Search Results (5,195)

Heart failure (HF) is a systemic syndrome in which prognosis depends on cardiac dysfunction, congestion, cardiorenal and cardiohepatic interactions, inflammation, and metabolic dysregulation. The liver is exposed to elevated systemic venous pressure and reduced forward flow, and contributes to albumin and coagulation factor synthesis, bile acid metabolism, iron homeostasis, and the acute-phase response. Cardiohepatic injury involves hemodynamic stress, sinusoidal endothelial dysfunction, oxidative stress, inflammatory signaling, fibrogenesis, and altered metabolic regulation. Congestive hepatopathy is associated with right-sided HF, tricuspid regurgitation (TR), pulmonary hypertension, and elevated central venous pressure, whereas hypoxic hepatitis develops during low-output states, shock, or acute circulatory deterioration. These mechanisms may coexist, producing congestive/cholestatic, hypoperfusive/ischemic and mixed/systemic reserve profiles. Composite liver-related scores, including Model for End-Stage Liver Disease (MELD), MELD excluding International Normalized Ratio (MELD-XI), MELD with sodium (MELD-Na), MELD-Albumin and albumin–bilirubin (ALBI) score, may reflect congestion, hepatorenal dysfunction, nutritional status and reduced systemic reserve. This review summarizes hemodynamic and molecular mechanisms of cardiohepatic injury, liver-related biomarkers and composite scores, with emphases on advanced HF, left ventricular assist device (LVAD) therapy and heart transplantation. Liver-related abnormalities remain underrecognized in HF. Their serial interpretation may support risk stratification, but composite scores should complement rather than replace comprehensive clinical assessment. Full article

Background/Objectives: Transcranial magnetic stimulation (TMS) initiates a cascade from intracranial electric-field exposure through neural recruitment and plasticity to distributed network responses. Neuronavigation improves the geometric reproducibility of delivery but does not guarantee equivalent cortical exposure or target engagement. This narrative review integrates these levels within an operational framework for precision TMS. Methods: Six domain-specific PubMed searches covering 1 January 1985 to 31 July 2026 were supplemented by Google Scholar and citation tracking. A documented rerun on 17 August 2026 yielded 6430 records (5617 unique after cross-query deduplication). Evidence was synthesized narratively; no quantitative synthesis or formal risk-of-bias assessment was performed. Results: Neuronavigation improves geometric precision by stabilizing target definition and coil pose, whereas individualized electric-field models estimate intracranial exposure. Neither establishes biological precision, which also depends on neuronal orientation, brain state, circuit architecture, medication, and behavior. Motor-system measures are not validated as universal biomarkers for nonmotor cortex, and no single validated biomarker captures TMS-induced plasticity. Convergent, controlled multimodal evidence may strengthen inference about target engagement; adaptive and closed-loop approaches remain experimental. Conclusions: Geometric delivery, modeled exposure, biological engagement, and durable functional or clinical benefit require separate validation. Spatial accuracy alone does not establish clinical value. Full article

Generative artificial intelligence has begun to answer for the collection in the institution’s own voice, yet commentary has accumulated far faster than working systems have been documented, and no prior review identified by this search has consolidated and critically read the record of what has actually been deployed. Using a single open bibliographic index (OpenAlex)—chosen for reach and reproducibility, at the acknowledged cost of studies indexed only elsewhere—and a scoping protocol, this review narrows the literature to the systems genuinely placed in a working museum or gallery and observed in use, and maps them onto a function-based taxonomy. From a de-duplicated pool of more than eight thousand records, twenty-eight works describing twenty-seven distinct deployments are included. Three centers of gravity emerge: conversational guides that address the visitor, co-creative installations that make the act of generation the exhibit, and behind-the-scenes tools that read and catalog the collection. Against that map, the review weighs the evidence, confining every judgment of how well a system worked to the six studies that meet the review’s predefined evaluation-strength criteria. The result is a field whose map is clear while its proof is thin: the deployments can be named and sorted with confidence, but evidence that any delivers what it promises rests on a handful of cases, and the one production-scale system is also the only one tested at scale. Education, access, and audience understanding are almost absent from the record this search retrieved. The review closes with evidence-calibrated guidance for institutions weighing a deployment—a decision aid, a set of questions to put to a vendor, and stage-by-stage recommendations for selection, implementation, and evaluation, each marked with the strength of the evidence behind it—and an agenda redirecting the field toward the civic work it has set aside. Full article

Flavones are natural substances widely distributed in fruits and vegetable. Their compounds are characterized by a broad spectrum of activities, including antioxidant activity. Their most interesting biological effect, however, is antihyperglycemic activity, mediated by the inhibition of α-glucosidase. A series of 7-hydroxyflavone derivatives was synthesized and comprehensively characterized using nuclear resonance magnetic spectroscopy. The biological potential of the synthesized derivatives was assessed through antioxidant (DPPH) and α-glucosidase inhibitory assays. The physicochemical and pharmacokinetic properties were analyzed using in silico methods. Finally, molecular docking studies were performed to elucidate the binding mode of compounds within the catalytic site of α-glucosidase. Full article

Meteorological, soil, and hydrological droughts are among the most important phenomena affecting the natural environment and water management. Prolonged precipitation deficits often result in low river flows, reducing water resources and degrading aquatic ecosystems. This study evaluates the potential of meteorological drought indices as predictors of observed low flows. Long-term meteorological and hydrological data, including precipitation and river discharge records, were analyzed for the Biała Lądecka River catchment in Lower Silesia, southwestern Poland. Meteorological drought was characterized using the Standardized Precipitation Index (SPI) and the Standardized Precipitation Evapotranspiration Index (SPEI) calculated for 1-, 3-, and 6-month timescales, together with corresponding one- and two-week indices. Relationships between drought index values and observed low flows were analyzed while accounting for the time lag of the catchment response. The predictive performance of individual indices was evaluated to determine their suitability for water resource monitoring and management. The results show that meteorological drought indices can effectively indicate the occurrence of low flows, although the strength of the relationships depends on the adopted timescale. Both classical and short-term indices proved useful for analyzing the development of hydrological drought and have potential applications in low-flow monitoring and early warning systems. Full article

The role of adamalysins (ADAMs) has been widely described in many processes related to carcinogenesis, angiogenesis, inflammation, metastasis, and metabolic disorders. Despite numerous studies, their role in colorectal cancer (CRC) remains unclear. The aim of this study was to evaluate the expression of selected ADAM genes in colorectal cancer tissue and corresponding surgical margins. In addition, for a subgroup of patients, the expression of selected proteins from the ADAM family was assessed. The final study group consisted of 67 patients who underwent elective surgery for colorectal cancer. The relative expression of the ADAM10, 12, 17, and 28 genes was expressed as relative quantification (RQ) and determined by real-time quantitative PCR (RT-qPCR) in tumor tissue and surgical margins. In addition, for a subgroup of 45 patients, the expression of ADAM10, 12, and 17 proteins was assessed by ELISA. Associations between ADAM expression and clinicopathological parameters were analyzed statistically. ADAM12 gene expression was significantly higher in tumor than in margin tissue (median RQ: 0.995 vs. 0.251; p = 0.003), whereas ADAM28 RQ was significantly higher in the margin (median RQ: 0.400 vs. 0.204; p = 0.021). No significant differences were observed in the expression of the ADAM10, ADAM12, ADAM17, or ADAM28 genes based on tumor stage, sex, substance use, BMI, or age, except for nominally higher ADAM12 gene expression in patients over 65 years of age (p = 0.033). Among patients under 65 years of age with cardiovascular disease (CVD), ADAM28 RQ in tumor tissue was significantly higher than in those without CVD (p < 0.05). In obese patients with CVD, a markedly increased expression of ADAM28 in tumor tissue was observed, regardless of age (1.469 vs. 0.132; p < 0.005). Significant positive correlations were observed between the ADAM10 and ADAM17 RQ, and between the ADAM10 and ADAM28 RQ, in both tumor and marginal tissues (all adjusted p < 0.01). No significant correlations were found between gene expression and corresponding protein levels for ADAM10, ADAM12, or ADAM17. ADAM10, 12, 17, and 28 are poor biomarkers for colorectal cancer, but their significance may increase in patients with comorbid metabolic disorders. The lack of correlation between protein expression and gene expression suggests the contribution of post-transcriptional and post-translational regulatory mechanisms, which justifies further research. Full article

Background and Objectives: Hymenoptera venom allergy (HVA) represents one of the most frequent causes of anaphylaxis in adults. Venom immunotherapy (VIT) remains the only causal intervention that effectively reduces the risk of systemic reactions following subsequent stings. Accelerated-induction protocols enable rapid attainment of the maintenance dose; however, data on their safety with depot preparations are still limited. To evaluate the safety of accelerated-induction VIT using a depot preparation in a real-world clinical setting. Materials and Methods: A retrospective, single-center study was conducted between 2022 and 2024; accelerated-induction VIT with a depot preparation was initiated in 54 consecutive patients at a tertiary referral center. All patients had a documented history of systemic allergic reactions after Hymenoptera stings. A three-day accelerated-induction protocol was applied. Safety outcomes and adverse events occurring during the induction phase were systematically recorded and analyzed. Results: All 54 patients successfully achieved the maintenance dose. Adverse reactions were observed only in five patients (9.3%) and were restricted to mild local reactions at the injection site, including erythema and localized swelling. No systemic reactions or cases of anaphylaxis were reported. None of the patients required permanent discontinuation of VIT. Conclusions: Accelerated-induction VIT using a depot preparation demonstrated a favorable safety profile. When performed in an experienced tertiary care setting, this approach allows for rapid attainment of the maintenance dose while maintaining excellent tolerability. Full article

Picture Fuzzy Sets (PiFSs) have appeared as an effective tool to tackle ambiguity in decision-making and offer greater flexibility than traditional extensions of Fuzzy Sets (FSs). Under the framework of evidence theory (ET), the concepts of belief and plausibility significantly boost the representative capacity of PiFSs, which enables the management of uncertain and ambiguous data. We constructed both distance and similarity measures specifically for Belief and Plausible Picture Fuzzy Sets (BP-PiFSs). The constructed measures detect the differences and connections between BP-PiFSs and addressed the key shortcomings in current methodologies. They are mathematically validated and applied to real-world scenarios, such as fault detection in complex systems and antenna design optimization, where managing uncertainty is critical. A modified decision-making method, Belief and Plausible SMART (BP-SMART), extends the classical SMART approach to more effectively handle multi-criteria decision-making (MCDM) in uncertain environments. Numerical evaluations across pattern recognition, clustering, fault detection, and MCDM demonstrates the effectiveness and robustness of the suggested framework, contributing significantly to both the theoretical and practical development of fuzzy set theory. Full article

Clinical decision support systems operating in hospital environments generate large numbers of alerts based on continuously monitored clinical data. A major challenge in such systems is alert fatigue, caused by excessive numbers of notifications and unnecessary escalation of alert severity, which may reduce clinicians’ responsiveness to truly critical events. This paper presents a hybrid decision architecture designed for the assessment and prioritization of clinically significant events in inpatient monitoring environments. The proposed approach combines deterministic expert-defined rules with conditional machine learning models within a unified decision pipeline. Expert rules provide transparent parameter-level assessments based on clinically validated thresholds, while machine learning is applied only when rule-based aggregation yields ambiguous outcomes. This design preserves interpretability and safety while enabling the system to capture complex interactions between clinical parameters. The solution was evaluated under conditions approximating real clinical environments using laboratory measurements, vital signs, and patient-specific diagnostic contexts. Experimental results indicate that the hybrid approach improves the balance between sensitivity and reliability, reducing unnecessary alert escalation while maintaining detection of critical events. These findings demonstrate the potential of hybrid decision architectures for improving the quality of alert generation in clinical monitoring systems. Full article

Background and Objectives: Sinonasal inverted papilloma (IP) is a benign yet locally aggressive tumour associated with a clinically relevant risk of recurrence and malignant transformation. While surgical outcomes are well documented, data on long-term patient-reported quality of life (QoL) remain limited and are often based on short-term or single time-point assessments using disease-specific instruments alone. Materials and Methods: We conducted a single-centre observational cohort study of adults with histologically confirmed IP treated endoscopically. Patients were followed in a university-affiliated otorhinolaryngology outpatient clinic and completed the Sino-Nasal Outcome Test-22 (SNOT-22) at each visit; from 2022 onwards, the generic WHOQOL-BREF questionnaire was additionally administered. Longitudinal SNOT-22 trajectories were analysed using generalised additive models and linear mixed-effects models. In a subgroup of patients, retrospectively recalled preoperative SNOT-22 and WHOQOL-BREF scores were used only for exploratory paired pre–post comparisons. Results: Sixty-nine patients were included. Mean follow-up was 63.1 ± 27.8 months, and recurrence occurred in 21 of 69 patients (30%). A total of 461 postoperative SNOT-22 assessments with complete follow-up time data were included in the longitudinal analysis, with a median of six assessments per patient. Mean postoperative SNOT-22 score was 25.4 ± 19.8, and longitudinal postoperative trajectories showed a largely stable course over time. In the paired exploratory subgroup (n = 34), retrospectively recalled preoperative SNOT-22 scores were higher than postoperative scores, although these exploratory findings should be interpreted cautiously because baseline PROMs were not collected prospectively. Exploratory paired comparisons of WHOQOL-BREF showed higher postoperative scores in the physical, psychological and environmental domains. Conclusions: Patients with sinonasal IP treated endoscopically can achieve favourable and largely stable long-term disease-specific and generic QoL. No single baseline clinical factor showed a clear association with postoperative SNOT-22 scores in the longitudinal models. Combining disease-specific and generic patient-reported outcome measures with longitudinal modelling may support more informed postoperative counselling in this rare, recurrent condition, while structured surveillance remains essential. Full article

Background: Pediatric craniofacial fractures are difficult to assess on computed tomography (CT) because growth-related anatomy and subtle fracture patterns can obscure clinically relevant findings. We evaluated a lightweight 2.5D deep-learning approach after expansion of an earlier 63-examination pilot. Methods: The retrospective cohort comprised 209 fully anonymized pediatric craniofacial CT examinations from 209 unique patients, with exactly one examination per patient (103 fracture-positive and 106 fracture-negative). The center contributions were Katowice (n = 135), Olsztyn (n = 34), and Lodz (n = 40). Central axial, coronal, and sagittal reconstructions were stacked as a three-channel input to an ImageNet-initialized ResNet-18. The historical experiment retained a stratified 146/63 training/development–validation split. Reviewer-requested post hoc analyses comprised descriptive calibration, controlled retraining without vertical flipping, three repetitions of five-fold cross-validation, input and initialization ablations, and leave-one-center-out testing. Results: On the 63-examination development-validation subset, AUROC was 0.934 (95% CI 0.862–0.989) and AUPRC was 0.938 (95% CI 0.878–0.987). Repeated five-fold cross-validation yielded mean AUROC 0.899 (SD 0.033) and AUPRC 0.891 (SD 0.040). Leave-one-center-out AUROC varied from 0.604 (SD 0.025) for Katowice to 0.793 (SD 0.097) for Lodz; the Olsztyn holdout permitted sensitivity-only assessment. Conclusions: The original split and repeated cross-validation support an internal feasibility signal, but the post hoc center-held-out results show that performance was not uniformly transportable across institutions. The findings do not establish external validity or clinical utility. Full article

The time interval between the collection of biological material and the performance of toxicological analyses is particularly important when the appropriate storage temperature cannot be maintained. This issue is especially relevant in the determination of ethanol concentration in specimens obtained from drivers suspected of intoxication or being under the influence of ethanol, as well as in samples collected during post-mortem examinations. The present study evaluated the effect of room-temperature storage on ethanol concentrations in post-mortem blood, urine, costal cartilage, and intervertebral disc cartilage collected from 57 cadavers. According to Polish law, blood ethanol concentrations > 0.2 mg/mL and >0.5 mg/mL were classified as “after alcohol use” and “intoxication”, respectively. Two subgroups were therefore distinguished from the study group: 27 ethanol-positive > 0.5 mg/mL (intoxicated) and 30 ethanol-negative cases—less than or equal to 0.5 mg/mL (sober). Ethanol concentrations were determined using gas chromatography with flame ionization detection (GC-FID). Statistically significant differences in blood ethanol concentration were observed in ethanol-positive individuals depending on storage time after sample collection (p < 0.001). Under the storage conditions used in this study, no increase in ethanol concentration was observed in samples collected from ethanol-negative individuals. In ethanol-positive individuals, ethanol concentrations decreased progressively in all analyzed matrices during room-temperature storage. Urine showed the greatest stability throughout the observation period. In both cartilage matrices, ethanol was detectable up to day 3, whereas all measurements were negative from day 4 onward. Blood ethanol concentrations also decreased during storage. By day 4, the mean concentration was below the legal intoxication threshold. Full article

Background: Familial hypercholesterolemia (FH) is associated with accelerated atherosclerosis and an increased risk of cardiovascular disease. Aims: To evaluate circulating biomarkers of inflammation and atherosclerosis in patients with clinically suspected FH stratified according to the Dutch Lipid Clinic Network (DLCN) criteria. Methods: This cross-sectional study included 80 patients (mean age, 53.4 [13.2] years; 58% women) receiving maximally tolerated lipid-lowering therapy (statins ± ezetimibe). Serum concentrations of lipoprotein-associated phospholipase A₂ (Lp-PLA₂), tumor necrosis factor-α (TNF-α), apolipoprotein B (ApoB), oxidized low-density lipoprotein (oxLDL), and monocyte chemoattractant protein-1 (MCP-1) were measured. Participants were classified as definite FH (DLCN score > 8; n = 45) or non-definite FH (DLCN score ≤ 8; n = 35). Biomarker concentrations were analyzed according to the above subgroups and sex. Results: Patients with definite FH had significantly higher serum Lp-PLA₂ concentrations (62.2 [33.8] vs. 46.5 [19.9] ng/mL; p = 0.03) and TNF-α concentrations (6.94 [4.53] vs. 4.51 [2.93] pg/mL; p = 0.02) compared to non-definite FH, whereas ApoB, oxLDL, and MCP-1 concentrations did not differ significantly between the subgroups. Women had significantly higher TNF-α concentrations compared to men (6.57 [4.74] vs. 4.60 [2.20] pg/mL; p = 0.04) with no differences among other cytokines. Conclusions: Patients with definite FH exhibited persistently higher circulating Lp-PLA₂ and TNF-α concentrations despite maximally tolerated lipid-lowering therapy, suggesting ongoing activation of specific inflammatory pathways. These findings support further investigation of Lp-PLA₂ and TNF-α as candidate biomarkers for cardiovascular risk assessment in FH. Full article

River ecosystems play a key role in both natural and urbanized environments, acting as essential links in ecological systems. However, they are increasingly exposed to the synergistic effects of anthropogenic pressure and hydrological instability. This study aims to identify and assess changes in land use and their impact on the phytosociological structure and functioning of ash-alder (Fraxino-Alnetum) patches in floodplains. Based on cartographic analyses (1941, 1961, 2025) and detailed geobotanical surveys (2024–2025) conducted at six representative sites, the spatio-temporal dynamics of land use and vegetation habitat conditions were evaluated using ecological indicator values. The results indicate a substantial landscape transformation: a transition from areas dominated by agricultural and forest ecosystems to zones heavily altered by urban expansion, transport infrastructure, and industrialization. Phytosociological analyses show that while species richness remains relatively stable, floristic composition is changing due to hornbeam succession and the emergence of mesophilous species. The presence of non-native species indicates ongoing anthropization in plant patches. Furthermore, hydromorphological modifications, including bank reinforcement and channel deepening in the vicinity of sports and railway infrastructure, have hindered natural river dynamics and accelerated floodplain drainage. The observed changes indicate that ash-alder forests in the Biała Przemsza valley are in a transitional phase between riparian and oak-hornbeam communities, with a clear oak-hornbeam transformation evident in many areas, driven by changes in water relations. This study highlights the urgent need to implement integrated restoration strategies that account for both hydrological catchment recovery and the mitigation of urban pressure to ensure the long-term resilience of riparian ecosystems. Full article

In forensic toxicology, the analysis of blood and urine is regarded as the so-called “gold standard.” However, when forensic experts are confronted with advanced postmortem changes, it becomes necessary to secure and examine alternative matrices. Suitable specimens in cases of advanced putrefactive decomposition may include: skin appendages (hair and nails), bones, bone marrow, cartilage tissue, teeth, antemortem fingerprints, cerebrospinal fluid, vitreous humor, breast milk, meconium, placenta and umbilical cord tissue, oral fluid, sweat, and other evidentiary materials. These tissues, owing to their structure and anatomical location, are more resistant to putrefactive decomposition than body fluids and soft tissues. However, several limitations complicate the reliable analysis of these matrices. These include incomplete drug incorporation, depending on physicochemical properties, the inability to correlate analyte concentrations with pharmacological effects, low xenobiotic levels, and the need for highly sensitive analytical methods. Collectively, these factors contribute to interpretative challenges during forensic expert evaluation and reporting. To address key forensic questions, epigenetic variability analyses (forensic epigenetics) may also be employed, particularly when standard DNA profiling is uninformative. DNA methylation patterns in specific tissues and in individual subjects can be used, among other purposes, to identify the tissue of origin of a human biological trace, to differentiate monozygotic twins, and to predict the age of an unidentified trace donor. Over the past few years, this approach has gained increasing importance; in the context of forensic trace analysis, it offers both advantages and limitations. The aim of this study is to present current scientific evidence regarding the use of alternative biological matrices as potential sources of information of forensic relevance. The paper discusses the characteristics of individual biological materials, with particular emphasis on their analytical properties, potential applications, limitations, and possible advantages in forensic toxicological investigations. Furthermore, the key aspects associated with the application of epigenetic methods in forensic science are presented, with particular focus on their role in individual identification and the reconstruction of circumstances surrounding forensic events. Alternative biological matrices and modern analytical approaches may constitute valuable complementary tools to conventional evidentiary materials used in forensic medicine and criminalistics. Due to their physicochemical properties, stability, and ability to preserve specific biological information, these matrices may provide significant data that enable substance identification, assessment of exposure to psychoactive compounds, reconstruction of event circumstances, and support for identification procedures. However, their application requires consideration of analytical limitations, the specific characteristics of the examined matrix, and the necessity for standardization and validation of diagnostic procedures Full article