Search Results (253)

Background/Objectives: Fine-needle aspiration biopsy (FNAB) is the primary diagnostic procedure for the evaluation of thyroid nodules. Although considered safe and minimally invasive, its immediate systemic biochemical effects, particularly those related to oxidative stress and mechanical tissue injury, remain insufficiently characterized. This study aimed to evaluate the acute systemic impact of FNAB on oxidative stress parameters and to determine whether these changes correlate with cytological malignancy risk. Methods: A total of 208 patients undergoing ultrasound-guided FNAB for a solitary thyroid nodule were prospectively included. Venous blood samples were collected in the supine position immediately before and within 1 min after the procedure. Thiol–disulfide homeostasis parameters were measured using an automated spectrophotometric method, and ischemia-modified albumin (IMA) levels were analyzed concurrently. Pre- and post-procedural values were compared using the Wilcoxon signed-rank test. Associations between oxidative stress markers and Bethesda cytological categories were assessed using Spearman’s correlation analysis. Results: Native thiol and IMA levels demonstrated statistically significant changes following FNAB, whereas total thiol, disulfide levels, and derived thiol–disulfide ratios remained unchanged. The reduction in IMA levels was predominantly observed in lower-risk cytological categories. No significant correlations were identified between oxidative stress parameters and Bethesda-based malignancy risk. Conclusions: FNAB induces only minor and transient alterations in selected systemic oxidative stress markers, which are clinically inconsequential. The observed changes in native thiol and IMA levels appear to reflect short-term procedural effects rather than malignancy-associated redox alterations. These findings support the systemic safety of FNAB and emphasize the need for careful temporal standardization when interpreting circulating oxidative biomarkers in thyroid nodule research. Full article

Background: Although chronic venous insufficiency is often treated as a localized problem, it is a systemic condition that can negatively affect cardiac hemodynamics. This study investigates the associated effects of eliminating the pathologic venous reservoir on right ventricular (RV) functions, systolic pulmonary artery pressure (sPAP), and inferior vena cava (IVC) diameter in patients undergoing endovenous radiofrequency ablation (RFA) for severe great saphenous vein (GSV) insufficiency. Methods: This retrospective observational study included 154 patients who presented between September 2023 and May 2025 with GSV insufficiency (CEAP C3-C4b) and underwent endovenous RFA. Patients with major cardiopulmonary diseases were strictly excluded. Preoperative and 6-month postoperative transthoracic echocardiography records were analyzed to evaluate RV diastolic diameter, tricuspid annular plane systolic excursion (TAPSE), sPAP, the TAPSE/sPAP ratio, and IVC diameter. Results: At 6 months post-RFA, compared to preoperative values, a significant decrease was detected in the mean sPAP (14.7 ± 2.5 vs. 11.8 ± 1.8 mmHg, p < 0.001) and IVC diameter (2.1 ± 0.2 vs. 1.9 ± 0.2 cm, p < 0.001). Furthermore, significant improvements were observed in TAPSE (20.0 ± 2.0 vs. 21.5 ± 1.8 mm, p < 0.001) and the TAPSE/sPAP ratio (1.36 ± 0.15 vs. 1.82 ± 0.18 mm/mmHg, p < 0.001). Conclusions: Endovenous RFA is associated with favorable changes in right heart parameters. Eliminating pathologic extremity blood pooling may optimize venous return kinetics and subclinically improve right ventricular–pulmonary arterial coupling. Full article

Venous thromboembolism (VTE) remains a clinically relevant complication of radical prostatectomy despite advances in surgical techniques and perioperative care. Current thromboprophylaxis strategies are largely based on fixed-duration approaches and static risk models focused on the early postoperative period. However, accumulating evidence suggests that postoperative hypercoagulability is a dynamic and prolonged process that may extend beyond this timeframe. This review summarizes the pathophysiological mechanisms and temporal dynamics of postoperative hypercoagulability after radical prostatectomy, with particular emphasis on biomarker-based evidence, including thrombin generation and von Willebrand factor. Clinical and laboratory findings suggest that haemostatic activation may persist after hospital discharge, supporting the concept of a biologically relevant post-discharge period during which insufficiently captured thrombotic risk may remain despite apparent clinical recovery. Current risk assessment models do not account for the time-dependent nature of postoperative haemostatic changes and do not incorporate biomarker data. This discrepancy highlights a gap between guideline-based thromboprophylaxis strategies and the underlying biological processes. To address this, we propose a conceptual framework in which postoperative thromboprophylaxis is considered in relation to the temporal evolution of hypercoagulability. This framework is hypothesis-generating and may help inform future studies aimed at identifying patients who could benefit from extended prophylaxis while avoiding unnecessary anticoagulation in those with more rapid haemostatic recovery. Further prospective studies are required to validate biomarker-guided strategies and to define clinically actionable thresholds for individualized thromboprophylaxis in prostate cancer patients undergoing radical prostatectomy. Full article

Background/Objectives: The Doppler perfusion index (DPI) quantifies the ratio of arterial to total hepatic blood flow and reflects hepatic hemodynamic balance. Its clinical applicability is limited by insufficient standardization and the absence of clearly defined physiological reference conditions. This study aimed to establish an upper physiological reference limit for the DPI and to assess its dependence on standardized physiological conditions in healthy adults. Methods: In this prospective study, 44 healthy adults underwent Doppler ultrasonography under standardized conditions (fasting/resting, post-exercise, postprandial). Volumetric blood flow was measured in the portal vein and via the proper hepatic artery and, where feasible, the common hepatic artery. The DPI was calculated as the ratio of arterial to total hepatic inflow. Nonparametric statistical methods were applied. Results: After exclusion of participants with non-standard hepatic arterial anatomy, 39 individuals were analyzed. The DPI varied across physiological conditions, reflecting changes in the relative contributions of arterial and portal venous inflow. Under fasting/resting conditions, values based on the proper hepatic artery showed low variability (mean 0.242 ± 0.057) and normal distribution (Shapiro–Wilk p = 0.625). The empirically derived 90th percentile was 0.30. Measurements based on the common hepatic artery were higher and more variable. Conclusions: The DPI is a physiologically dynamic parameter whose clinical use requires standardized measurement conditions. Under defined protocols, a value of approximately 0.30 may be considered an upper physiological reference limit. Standardization of acquisition and use of the proper hepatic artery enable reproducible and interpretable measurements. This provides a methodological basis for further clinical applications, including oncological contexts in which functional alterations of hepatic perfusion may be relevant. Full article

Background: The use of low-molecular-weight heparins (LMWH) for the treatment and prevention of thromboembolic diseases in pediatric patients is increasing, although optimal dosing and monitoring strategies remain insufficiently defined. Methods: This study was conducted at the Clinic of Pediatrics, University Hospital “St. George”, and included 26 hospitalized patients aged 0–18 years with confirmed arterial or venous thrombosis receiving treatment or prophylaxis with enoxaparin. A total of 42 samples were analyzed. Anti-factor Xa activity was measured using an LMWH-calibrated anti-FXa assay (Innovance Heparin, Siemens Healthineers) on a Sysmex CS-2500 analyzer. Therapeutic and prophylactic dosing followed CHEST 2012 guidelines. The study evaluated age- and weight-based dosing, the number of dose adjustments required to achieve target Anti-Xa levels, and the relationship between Anti-Xa levels and anticoagulant response. Results: The mean baseline Anti-Xa level achieved with the initial weight-based dose (1.0 mg/kg/12 h) was significantly lower in children aged 1–2 years compared with older age groups. Older children, as well as patients with oncological and nephrological diseases, achieved higher anticoagulant levels with standard prophylactic dosing. Age under 1 year, oncological disease, and baseline Anti-Xa level < 0.3 IU/mL were identified as independent predictors of the need for more frequent dose adjustments to achieve a therapeutic response. Conclusions: Monitoring of Anti-factor Xa levels is essential in pediatric patients receiving LMWH for both treatment and prophylaxis. Standard dosing regimens may be insufficient in younger children and specific clinical subgroups, supporting the need for individualized dosing strategies. Full article

Background: This study aimed to evaluate the effects of obstructive sleep apnea syndrome (OSAS) surgery on oxidative stress, antioxidant capacity, and oxidative protein modifications. Changes in Total Oxidant Status (TOS), Total Antioxidant Status (TAS), Advanced Oxidation Protein Products (AOPP), Ischemia-Modified Albumin (IMA), and Total Thiol (TT) levels were analyzed in the preoperative and postoperative periods. Methods: Sixty-seven patients aged 18–65 years with an Apnea–Hypopnea Index (AHI) > 5 who underwent OSAS surgery were included. Demographic characteristics were recorded. Venous blood samples were collected at four time points: before anesthesia induction (T1), at the end of surgery (T2), on postoperative day 3 (T3), and at postoperative month 3 (T4). TOS, TAS, AOPP, IMA, and TT levels were measured and statistically evaluated. Results: Of the patients, 13.4% (n = 9) were female and 86.6% (n = 58) were male. No significant changes were observed in TOS, TAS, AOPP, or IMA levels between time points. However, TT levels at postoperative month 3 were significantly higher than those at earlier measurements (p < 0.05). Positive correlations were found between AHI and TOS, AOPP, and IMA levels, while TAS and TT showed no significant correlation with AHI. Conclusions: Surgery for OSAS did not produce significant postoperative improvements in oxidative stress parameters except for TT elevation. These results indicate that surgical intervention alone may be insufficient for biochemical recovery in OSAS and should be complemented by lifestyle and supportive therapies. Full article

Extremity soft tissue sarcoma resection often results in complex defects requiring reconstruction to preserve function and support multidisciplinary treatment. Propeller flaps have emerged as a local alternative to free flaps in selected cases, but their role in sarcoma reconstruction remains incompletely defined. This systematic review aimed to assess the current evidence on the indications, reconstructive outcomes, and oncologic reporting of propeller flaps in extremity sarcoma reconstruction. A systematic literature search was conducted in PubMed/MEDLINE, Scopus, and the Cochrane Library in accordance with PRISMA 2020. Studies reporting perforator-based propeller flaps after extremity soft tissue sarcoma resection were included. Data were synthesized descriptively because of the heterogeneity of study design, patient populations, and outcome reporting. Nineteen studies were included. Across the published literature, 656 patients were described overall, including 185 propeller flaps used after sarcoma resection. Most reconstructions involved the lower extremity, accounting for more than 95% of reported cases. Flap survival was generally high; among studies providing extractable numerical data, complete flap survival was 92.7% (115/124), total flap loss was 3.8% (2/52), and partial necrosis occurred in 9.6% (5/52) of flaps. Venous congestion was the most frequently reported complication. Oncologic outcomes were inconsistently reported, and comparative recurrence-related data were very limited. Available data suggest that propeller flaps can provide reliable coverage with acceptable complication rates in selected cases. Oncologic outcomes were sparsely and inconsistently reported, and the current literature does not show a clear signal of increased local recurrence; however, the available evidence is insufficient to draw firm conclusions regarding oncologic safety or equivalence compared with other reconstructive strategies. These findings support consideration of propeller flaps as a complementary reconstructive option in carefully selected patients, although higher-quality studies with standardized oncologic outcomes are needed. Full article

Background: Acute portal vein thrombosis (aPVT) is a severe complication of the splanchnic venous system, often associated with portal hypertension, intestinal ischemia, and hepatic dysfunction. Anticoagulation is the first-line therapy but is frequently insufficient in advanced Yerdel grade III–IV cases, where recanalization rates remain low. Endovascular interventions have emerged as alternative therapeutic strategies in selected patients. Methods: We present three cases of patients with Yerdel grade III–IV aPVT who underwent endovascular management. The techniques included: (1) transhepatic aspiration thrombectomy combined with intra-thrombus thrombolysis using alteplase (Actilyse); (2) combined aspiration thrombectomy, intra-thrombus thrombolysis with alteplase, portal vein stenting, and transjugular intrahepatic portosystemic shunt (TIPS) creation; and (3) transsplenic aspiration thrombectomy followed by angioplasty, stent placement, and TIPS creation in a post-liver transplant patient. Results: All procedures were technically successful, achieving complete or near-complete recanalization of the portal venous system. Restoration of patency in the extrahepatic portal circulation was confirmed, and portal pressures were reduced in the TIPS-assisted case. No major periprocedural complications occurred. Clinical outcomes included preservation of transplant candidacy and graft salvage. Conclusions: Endovascular therapy may be an option in selected patients with acute portal vein thrombosis. Careful patient selection and an individualized technical approach are essential. Full article

Growing evidence implicates neuroinflammation, gut-derived endotoxemia, and dysregulated lipid metabolism in the pathogenesis of Parkinson’s disease (PD). However, the relationships among circulating lipopolysaccharide (LPS), LPS-handling proteins, systemic inflammatory activation, and lipid fractions remain insufficiently characterized. The aim of this study was to compare LPS levels, LPS-related inflammatory mediators, and plasma lipid parameters between PD patients and matched controls, and to explore correlations among these biomarkers. Twenty PD patients and twenty matched controls underwent fasting venous sampling. Circulating LPS, lipopolysaccharide binding protein (LBP), soluble cluster of differentiation 14 (sCD14), high-sensitivity C-reactive protein (hsCRP), and phospholipid transfer protein (PLTP) were quantified via LAL assay and ELISAs. Serum cholesterol, HDL cholesterol (HDL-C), phospholipids (PLs), HDL-PLs and triacylglycerols (TAGs) were assessed using validated biochemical techniques. LPS concentrations did not differ between groups. However, PD patients showed elevated sCD14 and hsCRP levels, reduced LBP, and increased PLTP. Lipid profiling revealed lower total cholesterol and reduced HDL-associated cholesterol and phospholipids in PD, while TAG levels remained unchanged. Correlation analyses indicated coordinated associations between inflammatory markers and lipid fractions, with distinct interaction patterns in PD compared with controls. These findings support a mechanistic interplay among endotoxemia, innate immune activation, and lipid dysregulation in the pathophysiology of PD. Full article

Background: Chronic venous insufficiency (CVI) is characterized by venous dysfunction in the lower extremities, leading to increased venous pressure, edema, and reduced quality of life. Objectives: This study aimed to evaluate the additional effect of a structured home-based calf muscle strengthening exercise program when combined with standard compression therapy, by comparing disease severity, musculoskeletal function, and quality of life over time between patients receiving compression therapy alone and those receiving combined intervention. Methods: A randomized controlled trial was conducted in 50 patients with CVI (CEAP C₃–C₅), who were assigned to an experimental group (n = 25) and a control group (n = 25). Outcomes were assessed at baseline, week 6, and week 12. Disease severity was measured using the Revised Venous Clinical Severity Score (rVCSS), and swelling, muscle, and joint function were assessed using calf muscle strength and ankle range of motion. Quality of life outcomes were assessed using the chronic venous disease quality of life questionnaire (CIVIQ-20). Data were analyzed using two-way repeated measures ANOVA. This trial was registered retrospectively at the Thai Clinical Trials Registry (registration number: TCTR20260307002). Results: Significant group × time interaction effects were observed for disease severity (right leg: F = 81.562, p < 0.001, η²p = 0.630; left leg: F = 73.765, p < 0.001, η²p = 0.606), indicating greater improvement in the experimental group over time. Calf muscle strength significantly increased in the experimental group (right leg: F = 395.246, p < 0.001, η²p = 0.892; left leg: F = 87.278, p < 0.001, η²p = 0.645). Ankle range of motion also improved significantly (p < 0.001). Quality of life showed significant improvement with a group × time interaction effect (F = 66.104, p < 0.001, η²p = 0.579). Conclusions: A structured home-based calf muscle strengthening exercise program combined with compression therapy produced significant improvements in disease severity, musculoskeletal function, and quality of life over time, demonstrating an additive therapeutic effect in patients with CVI. Full article

Background: Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is increasingly recognized as a thromboinflammatory disorder involving coagulation, innate immunity, endothelial dysfunction, and vascular homeostasis. Emerging evidence suggests that gut microbiome-related inflammatory and metabolic signals may influence pathways potentially relevant to VTE through intestinal barrier dysfunction, microbial translocation, and microbiome-derived metabolites. This review critically examines the direct and indirect evidence relating gut dysbiosis to mechanisms potentially relevant to venous thrombogenesis. Methods: A structured literature search of PubMed, Scopus, and Web of Science was conducted from database inception to February 2026. Observational, translational, experimental, preclinical, and selected genetic studies were narratively synthesized across heterogeneous evidence types. Results: Available evidence suggests that intestinal barrier dysfunction and microbial translocation may increase systemic exposure to lipopolysaccharide and other microbial products, potentially contributing to inflammatory signaling and procoagulant responses. Proposed downstream effects include tissue factor (TF) activation, platelet reactivity, neutrophil extracellular traps (NETs) formation, complement signaling, endothelial perturbation, and impaired balance of anticoagulant and fibrinolytic pathways. Microbiome-derived metabolites, including trimethylamine N-oxide (TMAO), phenylacetylglutamine (PAGln), bile acids, and short-chain fatty acids (SCFAs), have been linked, mainly in experimental or non-VTE settings, to thrombosis-related biology. However, most evidence remains indirect, associative, or experimental, whereas direct human VTE-specific evidence is limited and heterogeneous. Conclusions: The gut microbiome–VTE axis is biologically plausible and supported mainly by mechanistic and indirect evidence, but current data are insufficient to support strong causal conclusions. Further longitudinal, well-phenotyped, mechanistically informed studies are needed to determine whether microbiome-related pathways have measurable clinical relevance in human VTE. Full article

Venous thromboembolism (VTE), comprising deep vein thrombosis and pulmonary embolism, is an important but under-recognised complication in neuromuscular diseases. In adults, emerging epidemiological data suggests increased VTE occurrence in conditions such as Amyotrophic Lateral Sclerosis, myotonic dystrophy, myasthenia gravis, inflammatory neuropathies, inflammatory myopathies, and POEMS syndrome. This heightened risk reflects not only disease-related immobility but also disorder-specific biological mechanisms, including inflammation, endothelial dysfunction and cardiomyopathy-related stasis. Therapies such as corticosteroids, IVIG-related hyperviscosity, long-term central venous access, perioperative immobility, critical illness, and complex orthopaedic procedures have prothrombotic effects. Despite this multifactorial risk profile, disease-specific guidance for thromboprophylaxis is lacking, and current practice relies heavily on extrapolation from general medical and surgical recommendations rather than data derived from neuromuscular cohorts. In children and adolescents, the VTE burden is less well-characterised, but events have been reported in Duchenne and Becker muscular dystrophy, congenital myopathies, and spinal muscular atrophy particularly with advanced motor impairment, severe cardiomyopathy, ventilatory insufficiency, and prolonged hospitalisation. Beyond venous events, selected neuromuscular disorders also exhibit increased arterial thrombosis risk. Myotonic dystrophy and dystrophinopathies are associated with cardiomyopathy and arrhythmia that predispose to systemic embolism and stroke, while inflammatory myopathies may demonstrate arterial events related to vasculitic or endothelial processes, although overall evidence remains limited. This review summarises available empirical and epidemiological evidence on venous and arterial thrombosis across adult and paediatric neuromuscular disorders, outlines disease-specific mechanistic pathways, examines treatment-related contributors, and highlights key evidence gaps that must be addressed to guide rational and targeted prophylaxis strategies in this complex, heterogeneous population. Full article

Background/Objectives: Previous studies have compared nutritional deficiency parameters in patients with venous leg ulcers (VLUs) to healthy individuals or those with unrelated conditions. This single-center study assessed blood levels of factors involved in ulcer healing and compared patients with VLUs to those with chronic venous insufficiency without ulcers. Methods: A total of 24 patients were included: 17 with VLUs formed the study group, and 7 with lower-limb venous insufficiency without ulcers served as controls. Disease severity was assessed using the CEAP classification, and all participants underwent ankle–brachial index (ABI) measurement. Venous blood samples were analyzed for selected vitamins, proteins, ions, protein electrophoresis, and amino acid profiles. Results: Strong correlations were identified (r > 0.5 or r < −0.5), some of which were statistically significant. Positive associations in the study group included BMI with waist circumference (r = 0.85, p < 0.05), tyrosine with proline (r = 0.84, p < 0.05), and valine with leucine (r = 0.82, p < 0.05). Negative correlations included albumin with folic acid (r = −0.73, p < 0.05), albumin with vitamin B6 (r = −0.71, p < 0.05), and folic acid with waist circumference (r = −0.65, p < 0.05). No significant differences in blood concentrations were observed between groups. Conclusions: Statistically significant correlations were observed between selected biochemical parameters, including albumin and alpha-1 globulins, as well as amino acid and vitamin concentrations, in both patients with VLUs and controls with chronic venous insufficiency without ulcers. Larger studies are needed to confirm these findings and clarify their relevance to venous leg ulcers. Full article

Introduction: Venous leg ulcers are the most severe manifestation of chronic venous insufficiency, and their treatment is based on compression therapy, whose effectiveness depends on the magnitude of the pressure and the biomechanical properties of the system. Doubts persist about the actual correlation between interface pressure, bandage stiffness and clinical outcomes in real-world practice. Objective: To compare the clinical efficacy and biomechanical behavior of different multicomponent compression systems in venous leg ulcers, analyzing the relationship between interface pressure, static stiffness, edema reduction and variation in the wound area. Methodology: This is a prospective, observational and multicenter study in six districts/health areas of Andalusia, in adults with active venous ulcers attended by Advanced Practice Nurses in Complex Chronic Wounds. Several multi-component compression systems were applied, and interface pressure was monitored using Tight Alright^® at three points on the leg for 96 h, recording final pressure, static stiffness, perimeters and ulcer area. Results: All systems achieved a reduction in leg circumference, more marked at the proximal points, evidencing an overall decongestant effect. The correlation between final pressure and edema reduction was weak, and relevant differences were observed in the reduction in ulcer area, with Urgo K2 and CPK Compress 2 standing out with decreases of more than 50% compared to medium or low yields of other systems with comparable pressures. The static stiffness analysis showed specific patterns according to system and leg size, as well as a heterogeneous longitudinal distribution of pressure. Conclusions: The efficacy of compression in venous ulcers depends on both the interface pressure and the design and biomechanical behavior of the system, with clinically relevant differences between multicomponent dressings. Multipoint pressure and stiffness monitoring provides useful information to optimize system selection and support decisions based on biomechanical parameters and standardized clinical outcomes. Full article

Background: Vascular malformations are congenital structural abnormalities of the blood vessels that may present at any age. In the vulvovaginal region, these lesions are uncommon and frequently misdiagnosed because their clinical appearance overlaps with common gynecologic conditions, particularly Bartholin’s gland cyst or abscess. Inappropriate surgical intervention without prior vascular evaluation may result in hemorrhage, incomplete treatment, and recurrence. Methods: A structured narrative review of the literature was performed using PubMed/MEDLINE and EMBASE databases (January 2000–April 2024) to summarize the classification, pathophysiology, clinical presentation, imaging characteristics, differential diagnosis, and management of vulvovaginal vascular malformations. Publications addressing vascular anomalies in other anatomical locations were also included when clinically relevant. A representative clinical case confirmed by histopathologic and molecular analysis is presented to illustrate the diagnostic pitfalls. Results: Vulvovaginal vascular malformations are predominantly low-flow venous lesions but may include high-flow arteriovenous malformations. A clinical examination alone is insufficient for diagnosis. Doppler ultrasonography is the recommended initial imaging modality, followed by magnetic resonance imaging to define the lesion extent and flow characteristics. Misdiagnosis most commonly occurs when lesions are treated as Bartholin’s gland pathology without prior imaging. Low-flow lesions are generally managed with sclerotherapy or planned surgical excision, whereas high-flow lesions require embolization and multidisciplinary care. Hormonal and hemodynamic changes, including pregnancy, may precipitate enlargement or thrombosis. Conclusions: Vascular malformations should be considered in the differential diagnosis of atypical vulvar masses. Preoperative imaging is essential in order to avoid inappropriate surgical procedures. A structured diagnostic approach combining clinical assessment and imaging enables correct classification and guides treatment. The presented case demonstrates a typical diagnostic pitfall and emphasizes the importance of recognizing vascular lesions in gynecologic practice. Full article