Search Results (481)

Bacterial biofilms represent a major clinical challenge, being responsible for the majority of chronic infections and significantly reducing the effectiveness of antibiotic therapy. Their formation on implant surfaces, particularly those made of titanium and its alloys, is strongly associated not only with antimicrobial tolerance but also with persistent, hard-to-eradicate infections, implant loosening or failure, repeated surgical interventions, prolonged hospitalization, and increased morbidity. These complications contribute substantially to the growing problem of antimicrobial resistance and impose significant economic burdens on healthcare systems. This review discusses the mechanisms of biofilm formation, factors influencing bacterial adhesion, and the clinical implications associated with implant-related infections. Special attention is given to titanium-based biomaterials, including conventional Ti–6Al–4V and next-generation alloys such as Ti–13Nb–13Zr, highlighting their advantages and limitations in the context of biocompatibility and susceptibility to biofilm formation. Various strategies for combating biofilms are presented, including physical, chemical, and biological approaches, with emphasis on surface modification techniques. Advanced methods, particularly atomic layer deposition (ALD), are identified as promising solutions for creating uniform, antibacterial coatings, including those based on tin dioxide (SnO₂). Such modifications offer potential for reducing bacterial adhesion, improving osseointegration, and enhancing long-term implant performance. Full article

Background: The utilization of robot-assisted surgery in pediatric patients is increasing, with particularly notable advantages in complex reconstructive procedures. This study aims to evaluate the safety and efficacy of robotic-assisted resection of choledochal cysts in infants aged less than 3 months. Methods: A total of 73 infants with choledochal cysts who were admitted to the Department of General Surgery, Children’s Hospital of Zhejiang University School of Medicine, between April 2019 and December 2025 were included. The patients were divided into a robotic-assisted surgery (RAS) group (n = 39) and a laparoscopic-assisted surgery (LAS) group (n = 34). Clinical data, including demographic information, laboratory indexes, surgical data, and prognostic data, were retrospectively reviewed, and the Mann–Whitney U test, independent-samples t-test, and Fisher’s exact test were used for statistical analysis. Results: The groups were comparable in terms of age, sex, weight, pre- and postoperative biochemical markers, fasting time, cyst diameter, and operative time. Overall, 80.8% of cases were prenatally detected. The RAS group had a significantly shorter postoperative hospital stay (p = 0.004, Z = −2.864), drainage tube duration (p = 0.002, Z = −3.100), and hepaticojejunostomy time (p < 0.0001, df = 71, 95%CI (−5.70, −3.04)) compared to the LAS group. In the LAS group, three patients developed anastomotic fistulas, all of whom required reoperation, and one patient developed adhesive bowel obstruction, whereas in the RAS group, one patient developed incision infection, one developed cholangitis, one developed adhesive bowel obstruction, and one presented with postoperative liver function abnormalities. The hospitalization cost in the LAS group was significantly lower than that in the RAS group (p < 0.0001, Z = −5.468). Conclusions: In experienced pediatric centers, robotic-assisted resection of choledochal cysts is safe and effective for infants aged less than 3 months and deserves further exploration. Full article

Uncontrolled hemorrhage remains a major challenge in trauma care and surgical interventions, where rapid hemostasis and wound sealing are essential for improving patient survival. Natural polymer-based hydrogels have emerged as promising hemostatic materials owing to their excellent biocompatibility, biodegradability, and biomimetic properties. However, their clinical translation remains limited by insufficient mechanical robustness, wet adhesion, and functional responsiveness. To address these challenges, considerable progress has been achieved through rational material design and structural engineering strategies. Representative natural polymers, particularly polysaccharides and proteins, exhibit distinct physicochemical and biological characteristics that determine their hemostatic mechanisms and design strategies. Based on these material platforms, molecular modification strategies, including charge regulation, hydrophobic modification, and bioactive functionalization, have been widely employed to modulate interfacial interactions, platelet adhesion, coagulation activation, and tissue adhesion. In parallel, advanced structural architectures, such as porous, particulate, fibrous, multicrosslinked/multinetwork, and nanocomposite systems, have significantly enhanced fluid absorption, mechanical resilience, stress dissipation, and hemorrhage sealing efficiency. Beyond conventional hemostasis, increasing efforts have focused on integrating multifunctional properties, including antibacterial activity, inflammatory regulation, oxidative stress modulation, tissue regeneration, dynamic monitoring, and stimuli-responsive behaviors. This review systematically summarizes recent advances in natural polymer-based hemostatic hydrogels from the perspectives of advanced material modification strategies, structural engineering approaches, and functional integration, with particular emphasis on the relationships among material characteristics, interfacial behavior, structural organization, and hemostatic performance. Finally, current challenges and future perspectives for clinical translation are discussed, aiming to provide valuable insights for the rational design and clinical implementation of next-generation hemostatic biomaterials. Full article

Phimosis is rarely reported in cats and involves the inability to exteriorize the penis through an absent or abnormally narrowed preputial orifice. This case report describes the clinical presentation, surgical management, and outcome of two male domestic shorthair kittens with suspected congenital type II phimosis. Both cats presented with recurrent stranguria and dysuria, preputial swelling, urine pooling or dribbling, a markedly stenotic preputial orifice, and penile–preputial adhesions. In Case 1, cystic struvite urolithiasis was also identified; treatment included cystotomy and ventrally performed modified preputial urethrostomy because of extensive adhesions, penile hypoplasia, and limited penile mobility. In Case 2, adhesions were limited to the distal penis and were released, allowing circumferential preputioplasty. No postoperative complications occurred. Clinical signs resolved, and normal urination was recorded during available follow-up, which was 12 months in Case 1 and 2 months in Case 2. The congenital origin was suspected based on early onset of clinical signs but could not be definitively confirmed. These cases suggest that selected feline type II phimosis cases can be managed successfully by tailoring surgery to anatomical abnormalities, using ventral-modified preputial urethrostomy when adhesions and penile hypoplasia restrict mobilization, or circumferential preputioplasty when adhesions are limited distally. Full article

Background: The total vaginal hysterectomy (TVH) technique has been performed for many gynecological surgeries but is less used than total abdominal hysterectomy (TAH). The purpose of this study was to analyze the outcomes in patients who underwent either TVH or TAH for enlarged diffuse uterine adenomyosis (ADS). Methods: In this retrospective study, 160 hysterectomies with bilateral adnexectomy were scheduled for premenopausal women with diffuse ADS between 2020 and 2024 at a tertiary care center in Romania. The diagnosis was established based on clinical symptomatology, color Doppler transvaginal ultrasound, transabdominal ultrasonography and magnetic resonance imaging with histopathological confirmation of diffuse uterine ADS post-operatively from the hysterectomy specimen. All surgical procedures were performed by the same surgeon. The patients were divided into two groups: the TVH group (n = 80) and the TAH group (n = 80). Patient characteristics, including age, uterine weight, body mass index (BMI), parity, operative time, intraoperative blood loss, length of hospital stay, medical history, surgical history, intra- and postoperative complications, and the presence of adhesions, were evaluated. Results: No differences were observed between the two groups with regard to uterine weight, BMI, or parity. However, the TVH group was associated with significantly younger age, shorter operative time, lower intraoperative blood loss, and a reduced length of hospital stay (p < 0.001). Additionally, both medical and surgical histories were more frequently observed in the TAH group than in the TVH group. However, intra- (i.e., 3.75%) and postoperative complications (i.e., 13.75% vs. 3.75%) were slightly more frequent in the TAH group, as well as adhesions (i.e., 17.50% vs. 8.75%). Uterine hemisection, tactical myomectomy, or morcellation were frequently employed in the TVH group, being required in 77.5% of cases. Conclusions: In our cohort of patients with enlarged diffuse uterine ADS, TVH was associated with younger age, shorter operative time, reduced intraoperative blood loss, and a shorter length hospital stay compared with TAH, without an observed increase in perioperative complications. These results support the use of TVH as a feasible surgical approach for selected enlarged diffuse uterine ADS. Full article

Background/Objectives: Perioperative chemo-immunotherapy (CHT-IO) has emerged as a standard treatment strategy for resectable stage II–IIIB NSCLC. However, data regarding surgical feasibility, mini-invasive surgery rates, perioperative outcomes, and postoperative complications in real-world single-center experiences remain limited. Methods: A retrospective single-center analysis was performed including consecutive patients with locally advanced NSCLC treated with perioperative chemo-immunotherapy between March 2024 and March 2026. Patients received platinum-based chemotherapy combined with pembrolizumab or durvalumab, followed by surgical resection with curative intent. Surgical, pathological, and postoperative outcomes were analyzed. Results: Thirty patients received neoadjuvant CHT-IO, of which 25 (83.3%) underwent surgical resection. Reasons for failure to proceed to surgery included treatment-related toxicity or deterioration in performance status (n = 3), disease progression (n = 1), and patient refusal (n = 1). Lobectomy was the most performed procedure (64%), while a minimally invasive approach (uniportal VATS) was adopted in 44% of cases. Moderate-to-severe pleural adhesions (64%) and hilar fibrosis (60%) were observed intraoperatively. Despite these technical challenges, conversion to thoracotomy was required in only one case (4%), no intraoperative complications occurred, and complete (R0) resection was achieved in 96% of patients. Pathological complete response and major pathological response were observed in 36% and 52% of cases, respectively. Postoperative complications occurred in 56% of patients, although most were Clavien–Dindo grade I–II. The presence of comorbidities was the only factor associated with an increased risk of postoperative complications (OR 10.00, 95% CI 0.99–100.46; p = 0.05). Median length of hospital stay was 5.65 ± 2.04 days. One postoperative death due to septic complications was recorded. Conclusions: In this real-world monocentric experience, the combination of perioperative CH-ICIs and surgical resection (including mini-invasive approach) was safe and feasible in patients with locally advanced NSCLC. High rates of complete (R0) resection and encouraging pathological responses were observed, consistent with outcomes reported in randomized trials. Although surgery was overall frequently technically demanding, these changes did not appear to compromise perioperative safety or oncological radicality, even when minimally invasive approaches were adopted. Larger studies with longer follow-up are needed to better define long-term oncological outcomes. Full article

The adoption of neoadjuvant immune checkpoint inhibitor (ICI)-based chemoimmunotherapy has fundamentally transformed the operative landscape of resectable non-small cell lung cancer (NSCLC). Surgeons are now routinely confronted with ICI-altered tissue planes characterized by hilar fibrosis, vascular friability, and disrupted lymph node architecture. Simultaneously, robotic-assisted thoracic surgery (RATS) has consolidated its position as the dominant minimally invasive platform for pulmonary resection, accounting for the majority of lobectomies and segmentectomies performed at high-volume centers in 2023. Whether RATS confers specific technical advantages in this increasingly complex operative context remains incompletely characterized. We conducted a structured narrative review of published evidence, synthesizing data from randomized controlled trials, prospective cohorts, national registry analyses, and emerging technology reports addressing RATS in the setting of neoadjuvant ICI-based therapy for NSCLC. A systematic literature search was conducted across PubMed and EMBASE using predefined search terms. Available evidence, though largely retrospective and limited by small sample sizes, consistently demonstrates that RATS after neoadjuvant chemoimmunotherapy is technically feasible and oncologically sound, with R0 resection achievable in virtually all cases. The enhanced three-dimensional visualization, tremor filtration, and instrument degrees of freedom afforded by robotic platforms appear particularly advantageous in the setting of dense hilar adhesions and fragile pulmonary vasculature. Lymph node yield, a recognized robotic advantage, is preserved or enhanced despite post-ICI fibrosis. Pooled conversion rates to thoracotomy, derived from post hoc surgical analyses of ICI trial populations rather than trials designed to measure conversion, are higher than for upfront resection; available retrospective single-center data, including one direct RATS-versus-VATS comparison, suggest lower conversion rates with RATS in experienced hands, though this conclusion requires prospective validation. Emerging platform integrations, including combined robotic bronchoscopy and thoracoscopic surgery, single-port systems, and artificial intelligence-assisted anatomical navigation, are poised to further extend the reach of minimally invasive surgery in this challenging clinical scenario. In experienced centers, RATS appears to offer a technically favorable minimally invasive platform for pulmonary resection after neoadjuvant ICI-based therapy, with potential advantages over VATS in managing immunotherapy-altered anatomy; however, this conclusion is derived from retrospective series and should be interpreted cautiously pending prospective comparative data. Prospective multicenter trials with standardized surgical endpoints are urgently needed. Full article

Corneal endothelial dysfunction is a major cause of corneal blindness worldwide. This is primarily due to the limited regenerative capacity of human corneal endothelial cells (CECs) and the global shortage of donor tissues. Corneal endothelial cell therapy (CECT), which involves injecting cultured CECs into the anterior chamber, has emerged as a promising alternative to conventional transplantation. However, its clinical efficacy remains limited by several factors, including rapid cell loss, non-uniform distribution, and insufficient long-term adhesion following injection. Recent advances in biomaterials and regenerative engineering have led to the development of emerging biomaterial-assisted strategies aimed at addressing these challenges. In this review, we provide a mechanistic and translational overview of next-generation CECT, highlighting a range of biomaterial-assisted strategies aimed at improving cell retention, spatial localization, and long-term adhesion following injection. These emerging approaches aim to mitigate key limitations of conventional cell injection therapy, including variability in cell distribution and retention. However, their effectiveness and translational feasibility remain under active investigation. In addition, we analyze recent global patent trends, regulatory frameworks, and market dynamics to highlight emerging opportunities for innovation and development in this field. Although many of these technologies remain at the preclinical or early translational stage, these approaches may provide a promising direction to improve engraftment efficiency, reduce surgical variability, and enable more scalable, minimally invasive treatment options. This review highlights the potential of biomaterial-assisted CECT as a next-generation regenerative strategy and outlines key challenges that must be overcome for successful clinical translation. Full article

Spinal arachnoid diverticulum is a fluid-filled dilation within the subarachnoid space that can result in compressive myelopathy, prompting investigation into optimal surgical management and outcomes. This retrospective study reviewed clinical records of dogs treated surgically between January 2021 and July 2025, including 11 cases that met the criteria of chronic progressive para- or tetraparesis, MRI-confirmed diagnosis, and use of a standardized surgical technique. All dogs underwent dorsal laminectomy followed by durotomy, durectomy, and microsurgical dissection of adhesions performed by the same surgeon, with optical magnification and specialized instruments to ensure consistency. The condition was more common in males, with French Bulldogs overrepresented (n = 6); lesions were thoracolumbar in small breeds and cervical in the single large-breed dog. Short-term outcomes, assessed one month postoperatively, showed neurological improvement in all but one dog. These findings suggest that the described microsurgical approach is feasible and associated with favorable short-term neurological recovery in most cases. However, the absence of long-term follow-up limits definitive conclusions, and further studies are needed to evaluate sustained outcomes. Full article

Articular cartilage has attracted significant attention for its essential roles in joint lubrication and stress buffering. However, its inherent self-repair capacity is limited. Addressing inflammatory damage to this tissue, therefore, presents a major clinical challenge in orthopedics. Poly(vinyl alcohol) (PVA)-based hydrogels have emerged as promising repair materials due to their high water content, which mimics the properties of natural cartilage, as well as their tunable mechanical properties and favorable biocompatibility. This review comprehensively examines PVA-based hydrogels, beginning with an overview of their network formation. It then systematically summarizes the main methods and principles for constructing their networks, including physical crosslinking (e.g., cyclic freezing-thawing), chemical crosslinking, and radiation crosslinking, as well as targeted strategies to enhance performance and modify functionality. Particular emphasis is placed on their diverse clinical applications in treating osteoarthritis, primarily including their use as surgical adjuncts, such as injectable gels and anti-adhesion membranes, as long-term or biodegradable cartilage replacement implants, and their potential in partial joint surface resurfacing and reconstruction. Finally, prospects for the application of PVA-based hydrogels in osteoarthritis therapy are considered. Overall, as versatile platform materials, PVA-based hydrogels demonstrate significant potential for clinical translation in cartilage repair. Full article

Background: Endometriosis affects 10–15% of reproductive-aged women and is a leading cause of infertility through anatomical, inflammatory, and molecular mechanisms. Objective: This review synthesizes current evidence on the pathophysiology of endometriosis-associated infertility and evaluates medical, surgical, and ART strategies to guide individualized management. Methods: We conducted a narrative review (2000–2025; PubMed, Scopus, WoS) synthesizing RCTs, meta-analyses, and observational studies on mechanisms and treatment outcomes. Results: In rASRM stage III–IV, tubo-ovarian distortion and adhesions mechanically impair oocyte pickup and embryo transport. In superficial disease, animal models demonstrate that peritoneal inflammatory mediators and ROS can impair oocyte maturation, though direct causal evidence in humans is lacking. Epigenetic dysregulation has been identified in the eutopic endometrium and linked to progesterone resistance, though its direct causal role in infertility remains unestablished. Hormonal suppression controls pain but does not improve spontaneous conception rates. Laparoscopic surgery in stage I–II remains debated. Prospective evidence supporting fertility benefit from DIE excision without mechanical obstruction is lacking. Cystectomy consistently reduces AMH, favoring IVF over surgery unless symptoms or retrieval barriers exist. IVF/ICSI live birth rates per cycle in stage I–II are comparable to those without endometriosis; cumulative rates after ≤5 cycles reach 43–46% in treated vs. 28% in untreated stage III–IV patients. Conclusions: Management requires two sequential decisions: first, whether to perform a diagnostic laparoscopy to identify minimal disease and adhesions, and second, whether to proceed with surgery or transfer directly to ART. Age ≥ 35, infertility > 2 years, or low AMH/AFC favor immediate IVF. Post-surgical EFI guides timing: high EFI supports expectant management or IUI; low EFI should prompt ART referral. When cystectomy is necessary, tissue-sparing techniques should be prioritized and fertility preservation, including oocyte cryopreservation, discussed preoperatively. Full article

Background: Remodeling of epithelial junctional architecture contributes to colorectal cancer (CRC) progression; however, the spatial organization linking tight-junction components to early dissemination remains incompletely characterized. Claudin-2 (CLDN-2) is frequently upregulated in CRC, yet whether it is associated with compartment-specific epithelial remodeling has not been systematically examined. Methods: In a retrospective single-center cohort of 54 surgically resected CRCs, we integrated clinicopathological variables, quantitative tumor budding counts, compartment-specific membranous E-cadherin expression, lymphovascular invasion, lymphoid follicles, and immune-cell densities. Analyses focused on spatial structural relationships within the tumor. Results: Higher CLDN-2 expression was enriched among node-positive tumors and advanced TNM stages. CLDN-2–higher tumors exhibited increased tumor budding and spatially selective adhesion remodeling, characterized by reduced membranous E–cadherin at the invasive front and budding sites, with more preserved membranous epithelial organization within metastatic lymph-node deposits. Descriptive co-occurrence and correlation analyses demonstrated concordant spatial relationships among CLDN-2 expression, tumor budding, nodal involvement, lymphovascular invasion, and compartment-specific E-cadherin patterns. In contrast, immune-related parameters showed weaker differentiation across CLDN-2 strata. Conclusions: CLDN-2 expression is associated with spatial epithelial remodeling in colorectal cancer, characterized by compartment-specific adhesion changes and increased microinvasive activity. The findings support a model in which CLDN-2 expression aligns with an invasion-associated epithelial configuration linked to tumor budding and nodal dissemination. These observations warrant validation in independent cohorts with outcome data. Full article

Recurrent intrauterine adhesions (IUA) and refractory thin endometrium are associated with impaired endometrial regeneration, reduced implantation, and poor live birth outcomes. Regenerative therapy using mesenchymal stromal cells (MSCs) has shown promising results; however, factors associated with reproductive success remain unclear. In this prospective, single-centre, single-arm uncontrolled observational study, 35 women with recurrent IUA and thin endometrium (<7 mm) unresponsive to standard surgical and hormonal therapy received combined subendometrial and systemic administration of placenta-derived MSCs. The primary endpoint was live birth. Secondary endpoints included clinical pregnancy rate, time to pregnancy, endometrial thickness changes, uterine blood flow (resistance index, RI), and anti-Müllerian hormone (AMH) levels. Univariable logistic regression was performed to identify factors associated with live birth. Clinical pregnancy occurred in 13/35 patients (37.1%), and live birth was achieved in 11/35 (31.4%). Median time to pregnancy was 7 (5–8) months. Shorter duration of infertility or prior pregnancy loss (OR 1.55 per year; 95% CI 1.10–2.57), AFS stage I adhesions (OR 6.8; 95% CI 1.1–42; p = 0.04), lower baseline RI in uterine, arcuate and radial arteries, and higher baseline AMH (OR 2.59 per doubling; 95% CI 1.15–6.89) were significantly associated with live birth. Endometrial thickness increased after therapy but was not significantly associated with live birth. No severe adverse events were observed. Placenta-derived MSC therapy was followed by live birth in 31.4% of women with recurrent IUA and refractory thin endometrium. A shorter duration of reproductive disorders, less severe adhesions, lower baseline RI in uterine, arcuate and radial arteries, and higher AMH levels were associated with live birth after treatment and may help identify patients with a more favourable reproductive prognosis in future controlled studies. Full article

Articular cartilage defects affect millions of patients annually and pose one of the most persistent challenges in orthopedic surgery, owing to the tissue’s inherent avascular and alymphatic nature. Current surgical approaches, microfracture, autologous chondrocyte implantation (ACI/MACI), and osteochondral grafting, share a common failure mode: inadequate adhesion between repair constructs and surrounding native cartilage, contributing to deterioration rates of 15–75% at five-year follow-up across all techniques. This review repositions adhesion not as a supplementary material property but as the central determinant of clinical success in cartilage repair. We systematically evaluate the biomechanical demands imposed by the joint environment and define clinically relevant adhesion thresholds. Adhesive hydrogel strategies are categorized by surgical context: microfracture augmentation, ACI/MACI enhancement, osteochondral graft integration, and standalone repair platforms. Material platforms are analyzed across catechol/dopamine systems, NHS ester chemistry, photocrosslinkable hydrogels, supramolecular approaches, and multi-mechanism hybrids. Injectable formulations for arthroscopic delivery are critically examined alongside key translational barriers, including fatigue durability, biocompatibility–adhesion trade-offs, sterilization compatibility, batch variability, and regulatory classification ambiguity. Future directions encompass 4D bioprinting, AI-guided formulation optimization, and stimuli-responsive reversible adhesion systems. Adhesive hydrogels represent the missing link that current cartilage repair paradigms require. Full article

Purpose: Lymph node (LN) excision is critical in oncologic surgery to provide important therapeutic and diagnostic information. LN evaluation helps in staging cancers, predicting prognosis and improving survival. The ultimate wish of a surgical oncologist would be to localize and dissect all pathologically positive LNs while avoiding the morbidity of removing true negative LNs. The goal of our study was to identify a reliable marker for clinical prediction of LNs with cancer cells from non-small cell lung cancer (NSCLC) versus LNs without. We identified epithelial cell adhesion molecule (EpCAM), a membrane protein normally expressed in epithelial tissues, including in lung. Patients and Methods: We used human specimens immunostained with anti-EpCAM monoclonal antibody. Results: EpCAM was expressed in NSCLC metastasis to LNs, as shown in 74 positive LNs from patients with resected primary NSCLC. Among pathologically negative LNs, regardless of PET avidity, EpCAM was absent; whereas among pathologically positive LNs, all PET uptake groups exhibited high EpCAM positivity. Together, these biomarkers had a 100% accuracy. There was no difference in expression between hilar and mediastinal LNs, nor between primary tumor histology. Conclusions: EpCAM may be useful for the surgical oncologist for preoperative or intraoperative detection of positive LNs from NSCLC. Full article