Search Results (3,530)

Background/Objectives: Transarterial embolization nowadays has a pivotal role in non-operative management strategies of post-traumatic bleeding. Timely control of hemorrhage is critical in trauma care; however, the impact of procedural timing remains underexplored. This single-center study, conducted at a Level II trauma center with 24/7 interventional radiology coverage, evaluated the influence of interval time on embolization outcomes in post-traumatic bleeding patients. Methods: In this retrospective study, 182 trauma patients who underwent embolization between June 2020 and June 2025 were analyzed. Patients were stratified by CT-to-angiography interval time (≤1 h [early, n = 46] and >1 h [delayed, n = 136]). Hemodynamic parameters, laboratory values, transfusion needs, and outcomes were compared and adjusted for baseline differences. Results: Early group patients showed more severe baseline physiology, including hypotension, higher lactates, and lower hemoglobin. No significant differences were found in mortality (2.9% vs. 2.5%), hospital stay (18.7 ± 26.1 vs. 18.1 ± 22.2 days), or transfusion requirements. Embolizations within one hour from CT were associated with significant lactate reduction at 24 h in univariate analysis (p = 0.039), but this was not confirmed in multivariate analysis. Re-embolization (8.7% vs. 1.5%, p = 0.036) and surgical rescue (13.0% vs. 3.7%, p = 0.033) rates were more frequent in the early group. Conclusions: Early embolization improves metabolic parameters in post-traumatic bleeding, especially in patients with greater baseline severity of injuries. These findings support prioritization of early embolization and structured interventional radiology networks for timely procedures. A personalized approach according to baseline injury is required. Full article

Introduction: Robotic splenectomy has emerged as a promising alternative to laparoscopic surgery, offering potential advantages in precision, ergonomics, and individualized surgical planning. In the context of personalized medicine, robotic technology may enable tailoring of surgical strategies to patient-specific anatomy, spleen size, and comorbid hematologic conditions. However, its clinical superiority remains uncertain due to limited and heterogeneous evidence. Methods: We performed a systematic review and meta-analysis following PRISMA guidelines, utilizing PubMed, CINAHL, Web of Science, and EMBASE databases to locate studies on robotic splenectomies in children. This review was prospectively registered in PROSPERO (CRD420251104285). Risk of bias was assessed using the ROBINS-I tool for non-randomized studies. Random-effects models were fitted using restricted maximum likelihood (REML), and confidence intervals were adjusted using either Knapp–Hartung (HKSJ) or modified Knapp–Hartung (mKH) methods when appropriate. 95% prediction intervals were calculated, and the certainty of evidence for each outcome was assessed using the GRADE approach. Results: This review included 272 pediatric patients from 16 studies conducted between 2003 and 2025, of which five were included in the meta-analysis. No statistically significant differences were observed between robotic and laparoscopic splenectomy for operative time, intraoperative blood loss, conversion to open surgery, blood transfusions, or complications. However, the direction of effect estimates consistently favored the robotic approach. A statistically significant reduction in hospitalization days (−0.93 days; 95% CI: −1.61 to −0.24; p = 0.01) was found, though this became marginally significant after HKSJ adjustment (p = 0.06). Intraoperative blood loss showed significance in the primary model (−63.88 mL; 95% CI: −120.38 to −7.38; p = 0.03), but not after mKH correction (p = 0.16). Heterogeneity was substantial-to-extreme for several outcomes and was only partially accounted for by leave-one-out sensitivity analyses. All findings were rated as very low certainty according to the GRADE framework. Conclusions: Robotic-assisted splenectomy in pediatric patients has been reported as technically feasible and performed safely in selected cases. However, the small number of studies, their retrospective design, substantial methodological heterogeneity, and the resulting very low certainty of the evidence according to GRADE preclude any firm conclusions about its comparative safety or efficacy versus laparoscopy. Well-designed prospective studies are needed to clarify its clinical benefits. Full article

Background: Inherited retinal dystrophies (IRDs) include a clinically and genetically diverse array of conditions resulting in progressive visual impairment. The PROM1 gene is crucial for the development and maintenance of photoreceptors. Variants in PROM1 are linked to a wide phenotypic spectra of IRDs; however, the correlation between genotype and phenotype is not fully elucidated. Comprehending these relationships is essential for enhanced diagnostic precision, patient guidance, and formulation of focused treatments. Objective: This study aims to examine the genotype–phenotype associations in patients with PROM1-associated IRDs. Clinical variability and inheritance patterns linked to different pathogenic variants are examined, aiming to clarify their different behaviors. Methods: We performed a retrospective investigation of patients identified as affected by PROM1-related IRDs. Thorough ophthalmologic assessments, including retinography, fundus autofluorescence, optical coherence tomography (OCT), and electrodiagnostic testing (EDT), were conducted. Genetic testing was performed via targeted gene panels or whole-exome sequencing. Variants were categorized based on ACMG criteria, and inheritance patterns were determined by familial segregation analysis. Clinical characteristics were analyzed among genotypic groups to ascertain potential phenotype–genotype relationships. Results: All patients had pathogenic or likely pathogenic PROM1 mutations. Both autosomal dominant and autosomal recessive inheritance patterns were identified. Dominant pathogenic variants were predominantly linked to late-onset cone-rod dystrophy or macular dystrophy, whereas biallelic variants frequently resulted in early-onset severe rod–cone dystrophy characterized by fast vision deterioration. A group of patients with the same genotypes displayed significant phenotypic variability, indicating the potential impact of modifier genes or environmental influences. Truncating mutations in the N-terminal region were significantly associated with earlier illness onset and greater functional impairment. Conclusions: PROM1-related IRDs demonstrated significant clinical and genetic heterogeneity, with the route of inheritance and type of variant affecting disease severity and progression. Our findings underscore the significance of thorough genotypic and phenotypic characterization in afflicted individuals. A deeper comprehension of PROM1-related IRD disease pathways can enhance prognosis, direct clinical care, and facilitate the advancement of genotype-based therapy strategies. Full article

Background: Surgical aortic valve replacement (SAVR) is the main treatment for severe aortic valve disease, the most common valvular heart disease worldwide. Methods: We evaluated the in-hospital mortality risk factors and predictors following on-pump SAVR. We retrospectively reviewed data from consecutive patients treated at a tertiary center from 2022 to 2024, focusing on routine hematological data and inflammatory indexes, alongside established factors. Results: Postoperative vasoactive-inotropic score (VIS) (OR1.058, CI95%: 1.007–1.112), platelet count (OR1.033, CI95%: 1.002–1.064), lymphocyte counts (OR3.532, CI95%: 1.507–8.278), and perioperative fresh frozen plasma transfusion (OR1.335, CI95%: 1.068–1.669) were independent risk factors for SAVR in-hospital mortality. VIS best predicted the endpoint (AUC 0.929, p = 0.001). Postoperative platelet count and platelet-to-lymphocytes ratio (PLR) outperformed the additive EuroSCORE in predicting the outcome, but not EuroSCORE II. Conclusions: Although EuroSCORE II remained superior to inflammatory indexes in predicting in-hospital death, the dynamic postoperative monitoring provided added value beyond static preoperative risk scores. This dynamic approach supported personalized monitoring and targeted therapeutic interventions. Postoperative VIS, platelet, lymphocyte counts, and PLR represent dynamic, low-cost predictors of in-hospital mortality after on-pump SAVR, offering a complementary value to EuroSCORE II–based models. Full article

Background/Objectives: Breast cancer is a leading cause of cancer-related mortality among women worldwide. Small nucleolar RNAs (snoRNAs) represent a class of non-coding RNAs with potential as novel biomarkers applicable to improve diagnostic and prognostic applications. Methods: We performed a comprehensive evaluation of the snoRNA-related gene expression by qPCR using benign and tumor tissue samples associated with invasive breast carcinomas of no special type (NST). Selected candidate snoRNAs, i.e., SCARNA2, SCARNA3, SNORD15B, SNORD94, SNORA68, and SNHG1, along with RNU2-1 snRNA, were further validated and their associations with clinicopathological parameters were examined. External datasets and plasma samples were used for additional validation. Results: SCARNA2 was identified as the most promising snoRNA biomarker candidate, showing a positive association with better progression-free survival (PFS) in our data (13.3-month survival difference between low- and high-expression groups) and with both PFS and overall survival in external RNA-seq datasets. SNORD94, SNORD15B, SCARNA3, and RNU2-1 snRNA were also indicated as putative tumor suppressors. SNORD94 was associated with better progression-free survival (PFS) in our data as well (12.4-month survival difference between low- and high expression groups). Greater downregulation in the low-expression tumor subgroup compared to benign samples further supports the prognostic potential of SCARNA2 and SNORD94. Evidence for SNHG1 and SNORA68 as putative oncogenes was less conclusive. Conclusions: Several small nucleolar RNAs were found to be dysregulated in breast cancer specimens, supporting their further evaluation as potential biomarkers. In particular, SCARNA2, SNORD94, SNORD15B, SCARNA3, and RNU2-1 snRNA merit further investigation to determine their clinical relevance and biological roles in breast cancer. Full article

Aspergillus species are major opportunistic pathogens responsible for invasive aspergillosis, with antifungal resistance posing increasing challenges to their treatment worldwide. We investigated the antifungal susceptibility and genomic features of Aspergillus isolates from sterile clinical specimens collected at a tertiary hospital in Thailand between January and December 2023. In total, 24 isolates were identified via culture and tested for amphotericin B and voriconazole susceptibility using CLSI M38 broth microdilution, and whole-genome sequencing was performed on selected isolates to characterize resistance mechanisms. Aspergillus fumigatus was the most frequent species (54%), followed by A. flavus (29%) and other less common species. Voriconazole exhibited potent activity against most isolates, although two A. fumigatus strains showed elevated MICs (2–4 µg/mL), meeting resistance thresholds. One isolate (CUAFU23) was confirmed to harbor the cyp51A TR34/L98H mutation, marking the first identification of this canonical azole resistance mechanism in a clinical specimen from Thailand and supporting earlier environmental findings of azole-resistant A. fumigatus carrying the same allele. Genomic profiling of CUAFU23 further revealed subtle but distinct shifts in domain composition compared with susceptible strains, suggesting broader adaptive changes. The above findings underscore the emergence of azole-resistant A. fumigatus in Thailand and highlight the importance of ongoing surveillance using combined phenotypic and molecular approaches. Full article

Inherited platelet function disorders (IPFD) are characterized by normal platelet count and morphology but impaired function due to pathogenic variants in genes encoding membrane receptors, granule constituents, or intracellular signaling proteins. Glanzmann’s thrombasthenia, the most representative IPFD, results from ITGA2B or ITGB3 mutations that disrupt the αIIbβ3 integrin complex, producing severe mucocutaneous bleeding. Advances in molecular genetics have expanded the IPFDs landscape to include defects in other platelet receptors (Glycoprotein (GP)-VI, P2Y₁₂, and thromboxane A₂[TxA₂]-R), signaling mediators (RASGRP2, FERMT3, G-protein regulators, PLC, and TxA₂ pathway enzymes), and granule biogenesis disorders such as Hermansky–Pudlak and Chediak–Higashi syndromes. High-throughput sequencing technologies, including long-read approaches, have greatly improved diagnostic yield and clarified genotype–phenotype correlations. Clinically, bleeding severity varies from mild to life-threatening, and management relies on antifibrinolytics, desmopressin, or platelet transfusion; recombinant activated factor VII and hematopoietic stem cell transplantation are reserved for selected cases. Emerging strategies such as gene therapy and bispecific antibodies that link platelets and coagulation factors represent promising advances toward targeted and preventive treatment. A better knowledge of the clinical features and understanding molecular pathogenesis of IPFDs not only enhances diagnostic precision and therapeutic options but also provides key insights into platelet biology, intracellular signaling, and the broader mechanisms of human hemostasis. Full article

A 12-year-old female captive Malayan tapir (Tapirus indicus) in Thailand presented with clinical signs including depression, anorexia, pale mucous membrane, dark-brown urine, dry feces, and tick infestation. Hematological analysis revealed severe anemia (packed cell volume, PCV = 9%), and blood smear examination suggested blood parasite infection, which was subsequently confirmed as Theileria orientalis using PCR targeting the 18S rRNA gene and sequencing. Treatment consisted of the administration of diminazene aceturate (2.5 mg/kg, IM, q14days for three doses), whole-blood transfusion, fluid therapy, and other supportive care. Clinical improvement was observed within three days post-treatment, including normalization of urine color and a progressive increase in PCV. By Day 42, the PCV had returned to normal (33%), with no observed complications from the medication or blood transfusion. Further screening using PCR targeting the 18S rRNA gene of piroplasmid parasites revealed an 80% apparent prevalence of Theileria infection among sampled tapirs in the same facility, although only one individual exhibited clinical signs. These findings indicate that asymptomatic carriage of T. orientalis can be observed in tapirs and that clinical disease could emerge under stress or immunocompromised conditions. Given the presence of ticks and potential contact with other susceptible species in zoo settings, routine surveillance and preventive tick control are essential for mitigating transmission risks. Full article

Background: The American Society of Clinical Oncology (ASCO) established recommendations for palliative care (PC), and they still remain the most trusted source overall. The standard published by C. Earle (defined in solid tumors) for referral to PC is > 55%. However, these rates remain unclear in general onco-hematology. Our referral rate reaches 60%; while it meets the standard, there are significant differences between ST and HM. Several authors have already pointed out these discrepancies. Arguing in some cases its possible relationship with the different behavior of professionals with different pathologies. Objective: The primary objective of this work is to understand the role that PC plays in onco-hematology and to determine the profile of patients referred to PC. Therefore, the article aims to establish some recommendations related to the results of prevalent characteristics. Methods: The Mortality Subcommittee (MS) includes and registers in a database all cancer patients who died in hospital undergoing systemic anticancer therapy (SACT) in their last 30 days of life (SACT ≤ 30 d). PC, in turn, works on relieving symptoms related to the disease and the patient. To understand the impact of PC in the MS database patients, we reviewed the literature for symptoms related to palliative care activity. Subsequently, we selected some signs and symptoms, by consensus with our PC specialists, in order to add them to the MS database and register them retrospectively. We measured the percentage of patients who registered these symptoms based on the data found in their electronic records. The results include the comparison by group: between patients referred or not to the PC program (PCP), and between the pathologies ST and HM. We used the programming language R (version 4.2) in our statistical analysis, including the “compareGroups” package (version 4.6), applying the pertinent tests based on the distribution of the data. Results: We completed the records on the 1681 patients from the period 2020–2023. 59.4% were men, the average age was 65.5 years, and 73.5% had ST and 26.5% had HM. Patients with lung cancer predominate (28.5%), with 71% of them being in the stage IV, followed by leukemia (9.76%). 60% are in progression of their disease, and 77% have advanced disease (AD). The average therapeutic aggressiveness indicators were SACT < 30 d: 38.9% (ST: 33.4%; HM: 70.97%); SACT < 14 d: 16.36% (ST: 13.76%; HM: 31.56%); the change in therapeutic regimen was 22% (ST: 20.8%; HM: 25.1%). The referral rate to PCP was 59.7% (ST: 68.2% and HM: 36.3%). Late referral (PCP ≤3 days before death) occurred in 29.2% of all patients, being 29% for ST cases and 30.4% for HM cases. Regarding the recording of signs and symptoms: psycho-emotional and analgesia regimens (including opioids) are better recorded in the PCP group (p < 0.001); the more physical symptoms (dyspnea, bleeding, infections, and severe symptoms) do not present statistically significant differences, although the severe symptoms in the PCP group are more disabling (cerebral involvement, spinal cord compression, vertebral crushing). The number of bags of blood products transfused is significantly lower in the PCP group (average 6.9 vs. 12.7). The total number of symptom variables with significant statistical differences was 13 for ST and 8 for HM. Conclusions: In this cohort, patients visited by PC had a better record of psycho-emotional symptoms. We consider that patients who are in any of the following situations should be referred to PC: initial diagnosis of stage IV lung cancer, leukemia; patients with advanced disease; presence of pain requiring opioids; psychoemotional symptoms; need for >7 to 15 transfusions of blood products and, if there are disabling symptoms. PC improves professional interest in the psycho-emotional and fragility situation of these patients. According to our data (in terms of the number of variables with significant differences by pathology group), we observed that hematologists tend to take on palliative tasks more frequently than their oncologist peers, who delegate them to PC in order to have more time dedicated to their specific field. Full article

Objective: Partial hip arthroplasty (PHA) procedures are often associated with significant blood loss, particularly in elderly patients with comorbidities. Predicting the need for intraoperative transfusion in advance is crucial for patient safety and surgical planning. Machine learning (ML) algorithms offer data-driven solutions to support clinical decision-making in such scenarios. Methods: This retrospective, single-center cohort study evaluated data from 202 patients who underwent PHA between December 2023 and July 2025. Demographic data, as well as preoperative and intraoperative variables, were collected. Six ML algorithms—Logistic Regression, Decision Tree, Support Vector Machines (SVM), Artificial Neural Network (ANN), Random Forest, and Gradient Boosting—were trained and tested to predict intraoperative blood transfusion. Model performance was assessed using accuracy, F1-score, and area under the ROC curve (AUC). SHAP (SHapley Additive exPlanations) analysis was used to evaluate model interpretability. Results: Among the 202 patients, 85 (42.1%) received intraoperative blood transfusions. Significant predictors included low preoperative hemoglobin, high ASA score, prolonged operative time, increased intraoperative blood loss, and elevated INR (all p < 0.05). The Random Forest and Decision Tree models achieved the highest accuracy (95.1%) and F1-score (0.960), while the SVM model yielded the highest AUC (0.992). SHAP analysis identified hemoglobin, age, ASA score, INR, and operative time as the most influential features in model decision-making. Conclusions: Machine learning models—particularly Random Forest, Decision Tree, and SVM—demonstrated high performance in predicting intraoperative transfusion needs during PHA. The incorporation of explainable AI techniques such as SHAP enhanced the clinical interpretability of model outputs, supporting personalized patient management. These findings provide a strong foundation for integrating such models into clinical decision support systems, though external validation through multicenter and prospective studies is warranted. Full article

Maintaining redox balance is essential for platelet physiology and overall cellular homeostasis. Upon activation, platelets generate reactive oxygen species (ROS), which act as signaling mediators in responses to collagen and are required for collagen-dependent thrombus formation. Multiple enzymatic systems contribute to platelet ROS production, with nicotinamide adenine dinucleotide (phosphate) oxidases (NOX isoforms) serving as the primary source, complemented by cyclooxygenase (COX), xanthine oxidase (XO), and the mitochondrial respiratory chain. Both oxidative and reductive stress disrupt this equilibrium and have been implicated in the pathophysiology of diverse diseases, including bleeding disorders, thrombosis, cardiovascular disorders, diabetes and cancer. In transfusion medicine, mitochondrial dysfunction and the resulting oxidative stress are key drivers of platelet lesion resulting in clearance defects and the progressive loss of hemostatic activity during storage. Targeting platelet-specific redox regulatory pathways represents a promising strategy to better define platelet contributions to human health and to develop interventions that may alter disease outcomes in which platelets play a central role. Full article

SARS-CoV-2 infection remains a global health concern, with its impact on host immune responses not fully understood. In a case–control study, we examined how COVID-19 affects DNA methylation patterns in the upper respiratory airway of hospitalized individuals. DNA methylation arrays were performed on nasopharyngeal samples at inclusion/hospitalization and 6 weeks post-inclusion. We found a distinct DNA methylation pattern in COVID-19 patients compared to healthy controls, identifying 510,099 differentially methylated CpGs. Within the transcription start sites (TSSs) and gene body, COVID-19 patients displayed a higher number of genes/CpGs with elevated methylation levels. Enrichment analysis of TSS-methylated genes revealed effects of SARS-CoV-2 on genes associated with type I interferons, anti-viral and inflammatory responses, and immune functions. Some CpG methylations were transient, and normalized at group level by 6 weeks post-inclusion. Several IFN-regulated genes, including OAS1, OAS3, IFIT3, and MX1, were identified. Among the top regulators were IL17A and ERK1/2, both involved in inflammatory processes. Networks nodes included IGF1 and EGF, associated with processes including tissue repair and activation of immune responses. Overall, our data suggests that COVID-19 can impact the upper airway by modifying gene methylation patterns. This could have implications for conditioning of the airways, how individuals respond to future airway infections, and therapeutic interventions. Full article

Background and Objectives: This study aimed to comparatively investigate the impact of postoperative intravenous iron therapy (IVIT) as an add-on to preoperative IVIT on clinical outcomes in frail versus non-frail patients with iron-deficiency anemia (IDA) in the setting of elective cardiac surgery. Materials and Methods: This was a retrospective single-center study. The data was collected prospectively between January 2021 and November 2024. A total of 200 patients with IDA (100 frail and 100 propensity-score-matched non-frail patients) who received IVIT before and/or after elective cardiac surgery were included. Patients were divided into four equal groups including frail pre/post group (frail patients with preoperative plus postoperative IVIT), non-frail pre/post group (non-frail patients with preoperative plus postoperative IVIT), frail pre group (frail patients with preoperative IVIT) and non-frail pre group (non-frail patients with preoperative IVIT). Perioperative parameters, postoperative complications, and length of hospital stay (LOS) were recorded in each group. Postoperative follow-up parameters included change in hemoglobin levels and reticulocyte count from baseline (on operation day, postoperative day 1, day 7, 1st month and 3rd month) as well as the hospital readmission and mortality rates within 3 months after surgery. Results: Hemoglobin levels (10.6 ± 1.2 g/dL at baseline to 12.6 ± 1.4 g/dL at 1st month and 13.4 ± 1.4 g/dL at 3rd month, p = 0.01 and p = 0.02) and reticulocyte counts (0.035 ± 0.005 × 10¹²/L at baseline to 0.075 ± 0.005 × 10¹²/L at 1st month and 0.085 ± 0.005 × 10¹²/L at 3rd month, p = 0.004 and p = 0.002) were significantly improved from baseline only in the frail pre/post group. Conclusions: Postoperative IVIT demonstrated improved postoperative hemoglobin levels and reticulocyte counts, besides its potential in reducing perioperative transfusions, in the setting of elective cardiac surgery in frail patients with IDA. Full article

Background: The SARS-CoV-2 pandemic raised concerns about severe asthma (SA) patients, especially those on biological therapy. While initial fears of increased risks diminished for the general asthma population, a subset of severe cases undergoing specific treatments continued to be closely monitored. Our study aimed to evaluate COVID-19 occurrence, asthma exacerbations, hospitalizations, and outcomes in severe asthma patients. Methods: This multicenter study gathered data from 237 adult severe asthma patients in Croatia and Serbia to assess COVID-19 impact compared to the general population. Participants received omalizumab, mepolizumab, benralizumab, or reslizumab. Data on demographics, clinical features, and COVID-19 were collected. COVID-19 symptoms and diagnostic testing were assessed as described. Results: No demographic differences were seen between COVID-19-positive and -negative groups, with eosinophilic asthma prevailing. Among patients with SA treated with biologics, the occurrence of COVID-19 did not differ significantly from that in the general population, and biologic therapy was not associated with more severe disease or higher mortality. Importantly, no meaningful differences were observed among different biologics regarding COVID-19 outcomes. Vaccination was associated with a reduction in severe cases and hospitalizations. Conclusions: Biologic therapy for severe asthma appears safe during the COVID-19 pandemic. Patients receiving biologics did not experience worse outcomes than the general population, and no biologic was linked to poorer COVID-19 prognosis. Vaccination further contributed to protection against severe disease. Full article