Search Results (65)

A significant proportion of patients undergoing invasive coronary angiography for angina have no obstructive coronary artery disease (CAD). In such patients, coronary microvascular dysfunction (CMD) and vasospastic angina (VSA) represent key pathophysiological mechanisms. We report a case of a 58-year-old male with exertional chest pain and exercise ECG changes typical of left main or multivessel CAD. Coronary computed tomography angiography (CCTA) showed borderline stenosis of the distal left main coronary artery. Coronary angiography revealed no critical stenosis. A comprehensive functional assessment demonstrated reduced coronary flow reserve (CFR = 2.0) and an elevated index of microcirculatory resistance (IMR = 25), consistent with CMD. An intracoronary acetylcholine provocation test induced severe focal vasospasm of the mid-left anterior descending artery (LAD) with ST-segment elevation and anginal pain, promptly relieved by nitroglycerin, confirming VSA. This case highlights the diagnostic and clinical importance of invasive functional testing in patients with angina and non-obstructive coronary arteries (ANOCA/INOCA). The coexistence of CMD and VSA (two distinct but overlapping pathophysiological endotypes) is increasingly recognized as a marker of adverse prognosis. Functional coronary assessment should be considered in all patients with angina and non-obstructive coronary arteries, as identifying mixed endotypes enables precise, mechanism-guided therapy. Full article

Background: Recent observational studies suggest that coronary sinus reducer (CSR) implantation may have a beneficial effect on microcirculatory indices in patients with coronary microvascular dysfunction (CMD). However, to date, there is no comprehensive summary of the evidence regarding the impact of CSR in this population. Methods: This systematic review was conducted in accordance with the PRISMA 2020 Statement. The following databases were searched: PubMed, EMBASE, MEDLINE, and ClinicalTrials.gov. Studies assessing microcirculatory indices or primarily involving patients with CMD undergoing CSR implantation were included. Results: After the selection process, 17 studies or trials were included in this systematic review. Across observational studies and case series, CSR implantation was associated with significant improvements in coronary microvascular function, including reductions in the index of microvascular resistance and an increase in coronary flow reserve. These physiological changes were accompanied by consistent improvements in angina severity (CCS class), exercise capacity, and quality-of-life measures, particularly in patients with more severe baseline CMD. Evidence was derived mainly from non-randomized studies involving small patient cohorts, with low procedural complication rates. Ongoing randomized trials are expected to clarify the magnitude of benefit and its clinical relevance in this population. Conclusions: CSR implantation may offer clinical and physiological benefits in patients with refractory angina due to CMD. However, the lack of randomized evidence and uncertainty regarding long-term effects warrant further adequately powered trials. Full article

Cassava mosaic disease (CMD) and cassava brown streak disease (CBSD) are the two main viral diseases threatening cassava production in the Democratic Republic of the Congo (DRC). CMD can be effectively controlled using resistant varieties; however, currently, there are no cassava varieties that exhibit durable resistance to CBSD. As the deleterious effects of CBSD become more pronounced with the maturity of the cassava, we assessed the potential benefits of early harvesting on mitigating the impact of CBSD on the performance of two improved CMD-resistant cassava varieties, Nabana (MM 96/4653) and Sawasawa (MM 96/3920). The percentage yield reduction was calculated by comparing the yield of infected treatments to that of uninfected treatments. At 9 months after planting (MAP) and 12 MAP, overall fresh root yield from farmer-selected healthy planting material of varieties Nabana and Sawasawa was significantly higher than the yield of crops established using CBSD-infected cuttings of the same varieties. Fresh root yield losses due to CBSD for Nabana were 44% at 9 MAP and 86% at 12 MAP, while for Sawasawa, they were 40% at 9 MAP and 72% at 12 MAP. Healthy planting material of the two varieties yielded 5% more at 12 MAP than at 9 MAP, while infected planting material yielded 52.5% less at 12 MAP than at 9 MAP. These results highlight the benefits of using healthy planting material in conjunction with early harvesting to minimize losses among CBSD-susceptible cassava varieties. These results suggest the need for a robust seed system that can deliver disease-free planting material of market-preferred varieties to farmers, thereby promoting food security. Full article

Cassava mosaic disease (CMD) is caused by begomoviruses and can result in yield losses of up to 90% in susceptible varieties. Using disease-free planting material from in vitro cultures is one of the most effective ways of controlling this disease. A CMD epidemiological assessment was conducted in fields established with disease-free plantlets in Bouaké, Dabou, and Man, selected for their contrasting agroecological and CMD prevalence conditions. Virus and whitefly species characterisation was performed using PCR and sequencing. CMD incidence and severity were lowest at the Man site and highest at the Dabou site. Although whitefly abundance was relatively low at the Man and Bouaké sites compared to the Dabou site, they were a significant factor in the spread of the disease. While all resistant varieties remained asymptomatic, susceptible and tolerant varieties became infected, and some tolerant varieties were able to recover from the disease. Molecular analyses revealed the presence of two viral species: Begomovirus manihotis (ACMV) and Begomovirus manihotiscameroonense (EACMCMV). No viral infection was detected 4 weeks after planting (WAP). Cases of single infection and double infection were observed at 12 and 20 WAP. Also, no double infections were found at the Man site, in contrast to the Bouaké site (12 WAP: 2.36%) and Dabou site (12 WAP: 2.59%; 20 WAP: 5.76%). EACMCMV was found in a single infection in Bouaké (12 WAP: 1.39%) and Man (20 WAP: 0.66%). The whitefly species Bemisia tabaci and Bemisia afer were most commonly found feeding on all cassava varieties. A high diversity of whitefly species was observed in Bouaké and Dabou compared to Man. Furthermore, the Bemisia tabaci species identified in this study was found to be able to transmit ACMV and EACMCMV viruses. These highlights would contribute to improving CMD management and control strategies. Full article

The catalytic decomposition of CH₄ is a promising method for producing high-purity CO_x-free hydrogen. A Ni-Al-LDH catalyst synthesized via coprecipitation was modified with alkali metals (Mg, La, Ca, or Li) through reconstruction to enhance catalytic activity and resistance to deactivation during catalytic methane decomposition (CMD). The catalysts were evaluated by two activation methods: H₂ reduction and direct heating with CH₄. The MgNA-R catalyst achieved the highest CH₄ conversion (65%) at 600 °C when reduced with H₂, attributed to a stronger Ni-Al interaction. Under CH₄ activation, LaNA-C achieved a 55% conversion at the same temperature, associated with a smaller crystallite size and higher reducibility due to La incorporation. Although all catalysts deactivated due to carbon deposition and/or sintering, LaNA-C was the only sample that could resist deactivation for a longer period, as La appears to have a protective effect on the active phase. Post-reaction characterizations revealed the formation of graphitic and filamentous carbon. Raman spectroscopy exhibited a higher degree of graphitization and structural order in LaNA-C, whereas SEM showed a more uniform distribution of carbon filaments. TEM confirmed the presence of multi-walled carbon nanotubes with encapsulated Ni particles in La-promoted samples. These results demonstrate that La addition improves the catalytic performance under CH₄ activation and carbon structure. This finding offers a practical advantage for CMD processes, as it reduces or eliminates the need to use hydrogen during catalyst activation. Full article

In healthy humans, insulin at physiological concentrations exerts acute vasodilatory actions on both resistance and terminal arterioles, leading, respectively, to increased total blood flow and the microvascular network volume being perfused. The process of increasing capillary network volume is frequently referred to as “capillary recruitment”. Together these two vascular actions of insulin enhance the delivery of oxygen, nutrients, and insulin itself to tissues. Both processes are diminished by insulin resistance. Here we examined interactions between insulin’s acute (within 2 h) actions on blood pressure (both central and peripheral) and on capillary recruitment in healthy controls and in four distinct groups of people with heightened cardio-metabolic disease (CMD) risk: individuals with obesity, metabolic syndrome, and type 1 or type 2 diabetes. Insulin increased microvascular blood volume (MBV) more effectively in controls than in each of the four CMD risk groups (p < 0.001). Conversely, insulin lowered both central and peripheral systolic pressure (p < 0.05 or less) in each of the CMD risk groups but not in the controls. The insulin-induced blood pressure decrements were greater in the metabolic syndrome, type 2 diabetes, and obesity groups (p < 0.05 or less) than in the controls. The greater blood pressure declines likely reflect decreased sympathetic baroreceptor reflex tone. These effects on blood pressure combined with the diminished dilation of terminal arterioles due to microvascular insulin resistance in the CMD risk subjects led to decreased distal microvascular perfusion as evidenced by changes in MBV. These findings highlight the complex interplay between insulin’s actions on resistance and terminal arterioles in individuals with a high CMD risk, underscoring the importance of addressing microvascular dysfunction in these conditions. Full article

Background: Chronic musculoskeletal disorders (CMDs) represent a leading cause of global disability and diminished quality of life, and they are often resistant to conventional physiotherapy. Emerging technologies such as virtual reality (VR), augmented reality (AR), and exergaming are increasingly used to enhance rehabilitation outcomes, yet their comparative effectiveness remains unclear. Objective: To systematically evaluate the effectiveness of VR, AR, and exergaming interventions in improving pain, function, balance, and psychological outcomes among adults with CMDs. Methods: This systematic review and exploratory meta-analysis followed PRISMA 2020 guidelines and was prospectively registered (PROSPERO: CRD42024589007). A structured search was conducted in PubMed, Cochrane CENTRAL, Scopus, and PEDro (up to 1 May 2025). Eligible studies were randomized controlled trials (RCTs) involving adults (≥18 years) with CMDs receiving VR, AR, or exergaming-based rehabilitation. Risk of bias was assessed using the PEDro scale and the Downs and Black checklist. Where feasible, standardized mean differences (SMDs) for pain outcomes were pooled using a random-effects model. Results: Thirteen RCTs (n = 881 participants) met the inclusion criteria. Interventions spanned immersive VR, AR overlays, exergaming platforms (e.g., Kinect, Wii), and motion-tracking systems. Pain, function, and quality of life improved in most studies. An exploratory meta-analysis of eight RCTs (n = 610) yielded a significant pooled effect favoring VR/AR interventions for pain reduction (SMD = −1.14; 95% CI: −1.63 to −0.75; I² = 0%). Exergaming showed consistent improvements in physical performance, while immersive VR was more effective for kinesiophobia and psychological outcomes. AR was underrepresented, with only one study. Risk of bias was generally low; however, publication bias could not be excluded due to limited funnel plot power (n < 10). Conclusions: VR, AR, and exergaming are effective adjuncts to conventional rehabilitation for CMDs, improving pain and function with high patient adherence. Nevertheless, gaps in long-term data, economic evaluation, and modality comparison persist. Future RCTs should address these limitations through standardized, inclusive, and longitudinal design. Full article

A study was conducted in Sierra Leone to identify cassava plants that are asymptomatic and symptomatic to cassava mosaic disease (CMD) and collect planting materials for field trial establishment; determine the prevalence of CMD caused by African cassava mosaic virus (ACMV) and East African cassava mosaic virus (EACMV) using the Nuru App and virus indexing techniques; and assess selected agronomic traits in cassava. A total of 80 cassava farms spanning four provinces (Southern, Eastern, Northern, and North-West) were surveyed in April 2022. Findings showed that the cassava variants of the experiment and locations significantly (p < 0.001) affected CMD incidence, severity, growth, and fresh storage root yield traits. The CMD incidence (87.0%) and whitefly abundance (144.8) were highest, and the CMD severity was moderate (4.0) for the plants derived from cuttings obtained from symptomatic Cocoa mother plants, while plants derived from cuttings of improved mother plants exhibited no visible symptoms of the disease and the lowest population (45.1) of whiteflies. The Nuru app is inefficient for phenotypically detecting CMD at 3 months after planting (MAP), while at 6, 9 and 12 MAP, the app efficiently detected the disease using a molecular analysis technique. Resistant, non-diseased plants derived from cuttings obtained from SLICASS 4 mother plants produced the highest fresh storage root yield (54.9 t ha⁻¹). The highest storage root yield loss was recorded in the plants obtained from cuttings of symptomatic variety Cocoa mother plants harvested at Matotoka grassland ecology, Bombali District (90.2%), while those harvested from cuttings of asymptomatic variety Cocoa mother plants grown at the four test environments had a similar storage root yield loss ranging from 40.3 to 46.2%. Findings suggest the importance of genetic variability, environmental adaptation, utilization of diseased-free materials, and phytosanitation as disease management strategies for increased production. These findings provide important insights into the distribution, impact, and spread of CMD and whitefly abundance in the studied areas in Sierra Leone that could be exploited for cassava production, productivity, conservation, and population improvement. Full article

Background: Cassava mosaic disease (CMD), caused by the Sri Lankan cassava mosaic virus (SLCMV), significantly increases cassava yield losses in Thailand, with losses ranging from 30% to 80%, and is exacerbated by limited access to healthy planting materials. Methods: This study explored salicylic acid (SA) as a potential treatment for enhancing disease resistance in CMD infected cassava plants. SA was applied at 100 and 200 mg/mL, and its effects were evaluated using quantitative real-time polymerase chain reaction (qPCR) and reverse transcription qPCR (RT-qPCR) to measure viral loads and the expression levels of resistance genes. Results: Although SA treatment did not considerably affect disease severity, foliar CMD symptoms visibly decreased, particularly with 200 mg/mL SA, which also reduced SLCMV particle counts at 1- and 2-weeks post-treatment. SA upregulated the expression of pathogenesis-related proteins (PRs), including HSP90.9, WRKY59, SRS1, and PR9e. Additionally, SA enhanced the regulation of secondary metabolite pathways involving L-serine within the glycine, serine, and threonine metabolism, as well as the phenylpropanoid biosynthesis pathways. Conclusions: These findings collectively indicate that SA enhances resistance through the systemic acquired resistance (SAR) pathway and can serve as a potential strategy for the management of CMD, particularly in regions where healthy cassava planting materials are scarce. The study highlights the efficacy of SA in reducing viral particles, inducing the immune response, and providing a promising approach for controlling CMD. Full article

Cassava mosaic disease (CMD) is caused by viruses such as Sri Lankan cassava mosaic virus (SLCMV). It poses a significant threat to the cassava (Manihot esculenta) yield in Southeast Asia. Here, we investigated the expression of WRKY transcription factors (TFs) in SLCMV-infected cassava cultivars KU 50 (tolerant) and R 11 (susceptible) at 21, 32, and 67 days post-inoculation (dpi), representing the early, middle/recovery, and late infection stages, respectively. The 34 identified WRKYs were classified into the following six groups based on the functions of their homologs in the model plant Arabidopsis thaliana (AtWRKYs): plant defense; plant development; hormone signaling (abscisic, salicylic, and jasmonic acid); reactive oxygen species production; basal immune mechanisms; and other related hormones, metabolites, and abiotic stress responses. Regarding the protein interactions of the identified WRKYs, based on the interactions of their homologs (AtWRKYs), WRKYs increased reactive oxygen species production, leading to salicylic acid accumulation and systemic acquired resistance (SAR) against SLCMV. Additionally, some WRKYs were involved in defense-related mitogen-activated protein kinase signaling and abiotic stress responses. Furthermore, crosstalk among WRKYs reflected the robustly restricted viral multiplication in the tolerant cultivar, contributing to CMD recovery. This study highlights the crucial roles of WRKYs in transcriptional reprogramming, innate immunity, and responses to geminivirus infections in cassava, providing valuable insights to enhance disease resistance in cassava and, potentially, other crops. Full article

Background: The soluble triggering receptor expressed on myeloid cells 2 (sTREM2) is linked to the progression of cardiovascular conditions, but its role in coronary microcirculation dysfunction (CMD) is not yet clear. Methods: A cross-sectional observational study from July 2023 to May 2024 was conducted in the China–Japan Friendship Hospital, after registration in the ClinicalTrials database (Registry Name: Coronary Microvascular Dysfunction in Angina Patients With Non-obstructive Coronary Artery Disease (ANOCA-CMD); Registry Number: NCT06503640; Registry Date: 23 September 2022). This cross-sectional study involved 76 subjects, including 55 patients with CMD and 21 without CMD, admitted to the China–Japan Friendship Hospital. CMD was defined by a coronary flow reserve (CFR) < 2.5 or index of microvascular resistance (IMR) ≥ 25. sTREM2 levels were measured using an enzyme-linked immunosorbent assay. Linear correlation analysis assessed the relationship between sTREM2 levels and CFR, IMR, microvascular resistance reserve (MRR), and the resistive reserve ratio (RRR). Univariate and multivariate regression analyses further examined the association between sTREM2 and CMD. Additionally, receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic accuracy of plasma sTREM2 for identifying CMD patients. Results: Elevated sTREM2 levels were found in the CMD group. Correlation analysis showed a significant positive relationship with IMR and an inverse correlation with CFR, MRR, and RRR. After adjusting for confounders, sTREM2 was found to be an independent risk factor for CMD [OR = 1.003, 95% CI 1.001–1.007, p = 0.008]. ROC analysis revealed a sensitivity of 59.46%, specificity of 90.48%, and an AUC of 0.7677 (95% CI: 0.6481–0.8872, p = 0.008) for CMD diagnosis at a threshold of 595.5 pg/mL, indicating good diagnostic performance. Conclusions: Elevated sTREM2 levels in CMD patients indicate its potential as a biomarker. Full article

With more China railway business information systems migrating to the China Railway Cloud Center (CRCC), the attack surface is expanding and there are increasing security threats for the CRCC to deal with. Cyber Mimic Defense (CMD) technology, as an active defense strategy, can counter these threats by constructing a Dynamic Heterogeneous Redundancy (DHR) architecture. However, there are at least two challenges posed to the DHR deployment, namely, the limited number of available schedulable heterogeneous resources and memorization-based attacks. This paper aims to address these two challenges to improve the CRCC-DHR reliability and then facilitate the DHR deployment. By reliability, we mean that the CRCC-DHR with the limited number of available heterogeneous resources can effectively resist memorization-based attacks. We first propose three metrics for assessing the reliability of the CRCC-DHR architecture. Then, we propose an incomplete-information-based game model to capture the relationships between attackers and defenders. Finally, based on the proposed metrics and the captured relationship, we propose a redundant-heterogeneous-resources scheduling algorithm, called the Entropy Weight Scheduling Algorithm (REWS). We evaluate the capability of REWS with the three existing algorithms through simulations. The results show that REWS can achieve a better reliability than the other algorithms. In addition, REWS demonstrates a lower time complexity compared with the existing algorithms. Full article

Background/Objectives: Coronary microvascular dysfunction (CMD) is emerging as a critical factor in patients presenting with anginal symptoms without obstructive coronary artery disease (CAD). This study aims to investigate the relationship between invasive measurements of coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR) using thermodilution techniques, compared to non-invasive assessments of CFR with transthoracic Doppler echocardiography (TDE). Methods: In this observational prospective cross-sectional study, a total of 49 patients, clinically characterized as having angina with no obstructive CAD (ANOCA) or ischemia with no obstructive CAD (INOCA), underwent both TDE and invasive coronary angiography (ICA) followed by thermodilution assessment of CFR and IMR. Results: It was found that there is a statistically significant negative correlation between both non-invasive and invasive CFR measurements and IMR. Specifically, a negative moderate correlation was observed between non-invasive CFR and IMR (r_s = −0.477, p < 0.01), as well as a high negative correlation between invasive CFR and IMR (r = −0.541, p < 0.01). Receiver operating characteristic (ROC) analysis indicated that both non-invasive and invasive CFRs are effective predictors of CMD, defined as IMR > 25. Conclusions: Both noninvasive and invasive CFR measurements are significant independent predictors of CMD. Our results indicate that noninvasive TDE CFR can be a reliable tool for assessing CMD in patients with ANOCA, potentially facilitating earlier diagnosis and management strategies for this patient population. Full article

Coronary artery disease is one of the leading public health problems in the world in terms of mortality and economic burden from the disease. Traditionally, the focus of research and clinical pathways leading to the diagnosis and treatment of coronary artery disease was on the more common variant of the disease resulting from atherosclerosis in the epicardial coronary arteries. However, coronary microvasculature, representing the vast majority of the total heart circulation, has the greatest influence on overall coronary resistance and, therefore, blood flow. Coronary microvascular dysfunction (CMD), characterized by structural or functional abnormalities in the microvasculature, significantly impacts myocardial perfusion. Endothelial dysfunction results in inadequate coronary dilation during exercise or spontaneous spasm in the microvasculature or epicardial arteries. A significant proportion of people presenting for coronary angiography in the context of angina have unobstructed epicardial coronary arteries yet are falsely reassured about the benign nature of their condition. Meanwhile, increasing evidence indicates that patients diagnosed with CMD as well as vasospastic angina (VSA) face an increased risk of Major Adverse Cardiovascular Events (MACEs), including death. The aim of this review is to outline the current practice with regard to invasive and non-invasive methods of CMD and VSA diagnosis and assess the evidence supporting the existing treatment strategies. These include endotype-specific pharmacological therapies, a holistic approach to lifestyle modifications and risk factor management and novel non-pharmacological therapies. Furthermore, the review highlights critical gaps in research and suggests potential areas for future investigation, to improve understanding and management of these conditions. Full article

Cassava brown streak disease (CBSD) remains the most severe threat to cassava production in the Great Lakes region and Southern Africa. Screening for virus resistance by subjecting cassava to high virus pressure in the epidemic zone (hotspots) is a common but lengthy process because of unpredictable and erratic virus infections requiring multiple seasons for disease evaluation. This study investigated the feasibility of graft-infections to provide a highly controlled infection process that is robust and reproducible to select and eliminate susceptible cassava at the early stages and to predict the resistance of adapted and economically valuable varieties. To achieve this, a collection of cassava germplasm from the Democratic Republic of Congo and a different set of breeding trials comprising two seed nurseries and one preliminary yield trial were established. The cassava varieties OBAMA and NAROCASS 1 infected with CBSD were planted one month after establishment of the main trials in a 50 m² plot to serve as the source of the infection and to provide scions to graft approximately 1 ha. Grafted plants were inspected for virus symptoms and additionally tested by RT-qPCR for sensitive detection of the viruses. The incidence and severity of CBSD and cassava mosaic disease (CMD) symptoms were scored at different stages of plant growth and fresh root yield determined at harvesting. The results from the field experiments proved that graft-infection with infected plants showed rapid symptom development in susceptible cassava plants allowing instant exclusion of those lines from the next breeding cycle. High heritability, with values ranging from 0.63 to 0.97, was further recorded for leaf and root symptoms, respectively. Indeed, only a few cassava progenies were selected while clones DSC260 and two species of M. glaziovii (Glaziovii20210005 and Glaziovii20210006) showed resistance to CBSD. Taken together, grafting scions from infected cassava is a highly efficient and cost-effective method to infect cassava with CBSD even under rugged field conditions. It replaces an erratic infection process with a controlled method to ensure precise screening and selection for virus resistance. The clones identified as resistant could serve as elite donors for introgression, facilitating the transfer of resistance to CBSD. Full article