Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 31 appraisals
European journal of trauma and emergency surgery : official publication of the European Trauma Society
Initial surgical management of injuries to the upper extremities for patients with multiple and/or severe injuries - a systematic review and clinical practice guideline update.
PURPOSE: Our objective was to update the evidence-based and consensus-based recommendations for the initial surgical management of upper extremity injuries in patients with suspected multiple and/or severe injuries based on current evidence. This guideline topic is part of the 2025 update of the German Guideline on the Treatment of Patients with Multiple and/or Severe Injuries. METHODS: MEDLINE and Embase were systematically searched to September 2024. Further literature reports were obtained from clinical experts. Randomised controlled trials (RCTs) or observational studies reporting risk-adjusted outcomes were included if they compared early versus delayed surgical treatment for fractures, vascular injuries, or nerve injuries affecting the upper extremities in patients with multiple and/or severe injuries. Studies comparing limb salvage versus amputation or comparing amputation criteria for the upper extremities were also included. We considered patient-relevant outcomes such as mortality and limb salvage, as well as the sensitivity and specificity of scores for predicting upper extremity amputation. Risk of bias was assessed at the outcome level using ROBINS-I for observational studies and AMSTAR-2 for systematic reviews. We used available meta-analyses if possible; alternatively, we synthesised the evidence narratively. We used GRADE to rate the certainty of evidence. Expert consensus was used to develop recommendations and determine their strength. RESULTS: Among 2498 records screened for eligibility, four studies were included. Observational studies addressed the timing of humeral fixation, the timing of revascularisation, or compared limb salvage with amputation. A systematic review evaluated scoring systems for mangled upper limb salvage. Four recommendations were modified, and one consensus-based recommendation was added. All five recommendations achieved strong consensus. CONCLUSION: The timing of surgical intervention for upper extremity injuries in polytrauma patients should be individualized, based on the patient's physiological status, injury pattern, and the risks and benefits of early versus delayed surgery. Although early surgery may improve functional outcomes and reduce complications, adequate patient stabilization is essential before proceeding. Limb salvage should be attempted for patients with a MESS score of less than seven, provided the patient is sufficiently stable and depending on the condition of the amputated limb.Although the guideline addresses patients with multiple and/or severe injuries, the scarce evidence, heterogeneity of the included studies and the limited representation of true polytrauma cohorts may restrict the applicability of the findings to the broader critically injured trauma population.
10 July 2026
Read appraisal →ACS nano
Design and Applications of Magnetically Actuated Microrobots in Endovascular Embolization
Endovascular embolization is one of the core techniques in minimally invasive interventional medicine. It allows catheters to be accurately delivered to target blood vessels under image guidance for the implantation of embolic materials to achieve vascular occlusion. Although this technique has become increasingly mature, it still faces major challenges in precise delivery due to the limitations of embolic-agent properties and design concepts, restricting further improvement of the embolization therapeutic efficacy. Driven by continuous breakthroughs in materials science and control engineering, as well as the inevitable trend of medical development toward miniaturization, precision, and intelligence, microrobots show broad application prospects in precision disease treatment. They present advantages in accurate embolization and remote control in endovascular embolization, which can effectively improve embolization outcomes and reduce the risk of ectopic embolism. Taking the embolic microrobot system as the research focus, this paper systematically elaborates the design strategies, validation models, and practical applications of magnetically actuated embolic microrobots, comprehensively evaluates various imaging systems, and summarizes the supporting magnetic actuation technologies. It concludes the multimodule collaboration and adaptation framework of embolic microrobot systems. Finally, it analyzes the current limitations and potential translational challenges and presents a systematic prospect of its future development trends.
8 July 2026
Read appraisal →Journal of diabetes science and technology
Artificial Intelligence for Diabetic Foot Screening Based on Digital Image Analysis: A Systematic Review
INTRODUCTION: Early detection of diabetic foot complications is essential for effective management and prevention of complications. Artificial intelligence (AI) technology based on digital image analysis offers a promising noninvasive method for diabetic foot screening. This systematic review aims to identify a study on the development of an AI model for diabetic foot screening using digital image analysis. METHODOLOGY: The review scrutinized articles published between 2018 and 2023, sourced from PubMed, ProQuest, and ScienceDirect. The keyword-based search resulted in 2214 relevant articles and nine articles that met the inclusion criteria. The article quality assessment was done through Quality Assessment of Diagnostic Accuracy Studies (QUADAS). Data were extracted and analyzed using NVivo. RESULTS: Thermal imagery or foot thermogram was the main data source, with plantar temperature distribution patterns as an important indicator. Deep learning methods, specifically artificial neural networks (ANNs) and convolutional neural networks (CNNs), are the most commonly used methods. The highest performance is demonstrated by the ANN model with MATLAB's Image Processing Toolbox that is able to classify each type of macula with 97.5% accuracy. The findings show the great potential of AI in improving the accuracy and efficiency of diabetic foot screening. CONCLUSION: This research provides important insights into the development of AI in digital image-based diabetic foot screening. Future studies need to focus on evaluating clinical applicability, including ethical aspects and patient data security, as well as developing more comprehensive data sets.
2 July 2026
Read appraisal →Journal of neuro-oncology
Endovascular treatment of tumor-related dural sinus stenosis, venous outflow obstruction, and secondary intracranial hypertension: a systematic review of the literature.
INTRODUCTION: Tumors involving dural venous sinuses can lead to venous outflow obstruction and secondary intracranial hypertension. While surgical resection can decompress the sinus, such procedures carry significant risks. With the success of endovascular interventions for idiopathic intracranial hypertension (IIH), venous sinus stenting (VSS) and angioplasty have emerged as potential treatments for tumor-related sinus stenosis. However, evidence remains limited and dispersed. This systematic review aimed to synthesize the available literature on the safety and efficacy of endovascular treatment for tumor-related venous sinus obstruction. METHODS: A systematic search of PubMed, Embase, and Web of Science was conducted from database inception to November 2025. Eligible studies included any report describing endovascular treatment (VSS and/or angioplasty) for tumor-related venous sinus obstruction, whether due to tumor invasion or compression, or even stenosis following surgery or radiotherapy. Data on patient demographics, tumor characteristics, procedural details, and outcomes were extracted and summarized descriptively. RESULTS: Twenty studies comprising 57 patients were included. Most patients were female (65%) with a mean age of 48 years. Meningioma represented the most common underlying tumor (75%). The majority of obstructions resulted from tumor compression or invasion (86%), and most patients underwent VSS alone (74%), while the rest underwent VSS and angioplasty (23%). No periprocedural complications were reported. Mean trans-stenotic pressure gradient decreased by 10 ± 9 mmHg post-treatment and mean lumbar opening pressure decreased by 11 ± 12 cmH2O. Clinical improvement was reported in 63% of patients, including resolution or improvement of papilledema in 94% and vision changes in 94%. Repeat intervention was required in 28% of cases, and only about half of patients achieved further improvement after reintervention. CONCLUSION: Endovascular therapy for tumor-related venous sinus stenosis appears safe and effective, leading to meaningful pressure reduction and symptomatic improvement in two-thirds of patients. These findings support VSS as a viable adjunct or alternative to surgery in selected patients. Nonetheless, the certainty of evidence remains very low, and current data cannot establish definitive conclusions.
28 June 2026
Read appraisal →Journal of robotic surgery
Outcomes in laparoscopic versus robotic-assisted surgery for median arcuate ligament syndrome: a systematic review and meta-analysis
Median Arcuate Ligament Syndrome (MALS) is a rare condition caused by external compression of the coeliac artery by the median arcuate ligament (MAL), leading to postprandial abdominal pain, nausea, vomiting, and weight loss. This study aims to compare outcomes of robotic (RMALR) and laparoscopic (LMALR) MAL release. A systematic search of PubMed/MEDLINE, Scopus, and Embase databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to compare perioperative and postoperative outcomes of LMALR versus RMALR. Comparative studies including adult patients undergoing either approach were included. Outcomes assessed were conversion to open surgery, resolution of pain, length of admission, postoperative complications, symptom recurrence and time to recurrence. Five retrospective comparative studies comprising 158 patients were included. No differences were found between laparoscopic and robotic approaches in conversion to open, resolution of pain, postoperative complications, length of admission, or overall time to recurrence. However, RMALR showed a significantly longer time to symptom recurrence (9.04 months, 95% CI 4.18-13.89; p = 0.0003). Both LMALR and RMALR are safe and effective for MALS, with comparable perioperative and postoperative outcomes. The longer symptom-free interval after robotic surgery may reflect greater precision in dissection around the coeliac axis. However, further prospective studies with standardised follow-up are needed to validate these findings.
20 June 2026
Read appraisal →PloS one
Time-to-event ensemble machine learning approach for predicting long-term survival of abdominal aortic aneurysm patients undergoing endovascular aneurysm repair
BACKGROUND: Endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is associated with risks such as endoleaks and late aneurysm rupture, highlighting the importance of long-term survival prediction. Despite recent advancements in machine learning (ML), predictive models utilizing time-to-event analysis remain limited for AAA patients undergoing EVAR. We aimed to develop a stacking ensemble ML model to predict long-term outcomes in EVAR-treated AAA patients. METHODS: From 2002 to 2019, a total of 12,312 patients underwent EVAR. The primary outcome was AAA-related mortality, with follow-up until December 31, 2019. Using 5 ML algorithms, we developed a model comprising 34 variables. Model performance was assessed using the time-dependent C-index and Brier score. Variable importance was evaluated through permutation-based and partial dependent plots. RESULTS: The stacking ensemble model showed the best predictive performance among the tested models (time-dependent C-index: 0.759 at 30 days, 0.716 at 365 days). The time-dependent Brier scores generally increased slightly over time but remained stable across all ML algorithms. Important predictors included age, smoking status, duration between diagnosis and surgery, household income, renal function, and blood pressure. Variable importance differed over time, and each predictor presented a nonlinear relationship with AAA-related mortality risk. CONCLUSION: The stacking ensemble ML model for time-to-event prediction identified dynamic, time-varying changes in predictor importance, providing improved risk stratification and phase-specific management after EVAR.
14 June 2026
Read appraisal →Translational stroke research
AI-Guided Patient-Derived Endothelial Modeling Identifies a Reversible Moyamoya-Specific miRNA Deficiency Corrected by Stem Cell-Extracellular Vesicles
Moyamoya disease (MMD) is a progressive cerebrovascular disorder characterized by abnormal vascular remodeling and impaired angiogenesis. We profiled plasma extracellular vesicle (EV)-derived microRNAs (miRNAs) from MMD patients and healthy controls and generated patient-specific induced pluripotent stem cell-derived endothelial cells (iPSC-ECs) to investigate disease-associated molecular alterations and therapeutic reversibility. Both plasma EVs and iPSC-ECs from MMD patients showed significant depletion of angiogenesis-related miRNAs. Small RNA sequencing data revealed mesenchymal stem cell-derived EVs (MSC-EVs) contain a miRNA repertoire that substantially overlaps with miRNAs deficient in MMD. Treatment of MMD iPSC-ECs with MSC-EVs restored the majority of the depleted miRNAs to normal levels, normalized predicted target mRNA expression, and rescued angiogenic function in a dose-dependent manner, as demonstrated by tube formation assays. To improve identification of biologically relevant miRNA-mRNA interactions, we developed an artificial intelligence-based framework integrating experimentally validated databases, endothelial-focused literature mining, and large language model (LLM)-assisted mechanistic scoring. Incorporation of LLM-derived contextual features modestly improved prediction performance compared with conventional sequence-based models (baseline AUROC ~ 0.51; LLM-enhanced AUROC ~ 0.72), suggesting that literature-informed biological context provides meaningful signal beyond structural target features alone. Furthermore, our findings demonstrate that MSC-EV therapy can substantially reverse molecular and functional endothelial deficits. Integrated profiling and AI-driven interaction mapping together establish a hypothesis-generating framework ("Exo-Courier") for biologically informed prioritization of EV-based therapeutic targets in vascular disorders.
12 June 2026
Read appraisal →Translational stroke research
Transcarotid Artery Revascularization for Asymptomatic Carotid Stenosis: A Systematic Review and Meta-Analysis
Management of asymptomatic carotid stenosis remains controversial despite advances in contemporary best medical therapy. Transcarotid artery revascularization (TCAR) has been introduced as an alternative revascularization option alongside carotid endarterectomy (CEA) and transfemoral carotid artery stenting (TF-CAS). Evidence focused specifically on asymptomatic carotid disease, however, remains limited and is derived mainly from observational analyses of clinical databases, with only a small amount of single-center retrospective evidence. The present study therefore examined the available comparative evidence on TCAR for asymptomatic carotid stenosis. A systematic review and meta-analysis was performed of studies reporting outcomes of TCAR in asymptomatic carotid stenosis. Eligible studies included asymptomatic cohorts or mixed populations with extractable asymptomatic subgroup data and reported outcomes after TCAR with comparison against CEA and/or TF-CAS. The primary pooled outcomes were stroke, death, stroke or death, and myocardial infarction at 30 days, together with the corresponding stroke, death, and stroke or death outcomes at approximately 1 year. For TCAR versus CEA, no significant between-group differences were identified in the pooled 30-day risks of stroke (risk ratio (RR), 1.25; 95% CI, 0.98-1.59; I²=82%), death (RR, 0.94; 95% CI, 0.64-1.38; I²=57%), or stroke or death (RR, 1.10; 95% CI, 0.95-1.26; I²=75%). In contrast, myocardial infarction within 30 days occurred less frequently after TCAR (RR, 0.68; 95% CI, 0.48-0.96; I²=71%). At approximately 1 year, pooled estimates likewise showed no significant difference in stroke (RR, 1.27; 95% CI, 0.70-2.29; I²=0%) or death (RR, 1.14; 95% CI, 0.97-1.35; I²=0%), whereas the pooled estimate for stroke or death favored CEA (RR, 1.25; 95% CI, 1.15-1.36; I²=31%). A different pattern emerged in the TCAR versus TF-CAS comparison. TCAR was associated with significantly lower pooled 30-day risks of stroke (RR, 0.60; 95% CI, 0.48-0.73; I²=0%), death (RR, 0.55; 95% CI, 0.38-0.81; I²=20%), and stroke or death (RR, 0.60; 95% CI, 0.52-0.70; I²=6%), while no significant difference was observed for 30-day myocardial infarction (RR, 0.91; 95% CI, 0.65-1.29; I²=44%). At approximately 1 year, stroke remained comparable between the 2 groups (RR, 0.75; 95% CI, 0.46-1.23; I²=26%), whereas death (RR, 1.09; 95% CI, 1.00-1.20; I²=66%) and stroke or death (RR, 0.79; 95% CI, 0.71-0.87; I²=45%) differed, with the pooled stroke-or-death estimate favoring TCAR. Current observational evidence suggests that TCAR compares favorably with TF-CAS in asymptomatic carotid stenosis. When compared with CEA, TCAR does not appear to provide a clear benefit in pooled perioperative neurologic outcomes, although myocardial infarction may occur less frequently after TCAR.
11 June 2026
Read appraisal →Medicine
Machine learning identifies a NETs-related four-gene diagnostic signature for abdominal aortic aneurysm
Abdominal aortic aneurysm (AAA) is a chronic degenerative disease characterized by localized aortic dilation and persistent inflammation. While neutrophil extracellular traps (NETs) are increasingly recognized as key drivers of vascular inflammation and aneurysm progression, the transcriptomic landscape of NETs-related genes (NRGs) in AAA remains inadequately characterized. This study aimed to identify reliable diagnostic biomarkers and explore the immune heterogeneity of AAA to facilitate early risk stratification. We integrated transcriptomic datasets from the Gene Expression Omnibus to elucidate the role of dysregulated NRGs. A comprehensive bioinformatics pipeline was employed, combining weighted gene co-expression network analysis with differential expression profiling to screen for AAA-specific NRGs. Rigorous feature selection was conducted through the intersection of 3 machine learning algorithms - least absolute shrinkage and selection operator, support vector machine-recursive feature elimination, and random forest - to derive a diagnostic signature. The model was constructed using the GSE232911 cohort and validated in an independent external cohort. A robust 4-gene diagnostic signature comprising CXCR4, GZMB, ITGA6, and CD47 was identified. This signature demonstrated a favorable diagnostic performance, achieving an area under the curve of 0.920 in the training cohort. The model maintained consistent discriminatory ability in the external validation cohort, primarily driven by the high discriminative ability of CXCR4 and GZMB. Consensus clustering based on these hub genes revealed 2 distinct molecular subtypes, with Cluster 2 characterized by significant enrichment of neutrophils and innate immune pathways, suggesting intense NETosis activity. Furthermore, drug prediction analyses identified candidate therapeutic compounds, including Eugenol and Tretinoin, offering potential avenues for targeting the NETs-associated molecular landscape. Our findings underscore the pivotal role of NETs-mediated inflammation in AAA pathogenesis and validate a robust 4-gene signature for early diagnosis. By delineating immune-related molecular subtypes and identifying potential drug candidates, this study provides a foundational framework for precision risk stratification and the development of targeted nonsurgical therapies for aneurysm management.
25 May 2026
Read appraisal →Scientific reports
Impact of nurse-led postoperative education on health outcomes following endovascular aortic repair: a randomized trial
The purpose of this randomized controlled clinical trial was to investigate the health effects of an education-based intervention performed at a nurse-led clinic, for patients who underwent endovascular treatment for abdominal aortic aneurysm. Fifty-four adult patients were randomized to the intervention group (n = 26) or the control group (n = 28). The control group received standard care, and the intervention group received standard care alongside two consultations at a specialist surgical nurse-led clinic. The consultations focused on individual motivational support and education about abdominal aortic aneurysm disease. Data was collected prior to surgery (baseline) and at one, six, and 12 months postoperatively for each group. Outcomes of interest included participants' responses to the Health Education Impact Questionnaire, responses to the EuroQol Five Dimensions Questionnaire, and responses to four complementary items specific to the scope of this study. Both groups reported overall high ratings of perceived health throughout the study period. While there were no statistically significant differences between the two groups, the control group showed a substantial improvement in perceived understanding of their diagnosis over time. This randomized controlled trial did not find any significant health benefits as compared to standard treatment.Trial registration ClinicalTrials.gov (19/05/2025 NCT06986252). Retrospectively registered.
24 May 2026
Read appraisal →BMJ open diabetes research & care
Topical therapies for diabetic foot ulcers: a systematic review and network meta-analysis
OBJECTIVE: Diabetic foot ulcer (DFU) is a life-threatening complication associated with high amputation and mortality rates. While numerous topical therapies exist, their comparative efficacy and safety remain unclear. We aimed to compare the efficacy and safety of topical therapies for DFUs to identify optimal treatment strategies. RESEARCH DESIGN AND METHODS: We searched PubMed, Embase, and CENTRAL from inception to February 1, 2025, for randomized clinical trials (RCTs) evaluating topical therapies for DFUs. We excluded non-topical interventions to ensure clinically relevant comparisons. A Bayesian network meta-analysis was performed. The primary outcome was wound healing rate. RESULTS: We included 51 RCTs involving 6161 patients and 23 interventions. 12 topical therapies, including placenta-derived products, platelet-related products, ON101, epidermal growth factor, and tissue-engineered skin substitutes, significantly improved wound healing rates vs standard of care (SOC). Placenta-derived products showed the greatest efficacy (OR 7.85 (95% credible interval (CrI) 4.62 to 14.15)) and were the only intervention to significantly reduce adverse events vs SOC (0.25 (95% CrI 0.10 to 0.60)). No interventions differed significantly from SOC in time to wound healing, serious adverse events, or infections. CONCLUSIONS: Placenta-derived products and other biological or advanced topical therapies may demonstrate greater efficacy than the SOC in facilitating the healing of DFUs. Nevertheless, the certainty of evidence for most comparisons remains in the low-to-moderate range. These findings suggest potential benefits in integrating these therapies into the management of DFUs. However, high-quality RCTs are necessary to verify long-term outcomes.
23 May 2026
Read appraisal →Journal of neurointerventional surgery
Comparative safety and efficacy of invasive therapies for carotid artery stenosis: a systematic review and network meta-analysis
BACKGROUND: Carotid artery stenosis is a major cause of stroke and is commonly treated with carotid endarterectomy (CEA) or carotid artery stenting (CAS). Trans-carotid artery revascularization (TCAR) has emerged as a newer alternative designed to reduce the risk of procedural stroke. However, comparative evidence on the safety and efficacy of these interventions is limited. This study evaluates the clinical outcomes of CEA, CAS, and TCAR in patients with carotid artery stenosis. METHODS: A comprehensive search of multiple databases was conducted to identify relevant studies. The outcomes were stroke, mortality, and myocardial infarction, cranial nerve injury, hematoma, infection, transient ischemic attack, and length of hospital stay. Meta-analysis and a frequentist graph-theoretical approach network meta-analysis were performed using the netmeta package in R platform. Risk of bias was assessed using RoB 2 Cochrane and ROBINS-I. RESULTS: Fifty-five studies were included in the review. The short-term stroke risk was significantly lower with CEA than with CAS. TCAR had a potential long-term mortality benefit over CAS, while no significant differences were observed in short-term mortality or myocardial infarction across treatments. CAS was associated with lower risks of cranial nerve injury, hematoma, and infection compared with CEA. CONCLUSION: CEA and TCAR offer better short-term stroke protection than CAS, with TCAR showing promise for long-term mortality benefits. CAS has advantages in reducing cranial nerve injury, hematoma, and infection risks. Overall, the choice of treatment should consider both efficacy and safety profiles. Further high-quality randomized controlled trials, particularly focusing on TCAR, are needed to validate these comparative outcomes. PROSPERO REGISTRY NUMBER: CRD420251055287.
16 May 2026
Read appraisal →Archives of orthopaedic and trauma surgery
Defining orthoplastic limb salvage centers: a systematic review
INTRODUCTION: Limb salvage centers have increased in number over time, but lack standardized defining criteria. This systematic review aimed to assess organizational features of limb salvage centers and determine whether orthoplastic centers, in comparison to vascular limb salvage centers, represent a distinct care model that may benefit from standardization. METHODS: We conducted a systematic review of publications related to limb salvage centers by searching MEDLINE, Embase, Web of Science, and Cochrane databases from their inception through 2024. We quantified binary data extraction as a reporting score of 26 organizational features across six structural care domains for limb salvage centers, based on a validated quality measurement framework. Organizational features differentiating distinct center types were identified to establish a quality framework for orthoplastic centers. Statistical comparisons between center types were performed using appropriate tests (p < 0.05). RESULTS: Of 118 included studies, orthoplastic (n = 43) and vascular (n = 48) centers represented 77% of all studies. Recent increases in orthoplastic publications show substantial variability in organizational features. Orthoplastic center literature more frequently reported plastic surgery consultation criteria (p < 0.001), surgical outcomes (p < 0.001), and centralized network integration (p ≤ 0.006), highlighting acute reconstructive approaches. Vascular center studies documented significantly more organizational team features (p < 0.001) and quality systems (p = 0.033), reflecting established care frameworks for chronic disease management. Six organizational features characterized orthoplastic centers with > 70% prevalence, providing a benchmark framework with standardization priorities. CONCLUSION: Orthoplastic limb salvage centers demonstrate distinct care paradigms that benefit from standardization. Our findings suggest structural benchmarks to support the need for standardized development of orthoplastic limb salvage centers.
10 May 2026
Read appraisal →Journal of vascular and interventional radiology : JVIR
A Deep Learning Model for Artery of Adamkiewicz Detection in Bronchial Artery Embolization: A Multicenter Retrospective Study
PURPOSE: To evaluate the effectiveness of a deep learning model for recognizing the artery of Adamkiewicz and anterior spinal artery (ASA) to prevent spinal artery non-target embolization during bronchial artery embolization (BAE). MATERIALS AND METHODS: This multicenter, retrospective study included 2036 patients from January 2019 to December 2023 with hemoptysis who underwent de novo BAE. A deep learning-based framework was proposed for spinal artery identification, comprising region of interest (ROI) perception and target spinal artery identification. The ROI perception extracted vessel-related regions to improve the conspicuity of the spinal artery. The target spinal artery identification utilized a progressive refinement learning network, localizing the artery from the global view, and progressively refined the identification results through cross-scale information interaction. RESULTS: Seventy-eight patients (3.8%) had an identifiable artery of Adamkiewicz and ASA on right intercostal-bronchial artery angiography. The sensitivity of the proposed method was 92.1% and the specificity was 84.6%, with no statistically significant difference from a fellow radiologist interpretation. CONCLUSIONS: The deep learning system for spinal artery detection during BAE exhibited high sensitivity and performance, comparable to radiology fellows.
4 May 2026
Read appraisal →Renal failure
Factors influencing patency after percutaneous transluminal angioplasty for autogenous arteriovenous fistulae: a systematic review and meta-analysis
This systematic review and meta-analysis identified factors influencing patency after percutaneous transluminal angioplasty (PTA) for autogenous arteriovenous fistulae (AVF) in hemodialysis patients. Literature through July 2025 was searched for observational and randomized trials. Two reviewers independently performed study selection, quality assessment (Newcastle-Ottawa Scale/Cochrane tool), and data extraction. Meta-analyses used fixed-/random-effects models in R (per I2 statistic), with sensitivity and publication bias analyses. Fifty-two studies (n = 6,407) were included, 45 of high quality. For primary patency, independent risk factors were diabetes (OR = 1.02, 95% CI 1.01-1.02), lesion length >2 cm (OR = 2.87, 1.38-5.96), previous intervention (OR = 3.13, 1.69-5.79), failed AVF history (OR = 1.69, 1.22-2.35), brachiocephalic configuration (vs. radiocephalic, OR = 1.73, 1.33-2.26), vascular calcification, and multiple comorbidities. High post-PTA flow was protective, and drug-coated balloons outperformed conventional angioplasty. Secondary patency was compromised by diabetes (OR = 1.05, 95% CI 1.02-1.08), longer lesions (OR = 1.01, 95% CI 1.01-1.02), and residual stenosis (OR = 1.02, 95% CI 1.01-1.04), with procedural success protective. Intimal hyperplasia strongly predicted failure. Restenosis risk was elevated by diabetes (OR = 1.72, 95% CI 1.28-2.31) and hypertension (OR = 1.59, 95% CI 1.04-2.44), while medical therapy with nitrates (OR = 0.20, 95% CI 0.05-0.79) and higher albumin were protective. Conventional biomarkers had limited value. Long-term AVF patency after PTA depends on anatomical, historical, and pathological factors, emphasizing the need to target modifiable procedural and hemodynamic variables in clinical practice.
25 Apr 2026
Read appraisal →BMJ open
Prevalence of incidental findings requiring interventions in CT for trauma patients in the emergency department: a systematic review and meta-analysis
OBJECTIVE: To systematically review and meta-analyse the prevalence of incidental findings (IFs) requiring interventions identified in CT performed for patients with traumatic injuries in the emergency department, including pathologically confirmed cancers and emergent non-traumatic vascular pathologies. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, EMBASE and Cochrane CENTRAL databases from database inception to 22 November 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Prospective or retrospective studies involving traumatic injury patients presented at the emergency department reporting IFs of clinical significance detected through CT with any interventions proposed were included. Studies that exclusively included paediatric populations were excluded. The systematic review methods included double-screening, dual assessment of eligibility and study validity, dual data extraction, Bayesian multivariate random-effects meta-analysis of prevalence and employing the Grading of Recommendations, Assessment, Development and Evaluations' rating for the certainty of evidence. The primary outcomes were IFs requiring any interventions, and subset IFs requiring urgent interventions. Secondary outcomes were histologically confirmed cancers and emergent non-traumatic vascular pathologies. RESULTS: 22 studies (1 with a prospective and 21 with a retrospective design) mainly from high-income countries using limited-quality data based on clinical practice involving 18 538 patients were included. 9 studies evaluated the whole body, while 13 evaluated selective body regions. The grading criteria for IFs were non-uniform, and the image interpreters involved had diverse experience and expertise. The summary prevalence estimates for IFs requiring any interventions, urgent interventions, pathologically confirmed cancers and emergent non-traumatic vascular pathologies detected in the whole body were 29.8% (95% credible interval (CrI) 20.4% to 42.9%; very low certainty), 7.6% (95% CrI 4.5% to 14.8%; low certainty), 0.6% (95% CrI 0.3% to 1.6%; moderate certainty) and 0.3% (95% CrI 0.1% to 0.9%; moderate certainty), respectively. These findings were largely identified in the chest or abdomen and pelvis, with the overall detection frequency reduced with the scanned body regions narrowed (very low to moderate certainty). Sparse data on the head, neck and spine resulted in limited results. CONCLUSIONS: IFs identified in trauma whole-body CT requiring intervention are prevalent and can lead to substantial medical costs. The widely reported prevalence range suggests variations in radiologist recommendations and reporting in clinical practice and calls for standardisations. IFs requiring urgent intervention are not rare, which leads to a diagnosis of significant diseases including cancers and urgent vascular pathologies. Future studies should report long-term, patient-relevant results based on standardised classification and reporting systems. PROSPERO REGISTRATION NUMBER: CRD42020187852.
18 Apr 2026
Read appraisal →Journal of global health
National, regional and provincial prevalence of peripheral artery disease in Chinese adults in 2023: an updated systematic review and modelling study
BACKGROUND: Peripheral artery disease (PAD), a common atherosclerotic condition characterised by the narrowing or obstruction of peripheral arteries, has become a substantial public health concern in China. However, its prevalence across the country at the provincial level has never been quantified. Through an updated systematic review and modelling study, we aimed to estimate the national, regional, and provincial prevalence of PAD among Chinese individuals aged 30-89 years in 2023. METHODS: We conducted an updated literature search in PubMed, Embase, MEDLINE, the China National Knowledge Infrastructure, Wanfang, and the Chinese Science and Technology Journal Database to identify studies published between 4 March 2017 and 12 August 2024 reporting on the prevalence of PAD in the general Chinese population. We also identified and included studies from previous systematic reviews. We then used a multilevel mixed-effects meta-regression model to generate the age- and sex-specific prevalence estimates of PAD among individuals aged 30-89 years at the national level. We calculated pooled odds ratios (ORs) for factors associated with PAD using a random-effects meta-analysis and incorporated them into an 'associated factor-based model' to estimate regional and provincial prevalence. RESULTS: We included 54 articles from all searches. Model-based estimates indicated that the overall prevalence of PAD among Chinese adults aged 30-89 years in 2023 was 5.47% (95% confidence interval (CI) = 4.64-6.44), equivalent to 49.90 million (95% CI = 42.32-58.73) affected individuals. Prevalence increased progressively with age, ranging from 4.23% (95% CI = 3.58-5.00) among individuals aged 30-34 years to 18.37% (95% CI = 15.90-21.13) among those aged 85-89 years. The overall prevalence was higher in females (6.19%; 95% CI = 5.25-7.27) than males (4.76%; 95% CI = 4.03-5.61). Regionally, Northeast China had the highest prevalence of PAD at 5.87% (95% CI = 4.98-6.91), while Central China had the lowest at 5.26% (95% CI = 4.46-6.19). At the provincial level, the prevalence of PAD was the highest in Beijing (6.40%; 95% CI = 5.43-7.53) and lowest in Tibet (4.35%; 95% CI = 3.68-5.12). Female sex, current smoking, hypertension, diabetes, coronary heart disease, and stroke were identified as factors significantly associated with PAD. CONCLUSIONS: We found that PAD is prevalent in China, with pronounced age-related trends, sex differences, and regional disparities. These findings could inform targeted public health initiatives and appropriate resource allocation. REGISTRATION: PROSPERO: CRD420251118923.
18 Apr 2026
Read appraisal →Journal of neurointerventional surgery
Intravascular lithotripsy in calcified carotid stenosis: technical and clinical outcomes
INTRODUCTION: Carotid artery stenosis (CAS) is a major cause of stroke, disability, and mortality worldwide. While medical therapy and revascularization remain the cornerstones of management, both surgical and endovascular approaches can be limited by complex anatomy and heavily calcified plaques, which increase procedural risk. Intravascular lithotripsy (IVL), originally developed for coronary and peripheral interventions, has recently emerged as a potential strategy for plaque modification in CAS. By delivering localized shockwave pulses, IVL fractures vascular calcium, facilitating safer angioplasty and stent deployment. However, its use in CAS remains off-label and poorly described. METHODS: A systematic search of PubMed, Google Scholar, and Embase was conducted in September 2025 in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies included patients with CAS undergoing IVL with reported procedural success and/or clinical outcomes. Risk of bias was assessed using the Joanna Briggs Institute (JBI) appraisal tools. RESULTS: Fifteen studies comprising 120 patients were included. The mean age ranged from 50 to 82 years, and the degree of stenosis from 70%-95%. Technical success was reported in 100% of cases. Across the pooled cohort, 101 of 120 patients (84.2%) achieved residual stenosis ≤30%. Seven patients (5.8%) experienced ipsilateral stroke or transient ischemic attack within 30 days. CONCLUSION: IVL for CAS is an emerging therapy demonstrating consistent technical feasibility and favorable short-term safety across published studies. These findings suggest that IVL may benefit patients with complex calcified plaques at high risk for standard revascularization; however, randomized controlled trials are needed to confirm its role in clinical practice.
17 Apr 2026
Read appraisal →Molecular biomedicine
Machine learning integrated clinical-proteomics data identifies a 6-protein panel signature for atherosclerotic severity and enhanced patient stratification
Atherosclerosis, a major cause of adverse cardiovascular events and mortality rates worldwide, stems from sustained lipid accumulation and subsequent chronic inflammation within the arterial walls. An early identification of patients at risk is crucial to prevent life-threatening thrombotic events and provide effective and personalized treatments. Leveraging the power of machine learning (ML) to enhance diagnostics and biomarker discovery, we applied a high-throughput approach using five ML classification algorithms (MLCA), integrating clinical and serum proteomic data from patients with carotid atherosclerotic stenosis (AT, n:60), dyslipidemic patients (DLP, n:55), and healthy controls (HC, n:66). As a result, a robust 6-protein panel (B2M, GPV, MMP9, PLF4, TSP1, and FB isoforms) was identified with a ROC-AUC value > 0.9 for all algorithms applied, highly discriminating AT patients compared to DLP or CTRL. The levels of these proteins were further validated in an independent external cohort, including patients presenting with acute atherothrombotic stroke, corroborating the potential of this panel as biomarker for atherosclerosis severity. In addition, the combined clinical-proteomic ML approach provided a more accurate patient stratification than the clinical or proteomic analysis alone. Mechanistically, the identified biomarkers highlight the importance of platelet activation, uncontrolled angiogenesis and intraplaque haemorrhage in the atherosclerotic process, underscoring the need for multipathway therapies to prevent unwanted thrombotic events.
12 Apr 2026
Read appraisal →European journal of trauma and emergency surgery : official publication of the European Trauma Society
A machine-learning-based tool for stroke risk prediction in blunt cerebrovascular injury: development and preliminary evaluation
PURPOSE: Stroke risk correlates with the Biffl grading system in blunt cerebrovascular injury (BCVI). Although anti-thrombotic therapy is the mainstay of stroke prevention, no point-of-care clinical decision-support tool exists to guide timing for therapy. We sought to develop an interactive online calculator that incorporates patient-specific demographic and injury characteristics to estimate stroke risk and risk reduction with anti-thrombotic (AT) administration. METHODS: Data from BCVI patients (n = 1,197) at a Level I Trauma Center were retrospectively collected. Six machine learning methods were employed to predict stroke risk with and without AT therapy. Class imbalance was addressed using downsampling and/or class weighting. Model performance was assessed using 10-fold cross-validation. The model was implemented as an R-based Shiny online application. RESULTS: Stroke rate among the population was 4%, and the strongest predictors for stroke were the greatest Biffl grade of carotid (aOR [95%CI] = 2.02 [1.62-2.53]) and vertebral injuries (1.44 [1.18-1.77]). The least absolute shrinkage and selection operator (LASSO) model outperformed all others, achieving 66% [33%-100%] sensitivity and 74% [62%-82%] specificity for stroke prediction, with an area under the receiver operating characteristic curve of 0.79 [0.57-0.95]. This model was integrated into an interactive online tool ( https://grady-bcvi-calc.shinyapps.io/calculator/ ), where patient demographic and injury characteristics can be used to compute baseline stroke risk and estimate stroke risk with AT. CONCLUSION: We developed and evaluated a preliminary predictive model for personalized stroke risk assessment in patients with BCVI using key risk factors. The integration of patient-specific risk-benefit assessments into clinical decision-making could optimize and reduce variability in AT therapy. External validation is warranted to prepare this tool for broad clinical applicability.
11 Apr 2026
Read appraisal →JMIR medical informatics
Exploring the Role of AI in Managing Treatment Recommendations for Lymphedema: International, Multidisciplinary, Multiprofessional Survey Study of Trust, Reliability, and Impact on Decision-Making
BACKGROUND: Upper and lower extremity lymphedema is a chronic, progressive condition that significantly impairs the quality of life of affected patients. Despite the recently established effectiveness of physical therapy and supermicrosurgical interventions, current guidelines frequently lag behind emerging evidence and commonly do not offer stage-specific treatment algorithms. This gap in evidence-based guidance may prompt clinicians with limited experience to seek support from large language models such as ChatGPT. OBJECTIVE: Given the potential of artificial intelligence to rapidly integrate emerging research, this study evaluated how clinicians from different professional backgrounds rate the quality and reliability of personalized lymphedema management recommendations generated by ChatGPT. METHODS: In this exploratory cross-sectional study, ChatGPT generated treatment recommendations for 6 standardized lymphedema case scenarios. An international panel of 67 participants (resident doctors, board-certified specialists, physiotherapists, and advanced practice nurses) from 34 institutions across 11 countries assessed the recommendations using a modified DISCERN questionnaire with a 9-point agreement scale ranging from 1 (completely disagree) to 9 (completely agree). Ratings were summarized as pooled means with variability measures and compared across clinician groups (residents vs board-certified physicians vs physiotherapists or advanced practice nurses) using group comparison testing. RESULTS: ChatGPT was rated most favorably for diagnostic accuracy and treatment relevance, with higher ratings among residents than board-certified physicians. Residents assigned significantly lower scores for source indication, source currency, and communication of uncertainty. Between-group differences were observed across multiple DISCERN items, consistent with systematically more critical appraisal by experienced specialists. Participants reported moderate to high trust and willingness to consider ChatGPT as a supplementary resource, with more favorable perceptions among younger respondents. CONCLUSIONS: Clinicians perceived ChatGPT as potentially useful for preliminary orientation and educational support in lymphedema management, especially for less experienced users. Despite not being blinded, lower ratings in evidence transparency and uncertainty communication, particularly among experienced specialists, suggest that current artificial intelligence outputs should not be used as stand-alone guidance. Future work should test clinically integrated, citation-grounded workflows in prospective settings and evaluate whether they improve decision quality and efficiency.
9 Apr 2026
Read appraisal →Journal of the American Heart Association
A Position Statement on Endovascular Models and Effectiveness Metrics for Mechanical Thrombectomy Navigation, on Behalf of the Stakeholder Taskforce for Artificial Intelligence-Assisted Robotic Thrombectomy (START)
Although we are making progress in overcoming infectious diseases and cancer, one of the major medical challenges of the mid-21st century will be the increasing prevalence of stroke. Occlusions in large vessels are especially debilitating, yet effective treatment-needed within hours to achieve best outcomes-remains limited because of geographic accessibility. One solution for improving timely access to mechanical thrombectomy in geographically diverse populations is the widespread deployment of robotic surgical systems. Artificial intelligence assistance may enable the safe and effective upskilling of operators in this emerging therapeutic delivery approach. Our aim was to establish consensus frameworks for developing and validating artificial intelligence-assisted robots for thrombectomy. Objectives included standardizing effectiveness metrics and defining reference testbeds across in silico, in vitro, ex vivo, and in vivo environments. To achieve this, we convened experts in neurointervention, robotics, data science, health economics, policy, statistics, and patient advocacy. Consensus was built through an incubator day, a Delphi process, and a final position statement. We identified that the 4 essential testbed environments each had distinct validation roles. Realism requirements vary: simpler testbeds should include realistic vessel anatomy compatible with guidewire and catheter use, whereas standard testbeds should incorporate deformable vessels. More advanced testbeds should include blood flow, pulsatility, and disease features, such as atheromatous plaques. There are 2 macroclasses of effectiveness metrics: one for in silico, in vitro, and ex vivo stages focusing on technical navigation (eg, path-following error), and another for in vivo stages, focused on clinical outcomes (eg, modified treatment in cerebral infarction scores). Patient safety is central, and not a barrier, to this technology's development. One requisite patient safety task needed now is to correlate in vitro measurements to in vivo complications.
8 Apr 2026
Read appraisal →PloS one
Advanced microfluidic and 3D cell culture platforms for modeling vascularization in diabetic foot ulcers: A systematic review of translational challenges and perspectives
The healing process of diabetic foot ulcers (DFUs) presents a slow pattern with an increased risk of infections, ischemia, and thrombosis correlated with high levels of reactive oxygen species production. Vascular injury is one of the factors contributing to the difficulty of wound healing in diabetic patients. Although the understanding of the pathophysiology of DFUs has significantly increased in recent years, associated treatments still have a high level of failure, leading to high morbidity rates, mortality, and amputations. Three-dimensional (3D) cell culture platforms offer a new approach to investigating and treating these wounds, as they can reproduce one or more physiological systems in a relevant microenvironment. This systematic review describes the advancements, challenges, and future implications of advanced 3D culture models in vascularization, encompassing pathophysiological understanding, treatment, and prognostic perspectives. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This work was registered under PROSPERO protocol number CRD42022336473. The eligibility criteria addressed studies related to chronic DFUs that analyzed vascularization during the healing process. The selected study designs involved 3D cultures and organ-on-a- chip (OoC) platforms, utilizing either primary or secondary human cell lines. Studies published more than 10 years ago or using only animal cells in 2D culture environments were excluded. The search was conducted in PubMed, LILACS, Embase, MEDLINE, IEEE, the BSV regional portal, ScienceDirect, Scopus, CINAHL, EBSCO, and Web of Science. A total of 2,539 relevant studies were identified as of June 1, 2025. After screening, only seven met the inclusion criteria. These studies reflect a growing interest in using hydrogel scaffolds and microfluidic systems to replicate diabetic skin environments; however, the field remains in an early stage of development. OoC platforms, in particular, stand out for their ability to recreate dynamic, tissue-like conditions and vascular function. While some promising attempts have been made to combine hydrogels with these technologies, the evidence is still limited and inconclusive for chronic wound modeling. This review underscores both the potential and the urgent need for more robust and translational research in this area-especially toward building personalized, clinically relevant models to support future drug testing and therapeutic innovation.
7 Apr 2026
Read appraisal →Journal of wound care
Micrografts-a novel ally in hard-to-heal wounds: a systematic review.
OBJECTIVE: Wound healing is complex, and hard-to-heal (chronic) wounds pose significant treatment challenges, especially in adults. Micrografts (MGs) are emerging as a promising treatment for wounds refractory to conventional approaches. MG involves transplanting a stem cell suspension to the wound to promote healing. Scientific studies on MG are increasing; however, a systematic review is needed for a comprehensive understanding of its efficacy. METHOD: A systematic review conducted on 30 March 2024 used PubMed, Scopus and Web of Science databases to evaluate skin and dermal MGs in wound healing. PRISMA guidelines were followed and predefined inclusion and exclusion criteria were applied. All authors reviewed the studies and discussed results to ensure consistency in study screening, selection and data extraction. RESULTS: A total of 1251 papers were examined, with 23 eligible for full-text review. After exclusions based on language, reviews, MG size and tissue focus, 15 articles were included in the final review: seven case reports; five case series; two prospective series (one with 70 patients, the other with 30 patients) and a case-control study. CONCLUSION: The results of the reviewed studies suggest that MGs may promote wound healing, with reported reductions in healing time and improvements in clinical symptoms in hard-to-heal wounds. However, standardisation of treatment protocols and application methods is required. The role of MGs in the treatment of acute wounds remains to be clarified.
4 Apr 2026
Read appraisal →Biofabrication
High-fidelity 'top-down' DLP bioprinting of multi-material soft tissue constructs enabled by computer vision-based layer control
Bioprinting continues to redefine the frontiers of regenerative medicine by enabling the fabrication of complex, three-dimensional (3D) tissue constructs that emulate native biological and mechanical functions. However, despite significant progress, critical challenges remain, particularly in achieving precise multi-material integration, high-resolution patterning, and structural fidelity necessary for functional tissue engineering. A major limitation in 'top-down' vat photopolymerization bioprinting, especially digital light processing (DLP)-based approaches, lies in the precise control of layer thickness, a parameter that directly affects mechanical integrity, biological activity, and spatial resolution. This study presents a novel, automated platform designed to overcome one of the most persistent bottlenecks in multi-material top-down DLP bioprinting: the real-time, accurate measurement of the dynamic gap between the cured layer and the bioink surface. Through a comparative assessment of classical computer vision and deep learning (convolutional neural network-based) techniques, we demonstrate a system capable of achieving sub-0.1 mm precision (0.092 mm) with strong correlation to mechanical measurements (R= 0.994). This vision-based system adapts to a wide range of bioinks with varying viscosities, opacities, and photopolymerization kinetics, eliminating the need for manual recalibration during material switching. As a demonstration of its capabilities, we successfully printed a multimaterial vascular-like tissue structure with high spatial fidelity across heterogeneous biomaterials. Further, we bioprinted a multimaterial skin tissue model, featuring compartmentalized dermal/bone analogs, to enablein vitrofunctional evaluation. These case studies highlight the platform's potential to advance biofabrication workflows by improving reproducibility, material adaptability, and structural precision, paving the way toward clinically scalable tissue manufacturing systems.
4 Apr 2026
Read appraisal →Computer methods in biomechanics and biomedical engineering
Reconstruction of blood flow velocity with deep learning information fusion from spectral ct projections and vessel geometry
In this work, we investigate a new deep learning reconstruction method of blood flow velocity within deformed vessels from contrast enhanced X-ray projections and vessel geometry. The principle of the method is to perform linear or nonlinear dimension reductions on the Radon projections and on the mesh of the vessel. These low dimensional projections are then fused to obtain the velocity field in the vessel. The accuracy of the reconstruction method is proved using various neural network architectures with realistic unsteady blood flows. The approach leverages the vessel geometry information and outperforms the simple PCA-net.
4 Apr 2026
Read appraisal →Angiology
Artificial Intelligence Techniques for Prognostic and Diagnostic Assessments in Peripheral Artery Disease: A Scoping Review
Peripheral artery disease (PAD) is a major public health concern worldwide, associated with high risk of mortality and morbidity related to cardiovascular and adverse limb events. Despite significant advances in both medical and interventional therapies, PAD often remains under-diagnosed, and the prognosis of patients can be difficult to predict. Artificial intelligence (AI) has brought a wide range of opportunities to improve the management of cardiovascular diseases, from advanced imaging analysis to machine-learning (ML)-based predictive models, and medical data management using natural language processing (NLP). The aim of this review is to summarize and discuss current techniques based on AI that have been proposed for the diagnosis and the evaluation of the prognosis in patients with PAD. The review focused on clinical studies that proposed AI-methods for the detection and the classification of PAD as well as studies that used AI-models to predict outcomes of patients. Through evaluation of study design, we discuss model choices including variability in dataset inputs, model complexity, interpretability, and challenges linked to performance metrics used. In the light of the results, we discuss potential interest for clinical decision support and highlight future directions for research and clinical practice.
4 Apr 2026
Read appraisal →J Am Coll Cardiol
Contemporary Diagnosis and Treatment of Aortic Regurgitation: A State-of-the-Art Review
Aortic regurgitation (AR) is progressive and frequently under-recognized; without timely intervention it drives adverse left-ventricular remodeling and heart failure. Despite Class I guideline indications, many patients-especially older, frail individuals with multimorbidity-remain untreated. Advancements in high-fidelity multimodality imaging-including cardiac magnetic resonance, 4-dimensional flow, and speckle-tracking echocardiography-have enabled earlier detection of remodeling and more accurate quantification of regurgitant burden. These techniques are redefining thresholds for treatment and may enable biomarker-imaging composite staging of disease. Surgery remains the gold standard of therapy for native AR. Contemporary surgical management is tailored to age, anatomy, and root pathology. Although surgical aortic valve replacement remains the predominant therapy for most candidates, valve-sparing root procedures, the Ross operation, and aortic valve neocuspidization are increasingly offered at experienced centers for carefully selected lower-risk patients. Transcatheter aortic valve replacement is expanding rapidly as a viable option that helps bridge the treatment gap for those at prohibitive or high risk for surgery. Yet, devices optimized for calcific aortic stenosis encounter technical obstacles in native AR-including large, noncalcified annuli, elliptical root geometry, and high stroke volumes-leading to suboptimal anchoring, residual paravalvular regurgitation, and device embolization. Purpose-built AR systems with leaflet-engaging anchoring and enhanced sealing have shown encouraging outcomes in feasibility and pivotal studies and have obtained commercial approval in Europe, and U.S. authorization is anticipated. This state-of-the-art review synthesizes current insights into AR pathophysiology, diagnostic advances, and therapeutic innovations in surgical and transcatheter techniques, highlighting knowledge gaps and proposing research priorities to accelerate access to care for this historically undertreated population.
1 Feb 2026
Read appraisal →Interv Cardiol Clin
Proximal Cap Ambiguity
This article reviews how to approach the proximal cap of a chronically occluded coronary artery. Safely crossing this region of the lesion is a crucial step in the procedure. While many proximal caps are understood angiographically, a significant proportion are not. This article describes steps that can be taken to resolve anatomic ambiguity, either by the use of supplementary intravascular ultrasound or by more advanced maneuvers, which should enhance the safety and efficiency of the percutaneous coronary intervention.
1 Jan 2026
Read appraisal →Am Surg
Neurogenic Thoracic Outlet Syndrome: A Current Literature Review
Neurogenic Thoracic Outlet Syndrome (nTOS), the most prevalent type of thoracic outlet syndrome, results from compression of the compression of the brachial plexus as it traverses the scalene triangle and rectopectoralis minor space. It typically presents with upper extremity pain, hand weakness, paresthesia, and muscle atrophy that is often exacerbated by arm elevation or overhead activity. Etiology commonly includes congenital anatomical variants, trauma, and repetitive overhead activity. Diagnosis remains challenging as a result of significant symptom overlap with cervical radiculopathy, brachial plexopathies, and entrapment neuropathies. Work up involves a combination of thorough history and physical with electrophysiologic testing, diagnostic injections and imaging such as MRI or duplex ultrasonography. Initial therapy indicates physical therapy with a focus on decompression and postural correction. In patients with persistent symptoms, motor deficits or failed conservative management, surgical decompression using transaxillary, supraclavicular or minimally invasive techniques is indicated. Rib-sparing surgical decompression is increasingly favored given lower complication rates. Postoperative rehabilitation focuses on restoring range of motion and shoulder girdle strength. This review serves to outline clinical presentation, diagnostic strategies and operative options for nTOS while emphasizing an individualized, stepwise approach to optimize outcomes and minimize risk.
1 Dec 2025
Read appraisal →Methodist Debakey Cardiovasc J
Vascular Robotics: Webcast
This 55-minute webcast features a conversation about "Vascular Robotics"-the focus of Issue 21.5. Led by the issue's editors, the discussion engages the authors on emerging themes and lessons learned while researching and writing the articles. View the video at https://vimeo.com/event/5556427.
1 Jan 2025
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