Invasive Method Research Articles

Investigating the Effects of Shockwave and Percussion Massage Gun on Subacute Myofascial Pain in Gasterocenemious Muscle

Introduction: Myofascial pain syndrome is a common musculoskeletal injury, especially among athletes, typically treated with symptomatic invasive and non-invasive methods. This study compares the effects of massage guns and radial extracorporeal shock wave therapies on myofascial pain syndrome symptoms in amateur athletes. Materials and Methods: In this clinical trial, 45 amateur athletes (18-30 years old) were recruited, who were randomly assigned to 15-member groups of shock wave, massage gun, and control (routine treatment included electrotherapy and stretching, which was applied on three groups). After initial evaluations of the pain intensity, pain pressure threshold (PPT), isometric muscle strength, and range of motion (ROM), the patients received single-session treatment and were immediately reassessed. Results: The results showed pain relief and improved PPT following shock wave plus routine treatment (P=0.03). The control group had less pain, while pain intensity and PPT did not change. The variables were not significantly different between the groups (P=0.12). Shock wave along with routine treatment increased plantar flexion ROM (P=0.00), unlike the massage gun. Additionally, dorsiflexion ROM (P=0.63) and maximal isometric gastrocnemius muscle strength (P=0.95) remained unchanged in all groups. Conclusion: One session of massage gun therapy immediately reduced gastrocnemius muscle pain, while it failed to change PPT, maximal isometric gastrocnemius muscle strength, or dorsiflexion and plantar flexion ROM. However, shock wave therapy immediately increased plantar flexion ROM and PPT, and reduced pain intensity. These modalities led to limited changes, suggesting the need for repeated sessions and supplementary treatments.

Voiding sonography: Technical description of a novel ultrasound method for assessment of micturition in women

AbstractVoiding sonography (VS) is a novel non‐invasive method that can be used to assess micturition in real time. When performed in a functional seated position and combined with free uroflowmetry, detailed evaluation of voiding can be conducted. VS presents advantages over current invasive assessment methods such as urodynamics. This methodological paper describes the rationale; advantages and disadvantages of VS; participant preparation; technique; a practical approach to obtain the video/image (including transducer placement to achieve an assessment of voiding with minimal obstruction of urine flow); recommended machine and transducer specifications; and the potential usefulness of ultrasound measurements. These measurements might provide information regarding the function of the pelvic floor muscle and urethral dynamics during voiding. Measures assessed with VS can also provide information regarding urine storage. In summary, VS is a new method to assess female voiding. Future work should evaluate the potential utility of the method to evaluate characteristics and mechanisms for voiding dysfunction in females with a variety of relevant clinical conditions. Use of VS as a screening tool before and after surgical or non‐surgical treatment intervention may also be a future consideration to assess progress and provide feedback to clinicians and patients.

Mid-term efficacy of non-contact orthopedic robot navigation in the treatment of lumbar spondylolisthesis

ObjectiveThis study was aimed to explore the mid-term efficacy of non-contact orthopedic robot navigation in the treatment of lumbar spondylolisthesis.MethodsThe clinical data of young and middle-aged patients with lumbar spondylolisthesis were retrospectively analyzed and divided into an observation group and a control group according to surgical methods. The observation group was treated with minimally invasive transforaminal interbody fusion (MIS-TLIF) combined with orthopedic robot-navigated percutaneous pedicle screw fixation; while the control group underwent traditional posterior lumbar interbody fusion (PLIF). Perioperative indicators, waist and leg pain Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI), and complications were compared between groups.ResultsA total of 32 patients with lumbar spondylolisthesis were included in this study, with the average age of 50.3 ± 2.7 years old. There were 17 patients in the observation group and 15 patients in the control group. Although the new surgical technique for the observation group may require longer operative time, it showed significant advantages in reducing intraoperative bleeding, postoperative drainage, and shortening hospital stay. These benefits might result in faster recovery for patients, reduced risk of complications, and improved overall quality of life. The new technology was also significantly better compared to the traditional method in terms of VAS scores and ODI at 1 week, 1 month, 3 months, and 6 months post-surgery. These results provided patients with better treatment options and potentially a faster path to recovery. One case with infectious incision in the observation group and one case with intraspinal hematoma formation in the control group were observed. However, there was no statistical difference in the complication rates between the two groups (P > 0.05).ConclusionThe non-contact orthopedic robot navigation for the treatment of lumbar spondylolisthesis was demonstrated to be minimally invasive, precise, and stable surgical method. It is a treatment option worth considering for suitable patients.

Effectiveness of minimally invasive methods (laser-induced interstitial thermotherapy and percutaneous ethanol sclerotherapy) in the treatment of Plummer’s disease

Background. The purpose of the study was to investigate the effectiveness of minimally invasive methods, such as laser-induced interstitial thermotherapy (LITT) and its combination with percutaneous ethanol ablation (PEA), in treating toxic thyroid adenomas. To determine the multiplicity of the LITT procedure and parameters of laser radiation to achieve a stable positive therapeutic effect. Materials and methods. Between 2020 and 2024, 24 patients with Plummer's disease who did not receive previous thyrostatic therapy before the LITT session were treated and were divided into 2 groups. Patients of the first group with a predominantly parenchymal structure of the node received LITT monotherapy (16 patients), patients of the second group with an existing cystic component received percutaneous ethanol sclerotherapy followed by LITT (8 patients). Patients underwent ultrasound and hormonal follow-up after laser ablation at 2, 4, and 6 months. Study endpoints: percent nodal volume reduction compared to pretreatment volume (VRR), thyroid-stimulating hormone (TSH), free thyroxine, free triiodthyronine, TSH-receptor antibodies. Results. All patients had a positive result of treatment. The average nodal volume reduction ratio (VRR) for patients in the first group was 88.3 ± 7.9 % (min — 71.5, max — 95.4), and for patients in the second group — 72 % (min — 59.5, max — 85.4). The percen­tage of patients in whom the euthyroid status was recorded after the first session ranged from 100 % for nodes of smaller volume (up to 4 cm3) to 63 % for nodes of maximum volume (up to 13 cm3). After the completed treatment (the maximum number of LITT sessions — 4), all patients had a stable euthyroid status. The effective specific ener­gy for solid nodules is ≈ 900 J/ml, for mixed cystic-parenchymal nodules the specific energy is lower and ≈ 790 J/ml (for the volume of the nodule after PEA). Complications: one case of bleeding was recorded, and a moderate pain syndrome: 6 points on the Visual Analog scale. Conclusions. Laser thermal ablation of toxic thyroid adenomas under ultrasound guidance offers an additional safe and effective minimally invasive treatment option. Reduction of solid thyroid nodules is effective over time if the specific energy exceeds 900 J/ml (for the primary nodule volume). The reduction of mixed cystic-parenchymal nodules is effective under the condition of the effectiveness of ethanol, the specific energy for such nodules is less than ≈ 790 J/ml (for the volume of the nodule after PEA). The total energy for the course of treatment should not be less than the calculated (Е∑ ≈ Espec × Vnode). Clinical outcomes are significantly more favorable in small toxic adenomas than in large nodes

A Comprehensive Review of Clinical Studies Applying Flow-Mediated Dilation

Flow-mediated dilation (FMD) is a noninvasive method to evaluate vascular endothelial function, which manifests the vascular inflammatory response, cell proliferation, and autoregulation. Since FMD is noninvasive and assesses commonly in the brachial artery by ultrasound, compared to other invasive methods such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS), it is widely used to evaluate endothelial function and allows serial assessment. In this review, we present the currently accepted mechanisms and methods of FMD measurement with the studies applied in the current clinical practice using FMD. After all, the association with cardiovascular diseases is of substance, and so we introduce clinical studies of FMD related to cardiovascular disease such as diabetes, hyperlipidemia, chronic kidney disease, coronary artery disease, and peripheral vascular disease. In addition, studies related to pregnancy and COVID-19 were also inspected. Yet, endothelial examination is not endorsed as a cardiovascular prevention measure, for the lack of a clear standardized value methodology. Still, many studies recommend practicable FMD and would be a better prognostic value in the cardiovascular prognosis in future clinical research.

Therapeutic Effects of Pterocarpus santalinoides Stem Bark Aqueous Extract: Evidence from L-NAME-induced Hypertensive Wistar Rats

Aims: Ethnopharmacological information indicates that the stem bark of Pterocarpus santalinoides is used in traditional medicine to treat many diseases including hypertension. Thus, this study was designed to evaluate the therapeutic effects of the stem bark aqueous extract of Pterocarpus santalinoides (AEPS) in L-NAME-induced hypertensive rats (LNHR). Methodology: Hypertension was induced in normotensive rats by intraperitoneal administration of L-NAME (25 mg/kg/day) for 42 days. Forty-two animals were divided into two main groups: one group of seven rats (group 1) receiving distilled water (10 mL/kg) and another thirty-five rats receiving L-NAME (group 2). After three weeks of treatment, the hypertensive animals (group 2) were divided into five groups of seven rats each. Animals of the first group received distilled water, those of the second group were treated with captopril (20 mg/kg), and the three last groups received the AEPS (50, 100, and 200 mg/kg). These rats were daily treated per os with the above substances for three weeks. At the end of the experimental period (42 days), animals were anesthetized and the blood pressure and heart rate were recorded by invasive method. Afterward, the blood, aorta, and heart of each rat were collected for some biochemical and/or histological examination. Results: L-NAME administration induced hypertension, as associated with left ventricular hypertrophy, dyslipidemia, oxidative stress, hepatic and renal dysfunctions. Aqueous extract administration significantly improved all these metabolic disorders induced by L-NAME. Furthermore, the remodeling of the aortic media after NO deficiency-induced L-NAME has also been improved by Pterocarpus santalinoides aqueous extract. The therapeutic effect of AEPS against L-NAME-induced hypertension could probably be due to its antihypertensive, hypolipidemic, and antioxidant properties. Conclusion: Current results confirmed the empirical use of Pterocarpus santalinoides stem bark for the treatment of hypertension in traditional medicine.

Capnodynamic assessment of mixed venous oxygen saturation in a porcine experimental endotoxemic model.

Sepsis continues to be a major cause of death and illness globally, posing significant challenges for healthcare professionals. In the pursuit of more accurate and timely monitoring tools, the concept of capnodynamically derived mixed venous oxygen saturation (Capno-SvO2) has emerged as a promising method. Capno-SvO2 provides a non-invasive way to assess and track SvO2 and could serve as an additional tool alongside more invasive methods like the pulmonary artery catheter. This could potentially be of great value in the care of critically ill patients with sepsis, where alternative minimal invasive monitoring methods may vary in reliability. The aim of the current study was to compare capno-SvO2 against values obtained through pulmonary artery blood sample CO-oximetry and continuous fiberoptic SvO2 monitoring, using a well-established porcine experimental sepsis model. Anesthetized pigs were exposed to a standardized endotoxin infusion sepsis protocol, followed by a series of maneuvers typically applied in sepsis care. Simultaneous recordings were done throughout the experiment for all three monitoring methods. Bland-Altman analysis corrected for repeated measurements was used to assess the agreement of absolute values between the paired recording of CO-oximetry and Capno-SvO2 as well as between CO-oximetry and fiberoptic SvO2. The ability of Capno-SvO2 and fiberoptic SvO2 to track changes was assessed by concordance rate. A total of 10 animals and 275 paired datapoints were included in the study. The majority of the animals displayed pronounced hemodynamical instability in response to endotoxin exposure and subsequent treatment interventions. Analysis of all paired data points showed a bias between Capno-SvO2 and CO-oximetry SvO2 of + 1% with 95% limits of agreement of -14% to + 17%. The corresponding numbers for fiberoptic SvO2 and CO-oximetry SvO2 were -4% and -15% to + 8%. The concordance rate as compared to CO-oximetry, were 97% and 93% for Capno-SvO2 and fiberoptic SvO2, respectively. In this experimental sepsis model, continuous, non-invasive Capno-SvO2 generates average absolute values comparable to the gold standard CO-oximetry albeit with relatively wide limits of agreement. Capno-SvO2 displayed a concordance rate of 97% against CO-oximetry and exhibits better trending ability compared to invasive fiberoptic SvO2.

A Comparative Study of the Rate of Helicobacter pylori infection Using Three Diagnostic Techniques among Patients in Rivers State

Background: Approximately 89% of gastric cancers are attributable to H. pylori infection, however, only 1 in 5 patients survive longer than 5 years after diagnosis. Evidence has shown that screening and eradication of H. pylori in young adults would be cost-effective and could prevent 1 gastric cancer in every 4 to 6 cases. Diagnostic tests used to detect Helicobacter pylori are either invasive or noninvasive methods. These tests have varying sensitivity and specificity, having about 90% accuracy in the diagnosis of H. pylori infection in clinical practice. Aim: This study aims at detecting Helicobacter pylori using antibody-antigen, stool antigen and polymerase chain reaction (PCR) and to compare the infection rate among the different diagnostic techniques. Methodology: This was a cross-sectional study. The participants included attendants to tertiary and private hospitals in Port Harcourt metropolis for medical treatment. Blood and stool samples were collected from one hundred and eighty (180) subjects aged 1 to 60 years and above. Ethical approval for the study was obtained from the Rivers State University Teaching Hospital Ethics Committee. Convenience sampling technique was deployed. Samples were collected from subjects who consented to the study. All samples collected were analyzed in Medical Microbiology Laboratory, Rivers State Teaching Hospital and subsequently, molecular analysis was carried out. Results: The blood antibodies test (serology) method shows a greater number of positive cases (43.9%) than stool antigen method (8.3%). Also, out of the 75% stool antigen positive samples, subjected to more specific PCR, only 25% were positive. There was a significant difference (p-value of <0.001) in sensitivity between antigen and serology, there was also a significant difference (p-value of <0.025) between antigen and PCR result outcomes. Conclusion: The study has shown that there is a notable variation in the diagnosis of H pylori among the laboratory techniques used.

Remote Monitoring in Heart Failure Patient: A Review of Non-invasive Approach

Remote monitoring (RM) has been actively developed in recent years, including in of patients with chronic heart failure. Unlike invasive methods, non-invasive methods do not involve surgical risks and offer a wide range of management options: telemonitoring, virtual visits, forward triage, hospital telemedicine, telerehabilitation, psychological support. The first RM was performed by a multidisciplinary team of healthcare providers from different specialties and showed effectiveness. Unfortunately, attempts to use modern technology to reduce human involvement have often been unsuccessful. However, the COVID-19 pandemic triggered a dramatic development of mHealth. Today, there is a huge variety of methods available, but it is still impossible to give a definitive answer about the effectiveness of non-invasive RM due to the lack of uniform standards, imperfect legislation, regional, social and economic differences in the availability of technology. Nevertheless, it was included in the European Society of Cardiology clinical guidelines for the diagnosis and treatment of acute and chronic heart failure in 2021 (IIb). This review focuses on the history of development, current and potentially effective methods, the problems they aim to solve, and the challenges society needs to overcome to use them effectively.

Ventricular-arterial coupling: Advances and current perspectives in cardiovascular research

The concept of ventricular-arterial coupling (VAC) was first introduced in the early 1980s to quantify the relationship between left ventricular contractility and arterial load. The mathematical formulation of VAC, expressed as the ratio of arterial elastance to ventricular elastance, has since then been refined with adjustments to allow for non-invasive assessment. By the early 2000s, advancements in echocardiography, cardiac magnetic resonance and arterial tonometry provided non-invasive alternatives to the traditional invasive method of cardiac catheterization, broadening the clinical application of VAC. Emerging technologies, such as machine learning and computational models, have further enhanced the precision and personalization of VAC, with potential applications in heart failure, hypertension and other clinical scenarios.<br /> This review describes the physiological basis and the historical development of VAC, highlights the non-invasive assessment techniques, and discusses the potential for personalized treatment based on VAC insights. Machine learning models trained on large datasets from non-invasive imaging modalities may open new avenues in predicting individual patient responses to therapies. However, lack of standardized protocols across imaging modalities represents a challenge, making the call for standardization critical for consistent clinical application. This review underscores the need for harmonized methodologies to better utilize VAC in personalized medicine, aiming to improve cardiovascular outcomes through tailored therapies.

Pathomorphological examination of specimen after vacuum-assisted biopsy in patients with breast cancer after neoadjuvant systemic therapy

Introduction. Vacuum-assisted biopsy (VAB) of the tumor bed in the breast has shown promising results as a minimally invasive method for determining pCR. A significant disadvantage of VAB is the fragmentation of the obtained material and the lack of methods for determining generally accepted predictive and prognostic factors.The objective was to provide a description of the accumulated experience of histological examination of specimens obtained using VAB in patients with breast cancer after neoadjuvant systemic therapy.Methods and materials. A single-center, prospective, non-randomized study included patients with unifocal breast cancer (cT1–2N0–1M0). Patients who achieved a complete clinical response (cCR) underwent VAB. Based on the results of histological examination, patients without signs of residual tumor (pCR, ypT0N0) did not undergo further surgical intervention. When residual tumor cells (ypTisN0-1, ypT1-2N0-1) were detected, standard breast surgery was performed.Results. 35 patients with a mean age of 48.3 (31–67) years were included in the analysis. The examination of VAB samples showed that 11 (31.4 %) patients had a residual tumor, and in 24 (68.6 %) patients, no tumor cells were detected (ypT0N0). According to the Miller-Payne system, 28 patients had a complete pathological response, which corresponds to Miller-Payne=5 and pathological stage ypT0/ypTis (24 patients ypT0N0, 3 patients ypTisN0 and 1 patient ypT0N1). In 3 patients with residual invasive tumor, the tumor response according to the Miller-Payne scale corresponded to grade 3. There was a statistically significant correlation between presence of residual tumor cells in the outer counter after VAB and presence of residual tumor cells in the postoperative histology after standard surgery (Х2 p=0.01, Fisher exact test p=0.048). In addition, there was a statistically significant correlation between hormone receptor status and the degree of tumor response when evaluated using the Pearson criterion (p=0.046). We observed the smallest discordance between the data of the control examination and the data of the histological conclusion when interpreting the results of mammolymphoscintigraphy (25 %) and if 3 out of 3 studies described a complete clinical regression (16.7%).Conclusions. The method used to evaluate histological material allows to obtain predictive and prognostic information necessary to clarify further treatment tactics in accordance with modern standards. It is necessary to conduct more largescale studies in this area to answer the question if this method can be used in routine clinical practice.

Assessing the Effect of Minimally Invasive Lipid Extraction on Parchment Integrity by Artificial Ageing and Integrated Analytical Techniques.

To assess the short and long-term effect of a newly developed minimally invasive lipid extraction method on parchment, sacrificial pieces of parchments were subjected to artificial ageing and investigated using various analytical methods. Lipids were extracted using our novel vacuum-aided extraction method and characterised by high-temperature gas chromatography (HTGC-FID). Lipids were identified as arising from degraded animal fats. The physical, molecular, and mechanical properties of the parchment samples before/after lipid extraction, and before/after ageing were assessed using scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR) and pure shear single notch fracture testing. SEM imaging allowed for an assessment of potential structural changes of the collagen fibres while FTIR was used to investigate the possible molecular changes indicated by changes in amide I and II bands. Mechanical tests were used to record the changes in brittleness and stiffness occurring in the materials through lipid extraction and ageing. The multimodal investigation did not highlight measurable changes in the structural, molecular, and mechanical properties of the lipid-extracted parchment, thus indicating the suitability for the minimally invasive lipid extraction method to be applied to historical parchments.

Different minimally invasive surgical methods to hysterectomy for benign gynecological disease: A systematic review and network meta-analysis.

This network meta-analysis aimed to compare the perioperative efficacy of various minimally invasive hysterectomy procedures for treating benign gynecological diseases and to assess whether vaginal natural orifice transluminal endoscopic hysterectomy (VNOTEH), a recently emerging procedure, is inferior to traditional laparoscopy. We searched PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), Wanfang Data, and China VIP Database from inception to August 2022 and updated in June 2023. We included randomized controlled trials (RCTs) comparing different minimally invasive hysterectomy techniques in patients with benign gynecological conditions. The intervention measures included nine minimally invasive hysterectomies. The two researchers used the Cochrane risk-of-bias assessment tool for study appraisal. All statistical analyses and drawings were performed using STATA 17.0 and R 4.4.1. A network meta-analysis (NMA) was conducted to compare the effectiveness of minimally invasive hysterectomy and rank its relative impact probabilistically. A total of 78 RCTs involving 7640 patients and nine minimally invasive hysterectomy methods with 16 intervention combinations were included in this study. Among these, 2, 63, and 13 studies were deemed to have a low, medium, and high risk of bias, respectively. Based on the Surface Under the Cumulative Ranking (SUCRA) probability ranking results of NMA, laparoendoscopic single-site surgery-laparoscopic-assisted vaginal hysterectomy (LESS-LAVH) demonstrated superior outcomes in terms of complications, infections, and 24-h postoperative pain scores. LAVH exhibited better performance in injuries and hospital stays, total laparoscopic hysterectomy showed the least blood loss, and vaginal hysterectomy had the shortest operation time. LESS-LAVH and LAVH are recommended options, if feasible. Meanwhile, VNOTEH can achieve comparable results to traditional laparoscopy but requires careful attention to the risk of injury and infection. Future research should aim to broaden the search scope by including high-quality, large-scale, multicenter RCTs.

Evaluation of registration-based vs. manual segmentation of rhesus macaque brain MRIs.

With increasing numbers of magnetic resonance imaging (MRI) datasets becoming publicly available, researchers and clinicians alike have turned to automated methods of segmentation to enable population-level analyses of these data. Although prior research has evaluated the extent to which automated methods recapitulate "gold standard" manual segmentation methods in the human brain, such an evaluation has not yet been carried out for segmentation of MRIs of the macaque brain. Macaques offer the important opportunity to bridge gaps between microanatomical studies using invasive methods like tract tracing, neural recordings, and high-resolution histology and non-invasive macroanatomical studies using methods like MRI. As such, it is important to evaluate whether automated tools derive data of sufficient quality from macaque MRIs to bridge these gaps. We tested the relationship between automated registration-based segmentation using an open source and actively maintained NHP imaging analysis pipeline (AFNI) and gold standard manual segmentation of 4 structures (2 cortical: anterior cingulate cortex and insula; 2 subcortical: amygdala and caudate) across 37 rhesus macaques (Macaca mulatta). We identified some variability in the strength of correlation between automated and manual segmentations across neural regions and differences in relationships with demographic variables like age and sex between the two techniques.

Promising Neuroscience Methods in Exploring the Spatiotemporal Mechanisms underlying Speech Motor Control

Speech motor control is a complex neuromotor behavior that requires the combined efforts of feedforward control and feedback control subsystems. With the advent of neuroscience, multiple lines of research have explored the spatiotemporal mechanisms underlying this process. The purpose of this review was to point out several promising neuroscience methods and their unique values in enriching the speech motor control literature. We discussed the clinical value of noninvasive brain stimulation methods, and the theoretical value of invasive brain recording methods, as well as the predictive value of brain connectivity techniques. Based on prior findings, we propose a roadmap for future research, identifying structure-function coupling that supports speech motor control.

Pediatric limbal stem cell deficiency: An overview of a rarely studied pathology.

The cornea is the outermost transparent layer of the eye, and the continuous renewal of the corneal epithelium is important for its transparency. This process is primarily facilitated by corneal stem cells, most of which are found at the limbus. However, any deterioration or damage in this region leads to corneal conjunctivalization and consequent limbal stem cell deficiency (LSCD), which compromises corneal transparency. LSCD is an important condition, especially in the pediatric population, as it can lead to corneal vascularization, opacity and ultimately loss of vision and subsequent amblyopia, unlike adults. Although pediatric LSCD is often due to chemical injuries, as in adults, it is also caused by conditions such as congenital aniridia, Steven Johnson Syndrome and various other immunological disorders. Appropriate and timely treatment in pediatric LSCD is of particular importance in preventing progression to amblyopia, unlike adults. Accurate staging of the disease is essential for the necessary medical and surgical treatment decision. While medical approaches are at the forefront to eliminate the causative agent and improve the ocular surface in reversible cases, it is essential to replace the limbal stem cells lost in advanced disease. For these replacement procedures, it is noteworthy that there is a tendency for minimally invasive methods compared to adults to avoid possible complications due to long life expectancy in children. In conclusion, although there are various reviews on limbal stem cell deficiency (LSCD) in adults, we believe that this review for childhood LSCD will make an important contribution to the literature, since the relevant literature currently reported for the pediatric population is limited.

Hemodynamic monitoring- (NOT) anursing task?!

Ensuring adequate and stable hemodynamic conditions is an essential component of patient care in emergency and intensive care units. The assessment of circulatory status is complex and influenced by patient-specific characteristics, medical staff experience, and available equipment. Hemodynamic monitoring encompasses both invasive and noninvasive methods to monitor circulatory parameters. It supports patient management and ensures therapeutic success by alerting healthcare providers to deviations, including critical values. In practice, numerical data often receive more emphasis than comprehensive patient observation, potentially leading to misinterpretation. Advanced practice nurses (APNs) are highly qualified nursing professionals who work largely autonomously due to their advanced training. However, there is currently no uniform legal regulation for these professions in Germany. Clear definitions and nationwide regulations for related academic programs are necessary. Interprofessional collaboration, as well as the qualifications and numbers of nursing staff, significantly impact therapeutic outcomes. Hemodynamics involves the physical principles of blood flow and the assessment of vital parameters to ensure organ perfusion and oxygenation. The competence and knowledge of nursing staff are crucial for safe patient care. Local standard operating procedures (SOPs) should consider interprofessional collaboration and the qualifications of team members.

The correlation between angio-IMR and thermodilution-based IMR in patients with ischemia and non obstructive coronary arteries

Abstract Background The diagnostic dilemma of angina with no obstructive coronary lesions (INOCA) poses remarkable challenges in clinical practice, and presents as a significant disease burden affecting up to 4 million people annually. Additionally, standard diagnostic tests such as angiography, do not reveal microvascular dysfunction despite clinical symptoms being present. Since the current Gold Standard of functional assessment is based on guidewire dependent measurements (i.e. CFR, IMR). As an invasive method, it is associated with an increased risk of adverse events such as arterial damage. Therefore new modalities are being introduced to improve patient safety, specifically, an angio-IMR (QMR, calculated based on angiography), shows a substantial promise as a potential diagnostic tool for INOCA patients. Purpose The aim of this study is to assess correlation between angio-IMR and thermodilution-based invasively measured IMR in INOCA patients. Methods In a group of INOCA patients who had undergone coronary angiography with concomitant thermodilution-based assessment of index of microcirculatory resistance (IMR) an additional angio-based IMR calculation was performed. The INOCA group consisted of 92 patients ranging in age from 49 to 80 years old, with a median age of 66 years. The majority of the patients were female (59.3%), predominantly with arterial hypertension (87%) and dyslipidemia (100%). Diabetes was present in 27% of cases. Angio-IMR (QMR) was determined by a qualitative angiography software using information about aortic pressures registered during angiography. Coronary microcirculatory dysfunction (CMD) was diagnosed according to current guidelines when IMR ≥ 25 or CFR < 2.0 were present. Results Increased IMR values were detected in 26% of patients. Median calculated value of angio-IMR value was 29 [IQR: 22,46], whereas the invasively measured IMR median value was 17 [IQR: 13,26]. A significant correlation between angio-IMR and invasive-IMR values was observed, Spearman Rho 0.29, p<0.001. Detailed scatterplot with histograms is presented in the figure. Conclusions Noninvasive methods, such as the Angio-IMR, represent a shift towards reducing the need for additional invasive procedures while still providing valuable diagnostic insights. Angio-IMR is significantly correlated with invasively measured IMR. When evaluated along with the clinical presentation, noninvasive approaches may therefore help mitigate certain risks and healthcare costs associated with invasive techniques.Figure.Correlation angio-IMR vs MR

Detection of Aspergillus flavus in Figs by Means of Hyperspectral Images and Deep Learning Algorithms

Plant diseases cause economic losses and health risks, such as aflatoxins linked to liver cancer. These toxins, produced by fungi like Aspergillus flavus in figs, are often detected late through invasive methods or visual inspection. Since Spain, particularly Extremadura, is a key fig producer, alternative detection methods are essential to preventing aflatoxins in the food chain. The aim of this research is the early detection of Aspergillus flavus fungus using non-invasive techniques with hyperspectral imaging and applying artificial intelligence techniques, in particular deep learning. The images were taken after inoculation of the microtoxin using 3 different concentrations, related to three different classes and healthy figs (healthy controls). The analysis of the hyperspectral images was performed at the pixel level. Firstly, a fully connected neural network was used to analyze the spectral signature associated with each pixel; secondly, the wavelet transform was applied to each spectral signature. The resulting images were fed to a convolutional neural network. The hyperparameters of the proposed models were adjusted based on the parameter tuning process that was performed. The results are promising, with 83% accuracy, 82.75% recall, and 83.25% F1-measure for the fully connected neural network. The high F1-measure demonstrates that the model’s performance is good. The model has a low incidence of false positives for samples that contain aflatoxin, while a higher number of false positives appears in healthy controls. Due to the presence of false negatives, this class also has a high recall. The convolutional neural network results, accuracy, recall, and F1 are 77.25%, indicating moderate model performance. Only class 3, with higher aflatoxin concentration, achieves high precision and low false positive incidence. Healthy controls exhibit a high presence of false negatives. In conclusion, we demonstrate the effectiveness of pixel-level analysis in identifying the presence of the fungus and the viability of the non-invasive techniques applied in improving food safety. Although further research is needed, in this study, the fully connected neural network model shows good performance with lower energy consumption.

Transcriptome amplification and fusion gene detection using ultra-trace cells derived from cytology specimens

Tumours are complex and despite scientific breakthroughs, there is much to be elucidated about cancer and its mechanisms. By personalising treatment, outcomes can be improved and genetic analysis is key to this as it allows genetic alterations to be identified and treatment to be precisely targeted. Dr Kenji Amemiya is a cytotechnologist and Chief Clinical Laboratory Technician at the Yamanashi Prefectural Central Hospital Genome Analysis Center (GAC). He is working to better understand the complex inner landscape of cancer and therefore improve cancer detection, diagnosis and treatment. Formalin‐fixed paraffin‐embedded (FFPE) specimens are typically used for genetic testing but there are drawbacks to this, including the FFPE DNA becoming damaged during the fixation process with formalin, resulting in low quality and quantity of DNA. Amemiya is collaborating closely with Chairman of the GAC, Professor Emeritus Masao Omata. They are interested in the use of cytology samples instead of tissue samples in genome analysis, as a less invasive method. Survival rates are increased when genomic analysis is utilised in non-small cell lung cancer (NSCLC). In one project, Amemiya, Omata and the team explored the potential of performing NGS analysis with archived cytological specimens (ACSs). They utilised an integrated NGS platform called the Oncomine Dx Target Test Multi-CDx system to compare the quantity and quality of extracted nucleic acids, the sequencing quality control (QC) and the detected variants between ACSs and FFPE tissues. They found that the RNA integrity was higher in ACSs and there was no difference in sequencing results, compared with FFPE tissues.