Search Results (81)

The number of pulmonary nodules detected is steadily increasing. While some are low or high risk, most are indeterminate. Within the indeterminate group, the vast majority are benign. Statification of indeterminate pulmonary nodules (IPNs) is challenging. Validated risk calculators are not routinely employed in clinical practice because they are cumbersome. Most clinicians rely upon clinical gestalt. This strategy often results in unnecessary biopsies, which are costly, stressful, and have the potential for iatrogenic injury. There are a number of commercially available lung cancer risk biomarkers, which each have their own strengths and weaknesses. Barriers to widespread adoption include lack of guideline support, clinical practice inertia, and limited clinical utility data. Upcoming multicenter trials aim to provide high quality data that could lead to guideline incorporation. Full article

Medical image transmission across cloud-enabled healthcare networks has become increasingly common in modern telemedicine systems. However, existing approaches suffer from increased computational overhead, inadequate resistance against statistical attacks, poor reconstruction quality and so on. Hence, an efficient secure medical image transmission framework that integrates compression and encryption is needed. This work presents a ‘denoising-compression-encryption’ framework, which integrates Huang’s Block Truncation Coding (HBTC) with Gauss-iterated map with Inertia Weight-based Chimp Optimization Algorithm (GIW-CHO) optimized Elliptic Curve Cryptography (ECC) and termed as ‘OKBECC’. Initially, the images are denoised for intensity stabilization and then HBTC is employed to binarize and decorrelate the images. Finally, encryption is performed by ECC using the keys optimized by GIW-CHO algorithm. HBTC greatly influences the interpixel-correlation and histogram structure by reducing the entropy to approximately one before encryption, which makes it unpredictable. GIW-CHO helps explore larger key space and provides stronger optimal keys, which helps in attaining better quality of reconstructed image. The proposed work is tested across different image modalities including X-ray, ultrasound, Magnetic Resonant Imaging (MRI), Computed Tomography (CT) and histopathology upon standard performance measures. The proposed OKBECC shows an average NPCR, UACI and cipher entropy of about 99.6%, 33.4% and 7.99 bits, respectively, which outperforms multiple existing algorithms. In addition, the image reconstruction quality is proven with PSNR of about 68 dBs, which is clinically acceptable. Full article

Background: Workplace victimization is a form of repeated and systematic psychological violence that can severely affect both mental and physical health. From a psychological perspective, it impacts mood states, defense mechanisms, and personality functioning. Methods: This cross-sectional study investigated the psychological and behavioural correlates of workplace victimization in a sample of 33 workers from various professional sectors, using a multidimensional assessment including standardized measures of personality traits, mood states, and defense mechanisms. Results: The MMPI-2 profile revealed elevated scores in Hypochondriasis (Hs: 72.00), Depression (D: 70.21), Hysteria (Hy: 67.61), and Paranoia (Pa: 68.76), indicating somatic symptoms, depressive features, and suspiciousness. The POMS showed increased Tension–Anxiety (T: 65.06), Depression–Dejection (D: 68.21), Anger–Hostility (A: 68.15), and Fatigue–Inertia (F: 65.24), alongside reduced Vigor–Activity (V: 43.18). The DMI analysis highlighted a high Reversal score (REV: 65.91), suggesting a predominant use of defense mechanisms such as altruism and idealization to cope with distress. Conclusions: In this selected sample of adults referred for psychological evaluation for suspected or documented workplace victimization, participants showed a clinically relevant psychological burden, including depressive symptoms, somatic concerns, Anger–Hostility, fatigue, reduced vigor, and specific defensive patterns. Given the cross-sectional design, small sample size, and absence of a control group, these findings should be interpreted as preliminary and cannot establish causality or the specificity of this profile to workplace victimization. Full article

Chronic kidney disease (CKD) is a major global health burden associated with substantially increased risks of morbidity and mortality. Cardiovascular disease remains the leading cause of death across all stages of CKD. Over the past few decades, several pharmacologic therapies—including renin–angiotensin system inhibitors, sodium–glucose cotransporter-2 inhibitors, mineralocorticoid receptor antagonists, glucagon-like peptide-1 receptor agonists, and lipid-lowering agents—have demonstrated substantial cardio-nephroprotective benefits and are recommended in international guidelines. However, real-world implementation of these therapies remains incomplete, and emerging evidence highlights important sex-based disparities in prescribing patterns. Although CKD is more prevalent in women worldwide, women with CKD are consistently less likely than men to receive guideline-directed cardioprotective and nephroprotective medications. This treatment gap spans both traditional therapies, such as angiotensin-converting enzyme inhibitors and statins, and newer agents with proven outcome benefits. Women are less likely to initiate treatment, less likely to receive high-intensity or target doses, and less likely to achieve recommended blood pressure and lipid goals. Importantly, the presence of CKD attenuates the usual female survival advantage, and the relative excess cardiovascular risk associated with CKD may be particularly pronounced in women. The under-prescription of cardio-renal therapies in women with CKD reflects a complex interplay of factors. These include older age at presentation, higher reported rates of adverse drug reactions, concerns regarding tolerability and safety in advanced kidney disease, therapeutic inertia, underestimation of cardiovascular risk, and persistent underrepresentation of women in clinical trials. Biological differences in pharmacokinetics and pharmacodynamics, as well as structural and system-level barriers, further contribute to inequities in care. Addressing these disparities requires improved risk recognition, sex-informed prescribing practices, enhanced representation of women in clinical research, and implementation strategies that incorporate sex-disaggregated performance metrics. Reducing treatment gaps is essential to improving cardiovascular and renal outcomes and to achieving equitable, precision-based care for women with CKD. Full article

Although ombitasvir/paritaprevir/ritonavir plus dasabuvir (OPrD) therapy is highly effective for chronic hepatitis C (CHC), clinicians frequently encounter transient hyperbilirubinemia, which can be misidentified as hepatotoxicity. This study investigated the role of SLCO1B1 (OATP1B1) and SLCO1B3 (OATP1B3) genetic polymorphisms in predicting bilirubin spikes and distinguishing transporter-mediated interference from hepatocellular injury. In this prospective study of 65 patients with HCV genotype 1, genotyping for OATP1B1 (c.388A>G, c.521T>C) and OATP1B3 (c.334T>G, c.699G>A) was performed using PCR-RFLP and capillary electrophoresis (QIAxcel Advanced System). Clinical and biochemical parameters were monitored over a 12-week treatment period. Hyperbilirubinemia (total bilirubin >1.1 mg/dL) developed in 18.5% of the cohort, typically within the first month. A distinct ‘AST-dominant’ biochemical signature, elevated bilirubin and AST paired with stable ALT, was identified, suggesting transporter-specific interference rather than hepatocyte damage. Statistical analysis pinpointed the OATP1B3 c.699G>A (rs7311358) variant as the sole genetic driver (p = 0.007). Carriers of the c.699G>A allele faced a 6.3-fold higher risk of developing hyperbilirubinemia (OR: 6.30, 95% CI: 1.48–26.80, p = 0.032), while no significant associations were found for OATP1B1 variants. We conclude that OATP1B3 c.699G>A is a potent predictor of OPrD-induced hyperbilirubinemia. Identifying this genotype pre-treatment allows clinicians to anticipate transient, benign bilirubin elevations and prevent unnecessary drug discontinuation, thereby mitigating therapeutic inertia and ensuring treatment continuity for CHC patients. Full article

Introduction/Objectives: Although contemporary guidelines strongly support intensive low-density lipoprotein cholesterol (LDL-C) lowering and the use of advanced lipid biomarkers for cardiovascular risk stratification, implementation in daily clinical practice remains inconsistent. This study aimed to assess current practices, knowledge, and perceived barriers in dyslipidemia management across medical specialties. Methods: We conducted a cross-sectional, anonymous online survey from August to September 2025 among physicians actively involved in lipid management. The questionnaire evaluated the use of Systematic Coronary Risk Evaluation 2 (SCORE2)-based risk assessment, familiarity with LDL-C targets, treatment intensification strategies, awareness and use of apolipoprotein B (apoB) and lipoprotein(a) [Lp(a)], perceived barriers to LDL-C goal attainment, and responses to a standardized clinical vignette. Descriptive analyses and chi-square testing were conducted. Results: Ninety-five physicians completed the survey, the majority practicing in Europe (92.7%), including 83.2% from Portugal (41.1% general practice/family medicine; 14.7% cardiology; 14.7% internal medicine/geriatrics; 14.7% vascular surgery; 9.5% endocrinology). SCORE2 calculators were used “often” or “always” by 52.6%, with significant inter-specialty variation (p < 0.001). Familiarity with LDL-C targets was high (76.8%), and 89.4% reported frequent therapy intensification when goals were not achieved; however, consistent escalation (“always”) differed markedly across specialties (p < 0.001). Although 69.5% were aware of recommendations for lifetime assessment of apoB/non–HDL-C/Lp(a), only 17.9% implemented them routinely. Most clinicians reported never or rarely using advanced biomarkers for residual risk assessment, and in a clinical vignette only 12.6% would consistently intensify therapy despite elevated Lp(a) and apoB (p = 0.004). Patient non-adherence (86.3%) was the most frequently perceived barrier. Conclusions: Despite the widespread awareness of LDL-C targets, important gaps persist in the consistent application of guideline-directed therapy and in the use of advanced biomarkers. The underutilization of apoB and Lp(a), together with therapeutic inertia and structural barriers, limits effective residual risk management. Bridging this gap will require coordinated efforts focused on implementation, access, and multidisciplinary care. Full article

Background/Objectives: Prosthesis optimization after transfemoral amputation is often guided by clinical experience, yet quantitative evidence isolating how prosthesis mass, inertial properties, and alignment affect mechanical load transmission remains limited. Musculoskeletal modeling can be used as a controlled framework for examining relative sensitivity rankings of constraint force transmission across prosthetic junctions under fixed gait inputs. Methods: A model was modified to incorporate a transfemoral prosthesis. Experimental walking data from a healthy adult reference subject (Qualisys motion capture, synchronized AMTI force plates) provided kinematics and ground reaction forces for model scaling, inverse kinematics, and loading. These inputs provided a standardized mechanical reference and were not intended to represent transfemoral amputee gait. Prosthesis mass (2.625, 3.50, 4.375 kg), inertia (0.5×, 1.0×, 1.5×), and mediolateral alignment (−10, 0, +10 mm) were varied while keeping kinematics and ground reaction forces identical across conditions. Constraint reaction forces at the socket–residual limb junction and prosthetic ankle were computed and normalized to body weight. Results: Increasing mass produced the largest monotonic increases in peak resultant constraint reactions, most prominently at the socket-level junction (8.51 → 10.48 → 12.29 BW), with smaller changes at the ankle and unchanged peak timing. Inertia caused joint-specific effects, whereas mediolateral alignment minimally affected constraint reaction forces and redistributed force components. Conclusions: This study quantified the one-factor-at-a-time effects of prosthesis mass, inertia, and mediolateral alignment on inter-segment constraint reaction forces. The reported reactions should be interpreted as net rigid-body constraint reactions under fixed inputs, not as physiological joint contact forces or direct interface loads. Full article

Hypertension remains a leading modifiable risk factor for cardiovascular morbidity and mortality. Nonetheless, blood pressure control rates remain suboptimal despite established treatment guidelines and effective pharmacologic therapies. In parallel, artificial intelligence (AI) has rapidly expanded within cardiovascular medicine, demonstrating promising capabilities in disease detection, risk prediction, and clinical decision support. However, most AI applications in hypertension have focused primarily on algorithmic performance rather than real-world implementation or measurable improvements in patient outcomes. This review examines artificial intelligence-driven hypertension management through the lens of quality improvement and prevention of end-organ damage. We summarize current applications of machine learning, deep learning, natural language processing, and imaging analytics in hypertension detection and risk stratification, and critically evaluate their integration into clinical workflows. Particular emphasis is placed on therapeutic inertia, primary care-centered implementation, and the use of AI to support continuous quality improvement frameworks. Beyond blood pressure reduction alone, we explore the potential of AI to identify patients at risk for hypertensive heart disease, heart failure, aortic pathology, renal dysfunction, and cerebrovascular events. We discuss implementation challenges, including external validation, algorithmic bias, workflow integration, and regulatory considerations, which must be addressed to ensure safe and equitable deployment. Artificial intelligence offers the opportunity to transform hypertension management from reactive blood pressure control to proactive organ protection. Critically, AI-driven quality improvement interventions must be evaluated against established non-AI strategies, including pharmacist-led management and team-based care, which provide the benchmarks for demonstrating added clinical value. Achieving this shift will require embedding predictive analytics within structured, outcome-oriented systems of care and rigorously evaluating their impact on cardiovascular morbidity and mortality. Full article

Background/Objectives: Renal denervation (RDN) has re-emerged as an adjunctive treatment option for patients with uncontrolled or resistant hypertension, with contemporary sham-controlled trials showing a modest but reproducible reduction in out-of-office blood pressure. However, in routine practice, apparent treatment resistance often reflects pseudoresistance caused by the white-coat effect, poor measurement quality, therapeutic inertia, or nonadherence. This review aimed to summarize the contemporary evidence on renal denervation in uncontrolled or resistant hypertension and to propose a pragmatic, measurement-first framework for patient selection, integration into routine care, and a structured post-procedural response assessment. Methods: This article is a narrative, implementation-focused review. A structured search of PubMed, Embase, Cochrane CENTRAL, and Web of Science was performed from database inception through January 2026. We prioritized the randomized sham-controlled RDN trials, major meta-analyses, guidelines, consensus documents, and studies addressing ABPM, HBPM, medication adherence, and telemonitoring. Results: The contemporary sham-controlled trials support RDN as an adjunctive option with a modest blood pressure-lowering effect, which is best assessed by out-of-office measurements. The placebo-adjusted reductions in ambulatory systolic blood pressure were generally in the 4–6 mmHg range. Appropriate use requires the confirmation of sustained uncontrolled hypertension, the exclusion of pseudoresistance, the optimization of treatment, and an adherence assessment. We identified three phenotypes most likely to benefit and proposed a three-axis framework for a response assessment at 3 and 6 months. Conclusions: RDN should be viewed not as a substitute for antihypertensive therapy but as a program-based adjunct for carefully selected patients. The measurement-first care pathway presented here should be interpreted as a pragmatic clinical model intended to operationalize the available trial and guideline evidence in routine care, rather than as a prospectively validated algorithm or formal consensus recommendation. Full article

Background/Objectives: Women’s health has historically lagged behind other medical specialties in transformative innovation, despite significant technological advances in adjacent fields. In this collection of papers, we examine the current state of innovation in women’s health and maternal–fetal medicine, identify barriers to transformation, and propose strategies for accelerating breakthrough developments. This paper presents an overview of multiple forces and their often-competing relationships that influence the environment in which advances in multiple areas of healthcare have had to navigate to enter mainstream practice. An understanding of these forces is essential to explain why some new technologies are readily deployed into clinical practice while others take many years to be adopted. Understanding the entire “echo-system” around any specific technology provides a much fuller understanding of how any individual advance can make its way into actual utilization. Methods: We synthesized current literature on innovation in women’s health, analyzing technological advances in artificial intelligence, precision medicine, non-invasive diagnostics, and surgical robotics. We examined patterns of innovation adoption and barriers to implementation across multiple domains. Results: Several key areas presented in this paper and the following show promise for transformative change: artificial intelligence (AI)-driven diagnostics achieving expert-level performance in prenatal screening, precision medicine approaches transforming genetic disease management, and non-invasive monitoring technologies revolutionizing maternal–fetal care. However, systemic barriers including regulatory complexity, liability concerns, and institutional inertia continue to limit widespread adoption of numerous breakthrough technologies. Conclusions: The convergence of multiple technological advances, particularly artificial intelligence and precision medicine, positions women’s health for unprecedented transformation. Success requires fostering innovation-ready environments, embracing systems-awareness approaches, and maintaining focus on human-centered care while leveraging technological capabilities with continual feedback and course corrections. Full article

Dysglycemia represents an early and progressive stage of cardiometabolic disease, characterized by IR, metabolic inflammation, and increased cardiovascular risk. Its high prevalence and largely asymptomatic course often lead to diagnostic and therapeutic inertia, resulting in missed opportunities for early intervention. Recognizing dysglycemia as a disease continuum rather than a transitional condition supports the need for anticipatory and integrated preventive strategies. Within this framework, nutraceuticals are emerging as valuable supportive tools in the management of dysglycemia, particularly in individuals with increased metabolic risk who are not yet candidates for pharmacological therapy. Nutraceutical compounds can target key pathophysiological mechanisms underlying dysglycemia, including impaired insulin sensitivity, oxidative stress, chronic low-grade inflammation, and altered postprandial glucose metabolism. Clinical evidence supports the use of selected micronutrients, polyphenols, and standardized plant extracts in improving fasting and postprandial glycemic control. Phytocomplexes derived from plants such as Mangifera indica, Momordica charantia, and Malus domestica exert complementary and multitarget actions, including modulation of carbohydrate absorption, activation of AMPK-related pathways, enhancement of peripheral glucose uptake, stimulation of incretin secretion, and improvement of endothelial function. When integrated with lifestyle and dietary interventions, nutraceuticals may reduce glycemic variability, improve metabolic resilience, and delay progression toward type 2 diabetes. Overall, nutraceuticals represent a rational bridge between lifestyle measures and pharmacological treatment in the personalized management of dysglycemia. Full article

Background/Objectives: While postpartum depression is widely screened, the predictive value of antenatal symptoms remains underutilized. This study aimed to retrospectively analyze the longitudinal trajectory of depressive and anxiety symptoms from mid-pregnancy to the late postpartum period to identify critical windows for intervention and assess the impact of mental health service utilization. Methods: A retrospective longitudinal cohort study was conducted on 125 pregnant women monitored at the Emergency County Clinical Hospital of Craiova, Romania. Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire-9 (PHQ-9), while anxiety was evaluated using the Generalized Anxiety Disorder-7 (GAD-7) scale. Data were collected at four intervals: 20–24 weeks (T1), 32–36 weeks (T2), 6 weeks postpartum (T3), and 12 weeks postpartum (T4). Results: The highest burden of depressive symptoms occurred in the antenatal period (mean EPDS: 15.6 ± 9.41) rather than postpartum. Antenatal depression scores were strongly correlated with postpartum scores (rho = 0.98, p < 0.001), indicating a stable continuum of distress, though this high correlation may also reflect measurement inertia. Anxiety scores demonstrated a “plateau” effect during pregnancy (mean GAD-7 ≈ 8.0) before declining postpartum. A stratified analysis revealed a “treatment paradox”: women receiving mental health services had higher baseline morbidity and a slower rate of recovery compared to those who did not, remaining symptomatic at 12 weeks (mean EPDS: 14.2 vs. 11.0, p = 0.049). Conclusions: Perinatal distress in this cohort was primarily an antenatal phenomenon that persisted in the postpartum period. The “antenatal peak” suggests the hypothesis that screening should commence in the second trimester. Current interventions appear to stabilize but not fully resolve symptoms in high-risk women, suggesting a need for more intensive management strategies. Full article

Background: Chronic obstructive pulmonary disease (COPD) is frequently complicated by psychological distress and suboptimal treatment adherence, both of which adversely affect clinical outcomes. However, the relationship between disease severity, emotional well-being, and adherence behavior remains insufficiently characterized. Methods: This multicenter observational study included 285 patients with COPD recruited from two primary care clinics. COPD severity was classified according to GOLD criteria. Psychological well-being was assessed using the World Health Organization–Five Well-Being Index (WHO-5), and treatment adherence was evaluated using the Medication Adherence Report Scale (MARS). Multidimensional relationships between clinical variables, WHO-5, and MARS were explored using correspondence analysis with symmetrical normalization. Results: Most patients had severe or very severe COPD (GOLD 3–4, 65.6%). WHO-5 scores showed marked heterogeneity across all GOLD stages, with very low values (20–26%) contributing disproportionately to the overall data structure (total contributions up to 0.97), indicating substantial anxiety and depression-related burden. Non-adherent patients represented 28.4% of the cohort but accounted for 71.6% of the inertia in the adherence-related correspondence analysis, forming a distinct psychological and behavioral profile. Mean GOLD stage was comparable between adherent and non-adherent patients (approximately 2.8–3.0). Conclusions: Correspondence analysis demonstrated substantial heterogeneity in WHO-5 and MARS profiles across all GOLD stages. Notably, mean GOLD severity was comparable between adherent and non-adherent patients (approximately 2.8–3.0), indicating that differences in adherence behavior were not primarily driven by spirometric disease severity. Full article

Background: Atherosclerotic cardiovascular disease (ASCVD) frequently coexists with type 2 diabetes (T2D), amplifying morbidity and mortality. Glucagon-like peptide-1 receptor agonists (GLP-1RA) confer significant cardiovascular benefits and are recommended for patients with T2D and established ASCVD. However, real-world use may not reflect a complication-driven therapeutic approach. Methods: This retrospective study included adults with T2D and established ASCVD (prior myocardial infarction, ischemic stroke, transient ischemic attack, or symptomatic peripheral arterial disease) consecutively admitted to the internal medicine and cardiology departments of a tertiary hospital over a 60-day period. Pre-admission medication use, comorbidities, and laboratory parameters were recorded. Factors associated with GLP-1 RA use were assessed using logistic regression before and after 1:1 propensity score (PS) matching. Results: Among 202 eligible patients, 49 (24.3%) were treated with a GLP-1RA. GLP-1RA users were younger (71.9 vs. 77.8 years, p < 0.001), had lower hypertension prevalence (61.2% vs. 78.4%, p = 0.02), and were more frequently on insulin (69.4% vs. 25.5%, p < 0.001) and sodium-glucose cotransporter 2 inhibitors (55.1% vs. 28.1%, p = 0.001). After PS matching (48 pairs), demographic and comorbidity differences were attenuated, although insulin remained strongly associated with GLP-1RA therapy (Odds Ratio 11.85, p < 0.001). Neither cardiovascular disease burden—captured through the presence of multiple cardiovascular comorbidities—nor renal function were independently associated with GLP-1RA use after adjustment. Conclusions: In patients with T2D and established ASCVD, GLP-1RA use was more strongly associated with the intensity of glucose-lowering therapy—particularly insulin use—than with cardiovascular or renal risk profiles. These findings should be interpreted with caution given the retrospective observational design and the limited availability of glycated hemoglobin, anthropometry and diabetes duration data. However, they suggest that, in real-world clinical practice, GLP-1RA prescribing may remain predominantly glucose-centric rather than complication-driven, underscoring the need for improved implementation of contemporary diabetes guidelines. Full article

This review develops a materials-to-clinic framework for patient-specific, functionally graded (FG) NiTi shape memory alloy (SMA) rods as a complementary paradigm for scoliosis correction that targets durable alignment with motion preservation. The article synthesizes the thermomechanical basis of NiTi (thermoelastic martensitic transformation, near constant superelastic plateau, and hysteretic damping) while leveraging additive manufacturing (AM) capabilities to spatially program transformation temperatures (e.g., A_f), effective stiffness, and geometric inertia along the rod. Consolidated process–structure–property linkages are provided for the PBF-LB, DED, and BJAM routes, together with contamination and composition-control strategies (mitigation of Ni volatilization; management of O/C uptake; gradient heat treatments) and segment-level quality assurance (DSC mapping, micro-CT, EBSD/indentation, and bench bending/torsion in physiologic media). Building on clinical curve classification, the methodology formalizes a grading mask and target moment vector that drive multi-objective optimization of the segmental A_f, relative density/architecture, and cross-section, followed by route-specific build plans and acceptance tolerances. A phenomenological constitutive description provides the forward map from local design variables to temperature-dependent moment–curvature loops for finite element verification and uncertainty control. Surgical handling and activation policies are codified (cold shaping in martensite and controlled intra-/postoperative warming within tissue-safe bounds), and a translational roadmap is outlined, encompassing prospective calibration of classification-to-design mappings, AM process maps with in situ monitoring, digital twin planning, and long-horizon fatigue/corrosion protocols. The proposed graded structures provide an adaptive transformation temperature gradient and tunable mechanical response, representing an important design direction toward 3D-printed, patient-specific SMA rods for durable, adjustable, and efficient scoliosis correction. Full article