Invasive Diagnostic Procedures Research Articles

Raman Spectroscopy Detects Bone Mineral Changes with Aging in Archaeological Human Lumbar Vertebrae from Thornton Abbey

Archaeological human remains provide key insight into lifestyles, health, and diseases affecting past societies. However, only limited analyses can be conducted without causing damage due to the destructive nature of current technologies. The same problem exists with current clinical analyses of the skeleton, and the preferred advanced imaging techniques only provide macroscopic information. Raman spectroscopy could provide chemical information without detriment to archaeological bone samples and perhaps the need for invasive diagnostic procedures in the future. This study measured archaeological human vertebrae to investigate if chemical differences with aging were detectable with Raman spectroscopy and if differences in mineral chemistry could contribute to information on bone mineral diseases. The three lowest bones of the spine (lumbar vertebrae L3–L5), which are subject to the heaviest loading in life, of nine adults from three age groups (18–25, 25–45, and 45+ years) were provided by the Thornton Abbey Project. Three biomechanically important anatomical locations were selected for analysis; likely sites chosen to measure any chemical changes associated with aging, the vertebral body center and the zygapophyseal joints. Results detected chemical changes associated with aging. These changes relate to the minerals phosphate (∼960 cm–1) and carbonate (∼1070 cm–1), which are fundamental to bone function. Overall mineralization was found to increase with aging, but while carbonate increased with age, phosphate increased up to ∼45 years and then declined. These fluctuations were found in all three vertebrae, but were more distinct in L5, particularly in the vertebral body, indicating this is an optimal area for detecting bone mineral chemistry changes with aging. This is the first Raman analysis of bone samples from the historically significant site of Thornton Abbey. Results detected age-related changes, illustrating that ancient remains can be used to enhance understanding of modern diseases and provide information on the health and lifestyle of historic individuals.

Unexpected findings of Duchenne muscular dystrophy in prenatal screening of chromosome abnormality based on cell-free fetal DNA.

Objective：This study aims to assess the feasibility of detecting and diagnosing Duchenne muscular dystrophy (DMD) during prenatal screening for chromosome abnormalities using cell-free fetal DNA extracted from peripheral blood samples of pregnant women. Methods：Two pregnant women identified as high-risk through non-invasive prenatal testing (NIPT) underwent amniocentesis to obtain fetal cells. Subsequent fetal chromosomal karyotyping was conducted, and genomic DNA from fetal cells was extracted for Copy Number Variation Sequencing (CNV-Seq) analysis, complemented by Multiplex Ligation-dependent Probe Amplification (MLPA) to detect deletions or duplications within the DMD gene. Results：NIPT results for the two samples indicated potential abnormalities involving chromosomes 21 and 18. However, karyotype analysis of the fetuses revealed no abnormalities. CNV-Seq identified deletions of 0.28Mb and 0.18Mb within chromosome Xp21.1, encompassing the DMD gene, in each fetus. In family 1, MLPA results indicated a maternal heterozygous deletion spanning exons 12-41 in the DMD gene, while the fetus exhibited deletions in exons 12-41. In family 2, MLPA results confirmed normal DMD gene status in the pregnant woman's peripheral blood genomic DNA but revealed a fetal deletion spanning exons 48-52. Both fetuses were diagnosed with DMD and subsequently underwent termination. Conclusions：Abnormalities identified through NIPT necessitate further invasive prenatal diagnostic procedures. For cases involving chromosomal microdeletions or microduplications, a combination of karyotyping and CNV-Seq testing is essential for comprehensive diagnosis. NIPT followed by CNV-Seq may offer insights into large exon deletions within the DMD gene in specific instances.

Diagnostic Value of the Voltage-to-Mass Ratio in Biopsy-Proven Cardiac Amyloidosis.

The calculation of left ventricular mass varies in different studies, and reference values of the voltage-to-mass ratio for diagnosing cardiac amyloidosis (CA) are lacking. This study aimed to determine the value of the voltage-to-mass ratio in diagnosing CA and provide an optimal cut-off value for different calculation methods. We reviewed the electrocardiograms and echocardiograms of 213 consecutive biopsy-proven CA patients, 236 hypertrophic cardiomyopathy (HCM) patients, 100 hypertensive heart disease patients, and 181 healthy controls. Left ventricular mass was calculated using linear and cross-sectional area (CSA) methods. The voltage-to-mass ratios were compared between the CA group and other groups. The voltage-to-mass ratio obtained was used to build multivariate logistic regression models that predicted the log odds of developing CA. The CA group had a significantly lower voltage-to-mass ratio than the HCM, hypertensive heart disease, and healthy control groups. The voltage-to-mass ratio was an independent factor significantly associated with the CA diagnosis after adjusting for baseline characteristics. Linear and CSA methods yielded areas under the ROC curve of 0.86 and 0.90, respectively. Using the CSA method, the optimal cut-off was 16.42 mV/mm2/m2, with 89.0% sensitivity and 80.8% specificity. The voltage-to-mass ratio could differentiate patients with CA, HCM, and hypertensive heart disease from healthy controls, potentially providing an accurate and non-invasive alternative to current expensive and invasive diagnostic techniques.

Utility of Serum Matrix Metalloproteinase-7 as a Biomarker in Cholestatic Infants with Congenital Heart Disease.

Background: Matrix metalloproteinase 7 (MMP-7) is a novel biomarker for diagnosis of biliary atresia (BA), the most common cholestatic liver disease in infancy. There is a pressing need to determine the utility of MMP-7 levels in infants with congenital heart disease (CHD) to avoid unnecessary invasive diagnostic procedures in this high-risk population. We investigated the utility of MMP-7 in discriminating BA from non-BA cholestasis in infants with CHD and whether MMP-7 elevation was present in infants requiring treatment for clinically significant PH. Methods: This is a single center cross sectional study including infants <180 days of age with cholestasis and serum MMP-7 levels collected from 2019-2023. Demographic data and descriptive statistics were summarized with medians with interquartile ranges and frequencies with percentages. Median MMP-7 levels were assessed via Wilcoxon rank-sum test. Results: A total of 149 patients were included. Patients with CHD had significantly elevated MMP-7 levels relative to the non-CHD cohort (50 vs. 34 ng/mL, p=0.009). Sub-analysis comparing infants with and without PH revealed significantly elevated median MMP-7 levels in those with clinically significant PH (125 vs. 39 ng/mL, p=0.010). CHD patients with PH had greater median MMP-7 compared to CHD patients without PH (154 vs 43 ng/mL, p=0.028). Conclusions: Serum MMP-7 levels in infants with CHD-C were significantly elevated compared to those with cholestasis alone. MMP-7 may help identify non-BA cholestatic infants who have concurrent clinically significant pulmonary hypertension. Larger, prospective studies are needed to validate this finding and establish CHD-specific MMP-7 cutoffs.

Chinese expert consensus on diagnosis, treatment and prevention of pulmonary infection in patients with solid tumors (2024 edition)

Patients with solid tumors have an increased risk of developing pneumonia during the management of tumor. The prevention, diagnosis, and treatment of pneumonia in these patients have different characteristics compared to the general population, such as the correction of specific risk factors for pneumonia and the rational use of prophylactic antimicrobial drugs, the strategy of invasive sampling diagnostic techniques application, differential diagnosis from anti-tumor treatment associated pulmonary conditions, and consideration of pathogens and drug resistance in empirical antimicrobial treatment. In order to standardize the diagnosis, treatment, and prevention of pneumonia in patients with solid tumors, Oncology Respiratory Disease Committee initiated the "Chinese expert consensus on the diagnosis and treatment of pneumonia in patients with solid tumors". Based on a review of the latest evidence in this field, the consensus provides diagnostic and treatment pathways as well as recommendations. This consensus applies to oncologists, pulmonologists, infectious disease physicians, surgeons, emergency medicine physician, and general practice healthcare professionals involved in the management of solid tumors in adults.

Decoding sex-specific metabolomic biomarkers in the loggerhead sea turtle (Caretta caretta)

There is need for advancing minimally invasive diagnostic techniques for sex differentiation at early life-stage classes in sea turtles. The objectives of this study were to determine whether there are sex-specific effects on the metabolome of the loggerhead sea turtle (Caretta caretta) and to identify potential biomarkers for sex classification at early life-stage classes (50 post-hatchling and 50 juvenile). Comprehensive analyses including plasma chemistry (n = 100) and untargeted (n = 48) metabolomic analyses were performed. Unlike with plasma chemistry analytes, there were significant differences in the metabolomic profiles between sexes. Nine metabolites differed significantly between sexes, with several metabolites deserving greater attention as potential biomarkers: C22H32O6 and pantothenic acid was higher in females than in males, and carboxylic acid ester (C10H16O5), 1-methylhistidine and C7H14N2O7 was higher in males than females. These differences remained constant both across and within the same life-stage class. This work identified a discernible effect on the metabolic profile based on sex of loggerhead sea turtles and it suggests that these metabolites and/or their ratios could serve as potential biomarker candidates for sex classification in this species.

Patient Perceived Quality Of Care And TheAssociated Factors For Selected InvasiveDiagnostic Procedures In Outpatient Departments

Background: Continuous assessment is essential for delivering high-quality care, particularly in outpatient departments, which serve as the gateway to hospital services. It is crucial to evaluate the quality of care provided during diagnostic procedures in this setting. This study aims to assess patient-perceived quality of care and the associated factors for selected invasive diagnostic procedures in the outpatient department of CMC Vellore. Materials and Method: A descriptive cross-sectional study was conducted to evaluate patient-perceived quality of care in the Medical, Surgical, and Orthopaedic Departments of Christian Medical College. Using Total Enumerative Sampling Technique, 140 subjects were enrolled and assessed through a Patient Perception Scale and a checklist developed by the investigator. Results: More than half of the patients (55%) reported receiving high-quality care during their procedure, while 34.29% perceived moderate quality, and only 10.71% indicated low overall care quality. A statistically significant association was found between the type of procedure, doctor's gender, and the quality of care perceived by patients. Additionally, there was a negative correlation between perceived quality of care and waiting time (r = -0.211)

Bronchial washing fluid sequencing is useful in the diagnosis of lung cancer with necrotic tumor

BackgroundEarly-stage lung cancers detected by low-dose computed tomography (CT) often require confirmation through invasive procedures due to the absence of endobronchial lesions. This study assesses the diagnostic utility of bronchial washing fluid (BW) sequencing, a less invasive alternative, aiming to identify patient characteristics most suited for this approach. MethodsFrom June 2017 to March 2018, we conducted a prospective cohort study by enrolling patients with incidental lung lesions suspected of early-stage lung cancer at two independent hospitals, and 114 were diagnosed with lung cancer while 50 were diagnosed with benign lesions. BW sequencing was performed using a targeted gene panel, and the clinical characteristics of patients detected with cancer through sequencing were identified. ResultsMalignant cells were detected in 33 patients (28.9 %) through BW cytology. By applying specificity-focused mutation criteria, BW sequencing classified 42 patients (36.8 %) as having cancer. Among the cancer patients who were BW sequencing positive and BW cytology negative, 15 patients (75.0 %) showed necrosis on CT. The sensitivity of BW sequencing was particularly enhanced in patients with necrotic tumors, reaching 75 %. ConclusionsBW sequencing presents a viable, non-invasive diagnostic option for early-stage lung cancer, especially valuable in patients with necrotic lesions. By potentially reducing the reliance on more invasive diagnostic procedures, this method could streamline clinical workflows, decrease patient burden, and improve overall diagnostic efficiency.

Augmented Reality in Extratemporal Lobe Epilepsy Surgery.

Background: Epilepsy surgery for extratemporal lobe epilepsy (ETLE) is challenging, particularly when MRI findings are non-lesional and seizure patterns are complex. Invasive diagnostic techniques are crucial for accurately identifying the epileptogenic zone and its relationship with surrounding functional tissue. Microscope-based augmented reality (AR) support, combined with navigation, may enhance intraoperative orientation, particularly in cases involving subtle or indistinct lesions, thereby improving patient outcomes and safety (e.g., seizure freedom and preservation of neuronal integrity). Therefore, this study was conducted to prove the clinical advantages of microscope-based AR support in ETLE surgery. Methods: We retrospectively analyzed data from ten patients with pharmacoresistant ETLE who underwent invasive diagnostics with depth and/or subdural grid electrodes, followed by resective surgery. AR support was provided via the head-up displays of the operative microscope, with navigation based on automatic intraoperative computed tomography (iCT)-based registration. The surgical plan included the suspected epileptogenic lesion, electrode positions, and relevant surrounding functional structures, all of which were visualized intraoperatively. Results: Six patients reported complete seizure freedom following surgery (ILAE 1), one patient was seizure-free at the 2-year follow-up, and one patient experienced only auras (ILAE 2). Two patients developed transient neurological deficits that resolved shortly after surgery. Conclusions: Microscope-based AR support enhanced intraoperative orientation in all cases, contributing to improved patient outcomes and safety. It was highly valued by experienced surgeons and as a training tool for less experienced practitioners.

Comparison of the accuracy of minimally invasive techniques (cytology, cell block, immunocytochemistry and clonality assay) in the diagnosis of canine multicentric lymphoma

Lymphoma ranks among the most prevalent neoplasms in veterinary oncology, frequently diagnosed in dogs, particularly in its multicentric form. While histopathology plays a crucial role in lymphoma diagnosis, prognosis and prediction of biological behavior, minimally invasive diagnostic methods are increasingly emerging as viable alternatives. This study aims to assess and compare various minimally invasive diagnostic techniques for multicentric lymphomas in dogs. A total of 38 dogs, encompassing various sexes, ages, and breeds, with clinical suspicion of multicentric lymphoma, was included in the study. Fine needle aspiration was employed to collect samples from lymph nodes, which were subsequently used for cytology, cell block preparation, PCR for antigen receptor rearrangement (PARR), and immunocytochemistry. Among the animals evaluated, 31 dogs received a cytological diagnosis of lymphoma, while 7 showed findings suggestive of lymphoma or lymphadenitis. Immunocytochemistry on cytological smears yielded inconclusive results in 50 % of cases, with 44.74 % diagnosed with B-cell lymphoma and 5.26 % with T-cell lymphoma. Cell block analysis identified lymphoma in 30 dogs and suggested lymphoma or a round cell neoplasm in 8 cases. Cell block immunocytochemistry confirmed lymphoma in 35 dogs, comprising 80 % B-cell and 20 % T-cell lymphomas. PARR revealed monoclonal rearrangement/clonality in 33 cases, with 84.85 % of these being B-cell and 15.15 % T-cell lymphomas. This study underscores the precision of minimally invasive techniques in diagnosing and characterizing multicentric lymphoma in dogs, reaffirming their significance in veterinary clinical practice.

CCL4 as a potential serum factor in differential diagnosis of central nervous system inflammatory diseases and gliomas.

Computed tomography (CT) scans and magnetic resonance imaging (MRI) are commonly utilized to detect brain gliomas and central nervous system inflammation diseases. However, there are instances where depending solely on medical imaging for a precise diagnosis may result in unsuitable medications or treatments. Pathological analysis is regarded as the definitive method for diagnosing brain gliomas or central nervous system inflammation diseases. To achieve this, a craniotomy or stereotaxic biopsy is necessary to collect brain tissue, which can lead to complications such as cerebral hemorrhage, neurological deficits, cerebrospinal fluid leaks, and cerebral edema. Consequently, the advancement of non-invasive or minimally invasive diagnostic techniques is currently a high priority. This study included samples from four glioma patients and five patients with central nervous system inflammatory diseases, comprising both serum and paired cerebrospinal fluid (CSF). A total of 40 human cytokines were identified in these samples. We utilized a receiver operating characteristic (ROC) analysis to assess the sensitivity and specificity for distinguishing central nervous system inflammation diseases and gliomas. Additionally, we examined the correlation of these factors between serum and CSF in the patients. Ultimately, the identified factors were validated using serum from patients with clinically confirmed gliomas and central nervous system inflammation diseases followed by detection and statistical analysis through ELISA. The levels of serum factors IL-4, IFN-α, IFN-γ, IL-6, TNF-α, CCL4, CCL11, and VEGF were found to be significantly higher in gliomas compared with inflammatory diseases of the central nervous system (p < 0.05). Furthermore, a strong correlation was observed between the levels of CCL4 in serum and CSF, with a correlation coefficient of r = 0.92 (95% CI = 0.20-0.99, p = 0.027). We gathered more clinical samples to provide further validation of the abundance of CCL4 expression. A clinical study analyzing serum samples from 19 glioma patients and 22 patients with central nervous system inflammation diseases revealed that CCL4 levels were notably elevated in the inflammatory group compared with the glioma group (p < 0.001). These results suggest that assessing serum CCL4 levels may be useful in distinguishing those patients for clinical diagnostic purposes.

RvXmBlendNet: A Multi-architecture Hybrid Model for Improved Skin Cancer Detection

AbstractSkin cancer, one of the most dangerous cancers, poses a significant global threat. While early detection can substantially improve survival rates, traditional dermatologists often face challenges in accurate diagnosis, leading to delays in treatment and avoidable fatalities. Deep learning models like CNN and transfer learning have enhanced diagnosis from dermoscopic images, providing precise and timely detection. However, despite the progress made with hybrid models, many existing approaches still face challenges, such as limited generalization across diverse datasets, vulnerability to overfitting, and difficulty in capturing complex patterns. As a result, there is a growing need for more robust and effective hybrid models that integrate multiple architectures and advanced mechanisms to address these challenges. Therefore, this study aims to introduce a novel multi-architecture hybrid deep learning model called "RvXmBlendNet," which combines the strengths of four individual models: ResNet50 (R), VGG19 (v), Xception (X), and MobileNet (m), followed by "BlendNet" to signify their fusion into a unified architecture. The integration of these models is achieved through a synergistic combination of architectures, incorporating self-attention mechanisms using attention layers and adaptive content blocks. This study used the HAM10000 dataset to refine dermoscopic image preprocessing and enhance deep learning model accuracy. Techniques like OpenCV-based hair removal, min–max scaling, and adaptive histogram equalization were employed to improve image quality and feature extraction. A comparative study between the proposed hybrid "RvXmBlendNet" and individual models (CNN, ResNet50, VGG19, Xception, and MobileNet) demonstrated that "RvXmBlendNet" achieved the highest accuracy of 98.26%, surpassing other models. These results suggest that the system can facilitate earlier interventions, improve patient outcomes, and potentially lower healthcare costs by reducing the need for invasive diagnostic procedures.

Trends of ankle arthroscopy in Italy: Analysis of an official national database

ObjectivesAnkle arthroscopy has become increasingly popular as a less invasive surgical diagnostic and therapeutic procedure for a variety ankle disorder previously managed with open surgery. Despite literature reports encouraging outcomes and low complication rates, nationwide trends in ankle arthroscopy have been poorly investigated. To fully understand the burden of an emerging surgical approach as well as helping to create global standards for the diagnosis and treatment of ankle diseases, this study aimed to evaluate the incidence and demographics of patients undergoing ankle arthroscopy in Italy from 2001 to 2016. MethodsData were obtained from the National Hospital Discharge Records (SDO) provided by the Italian Ministry of Health. The patient's age, gender, length of hospital stays, primary diagnosis, and primary procedure are among the anonymized data. Population data were obtained from the National Institute for Statistics (ISTAT). According to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) ankle arthroscopy was defined by the following procedure code: 80.27. ResultsA total of 23,644 procedures were performed in Italy. The 25 to 29 and 30 to 34 age groups underwent this type of surgery at most. The majority of patients were males. The median length of hospital stay was 2.1 ​± ​2.3 days. Each year in Italy, this surgery costs an average of 2,133,401€ ± 342,143€. The main primary codified diagnoses were: “contracture of joint, ankle and foot” (13.4 ​%), “articular cartilage disorder, ankle and foot” (8.6 ​%), “late effect of sprain and strain without mention of tendon injury” (7.5 ​%) and “other joint derangement, not elsewhere classified, ankle and foot” (6.4 ​%). ConclusionsThe present study evaluated the burden of ankle arthroscopy on the national health care system and the distribution of the main diseases requiring this type of surgery. Surgeons and policy makers can allocate healthcare resources more effectively and provide patients with high-quality care by having a better understanding of national practice patterns. Level of EvidenceIII.

Fine needle aspiration cytology of Basal Cell Carcinoma: A Case series

Basal cell carcinoma (BCC) is the most common type of skin cancer, characterized by its local invasiveness and low metastatic potential. Fine needle aspiration (FNA) is a minimally invasive diagnostic technique that can be used to obtain cytological samples from suspected BCC lesions. This study aims to evaluate the efficacy and diagnostic accuracy of FNA in the diagnosis of BCC of the skin.

Computed Tomography Angiography as a Method for Diagnosing Intracavitary Coronary Arteries.

The intracavitary coronary arteries (ICCA) course is a rare phenomenon, where the segments of the coronary artery go through the atria or ventricles of the heart. In the past, these changes were incidentally detected during invasive diagnostic procedures for other reasons, as well as during postmortem examinations. As the use of multidetector computed tomography angiography (CTA) becomes more widespread, it has emerged that the incidence of ICCA has been underestimated. We present images from two coronary computed tomography angiography cases, which document the existence of ICCA in patients with non-specific chest pain. In the first case, in a 66-year-old woman, in addition to confirming coronary artery disease without significant stenosis (CAD-RADS 2-category 2 in the coronary-artery-disease-reporting and data system), the course of the middle section of the right coronary artery (RCA) in the lumen of the right atrium was demonstrated. In the second case, in a 47-year-old man in whom the presence of atherosclerotic lesions in the coronary arteries was excluded (CAD-RADS 0), the course of the distal segment of the left anterior descending (LAD) was found in the lumen of the apical layers of the right ventricle. To sum up, it should be stated that coronary CTA is a non-invasive diagnostic method that allows for visualization of the ICCA. In coronary CTA performed for indications consistent with the guidelines of scientific societies, attention should also be paid to the possible intracavitary course of the coronary arteries. The identification of such a course of the coronary arteries may be useful when preparing the patient for potential future invasive procedures involving the cardiac cavities.

The added value of shear wave elastography when combined to conventional ultrasonography and fine-needle aspiration cytology in detection of malignant thyroid nodule

BackgroundThis study aims to evaluate the effectiveness of ultrasound criteria, TI-RADS score, and elastography in distinguishing benign thyroid nodules from malignant ones, as a substitute for invasive diagnostic procedures. Although the minority of thyroid nodules is malignant, invasive diagnostic procedures are often necessary.MethodsIn this prospective study, a total of 104 thyroid nodules were assessed using fine-needle aspiration cytology. The euthyroid state of the patients was ensured. Conventional ultrasound and shear wave elastography (SWE) were performed by a single experienced operator. Final postoperative histopathologic findings were compared to conventional ultrasound and elastography findings.ResultsSWE elasticity indices (EIs) were found to be significantly higher in malignant nodules than benign ones (p < 0.05). Combined results of both TI-RADS and SWE increased the sensitivity of detection of malignant nodules.ConclusionCombined SWE and TI-RADS could enhance the diagnostic accuracy in differentiating thyroid nodules by leveraging their complementary strengths.

Predicting early-stage coronary artery disease using machine learning and routine clinical biomarkers improved by augmented virtual data.

Coronary artery disease (CAD) is a highly prevalent disease with modifiable risk factors. In patients with suspected obstructive CAD, evaluating the pre-test probability model is crucial for diagnosis, although its accuracy remains controversial. Machine learning (ML) predictive models can help clinicians detect CAD early and improve outcomes. This study aimed to identify early-stage CAD using ML in conjunction with a panel of clinical and laboratory tests. The study sample included 3316 patients enrolled in the Ludwigshafen Risk and Cardiovascular Health (LURIC) study. A comprehensive array of attributes was considered, and an ML pipeline was developed. Subsequently, we utilized five approaches to generating high-quality virtual patient data to improve the performance of the artificial intelligence models. An extension study was carried out using data from the Young Finns Study (YFS) to assess the results' generalizability. Upon applying virtual augmented data, accuracy increased by approximately 5%, from 0.75 to -0.79 for random forests (RFs), and from 0.76 to -0.80 for Gradient Boosting (GB). Sensitivity showed a significant boost for RFs, rising by about 9.4% (0.81-0.89), while GB exhibited a 4.8% increase (0.83-0.87). Specificity showed a significant boost for RFs, rising by ∼24% (from 0.55 to 0.70), while GB exhibited a 37% increase (from 0.51 to 0.74). The extension analysis aligned with the initial study. Accurate predictions of angiographic CAD can be obtained using a set of routine laboratory markers, age, sex, and smoking status, holding the potential to limit the need for invasive diagnostic techniques. The extension analysis in the YFS demonstrated the potential of these findings in a younger population, and it confirmed applicability to atherosclerotic vascular disease.

Modern methods of diagnosis and treatment of vasculogenic erectile dysfunction

A review of modern methods of diagnosis and treatment of vasculogenic erectile dysfunction is presented. Data regarding the diagnostic value of noninvasive and invasive diagnostic techniques are displayed: stamp test, Snap-Gauge test, use of the RigiScan and Androscan-MIT systems, intracavernous injections of vasoactive drugs, Doppler ultrasound of penile vessels, penile angiography, and magnetic resonance arteriography. The advantages and disadvantages of each of these tests are shown. The main directions of conservative and surgical treatment of vasculogenic erectile dysfunction are presented. Notably, early detection of erectile dysfunction with the prescription of appropriate treatment can improve the quality of life of patients and prevent life-threatening complications of cardiovascular conditions.

Stereo-electroencephalography-guided radiofrequency thermocoagulation restricted to periventricular nodular heterotopias in patients with drug-resistant epilepsy: A single center experience

IntroductionPeriventricular nodular heterotopias (PVNH) are developmental abnormalities with neurons abnormally clustered around the cerebral ventricles. Patients frequently present with focal drug-resistant epilepsy (DRE). However, the relationship between PVNH and the seizure onset zone (SOZ) is complex.Stereo-electroencephalography (SEEG) is an invasive diagnostic procedure for patients with DRE. In selected patients, the SEEG may be converted into a therapeutic procedure, lesioning the probable (SOZ) with pulsed radiofrequency thermocoagulation (RFTC). The aim of our study was to evaluate the efficacy and safety of SEEG-RFTC in a series of DRE patients with PVNH. MethodsTwenty-four patients with focal DRE related to PVNH and treated with SEEG-guided-RFTC restricted to nodules were prospectively collected between 2016 and 2023 and retrospectively analyzed after a follow-up of at least 12 months. ResultsSeventeen patients (71 %) responded (ILAE class 1–4) after SEEG-guided RFTC of whom eleven (46 %) became seizure-free (class 1) at last follow up, nine (45 %) despite residual PVNH tissue on MRI. SEEG seizure onset was restricted to PVNH in eleven patients (class 1 in 45 %) and simultaneously in PVNH and other cortical areas in thirteen patients (class 1 in 46 %). Out of 31 SEEG-RFTC procedures in twenty-four patients, adverse events, related to RFTC, were recorded in eight (26 %), of which two patients (8 %) had predicted permanent visual complaints whilst the other five had transient complaints. SignificanceThis study demonstrates that a considerable percentage of patients, even with bilateral, multiple PVNH and involvement of adjacent cortical regions can be rendered seizure-free with SEEG-guided-RFTC restricted to the nodules. Furthermore, this study delivers evidence that the complete destruction of the entire nodule is not necessary to render a patient seizure free. This justifies the use of SEEG in patients with single, multiple or bilateral PVNHs to provide insight into the epileptogenic organization in and around these lesions.

Future of invasive and non-invasive hemodynamic assessment for coronary artery disease management.

Coronary artery disease represents a global health challenge. Accurate diagnosis and evaluation of hemodynamic parameters are crucial for optimizing patient management and outcomes. Nowadays a wide range of both non-invasive and invasive methods are available to assess the hemodynamic impact of both epicardial coronary stenosis and vasomotor disorders. In fact, over the years, important developments have reshaped the nature of both invasive and non-invasive diagnostic techniques, and the future holds promises for further innovation and integration. Non-invasive techniques have progressively evolved and currently a broad spectrum of methods are available, from cardiac magnetic resonance imaging with pharmacological stress and coronary computed tomography (CT) to the newer application of FFR-CT and perfusion CT. Invasive methods, on the contrary, have developed to a full-physiology approach, able not only to identify functionally significant lesions but also to evaluate microcirculation and vasospastic disease. The aim of this review is to summarize the current state-of-the-art of invasive and non-invasive hemodynamic assessment for CAD management.