Search Results (425)

Background and Objectives: Post-menopausal estrogen decline is considered a contributing factor to sarcopenia, and inspiratory muscle training (IMT) may provide benefits in this demographic. This study examined the impact of a four-week IMT program on diaphragm thickness, abdominal wall muscle thickness (AWMT; transversus abdominis, internal oblique, and external oblique), and liver fat percentage in healthy elderly women. Materials and Methods: Twenty-six women aged 60–80 years were randomly assigned to an IMT group (n = 13) or a control group (n = 13). The IMT group used the PowerBreathe^® Classic device at 40% of maximal inspiratory pressure (MIP), with weekly increments of 10%. Training was performed twice daily, five days per week, with 30 breathing cycles per session (60 per day). The control group maintained their usual routines. AWMT, diaphragm thickness (DT), and fatty liver density (FLD) were measured by a radiologist before and after the intervention. Results: After four weeks, the IMT group showed significant improvements in all parameters compared to controls. Mid-diaphragm thickness (MDT) increased by 11.44% (effect size (ES) = 0.358, p < 0.001) versus 0.76% in controls (p = 0.271). Posterior diaphragm thickness (PDT) improved by 7.48% (ES = 0.282, p < 0.001) versus 0.38% (p = 0.564). Right AWMT increased by 12.7% (ES = 0.492, p < 0.001) compared to 0.10% (p = 0.872), and left AWMT increased by 9.93% (ES = 0.395, p < 0.001) versus 2.64% (p = 0.014). FLD improved by 11.79% (ES = 0.959, p < 0.001) in the IMT group, while the control group showed no meaningful change (−0.13%, p = 0.847). Conclusions: A short-term IMT protocol significantly enhanced diaphragm and AWMT and reduced liver fat in elderly women. These findings support the use of IMT as a simple, non-invasive intervention to preserve musculoskeletal and metabolic health in aging populations. Full article

Background: A major factor in the development of atherosclerosis is the presence of a chronic inflammatory state. The CX₃CL1/CX₃CR1 axis has been implicated in the development of atherosclerosis and cardiovascular disease, but until now, scarce data are available regarding the influence of the CX₃CL1/CX₃CR1 axis in familial combined hyperlipidaemia (FCH). Since FCH is associated with a high risk of cardiovascular disease, the objective of the present study was to assess the presence of alterations in the CX₃CL1/CX₃CR1 axis in patients with FCH and to evaluate the influence of insulin resistance (IR) and sex. Methods: A cohort of 47 subjects with FCH and 38 control subjects was included. We measured the lipid profile, glucose, and insulin levels in plasma, circulating blood CX₃CL1 levels, and CX₃CR1 mRNA expression. Carotid IMT and the presence of atheroma plaques were also evaluated. Results: FCH subjects showed significantly higher activation of the CX₃CL1/CX₃CR1 axis than controls. In addition, FCH individuals with IR showed the worst profile of inflammation status, higher carotid IMT, and a higher prevalence of atherosclerotic plaque compared to controls and FCH patients without IR. However, sex did not influence the CX3CL1/CX3CR1 axis. Conclusions: FCH patients showed an increased CX₃CL1/CX₃CR1 axis, which was positively correlated with IR, but not with sex. These data could partially explain the increased risk of cardiovascular events in primary dyslipidemic patients. Full article

Background and Aims: Placental growth factor (PlGF) is an important predictive marker of pregnancy complications such as preeclampsia. The aim of this study is to assess whether PlGF measured outside of pregnancy is a predictive marker for cardiovascular disease (CVD) risk in young women. Methods: This study was embedded in the Generation R Study, a population-based prospective cohort study. PlGF concentrations, as well as systolic and diastolic blood pressure (SBP and DBP), cardiac outcomes, carotid-femoral pulse wave velocity, and central retinal arteriolar and venular calibres of 5077 women, were assessed six years after pregnancy, which was considered baseline. Four years after baseline, we measured blood pressure and intimal media thickness (IMT). Eight years after baseline, we measured blood pressure and the post-occlusive reactive hyperaemia index (PORH index). In addition, we examined the influence of pregnancy complications on these associations. Results: We found a positive association between PlGF levels with SBP (0.46, 95% CI 0.04; 0.89). PlGF was not associated with retinal or echocardiographic measurements. PlGF was positively associated with DBP after four years and with both SBP and DBP eight years after baseline, independent of the occurrence of pregnancy complications. PlGF was not associated with IMT or the PORH index. Conclusions: PlGF is associated with higher blood pressure. PlGF may, therefore, be used as a marker of hypertension. These results need to be replicated in an independent cohort study. Full article

Boulenophrys gutu sp. nov. was described from Mt. Hengshan, and B. hengshanensis was re-described based on the holotype and newly collected specimens using phylogenetic and morphological evidence. The new species forms an independent clade, and it is diagnosed by a combination of following characters: (1) male SVL 34.4–44.7 mm (n = 7), female SVL 36.2–52.8 mm (n = 8); (2) dorsal surface of head, body, and limbs relatively smooth; (3) vomerine ridge weak, vomerine teeth absent; (4) narrow lateral fringes on toes; (5) heels moderate long, meeting when thighs are positioned at right angles to body; (6) supratympanic fold behind tympanum thick, distinctly enlarged with thickness near diameter of tympanum; (7) inner metatarsal tubercle small (IMT/SVL 4.4–5.2%); (8) several large dark brown patches along both ventrolateral sides of abdomen; (9) coloration of inner and outer metacarpal tubercle, inner metatarsal tubercle, and tip of digits ivory. Phylogenetic analyses based on 16S rRNA and COI genes revealed that B. hengshanensis is sister to B. wugongensis. Morphological comparisons showed that B. hengshanensis is diagnosed by a combination of following characters: (1) moderate body size, male SVL 34.4–38.0 mm (n = 9), female SVL 48.4 mm (n = 1); (2) weak vomerine ridge, absence of vomerine teeth; (3) tongue not notched behind; (4) a small horn-like tubercle on upper eyelid; (5) rudimentary webbing between toes; (6) narrow lateral fringes on toes; (7) heels relatively short, not meeting when thighs are positioned at right angles to body; (8) supratympanic fold behind tympanum narrow, not distinctly enlarged; (9) a pair of dark brown broad stripes along ventrolateral sides of abdomen; (10) dense creamy white dots present on lower abdomen, merge with deep brown patches without clear boundary. Full article

Background: Atherosclerosis is a chronic inflammatory condition that underlies both cardiovascular and cerebrovascular complications. Emerging evidence suggests that COVID-19 may play a role in its progression. Purpose: The aim of the study was to evaluate the potential impact of SARS-CoV-2 infection on the development of atherosclerosis. Patients and Methods: Common carotid artery (CCA) intima media thickness (IMT) was measured by ultrasonography twice, 12–18 months apart, in a cohort of 92 patients (47 with COVID-19 and 45 controls). Clinical data were collected from medical histories, physical examinations, and laboratory findings. Results: Baseline IMT values were comparable between the study groups (0.85 mm vs. 0.78 mm). However, the COVID-19 group exhibited a significantly greater increase in IMT over time, with a median change of 0.13 mm compared to 0.05 mm in the controls (p = 0.018). Furthermore, 69.2% of COVID-19 patients exceeded the median IMT progression threshold compared to 36% in the control group (p = 0.017). An elevated level of C-reactive protein (CRP) and a higher triglyceride (Tg)-to-High-Density Lipoprotein Cholesterol (HDL) ratio were significantly associated with increased IMT in the COVID-19 group. Age and heart rate were identified as significant predictors of IMT progression across both groups. Conclusions: COVID-19 may accelerate the progression of subclinical atherosclerosis. The strong associations of CRP and the TG/HDL ratio with IMT highlight the potential roles of chronic inflammation and metabolic dysregulation in driving these vascular changes. Further large-scale, multicenter studies are needed to elucidate the underlying mechanisms, confirm these observations, and guide targeted preventive and therapeutic strategies for individuals with an increased cardiovascular and cerebrovascular risk. Full article

Background: Chronic obstructive pulmonary disease (COPD) is a progressive condition leading to declining lung function, dyspnea, and reduced quality of life. Pulmonary rehabilitation (PR) remains a cornerstone in COPD management; however, access remains limited, with less than 3% of eligible patients participating. Inspiratory muscle training (IMT), especially through novel methods like the Test of Incremental Respiratory Endurance (TIRE), offers a potential home-based alternative to traditional rehabilitation services. Despite growing interest, a key knowledge gap persists: few randomized trials have directly compared TIRE with threshold loading IMT over extended, largely unsupervised home-based periods while concurrently evaluating inspiratory muscle endurance and adherence. This randomized controlled trial aimed to evaluate the long-term efficacy of TIRE IMT compared to traditional threshold IMT and sham training in COPD patients. The study also assessed adherence to these home-based interventions, focusing on unsupervised periods without additional motivational support. Methods: A total of 52 COPD patients were randomly assigned to one of three groups: TIRE IMT, Threshold IMT, or Sham IMT. The study consisted of an 8-week supervised Phase I followed by a 24-week unsupervised Phase II. Training details: TIRE—session template set to 50% of the day’s maximal sustained effort; 6 levels × 6 inspirations (total 36) with preset inter-breath recoveries decreasing from 60 s to 10 s. Threshold IMT—spring-loaded valve set to 50% MIP (re-set at week 4); 36 inspirations completed within ≤30 min. Sham—valve set to minimal resistance (9 cmH₂O); 36 inspirations within ≤30 min. Primary outcomes included changes in maximal inspiratory pressure (MIP) and sustained maximal inspiratory pressure. Secondary outcomes focused on adherence rates and correlations with functional capacity. Results: Of the 52 participants, 36 completed the study. Participant details: TIRE n = 12 (mean age 60.9 ± 12.9 years), Threshold n = 12 (67.4 ± 6.9 years), Sham n = 12 (67.3 ± 8.7 years); overall 21/36 (58%) men; mean BMI 30.0 ± 7.5 kg/m². The TIRE IMT group demonstrated significantly greater improvements in MIP (31.7%) and SMIP compared to both the Threshold and Sham groups at 24 weeks (p < 0.05). Despite a decline in adherence during the unsupervised phase, the TIRE group maintained superior outcomes. No adverse events were reported during the intervention period. Conclusions: In this randomized trial, TIRE IMT was associated with greater improvements in inspiratory muscle performance than threshold and sham IMT. While adherence was higher in the TIRE group, it declined during the unsupervised phase. The clinical interpretation of these findings should consider the relatively wide confidence intervals and modest sample size. Nevertheless, the mean change in MIP in the TIRE arm exceeded a recently proposed minimal important difference for COPD, suggesting potential clinical relevance; however, no universally accepted minimal important difference exists yet for SMIP. Further adequately powered trials are warranted. Full article

Background: The Induced Membrane Technique (IMT), commonly known as the Masquelet Technique (MT), has shown promising results in the reconstruction of bone defects caused by osteomyelitis. However, it is not a standardized surgical protocol but a treatment concept that has undergone various modifications, often yielding heterogeneous outcomes. Methods: This retrospective, single-center clinical cohort study included 49 patients treated with the Bone Block Technique (BBT) between 2013 and 2019 for bone defects resulting from osteomyelitis. The primary outcomes were time to bone healing, reinfection rate, and time to full weight-bearing. Additionally, infectious disease parameters, surgical site complications (SSCs), and epidemiological data were evaluated. Results: Data from 49 patients (mean age: 51 years, range: 17.6–76.9; 28.6% female) were analyzed, with a mean follow-up of 6.1 years (range: 4–10.5). The average bone defect length was 4.2 cm (range: 2.1–8.4 cm), predominantly involving the lower extremity. Primary bone consolidation was achieved in 93%, and secondary consolidation (requiring additional surgery) in 7%. Revision surgery due to recurrent infection was necessary in 16.6% of cases. The average time to full weight-bearing was 101.3 days. Conclusions: The BBT, as a modified approach based on the original IMT, represents a viable and reproducible option for bone defect reconstruction. When applied in accordance with the principles of the Diamond Concept, this technique facilitates reliable primary consolidation with a low complication rate. Full article

Background: High-sensitivity cardiac troponin T serum concentration (hs-cTnT) measurement is a well-established tool in the diagnosis of acute cardiovascular (CV) disease. It remains unclear whether resting hs-cTnT could be useful for screening the status of the CV system. The purpose of this study was to compare the correlation between hs-cTnT, determined in patients without clinical symptoms of acute illness, and selected parameters of subclinical CV dysfunction in relation to the coexistence of arterial hypertension (AH). Methods: In total, 101 patients were included in the analysis. The following methods were used to assess the CV system: transthoracic echocardiography, Doppler ultrasonography of the carotid and lower extremity arteries with intima–media thickness (IMT) measurement, pulse wave velocity (PWV), central blood pressure measurement, ankle–brachial index (ABI), and toe–brachial index (TBI). Results: In patients with AH, significant correlations were found between hs-cTnT and maximal velocity of tricuspid regurgitation (R = 0.397; p = 0.003), left atrium volume index (LAVI) (R = 0.39; p = 0.002), and IMT in carotid arteries (cIMT) (R = 0.4; p = 0.001), common femoral arteries (cfIMT) (R = 0.384; p = 0.004), and superficial femoral arteries (sfIMT) (R = 0.352; p = 0.01), as well as PWV (R = 0.63; p < 0.001), central systolic blood pressure (cSBP) (R = 0.34; p = 0.006), central pulse pressure (cPP) (R = 0.354; p = 0.004), and ankle–brachial index (ABI) (R = −0.28; p = 0.024). In multivariate analysis, the relationship between subclinical CV dysfunction and hs-cTnT remained significant for LAVI, cSBP, cPP, and ABI, as well as showing borderline significance for sfIMT. In patients without AH, only the relationship between hs-cTnT and ABI was significant. According to interaction analysis, AH significantly influenced the relationship between hs-cTnT and cSBP, cPP, and sfIMT. Conclusions: Resting hs-cTnT correlates significantly with selected parameters of subclinical CV dysfunction in patients with AH. This relationship is clearly weaker in patients without AH. Further research is needed, especially prospective studies on a larger group of patients. Full article

Background and Clinical Significance: Inflammatory myofibroblastic tumors (IMTs) are rare neoplasms with low metastatic potential but a high recurrence rate. Approximately 60–80% of IMTs harbor anaplastic lymphoma kinase (ALK) gene rearrangements, making ALK inhibitors (ALKis) a key therapeutic option. However, resistance to ALKis remains a significant clinical challenge, necessitating alternative treatment strategies. Case Presentation: We report the case of a 23-year-old woman diagnosed with a metastatic TPM3::ALK fusion-positive IMT, initially managed with crizotinib and ceritinib. Disease progression prompted a switch to alectinib, followed by lorlatinib in combination with immune checkpoint inhibitors (nivolumab + ipilimumab). The patient tolerated this regimen well, with manageable side effects, and has remained progression-free for over three years, demonstrating the potential efficacy of ALK-ICI combination therapy. Conclusions: This case highlights the rapid development of resistance to first- and second-generation ALKis and the emerging role of immune checkpoint inhibitors (ICIs) in IMT treatment. PD-L1 expression in ALK-positive IMTs suggests an immune escape mechanism, supporting combination ALK-ICI therapy as a viable approach. The successful long-term disease control achieved in this case underscores the importance of molecular profiling in guiding personalized treatment strategies for IMT. This report contributes to the growing body of evidence supporting precision medicine and immunotherapy in rare sarcomas. Full article

Background: Digital ulcers (DUs) are among the most debilitating vascular complications in SSc and are commonly attributed to microvascular damage. However, recent evidence suggests a potential involvement of macrovascular abnormalities, including subclinical atherosclerosis and altered hemodynamic parameters. Objectives: This study aimed to investigate the association between a history of DUs and macrovascular involvement in SSc patients through carotid and vertebral Doppler ultrasonography, with a focus on hemodynamic indices such as Peak Systolic Velocity (PSV), End-Diastolic Velocity (EDV), Resistive Index (RI), and Intima–Media Thickness (IMT). Methods: A cross-sectional study was conducted on 107 SSc patients. Clinical, serological, cardiovascular, and metabolic data were collected, and carotid–vertebral ultrasound was performed. Patients were stratified based on DU history. Statistical analyses assessed associations between DU status and carotid–vertebral US findings. Results: Patients with DUs showed a significantly higher PSV in both right (86.9 ± 67.9 vs. 64.2 ± 20.5 cm/s, p = 0.010) and left ICA (78.9 ± 29.6 vs. 63.4 ± 18.2 cm/s, p = 0.002). Right ICA RI vas elevated in the DU group (p = 0.021). PSV in the external carotid arteries was also bilaterally increased in DU patients (p < 0.005). DU-positive patients had a higher prevalence of left carotid plaques (p = 0.012) and right-sided ICA RI > 0.75 (p = 0.01). Logistic regression identified DU history as an independent predictor of PSV at ICA (β = 31.89, p = 0.043) and carotid plaque presence at any side (OR 14.34, p = 0.012). Conclusions: A history of digital ulcers in SSc patients is associated with altered carotid hemodynamics and an increased subclinical atherosclerotic burden. These findings suggest that DUs may reflect not only microvascular damage, but also macrovascular dysfunction, supporting the need for integrated vascular assessment in SSc clinical practice. Full article

Background: Chronic heart failure (HF) is a systemic condition in which the heart is unable to meet the body’s peripheral demands, leading to both acute and chronic functional decline, accompanied by high morbidity and mortality rates. A non-pharmacological, non-surgical standard approach to managing HF is cardiovascular rehabilitation, which is widely endorsed by international cardiology societies. This typically includes aerobic and anaerobic physical activity involving the peripheral skeletal muscles. However, international guidelines often overlook the clinical significance of the diaphragm and the role of inspiratory muscle training (IMT) in rehabilitation. The diaphragm plays a critical role not only in respiratory and cardiac function but also in supporting limb movements and overall physical performance. In patients with HF, diaphragmatic dysfunction contributes significantly to the symptoms they experience. Conclusions: This review highlights the need for a greater emphasis on incorporating IMT into the standard rehabilitation protocols for patients with HF, given its potential to improve both respiratory function and overall physical capacity. Full article

Objective: To investigate the effect of an 8-week inspiratory muscle training (IMT) intervention on respiratory muscle strength and cardiovascular autonomic regulation in obese young men. Methods: The study included 36 obese young men who met the inclusion and exclusion criteria. Participants were randomly divided into two groups: the IG (inspiratory muscle training group, n = 17), which underwent high-intensity IMT intervention for 8 weeks, 5 times a week, and the CG (control group, n = 18), which was not given any additional intervention. Assessed parameters included maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR), as well as heart rate variability metrics such as the standard deviation of normal-to-normal intervals (SDNN), root mean square of successive differences (RMSSD), standard deviation of successive differences (SDSD), low-frequency power component (LF), high-frequency power component (HF), and LF/HF ratio. These measurements were taken both at baseline and following the completion of the 8-week intervention period. Results: After 8 weeks of IMT, the MIP and MEP of the IG increased by 31.8% and 26.5%, respectively (p < 0.01). In addition, SBP, DBP, and HR decreased by 2.2%, 3.2%, and 2.1%, respectively (p < 0.01). In the HRV time domain, SDNN and RMSSD increased by 54.1% and 33.5%, respectively (p < 0.01), and there was no significant improvement in SDSD (p > 0.05); in the HRV frequency domain, LF decreased by 40.5%, HF increased by 59.4% (p < 0.01), and the LF/HF ratio decreased by 58.2% (p < 0.05). Conclusion: An 8-week 80%MIP IMT intervention significantly improves respiratory muscle strength and cardiovascular autonomic regulation in obese young men, suggesting that IMT is a promising non-pharmacological strategy for mitigating obesity-related cardiovascular risk. Full article

Background and Objectives: Type 2 diabetes mellitus (T2DM) is associated with subclinical cardiovascular changes, such as increased arterial stiffness and myocardial dysfunction. Vitamin D deficiency has been recognized as a potential contributing factor to vascular disease; however, its impact on early cardiac changes associated with T2DM remains poorly understood. Our aim was to evaluate the association between serum levels of 25-hydroxyvitamin D3 [25(OH)D3], arterial stiffness, and left ventricular global longitudinal strain (LV GLS) in patients with T2DM who do not have a clinically evident cardiovascular disease. Material and methods: This cross-sectional study evaluated the carotid intima–media thickness (IMT), aortic pulse wave velocity (PWVao), LV GLS, and serum 25(OH)D3 levels in patients diagnosed with T2DM (n = 65) compared to healthy control subjects (n = 55). Independent predictors of arterial stiffness were identified by a multivariate logistic regression analysis. Results: Patients with T2DM showed a significant increase in IMT and PWVao, a reduction in LV GLS, and low levels of 25(OH)D3 compared to subjects in the control group (all p < 0.05). Both vitamin D deficiency and T2DM were found to be independently associated with an increased arterial stiffness, with odds ratios of 2.4 and 4.8, respectively. A significant inverse relationship was identified between 25(OH)D3 levels and markers of arterial stiffness, as well as LV GLS, suggesting a possible association between the vitamin D status and the early onset of cardiovascular dysfunction. Conclusions: Patients with T2DM show early signs of heart and blood vessel problems, even with an ejection fraction that remains within normal limits. There is a significant correlation between vitamin D deficiency and increased arterial stiffness, along with impaired LV GLS, indicating its possible involvement in cardiovascular complications associated with diabetes. These findings support the utility of integrating vascular, myocardial, and vitamin D assessments in early cardiovascular risk stratification for T2DM patients. Full article

Background/Objectives: Primary malignant lung tumors in children are rare and diagnostically challenging. This study presents a single-center experience in the diagnosis and treatment of these tumors, emphasizing the role of histopathological and genetic profiling in informing individualized therapeutic strategies. Methods: We retrospectively reviewed records of seven pediatric patients (ages 2–18) treated from 2015 to 2025. Diagnostics included laboratory tests, chest CT, bronchoscopy, and histopathological/immunohistochemical analysis. Treatment primarily involved surgical resection, complemented by chemo-, radio-, or targeted therapies when indicated. Results: Inflammatory myofibroblastic tumor (IMT) represented the most commonly diagnosed entity (3/7 cases). The tumors presented with nonspecific symptoms, most frequently dry cough. Tumor type distribution was age-dependent, with aggressive forms such as pleuropulmonary blastoma predominantly affecting younger children, whereas IMT and carcinoid tumors were more common in older patients. Surgical resection remained the mainstay of treatment in the majority of cases. Bronchoscopy served as a valuable adjunct in the initial management of tumors exhibiting intraluminal growth, allowing for direct visualization, tissue sampling, and partial debulking to alleviate airway obstruction. In patients with an initially unresectable IMT harboring specific gene fusion rearrangement (e.g., TFG::ROS1), neoadjuvant targeted therapy with crizotinib enabled adequate tumor shrinkage to allow for subsequent surgical resection. Two patients in the study cohort died as a result of disease progression. Conclusions: A multidisciplinary diagnostic approach—integrating radiologic, bronchoscopic, histopathological, and genetic evaluations—ensures high diagnostic accuracy. While conventional treatments remain curative in many cases, targeted therapies directed at specific molecular alterations may offer essential therapeutic options for selected patients. Full article

Background: Patients with chronic kidney disease (CKD) have a substantially higher risk of developing cognitive impairment (CI) than the general population. Patients with CKD undergoing haemodialysis (HD) treatment also have an elevated risk of developing cerebrovascular and cardiovascular diseases. This study aims to investigate the relationship between the cognitive performance of haemodialysis patients and cerebral and carotid haemodynamic indices. Methods: This study was a non-interventional observational study; the sample consisted of 32 patients (age 65 ± 12 years) undergoing chronic HD treatment. The patients underwent neuropsychological and haemodynamic instrumental investigations, including Supra-Aortic Trunk Echodoppler (SAT) and Transcranial Doppler (TCD). Results: Patients were 17% deficient at Montreal Cognitive Assessment (MoCA), 45% deficient at Frontal Assessment Battery (FAB), 55% deficient at Trail-Making Test-A (TMT-A) and 65% deficient at TMT-B. The TCD investigation detected a decrease in flow (MFV) and an increase in Breath Hold Index (BHI) predominantly in the right cerebral arterial district. The SAT investigation revealed an altered IMT, plaques and the presence of severe carotid stenosis. A strong association between cerebral and carotid indices and cognitive scores was also observed. Correlation analyses reported statistically significant correlations between TMT-A and TMT-B and cerebral flow indices. Conclusions: Among haemodialysis patients, there is a high percentage of cognitive impairment associated and correlated with alterations in cerebral and carotid haemodynamics. Cerebral haemodynamics are a factor to be taken into consideration as a possible pathological mechanism underlying cognitive impairment in haemodialysis. Full article