserve the posterior tension band. Post-surgical follow-ups were conducted for over 48 months (range: 49–82). Outcome Measures: Radiological assessments were performed by two neurosurgeons, one orthopedic surgeon, and one neuroradiologist. The posterior disc height, listhesis distance, and dynamic angular changes were measured pre- and postoperatively to evaluate ASD progression. Methods: Dynamic instrumentation was assigned to the L3–L4 motion segment with lesser disc deterioration, in contrast to the L4–L5 segment, where static fixation was applied due to its greater degree of degeneration. FE analysis was performed under displacement-controlled conditions. Intersegmental motion analysis was conducted under load-controlled conditions in a synthetic model. Results: The DTO hybrid devices reduced stress and motion at the transition segment. However, compensatory biomechanical effects were more pronounced at the adjacent cephalad than the caudal segments. In the biomechanical trade-off zone—where balance between motion preservation and stabilization is critical—the flexible Dynesys cord significantly mitigated stiffness-related issues during flexion. At the L3–L4 transition level, the cord–spacer configuration enhanced dynamic function, increasing motion by 2.7% (rotation) and 12.7% (flexion), reducing disc stress by 4.1% (flexion) and 12.9% (extension), and decreasing the facet contact forces by 4.9% (rotation) and 15.6% (extension). The optimal cord stiffness (50–200 N/mm) aligned with the demands of mild disc degeneration, whereas stiffer cords were more effective for segments with higher degeneration. The pedicle screw motion in dynamic Dynesys systems—primarily caused by axial translation rather than vertical displacement—contributed to screw–vertebra interface stress, influenced by the underlying disc or bone degeneration. Conclusions: Modulating the cord pretension in DTO instrumentation effectively lessened the interface stress occurring at the screw–vertebra junction and adjacent facet joints, contributing to a reduced incidence of pedicle screw loosening, ASD, and revision rates. The modified DTO system, incorporating minimal decompression and preserving the posterior complex at the dynamic level, may be biomechanically favourable and clinically effective for managing transitional degeneration over the mid-term. Full article

Background: Oxidative stress represents a key pathogenic factor in spondyloarthritis (SpA), yet its comprehensive assessment remains underutilized in routine clinical practice. Objectives: We evaluated oxidative stress biomarker profiles in SpA patients to determine associations with disease activity, systemic inflammation, structural damage, lifestyle factors, and therapeutic responses for practical clinical implementation. Methods: This cross-sectional study included 101 patients meeting the Assessment of SpondyloArthritis International Society (ASAS) 2009 criteria. Oxidative stress assessment utilized a validated biomarker panel: copper, zinc, glutathione peroxidase (GPx), ceruloplasmin (Cp), transferrin (TF), haptoglobin (Hp), bilirubin (BR), and uric acid (UA). Clinical, radiological, lifestyle, and therapeutic data underwent systematic analysis. Results: Glutathione peroxidase activity was elevated in 82.1% of patients, establishing it as the most sensitive oxidative stress marker. Copper levels increased in 30.7% and zinc deficiency occurred in 36.4% of cases. Oxidative stress markers correlated significantly with inflammatory parameters (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], neutrophil-to-monocyte ratio [NMR], systemic immune-inflammation index [SII]) and disease activity scores (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Ankylosing Spondylitis Disease Activity Score based on CRP [ASDAS-CRP], Disease Activity Score 44 [DAS44-CRP]). Higher oxidative stress was associated with a poorer quality of life, as indicated by elevated Ankylosing Spondylitis Quality of Life (ASQoL) scores. Physical activity and adherence to a Mediterranean diet were independently associated with better antioxidant capacity. Smoking and nonsteroidal anti-inflammatory drug (NSAID) use correlated with increased oxidative burden. Anti-tumor necrosis factor alpha (anti-TNFα) therapy was associated with reduced levels of oxidative stress. Structural damage, particularly cervical spine involvement, correlated with heightened oxidative stress. Conclusions: This comprehensive evaluation reveals significant clinical correlations between oxidative stress and multiple disease domains in SpA. Modifiable lifestyle factors and therapeutic interventions have a significant impact on the redox balance. These findings establish practical targets for personalized management. The integration of oxidative stress assessment into routine practice could enhance disease monitoring and inform the development of antioxidant-based therapeutic strategies. Full article

Background and Objectives: Unilateral spinal stabilization has emerged as a less invasive alternative to bilateral fixation in the management of lateralized spinal pathologies. While both rigid and dynamic systems are utilized, comparative data regarding their clinical efficacy, radiological outcomes, and complication profiles—particularly in multilevel applications—remain limited. Materials and Methods: A retrospective, two-center analysis was conducted on 113 patients who underwent unilateral posterior spinal stabilization between 2019 and 2023. Patients were divided into unilateral rigid stabilization (URS, n = 41) and unilateral dynamic stabilization (UDS, n = 72) groups. Pathologies of the patients include disc herniations, foraminal and spinal stenosis, tumoral lesions and spondylolisthesis. Clinical outcomes were assessed using the Visual Analogue Scale (VAS) over a 24-month follow-up. Radiological parameters included fusion status, superior adjacent disc height, and foraminal height index. Complication rates, including adjacent segment degeneration (ASD), pseudoarthrosis, and screw loosening, were analyzed according to type-of-stabilization and construct length (two, three, or four levels). Results: Both URS and UDS groups demonstrated significant VAS improvement at final follow-up, with no significant differences between groups (p < 0.001). Fusion rates were significantly higher in the URS group (85.37% vs. 27.78%, p < 0.001), while pseudoarthrosis (39.02% vs. 16.62%, p = 0.081) were more frequent in URS. No cases of rod fracture or infection were observed. Complication rates, particularly ASD, increased with longer constructs (6.56%, 21.21%, vs. 31.58% p = 0.01), independent of stabilization type. Conclusions: Unilateral stabilization—whether rigid or dynamic—offers effective symptom relief with reduced surgical morbidity. However, dynamic systems may provide biomechanical advantages by preserving motion and minimizing adjacent segment stress. While rigid constructs yield higher fusion rates, they are associated with increased complications. These findings support the use of dynamic stabilization, particularly in multilevel constructs, and highlight the need for patient-specific surgical strategies to optimize outcomes and mitigate long-term complications. Full article

Background/Objectives: Admission hyperglycemia is frequent in COVID-19, reflecting stress hyperglycemia, systemic inflammation, and potential viral injury to pancreatic β-cells. It may serve as an early marker of severity. We assessed whether admission hyperglycemia predicts severe disease and poor outcomes in adults without diabetes. Methods: We performed a retrospective cohort study including adults hospitalized with RT-PCR/antigen-confirmed COVID-19 between August 2020 and July 2021. Patients < 18 or >80 years, with prior diabetes, or on corticosteroids were excluded. Hyperglycemia was defined as fasting glucose > 106 mg/dL and classified as mild (107–180 mg/dL), moderate (181–300 mg/dL), and severe (>300 mg/dL). Clinical, laboratory, imaging, treatment, utilization, and cost parameters were analyzed. Results: Of 1009 patients, 734 (72.7%) were hyperglycemic at admission. Compared with normoglycemic patients, hyperglycemics more often developed respiratory failure (67.7% vs. 38.2%), required CPAP (9.4% vs. 1.5%), and had severe/critical disease (46.9% vs. 25.1%), ICU transfer (6.5% vs. 1.5%), and mortality (3.8% vs. 1.1%) (all p ≤ 0.0256). They also showed lymphopenia, eosinopenia, higher inflammatory and coagulation markers, longer hospitalization (12.1 vs. 10.1 days), and increased costs (EUR 1846 vs. 1043) (all p < 0.001). Severe hyperglycemia (>300 mg/dL) strongly correlated with inflammation, coagulopathy, tissue injury, and radiologic severity. Conclusions: Admission hyperglycemia is a robust, easily measurable predictor of severe COVID-19 and adverse outcomes in non-diabetic adults and is associated with greater resource utilization and higher costs. Early identification may improve risk stratification. Future prospective studies should determine whether early detection and aggressive glycemic control can modify prognosis. Full article

Background: Long-term survivorship in total hip arthroplasty (THA) is influenced by implant stability and stress distribution to surrounding bone. Isoelastic acetabular components are monoblock polyethylene cups with a low elastic modulus, which were developed to reduce stress shielding and enhance periacetabular bone preservation. This systematic review aimed to evaluate the mid- to long-term clinical outcomes, wear rate, and survivorship of isoelastic cups in primary THA with a minimum follow-up of five years. Materials and methods: A systematic literature search was performed in April 2025 across PubMed, Embase, Cochrane Library, and Google Scholar following PRISMA 2020 guidelines. Inclusion criteria comprised clinical studies on isoelastic acetabular cups in primary THA with a minimum of five years of follow-up. Data on survivorship, complications, clinical outcomes, wear, and radiological performance were extracted and analyzed. Risk of bias in each study was assessed through the Newcastle–Ottawa Scale (NOS) for observational studies and the Cochrane Risk of Bias 2 (RoB 2) tool for randomized controlled trials. Results: Twelve studies, encompassing 1491 hips, met the inclusion criteria. Mean follow-up was 8.1 years. Overall implant survival rate ranged from 82.7% to 100%. Mean Harris Hip Score was 92.6, with low reported pain and high satisfaction. Mean annual wear was 0.05 mm/year. Vitamin E-infused highly cross-linked polyethylene (VEHXLPE) cups demonstrated lower femoral head penetration compared to UHMWPE. A randomized trial showed reduced bone loss in the polar region with isoelastic cups versus modular titanium cups (4.9% versus 15.9%, p = 0.005). Complication and revision rates were low, though heterogeneity in cup positioning reporting and variable follow-up durations were noted. Conclusions: Isoelastic acetabular components demonstrate excellent survivorship, low wear rates, and favorable clinical outcomes at mid- to long-term follow-up. High-quality, long-term comparative studies are needed to confirm these findings across broader patient populations. Full article

Background: Pancreatic cancer (PC) remains one of the deadliest malignancies, with long-term survival often reliant on early detection through surgery and chemotherapy. Unfortunately, the late-stage presentation of the disease contributes to its poor prognosis, leading to an increased focus on surveillance for high-risk individuals (HRIs) to facilitate earlier diagnosis. Despite the growing implementation of such programmes globally, there is a lack of longitudinal studies examining the benefits of PC surveillance, particularly regarding the well-being of participants. The study aimed to evaluate the distress experienced by HRIs 3-years after engaging in PC screening at Verona Pancreas Institute and to describe which participant characteristics contributed to the increase in stress. Methods: This is a longitudinal follow-up (FU) of a previously published cohort. HRIs with heredo-familial predisposition undergoing PC surveillance with MRCP and a clinical visit were re-evaluated from 2019 to 2023 in the same psychological assessment using Perceived Stress Scale (PSS), General Self-Efficacy Scale (GSES), Coping Orientation to Problems Experienced (COPE) and The Scale of Perceived Social Support (MSPSS) 3 years after the baseline assessment. The FU assessments were conducted by a clinical psychologist via telephone after the radiological and clinical evaluations were made. Results: Of the 54 HRIs initially evaluated, ten did not respond to phone contacts. The remaining 44 HRIs, of whom 29 (65.9%) were female, with a mean age of 56.1 years (SD = 10.2), agreed to participate in a FU psychological assessment. After 3 years, the participant exhibited an increase in stress levels (PSS—T0 mean 14.8; T1 mean 16.9), a decrease in problem-solving abilities (GSES—from 32.02 to 28.09, p < 0.01), a deterioration in adaptive capacity to the situation (COPE total score from 64.0 to 61.39, p = 0.05), and a reduction in perceived social support (MSPSS—T0: 4.59; T1: 4.27, p = 0.02). A significant decrease was also observed in the use of denial (from 2.84 to 2.32; p = 0.02). Based on the psychological characteristics of the 44 HRIs, stratified according to PSS reassessed at FU, 3 distinct clusters were identified: (a) Normal Stress (32% of the sample): HRIs with a PSS score < 14; (b) Stable Clinical Stress (46% of the sample): HRIs with PSS at FU > 14 and PSS at baseline > 14; (c) New Clinical Stress (22% of the sample): HRIs with PSS at FU > 14 and PSS at baseline < 14. After 3 years of surveillance for PC, 67% of the total study sample (Stable Clinical Stress group and New Clinical Stress group) exhibited high perceived stress. Over the course of the 3 years, 7 HRIs (15.9%) lost a family member due to PC. Conclusions: The data suggest the need to include psychological care pathways within the surveillance programmes. These insights can enhance existing literature and aid in creating comprehensive surveillance programmes for PC, addressing all care aspects, including mental health. Full article

Background and Objectives: Revision anterior cruciate ligament reconstruction (ACLR) is demanding and yields inferior outcomes compared with primary procedures. The quadriceps tendon (QT) autograft with bone block has biomechanical and biological advantages though clinical evidence in revision remains limited. This study evaluated the clinical and radiological outcomes of revision ACLR using bone-block QT autograft in young, active patients. Materials and Methods: A case series with a level of evidence of 4. Thirty-four patients (28 men, 6 women; mean age, 27.2 ± 5.8 years) who underwent revision ACLR with a bone-block QT autograft between 2021 and 2023 were retrospectively reviewed. The mean follow-up was 37.4 ± 3.2 months. Clinical assessments included the Lysholm, International Knee Documentation Committee (IKDC) subjective, and Tegner activity scores, along with isokinetic strength testing. Objective stability was evaluated using pivot shift grading and Telos stress radiography. Radiological analyses included 3D computed tomography for tunnel positioning and magnetic resonance imaging for tunnel widening. Perioperative and postoperative complications were recorded. Results: All clinical outcomes improved significantly from baseline to 2-year follow-up: Lysholm (62.7 ± 9.6 to 87.1 ± 10.3), IKDC (59.0 ± 10.8 to 79.5 ± 11.1), and Tegner (3.5 ± 1.2 to 5.6 ± 1.3; all p < 0.001). However, the Tegner score remained lower than the pre-injury level (6.1 ± 1.4; p = 0.035). At the final follow-up, 91.2% of the patients had returned to sports, with 59% resuming sports at their pre-injury level or higher. Side-to-side anterior laxity decreased from 8.5 ± 1.7 mm to 1.4 ± 1.1 mm on Telos stress radiography (p < 0.001). Preoperatively, 82% of patients demonstrated high grade pivot shift (≥grade 2), which improved to 91% graded as negative or grade 1 at final follow-up (p < 0.001). Isokinetic evaluation showed improvements in quadriceps (28.7% ± 12.5% to 12.4% ± 8.1%) and hamstring (18.3% ± 9.7% to 8.9% ± 6.5%) deficit (both p < 0.001). MRI demonstrated minimal tunnel widening (tibia, +1.3 ± 0.9 mm, p = 0.012; femur, +0.3 ± 0.6 mm, p = 0.148). Three complications (8.8%) were observed: one cyclops lesion, one transient extension deficit, and one graft rupture. No patellar fractures, septic arthritis, or revision procedures occurred during the follow-up period. Conclusions: Bone-block QT autografts provide a reliable option for revision ACLR, yielding functional improvement, restored stability, and minimal donor-site morbidity, with low complications. These findings support their consideration as the preferred graft choice for young active patients needing revision reconstruction. Full article

Background: Plantar plate injuries represent a common yet frequently underdiagnosed etiology of forefoot pain and metatarsophalangeal joint instability. Diagnostic accuracy is often compromised by nonspecific clinical presentations and significant symptom overlap with other forefoot pathologies, including Morton’s neuroma and synovitis. Early and accurate identification is essential to prevent progression to irreversible deformity. Methods: This narrative review synthesizes recent literature on the clinical evaluation, imaging modalities, and differential diagnosis of plantar plate injuries. A comprehensive literature search in a narrative review format of key databases and relevant journals was performed to critically appraise the diagnostic accuracy, advantages, limitations, and clinical implications of various diagnostic techniques. Results: Physical examination maneuvers—including the drawer test, toe purchase test, and Kelikian push-up test—provide important diagnostic insights but are constrained by operator dependency and lack of standardization. Among imaging modalities, MRI and dynamic ultrasound offer high diagnostic utility, with MRI providing superior specificity and ultrasound enabling functional, real-time assessment. Emerging techniques such as dorsiflexion-stress MRI and dual-energy CT show promising diagnostic potential, though broader clinical validation is lacking. Differential diagnosis remains a major challenge, given the clinical and radiological similarities shared with other forefoot conditions. Conclusions: Accurate diagnosis of plantar plate injuries necessitates a multimodal strategy that combines clinical suspicion, structured physical examination, and advanced imaging. Acknowledging the limitations of each diagnostic modality and integrating findings within the broader clinical context are essential for timely and accurate diagnosis. Future research should prioritize validation of diagnostic criteria, enhanced access to dynamic imaging, and the development of consensus-based grading systems to improve diagnostic precision and patient outcomes. Full article

Moyamoya disease (MMD) is primarily associated with genetic variants in RNF213. RNF213 p.R4810K (c.14429G>A, p.Arg4810Lys) is a founder variant predominantly found in East Asian populations and is strongly associated with MMD, a rare cerebrovascular condition characterized by progressive stenosis of intracranial arteries and the development of abnormal collateral networks. Recent evidence suggests that RNF213 variants are also enriched in non-moyamoya intracranial arteriopathies, such as large-artery atherosclerotic stroke and intracranial arterial stenosis/occlusion (ICASO), particularly in east Asian individuals with early-onset or cryptogenic stroke. This expanded phenotypic spectrum, termed RNF213-related vasculopathy (RRV), represents a distinct pathogenic entity that may involve unique pathogenic processes separate from traditional atherosclerosis. In this review, we synthesize current genetic, clinical, radiological, and experimental findings that delineate the unique features of RRV. Patients with RRV typically exhibit a lower burden of traditional vascular risk factors, negative vascular remodeling in the absence of atheromatous plaques, and an increased propensity for disease progression. RNF213 variants may compromise vascular resilience by impairing adaptive responses to hemodynamic stress. Furthermore, emerging cellular and animal model data indicate that RNF213 influences angiogenesis, lipid metabolism, and stress responses, offering mechanistic insights into its role in maintaining vascular integrity. Recognizing RRV as a distinct clinical entity has important implications for diagnosis, risk stratification, and the development of genome-informed therapeutic strategies. Full article

Objective: We aimed to evaluate the feasibility, added value, and radiation dose of coronary computed tomography angiography (CCTA) and stress dynamic CT myocardial perfusion imaging (MPI) in patients with coronary artery disease (CAD) in a real-world setting. Materials and Methods: This retrospective study included 65 patients (mean age: 51.2 ± 11.5 years; 21 female) with moderate CAD, selected from the Radiological Database of our hospital between May 2022 and December 2024. All patients underwent CCTA and stress dynamic CT-MPI using a third-generation dual-source CT scanner. The shuttle-mode acquisition technique was used for CT-MPI with 60 mL of contrast (iopamidol, 370 mg iodine/mL) administered at a flow rate of 6 mL/s. The mean myocardial blood flow (MBF) and other quantitative parameters were measured for both CAD and reference segments (RSs). A 17-segment-based analysis was employed (excluding the apex). The MBF ratio, defined as the mean MBF value of CAD segments divided by that of RS, was used with a cut-off value of 0.85 to distinguish hypoperfused from non-hypoperfused segments within CAD territories. Non-parametric statistical tests were applied. Results: A total of 1040 segments were evaluated. In 62 segments, the mean MBF of CAD territories was found to have decreased. The mean MBF and myocardial blood volume (MBV) in hypoperfused CAD segments were 65.1 ± 19.8 mL/100 mL/min and 14.5 ± 2.7 mL/100 mL, respectively, both significantly lower compared to non-hypoperfused CAD segments and RSs (p < 0.001). The mean effective dose of the protocol was 6.3 ± 1.4 mSv, corresponding to an estimated individual lifetime cancer risk of approximately 0.06% per test, based on BEIR VII Phase 2 modeling. This risk is cumulative, with repeat testing over a 10-year period potentially increasing lifetime cancer risk in proportion to total radiation exposure. The mean total examination time was 26 ± 4 min. Conclusion: The combined CCTA and dynamic CT-MPI protocol is feasible in real-world clinical practice and offers a comprehensive morphological and functional assessment of moderate CAD, with a manageable radiation dose and examination time. Full article

Objectives: In healthy young adults, thoracic kyphosis can be attributed to a number of factors, including a sedentary lifestyle, stress, poor posture, activity and daily habits, muscle pain, fatigue, and anxiety. In regard to clinical diagnosis and evaluation methods, high-cost radiological measurements and a variety of non-radiological clinical methods are employed. In this study, a decision support system that performs automatic thoracic kyphosis angle measurements has been developed with the objective of avoiding exposure of the human body to radiation and reducing the time required for measurements. Methods: The features were determined with reference to the thoracic kyphosis measurements that were manually marked by the expert on the subjects. The kyphosis angle was calculated by automatically identifying the T1 and T12 points through image segmentation using a convolutional neural network (CNN), which is a type of deep learning algorithm. Results: Intra-class consistency of ICC > 0.95 (p < 0.05) and internal consistency reliability of Cronbach’s α = 0.947 are obtained. Conclusions: The results demonstrate that the proposed algorithm exhibits high intra-class consistency and high internal consistency reliability to provide an automated thoracic kyphosis angle measurement system. Full article

Heart failure (HF) remains a major global health challenge, driven by multifactorial pathophysiological processes, such as systemic congestion, endothelial dysfunction, and inflammation. While natriuretic peptides are well-established biomarkers for diagnosing and monitoring HF, they do not fully capture the complexity of vascular involvement. CD146, also known as melanoma cell adhesion molecule (MCAM), is a transmembrane glycoprotein primarily expressed on endothelial cells and involved in cell adhesion, vascular permeability, and angiogenesis. Its soluble form (sCD146), released in response to multiple pathophysiological stimuli, including venous and arterial endothelial stretch, oxidative stress, and inflammatory cytokine activation, has emerged as a promising biomarker reflecting both hemodynamic congestion and systemic endothelial stress. This review synthesizes current knowledge on the structure, regulation, and release mechanisms of CD146 and explores its clinical utility in HF. Elevated sCD146 levels have been associated with echocardiographic and radiological indicators of congestion, as well as with adverse outcomes. While promising, its application is limited by variability, lack of standardization, and confounding elevations in non-cardiac conditions, including malignancy. Full article