Search Results (1,341)

Purpose: We hypothesised that cognition following consumption of an isomaltulose beverage would be comparable to that of an isoenergetic sucrose-based beverage, but the latter would attenuate post-ingestive metabolic responses. Methods: Thirty adults (15 males, 15 females) aged 21–44 years completed three experimental sessions, following at least 3 h fasting. Plasma insulin and glucose were measured in arterialised capillary blood 30 min after beverage consumption. Cognitive functions were assessed 45 min after beverage consumption using a computerised test battery; the primary cognitive performance outcome was a composite neurocognitive index score. Subjective symptoms were measured using questionnaires. Data are presented as the mean [95% confidence interval]. Results: Circulating glucose was greater after ingesting sucrose compared to isomaltulose and placebo beverages (sucrose: 7.3 [6.9, 7.7] mmol·L⁻¹; isomaltulose: 6.3 [6.1, 6.6] mmol·L⁻¹; and placebo: 5.3 [5.2, 5.4] mmol·L⁻¹). Insulin rose to a greater degree with sucrose compared to isomaltulose (mean difference = 8.5 [2.4, 14.6] µU·mL⁻¹, p = 0.005). Non-inferiority was shown between isomaltulose and sucrose for the composite neurocognitive index score (isomaltulose mean score = 0.931 [−2.3, 4.2]; sucrose mean score = 0.414 [−2.6, 3.5]). However, performance with the sucrose and placebo beverages was similar, limiting broader interpretation. The sensation of postprandial tiredness for isomaltulose was non-inferior to sucrose (isomaltulose mean score = −3.8 [−15.8, 8.2]; sucrose mean score = 0.1 [−10.9, 11.1]). Conclusions: A commercial stimulant beverage with isomaltulose as the energy substrate elicits substantial reductions in glycaemic and insulinaemic responses compared with an isoenergetic sucrose-based beverage, without compromising cognitive performance. Full article

Background/Objectives: Stigmatization is an under-recognized burden in hereditary angioedema (HAE) that may exacerbate psychosocial distress and functional impairment. Although links to adverse outcomes exist, the domain-specific pathways remain insufficiently characterized. This study investigated the impact of stigma types (workplace, healthcare, social) on anxiety, quality of life, and functional impairment, specifically testing the mediating role of disease-specific quality of life. Methods: This single-center, cross-sectional study included 60 adults with confirmed HAE. Participants completed the Chronic Illness Anticipated Stigma Scale (CIASS), Hospital Anxiety and Depression Scale (HADS), Angioedema Quality of Life Questionnaire (AE-QoL), and Work Productivity and Activity Impairment Questionnaire (WPAI). Hierarchical regression and mediation analyses were used to assess relationships between stigma domains, psychosocial outcomes, and activity impairment. Results: Female patients reported significantly higher anxiety (d = 0.85) and poorer quality of life (d = 0.77) compared to males. In hierarchical regression models, workplace stigma was a significant predictor of activity impairment (p = 0.002). Mediation analysis suggested an indirect association between workplace stigma and activity impairment through disease-specific quality of life (Indirect effect = 1.22; 95% CI: 0.29–3.01). Conclusions: Anticipated stigma in HAE appears to follow domain-specific patterns, with workplace stigma showing the strongest association with functional impairment and poorer disease-specific quality of life. Female gender emerged as an independent correlate of anxiety. These findings underscore the need for HAE management strategies that integrate psychosocial evaluation alongside biomedical control. Full article

Background: Transient ischemic attack (TIA) and minor stroke often result in excellent functional recovery but are frequently followed by substantial psychological morbidity. It remains unclear whether mood disturbances or cognitive impairment are the primary contributors to reduced health-related quality of life (HRQoL) in this population. Methods: We conducted a prospective observational case–control study including 90 patients with acute TIA or minor stroke confirmed by diffusion-weighted imaging and 92 age-matched healthy controls. At 90 days, participants completed the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Montreal Cognitive Assessment, and the EQ-5D-5L. Hierarchical multiple regression using standardized z-scores identified independent predictors of HRQoL. Bias-corrected bootstrapped mediation analyses (5000 iterations) assessed whether cognitive impairment mediated the relationship between mood symptoms and HRQoL. Results: Compared with controls, patients exhibited markedly higher rates of depressive symptoms (82.2% vs. 18.5%), anxiety symptoms (81.1% vs. 21.7%), and cognitive impairment (66.7% vs. 13.0%) (all p < 0.001). Psychopathological variables explained an additional 36.6% of HRQoL variance, whereas cognitive and neuroimaging variables contributed only 1.7% (ΔR² = 0.017; p = 0.523). In the fully adjusted regression model, HAM-A showed the numerically largest standardized coefficient (β = −0.055; p = 0.064), representing a trend toward significance, while HDRS-17 did not individually reach statistical significance (β = −0.043; p = 0.147); cognitive impairment had negligible independent effects (β = −0.001; p = 0.947). Both mood variables collectively accounted for the substantial majority of explained HRQoL variance, far exceeding the contribution of cognitive and neuroimaging predictors. Mediation analyses revealed no significant indirect effects, indicating that mood and cognitive complications are statistically consistent with a model in which mood and cognitive symptoms exert independent effects on HRQoL; temporal ordering cannot be established from these cross-sectional measures. Conclusions: Following TIA or minor stroke, depressive and anxiety symptoms are highly prevalent, persist despite good neurological recovery, and exert a disproportionately negative impact on HRQoL. Anxiety appears particularly influential in determining patient-reported outcomes. The statistical consistency of the mediation models with parallel rather than sequential mood–cognition pathways suggests that these represent independent neurobiological sequelae requiring separate clinical attention, underscoring the need for routine and concurrent assessment of both mood and cognitive function after TIA and minor stroke. Full article

Seed priming is a simple, economical, and sustainable technique capable of enhancing crop resilience to abiotic stresses. A plastic greenhouse experiment was conducted on the durum wheat cultivar, Karim, sown in a 375 L volume container under semi-controlled conditions. Plots were arranged in a completely randomized design regarding treatments (control, salinity) and priming agents (indole-3-acetic acid, IAA; gibberellic acid, GA₃; and salicylic acid, SA). Some physiological, biochemical, and morphometric traits were analyzed at vegetative and reproductive stages. The obtained results demonstrated that salinity stress reduced plant growth and the SPAD index, hampered photosynthetic efficiency through disrupted PSII integrity and energy management in the electron transfer chain, and significantly affected ear filling (EF) and grain caliber (marked by mean weight of 100 grains, MW100G). However, seed hormonal priming allowed the alleviation of salinity stress effects on durum wheat growth and yield. Although IAA and GA₃ have shown significant potential in improving durum wheat tolerance to salinity, SA was found to be the most effective priming agent. It promotes the biosynthesis of chlorophyll pigments, restores the functional integrity of PSII, enhances photosynthetic efficiency, increases plant growth, and stimulates ear filling and wheat grain development. The principal component analysis demonstrated the interdependence of the vegetative and reproductive traits and presents SA as the most effective treatment that brings plants close to control conditions, despite the salinity. Full article

This study employed UPLC-MS/MS to determine the contents of major polyphenolic compounds and proanthocyanidins (PCs) in Kyoho grape seeds, optimized the extraction method and conditions for PCs using response surface methodology (RSM), and further evaluated the scavenging activities of PCs against 2,2-diphenyl-1-picrylhydrazyl (DPPH) and hydroxyl (•OH) radicals as well as their effects on growth, immunity, and oxidative stress in mice. Three hundred and sixty 3-week-old male mice (42.28 ± 0.31 g) were assigned to a single factor complete randomized trial design and fed with six different diets including 0 mg/kg vitamin E(VE) + 0 mg/kg PCs, 100 mg/kg VE, 25 mg/kg PCs + 75 mg/kg VE, 50 mg/kg PCs + 50 mg/kg VE, 75 mg/kg PCs + 25 mg/kg VE and 100 mg/kg PCs, respectively. The results demonstrated that PCs were identified as the predominant phenolic compounds, accounting for 29.6% of total phenolic substances in Kyoho grape seeds. Additionally, the ultrasound-assisted extraction method was superior to the shaker-assisted and low-temperature infiltration extraction methods, with optimal conditions of 60% ethanol concentration, material-to-liquid ratio of 1:20 g/mL, temperature of 30 °C, and extraction time of 50 min. Scanning electron microscopy (SEM) revealed that ultrasound treatment effectively disrupted the seed surface structure, facilitating PC release. In vitro, PCs exhibited significantly stronger DPPH and hydroxyl radical (•OH) scavenging activities than vitamin C (VC), Trolox, and gallic acid. Compared with the control group, mice fed diets containing PCs and VE showed higher superoxide dismutase (SOD) activity, glutathione peroxidase (GSH-PX) activity, and total antioxidant capacity (TAOC), Catalase (CAT), GPX and inflammation factor 10 (IL-10) genes levels in the serum and liver (p < 0.05), whereas the levels of immunoglobulin G (IgG), immunoglobulin A (IgA), immunoglobulin M (IgM), tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6), as well as the mRNA expression of IL-1β and TNF-α, showed the opposite trend (p < 0.05). In conclusion, the antioxidant capacity of PCs was stronger than that of VC and VE. The addition of PCs improved the antioxidant activity and immune function of mice. Full article

Background: Posterior neck lipomatosis, commonly referred to as a buffalo hump, is characterized by abnormal accumulation of adipose and fibrofatty tissue in the dorsocervical region, leading to aesthetic deformity and functional discomfort. Ultrasound-assisted liposuction (UAL) has been widely used as a minimally invasive treatment option, particularly for fibrous adipose tissue; however, surgical outcomes may vary depending on regional anatomical characteristics. Methods: This retrospective observational study included five patients with idiopathic posterior neck lipomatosis who underwent UAL using a superwet infiltration technique. Liposuction was performed through three access ports, with initial deep-plane debulking followed by contour refinement. Postoperative outcomes were assessed based on clinical examination, standardized photographic documentation, and patient-reported satisfaction during follow-up. Results: The mean follow-up duration was 8.2 months (range, 7–10 months). All patients demonstrated visible improvement in dorsocervical contour following UAL. The mean volume of tumescent infiltration was 176 mL (range, 100–250 mL), and the mean lipoaspirate volume was 178 mL (range, 110–280 mL). Four patients achieved satisfactory contour improvement and reported high satisfaction. One patient exhibited residual dorsocervical prominence consistent with relative undercorrection, despite adequate aspiration volume and ultrasonic application. No major perioperative or postoperative complications were observed. Conclusions: Ultrasound-assisted liposuction appeared to provide favorable short-term contour improvement in this small series of idiopathic posterior neck lipomatosis. However, dense fibrous septation and deep fascial tethering in the dorsocervical region may limit complete correction in selected patients, even when aspiration volume and ultrasonic application are considered adequate. Recognition of these anatomical constraints may help refine surgical planning, improve preoperative counseling, and guide expectations regarding residual fullness. Full article

Background: Malignant lymphoma is the most common hematological malignancy; however, primary central nervous system lymphoma accounts for only a small percentage of non-Hodgkin lymphoma (NHL). Among these, primary cauda equina lymphoma (CEL) is extremely uncommon. Its rarity and atypical clinical presentation often make diagnosis challenging. Case Presentation: An 80-year-old man presented with progressive gait disturbance, lower-extremity weakness, and numbness. MRI revealed diffuse swelling and homogeneous gadolinium enhancement of the cauda equina at T12–L1; additionally, CSF cytology identified malignant lymphocytes. Open biopsy confirmed a diagnosis of diffuse large B-cell lymphoma. At diagnosis, the patient was classified as Ann Arbor stage IV, and the clinical parameters corresponded to a high-risk International Prognostic Index (IPI) category. The patient received five courses of immunochemotherapy with rituximab, methotrexate, vincristine, and procarbazine (R-MPV), resulting in marked radiological improvement and functional recovery, achieving a complete response. However, consolidation therapy was discontinued as the patient did not wish to continue. Unfortunately, intracranial relapse occurred four months later, and the patient ultimately succumbed to infectious complications. Only 29 cases of primary CEL have been reported. For all cases, a biopsy with histopathological examination is required for a definitive diagnosis. Currently, combined chemotherapy and radiotherapy are considered the standard treatment. This case was diagnosed through nerve biopsy with cauda equina at T12 to L1 levels, and immunochemotherapy successfully reduced the lesion while improving lower extremity function. Conclusions: Despite the considerable burden on patients, nerve biopsy is necessary for primary CEL to obtain a diagnosis and an early therapeutic approach for both neurological and vital prognoses. Full article

Background: The low-dose Synacthen stimulation test (LD-SST) is the reference dynamic test for diagnosing glucocorticoid-induced adrenal insufficiency (AI) in children, but it is resource-intensive and costly. This study aimed to establish morning cortisol thresholds predictive of hypothalamic–pituitary–adrenal (HPA) axis response to LD-SST in pediatric patients receiving chronic corticosteroid therapy. Methods: We conducted a prospective study including 71 children (mean age 6.23 ± 3.49 years; 57.7% male) receiving prolonged oral or inhaled corticosteroids. All patients underwent LD-SST with cortisol measurements at 0, 30, and 60 min. Patients were classified as having AI (peak cortisol < 18 μg/dL at T30 or T60, n = 39) or normal adrenal function (peak cortisol ≥ 18 μg/dL, n = 32). ROC curve analysis determined optimal cortisol thresholds for predicting AI. Results: Among the 71 patients, 44 received inhaled corticosteroids (62%) and 27 oral corticosteroids (38%). Asthma (61.9%) and autoimmune diseases (18.3%) were the main indications. The prevalence of AI was 54.9% (n = 39). Mean morning cortisol was significantly lower in the AI group compared to the normal group (6.69 ± 1.99 vs. 9.21 ± 2.49 μg/dL, p < 0.001). ROC analysis identified a morning cortisol <6 μg/dL as predictive of AI with 96.9% sensitivity and 46.2% specificity (AUC = 0.823), while a threshold >13 μg/dL predicted normal HPA function with 100% specificity. Using these thresholds would have avoided LD-SST in 29.6% of patients. The cortisol increment following stimulation also demonstrated diagnostic value (AUC = 0.822), with an increment <9 μg/dL suggesting AI and ≥9 μg/dL likely excluding the diagnosis. Conclusions: In this North African pilot study, morning cortisol measurement at 7 days after oral corticosteroid withdrawal predicted LD-SST response. A threshold of ≤6 μg/dL identified patients with persistent HPA suppression with high sensitivity (97.4%), while ≥13 μg/dL identified patients with preserved function with high specificity (100%). However, the 7-day washout period might be insufficient for complete HPA recovery; therefore, these thresholds reflect residual suppression rather than permanent adrenal insufficiency. Full article

In ruminant nutrition, the lignocellulosic complex is a primary constraint limiting the utilization of dietary fiber. The objective of this study was to evaluate the effects of inoculating lignin-degrading bacteria (LDB) isolated from the ruminant rectum on in vitro rumen fermentation characteristics. Rectal fecal samples were collected from healthy beef cattle, dairy cattle, buffaloes, and goats (n = 4 per species) using the grab sampling technique. Twenty-eight bacterial colonies were isolated through enrichment and screening on media containing sodium lignosulfonate. Lignin degradation efficiency was assessed spectrophotometrically, while laccase activity was determined using a 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) oxidation assay. Seven isolates exhibiting ligninolytic activity (1.4–5.6% degradation efficiency) were selected to evaluate their effects on in vitro rumen fermentation using a completely randomized design with four replicates. LDB treatments were standardized to a concentration of 2.4 × 10⁵ colony-forming units/mL of rumen fluid medium, while the control received an equal volume of a 0.85% sterile NaCl solution. A rice straw-based total mixed ration served as the substrate, with rumen fluid collected from beef cattle. All treatments were incubated for 48 h. Notably, isolate BC3 consistently enhanced in vitro dry matter digestibility (23.1%), total gas production (18.6%), and total volatile fatty acid concentrations (13.2%) relative to the control and other LDB isolates (p < 0.01). All seven LDB isolates were identified as Gram-negative, rod-shaped, facultative anaerobic bacteria that exhibit catalase activity and tolerate moderately acidic conditions. Phylogenetic tree analysis based on 16S rRNA gene sequencing identified isolate BC3 as being closely related to Escherichia coli strains. These findings demonstrate that the ruminant hindgut is a promising source of LDB with the functional potential to enhance feed digestibility and fermentation end-products in the rumen. Future research should prioritize in vivo trials to evaluate the safety and efficacy of LDB as a direct-fed microbial, specifically focusing on its impact on animal performance and health. Full article

Spiral inertial microfluidic devices provide a simple, high-throughput approach for size-based particle separation; however, translating PDMS-optimized designs into monolithic, fully enclosed 3D-printed channels is often limited by printability and post-print channel clearing. In our previous PDMS study, a $400\times 120\mu \mathrm{m}$ spiral achieved high separation performance after computational optimization and experimental validation. To translate this high-performing PDMS concept into a faster and more cost-effective manufacturing approach, the same separation principle is transferred to a fully 3D-printed, closed-channel spiral device, and the geometry is re-optimized around manufacturability constraints. Printing trials showed that enclosed channels at $400\times 120\mu \mathrm{m}$ and $600\times 180\mu \mathrm{m}$ could not be cleared reliably due to trapped resin and frequent blockage, most often near the inner-outlet region. In contrast, $800\times 240\mu \mathrm{m}$ and $1200\times 360\mu \mathrm{m}$ channels were printed and flushed successfully, and $800\times 240\mu \mathrm{m}$ was selected as the smallest reproducibly functional cross-section. Particle-tracking simulations were then used to re-optimize spiral development length, showing that a 4-turn device provides limited collection for $12\mu \mathrm{m}$ targets (10%), intermediate lengths (5–7 turns) improve collection to 50%, and an 8-turn spiral achieves complete large-particle collection (100%) across tested target sizes (12–$24\mu \mathrm{m}$) while reducing small-particle crossover. Experimental validation of the 8-turn $800\times 240\mu \mathrm{m}$ device at $Q=6\mathrm{m}\mathrm{L} {\min }^{-1}$ using fluorescent polystyrene particles ($18\mu \mathrm{m}$ target; $6\mu \mathrm{m}$ background) yielded an average collection efficiency of 84% and an inner-outlet purity of 92%. Overall, these results demonstrate that spiral inertial separation can be retained in a monolithic 3D-printed format when the design is re-optimized around the smallest reliably clearable enclosed cross-section and sufficient spiral development length. Full article

Background/Objectives: Cancer survivors often experience physical decline, fatigue, and reduced quality of life (QoL) following cancer treatment. Exercise is an important strategy in survivorship care; however, the role of exercise motivation in sustaining exercise behavior and improving QoL remains unclear. This study evaluated the effects of a structured exercise intervention on QoL, fatigue, and exercise motivation among cancer survivors. Methods: This single-arm longitudinal pre–post-intervention study recruited adult cancer survivors (median age: 55 years) with heterogeneous cancer types from E-Da Hospital, Taiwan, between October 2023 and July 2024. Participants completed a 3-month supervised exercise program consisting of weekly 60 min sessions that included aerobic, resistance, balance, and flexibility training. Assessments were conducted at baseline, immediately after the intervention, and at a 3-month follow-up. Outcome measures included physical fitness tests, fatigue scales, and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and the Relative Autonomy Index for exercise motivation. Results: Thirty-nine participants completed the study. Improvements in several QoL domains were observed at the 3-month follow-up, particularly in physical and emotional functioning. Pain and fatigue symptoms decreased following the intervention, although some fatigue indicators increased again during follow-up. Female participants showed greater improvements in certain physical fitness measures. Intrinsic exercise motivation increased after the intervention, and greater motivation gains were associated with larger improvements in QoL. Conclusions: Participation in a structured exercise program may be associated with improvements in QoL, fatigue symptoms, and exercise motivation among cancer survivors. However, given the single-arm design and small sample size, these findings should be interpreted cautiously. Larger randomized controlled studies are needed to confirm the long-term benefits of exercise interventions in cancer survivorship care. Full article

Background/Objectives: To study the hypothesis that cognitive functions and learning skills are impaired in child/adolescent childhood cancer survivors (CCS). Secondary outcomes included psychosocial parameters and quality of life. Methods: This case–control study was conducted over four years (2017–2021) at the largest pediatric Aghia Sophia Children’s Hospital, in Greece. Eligible participants were children and adolescents in Greece. For CCS, ≥1 year should have elapsed from completion of cancer treatment. Assessments of neurocognitive function, learning and psychosocial skills and health-related quality of life (HRQoL) were performed with validated instruments (WISC-III, LAMDA software, Achenbach CBCL/6-18 and YSR, KIDSCREEN-52, respectively). Results: In total, 219 participants (47.49% males, mean age ± SD 11.72 ± 2.32 years), 70 CCS and 149 controls (matched for age, sex, family income), were included. Cases were CCS of acute lymphoblastic leukemia (n = 25)/brain tumors (n = 19)/lymphoma (n = 17)/nephroblastoma (n = 5)/Ewing sarcoma (n = 3)/rhabdomyosarcoma (n = 1). CCS had worse scores in full-scale Intelligence Quotient (FSIQ) (p = 0.004), verbal IQ (VIQ) (p = 0.005) and all its subscales, performance IQ (PIQ) (p = 0.021), and almost all learning parameters than controls. Attention, working memory, writing/visual–motor coordination, processing accuracy/speed, language acquisition/expression, all psychosocial scales, and HRQoL domains of mood and emotions, were negatively affected in CCS. Female CCS demonstrated lower FSIQ (p = 0.019) and VIQ (p = 0.014) than control females, whereas male CCS retained their total IQ unaffected. Among CCS, those with non-central nervous system (CNS) tumors, higher parental educational level or higher family income had significantly higher IQ than those with CNS tumors, lower parental educational level or lower family income, respectively. Conclusions: CCS in Greece carry a significant burden of cognitive and psychological morbidity. Cognitive/educational and psychosocial support to CCS is imperative. Full article

Chinese rice-field eels (Monopterus albus) are a commercially farmed freshwater fish species in China. In recent years, the rapid expansion of aquaculture has been accompanied by frequent outbreaks of viral diseases, posing a serious threat to the sustainability of the Chinese rice-field eel farming industry. In this study, a rhabdovirus strain was isolated from diseased Chinese rice-field eels at a farm located in Xiantao, Hubei Province, China. Although the complete genomic sequence of CrERV-XT showed higher identity to the infectious hemorrhagic syndrome virus (IHSV) (96.16%) than to CrERV (94.39%), phylogenetic analysis based on the L protein placed CrERV-XT within the same clade as CrERV, supporting its tentative classification as a novel variant of CrERV. Furthermore, the amino acid sequence of the L protein showed greater similarity to that of CrERV (97.89%) than to IHSV, while the N, P, M and G proteins exhibited higher homology with their counterparts in IHSV. CrERV-XT displayed considerable genetic divergence from known CrERV isolates, which is presumably attributed to its geographic isolation in different locations. Alignment of the G protein sequences from five strains (CrERV-XT, CrERV, CrERV-TYY25, CrERV-XY0907 and IHSV) revealed a total of 39 amino acid mutation sites. These findings provide valuable insights for investigating conserved functional domains within the CrERV G protein for the rational design of vaccine antigens against this emerging virus. Full article

The adoption of photovoltaic (PV) energy in irrigation is rapidly increasing, supported by a range of available technologies. However, an agronomic perspective that could help overcome inherent limitations of PV systems remains absent. In fact, current irrigation design methods do not explicitly take into account the dynamic nature of PV power generation. While irrigation engineering conceptualises soil as a reservoir for plant-available water, it can also function as an energy reservoir, storing solar-derived energy in the form of soil moisture for subsequent crop use. Building on this concept, this study proposes an integrated framework for designing off-grid PV irrigation systems based on asymmetric irrigation sectors. The framework couples hydrological, agronomic, and energy components to synchronise solar energy generation with crop water requirements, thereby eliminating the need for intermediate energy storage. The methodology was applied to two case studies: a hedgerow olive orchard and an almond orchard in southern Portugal, both with drip irrigation. Results demonstrate that the asymmetric-sector design provides a technically feasible and low-complexity solution for integrating photovoltaic energy into irrigation systems. The conventional irrigation system required 1.42 kW of minimum pumping power for olive orchards and 1.32 kW for almond orchards. The dimensions of the main lines ranged from 97.8 mm for olive and 75 mm for almond orchards, while the flow rate of the emitter was 2.3 L h⁻¹ for olive and 3 L h⁻¹ for almond orchards. Although PV-compatible operation required hydraulic adjustments including increases in design flow rate (226–255%), pump power demand (87.5–241%), and pipe diameters (up to 120% in olive and 75% in almond), these adaptations enable irrigation systems to operate under the variability inherent to solar-based energy supply. This hydraulic oversizing leads to higher initial investment costs; however, this can be mitigated to a certain extent by diminished operating costs and complete energy autonomy from the electricity grid. Full article

Background and Clinical Significance: Left atrial myxoma is the most common benign primary cardiac tumor and is associated with embolic and hemodynamic complications. Complete surgical excision is the treatment of choice, while postoperative cardiovascular rehabilitation is essential for functional recovery. Case Presentation: We report the case of a 75-year-old woman with arterial hypertension, dyslipidemia, and chronic venous insufficiency (Clinical–Etiological–Anatomical–Pathophysiological (CEAP) class 2), and chronic hepatitis B virus (HBV) infection who underwent surgical excision of a left atrial myxoma and was subsequently admitted three weeks postoperatively for phase II cardiovascular rehabilitation. The postoperative course was complicated by transient atrial fibrillation, peripheral edema, pleural effusion, and progressive purpuric lesions of the lower limbs. Laboratory and immunological evaluation revealed positive cryoglobulins, markedly elevated rheumatoid factor (1058 UI/mL) and IgM levels (715 mg/dL), reduced complement levels (C3, C4), normocytic normochromic anemia, microscopic hematuria, and elevated ALT (156 U/L), AST (142 U/L), total bilirubin (1.4 mg/dL), and INR (1.6), suggestive of hepatic inflammatory activity. HBV status was scheduled for evaluation through Gastroenterology referral (HBV DNA viral load, serological markers: HBsAg, HBeAg, anti-HBe), as our Cardiology Rehabilitation Clinic lacks the possibility of evaluation. After systematic exclusion of alternative etiologies, secondary cryoglobulinemic vasculitis in the context of chronic HBV infection with biochemical evidence of hepatic activity was considered the most plausible diagnosis. Conclusions: This case highlights the complexity of managing elderly patients after cardiac tumor surgery, particularly in the presence of systemic comorbidities. Early recognition of extracardiac complications and an individualized, multidisciplinary strategy are essential to optimize outcomes. Full article