Search Results (224)

Crack detection in complex pavement scenarios remains challenging due to the sparse small-target features and computational inefficiency of existing methods. To address these limitations, this study proposes an enhanced architecture based on Mask2Former. The framework integrates two key innovations. A Local Perception Module (LPM) reconstructs geometric topological relationships through a Sequence-Space Dynamic Transformation Mechanism (DS2M), enhancing neighborhood feature extraction via depthwise separable convolutions. Simultaneously, an Auxiliary Convolutional Layer (ACL) combines lightweight residual convolutions with shallow high-resolution features, preserving critical edge details through channel attention weighting. Experimental evaluations demonstrate the model’s superior performance, achieving improvements of 3.2% in mIoU and 2.7% in mAcc compared to baseline methods, while maintaining computational efficiency with only 12.8 GFLOPs. These results validate the effectiveness of geometric relationship modeling and hierarchical feature fusion for pavement crack detection, suggesting practical potential for infrastructure maintenance systems. The proposed approach balances precision and efficiency, offering a viable solution for real-world applications with complex crack patterns and hardware constraints. Full article

Background and Objectives: Early cholecystectomy (EC) is widely regarded as the first-line treatment for acute calculous cholecystitis (ACC). Current debate centers on the feasibility of EC as an option even for elderly patients. This study aims to determine whether age alone is an independent risk prediction factor for prognosis after EC for ACC. Materials and Methods: This study is a post-hoc analysis of the S.P.Ri.M.A.C.C. WSES prospective international multicenter observational study database, including patients with ACC undergoing EC. Univariate and multivariate analyses were conducted, examining different risk factors for major morbidity and mortality after EC. Results: In the univariate analyses, age was found to be a statistically significant risk factor for both 30-day major complications (p < 0.001) and 30-day mortality (p = 0.003). However, in the multivariate analysis, age alone was not a significant predictor for either outcome, with p-values of 0.419 and 0.094, respectively. The only significant risk factor associated with both 30-day mortality and major morbidity in the multivariate model was the POSSUM Physiological Score (PS). Conclusions: Age alone cannot be considered a reliable risk predictor for a complicated postoperative course after EC in patients with ACC. Frailty, rather than chronological age, should be assessed to predict the outcome of these patients. Full article

Background: The optimal antithrombotic therapy after transcatheter aortic valve replacement (TAVR) remains uncertain. Limited data exist comparing novel oral anticoagulants (NOACs) with standard antiplatelet therapy in this population. Methods: We conducted a retrospective analysis of 171 patients who underwent TAVR between January 2018 and August 2024. Patients were categorized according to the discharge antithrombotic regimen as follows: NOACs (n = 27, 16%), vitamin K antagonists (VKAs; n = 8, 5%), and antiplatelet therapy only (APT-only; aspirin and/or clopidogrel without oral anticoagulation; n = 136, 79%). Due to the small VKA sample size, the primary analysis compared NOACs with APT-only. VKA outcomes were reported descriptively without statistical comparisons. Results: Compared with APT-only, NOAC users had significantly higher 30-day mortality (33% vs. 12%, p = 0.017) and 1-year mortality (41% vs. 20%, p = 0.048). NOACs were associated with higher rates of major adverse cardiovascular events (MACCE) at 30 days (22% vs. 8%, p = 0.051) and 1 year (34% vs. 17%, p < 0.001). After inverse probability treatment weighting, NOACs showed increased odds of 30-day MACCE (OR 5.59, 95% CI 2.56–12.18, p < 0.001) and increased hazard of 1-year mortality (HR 2.22, 95% CI 1.22–4.03, p = 0.009). Conclusions: NOAC use was associated with inferior outcomes compared to antiplatelet therapy in post-TAVR patients, although residual confounding cannot be excluded. Given the limited sample size and retrospective design, these hypothesis-generating findings require validation in larger prospective studies before they can influence clinical practice. Full article

The 83rd session of the IMO Maritime Environment Protection Committee (MEPC 83) approved a global pricing mechanism for the shipping industry, with formal adoption scheduled for October 2025. Proposed mechanisms include the International Maritime Sustainable Fuels and Fund (IMSF&F) and a combined approach integrating GHG Fuel Standards with Universal GHG Contributions (GFS&UGC). This study developed a model based on the marginal abatement cost curve (MACC) methodology to assess the cost-effectiveness of alternative fuels under both mechanisms. Sensitivity analyses evaluated the impacts of fuel prices, carbon prices, and the GHG Fuel Intensity (GFI) indicator on MAC. Results indicate that implementing the GFS&UGC mechanism yields higher net present values (NPVs) and lower MACs compared to IMSF&F. Introducing universal GHG contributions promotes a comparatively fairer transition to sustainable shipping fuels. Investments in zero- or near-zero-fueled (ZNZ) ships are unlikely to be recouped by 2050 unless carbon prices rise sufficiently to boost revenues. Bio-Methanol and bio-diesel emerged as the most cost-competitive ZNZ options in the long term, while e-Methanol’s poor competitiveness stems from its extremely high price. Both pooling costs and universal GHG levies significantly reduce LNG’s economic viability over the study period. MACs demonstrated greater sensitivity to fuel prices (P_fuel) than to carbon prices (P_carbon) or GFI within this study’s parameterization scope, particularly under GFS&UGC. Ratios of P_carbon%/P_fuel% in equivalent sensitivity scenarios were quantified to determine relative price importance. This work provides insights into fuel selection for shipping companies and supports policymakers in designing effective GHG pricing mechanisms. Full article

Background: Obstructive sleep apnea (OSA) is a prevalent but frequently underdiagnosed comorbidity in patients undergoing cardiac surgery, including coronary artery bypass grafting (CABG), aortic valve replacement (AVR), and mitral valve repair or replacement (MVR). This systematic review and meta-analytic synthesis investigates the relationship between OSA and postoperative morbidity and mortality, with particular attention to the predictive utility of established screening instruments. Methods: A systematic search of the PubMed database was conducted (April 2025), identifying 724 articles published in the last ten years. Seventeen primary studies met the inclusion criteria for qualitative synthesis, and four additional studies were included in the meta-analyses. Outcomes assessed included atrial fibrillation, major adverse cardiac and cerebrovascular events (MACCE), acute kidney injury (AKI), respiratory complications, pneumonia, hospital length of stay (LOS), and mortality. Risk of bias was assessed qualitatively based on study design and reporting limitations. This review was registered in the PROSPERO database under registration number CRD420251049574. Results: Meta-analyses demonstrated significantly elevated odds of atrial fibrillation (OR = 2.44, 95% CI: 1.46–4.07), major adverse cardiac and cerebrovascular events (OR = 2.06, 95% CI: 1.61–2.63), acute kidney injury (OR = 2.24, 95% CI: 1.67–3.01), and respiratory complications (OR = 1.15, 95% CI: 1.05–1.25) among patients with OSA. Additionally, OSA was associated with a significantly prolonged hospital length of stay (standardized mean difference [SMD] = 0.62, 95% CI: 0.46–0.78) and a marginal increase in pneumonia risk (OR = 1.07, 95% CI: 1.00–1.15). Evidence regarding stroke, intensive care unit (ICU) stay, and mortality was inconsistent or underpowered. Conclusions: Across core outcomes, findings were consistent across multiple studies involving a large patient population. Obstructive sleep apnea is a clinically consequential risk factor in cardiac surgery, associated with increased perioperative complications and prolonged hospitalization. These findings support the integration of routine OSA screening into preoperative risk assessment protocols. Further prospective, multicenter trials are warranted to assess the efficacy of perioperative management strategies, including continuous positive airway pressure (CPAP) therapy, in improving surgical outcomes. Full article

Background/Objectives: To evaluate the prognostic role of the inflammatory prognostic index (IPI) value at admission in major adverse cardiovascular and cerebrovascular events (MACCEs) in individuals with non-ST elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI). Methods: A total of 1142 NSTEMI patients with a mean age of 61.9 ± 12.5 years were included. Admission C-reactive protein level, serum albumin level, and complete blood counts of participants were collected from hospital records. The IPI was calculated based on the following formula: C-reactive protein/albumin ratio (CAR) x neutrophil-to-lymphocyte ratio (NLR). An aggregate index of systemic inflammation (AISI) value was calculated using the ‘‘neutrophil count x monocyte count x platelet/lymphocyte count’’ formula. The study cohort was divided into two groups according to the median IPI value. Results: Patients with higher IPI values were statistically more likely to suffer from MACCEs within one year (p < 0.001), thus the admission IPI value was found to be associated with future development of MACCEs. Furthermore, it had sufficient discrimination power (AUC = 0.70) and predictive accuracy in identifying MACCEs compared to other inflammatory parameters such as the CAR (AUC = 0.64), the NLR (AUC = 0.64), and the AISI (AUC = 0.59). Adding the IPI to the baseline multivariable logistic regression model significantly improved the model’s discrimination and net clinical benefit effect for identifying patients who would suffer from MACCEs, with a C-index of 0.84 (95% CI: 0.82–0.86) and explanatory power of 23.2% (R² = 0.232, DeLong test p = 0.001). High-risk patients with an IPI value greater than 2.43 had significantly more adverse events (p < 0.001). Conclusions: The IPI may be a promising inflammatory index for use in clinical practice to determine the risk prediction of MACCEs in NSTEMI patients undergoing PCI. Full article

Background: Atherothrombosis is a systemic disease that may affect one or more than one vascular bed. Data on the impact of polyvascular disease (PVD) on the long-term prognosis of patients with coronary artery disease (CAD) are still scarce. Aim: To assess the prevalence of symptomatic PVD in a cohort of patients with a new episode of acute coronary syndrome (ACS) and to investigate the impact of multiple vascular beds involvement on long-term outcomes. Methods: We analysed a nationwide, comprehensive administrative database of consecutive patients aged ≥ 40 years admitted for a new episode of ACS in Italy in 2017–2018. Patients with ACS were stratified according to the presence of peripheral artery disease (PAD) only; cerebrovascular disease (CeVD) only; PAD+CeVD; or neither (no PAD/noCeVD, i.e., ACS only). A multivariate Cox proportional hazards model was used to assess the impact of PAD only; CeVD only and PAD+CeVD on 5-year MACCE. Results: A total of 342,052 patients hospitalised with ACS were identified. Among them, 24,727 (7.2%) were patients with PAD only, 16,887 (4.9%) with CeVD only, and 5810 (1.7%) with PAD+CeVD. After adjusting for age, sex, and comorbidities, the hazard ratio (HR) for 5-year MACCE was 1.37 (95% CI: 1.35–1.40), 1.36 (95% CI: 1.33–1.39), and 1.45 (95% CI: 1.40–1.50) in patients with PAD only, CeVD only, and PAD+CeVD, respectively, compared with patients with ACS only. Conclusions: In patients with ACS, the involvement of a second vascular bed increases the risk of long-term outcomes; the simultaneous involvement of three vascular beds further increases the risk of long-term outcomes. Full article

Aortic stenosis (AS) is a progressive valvular heart disease characterized by fibrocalcific remodeling, inflammation, and hemodynamic disturbances. Serum biomarkers may indirectly reflect these processes. Autotaxin (ATX) and lysophosphatidic acid (LPA) have been implicated in osteogenic differentiation of valvular interstitial cells, while growth differentiation factor-15 (GDF-15) reflects cellular stress and vascular changes. Thrombomodulin (TM) indicates endothelial injury and interacts with thrombin. This study aimed to evaluate biomarkers focusing on serum ATX, LPA, GDF-15, and TM levels and flow-mediated dilatation (FMD) in patients with AS. Overall, 149 patients were included in the study: 86 consecutive patients with AS hospitalized due to qualification for invasive treatment of AS and 63 controls. The clinical characteristics, echocardiographic data, FMD, and the following biomarkers—ATX, LPA, GDF-15, and TM—were included in the analysis. AS patients presented increased serum levels of ATX, GDF-15, and TM as compared to the controls. Differences in LPA levels were not statistically significant. FMD values were significantly lower in AS patients. The biomarkers mentioned above and FMD correlated with AS severity. There were no differences in both biomarkers’ serum levels and FMD regarding the hemodynamic AS phenotype. GDF-15 serum level was a risk factor for all-cause mortality and MACCE in the 12-month follow-up. Full article

Background/Aim: Cervical adenocarcinoma associated with Human Papillomavirus (HPV) infection represents 85–90% of all adenocarcinomas that have poor prognostic factors and is an important health public concern. Currently, cervical adenocarcinoma molecular markers are scarce. This study searched databases and the literature regarding candidate genes to find these molecular markers, which were experimentally evaluated in fresh cervical samples. Materials and Methods: Bioinformatic analysis of 161 transcriptomic libraries of cervical tissues with or without lesions from the NCBI database was performed using the Partek Genomics Suite 6.6v software. The selected genes with a p value of >0.05, and 1.5-fold change were considered. A search of molecular marker candidates of cervical lesions that were already published in the literature was performed. To validate the selected genes, total RNA from fresh cervical adenocarcinoma and cervical normal tissues were subjected to RT-PCR experiments; HPV detection was also performed. Results: Initially, twenty-five genes were identified using bioinformatic analysis, and their expression was evaluated. The results showed that the HOXC6, HOXC8, RARβ, ELAVL2, URG4, CISD2, CA9, BCL2, Survivin, MACC1, CDKN2A, and HPV E6/E7 genes were found to be differentially expressed in CC. Among these, RARβ, MACC1, BCL2, HOXC8, and E6/E7/HPV exhibited higher statistical significance for CC samples. Conclusions: This five-gene panel could serve as a novel molecular tool for HPV-associated cervical adenocarcinoma detection. Full article

Background and Objectives: Rotational atherectomy (RA) is a crucial method for percutaneous coronary intervention (PCI) of heavily calcified coronary lesions. The aim of this study was to compare the clinical outcomes in patients undergoing RA via the radial versus femoral approach. Methods: The Rotational Atherectomy in Calcified Lesions in Korea (ROCK) registry included consecutive patients with severely calcified coronary artery disease who received RA during PCI at nine tertiary centers in Korea. A total of 540 patients who underwent PCI with RA were enrolled between October 2019 and January 2010. We retrospectively investigated the clinical outcomes between the transradial and transfemoral approaches. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) within 36 months of follow-up. Results: Of the 540 patients, 248 patients (45.9%) were in the transradial group, and 292 patients (54.1%) were in the transfemoral group. There were no significant differences in MACCE (11.3% vs. 17.8%, adjusted hazard ratio [HR]: 1.520; 95% confidence interval: 0.889–2.600; p = 0.126) and procedural success (97.6% vs. 95.2%, p = 0.145). The occurrence of in-hospital bleeding was numerically higher in the transfemoral group, but the difference was not statistically significant (8 [3.2%] vs. 19 [6.5%], p = 0.081) Conclusions: In this study, the transradial approach did not show a significant difference in clinical outcomes but tended to have lower bleeding events compared to the transfemoral approach. RA via the transradial approach can be a useful vascular access option compared to the transfemoral approach. Full article

The underwater conditions of the coastal ecosystem require careful monitoring to anticipate potential environmental hazards. Moreover, the unique characteristics of the marine underwater environment have presented numerous challenges for the advancement of underwater sensor networks. Current studies have not extensively integrated Digital Twins with underwater sensor networks aimed at monitoring the marine ecosystem. Consequently, this study proposes a decision-making framework based on Underwater Digital Twins (UDTs) utilizing the Exponential Hyperbolic Crisp Adaptive Network-based Fuzzy Inference System (EHC-ANFIS). The process begins with the initialization and registration of an Underwater Autonomous Vehicle (UAV). Subsequently, data are collected from the sensor network and relayed to the UDT model. The optimal path is determined using Adaptive Pheromone Ant Colony Optimization (AP-ACO) to ensure efficient data transmission. Following this, data compression is achieved through the Sliding–Huffman Coding (SHC) algorithm. The Twisted Koblitz Curve Cryptography (TKCC) method is employed to enhance data security. Additionally, an Anomaly Detection System (ADS) is trained, which involves collecting and pre-processing sensor network data. A Radial Chart is then utilized for effective visualization. Anomalies are detected using the CosLU-Variational Shake-Long Short-Term Memory (CosLU-VS-LSTM) approach. For standard data, decision-making based on the UDT model is conducted using EHC-ANFIS, with a fuzzification duration of 21,045 milliseconds. Finally, alerts are dispatched to the Maritime Alert Command Centre (MACC). This approach enhances maritime communication and monitoring along coastal areas, with specific reference to the Coromandel Coast, thereby contributing to the protection of the coastal ecosystem. Full article

Background/Objectives: Diabetes mellitus is a substantial risk factor for coronary artery disease (CAD). Diabetes duration is linked to clinical outcomes in CAD patients. This study aimed to investigate the impact of diabetes duration on major adverse cardiovascular and cerebrovascular outcomes, as well as all-cause mortality, in Korean patients diagnosed with non-obstructive CAD. Methods: This non-randomized, retrospective, single-center study was based on the medical records of 4287 patients who underwent coronary angiography from 1 January 2010 to 31 December 2015. Of these patients, 517 with non-obstructive CAD—defined as 20–49% coronary artery stenosis—were identified and categorized into three groups based on diabetes duration: those without diabetes, those with diabetes for <10 years, and those with diabetes for ≥10 years. Results: Over a median follow-up period of 60 months, the risk of major adverse cardiovascular and cerebrovascular events (MACCEs) increased nearly fourfold in patients who had non-obstructive CAD and diabetes for ≥10 years compared to those without diabetes, even after adjusting for covariates (adjusted hazard ratio [HR] 4.61, 95% confidence interval [CI] 2.04–10.40, p < 0.001). The risks of cardiovascular death and non-fatal stroke were also significantly higher in patients who had diabetes for ≥10 years compared to non-diabetic patients (adjusted HR 12.42, 95% CI 2.33–66.22, p = 0.003, adjusted HR 4.97, 95% CI 1.88–13.19, p = 0.001, respectively). Conclusions: Patients with non-obstructive CAD and a longer duration of diabetes exhibited a higher risk of MACCEs. Diabetes duration could be an important factor in predicting mortality in patients with non-obstructive CAD. Full article

Background/Objectives: Current evidence suggests that levosimendan may have a beneficial effect in the treatment of acute heart failure (AHF) or cardiogenic shock following primary percutaneous coronary intervention (PCI). However, there is a paucity of data on the use of levosimendan prior to PCI. Therefore, our pilot study aimed to assess the short-term prognosis of a new therapeutic protocol involving preprocedural infusion of levosimendan in patients with reduced left ventricular ejection fraction undergoing high-risk PCI for acute coronary syndrome (ACS). Methods: The study is a retrospective observational study, and the population includes all subjects who received levosimendan infusion prior to high-risk PCI for ACS. Subjects requiring urgent revascularization (cardiogenic shock, cardiac arrest) or with mechanical complications of ACS were excluded. Results: The study cohort consisted of 90 subjects, predominantly men (91.1%) with significantly reduced left ventricular function (28.7% (12)) and advanced coronary artery disease, mean SYNTAX Score 25.8 (19.3–33). During in-hospital follow-up, we observed 2 primary outcomes—death. The major adverse cardiac and cerebrovascular events (MACCE) rate was 7.8%. Two clinical adverse events that did not lead to discontinuation were observed during the in-hospital period. Both were related to hypotension. Conclusions: In short-term observation, novel therapeutic approach in the management of high-risk PCI in ACS patients—pre-procedural levosimendan—was a relatively safe approach. No significant adverse events were reported. Full article

Background: Heart failure with preserved ejection fraction (HFpEF) is a condition with limited large-scale data on the short- and long-term effects of SARS-CoV-2 infection. This study aimed to evaluate the prevalence of major adverse cardiac and cerebrovascular events (MACCEs) in HFpEF patients hospitalized with SARS-CoV-2 and identify sex-specific risk factors and predictors of MACCEs in this population. Methods: This retrospective study analyzed HFpEF patients hospitalized with SARS-CoV-2 from the 2020 National Inpatient Sample (NIS) using ICD-10 codes. Patients hospitalized with HFpEF and SARS-CoV-2 were categorized by age (18–44, 45–64, ≥65 years). Multivariate logistic regression was used to adjust for potential confounders, with the statistical significance set at a two-tailed p-value < 0.05. Results: Among 109,750 HFpEF patients hospitalized with SARS-CoV-2, 31,960 (29.1%) experienced MACCEs. Males experienced a higher rate of MACCEs than females (31.1% vs. 27.5%, OR: 1.20, 95% CI: 1.12–1.28, p < 0.001). Adjusted analysis revealed that elderly patients (≥65 years, OR: 1.47, 95% CI: 1.33–1.62) compared with the 45–64 age group and males (OR: 1.20, 95% CI: 1.12–1.28, p < 0.001) had a higher risk of MACCEs. Key predictors included prior coronary artery bypass grafting (CABG; OR: 1.15, 95% CI: 1.02–1.30), cancer (OR: 1.24, 95% CI: 1.08–1.42), and chronic kidney disease (OR: 1.15, 95% CI: 1.08–1.23). Subgroup analysis identified additional sex-specific risk factors. In males, hyperlipidemia, obesity, tobacco use disorder, prior stroke/transient ischemic attack (TIA), prior venous thromboembolism (VTE), alcohol abuse, depression, and valvular disease were significant predictors of MACCEs. In females, hyperlipidemia, tobacco use disorder, prior stroke/TIA, prior VTE, and depression were significant predictors. Conclusions: HFpEF patients hospitalized with SARS-CoV-2 have a high risk of MACCEs, with male sex, older age, prior CABG, cancer, and chronic kidney disease as key risk factors. This study provides the first large-scale analysis of sex-specific predictors of MACCEs in HFpEF patients hospitalized with SARS-CoV-2. These findings underscore the need for focused research and clinical gender-based strategies to mitigate cardiovascular risks in this unique and high-risk population. Full article

Objectives: Our aim was to investigate whether admission advanced lung cancer inflammation index (ALI) values have a prognostic role on one-year major adverse cardiovascular and cerebrovascular events (MACCEs) in non-ST elevation myocardial infarction (NSTEMI) patients undergoing percutaneous coronary intervention (PCI). Methods: Our study consisted of 1173 consecutive patients aged 61.9 ± 12.5 years. The study population was divided into two groups according to the occurrence of MACCEs. BMI (body mass index), serum albumin levels and NLR (neutrophil to lymphocyte ratio) of patients were collected from hospital records, and ALI was calculated based on the following formula: BMI × serum albumin/NLR. We also calculated neutrophil to lymphocyte ratio (NLR), C-reactive protein/albumin ratio (CAR) and uric acid to albumin ratio (UAR) and investigated the association of these inflammation-based biomarkers with one-year MACCEs. Results: During the 12-month follow-up period, 158 (13.5%) patients had MACCEs, 55 (4.7%) of whom had all-cause mortality, 96 (8.2%) had nonfatal MI and 7 (0.6%) had nonfatal stroke. Patients with MACCEs had significantly lower ALI (p < 0.001), and also ALI (area under the curve [AUC] = 0.658, p < 0.001) had better discriminatory power and predictive accuracy in determining one-year MACCEs compared to albumin (AUC = 0.594, p < 0.001), NLR (AUC = 0.631, p < 0.001), CAR (AUC = 0.595, p < 0.001) and UAR (AUC = 0.577, p = 0.001) in the ROC analysis. Individuals with an ALI value lower than 43.9 were at greater risk of developing MACCEs (p < 0.001) due to the Delong test. Conclusions: Determining the level of ALI may have the potential to improve risk prognostication in NSTEMI patients undergoing revascularization therapy. Full article