Invasive Method Research Articles

5156 Circulating MicroRNA-based Biomarker Combinations for Differentiating Uni- and Bilateral Primary Aldosteronism Using a Machine Learning Approach

Abstract Disclosure: B. Vekony: None. G. Nyiro: None. Z. Herold: None. J. Fekete: None. F. Ceccato: None. S. Gruber: None. L. Kurzinger: None. M. Parasiliti-Caprino: None. B. Szeredas: None. S.K. Nazri: None. V. Fell: None. M. Bassiony: None. E.A. Azizan: None. I. Bancos: None. F. Beuschlein: None. P. Igaz: None. Background: The differentiation of uni- and bilateral forms of primary aldosteronism (PA) is of pivotal clinical relevance. Whereas unilateral PA warrants surgical treatment, bilateral PA is treated by aldosterone antagonists. The most reliable way to differentiate these two entities is adrenal venous sampling (AVS) that is an invasive method with limited availability and requiring great expertise. Aim: To develop a circulating blood-borne microRNA-based approach using machine learning for the differentiation of uni- and bilateral PA. Methods: Circulating microRNA profiling on an Illumina MiSeq platform was performed on total RNA samples isolated from EDTA-anticoagulated blood specimens taken by AVS from 18 pairs of right and left suprarenal veins (10 uni-, 8 bilateral PA). Significantly differentially expressed microRNAs were analyzed by a neural network (90-10% learner-tester cross-validation simulation). From the top 29 significantly differentially expressed microRNAs, 9 were selected for validation by Taqman RT-qPCR on a separate cohort of 30 AVS-confirmed samples (15-15 uni- and bilateral forms) both on plasma samples from adrenal as well as from peripheral veins. The method was finally tested on another independent cohort of peripheral blood samples from 80 patients (40 uni- and 40 bilateral PA). Results: Regarding the 9 microRNAs selected for validation, microRNA abundance was non-significantly lower in peripheral samples compared to AVS samples. By analyzing peripheral plasma samples, ten combinations of 4-8 microRNAs from the pool of 9 microRNAs turned out to have maximal sensitivity and specificity values over 85 %. The best combination included 6 microRNAs with a sensitivity of 86.3 % and a specificity of 87.91 % (AUC = 0.871). The inclusion of further parameters such as imaging, potassium and renin levels did not improve the model’s performance. Conclusion: The analysis of circulating blood-borne microRNAs represents a minimally invasive and potentially reliable way of differentiating uni- and bilateral PA. If bilateral PA is confirmed by the model, no more localization efforts would be necessary thus simplifying the management of PA patients. This would be relevant both from the patient’s and a public health perspective. Presentation: 6/3/2024

Detection of Brain Tumor using Medical Images: A Comparative Study of Machine Learning Algorithms – A Systematic Literature Review

Abstract: Background: Brain tumors are a significant global health concern impacting both adults and children. Tumors are characterized by abnormal or excessive growth resulting from uncontrolled cell division. Diagnosing brain tumors poses various challenges, including limited funding, a shortage of qualified professionals, and insufficient access to medical facilities in remote regions. Different learning techniques for detecting brain tumors have been developed due to their ease of use, cost-effectiveness, and non-invasive nature, in contrast to other invasive methods. Methods: This research conducts a systematic literature review to explore modern trends and concepts of machine learning in healthcare, aiming to identify effective techniques for brain tumor detection. It also compares and analyzes the most efficient machine learning methods currently in use, focusing on aspects such as machine learning algorithms, image augmentation, evaluation metrics, and the sizes of datasets employed. Results: The findings indicate that non-invasive methods, such as machine learning algorithms for brain tumor detection, are cost-effective and provide quick results. Conclusions: This systematic literature review offers a technical overview, demonstrating the efficiency and effectiveness of machine learning techniques in making brain tumor detection feasible. The study utilizes deep learning and machine learning methods to comprehensively analyse diagnosis, imaging, and clinical evaluations in medical fields related to brain tumor detection.

8728 Radiofrequency Thermal Ablation in Thyroid Microcarcinomas: Experience of the Brazilian Group with 143 Cases

Abstract Disclosure: L.G. Amato: None. P.H. Carani: None. L.D. Volpi: None. A. Rahal: None. E.M. Volpi: None. Introduction: Thyroid nodules are quite prevalent worldwide, with papillary thyroid carcinoma (PTC) being the most common histological subtype of thyroid malignant neoplasm, accounting for approximately 85% of thyroid cancers. When this carcinoma is less than 10 mm in its longest axis, it is defined as papillary thyroid microcarcinomas (mPTCs) which has had an increasing proportion of thyroid cancers and with a disease-specific survival of patients having this diagnosis more than 99% after 10 years of follow-up. Most guidelines concerning thyroid cancer care recommend a lobectomy as the first-line treatment strategy for low-risk unifocal mPTC but often results in aggressive overtreatment. Thyroid surgery comes with significant costs and morbidity rates caused by iatrogenic hypothyroidism and recurrent laryngeal nerve damage, resulting in poor quality of life, justifying the growing search for minimally invasive and effective methods in the treatment of mPTC and in this context Radiofrequency thermal ablation (RFA), a minimally invasive treatment that preserves thyroid function have been proposed for patients with low-risk mPTC. Clinical case: From April 2018 to January 2024, 143 patients with mPTC, were submitted to RFA and patient's follow-up were dated 1, 3, 6, 12 and 18 months after the procedure. During the follow-up we observed 3 (2%), complications, 1 case of permanent paralysis unilateral vocal cord, 1 Horner Syndromes and 1 case of transient paralysis, with total reversal. In all cases there was a reduction in the volume of the node after 6 months of the procedure. Conclusion: The reported incidence rate of postoperative hypothyroidism in patients underwent hemithyroidectomy is 10.9-48.8%, therefore, risks of complications with radioablation in our series were lower than those previously described during hemithyroidectomy. Radiofrequency thermal ablation (RFA) is a minimally invasive treatment that preserves thyroid function with a lower incidence of complications compared to thyroidectomy or lobectomy, and and should be considered the selection procedure for low-risk thyroid microcarcinomas. Presentation: 6/3/2024

9303 Evaluation of The Consistency of Thyroid Indicators Tests in Minimally Invasive Peripheral Blood and Venous Blood

Abstract Disclosure: Z. Zhu: None. Y. Huang: None. Z. Cao: None. L. Zhang: None. D. Wang: None. S. Wang: None. J. Zhang: None. Y. Gao: None. Y. Zhang: None. Background The detection of thyroid indicators is of high demand in clinical and epidemiological screenings. Compared with existing venous blood tests, peripheral fingertip blood tests are less invasive and have a lower blood collection volume, which is the basis for point-of-care tests of thyroid indicators. Objective To explore the feasibility of minimally invasive and micro blood collection tests for thyroid disease (TD) patients by evaluating the consistency of thyroid indicators and TD diagnostic efficiency between fingertip blood tests and venous blood tests. Method 63 subjects with or without thyroid dysfunction were consecutively recruited. All subjects underwent serum, plasma and fingertip blood (same day collection) measurements for TSH and TT4 detection via the chemiluminescence method and for TPOAb detection via the electrochemiluminescence immunoassay method. The fingertip blood was centrifuged and diluted after EDTA anticoagulation. Bland–Altman plot, Passing–Bablok regression, and weighted kappa test were used for consistency test; AUC of ROC curve, sensitivity and specificity were used for authenticity evaluation among the three collection and testing methods. Results 43 subjects with euthyroidism and 20 subjects with thyroid dysfunction were included; including 29 (46.03%) females, the average age was 50.98±14.76 years. Bland-Altman plots showed more than 90% of the subjects had TSH and TT4 differences within the 95% limits of agreement between peripheral blood (PB) and venous blood (including serum and plasma). Passing–Bablok regression analyses revealed strong correlations between TSH levels in PB and serum (r=0.888) and plasma (r=0.894) (p<0.05); for TT4, there was a strong correlation between PB and serum (r=0.746), and there was also a moderate correlation between PB and plasma (r=0.664) (p<0.05 for both). Weighted kappa tests were performed for low, normal and high TSH values, indicating strong consistency between PB and serum and between PB and plasma, with coefficients of 0.901 and 0.881, respectively (P<0.001); for TT4, the coefficients between PB and serum, PB and plasma were 0.541 and 0.585 (P<0.001), indicating moderate consistency. Regardless of TPOAb positivity or negativity, the consistency among three blood sample sources was 100%. For euthyroidism (n=43), hyperthyroidism (n=6), subclinical hyperthyroidism (n=9), hypothyroidism (n=1), and subclinical hypothyroidism (n=4), the diagnostic sensitivities of PB were 97.06%, 83.33%, 87.50%, 100%, and 75.00%, respectively; the specificities were 94.74%, 97.87%, 95.74%, 98.11%, and 100.00%, respectively. The AUC of PB ROC curve for determining thyroid dysfunction was 0.944 (95% CI 0.867-1.000). Conclusion PB tests of thyroid indicators has high consistency with venous blood tests, offers sufficient diagnostic efficiency for TD, and is a feasible minimally invasive detection method. Presentation: 6/1/2024

7583 Evaluation of The Consistency of Thyroid Indicators Tests in Minimally Invasive Peripheral Blood and Venous Blood

Abstract Disclosure: Z. Zhu: None. Y. Huang: None. Z. Cao: None. L. Zhang: None. D. Wang: None. S. Wang: None. J. Zhang: None. Y. Gao: None. Y. Zhang: None. Background: The detection of thyroid indicators is of high demand in clinical and epidemiological screenings. Compared with existing venous blood tests, peripheral fingertip blood tests are less invasive and have a lower blood collection volume, which is the basis for point-of-care tests of thyroid indicators. Objective To explore the feasibility of minimally invasive and micro blood collection tests for thyroid disease (TD) patients by evaluating the consistency of thyroid indicators and TD diagnostic efficiency between fingertip blood tests and venous blood tests. Method 63 subjects with or without thyroid dysfunction were consecutively recruited. All subjects underwent serum, plasma and fingertip blood (same day collection) measurements for TSH and TT4 detection via the chemiluminescence method and for TPOAb detection via the electrochemiluminescence immunoassay method. The fingertip blood was centrifuged and diluted after EDTA anticoagulation. Bland–Altman plot, Passing–Bablok regression, and weighted kappa test were used for consistency test; AUC of ROC curve, sensitivity and specificity were used for authenticity evaluation among the three collection and testing methods. Results 43 subjects with euthyroidism and 20 subjects with thyroid dysfunction were included; including 29 (46.03%) females, the average age was 50.98±14.76 years. Bland-Altman plots showed more than 90% of the subjects had TSH and TT4 differences within the 95% limits of agreement between peripheral blood (PB) and venous blood (including serum and plasma). Passing–Bablok regression analyses revealed strong correlations between TSH levels in PB and serum (r=0.888) and plasma (r=0.894) (p<0.05); for TT4, there was a strong correlation between PB and serum (r=0.746), and there was also a moderate correlation between PB and plasma (r=0.664) (p<0.05 for both). Weighted kappa tests were performed for low, normal and high TSH values, indicating strong consistency between PB and serum and between PB and plasma, with coefficients of 0.901 and 0.881, respectively (P<0.001); for TT4, the coefficients between PB and serum, PB and plasma were 0.541 and 0.585 (P<0.001), indicating moderate consistency. Regardless of TPOAb positivity or negativity, the consistency among three blood sample sources was 100%. For euthyroidism (n=43), hyperthyroidism (n=6), subclinical hyperthyroidism (n=9), hypothyroidism (n=1), and subclinical hypothyroidism (n=4), the diagnostic sensitivities of PB were 97.06%, 83.33%, 87.50%, 100%, and 75.00%, respectively; the specificities were 94.74%, 97.87%, 95.74%, 98.11%, and 100.00%, respectively. The AUC of PB ROC curve for determining thyroid dysfunction was 0.944 (95% CI 0.867-1.000). Conclusion PB tests of thyroid indicators has high consistency with venous blood tests, offers sufficient diagnostic efficiency for TD, and is a feasible minimally invasive detection method. Presentation: 6/1/2024

Artificial Neural Networks to Predict Metabolic Syndrome without Invasive Methods in Adolescents.

Background/Objectives: The prevalence of metabolic syndrome (MetS) is increasing worldwide, and an increasing number of cases are diagnosed in younger age groups. This study aimed to propose predictive models based on demographic, anthropometric, and non-invasive clinical variables to predict MetS in adolescents. Methods: A total of 2064 adolescents aged 18-19 from São Luís-Maranhão, Brazil were enrolled. Demographic, anthropometric, and clinical variables were considered, and three criteria for diagnosing MetS were employed: Cook et al., De Ferranti et al. and the International Diabetes Federation (IDF). A feed-forward artificial neural network (ANN) was trained to predict MetS. Accuracy, sensitivity, and specificity were calculated to assess the ANN's performance. The ROC curve was constructed, and the area under the curve was analyzed to assess the discriminatory power of the networks. Results: The prevalence of MetS in adolescents ranged from 5.7% to 12.3%. The ANN that used the Cook et al. criterion performed best in predicting MetS. ANN 5, which included age, sex, waist circumference, weight, and systolic and diastolic blood pressure, showed the best performance and discriminatory power (sensitivity, 89.8%; accuracy, 86.8%). ANN 3 considered the same variables, except for weight, and exhibited good sensitivity (89.0%) and accuracy (87.0%). Conclusions: Using non-invasive measures allows for predicting MetS in adolescents, thereby guiding the flow of care in primary healthcare and optimizing the management of public resources.

The role of coronary microcirculation in heart failure with preserved ejection fraction: An unceasing odyssey.

Heart failure with preserved ejection fraction (HFpEF) represents an entity with complex pathophysiologic pathways, among which coronary microvascular dysfunction (CMD) is believed to be an important orchestrator. Research in the field of CMD has highlighted impaired vasoreactivity, capillary rarefaction, and inflammation as potential mediators of its development. CMD can be diagnosed via several noninvasive methods including transthoracic echocardiography, cardiac magnetic resonance, and positron emission tomography. Moreover, invasive methods such as coronary flow reserve and index of microcirculatory resistance are commonly employed in the assessment of CMD. As far as the association between CMD and HFpEF is concerned, numerous studies have highlighted the coexistence of CMD in the majority of HFpEF patients. Additionally, patients affected by both conditions may be facing an adverse prognosis. Finally, there is limited evidence suggesting a beneficial effect of renin-angiotensin-aldosterone system blockers, ranolazine, and sodium-glucose cotransporter-2 inhibitors in CMD, with further evidence being awaited regarding the impact of other pharmacotherapies such as anti-inflammatory agents.

Therapy for advanced stages of Parkinson's disease

The search and analysis of data on treatment options of advanced stages of Parkinson's disease from various scientific sources on biomedical research PubMed in the Medline, Russian scientific electronic library CyberLeninka databases are summarized in the article. A comparison of data was performed to highlight the main directions of modern approaches to the treatment of advanced stages of Parkinson's disease. To treat the disease at a late stage with pronounced motor fluctuations in the form of “off” symptoms and painful dyskinesias during the “on” period, invasive and non-invasive high-tech methods of treatment are used. The most relevant method of treatment for Parkinson's disease in patients with a long history of the disease and side symptoms of traditional medicinal methods of correction are the use of Duodopa - levodopa/carbidopa intestinal gel (LCIG). It is important to note that the increased "on" period can allow people with advanced Parkinson's disease to raise motor activity, thereby improving their independence in daily activities from other people.

Strength of activation and temporal dynamics of bioluminescent-optogenetics in response to systemic injections of the luciferin

BioLuminescent OptoGenetics (“BL-OG”) is a chemogenetic method that can evoke optogenetic reactions in the brain non-invasively. In BL-OG, an enzyme that catalyzes a light producing reaction (i.e., a luciferase) is tethered to an optogenetic element that is activated in response to bioluminescent light. Bioluminescence is generated by injecting a chemical substrate (luciferin, e.g., h-Coelenterazine; h-CTZ) that is catalyzed by the luciferase. By directly injecting the luciferin into the brain, we show that bioluminescent light is proportional to spiking activity, and this relationship scales as a function of luciferin dosage. Here, we build on these previous observations by characterizing the temporal dynamics and dose response curves of bioluminescence generated by luminopsins (LMOs), a proxy of BL-OG effects, to intravenous (IV) injections of the luciferin. We imaged bioluminescence through a thinned skull of mice running on a wheel, while delivering h-CTZ via the tail vein with different dosage concentrations and injection rates. The data reveal a systematic relationship between strength of bioluminescence and h-CTZ dosage, with higher concentration generating stronger bioluminescence. We also found that bioluminescent activity occurs rapidly (< 60 s after IV injection) regardless of concentration dosage. However, as expected, the onset time of bioluminescence is delayed as the injection rate decreases. Notably, the strength and time decay of bioluminescence is invariant to the injection rate of h-CTZ. Taken together, these data show that BL-OG effects are highly consistent across injection parameters of h-CTZ, highlighting the reliability of BL-OG as a minimally invasive neuromodulation method.

B-038 A Novel Ultrasensitive Single-Molecule Counting Technology for Quantitation of Low Abundance Biomarkers

Abstract Background There is a need for sensitive, robust, and scalable analytical methods for accurate, early detection of disease using less invasive sampling methods. Often, smaller volumes and low marker concentrations present challenges to achieving sufficient sensitivity and accuracy with traditional immunoassay methods. This is particularly the case for measuring markers for Alzheimer's and other neurological diseases in blood, where levels are typically at much lower concentrations than in CSF. Here we introduce a novel ultrasensitive technology for flow-based single molecule detection in an optofluidic chip. We have developed an Ultrasensitive Detection Module (UDM) device and optofluidic cartridge that enable easy integration of this technology into existing immunoassay systems. UDM sensitivity data is shown for three prototype biomarker assays in comparison to the Lumipulse G1200 (Fujirebio Inc., Japan). We also present analytical validation data for three Alzheimer’s Disease plasma biomarker assays developed on a fully automated benchtop analyzer with integrated UDM detector. Methods Ultrasensitive detection is achieved by integrated low-loss waveguide in an optofluidic chip that enables maximal excitation of fluorescent molecules traveling through a narrow fluidic channel. The resulting high-intensity emission is detected as a single digital event, enabling individual molecules to be counted without need for amplification. Fluorescence-based immunoassays were developed for detection with the UDM using high performance monoclonal antibodies and reagents (Fujirebio Inc., Japan). Capture antibodies were immobilized on magnetic particles and detection antibodies conjugated to a fluorescent reporter construct (“reporter-Ab”). Multiple incubation and wash steps were followed by dissociation of immune complexes and separation of reporter-Ab from magnetic particles. Released reporter-Ab molecules were injected into the UDM device for digital detection. Signal to noise performance was evaluated in the UDM using reporter construct alone (no assay), as well as for prototype PSA, IL-6, and TSH assays, to establish baseline performance for analytical sensitivity. Plasma assays for pTau181, Aβ1-40, and Aβ1-42 were developed and optimized for the automated benchtop analyzer and validated for analytical sensitivity (LOD/LOQ), linearity, parallelism, precision and repeatability using clinical samples. Results Detection signal-to-noise testing of the reporter construct alone (no immunoassay) demonstrated up to 1000-fold higher sensitivity than the Lumipulse G1200. Prototype assays for PSA, TSH, and IL-6 showed up to 118-fold, 36-fold, and 80-fold higher signal to noise ratio, respectively, when compared to the Lumipulse G1200. Plasma assays for pTau181, Aβ1-40, and Aβ1-42 showed preliminary LLOQs calculated at 0.03 pg/mL, 0.17 pg/mL and 0.37 pg/mL, respectively. Conclusions We have developed a new single molecule counting platform able to detect neurological biomarkers at sub-pg/ml levels in plasma, with the potential to provide sensitive and accurate diagnostic testing of low abundance biomarkers in blood. Such technologies can create new clinical value through higher detection sensitivity and accuracy in areas like Alzheimer’s and other neurological diseases, supporting clinical research and translation to clinical practice.

Atorvastatin-Loaded Dissolving Microarray Patches for Long-Acting Microdepot Delivery: Comparison of Nanoparticle and Microparticle Drug Formulations.

The increasing popularity of prolonged-release dosage forms, owing to their ability to provide continuous drug release after administration, has significantly improved patient compliance and overall quality of life. However, achieving prolonged release beyond 24 h frequently requires the use of invasive methods, including injections or implants, which may prove challenging for people suffering from needle phobia. This study introduces atorvastatin (ATR) microparticles (MPs) or nanocrystal (NCs) dissolving microarray patches (D-MAPs) as a noninvasive alternative for intradermal drug delivery over a two-week period for the management of hyperlipidemia. The MP-loaded D-MAPs exhibited an average drug loading of 5.15 ± 0.4 mg of ATR per patch, surpassing the 2.4 ± 0.11 mg/patch observed with NC-loaded D-MAPs. Skin deposition studies demonstrated the superior performance of MP D-MAPs, which delivered 2.0 ± 0.33 mg of ATR per 0.75 cm2 patch within 24 h, representing 38.76% of the initial amount of drug loaded. In contrast, NC D-MAPs delivered approximately 0.89 ± 0.12 mg of ATR per 0.75 cm2 patch at 24 h, equivalent to 38.42 ± 5.13% of the initial ATR loaded. Due to their favorable results, MP D-MAPs were chosen for an in vivo study using Sprague-Dawley rats. The findings demonstrated the capacity of D-MAPs to deliver and attain therapeutically relevant ATR concentrations (>20 ng/mL) for 14 days after a single 24-h application. This study is the first to successfully demonstrate the long-acting transdermal delivery of ATR using MP-loaded D-MAPs after a 24-h single-dose application. The innovative D-MAP system, particularly when loaded with MP, arises as a promising, minimally invasive, long-acting substitute for ATR delivery. This technology has the potential to improve patient compliance and therapeutic outcomes while also significantly advancing the field of transdermal drug delivery.

Amplified pain and complex regional pain syndrome in children: clinical cases and literature review

BACKGROUND: Musculoskeletal pain is a common reason for visiting pediatric clinics. Causes of chronic musculoskeletal pain include various inflammatory or noninflammatory conditions. Amplified pain syndrome refers to a wide range of conditions manifested by chronic pain, the common feature of which is central and/or peripheral sensory amplification of pain. Complex regional pain syndrome is characterized by spontaneously occurring or provoked by irritating stimuli pain of high intensity, disproportionate to the actual injury or other stimulus, and the presence of several concomitant vegetative and motor disorders. CLINICAL CASES: This article presents three clinical cases of pediatric patients with chronic musculoskeletal pain and an analysis of the current literature on chronic pain in children. DISCUSSION: Complex regional pain syndrome is more common in adolescent girls, and conflict or psychological trauma is a common trigger. Symptoms of disproportionate burning pain (causalgia) with trophic changes may indicate complex regional pain syndrome. To date, there are no generally accepted pharmacological treatments recommended for children with complex regional pain syndrome. Nonsteroidal anti-inflammatory drugs (ibuprofen) and paracetamol and their combination are commonly administered in cases wherein symptoms of chronic pain first appear. CONCLUSIONS: Currently, a multidisciplinary approach, including physical, psychological, medical, and invasive methods, appears to be the most adequate treatment method for musculoskeletal pain. The use of analgesics should comply with approved protocols of pain management in pediatric practice.

Robotic Surgery for Gynecologic Cancer: Optimism or Controversy in Surgical Oncology?

Robotic Surgery has made possible to remove cancerous organs and tissues in gynecologic cancer patients with less invasive methods. Gynecologist have observed that these minimally invasive surgeries often result in fewer complications and a faster recovery time. As robotic technology continues to develop, the potential advantages of robotic surgery in gynecologic oncology are becoming increasingly evident. Robotic Surgery offers greater precision and control during complex procedures, which can lead to improved patient outcomes and fewer complications. Robotic surgery can often outcome in smaller hospital halts and a rapid return to normal activities. Consequently, more and more GOs are adopting Robotic Surgery to provide their patients with the most advanced and effective treatment options available. Robotic Surgery is now a viable option compared to traditional open surgery. Since its extensive use, negligibly aggressive surgery has become a suitable choice not only for those with severe obesity, but also for women with gynecologic cancers, where traditional open surgery is often associated with significant complications. This review investigates the rationale behind Robotic Surgery, evaluates early results, analyzes its cost-effectiveness and implications for surgical training, and explores innovative applications of robotic-surgical procedure in the treatment of gynecologic cancer.

A NEW PERSPECTIVE ON DIAGNOSIS: THE POTENTIAL OF CT PERFUSION IN CHRONIC LIVER DISEASE (LITERATURE REVIEW)

The aim of this study is to analyze the current advances of CT perfusion in the diagnosis of liver disease. Liver fibrosis is a characteristic feature of chronic liver disease and is confirmed by liver biopsy, which is an invasive method. Morphologic parameters of cirrhosis are evaluated by conventional imaging techniques such as ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI). Additional studies of new imaging modalities are needed for earlier diagnosis, surveillance and accurate treatment, CT perfusion has several advantages by examining the arterial and venous blood flow of the liver, which gives a more complete picture of early functional changes in the liver. Despite the advantages of this method, the results of postprocessing in different stages of fibrosis and etiology of its development are not fully understood.

Association between postoperative pain and analgesic use in minimally invasive cardiac surgery.

This study aimed to investigate the effects of surgical methods on pain duration and oral analgesic administration in patients who underwent cardiac surgery using various minimally invasive methods. We included 90 patients who underwent an anterior incision with costal cartilage transection, lateral incision without costal cartilage transection, or total endoscopic cardiac surgery using a lateral incision and no retractor. Oral analgesics were postoperatively administered upon patient request. All the patients were instructed to rate their pain during the daytime 3 and 7 days postoperatively. Between-group differences included surgical method, wound size, operation/cardiopulmonary bypass time/cardiac arrest time, and intraoperative fentanyl dose. No differences were found in sex, age, diabetes status, paravertebral block use, or blood loss. The number of postoperative days, postoperative analgesic use, and pain 3 days postoperatively demonstrated no difference. Pain ratings were most severe for the costal cartilage resection group and least severe for the total endoscopic cardiac surgery group 7 days postoperatively. Similarly, patients who underwent costal cartilage research exhibited the highest rate of analgesic use for 30 days postoperatively, whereas patients who underwent total endoscopic cardiac surgery demonstrated the lowest. We revealed significant between-group differences in pain prevalence and postoperative oral analgesic administration in patients who underwent cardiac surgery relative to the minimally invasive surgical method used.

Automated Digital Sfigmomanometer Prototype Testing

Abstract Blood pressure is the pressure of blood flow in the arteries generated by the heart. Abnormal blood pressure can lead to hypertension and hypotension. Hypotension, or low blood pressure, has a prevalence of 5% to 34% among individuals aged 17 to 19, and over 50% in the elderly. Hypertension can cause death in patients with heart disease. About 39.7% of people suffer from hypertension, especially those over the age of 60. Blood pressure measurement needs to be done regularly because it has impact such as early detection of blood pressure health conditions and monitoring of health conditions for those already diagnosed with abnormal blood pressure. Unfortunately, only 59% of the population in Indonesia regularly measure their blood pressure. Accurate blood pressure measurement can be performed using an invasive method. Another method is non-invasive, which can be done using a sphygmomanometer that applies the oscillometric method. This method uses pressure oscillations in the cuff influenced by the pulse in the blood vessels. When using this method, several factors need to be considered, such as body position, cuff size, and the technique used during the measurement. In this study, a fully automatic digital sphygmomanometer has been developed with a cuff attached to the device, equipped with a thermal printer to print out the measurement results and classify blood pressure categories. The advantage of the developed prototype is that it has a smaller relative error value, with 1.03% for systolic blood pressure and 1.45% for diastolic blood pressure, and has already been integrated with a thermal printer to directly print the measurement results.

Long-term effectiveness of tonsillotomy versus tonsillectomy: A 12-year follow-up study.

To evaluate the long-term effectiveness of tonsillotomy (TT) compared to tonsillectomy (TE) with respect to disease-specific quality of life (QOL), sleep-disordered breathing symptoms, throat infections, and rate of reoperations over a median follow-up period of 12years. All patients < 16years of age who underwent tonsil surgery between 2010 and 2011 at Helsinki University Hospital, Finland, were included in the study. In 2023, the patients answered a questionnaire concerning tonsil-related issues and a modified Tonsil and Adenoid Health Status Instrument (disease-specific QOL). Information about possible revisits and reoperations was gathered. The study population consisted of 189 respondents, of which 87 had undergone TT and 102 TE. The median follow-up was 11.8years in the TT group and 12.4years in the TE group. The disease-specific QOL was equally good in both groups. Throat infections had not been an issue for the vast majority of patients and occurred to the same extent after TT and TE. The majority of participants (79.0% TT, 86.9% TE) were satisfied with the surgery, with no significant differences between the groups. After TT and TE, there were only a few revisits due to tonsil-related problems, and the reoperation rate was 6.9% and 1.0%, respectively. Long-term clinical effectiveness of TT seems excellent. Compared to TE, with TT, equal disease-specific QOL can be achieved with a less invasive surgical method. Over a median follow-up period of 12-years, TT was not shown to be associated with an increased risk of tonsil infection problems.

Laparoscopic prediction of primary cytoreducibility of epithelial ovarian cancer.

Ovarian cancer affects thousands of women every year and represents the female cancer with the highest mortality rate. Effectively, it is a severe disease that requires a multidisciplinary approach for optimal treatment. Surgery currently is the cornerstone of its treatment and numerous methods have been analyzed and developed to predict the possibility of obtaining a residual tumor of 0 (RT=0). This review aimed to analyze the available data in the literature about minimally invasive surgical methods to predict an RT=0 in patients with advanced epithelial ovarian carcinoma undergoing primary debulking surgery. An accurate review of the literature has been performed on the available data about the surgical criteria of cytoreducibility during primary debulking surgery. An accurate assessment of the extent of intra- and extra-abdominal pathology is essential to guide the surgeon in the most appropriate therapeutic choice for patients with ovarian cancer and multidisciplinary approaches that combine different methodologies such as radiological methods (magnetic resonance imaging, positron emission tomography and computed tomography), surgical (mini-laparotomy, laparoscopy) and serological (CA-125, HE4) data provide a complete picture in determining the extent of the tumor and an enormous aid in personalizing the therapeutic approach.

Transoral snare removal of subepiglottic cysts.

The objective of this demonstration was to describe and simulate a surgical technique for removing subepiglottic cysts in horses via an oral approach under endoscopic guidance using a cadaver model for simulation and clinical data. The technique aims to provide a minimally invasive method for the removal of these cysts. 2 clinical case images from the Washington State University Teaching Hospital were used in the video. In a third horse euthanized for reasons unrelated to the study, the procedure was simulated after the head was frozen and transected transversally. Files from 2 horses were reviewed, and the relevant parts were selected. The horse head was set on a stand, and a simulated cyst was implanted under the mucosa, made of the fingertip from a glove filled with carboxymethyl cellulose gel, and sutured. The procedure was performed by one of the authors (CAR) and recorded. A bronchoesophageal grasping forceps and cautery snare were used to simulate a clinical situation in dorsal recumbency. The cyst was successfully removed as in the real procedure, and the demonstration was recorded for educational use. The review of the videos shows that the simulated procedure is also achievable in a real clinical environment. This technique provides a minimally invasive method for the removal of subepiglottic cysts in horses. The demonstration of this procedure is crucial for the training of surgeons, as it allows the visualization of the procedure in a controlled setting, free from the complications of real clinical situations.

Deep learning approaches for assessing pediatric sleep apnea severity through SpO2 signals

Pediatric Sleep Apnea–Hypopnea (SAH) presents a significant health challenge, particularly in diagnostic contexts, where conventional Polysomnography (PSG) testing, although effective, can be distressing for children. Addressing this, our research proposes a less invasive method to assess pediatric SAH severity by analyzing blood oxygen saturation (SpO2) signals. We adopted two advanced deep learning architectures, namely ResNet-based and attention-augmented hybrid CNN-BiGRU models, to process SpO2 signals in a one-dimensional (1D) format for Apnea–Hypopnea Index (AHI) estimation in pediatric subjects. Employing the CHAT dataset, which includes 844 SpO2 signals, the data was partitioned into training (60%), testing (30%), and validation (10%) sets. A predefined validation subset was randomly selected to ensure the models' robustness via a threefold cross-validation approach. Comparative analysis revealed that while the ResNet model attained an average accuracy of 72.9% across four SAH severity categories with a kappa score of 0.57, the CNN-BiGRU-Attention model demonstrated superior performance, achieving an average accuracy of 75.95% and a kappa score of 0.63. This distinction underscores our method's efficacy in both estimating AHI and categorizing SAH severity levels with notable precision. Further, to evaluate diagnostic capabilities, the models were benchmarked against common AHI thresholds (1, 5, and 10 events/hour) in each test fold, affirming their effectiveness in identifying pediatric SAH. This study marks a significant advance in the field, offering a non-invasive, child-friendly alternative for pediatric SAH diagnosis. Although challenges persist in accurately estimating AHI, particularly in severe cases, our findings represent a critical stride towards improving diagnostic processes in pediatric SAH.