Invasive Method Research Articles

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.

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.

Assessment of coronary blood volume to left ventricular mass ratio: a comparative study among endurance athletes, hypertrophic cardiomyopathy patients and healthy controls

Abstract Background Pathologic left ventricular hypertrophy (LVH) may lead to a mismatch between left ventricular mass (LVM) and blood supply, potentially reducing coronary flowreserve. Typically, assessing this involves complex or invasive methods. Objective We assessed epicardial coronary blood volume (CBV) to LVM ratio (V/M) using coronary computed tomography (CT) angiography in athletes, HCM patients, and healthy controls. Methods A total of 169 individuals without obstructive coronary artery disease were included, comprising 39 endurance athletes, 55 HCM patients, and 79 healthy controls. Automated detection of the epicardial coronary tree facilitated the calculation of CBV, enabling the assessment of LVM and subsequent comparison of the V/M ratio. Results HCM patients had the highest LVM (242g ±115), followed by athletes (145g ±33.35) and healthy controls (106g ±22.53), the corresponding CBV were: (7ml ±2.09 ml), (6.35±1.68 ml), and (4.43±0.93 ml); respectively. V/M ratios were similar in athletes (0.04 ±0.01 ml/m2), and controls (0.04 ±0.01, P= 0.298 ml/m2), but were significantly lower in HCM patients (0.03 ±0.01, P<0.001 ml/m2). CBV and LVM significantly corelated among the three group (Figure). Conclusions Contrast CT findings reveal that unlike HCM patients with pathological LVH, athletes exhibit sufficient increase in CBV relative to LVM thereby maintaining normal V/M ratio.

Longitudinal assessment of transcranial Doppler imaging in children with sickle cell disease without neurological symptoms

IntroductionStroke is one of the most devastating complications of sickle cell disease (SCD). Transcranial Doppler Imaging (TCDI) is the least invasive screening method to predict patients at risk for developing stroke in the disease. After a 10-year follow-up, we longitudinally assessed the TCDI in children with SCD without neurological symptoms.Methods25 out of 43 pediatric patients with SCD studied 10-year previously were recruited. The remaining 18 patient were not available for follow-up, but their initial data are presented for comparison. TCDI scanning was carried out using a phased-array transducer of 1–3 MHz through the trans-temporal window. Peak systolic velocity (PSV), end-diastolic velocity (EDV), time-averaged mean of the maximum velocity (TAMMV), resistive index (RI), and pulsatility index (PI) were obtained in the anterior and posterior Circle of Willis vessels.ResultsThe highest initial and follow-up TAMMV (mean ± SD) were: 77.3 ± 20.9 and 71.6 ± 9.9 in the t-ICA, 94.3 ± 25.8 and 82 ± 18.2 in the MCA, 76.6 ± 25.6 and 70.6 ± 10.7 in the ACA, and 59.1 ± 15.8 and 63.9 ± 8.5 in the PCA, respectively. There was no statistically significant difference between initial and follow-up SCD data for all vascular parameters in all vessels on each side (P > 0.05) except for RI and PI (P < 0.05). There was significant correlation between TAMMV, PSV, and EDV (P = 0.001).ConclusionThere are no absolute Doppler velocity changes between the initial and follow-up period over the years. There is a possibility that PSV and EDV could be used in parallel with TAMMV Subclinical vascular degeneration is not suggested by these vascular measures.

From photonic technologies to microfluidics-A review on the techniques which revolutionize liquid biopsy, opening a new era in cancer therapy.

Cancer therapy is one of the most researched upon medical field in the world. Non invasive technologies such as liquid biopsy are gaining more importance in cancer therapy because of their manifold advantages over traditional invasive biopsy methods. Liquid biopsy is used to analyze nucleic acids such as ctDNA, cfDNA and RNA, cellular and subcellular components such as proteins, extracellular vesicles and circulating tumor cells in various biological fluids such as blood, urine, cerebrospinal fluid, pleural fluid and ascites fluid for diagnosis of cancer. Liquid biopsy has a wide range of applications such as assessment of residual diseases and tumors which cannot be biopsied easily and prediction of CAR-T response and response to immune checkpoint inhibitors. It can also be used to know the efficacy of cancer drugs in a patient by analyzing multiple samples. Liquid biopsy is becoming more popular as it allows biopsy of those samples in which solid tumor biopsies are challenging or impracticable. To achieve comprehensive insight on the status of cancer in a patient, various cutting edge liquid biopsy techniques have been developed. Microfluidics and photonic technologies, along with PCR, next generation sequencing, advanced and innovative molecular and cell biology approaches and imaging techniques have expanded the domain of liquid biopsy and elevated the accuracy of liquid biopsy results. This review discusses about the contributions of some widely used methods along with microfluidics and photonic technologies in detection of cancer biomarkers by liquid biopsy.

Single centre experience using vessel Fractional Flow Reserve (vFFR) and diagnostic performance compared with invasive Fractional Flow Reserve (FFR)

Abstract Background Fractional flow reserve (FFR) is a diagnostic gold standard in the functional assessment of coronary artery stenoses (1). Alternative invasive and non-invasive methods have been developed in an attempt to avoid limitations associated with FFR including added procedural risk, patient discomfort, time and cost. Vessel fractional flow reserve (vFFR) is a novel software using two angiographic projections to generate a 3D vessel reconstruction which has shown high diagnostic accuracy in predicting a positive FFR (2-4). Methods All patients undergoing coronary angiography between 01/10/2022 and 08/03/2023, where FFR was performed, were assessed. Patients were included where images met requirements necessary to use vFFR software. vFFR measurements were taken retrospectively by a single investigator and not used to inform patient care. Data were expressed as mean +/- standard deviation and %. The correlation of vFFR to FFR was compared using Pearson’s correlation coefficient. Receiving operator characteristic (ROC) area under the curve (AUC) analysis was used to determine diagnostic performance. Statistical analysis was performed using SPSS v27. Results 28 of 37 patients and 32 of 44 vessels were included and analysed with vFFR software. Excluded vessels were unsuitable due to insufficient frame rate or projection angulation during angiography. Mean age was 63 +/- 3.8 years and 75% of patients were male. Of 32 vessels assessed, 20 were LAD, 5 RCA, 5 LCx and 2 LMS. 29 of 32 vFFR values agreed with positive or negative FFR. Positive vFFR values were seen in all 15 vessels with positive FFR. 3 vessels received a positive vFFR where FFR values were negative. Mean vFFR was 0.76 +/- 0.1 and mean FFR was 0.81 +/- 0.09. vFFR correlated significantly with FFR (R=0.777, p&amp;lt;0.001). vFFR demonstrated good diagnostic accuracy in discriminating "positive" (&amp;gt;0.8) and "negative" (≤0.8) FFR with an AUC of 0.758 (95% CI 0.61-0.91, p&amp;lt;0.01). Conclusion vFFR correlated significantly with FFR and all positive FFR values also received positive vFFR values. vFFR demonstrated good diagnostic accuracy in predicting a positive FFR result. Thus, these data support a strategy of using a negative vFFR to avoid further testing.Pearson correlation of vFFR to invFFRROC curve: vFFR predicting invFFR

Evaluation of serum levels of sCD40, sCD40L and s4-1BB in advanced heart failure and after heart transplant

Abstract Heart failure is one of the most important problems in public health. Although big advances had been reached in treatment, the prognosis of advanced heart failure is still reserved and the heart transplant is the main therapy for this stage of disease. Allograft rejection is responsible for mortality in transplantation patients and the diagnosis of this complication is made through an invasive diagnostic method – the cardiac biopsy. The inflammatory response has been described in cardiovascular disease and in allograft rejection process. The objective of this study is to evaluate levels of sCD40, sCD40L and s4-1BB (inflammatory biomarkers) in advanced heart failure and post heart transplant with allograft rejection comparing to normal individuals and post heart transplant patients with no allograft rejection. The study population comprised 38 patients undergoing heart transplant in our center. Fifteen patients had biomarkers dosed before heart transplant and twenty three patients had dosed just after procedure. In this group, six patients were enrolled in the study for clinical suspicion of rejection. Nineteen health persons composed the control group with age between 18 and 49 years. Plasma dosage of sCD40, sCD40L e s4-1BB was made by enzyme linked immunosorbentassay (ELISA). Mann-Whitney test, Wilcoxon and t test were used to analyse dates. Statistical analysis used GraphPad®Prism6 and the value p&amp;lt; 0,05 was considered statistical significant. Allograft rejection occurred in 6,26% of studied patients. There was no statistical difference in age, sex, comorbities as hypertension, diabetes or etiology of cardiomyopathy. Serum levels of sCD40, sCD40L e s4-1BB were higher in patients with advanced heart failure comparing to controls (p&amp;lt; 0,0001). There was no difference in these levels of sCD40 (p = 0,74) e sCD40L (p = 0,44) between groups with and without rejection. Levels of s4-1BB were significantly lower in patients with allograft rejection (p= 0,02). The sCD40/PCR and s4-1BB/PCR indexs were significantly higher in the group of patients with allograft rejection (p =0,02 e p= 0,0001). We concluded that sCD40, sCD40L e s4-1BB are biomarkers of severe heart failure. The serum level of s4-1BB could be a potential biomarker of allograft rejection and the association of sCD40 and s4-1BB with PCR could be a better strategy to this.

Lost and found: the late discovery of a migrated intrauterine device after 15 years - a case report

Intrauterine devices (IUDs) are a preferred reversible contraceptive choice for about 159 million women worldwide. While generally safe, they pose risks like uterine perforation and device migration, which happen in about 1 in 1000 insertions. Other common issues include insertion failure, pain, infection, and menstrual changes. This report details a rare case of IUD migration in a 40-year-old woman, discussing the diagnostic challenges and the approaches used to manage such complications. IUD migration to the bladder is uncommon but can lead to serious, often undetected issues, thus underscoring the necessity for regular follow-up after placement. Early diagnosis with imaging is critical for proper treatment, with the World Health Organization recommending surgical removal in symptom-free cases. The rarity of uterine perforation during IUD use highlights the vital need for vigilant monitoring and patient follow-ups to prevent and quickly address such complications. The uncertain timing and cause of IUD migration further stress the importance of comprehensive counseling and regular patient check-ups. Abdominal discomfort may indicate an IUD has migrated, emphasizing the need for patient awareness and routine self-monitoring after placement. CT imaging is crucial for identifying and pinpointing the location of migrated IUDs, facilitating their removal using minimally invasive methods like colonoscopy and laparoscopy. For more complicated scenarios, such as those involving deep embedment, laparotomy may be necessary.