Search Results (800)

Objective: We evaluated the feasibility of a machine-learning (ML) model based on clinical features and radiomics from [¹⁸F]FDG PET/CT images to differentiate between infected and non-infected intracavitary vascular grafts and endografts (iVGEI). Methods: Three ML models were developed: one based on pre-treatment criteria to diagnose a vascular graft infection (“MAGIC-light features”), another using radiomics features from diagnostic [¹⁸F]FDG-PET scans, and a third combining both datasets. The training set included 92 patients (72 iVGEI-positive, 20 iVGEI-negative), and the external test set included 20 iVGEI-positive and 12 iVGEI-negative patients. The abdominal aorta and iliac arteries in the PET/CT scans were automatically segmented using SEQUOIA and TotalSegmentator and manually adjusted, extracting 96 radiomics features. The best-performing models for the MAGIC-light features and PET-radiomics features were selected from 343 unique models. Most relevant features were combined to test three final models using ROC analysis, accuracy, sensitivity, and specificity. Results: The combined model achieved the highest AUC in the test set (mean ± SD: 0.91 ± 0.02) compared with the MAGIC-light-only model (0.85 ± 0.06) and the PET-radiomics model (0.73 ± 0.03). The combined model also achieved a higher accuracy (0.91 vs. 0.82) than the diagnosis based on all the MAGIC criteria and a comparable sensitivity and specificity (0.70 and 1.00 vs. 0.76 and 0.92, respectively) while providing diagnostic information at the initial presentation. The AUC for the combined model was significantly higher than the PET-radiomics model (p = 0.02 in the bootstrap test), while other comparisons were not statistically significant. Conclusions: This study demonstrated the potential of ML models in supporting diagnostic decision making for iVGEI. A combined model using pre-treatment clinical features and PET-radiomics features showed high diagnostic performance and specificity, potentially reducing overtreatment and enhancing patient outcomes. Full article

Cannabis sativa L. is a versatile plant with applications in various sectors such as agriculture, medicine, food, and cosmetics. The therapeutic properties of cannabis are often linked to its secondary compounds. The worldwide cannabis market is undergoing swift changes due to varying legal frameworks. Medicinal cannabis (as a heterozygous and dioecious species) is distinct from most annual crops grown in controlled environments, typically propagated through stem cutting rather than seeds to ensure genetic uniformity. Consequently, as with any commercially cultivated crop, biomass yield plays a crucial role in overall productivity. The key factors involved in cultivation conditions, such as successful root establishment, stress tolerance, and the production cycle duration, are critical for safeguarding, improving, and optimizing plant yield. Grafting is a long-established horticultural practice that mechanically joins the scion and rootstock of distinct genetic origins by merging their vascular systems. This approach can mitigate undesirable traits by leveraging the strengths of particular plants, proving beneficial to various applications. Grafting is not used commercially in Cannabis. Only three very recent investigations suggest that grafting holds significant promise for enhancing both the agronomic and medicinal potential of Cannabis. This review critically examines the latest advancements in cannabis grafting and explores prospects for improving biomass (stem, root, flower, etc.) yield and secondary metabolite production. Full article

This study evaluated the bone regeneration effect and mechanical properties of “Sticky bone”, a mixture of platelet-rich fibrin (PRF) and synthetic bone grafts (SBGs), in the repair of large femoral bone defects in rabbits. Eighteen New Zealand white rabbits were included and randomly divided into a Sticky bone group and an SBG alone group. Bone graft samples were collected and analyzed at 4, 8, and 12 weeks after surgery. Micro- computed tomography (CT) analysis showed that the amount of the Sticky bone group in the grayscale ranges of 255–140 (highly mineralized tissue or unabsorbed bone powder) and 140–90 (representing new cancellous bone) was higher than that of the SBG group at each time point and decreased with the number of weeks. The compression strength test showed that the average compression strength of the Sticky bone group reached 5.17 MPa at the 12th week, which was 1.62 times that of the intact bone (3.19 MPa) and was significantly better than that of the SBG group (about 4.12 MPa). This study also confirmed for the first time that the use of a new polyethylene terephthalate (PET) blood collection tube to prepare PRF can stably release key growth factors such as platelet-derived growth factor-BB (PDGF-BB) and vascular endothelial growth factor (VEGF), which are conducive to early bone vascularization and cell proliferation. In summary, Sticky bone has the potential to promote bone formation, enhance tissue integration and mechanical stability, and can be used as an effective alternative material for repairing large-scale bone defects in clinical practice in the future. Full article

Background: Several epidemiological studies have indicated that metabolic syndrome (MetS) after renal transplantation is caused by an accumulation of non-immunological risks of renal transplantation, and affects the prognosis of the kidney and the patient by increasing the risk of arteriosclerosis and cardiovascular complications. The incidence of MetS in Japanese renal transplant recipients is 14.9 to 23.8%, but its effects on cardiovascular events and kidney prognosis are not clear. Here, we report the results of a longitudinal study on MetS in renal transplant recipients. Methods: A retrospective cohort study was conducted in 104 stable renal transplant recipients who attended our outpatient department from January 2006 to June 2007 and were diagnosed with MetS at least 6 months after renal transplantation until 31 December 2020, or did not have MetS. The impact of MetS on composite vascular events was examined using multivariate Cox proportional hazards analysis. Results: The hazard ratios for the impact of MetS on composite vascular events diagnosed by NCEP Japan, NCEP Original, NCEP Asia, and IDF criteria on composite vascular events were 2.78 (95% CI: 1.15 to 6.75, p = 0.024), 2.65 (95% CI: 1.04 to 6.80, p = 0.042), 2.37 (95% CI: 0.93 to 6.01, p = 0.070), and 1.91 (95% CI: 0.77 to 4.75, p = 0.164), respectively. P for interaction was used to test the influence of each indicator, but was not statistically significant. Conclusions: MetS is a robust risk factor for graft loss and development of cardiovascular events in Japanese renal transplant recipients, even during long-term follow-up. This finding emphasizes the importance of monitoring and managing MetS in this population to improve long-term outcomes. Full article

Background: Chronic wounds represent a persistent clinical challenge and impose a considerable burden on healthcare systems. These lesions often require multidisciplinary management due to underlying factors such as microbial colonization, impaired immunity, and vascular insufficiencies. Regenerative therapies, particularly autologous approaches, have emerged as promising strategies to enhance wound healing. Adipose tissue-derived stem cells (ADSCs) and platelet-rich plasma (PRP) may improve outcomes through paracrine effects and growth factor release. Methods: A prospective observational study was conducted on 31 patients with chronic wounds that were unresponsive to conservative treatment for over six weeks. Clinical and photographic evaluations were employed to monitor healing. All patients underwent surgical debridement, with adjunctive interventions—negative pressure wound therapy, grafting, or flaps—applied as needed. PRP infiltration and/or autologous adipose tissue transfer were administered based on wound characteristics. Wound area reduction was the primary outcome measure. Results: The cohort included 17 males and 14 females (mean age: 59 years). Etiologies included venous insufficiency (39%), diabetes mellitus (25%), arterial insufficiency (16%), and trauma (16%). Most lesions (84%) were located on the lower limbs. All patients received PRP therapy; five underwent combined PRP and fat grafting. Over the study period, 64% of the patients exhibited >80% wound area reduction, with complete healing in 48.3% and a mean healing time of 49 days. Conclusions: PRP therapy proved to be a safe, effective, and adaptable treatment, promoting substantial healing in chronic wounds. Autologous adipose tissue transfer did not confer additional benefit. PRP may warrant inclusion in national treatment protocols. Full article

The development of functional endothelial monolayers on synthetic vascular grafts remains challenging, particularly for small-diameter vessels (<6 mm) prone to thrombosis. Here, we present a pharmacological strategy combining 8-(4-chlorophenylthio) adenosine 3′,5′-cyclic monophosphate sodium salt (pCPT-cAMP, a tight junction promoter) with nitric oxide/cGMP pathway agonists 3-morpholinosydnonimine (SIN-1), captopril, and sildenafil) to enhance endothelialization. In human umbilical vein endothelial cells (HUVECs), this four-agent cocktail induced a flat, extended phenotype with a 3-fold increased cell area and 57.5% fewer cells required for surface coverage compared to controls. Immunofluorescence analysis revealed enhanced ZO-1 expression and continuous tight junction formation, while sustained nitric oxide (NO) production (3.9-fold increase) and restored prostacyclin (PGI₂) secretion demonstrated preserved endothelial functionality. Anticoagulation assays confirmed a significant reduction in thrombus formation (p < 0.01) via dual inhibition of platelet activation and thrombin binding. These findings establish a synergistic drug combination that promotes rapid endothelialization while maintaining antithrombogenic activity, offering a promising solution for small-diameter vascular grafts. Further studies should validate long-term stability and translational potential in preclinical models. Full article

S-nitrosoglutathione (GSNO), a promising S-nitrosothiol, has been recognized for its ability to modulate vascular tone through its vasodilatory, antiplatelet, and antiproliferative effects. However, data on its vasodilatory effects in human vessels remain limited, and its mechanisms of action have yet to be fully elucidated. In this study, we aimed to investigate the vasorelaxant effect of GSNO and its underlying mechanisms, with particular focus on the soluble guanylate cyclase (sGC)/nitric oxide (NO) pathway and potassium channels in isolated human saphenous veins (SVs) obtained from patients undergoing coronary artery bypass grafting (CABG). GSNO (10⁻⁸–10⁻⁴ M) produced concentration-dependent relaxations in SV rings precontracted with phenylephrine. These relaxations were unaffected by NO synthase inhibition with L-NAME (10⁻⁴ M, 30 min) or NO scavenging with PTIO (10⁻⁴ M, 30 min), but were significantly reduced by the sGC inhibitor, ODQ (10⁻⁵ M, 30 min). Inhibition of ATP-sensitive (glibenclamid; 10⁻⁵ M, 30 min.), high-conductance Ca²⁺-activated (charybdotoxin; 10⁻⁷ M, 30 min), small-conductance Ca²⁺-activated (apamin; 10⁻⁶ M, 30 min), or voltage-dependent (4-aminopyridine; 10⁻³ M, 30 min) potassium channels did not alter the maximum relaxant responses to GSNO. Furthermore, pretreatment with GSNO (10⁻⁴ M, 30 min) significantly attenuated both the contractile response and sensitivity to phenylephrine. Collectively, these findings demonstrate that GSNO exerts acute vasorelaxant and modulatory effects in human SV primarily via cGMP-dependent mechanisms, highlighting its potential as a local therapeutic agent for preventing graft spasm in CABG. Full article

Grafting involves complex hormonal interactions at graft interfaces that are not yet fully understood. In this study, we analyzed hormone fluctuations and gene expression during callus proliferation and vascular tissue differentiation in hickory (Carya cathayensis Sarg.) grafts. Cytokinin and ethylene precursor ACC levels steadily increased after grafting. The biosynthetic genes for these hormones (IPT3, ACS1, ACO1, and ACO5) exhibited heightened expression. Genes related to cytokinin signaling (RR3, ARR4, and ZFP5) and ethylene signaling (MKK9, ESE1, and ESE3) were similarly upregulated. Conversely, genes associated with jasmonic acid, abscisic acid, and strigolactone pathways were downregulated, including synthesis genes (AOC4 and AOS) and those involved in signal transduction (NAC3, WRKY51, and SMAX1). Correspondingly, JA-Ile and 5-deoxystrigol levels significantly decreased. Indole-3-acetic acid (IAA) levels also dropped during the early stages of graft union formation. These results suggest that low auxin concentrations may be essential in the initial stages after grafting to encourage callus proliferation, followed by an increase at later stages to facilitate vascular bundle differentiation. These findings imply that maintaining a balance between low auxin levels and elevated cytokinin and ethylene levels may be critical to support cell division and callus formation during the initial proliferation phase. Later, during the vascular differentiation phase, a gradual rise in auxin levels, accompanied by elevated ethylene, may facilitate the differentiation of vascular bundles in hickory grafts. Full article

Introduction: The scapholunate interosseus ligament (SLIL) is critical for wrist stability, with injuries causing carpal instability and potential scapholunate advanced collapse (SLAC). This technical note presents a novel ligament-sparing surgical technique for treating SLIL tears ranging from grade 2 to 4 of the Garcia-Elias classification. Materials and Methods: A retrospective study was performed on ten patients treated with this novel technique. The technique involves a dorsal approach to the wrist through a 5–7 cm incision ulnar to Lister’s tubercle. After exposing the scapholunate joint, reduction is performed using Kirschner wires (K-wires) as joysticks, followed by stabilisation with three K-wires through the scapholunate, scapho-capitate, and radio-lunate joints. Two 2.3 mm suture anchors with double sutures are placed where the reduction K-wires were removed. One pair of sutures connects the anchors and any remaining SLIL tissue, while the second pair create a shoelace-like capsulodesis. Post-operative care includes staged K-wire removal at one and two months, with progressive rehabilitation before returning to weight-bearing activities at six months. Results: All patients improved in pain and function. The technique addresses SLIL injuries by restoring both coronal alignment through ligament repair and sagittal alignment via dorsal capsulodesis. The use of suture anchors and direct repair preserves the native tissue while reinforcing the dorsal capsule–scapholunate septum complex, avoiding the need for tendon grafts or extensive bone tunnelling. Conclusions: This ligament-sparing technique offers several advantages, including absence of donor site morbidity, minimal damage to carpal cartilage and vascularity, and preservation of surgical options should revision be necessary. The procedure effectively addresses both components of scapholunate instability while maintaining a relatively straightforward surgical approach. Full article

Vein graft restenosis remains a major complication following coronary artery bypass grafting (CABG), mainly due to the abnormal proliferation of vascular smooth muscle cells (VSMCs) and impaired endothelial repair. While external stents (eStents) can provide mechanical support and limit adverse remodeling, traditional metallic stents are non-degradable and may induce chronic inflammation and fibrosis. In contrast, many bioresorbable materials degrade too quickly or lack mechanical strength. These challenges highlight the need for external stents that combine sufficient mechanical strength with biodegradability to support long-term graft patency. This is the first study that develops a chlorogenic acid–strontium (SrCA)-loaded polycaprolactone bioresorbable eStent that inhibits VSMC proliferation and enhances endothelial repair via Hippo–Yes-associated protein (YAP) signaling, addressing vein graft restenosis post-CABG. Combining mechanical support and biodegradability, it overcomes the limitations of non-degradable stents and rapidly degrading biomaterials, elucidates the potential of natural polyphenol–metal ion complexes in vascular remodeling, and offers an innovative strategy for the prevention of vein graft restenosis. Full article

Background/Objective: Thrombosis is the leading cause of graft failure and immediate hysterectomy following uterus transplantation (UTx). Currently, there is no standardized method for real-time assessment of UTx graft perfusion. This feasibility study aims to evaluate the utility of a near-infrared spectroscopy (NIRS) probe for non-invasive monitoring of local cervical tissue oxygenation (StO₂) during UTx. As proof-of-concept for the NIRS device, cervical StO₂ was also measured during non-donor hysterectomy and bilateral salpingo-oophorectomy to establish its capacity to reflect perfusion changes corresponding to vascular ligation. Methods: The ViOptix T. Ox Tissue Oximeter NIRS probe was attached to four uterine cervices during hysterectomy procedures and three separate donor cervices during UTx. Real-time StO₂ measurements were recorded at critical surgical steps: baseline, ovarian vessel ligation, contralateral ovarian vessel ligation, uterine vessel ligation, contralateral uterine vessel ligation, and colpotomy for hysterectomy; donor internal iliac vein anastomosis to recipient external iliac vein, donor internal iliac artery anastomosis to recipient external iliac artery, contralateral donor internal iliac vein anastomosis to recipient external iliac vein, contralateral donor internal iliac artery anastomosis to recipient external iliac artery, and donor and recipient vagina anastomosis for UTx. Results: During hysterectomy, average StO₂ levels sequentially decreased: 70.2% (baseline), 56.7% (ovarian vessel ligation), 62.1% (contralateral ovarian vessel ligation), 50.5% (uterine vessel ligation), 35.8% (contralateral uterine vessel ligation), and 8.5% (colpotomy). Conversely, during UTx, StO₂ progressive increased with each anastomosis: 8.9% (internal iliac vein- external iliac vein), 27.9% (internal iliac artery-external iliac artery), 56.9% (contralateral internal iliac vein-contralateral external iliac vein), 65.9% (contralateral internal iliac artery-contralateral external iliac artery), and 65.2% (vaginal anastomosis). Conclusions: The inverse correlation between StO₂ and vascular ligation during hysterectomy and the progressive rise in StO₂ during UTx suggests that cervical tissue oximetry may serve as a non-invasive modality for monitoring uterine graft perfusion. Further studies are warranted to determine whether these devices complement current assessments of uterine graft viability and salvage thrombosed grafts. Full article

Background/Objectives: Hepatic artery thrombosis (HAT) is a serious vascular complication in patients undergoing orthotopic liver transplantation (OLT). It is associated with a high risk of graft loss, re-transplantation (re-OLT), and mortality. This study aimed to evaluate the incidence and management of HAT, analyzing potential risk factors. The secondary objectives included quantifying 90-day postoperative morbidity and mortality rates. Methods: In this retrospective, observational, single-center study, data from liver transplant donors and recipients who underwent OLT between 2004 and 2024 were analyzed. HAT was classified as early (e-HAT, ≤30 days) or late (l-HAT, >30 days). Univariate statistical analysis was performed to identify the risk factors associated with HAT occurrence. Multivariate analysis was not performed due to the small number of HAT events, which would increase the risk of model overfitting. Results: In the 20 year study period, a total of 532 OLTs were performed, including 37 re-OLTs. The rates of major morbidity, reoperation, and mortality within 90 days were 44.5%, 22.3%, and 7.1%, respectively. HAT occurred in 2.4% of cases (e-HAT: 1.6%; l-HAT: 0.7%). Among e-HAT cases, 66.6% were asymptomatic and identified through routine postoperative Doppler ultrasound. All e-HAT cases were surgically treated, with a re-OLT rate of 33.3%. Three l-HAT cases required re-OLT. Overall, the HAT-related mortality and re-OLT rates were 7.6% and 46.1%, respectively. At a follow-up of 86 months, the rate of graft loss was 9.2%, and the rate of post-OLT survival was 77%. Patients who developed HAT had a higher donor-to-recipient body weight ratio and longer warm ischemia times (WITs). Additionally, patients undergoing re-OLT had a higher risk of developing HAT. Conclusions: Although the incidence of HAT is low, its clinical consequences are severe. Early Doppler ultrasound surveillance is crucial for detecting e-HAT and preventing graft loss. A high donor-to-recipient body weight ratio, a prolonged warm ischemia time, and re-OLT seem to be associated with a high risk of HAT. Full article

The natural history of focal non-infected lesions of the abdominal aorta (fl-AA) remains unclear and largely depends on their aetiology. These lesions often involve a focal “tear” or partial disruption of the arterial wall. Penetrating aortic ulcers (PAUs) and intramural hematomas (IMHs) are examples of focal tears in the aortic wall that can either progress to dilatation (saccular aneurysm) or fail to fully propagate through the medial layers, potentially leading to aortic dissection. These conditions typically exhibit a morphology consistent with eccentric saccular aneurysms. The management of focal non-infected pathologies of the abdominal aorta remains a subject of debate. Unlike fusiform abdominal aortic aneurysms, the inconsistent definitions and limited information regarding the natural history of saccular aneurysms (sa-AAAs) have prevented the establishment of universally accepted practice guidelines for their management. As emphasized in the latest 2024 ESVS guidelines, the focal nature of these diseases makes them ideal candidates for endovascular repair (class of evidence IIa—level C). Moreover, the Society for Vascular Surgery just referred to aneurysm diameter as an indication for treatment suggesting using a smaller diameter compared to fusiform aneurysms. Consequently, the management of saccular aneurysms is likely heterogeneous amongst different centres and different operators. Endovascular repair using tube stent grafts offers benefits like reduced recovery times but carries risks of migration and endoleak due to graft rigidity. These complications can influence long-term success. In this context, the use of endovascular bifurcated grafts may provide a more effective solution for treating these focal aortic pathologies. It is essential to achieve optimal sealing regions through anatomical studies of aortic morphology. Additionally, understanding the anatomical characteristics of focal lesions in challenging necks or para-visceral locations is indeed crucial in device choice. Off-the-shelf devices are favoured for their time and cost efficiency, but new endovascular technologies like fenestrated endovascular aneurysm repair (FEVAR) and custom-made devices enhance treatment success and patient safety. These innovations provide stent grafts in various lengths and diameters, accommodating different aortic anatomies and reducing the risk of type III endoleaks. Although complicated PAUs and focal saccular aneurysms rarely arise in the para-visceral aorta, the consequences of rupture in this segment might be extremely severe. Experience borrowed from complex abdominal and thoracoabdominal aneurysm repair demonstrates that fenestrated and branched devices can be deployed safely when anatomical criteria are respected. Elective patients derive the greatest benefit from a fenestrated graft, while urgent cases can be treated confidently with off-the-shelf multibranch systems, reserving other types of repairs for emergent or bail-out cases. While early outcomes of these interventions are promising, it is crucial to acknowledge that limited aortic coverage can still impede effective symptom relief and lead to complications such as aneurysm expansion or rupture. Therefore, further long-term studies are essential to consolidate the technical results and evaluate the durability of various graft options. Full article

In the last decade, magnetic nanoparticles (MNPs) have attracted much attention for the implementation of non-invasive approaches suitable for the diagnosis and treatment of vascular diseases. In this work, the optimization of novel vascular grafts loaded with Nickel-based nanoparticles via electrospinning is proposed. Two different polycarbonate urethanes—i.e., Corethane A80 (COT) and Chronoflex AL80 (CHF)—were used to fabricate 3D electrospun nanocomposite grafts. SEM analysis showed a homogeneous distribution of fibers, with slight differences in terms of average diameters as a function of the polymer used—(1.14 ± 0.18) µm for COT, and (1.33 ± 0.23) µm for CHF—that tend to disappear in the presence of MNPs—(1.26 ± 0.19) µm and (1.26 ± 0.213) µm for COT/NPs and CHF/NPs, respectively. TGA analyses confirmed the higher ability of CHF to entrap MNPs in the fibers—18.25% with respect to 14.63% for COT—while DSC analyses suggested an effect of MNPs on short-range rearrangements of hard/soft micro-domains of CHF. Accordingly, mechanical tests confirmed a decay of mechanical strength in the presence of MNPs with some differences depending on the matrix—from (6.16 ± 0.33) MPa to (4.55 ± 0.2) MPa (COT), and from (3.67 ± 0.18) MPa to (2.97 ± 0.22) MPa (CNF). The in vitro response revealed that the presence of MNPs did not negatively affect cell viability after 7 days in in vitro culture, suggesting a promising use of these materials as smart vascular grafts able to support the actuation function of vessel wall muscles. Full article

Background: The traditional management of acute burn wounds using eschar debridement followed by split-thickness skin grafting has notable drawbacks. Stromal vascular fraction (SVF), derived from autologous adipose tissue, promotes epithelialization and angiogenesis, while platelet-rich fibrin (PRF), obtained via centrifugation of patient blood, enhances wound healing. This study retrospectively analyzes the outcomes of patients with thermal injuries treated with a combination of topical SVF and PRF at the University Hospital Zurich Burn Center. Methods: From 2018 to 2020, 13 patients with deep partial-thickness burns (DPTBs) or mixed-pattern burns (MPBs) received combined topical SVF and PRF treatment. Eschar removal was performed enzymatically or surgically following hydrotherapy. SVF was collected via liposuction, and PRF from centrifuged blood. Healing progress, additional surgeries, and scar outcomes (assessed by the Manchester Scar Scale, MSS) were evaluated retrospectively. Results: The mean total body surface area burned was 29.6%, with 6.3% treated using SVF and PRF. Five patients required further surgical intervention for residual defects. Complete healing occurred within 20 days in patients without residual defects and within 51 days in those with defects. Higher MSS scores were observed in patients requiring additional surgery. No adverse effects were noted. Conclusions: Topical SVF and PRF offer a potentially less-invasive treatment for MPB and DPTB. However, due to frequent residual defects and regulatory concerns around SVF use, this approach cannot yet be considered a standard treatment. Full article