Search Results (354)

In heart failure (HF), elevated blood lactate levels, particularly during exercise or in advanced disease stages, reflect impaired tissue perfusion and altered metabolic regulation. Beyond its traditional role as a marker of anaerobic metabolism, lactate has emerged as a dynamic indicator of metabolic reserve and ventilatory control. This narrative review summarizes current evidence on lactate dynamics at rest and during exercise, highlighting their pathophysiological and clinical relevance. In HF patients, exercise-induced lactate accumulation occurs earlier and at lower workloads, reflecting impaired oxidative capacity and reduced peripheral oxygen utilization. This phenomenon is closely associated with ventilatory inefficiency, as demonstrated by the relationship between lactate levels and the VE/VCO₂ slope during cardiopulmonary exercise testing (CPET). Emerging data suggest that lactate is not only a marker of disease severity but also a potential mediator of chemoreflex activation and abnormal ventilatory responses. Furthermore, both pharmacologic and non-pharmacologic interventions may influence lactate production and utilization, supporting its role as a potential tool for therapeutic monitoring. Overall, the integration of lactate assessment, particularly during exercise, into clinical evaluation may provide additional insight into disease mechanisms, improve risk stratification, and contribute to personalized therapeutic optimization in patients with HF. Full article

This paper presents a novel dual-mode memristor-based ring oscillator designed for energy-efficient, wireless biomedical signal conditioning systems. The proposed architecture leverages a compact DTMOS memristor emulator, consisting of only two transistors and one capacitor, to replace the conventional NMOS pull-down devices in a three-stage PMOS ring oscillator. This integration enables two distinct operating modes within a single compact core: a fixed-frequency mode for stable clock generation and carrier synthesis, and a programmable chirp mode for frequency-modulated signal generation. The fixed-frequency mode achieves continuous tuning from 3.142 GHz to 4.017 GHz via varactor control, with an ultra-low power consumption of only 111 µW at 4.017 GHz. The chirp mode generates linear frequency sweeps starting from 0.8 GHz, with the sweep range independently controllable through the state capacitor value and the pulse width of the control signal (SW_Chirp). Designed in a standard 0.18 µm CMOS process, the oscillator exhibits a low phase noise of −87.82 dBc/Hz at a 1 MHz offset for the three-stage configuration, improving to −94.3 dBc/Hz for the five-stage design. The overall frequency coverage spans 0.8–4.017 GHz, representing a 133.6% fractional range. The calculated figure of merit (FoM) is −169.45 dBc/Hz. Experimental validation using a discrete CD4007 prototype confirms the oscillation principle, while comprehensive simulations demonstrate robust performance across process corners and temperature variations. With its zero-static-power memristor core, wide tunability, and dual-mode reconfigurability, the proposed oscillator is ideally suited for multi-standard wireless biomedical applications, including implantable telemetry, neural stimulation, ultra-wideband (UWB) transmitters, and non-contact vital sign monitoring. Full article

Arterial thrombosis emerges from the interplay between plaque disruption, platelet activation, and coagulation pathway amplification on a background of heterogeneous ischemic and bleeding risk. Optimal antithrombotic therapy therefore varies across clinical settings, from acute coronary syndromes (ACS) to chronic coronary syndromes (CCS), ischemic stroke, peripheral artery disease (PAD), and atrial fibrillation (AF) associated with atherosclerotic disease. Contemporary European and North American guidelines endorse an increasingly individualized approach, moving away from rigid “one-size-fits-all” dual antiplatelet therapy (DAPT) duration and intensity and incorporating dual pathway inhibition with low-dose rivaroxaban plus aspirin in selected high-risk CCS and PAD patients. In ischemic stroke, short-course DAPT is confined to minor events and transient ischemic attacks, whereas long-term monotherapy remains standard, and the coexistence of AF typically shifts the balance toward oral anticoagulation. Across all scenarios, antithrombotic benefit must be weighed against bleeding, especially in elderly, frail, or comorbid patients. Evidence gaps remain substantial, particularly in patients with overlapping vascular territories, AF plus atherosclerotic disease, and after ischemic stroke of complex or mixed mechanisms. This narrative review summarizes current evidence and guideline-based strategies in major atherosclerotic settings, proposes a unifying conceptual framework, and highlights key uncertainties and research directions for truly personalized antithrombotic care. Full article

Backround and Objectives: Basketball performance is shaped by repeated high-intensity actions interspersed with brief recovery. Conventional continuous or strictly incremental testing may not fully capture short active-recovery dynamics relevant to stop-and-go sports. Material and Methods: This study applied a VT₂-referenced progressive–intermittent treadmill protocol and focused on 60-s active-recovery kinetics to describe effort tolerance in an applied basketball setting. Basketball players from Mureș County completed anthropometry (24 h pre-test, fasted) and a single laboratory visit. Pre-test training and diet were standardized for 48 h (submaximal training; predominantly carbohydrate intake). CPET was performed in 3-min stages (6.5 km·h⁻¹ start; +0.7 km·h⁻¹ per stage) and stopped at RER = 1.00 and/or blood lactate = 4.0 mmol·L⁻¹ (operational VT2). After 3 min active recovery, participants completed six 60-s high-speed bouts separated by 60-s active recovery intervals (AR1–AR6), with intensities prescribed at 120–180% of VT2-derived speed, followed by an 8-min active recovery. For each AR interval, linear regression over 0–60 s yielded slopes for VO₂, VO₂/HR, VCO₂, V̇E, VE/VO₂, VE/VCO₂, and PetCO₂. Results: VT₁ was determined at 2.29 m·s⁻¹ (VO₂ 32 mL·min⁻¹·kg⁻¹) and VT2 at 3.07 m·s⁻¹ (VO₂ 42 mL·min⁻¹·kg⁻¹). Maximal intermittent speed was 5.33 m·s⁻¹ (VO₂ 45.5 mL·min⁻¹·kg⁻¹; RER 1.06; PetCO₂ 38 mmHg). VO₂ differed across successive bouts (p = 0.0001), while PetCO₂ showed a small downward drift across repetitions. Peak indices (max speed, VE/VCO₂max, PetCO₂max, VEmax) were associated with phase-specific recovery slopes across early, mid, and late recovery periods (false discovery rate–adjusted correlations). Lactate decreased over 8 min, but lactate change rates were not associated with peak indices. Conclusions: The VT₂-referenced progressive–intermittent protocol appears feasible in basketball players and provides phase-dependent recovery information that complements conventional peak CPET outcomes, with potential relevance for applied team settings. Full article

This work examined the development of amylose–lipid complexes in green banana flour (Musa × paradisiaca) incorporated with virgin coconut oil (VCO), focusing on their spectral, thermal, and in vitro digestibility characteristics. Firstly, the native banana flour was analyzed for apparent amylose content using a spectrophotometric assay. To facilitate amylose–lipid complexation, both hot-pressed and cold-pressed VCO were incorporated into the banana flour under controlled thermal conditions, after which amylose–lipid interactions were characterized using Fourier-transform infrared and Raman spectroscopy for spectral features and differential scanning calorimetry for thermal behavior. The banana flour exhibited an AAC of 26.40 ± 0.002%. GCMS analysis of FAME derivatized VCO detected medium- to long-chain fatty acids, including octanoic (C8:0), decanoic (C10:0), dodecanoic (C12:0), tetradecanoic (C14:0), and hexadecanoic acids (C16:0) stearic acid (C18:0) and oleic acid (C18:1). FTIR coupled with multivariate analysis and Raman spectra confirmed lipid incorporation/retention in green banana flour through characteristic O–H, C–H, and C=O bands. While DSC revealed distinct endothermic transitions at 89.56 ± 2.17 °C (ΔHₘ = 0.8587 ± 0.1014 J g⁻¹) for hot-pressed VCO and 89.18 ± 0.98 °C (ΔHₘ = 0.6267 ± 0.0777 J g⁻¹) for cold-pressed VCO, consistent with the melting of V-type amylose–lipid complexes. Morphological analysis revealed that thermal treatment transformed native banana flour from irregular granular structures into an amorphous matrix via starch gelatinization, whereas subsequent incorporation of VCO promoted aggregation. In vitro enzymatic digestion showed a slight reduction in starch hydrolysis in VCO-treated samples. The incorporation of an exogenous lipid, such as VCO, into green banana flour promotes the formation of thermally stable amylose–lipid complexes that reduce enzymatic digestibility. Full article

Long-Acting Buprenorphine Formulations (LAIB) have emerged as an alternative pharmacological approach for opioid use disorder, offering potential benefits extending beyond clinical stabilisation. Narrative medicine provides a unique approach to understand patients’ perspectives and experiences with sublingual buprenorphine and LAIB dispensed to fourteen patients across different Italian Addiction Services, examining how they impact the emotional, social, and motivational dimensions of recovery. Narratives were analysed by thematic content across eight domains: dependence on daily treatment regimen, emotional impact, self-perception, determination to change, quality of life, craving and withdrawal symptoms, treatment adherence, social burden, and therapeutic relationship. Statements were categorised by valence; experiential patterns were qualitatively analysed. Sublingual buprenorphine, although effective, was associated with reduced autonomy, symptom control, and difficulties in balancing treatment, work and life. These aspects were correlated with worse adherence. The stigma and burden of daily intake can reduce motivation and hinder identity reconstruction. In this setting, transitioning to LAIB resulted in improved self-autonomy, emotional balance, symptom control, self-esteem, and reduced daily and psychological burden, craving and stigma, facilitating social reintegration, and strengthening the therapeutic relationship. The results emphasise the importance of including both experiential and narrative elements in clinical care, as this helps create more tailored, recovery-focused treatment pathways. Full article

This paper presents a secure 2.4 GHz frequency shift keying (FSK) transmitter front-end with minimal overhead on the data stream using analog obfuscation techniques applied to the modulated waveform. An off-chip true random number generator (TRNG) unit is used to generate the required key for the encryption. Moving away from traditional FSK schemes, which benefit from constant local oscillator (LO) frequency within the channel, the proposed secure FSK scheme shifts the LO frequency in very small steps using an innovative capacitor-bank structure with a calibrated digitally controlled oscillator (DCO). The proposed capacitor bank uses a combination of parallel switches and series capacitors to minimize the impact of the layout parasitics on the minimum capacitor in the bank, thereby reliably creating sub-fF unit capacitors. When combined with the proposed capacitor bank, the cross-coupled CMOS LC voltage-controlled oscillator (VCO) forms a digitally controlled oscillator (DCO). The post-layout simulation results of the DCO reveal that the proposed scheme can achieve a resolution of <20 kHz for the LO frequency shifting while maintaining the phase-noise performance. The reported phase shift allows an equivalent entropy > 6 bits in the implemented analog-inspired secure transmitter front-end. Full article

Violence against minors remains a significant, often under-reported public health crisis. This study evaluated the incidence and clinical management of child abuse within the Verbano-Cusio-Ossola area (Northwest Italy) from January 2017 to August 2023. A retrospective descriptive analysis was conducted using two primary data streams: (1) Territorial data: records from the multidisciplinary “Maltrattamento, Trascuratezza, Abuso” (“Maltreatment, Neglect, Abuse”) team. (2) Hospital data: Pediatric Emergency Department admissions in Verbania and Domodossola, screened via diagnostic filters and ICD-related codes. At the territorial level, 161 minors were identified. While the territorial network demonstrated high activation rates (96.25%) and legal reporting (92.55%), a history of missed reports was noted in 8.13% of cases. Parental risk factors were prevalent: 72% of caregivers reported adverse childhood experiences and 27% presented with psychiatric comorbidities. In contrast, hospital data revealed a diagnostic gap. Out of 1,586 pediatric ED admissions, only one case was explicitly recorded as child abuse. Furthermore, none of the discharges utilized specific maltreatment diagnostic codes, despite several patients presenting with recurrent “accidental” traumas. These findings highlight a disconnect between community services and acute clinical settings. Enhancing intrahospital surveillance and implementing specialized training for healthcare providers are essential to bridge this diagnostic gap and ensure a coordinated, multidisciplinary response to child maltreatment. Full article

Coconut residue (CR) is a major by-product generated during the wet processing of virgin coconut oil (VCO). Despite its potential as a raw material for value-added products such as dietary fiber, it remains underutilized due to its perishable nature, highlighting the need for appropriate pretreatment to improve safety and quality prior to valorization. This study evaluated the effects of thermal pretreatments, namely pan-roasting at 65–70 °C, hot-air drying at 50 °C and 60 °C, and their combinations, on the microbiological and physicochemical properties of CR. Microbiological quality was assessed through aerobic plate count, yeast and mold count, and total coliform analysis, while physicochemical properties were evaluated using pH, titratable acidity (TA), and instrumental color measurements. Results showed that CR subjected to pan-roasting, either alone or followed by drying at 60 °C, maintained acceptable microbial counts and generally exhibited lower TA and higher pH compared to other treatments, suggesting improved stability and reduced acidity development. However, pan-roasting caused color changes as reflected by a significant reduction in lightness (L*) values relative to the control. Overall, pan-roasting could serve as a promising thermal pretreatment step to enhance microbiological safety and preserve the physicochemical quality of CR. While these results indicate its potential for preparing CR for dietary fiber valorization, confirmation through analysis of fiber content, techno-functional properties, and validation using CR from commercial VCO processing facilities is still required. Full article

Sedentary behavior contributes to obesity and metabolic dysfunction, yet few interventions individualize exercise intensity using fuel-based metrics such as the respiratory exchange ratio (RER; VCO₂/VO₂). This study investigated the effects of metabolically guided walking combined with whole-food, plant-based nutrition on body composition and metabolic outcomes in sedentary overweight and obese women. Forty-four women mean age 43 years; BMI 30.1 kg·m⁻²) were randomized to low-intensity continuous training (LICT; RER ≈ 0.75), moderate-intensity intermittent training (MIIT; RER ≈ 0.85), or high-intensity continuous training (HICT; RER ≈ 0.95). Following a 2-week dietary lead-in with an individualized ~200 kcal·day⁻¹ energy deficit, participants completed an 8-week RER-guided walking program (5 sessions·week⁻¹; 15–50 min·session⁻¹). Assessments included air-displacement plethysmography (BodPod) body composition, resting metabolic rate and substrate utilization, and oxygen uptake at the first ventilatory threshold (VT1). Data were analyzed using ANCOVA, mixed-factorial ANOVA, and Pearson correlations. Percent body fat decreased significantly across participants (p < 0.0001, η² = 0.827), with MIIT demonstrating the most favorable integrated outcomes. MIIT elicited the largest reductions in total body mass (−11.2%), fat mass (−25.9%), and percent body fat (−17.1%), alongside improvements in VT1 VO₂ (Δ = 1.487 ± 0.895 L·min⁻¹; p = 0.038). Resting respiratory quotient (RQ) declined in LICT and MIIT but increased in HICT, corresponding with increased fat oxidation in LICT and MIIT and reduced fat oxidation in HICT. Changes in RQ were significantly associated with changes in percent body fat (r = 0.316, p = 0.039). Metabolically guided moderate-intensity intermittent walking combined with whole-food, plant-based nutrition produced the most consistent improvements in adiposity, substrate utilization, and submaximal fitness, supporting the public-health feasibility of a community-deliverable, substrate-informed walking prescription. Full article

The miniaturization of dielectric sensing has driven the development of both oscillator- and receiver-based sensors. Wide-frequency-range and low-power-consumption voltage-controlled oscillators (VCOs) are required as a reference clock for receiver-based dielectric spectroscopy. In this paper, we propose a switched coupled inductor VCO offering sufficiently wide bandwidth in a power-efficient manner. The proposed switched coupled inductor offers higher coupling factor and mutual inductance compared to direct switched inductor schemes along with a higher quality factor and tuning range. The proposed switched coupled inductor improved the frequency tuning range by 21% compared to the conventional VCO. The measurement results show that the proposed VCO oscillates from 4.7 to 8.8 GHz frequency, suitable for dielectric spectroscopy sensors. With only 4.5 mW power consumption, the proposed VCO can achieve −103.3 dBc/Hz phase noise at 1 MHz offset, with a resulting tuning range figure-of-merit (FOM_T) of −187.4 dBc/Hz. Full article

Background/Objectives: Frailty, a syndrome characterized by diminished physiological reserves and increased vulnerability to stressors, is a strong predictor of adverse outcomes in heart failure. The MECKI (Metabolic Exercise Cardiac Kidney Index) score, derived from cardiopulmonary exercise testing and renal function parameters, has demonstrated prognostic value in HF patients. This study aimed to evaluate the prognostic value of physical frailty on mortality in patients with advanced heart failure and to compare it directly with the MECKI score. Methods: A total of 104 patients with advanced HF receiving optimized guideline-directed medical therapy were prospectively enrolled. At baseline, all patients underwent clinical, echocardiographic, and laboratory assessment and CPET for MECKI score calculation. Physical frailty was assessed using a modified Fried phenotype tailored for HF. The composite endpoint comprised all-cause mortality, urgent heart transplantation, or LVAD implantation. Results: Over a mean follow-up of 30.0 ± 15.3 months, there were 25 deaths, 5 urgent heart transplants, and 1 LVAD implantation. Patients who experienced the composite outcome had significantly worse NYHA class, higher NT-proBNP, lower VO₂max, higher VE/VCO₂ slope, higher frailty, and higher MECKI score (all p < 0.001). Frailty was significantly correlated with all MECKI score components, as demonstrated by Spearman’s rank correlation analysis. Both frailty (HR = 1.89; 95% CI 1.22–2.93; p = 0.005) and MECKI score (HR = 1.04; 95% CI 1.00–1.08; p = 0.037) independently predicted outcomes. ROC analysis showed high and comparable discriminative performance (AUC = 0.86 for frailty; AUC = 0.88 for MECKI). Conclusions: Physical frailty and MECKI scores independently predict mortality and adverse events in advanced HF. Physical frailty, despite its simplicity and low cost, provides prognostic insight comparable to the MECKI score and may represent a practical alternative when CPET is unavailable. Full article

Vaccination is a tool to control Lawsonia intracellularis (LI) in pigs. However, pigs may have co-infections that worsen clinical signs and lesions. The aim of this study was to characterize systemic and gut-mediated humoral and cell-mediated immune (CMI) responses in pigs vaccinated with a killed intramuscular LI vaccine and to analyze the impact of co-infection with Brachyspira hyodysenteriae (Bhyo) on the immune response. The study included eighty pigs and five study groups: V-CO (LI-vaccinated and co-infected with LI + Bhyo, n = 21), P-CO (placebo and co-infected with LI + Bhyo, n = 18), V-LI (LI-vaccinated and infected with LI, n = 21), P-LI (placebo and infected with LI, n = 12), and NC (negative control, placebo and non-challenged, n = 8). Parameters analyzed: fecal score and pathogen shedding), gross intestinal lesions, LI intestinal colonization (IHC), serum IgG, LI-specific IFN-γ production (ELISPOT), and immune cell subsets (flow cytometry) in blood, mesenteric lymph nodes, Peyer’s patches, and intestinal epithelium. LI vaccination significantly reduced LI fecal shedding, intestinal colonization, and macroscopic lesions—even under Bhyo co-infection. Vaccinated pigs had earlier and stronger serum IgG and IFN-γ responses. B cells seem to play an important role in the local immune response, and T regulatory cells apparently do not have a significant role in immunomodulation. This study contributes to a better understanding of LI immune response and can provide subtract for further research in the control of LI. Full article

Background: Precise measurement of resting energy expenditure (REE) is essential in the intensive care unit (ICU), where metabolic requirements evolve throughout the course of critical illness. Predictive equations frequently fail to capture this variability, and limited data describe phase-dependent changes in REE using indirect calorimetry (IC). This study aimed to evaluate phase-related variation in REE and metabolic phenotypes in mechanically ventilated adults and to identify clinical and physiological correlates of both absolute REE and REE normalized by ideal body weight (REE/IBW). Methods: We conducted an observational, retrospective cross-sectional study in two ICUs at different hospitals. A total of 149 mechanically ventilated adults with a valid IC measurement were included and classified by illness phase: acute (0–3 days), intermediate (4–14 days), or chronic (>14 days). Differences in metabolic and gas-exchange variables were assessed using ANOVA or Kruskal–Wallis tests. Two multivariable linear regression models were fitted, one using absolute REE and a second using REE/IBW, incorporating metabolic phenotype categories to account for body-size heterogeneity. Results: Metabolic profiles differed across illness phases. Median REE increased from the acute (1664 kcal/day) to the intermediate (1869 kcal/day) and chronic (2074 kcal/day; p = 0.024) phases. Hypometabolic profiles were more frequent in the acute phase (64%), whereas hypermetabolic profiles were more prevalent in later phases (48%). RQ values were higher in the chronic phase compared with the acute phase (median 0.99 vs. 0.80; p < 0.001). In multivariable analyses, illness severity scores showed weak or inconsistent associations with REE after adjustment for gas-exchange variables. VCO₂ was independently associated with absolute REE (adjusted R² = 0.83). In the REE/IBW model, VCO₂, RQ, BMI, and metabolic phenotype were associated with normalized energy expenditure, with higher adjusted R² (0.87) and lower prediction error metrics. Conclusions: Resting energy expenditure and metabolic phenotypes vary across phases of critical illness. Gas-exchange variables, particularly VCO₂, were more closely associated with measured energy expenditure than severity scores. Normalization of REE by ideal body weight reduced variability and improved model performance, highlighting the analytical value of indirect calorimetry for characterizing phase-dependent metabolic patterns in critically ill adults. Full article

Background: Sleep quality is critical to health, and its disturbances may affect multiple systems, including autonomic and respiratory regulation. However, its relationship with chronotropic and ventilatory responses in healthy young men remains underexplored. Thus, the study aimed to investigate the relationship between sleep quality, as measured by the Pittsburgh Sleep Quality Index (PSQI), and chronotropic and ventilatory responses during cardiopulmonary exercise testing (CPET) in a healthy young male population and to explore group differences between good and poor sleepers. Methods: Thirty-three healthy men completed the PSQI and a graded CPET with breath-by-breath gas analysis. Pearson correlation was used to examine relationships between the PSQI and CPET outcomes: chronotropic response (%), tidal volume (VT), minute ventilation (VE), VO₂, VCO₂, expired O₂/CO₂, VE/VO₂, and VE/VCO₂. After accounting for age, height, and weight, the correlation was reassessed. Secondary analyses using a standard cut-off point compared good (PSQI < 5) vs. poor sleepers (PSQI ≥ 5) with Welch’s t-tests. Results: Participants were predominantly poor sleepers (84.8%; PSQI 7.3 ± 3.2). A higher PSQI correlated with lower chronotropic response (r = −0.35, p = 0.04), lower VT (r = −0.42, p = 0.02), lower expired O₂ (r = −0.46, p = 0.01), and lower expired CO₂ (r = −0.33, p = 0.05). Associations with VE, VO₂, VCO₂, VE/VO₂, and VE/VCO₂ were small and non-significant (p > 0.05). When age, height, and weight were controlled for, the attenuated chronotropic response association with the PSQI was not significant; however, the PSQI association remained significant for expired O₂ (r = −0.32, p = 0.04), with a trend for VT. In group comparisons, chronotropic response was higher but not significant; good sleepers showed higher VT and greater expired O₂/CO₂ (p < 0.05). Conclusions: Poorer sleep quality was initially associated with multiple cardiopulmonary responses at peak during CPET. However, after controlling for age and anthropometry measures, only expired O₂ remained linked. The findings suggest that routine sleep quality screening may add interpretive value to CPET by flagging individuals with reduced ventilatory depth, warranting prospective studies to test whether improving sleep quality can enhance exercise responses. Full article