Search Results (167)

Background: Portal hypertension is a major cause of esophagogastric variceal bleeding in children. Endoscopic therapy is widely used for acute hemostasis; however, it primarily controls the bleeding episode rather than the underlying portal hypertensive physiology, and definitive management often requires surgical portal decompression. Evidence regarding the outcomes of a staged endoscopic–surgical management strategy in pediatric patients remains limited. This study aimed to evaluate the clinical outcomes of children with portal hypertensive bleeding managed with endoscopic hemostasis as a bridging therapy followed by definitive portal decompression surgery. Methods: We conducted a retrospective consecutive cohort study including 12 children presenting with portal hypertension-related variceal bleeding at our tertiary pediatric center between January 2021 and December 2024. All patients underwent endoscopic hemostasis, followed by evaluation for portal decompression surgery when anatomically feasible. Clinical outcomes including hemostasis success, rebleeding, shunt patency, and survival were analyzed. An age-stratified exploratory analysis was performed to examine the association with early dysfunction after Rex shunt reconstruction. Results: Endoscopic hemostasis was successfully achieved in all patients, with no early rebleeding prior to surgery. Ten patients underwent portal decompression surgery within 7 days (Rex shunt, n = 8; splenorenal shunt, n = 2). During a median follow-up of 18 months, early Rex shunt dysfunction (<3 months) was observed in 2 of 8 patients (25%), both of whom were younger than 3 years, whereas no dysfunction was observed in older children. Given the small sample size, this observation should be interpreted descriptively. Rebleeding and mortality occurred exclusively in association with shunt dysfunction. Conclusions: A staged endoscopic–surgical strategy appears feasible for stabilizing children with acute portal hypertensive bleeding and enabling timely definitive portal decompression. In this small cohort (n = 12), an age-related signal in early Rex shunt dysfunction was observed in very young children; however, this finding should be interpreted cautiously and requires further validation in larger studies. Full article

As social infrastructure intensively developed during the high economic growth period of the 1970s faces simultaneous aging, there is an urgent need to transition from conventional reactive maintenance to preventive maintenance utilizing various data (data-driven asset management. However, the greatest barrier in practice is that inspection data is unevenly distributed in analog formats such as paper and unstructured files, and heavily relies on the subjective visual evaluation of expert engineers (e.g., discrete graded evaluations from A to D). The intervention of this “Assessor Bias” makes it difficult to ensure the robustness required for direct statistical analysis. This paper serves as a bridge between this analog expert knowledge and quantitative data science. It formulates human cognitive conflicts (true state, peer pressure, avoidance of cognitive load) using the distance-decay model of the Analytic Hierarchy Process (AHP) and the Softmax function, constructing a micro-macro link model accompanied by stochastic variations. Through large-scale multi-agent simulations ($N={10}^7$) validating the model’s convergence, it was demonstrated that in long-tail distributions formed under peer pressure, macroscopic statistical distance metrics such as the Kullback-Leibler (KL) divergence ignore the fact that a small number of true signals are non-linearly suppressed, causing a statistical misinterpretation that “the error is within an acceptable range”. This implies that as long as macroscopic statistical indicators are over-trusted, signs of critical deterioration (minorities) will be structurally marginalized. Returning to the debate on “Homogeneity (Homogenität)” in German social statistics, this paper advocates that in order to realize objective “Micro-segmentation of Homogeneous Statistical Populations,” a paradigm shift from qualitative methods relying on human intuition to quantitative methods incorporating multi-criteria decision making is essential, rather than simply expanding the sample size. Full article

A key limitation in contemporary HF management is the marked heterogeneity of the syndrome, driven by diverse pathophysiological mechanisms that are not fully captured by traditional classifications based on left ventricular ejection fraction. Precision medicine has emerged as a promising approach to address this heterogeneity by integrating clinical characteristics, circulating biomarkers, advanced imaging, and computational phenotyping strategies. However, current frameworks predominantly emphasize myocardial dysfunction, while the contribution of vascular abnormalities remains underrepresented. The interaction between the left ventricle and the arterial system plays a fundamental role in cardiovascular performance. Arterial stiffness, commonly assessed by pulse wave velocity (PWV), represents a key determinant of vascular aging and a robust predictor of cardiovascular risk. Increasing evidence suggests that vascular dysfunction contributes significantly to the pathophysiology and clinical expression of HF, particularly in phenotypes characterized by preserved ejection fraction. This review synthesizes current evidence on precision medicine in HF and highlights the emerging role of arterial stiffness and PWV in multidimensional patient phenotyping. We propose that integrating vascular parameters into existing phenotyping frameworks may enhance risk stratification, improve mechanistic understanding, and support the development of more personalized therapeutic strategies in heart failure. Unlike previous reviews that have addressed arterial stiffness or heart failure phenotyping separately, this work uniquely integrates ventricular–vascular interaction and pulse wave velocity into a comprehensive precision medicine framework for heart failure. By bridging vascular physiology with data-driven phenotyping strategies, this review provides a novel conceptual model for incorporating arterial stiffness into multidimensional patient characterization across the full spectrum of heart failure phenotypes. Full article

Objectives: The Impella 5.5 (J&J MedTech, USA) is increasingly used for refractory cardiogenic shock (CS), yet early predictors of mortality and recovery remain unclear. This study aimed to evaluate early patient characteristics and device-related parameters in relation to clinical outcomes; to compare outcome-based phenotypic groups (native heart recovery (NHR), heart replacement therapy (HRT), and death on the device (DEC)); and to analyze P-level impact on hemolysis and acute kidney injury. Methods: This retrospective single-center study included 28 CS patients supported with Impella 5.5 between May 2023 and August 2024. Data included intensive care unit (ICU) hemodynamics, vasoactive-inotropic score (VIS), lab markers, and pump parameters. Primary analysis evaluated early (first 24 h) parameters as potential indicators associated with mortality on the device and recovery, while secondary analyses compared hemodynamic and pump performance parameters across outcome groups, evaluated the association between P-level and hemolysis, and assessed the impact of shock etiology on clinical outcomes. Results: Among 28 patients (mean age 56 years, 10.7% female, body mass index (BMI) 27.7 kg/m²), NHR occurred in 39.3% and bridged to HRT in 42.9%. Non-survivors (17.8%) had significantly higher lactate (3.1 vs. NHR: 1.9 vs. HRT: 1.4 mmol/L, p < 0.001) and VIS (307.0 vs. NHR: 18.8 vs. HRT: 12.6, p < 0.001) at implantation. Higher VIS values (>69) were strongly associated with mortality on the device, with 100% sensitivity and 77% specificity (area under the curve (AUC) = 0.86); VIS < 9.9 was related to NHR (AUC = 0.63, 94% sensitivity, 45% specificity). P-levels were not linked to hemolysis index (r = −0.03, p = 0.64) or lactate dehydrogenase (r = −0.06, p = 0.37). Conclusions: Early vasoactive burden was associated with clinical outcomes in Impella 5.5-supported patients. No association between P-levels and the analyzed hemolysis surrogates was detected in this cohort. Distinct phenotypes across recovery outcomes may guide personalized management, but prospective validation of this exploratory and hypothesis-generating analysis is needed. Full article

The growing complexity, age, and environmental exposure of civil infrastructure assets—bridges, tunnels, buildings, highways, and dams—have necessitated a transition from reactive or preventive maintenance strategies toward predictive, data-driven systems. The integration of IoT and Digital Twin (DT) technologies provides a transformative paradigm for intelligent monitoring, early fault detection, and real-time lifecycle management. This paper explores the technological convergence of IoT sensor networks, edge-cloud analytics, and digital twin platforms for predictive maintenance in civil and structural engineering. The study presents a multi-layered DT–IoT integration framework designed for infrastructure assets, emphasizing interoperability, cybersecurity, and semantic data synchronization. Key research outcomes include enhanced asset availability, reduced maintenance costs, and improved safety margins. The proposed architecture incorporates sensor-level digital shadows, edge inference modules, and cloud-based analytical twins powered by hybrid machine learning and finite element models. Real-world applications and case studies from smart bridges and intelligent building systems demonstrate prediction accuracies exceeding 90% in identifying early structural fatigue indicators. Ultimately, the results underscore the strategic role of DT–IoT convergence in realizing sustainable, resilient, and self-aware civil infrastructure aligned with Industry 5.0 principles. This study provides a roadmap for digital transformation in asset management, integrating standards such as International Organization for Standardization (ISO) 23247 and ISO 19650 to ensure interoperability and lifecycle traceability. The results reinforce that predictive maintenance through DT and IoT integration is not only technically viable but essential for extending infrastructure lifespan, minimizing unplanned downtime, and achieving carbon-efficient asset operation. Full article

Background: Bone and soft tissue sarcomas, while rare, making up less than 2% of adult cancers with an incidence below 5 per 100,000 annually, present a significant challenge due to their varied and often obscure pathology. Additionally, the absence of global sarcoma awareness contributes to delayed interventions, necessitating more-aggressive treatments and increasing mortality risks. Conversely, cancers such as breast and colon have seen improved outcomes through effective screening and early-management strategies. Methods: In this cross-sectional study, out of the total number of participants approached, using a preset questionnaire, by trained medical students to participate in this study, 626 met the inclusion criteria. The questionnaire started with an informed consent process followed by a set of questions regarding sociodemographic characteristics and lifestyle. Subsequently, the questionnaire delved into their understanding and awareness of bone and soft tissue sarcomas, focusing on risk factors, recognizable signs and symptoms, and tendencies regarding health-seeking behavior. Results: In this study with 626 participants, demographic insights showed a young cohort, with 43.5% between 21 and 30 years, and a male predominance of 60.1%. Risk factor awareness was moderate; genetics and smoking were recognized as primary risks for sarcomas. Participants showed limited awareness of sarcoma signs, symptoms, and management, with a substantial percentage unsure about the most at-risk age group, gender differences in risk, and recognizability of symptoms. Barriers to seeking medical care included a passive attitude towards healthcare, fear, and accessibility issues. Most participants had limited knowledge of sarcomas, with 58% unaware of risk factors and 72.3% of signs and symptoms. Conclusions: This study emphasizes the necessity for targeted interventions to bridge the knowledge gap and promote early detection practices, which could significantly impact the prognosis of sarcoma patients. Full article

Background: Intramyocardial bridge (MB) is a coronary anomaly characterized by a segment of the artery tunneling within the myocardium. While often asymptomatic, it may lead to ischemic events. Despite traditional disqualification from competitive sports, 2023 guidelines now permit participation for athletes with MBs that do not meet specific high-risk morphological criteria. This study aims to evaluate a novel combined provocative test, integrating Cardiopulmonary Exercise Testing (CPET) and stress echocardiography for the assessment of myocardial deformation (twist), to assess the functional impact of MB in asymptomatic athletes. Methods: This cross-sectional case–control study included 18 participants (nine cases with “significant” MB diagnosed via Computed Tomography (CT) coronary angiography and nine healthy, trained controls), aged 18–78 years. All subjects underwent evaluation at our facility for competitive certification. Assessment protocols included resting echocardiography, Global Longitudinal Strain (GLS), and Cardiopulmonary Exercise Testing (CPET) to quantify exercise capacity and dynamic myocardial function. Results: No significant differences in echocardiographic parameters were observed between groups at rest. However, during exercise, athletes with MB demonstrated a significant reduction in GLS and ventricular twist compared to the control group. These findings indicate a notable loss of apical reserve in the MB cohort during physical stress. Conclusions: The integration of CPET and myocardial deformation analysis provides an effective diagnostic tool for identifying functional impairment in asymptomatic athletes with MB. This combined approach offers a superior follow-up strategy for managing athletes who may be at risk for ischemic events despite lack of clinical symptoms. Full article

Acute lymphoblastic leukemia (ALL) presents significant clinical challenges due to its genetic complexity and high relapse rates. While outcomes like length of stay (LOS), mortality, and total charges (TCs) are critical quality indicators, most existing models rely on static data and separate outcome modeling. This study utilized the HCUP National Inpatient Sample (NIS) to develop a dynamic, concurrent prediction model for prolonged LOS and mortality (PLOSM), alongside a framework for TCs. By integrating temporally updated patient information, the concurrent approach outperformed single-outcome models. Within the first seven days of hospitalization, the model achieved accuracy and precision above 90%, with recall and F1-scores exceeding 80%. Key predictors of these outcomes included age, race, insurance type, financial indicators, and elective surgery status. Notably, both prolonged LOS and mortality were significant drivers of TCs. By bridging predictive modeling and real-time clinical data, this framework enables data-driven decision-making to optimize patient management, enhance safety, and mitigate the financial burden of ALL care. Full article

Degenerative mitral stenosis (MS) secondary to extensive mitral annular calcification (MAC) represents a growing clinical challenge in an aging population. These patients are often elderly, frail, and harbor a significant burden of comorbidities, rendering conventional mitral valve surgery prohibitively high-risk. While transcatheter mitral valve replacement (TMVR) has emerged as a potential alternative, the current evidence is only derived from single-arm observational registries. Therefore, the transition toward randomized controlled trials to define optimal patient selection and long-term prosthetic durability is necessary. This review examines the current landscape of TMVR for degenerative MS, focusing on the role of multimodal pre-procedural planning, procedural technique, and prevention of the principal complications. The integration of echocardiography and multi-slice computed tomography (MSCT) is essential for evaluating anatomical feasibility, particularly in predicting neo left ventricle outflow tract (neo-LVOT) obstruction, the primary determinant of procedural mortality. However, it is limited due to the absence of standardized protocol. We are showing the outcomes of off-label balloon-expandable aortic prostheses and dedicated TMVR system, which are the only two devices which data in patients with MS are available. Despite high technical success rates in specialized centers, complications, including paravalvular leak, valve thrombosis, and device migration, remain more prevalent than in aortic interventions. We present some tips and tricks to prevent and manage adverse events. TMVR represents a transformative frontier for inoperable patients with severe MAC. However, its routine clinical adoption requires further refinement of dedicated technologies and standardized imaging protocols to improve safety and bridge the gap between palliative medical therapy and definitive intervention. Full article

Background/Objectives: Impella support is increasingly utilized as a crucial bridge to durable left ventricular assist device (LVAD) in patients with refractory cardiogenic shock. However, the transvalvular path of the Impella catheter raises concerns regarding mechanical trauma, potentially precipitating or accelerating aortic regurgitation (AR). We aimed to characterize the complete longitudinal trajectory of AR following Impella bridge-to-LVAD and to determine its association with clinical and hemodynamic sequelae. Methods: We conducted a single-center retrospective cohort study including all patients bridged from Impella to durable LVAD between 2013 and 2024 (n = 19). At Impella initiation, all patients met the retrospective SCAI shock stage D or worse criteria. At LVAD implantation, all patients were classified as INTERMACS 1–2 (INTERMACS 2, n = 13). The Impella models were 5.0 in 11 (axillary access), 2.5 in 5 (femoral access), and CP in 3 (femoral access); no periprocedural Impella complications were recorded. The implanted LVAD systems were HeartMate II (n = 7), HVAD (n = 3), and HeartMate III (n = 9). Patients undergoing concomitant aortic valve intervention were excluded. Transthoracic/TEE echocardiography was performed at prespecified time points (pre-Impella, pre-LVAD, post-LVAD discharge, 12 months, and 24 months) with standardized aortic regurgitation (AR) grading. Right ventricular (RV) function was assessed qualitatively when quantitative indices (TAPSE) were unavailable. Primary endpoints were new or progressive AR and AR severity at LVAD implantation. Secondary endpoints included survival, renal dysfunction, biomarkers, and rehospitalization. Univariate analyses were used to compare outcomes according to AR severity. Results: Nineteen patients (68% male, median age 57 years, IQR 47–60) underwent Impella support for 13.3 ± 9.9 days before HeartMate 3 (84%) or HVAD (16%) implantation. All patients had competent aortic valves (grade 0 AR) at the time of LVAD implantation. AR ≥ mild developed in 9/18 (50%) at discharge, 12/15 (80%) at 12 months, and 13/15 (87%) at 24 months, and 8/15 (53%) progressed to ≥ moderate AR by 24 months. Patients with moderate-to-severe AR had higher NT-proBNP levels at 12 months (median 6318 vs. 2336 pg/mL, p = 0.137). Thirty-day and 24-month survival rates were 95% and 79%, respectively. Conclusions: Aortic regurgitation frequently develops or progresses from the pre-LVAD period to follow-up in patients bridged from Impella to durable LVAD. Although limited by a small sample size and incomplete quantitative RV metrics, these observations support structured echocardiographic surveillance after Impella use and management strategies—routine valve inspection at LVAD implantation and post-LVAD speed/blood pressure targets that encourage aortic valve opening—to mitigate the risk and clinical impact of aortic regurgitation. Full article

Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss worldwide and is driven by complex pathophysiological processes, including oxidative stress, chronic inflammation, complement dysregulation, and vascular endothelial growth factor (VEGF)-mediated neovascularization. Nutritional interventions—particularly supplementation with carotenoids, omega-3 fatty acids, polyphenols, and essential micronutrients—have demonstrated clinical benefits in slowing disease progression, as evidenced by landmark trials such as AREDS and AREDS2. However, many AMD-relevant bioactives exhibit poor aqueous solubility, low chemical stability, and limited gastrointestinal bioavailability, which significantly constrain their therapeutic efficacy. Food-grade microgels have emerged as versatile colloidal delivery platforms capable of addressing these limitations through rational structural and physicochemical design. This review provides a systematic roadmap for developing food-grade microgels, organized into: (1) the molecular design of protein- and polysaccharide-based networks; (2) advanced fabrication strategies such as microfluidics and atomization; (3) spatiotemporal release programming within the gastrointestinal tract; and (4) multi-nutrient synergy for retinal protection. This approach highlights how controlled crosslinking, interfacial assembly, and tunable network architectures enhance nutrient stabilization. Particular emphasis is placed on spatiotemporal release programming within the gastrointestinal tract, including diffusion-limited gastric retention, pH- and bile-responsive swelling in the small intestine, and microbiota-triggered degradation in the colon. These mechanisms collectively enable region-specific release, improved micellar incorporation, enhanced systemic absorption, and more consistent retinal delivery. Furthermore, we discuss co-encapsulation strategies that accommodate both hydrophilic and lipophilic bioactives, thereby minimizing antagonistic interactions and enabling synergistic nutritional modulation of oxidative and inflammatory pathways implicated in AMD. A central novelty of this review is the integration of the gut–eye axis, framing microgel-based oral delivery as a systemic pathway to modulate retinal health via the intestinal environment. By bridging retinal disease biology with food colloid science, this review proposes food-grade microgels as a translational platform for next-generation nutraceutical interventions. The integration of programmable release behavior with clinically validated nutrient regimens offers a promising pathway toward more effective and mechanistically informed dietary management of AMD. Full article

The implementation of digital twin (DTw) in infrastructure management is becoming increasingly important. Although digitalization in the Architecture, Engineering, Construction, and Operations (AECO) sector is progressing slowly, enabling technologies such as Building Information Modelling (BIM), Geographic Information Systems (GIS), Internet of Things (IoT) and data management allow for more informed and efficient management of ageing and highly complex assets. With the aim of improving the operation and maintenance (O&M) of transport infrastructure, the use of an integrated BIM–GIS model is proposed as the basis for a future DTw for an existing highway, the M-30 urban ring road in Madrid. This study develops an as-built digital model based on real GIS data, point clouds and BIM (LOD 300), adapting it to existing management systems using a relational database with unique identifiers. The infrastructure is modelled in a segmented and georeferenced manner, incorporating roads, tunnels, bridges and equipment as independent entities. Access to the model is guaranteed through 3D GIS scenes, interactive panels and BIM viewers geared towards management. In addition, a cost–benefit analysis is carried out using a Return On Investment (ROI) that evaluates the implementation of BIM in the management of this infrastructure. Full article

Maintenance of skeletal muscle mass is essential for mobility, metabolic homeostasis, and clinical outcomes across a wide spectrum of physiological and pathological conditions. While muscle atrophy and hypertrophy have traditionally been interpreted through upstream anabolic–catabolic signaling and proteolytic pathways, accumulating evidence indicates that ribosome biogenesis and translational control represent rate-limiting determinants of muscle plasticity. However, this regulatory layer remains insufficiently integrated into current models of muscle adaptation and disease. In this review, we synthesize recent advances in ribosomal RNA transcription, ribosomal protein dynamics, and translational regulation in skeletal muscle, with particular emphasis on signaling networks governed by mTORC1, c-Myc, AMPK, and FOXO. We highlight ribosome biogenesis as a central hub linking mechanical loading, nutrient availability, inflammatory stress, and metabolic status to protein synthesis capacity. Evidence from human and animal studies demonstrates that impaired ribosome production and translational efficiency precede and predict muscle atrophy in disuse, aging, cancer cachexia, and chronic disease, whereas ribosome expansion is a prerequisite for sustained hypertrophy. Beyond quantitative regulation, we discuss the emerging concept of ribosome heterogeneity as a qualitative layer of translational control that may enable selective mRNA translation during muscle growth, stress adaptation, and degeneration. We further examine ribosome–mitochondria crosstalk as a critical but underexplored mechanism coordinating anabolic capacity with cellular energetics. Finally, we outline therapeutic implications, highlighting exercise, nutritional strategies, and indirect pharmacological interventions that preserve ribosomal competence, and propose ribosome-based biomarkers as promising tools for precision management of muscle-wasting disorders. Collectively, this review positions ribosome biology as a translationally relevant framework bridging molecular mechanisms with therapeutic perspectives in skeletal muscle atrophy and hypertrophy. Full article

Sustainable aviation requires electrical power systems that can deliver both high energy and high power. Hybrid fuel cell–battery architectures offer a promising solution to meet these demands, and their overall performance can be significantly enhanced through the application of energy management strategies (EMSs). This paper develops several EMSs approaches, including rule-based state machine, equivalent consumption minimisation strategy (ECMS), and dynamic programming (DP) for a hybrid fuel cell–battery aircraft targeting specific objectives, such as improving system efficiency, reducing hydrogen consumption and extending battery lifetime. The EMS approaches are then evaluated across both nominal missions and a fuel cell-failure scenario to assess their effectiveness in meeting their defined objectives. Results show that while ECMS achieves the lowest cost per mission, it does not maximise system efficiency. DP provides the highest overall energy efficiency and longest battery lifetime but is limited to offline implementation. To bridge this gap, a hybrid DP–ECMS strategy is introduced and evaluated. The results show that the approach delivers globally optimal performance under nominal conditions, accounting for the trade-offs between cost, efficiency, and battery ageing, while also preserving real-time responsiveness during unforeseen events. This demonstrates the benefits of combining offline optimisation with real-time control for hybrid electric aircraft. Software-in-the-loop (SIL) further validates the real-time applicability and robustness of the proposed strategy. Full article

Background/Objectives: Ventricular repolarization abnormalities (VRA) represent a grey area in athlete screening: some patterns are physiological, while others are precursors to heart disease. Objective: to clarify the natural history of VRA and the associated factors of structural diagnosis. Methods: Retrospective observational single-center study of athletes with resting or stress VRA at the first evaluation, with normal echocardiography; minimum follow-up of 2 years. Clinical data, resting and stress ECG, echocardiography, and selective advanced imaging throughout follow-up were collected. Primary outcome: cardiovascular diagnosis at follow-up; time-to-event analysis and associations between ECG characteristics and diagnosis. Results: Fifty-three athletes (mean age 22.2 ± 9.2 years; 92.5% male) were included; 60.4% had resting VRA, and 100% had exercise-induced VRA at baseline. Over 7.3 ± 4.5 years, 28/53 (52.8%) received a diagnosis; median time-to-detection was 7.0 years (95% CI 6.0–not reached); RMST10 was 6.7 years (95% CI 5.7–7.7). Diagnoses included hypertrophic cardiomyopathy (24.5%), non-ischaemic left-ventricular scar (11.3%), myocardial bridging (7.5%), hypertensive remodelling (5.7%), coronary anomaly (1.9%), and ventricular pre-excitation (1.9%). Persistence of resting VRA from baseline to follow-up was more frequent in athletes with a final diagnosis (p = 0.01), whereas topography and exercise-induced abnormalities did not discriminate groups. Advanced imaging contributed substantially to case ascertainment. No major adverse cardiovascular events have been identified throughout follow-up. Conclusions: In athletes with screening-detected VRA and normal echocardiography, persistence of resting VRA was associated with higher detection of a cardiovascular diagnosis, while exercise-induced changes alone show limited diagnostic yield. The long median time-to-detection supports prolonged, pre-planned surveillance, with priority for advanced imaging in profiles with persistent abnormalities. These findings align with a risk-adapted, personalized management strategy in sports cardiology. Full article