Search Results (714)

Background/Objectives: To report our single-centre experience with the first 100 patients who underwent transcatheter aortic valve replacement (TAVR) with the new balloon-expandable Myval system. We report 3-year outcomes in low- to high-risk TAVR patient populations. Methods: From November 2019 to July 2021, 100 consecutive patients underwent TAVR, and their outcomes were classified according to the Valve Academic Research Consortium 3 definitions. Device performance was assessed using transthoracic echocardiography. Data collection was approved by the local ethical committee. Results: Among the 100 patients, most were male (n = 63), the mean age was 74.7 years, the mean EuroSCORE II score was 4.8 ± 4.9, and the mean Society of Thoracic Surgeons score was 5.6 ± 3.9. All patients were followed up for three years or until death. The rates of all-cause mortality, cardiac mortality and stroke were 28%, 7% and 5%, respectively. After three years, residual moderate aortic regurgitation was detected in eight patients without severe grade, and bioprosthetic valve dysfunction was observed in 17: structural valve deterioration in 10 (only stage 2), non-structural valve deterioration in three (paravalvular leak in one, patient–prosthesis mismatch in two), and endocarditis in four. Definite transcatheter heart valve thrombosis (hypoattenuated leaflet thickening) was not observed. Bioprosthetic valve failure was detected in four patients (stage 1: 1, stage 2: 0, stage 3: 3). After three years of follow-up, survival analysis revealed no significant differences in all-cause mortality, cardiac mortality, or the composite endpoint (including cardiac mortality, stroke and valve-related dysfunction) between patients with bicuspid (BAV) and tricuspid (TAV) aortic valve morphology and across annulus sizes (small, intermediate and large). Conclusions: TAVR resulted in significant and sustained improvements in valve haemodynamics with low rates of valve dysfunction and adverse clinical outcomes over a three-year follow-up period. Valve morphology (BAV vs. TAV) and annulus size did not significantly impact survival, haemodynamic performance, or valve durability. These results support the expanded use of TAVR in diverse patient populations, although extended follow-up is essential to fully establish long-term durability. Full article

Background: Pulmonary hypertension is common in left-sided heart valve disease, with historical studies reporting mortality rates up to 31% in severe cases undergoing mitral valve surgery. This study evaluates the impact of severe pulmonary hypertension on outcomes of mechanical mitral valve replacement with posterior leaflet preservation by comparing results with patients having mild-to-moderate pulmonary hypertension. Methods: Prospective analysis of 86 patients with mitral valve disease undergoing mechanical valve replacement with posterior leaflet preservation from March 2015 to September 2016 was conducted. Patients were stratified by pulmonary artery pressure: severe (≥60 mmHg, n = 19) versus mild–moderate (35–59 mmHg, n = 67). Primary outcomes included mortality, complications, and functional recovery at 1, 6, and 12 months. Results: The cohort included 67 patients (77.9%) with mild–moderate pulmonary hypertension and 19 patients (22.1%) with severe pulmonary hypertension. Severe pulmonary hypertension patients demonstrated higher NYHA functional class (73.7% class III vs. 46.2%, p = 0.03), larger left atrial diameter (56.3 ± 9.8 vs. 49.5 ± 6.7 mm, p = 0.01), and higher mean pressure gradients (14.4 ± 5.3 vs. 11.3 ± 5.0 mmHg, p = 0.025). Mortality was 5.3% in the severe group versus 0% in the mild–moderate group (p = 0.331). Patients with severe pulmonary hypertension required longer ICU stays (6.3 ± 3.7 vs. 4.7 ± 2.2 days, p = 0.024) but showed no significant differences in ventilation time, reoperation rates, or major complications. At the 12-month follow-up, both groups achieved equivalent outcomes in pulmonary artery pressures, left ventricular function, and cardiac dimensions. Conclusion: In this study with a relatively small sample size, severe pulmonary hypertension was associated with significantly longer intensive care unit stay but not with higher mortality compared to mild–moderate pulmonary hypertension, with both groups attaining comparable functional and hemodynamic parameters at 12 months after mechanical mitral valve replacement with posterior leaflet preservation. Full article

Primary tricuspid regurgitation (TR) is an underrecognized valve disease characterized by structural abnormalities of the tricuspid valve (TV) apparatus, including leaflet prolapse, flail, rheumatic degeneration, carcinoid involvement and congenital malformations such as Ebstein’s anomaly. Historically neglected and often misclassified as functional, primary TR has recently gained attention due to advances in multimodality imaging and increased awareness of its pathophysiological complexity and adverse outcomes. A major challenge that remains is the accurate diagnosis of primary TR, as well as the optimal timing for intervention, particularly in asymptomatic patients. While surgical repair or replacement has been the traditional approach, recent developments in transcatheter therapies, such as tricuspid edge-to-edge repair, have broadened the therapeutic landscape for patients considered at high surgical risk. In this context, personalized medicine has emerged as a central paradigm in the management of this valvular disease. Tailored therapeutic decisions should include anatomical, functional, and clinical parameters, as well as patient-specific risk factors such as age and comorbidities. Advanced imaging modalities, including 3D echocardiography and cardiac magnetic resonance, are essential for guiding this individualized approach. This review summarizes the current understanding of the etiology, pathophysiology, diagnostic tools, and treatment strategies for primary TR, highlighting the critical role of personalized treatment pathways in optimizing clinical outcomes. Full article

Operationalizing Earth Observation (EO)-based Machine Learning (ML) algorithms (or GeoML) for ingestion in environmental Digital Twins remains a challenging task due to the complexities associated with balancing real-time inference with cost, data, and infrastructure requirements. In the field of GHG monitoring, most GeoML models of land use CO₂ fluxes remain at the proof-of-concept stage, limiting their use in policy and land management for net-zero goals. In this study, we develop and demonstrate a Digital Twin-ready framework to operationalize a pre-trained Random Forest model that estimates the Net Ecosystem Exchange of CO₂ (NEE) from drained peatlands into a biweekly, field-scale CO₂ flux monitoring system using EO and weather data. The system achieves an average response time of 6.12 s, retains 98% accuracy of the underlying model, and predicts the NEE of CO₂ with an R² of 0.76 and NRMSE of 8%. It is characterized by hybrid data ingestion (combining non-time-critical and real-time retrieval), automated biweekly data updates, efficient storage, and a user-friendly front-end. The underlying framework, which is part of an operational Digital Twin under the UK Research & Innovation AI for Net Zero project consortium, is built using open source tools for data access and processing (including the Copernicus Data Space Ecosystem OpenEO API and Open-Meteo API), automation (Jenkins), and GUI development (Leaflet, NiceGIU, etc.). The applicability of the system is demonstrated through running real-world use-cases relevant to farmers and policymakers concerned with the management of arable peatlands in England. Overall, the lightweight, modular framework presented here integrates seamlessly into Digital Twins and is easily adaptable to other GeoMLs, providing a practical foundation for operational use in environmental monitoring and decision-making. Full article

Background/Objectives: Permanent colostomy requires significant physical and psychological adaptation. Patients often experience reduced physical activity, impaired quality of life, and fear of movement. Current exercise recommendations are inconsistent, and no consensus exists on safe return to activity. This study aims to evaluate the effect of a 12-week home-based graded exercise programme on physical activity, quality of life, kinesiophobia, exercise capacity, and self-efficacy in patients with permanent colostomies. Methods: This randomized controlled trial will recruit 51 adults with permanent colostomies, beginning six weeks post-surgery. Participants will be randomized (1:1) to an intervention or control group. The intervention group will receive a 12-week home-based exercise programme including patient education, resistance and core training, and progressive aerobic walking. The control group will receive standard medical care and an informational leaflet. Primary outcomes include physical activity (steps/day), quality of life (Stoma-QoL), kinesiophobia (Tampa Scale), exercise capacity (6-Minute Walk Test), and self-efficacy (General Self-Efficacy Questionnaire). Follow-up will be conducted at baseline, post-intervention, and six months. Data will be analyzed using intention-to-treat principles with a significance threshold of p < 0.05. Conclusions: This trial will be the first to assess the effects of a structured, home-based graded exercise programme in individuals with permanent colostomies. The findings are expected to provide evidence on the efficacy of exercise for improving physical and psychological outcomes in this population and to inform clinical guidelines for safe, individualized activity resumption. Full article

The inner mitochondrial membrane proteins ATP/ADP carrier protein 1 (AAC1) and Uncoupling protein 1 (UCP1) belong to the SLC25 mitochondrial carrier family. AAC1 is responsible for ATP/ADP exchange, while UCP1-dependent proton transport, which also requires small molecules known as activators, is the basis of brown fat thermogenesis. Arachidonic acid (AA) is an endogenous activator capable of inducing proton transport in both proteins. As such, both AAC1- and UCP1-dependent proton transport are potential targets of weight loss drugs. While AAC1 structures have long been available, only recently have structures of UCP1 been determined. Unfortunately, no AA-bound structure of either protein is available. To explore their interactions with AA, we performed molecular dynamics (MD) simulations of both proteins. Six parallel simulations of each protein were run with an average length of just over 6 μs, for a total of 75 μs of aggregate simulation across both proteins. AA bound deeply between transmembrane helix (TM) helices or in the central cavity of AAC1 in 14 events and between TM helices of UCP1 in 6 events. All AA involved in these deep binding events came from the intermembrane space-facing (C) leaflet. In AAC1, AA most often bound between TM1/TM2 and TM5/TM6. In four cases the fatty acid bound at the bottom of the central cavity rather than in an interhelical groove. In UCP1, all but one deeply bound AA sat between TM5 and TM6. No AA fully entered the cavity as observed in AAC1. In addition to entering the proteins, AAs were enriched around them in the surrounding membrane adjacent to the TM helices. While both protein structures exhibit hydrophobic stretches separating the intermembrane space (IMS) from the matrix, water wires formed through both AAC1 and UCP1, connecting the bulk water in both regions. Grotthuss shuttling along water wires has been proposed as a possible mechanism of AAC1/UCP1-dependent proton transport, but water wires are not present in experimental structures and have not previously been reported in MD simulations. Calculations of electric potentials along these water wires find a large 0.75–1 V electrostatic barrier along water wires through AAC1 and a substantially smaller such barrier of ~0.5 V through UCP1. Full article

Phyllotaxy is a key determinant of intraspecific variation in leaf functional traits, with different leaflet positions often representing distinct strategies of resource acquisition and utilization. Yet, the extent to which such phyllotactic differentiation is modulated by ontogenetic stage remains poorly understood. Here, we examined saplings and adult trees of Fraxinus mandshurica, a dominant compound-leaved species in temperate broadleaf forests, by quantifying four leaf economic traits and four stomatal traits across six phyllotactic positions. We further assessed the relative influences of phyllotaxy and environmental factors, including soil total nitrogen, soil water content, and canopy openness, on trait variation at different ontogenetic stages. Our results showed that economic traits varied significantly along phyllotaxy, whereas stomatal traits were relatively conservative. The effects of ontogenetic stage on traits at a given phyllotactic position were trait-specific. Within-group correlations of economic traits and of stomatal traits remained stable across ontogenetic stages and were consistently stronger than between-group correlations. Sapling traits were more strongly affected by soil total nitrogen and soil water content, whereas those in adult trees were primarily shaped by soil water content and canopy openness. Moreover, both trait–trait and trait–environment associations were weaker at the leaflet level than at the compound-leaf level. Our study highlights the critical role of ontogenetic stage in shaping leaf trait responses to phyllotaxy and environmental change, providing new insights into the mechanisms underlying intraspecific trait variation in compound-leaved tree species. Full article

This review investigates and analyzes the state of the art on scientific evidence related to educational interventions to improve air quality indoors and outdoors through a mapping review. The review followed proposed guidelines for mapping reviews in environmental sciences and the steps described in the Template for a Mapping Study Protocol. The search was conducted in PubMed, Web of Science, Embase, Cinahl, and Google Scholar with no language restrictions, and was completed in January 2025. Three filters were applied: search, selection with inclusion and exclusion criteria (PECOS strategy), and data extraction. Two independent reviewers assessed article eligibility, and disagreements were resolved by a third researcher. Twenty-four studies that met the eligibility criteria were included. Five research questions were answered. Studies published between 1977 and 2024 were included, totaling 7289 participants aged 12 to 85. The geographic distribution was concentrated in China (five studies) and the United States (four studies), followed by South Korea, India, Australia, and other countries, with fewer publications. The methodological predominance was experimental studies; observational studies were also analyzed, although less frequently. The period with the greatest increase in the number of publications was between 2020 and 2024. The educational methods most commonly used in the studies were lectures and the delivery of information leaflets. Particulate matter with diameters of 2.5 μm and 10 μm (PM_2.5 and PM₁₀) were the most widely investigated pollutants in the studies. From our analyses, it was observed that the educational interventions to improve air quality, adopted in the selected studies, resulted in the acquisition of knowledge about the environmental effects and the importance of individual actions. The changes in behavior included the adoption of more sustainable practices and an improvement in air quality in the environment, with a significant reduction in pollutant emissions. We conclude that interventions through environmental education demonstrate great potential to improve air quality. Based on the mapped evidence, governments and global policymakers can use this information to develop new strategies or improve existing ones to reduce air pollution in affected environments and regions. Full article

Background: Mitral valve prolapse (MVP) is the most common valvular abnormality in the general population and has been linked to mitral regurgitation, arrhythmias, and sudden cardiac death. Its prevalence and prognostic significance in athletes remain uncertain, raising important questions for pre-participation screening, eligibility for competition, and long-term follow-up. Methods: We systematically searched PubMed, Scopus, and EMBASE databases from inception through August 2025 for original studies reporting MVP prevalence in athletes, diagnosed by echocardiography or pathological assessment. Data on study characteristics, diagnostic definitions, prevalence, arrhythmias, and outcomes were independently extracted by three reviewers. Methodological quality was appraised using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: Twelve studies published between 1987 and 2024 met inclusion criteria, enrolling 19,463 athletes from diverse sports and competitive levels. A total of 407 MVP cases were identified, corresponding to a crude pooled prevalence of 2.4%. Prevalence estimates varied substantially (0.2–20%), reflecting heterogeneity in study populations and diagnostic definitions. When all studies were pooled using a random-effects model, the overall prevalence was 2.0% (95% CI 1.2–2.8%). A sensitivity analysis restricted to contemporary, unselected athletic cohorts yielded a prevalence of 1.1% (95% CI 0.4–1.9%), closely aligning with population-based estimates. Ventricular arrhythmias were more frequent than supraventricular arrhythmias, particularly in association with bileaflet prolapse, leaflet thickening, or significant mitral regurgitation. Most athletes were asymptomatic, and only one prospective study provided long-term follow-up, confirming a generally benign prognosis, though rare adverse events (atrial fibrillation, valve surgery) were documented. Conclusions: MVP is relatively uncommon in athletes and occurs at rates similar to the general population. In most cases, prognosis is favorable and should not preclude sports participation. Nonetheless, recognition of high-risk phenotypes with arrhythmogenic potential highlights the need for individualized evaluation and tailored surveillance strategies in sports cardiology practice. Full article

Fascination with the unknown has always characterized humanity. This includes creation of mythical creatures that are believed to exist even though fully unproven. Fabricating monsters began to peak in early modern Europe. Sixteenth-century monsters were among the earliest documented, often with printed leaflets that displayed such creatures. This monster tradition began to flourish, both in scientific and popular form including human, animal and hybrid monsters. One of the most famous products of the time was the Monster of Ravenna, inspired by a malformed human birth in 1512, Italy. Due to a lack of understanding of teratology, animal and, indeed, even human birth defects were mischaracterized and used as tools to support the validity of monsters for political agendas. Animals have been an ongoing part of these and other mythical conceptualizations, sometimes of the divine, sometimes of the demonic. This article considers appearance of human- and animal-based fictional monsters in early modern Europe with some later repercussions. Full article

IPM approaches based on pheromone-based techniques for the management of the South American tomato pinworm, Tuta absoluta (Meyrick) (Lepidoptera: Gelechiidae), are of great interest. We evaluated the effectiveness of mating disruption (MD) experiments against T. absoluta using a biodegradable pheromone dispenser (Isonet-T TT BIOX234) in greenhouse-grown tomatoes over two years in southern Italy. A base treatment alternating the most used insecticides for the pest, i.e., the farmer treatment schedule (FTS), was assigned as a reference, and two MD dispenser densities (i.e., 300 and 500 dispensers/ha) were compared with the MD commercial product Isonet T at 1000 units/ha. We conducted two trials on crops at a density of 37,000 plants/ha. Pest flights were monitored in summer–autumn 2023 and 2024 with pheromone-baited Delta traps. The FTS ensured a generally low level of T. absoluta attacks (about 1 leaflet/leaf and 1/300 fruits). Even so, mating disruption resulted in further appreciable reductions in the presence and attacks of the target pest: 89%, 76% and 52% fewer catches; 61%, 45% and 37% fewer mined leaflets; and 76%, 59% and 54% fewer attacked fruits, for Isonet-T TT 500, Isonet-T TT 300 and Isonet T 1000, respectively. Overall, MD biodegradable dispensers could be a valuable tool for controlling T. absoluta in greenhouse-grown tomatoes, while also reducing plastic waste in the agricultural setting. Full article

Objectives: To optimise surgical treatment of mitral valve disease (MVD), a better understanding of gender-based differences is required. In this study, we analyse the gender-based differences among patients undergoing mitral valve surgery. Methods: Between January 2019 and December 2024, 809 consecutive patients were admitted to our centre for surgery for MVD. We analysed the patient characteristics, surgical details, postoperative and short-term outcomes of these patients. Results: Females (31.8%) undergoing mitral valve (MV) surgery were older (p < 0.001). Females had a higher rate of atrial fibrillation (p < 0.001), Rheumatoid arthritis (RA) (p = 0.002) and malignancy (p = 0.030). Furthermore, females were more often admitted to the intensive care unit (ICU) preoperatively (p = 0.037). Among these patients, 419 patients underwent isolated MV surgery. Furthermore, males underwent minimally invasive MV surgery more often (p = 0.004). Females had higher rates of combined MVD (p < 0.001) and combined MS (p < 0.001). Males had higher rates of severe mitral regurgitation (MR) (p = 0.041) and Left Atrium (LA) dilation (p = 0.004). Females exhibited higher rates of severe Tricuspid Regurgitation (TR) (p = 0.032) and pulmonary hypertension (p < 0.001). males had higher rates of posterior mitral leaflet (PML) prolapse (p < 0.001) and Flail leaflets (p < 0.001). Males underwent mitral valve repair (MVr) more often (p = 0.002). Early MACCE were reported in 5.1% of the patients. Freedom from major adverse cardiac and cerebrovascular events (MACCE) was comparable at 1 year and three years (p = 0.548). Prognosis and freedom from events were comparable between genders. Conclusions: Mitral valve disease presents differently across genders. There exist fundamental differences in the pathophysiological processes and presentation of mitral valve disease. Mitral valve surgery can be carried out with low mortality and morbidity rates irrespective of gender. Full article

Unsafe disposal of unused and expired antimicrobial drugs increases their presence in the environment, thereby contributing to the emergence and spread of antimicrobial resistance. This study addressed the lack of sufficient data on unused and expired antimicrobial disposal practices among peri-urban residents in Ghana. This knowledge–attitude–practice (KAP)-based study offers context-specific insights to inform public health education and antimicrobial disposal policy interventions. A cross-sectional study was conducted among 310 residents in the Ho municipality using a well-structured questionnaire. Data was collected on the knowledge, attitudes, and practices of households on how they dispose of unused and leftover antimicrobials. Origin Pro 2022 software was used to analyze the data. Many respondents were males (n = 175, 56.5%) and aged between 18 and 30 years (n = 196, 63.2%). About 87.1% (n = 270) of the respondents agreed that improper disposal of unused antimicrobials could negatively affect the environment. Most of the respondents (71.9%, n = 223) had not received counseling on recommended antimicrobial disposal; 75.5% (n = 234) of respondents were not aware of institutions collecting unused or expired medicines; and 73.5% (n = 228) had never participated in a medicine-return program. Discarding antimicrobials into household trash bins was the most common way of disposal among respondents. The preferred sites to return unused/leftover antimicrobials were community pharmacies and hospitals. Although respondents showed some knowledge and positive attitudes toward safe antimicrobial disposal, further education is needed. Furthermore, most respondents disposed of antimicrobials in household trash, highlighting the need for take-back programs and community pharmacy-based collection. Incorporating disposal guidance into medication counseling and patient information leaflets can enhance awareness and promote appropriate practices. Full article

Recent evidence demonstrates that mitral valve prolapse (MVP) increases mechanical stress on the subvalvular apparatus and is linked to regional myocardial fibrosis and life-threatening ventricular arrhythmias. However, current surgical guidelines do not account for the extent of myocardial fibrosis or the severity of leaflet involvement, both key features of arrhythmogenic MVP. To address this gap, we conducted histopathological analysis of endomyocardial biopsies from patients with MVP and regionalized myocardial fibrosis (n = 6) who underwent mitral valve repair. Using digital pathology-based quantitative image analysis (QIA), we found that fibrosis in peri-papillary biopsies exhibited a significantly higher Morphometric Composite Score compared with remote biopsies (5.68 ± 0.69 vs. 3.71 ± 0.49, p = 0.042), reflecting larger, more branched, and more assembled collagen fibers, indicative of a mature and persistent fibrotic phenotype. These findings suggest that myocardial scarring in MVP is well-established by the time of surgery and underscore the potential value of earlier surgical intervention to reduce the risk of arrhythmia and preserve post-operative left ventricular function. Full article

Background: Shared Decision-Making (SDM) is important for patient-centred care, especially in areas such as gynaecological oncology where treatment decisions are often multifaceted. This study aimed to implement and measure SDM in a gynaecological oncology outpatient clinic, specifically assessing the impact of the BRAN (Benefits, Risks, Alternatives, Nothing) tool on patient and physician perceptions. Methods: A two-phased prospective observational and survey mixed-methodology study was conducted at the tertiary Northern Gynaecological Oncology Centre (NGOC) outpatient clinic in Gateshead, United Kingdom, from October 2023 to November 2024. SDM champions provided staff training. Patient and physician perspectives were measured using the nine-item Shared Decision Making Questionnaire (SDM-Q-9). Phase one was a baseline assessment; phase two involved the implementation of BRAN posters and leaflets. Statistical analyses included the Mann–Whitney U Test and Fisher’s Exact Test. A post-implementation online staff survey was conducted. Results: A total of 207 patients and 13 physicians participated: 107 patients and 13 physicians in phase one and 100 patients and 12 physicians in phase two. Whilst no statistically significant difference in patients’ perceptions of SDM was found between phases (p = 0.73), physicians’ perceptions showed a statistically significant improvement after BRAN tool implementation (p < 0.01). The staff survey results indicated that 84% observed increased patient involvement, and 92% agreed that SDM helped achieve consultation goals. Conclusions: The implementation of SDM at the NGOC led to a statistically significant improvement in the subjective use of SDM by physicians’, despite no significant change in patients’ perceptions, possibly due to high baseline levels. Staff reported increased patient engagement and improved consultation styles. These findings support implementing SDM in gynaecological oncology outpatient settings Full article