Search Results (214)

Non-invasive ventilation (NIV) reduces mortality in patients with acute cardiogenic pulmonary edema (ACPE). However, the 3CPO trial reported null results. Therefore, we hypothesized that the prevalence of acute coronary syndrome (ACS) would influence the effectiveness of NIV. A systematic literature review was conducted to identify randomized controlled trials (RCTs) comparing NIV and standard oxygen therapy in patients with ACPE from PubMed, CENTRAL, and Embase databases through December 2025. Random-effects meta-analysis and REML meta-regression were utilized, and evidence quality was evaluated using GRADE. (PROSPERO: CRD420251142245). Fourteen RCTs (n = 1967) were included in the analysis. NIV significantly reduced hospital mortality (RR 0.75, 95% CI 0.58–0.96; I² = 0%) and endotracheal intubation (RR 0.49, 95% CI 0.35–0.68). Meta-regression revealed that study-level ACS prevalence was significantly associated with the magnitude of NIV’s mortality effect (β₁ = −0.023 per 1% increase in ACS, p = 0.008; R² = 46.2%). The equilibrium point occurred at an ACS prevalence of 14.1% (95% CI 5.2–23.0%). At 3CPO’s ACS prevalence of 27%, the model predicted an RR of 0.75 (95% CI 0.58–0.97). The observed 3CPO RR was 0.97 (95% CI 0.66–1.43); the confidence intervals overlap substantially, and 3CPO was underpowered for mortality as an isolated endpoint. The mortality benefit of NIV appears to be associated with the prevalence of ACS among treated patients, though this ecological finding requires confirmation at the individual-patient level. Full article

Introduction: Pelvic floor disorders (PFDs) are a very widespread clinical phenomenon and are known to affect millions of women worldwide, significantly impairing their quality of life. New technologies and innovations such as electrotherapy and photobiostimulation are currently revolutionizing what concerns conservative treatment, allowing clinicians to tailor therapy to every woman. The aim of this study was to evaluate the feasibility of use of electrotherapy and photobiostimulation in PFD management and the initial results of treatment in clinical practice. Methods: This prospective study (IRB code: GSM-RF 2025) aimed to analyze the impact of the innovative DAFNE system to treat PFDs through electrotherapy and photobiostimulation. We enrolled patients with mild pelvic organ prolapse and stress urinary incontinence who desired a conservative treatment for their conditions. The following validated scales were used for assessing baseline quality of life before and after treatment: Urinary Distress Inventory-6 (UDI-6), Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), Female Sexual Function Index-6 (FSFI-6), 0–100 VAS Scale, and Vaginal Health Index. Electrotherapy was delivered through 4 gold rings, providing Functional Electrical Stimulation (FES), Transcutaneous Electrical Nerve Stimulation (TENS) and/or Microcurrent Electrical Neuromuscular Stimulation (MENS). The photobiostimulation system consisted of 24 LEDs per wavelength (420 nm UVA; 630 nm RED; 870 nm NIR/INFRARED) positioned at 360° along the entire length of the handpiece for antimicrobial purposes, microcirculation improvement, and anti-inflammatory action. The cycle of treatment consisted of 3–5 sessions, according to necessity. Overall improvement was measured through the Patient Global Impression of Improvement (PGI-I). Statistical analysis was performed using Student’s t-Test. A value of p < 0.05 was considered as significant. Results: In the period of interest, 32 women were treated with the DAFNE system. The mean age was 57.0 ± 16.6 years. Indications for treatment were stress urinary incontinence (16/32), mild pelvic organ prolapse (14/32), or both (2/32). The mean number of treatments per patient was 4. Quality of life improved as a consequence of the treatment according to the considered scales. Specifically, 87.5% of patients considered themselves improved. Conclusions: The DAFNE system has been successful in managing mild pelvic organ prolapse and stress urinary incontinence, improving quality of life scores. Embracing new technologies such as electrotherapy and photobiostimulation appears to be successful in conservatively managing a variety of PFDs. Full article

A significant proportion of patients undergoing invasive coronary angiography for angina have no obstructive coronary artery disease (CAD). In such patients, coronary microvascular dysfunction (CMD) and vasospastic angina (VSA) represent key pathophysiological mechanisms. We report a case of a 58-year-old male with exertional chest pain and exercise ECG changes typical of left main or multivessel CAD. Coronary computed tomography angiography (CCTA) showed borderline stenosis of the distal left main coronary artery. Coronary angiography revealed no critical stenosis. A comprehensive functional assessment demonstrated reduced coronary flow reserve (CFR = 2.0) and an elevated index of microcirculatory resistance (IMR = 25), consistent with CMD. An intracoronary acetylcholine provocation test induced severe focal vasospasm of the mid-left anterior descending artery (LAD) with ST-segment elevation and anginal pain, promptly relieved by nitroglycerin, confirming VSA. This case highlights the diagnostic and clinical importance of invasive functional testing in patients with angina and non-obstructive coronary arteries (ANOCA/INOCA). The coexistence of CMD and VSA (two distinct but overlapping pathophysiological endotypes) is increasingly recognized as a marker of adverse prognosis. Functional coronary assessment should be considered in all patients with angina and non-obstructive coronary arteries, as identifying mixed endotypes enables precise, mechanism-guided therapy. Full article

The autonomic nervous system (ANS) plays a key role in cardiovascular regulation by maintaining hemodynamic and metabolic homeostasis through balanced sympathetic and parasympathetic activity. While autonomic dysfunction is classically associated with diabetes, neurodegenerative diseases, autoimmune neuropathies, and chronic cardiovascular conditions, growing evidence suggests that disturbances in iron metabolism represent an underrecognized contributor to cardiac autonomic dysregulation. This narrative review summarizes data from 107 studies on ANS disorders, including 49 investigating cardiovascular involvement. Reported abnormalities included reduced heart rate variability and baroreflex sensitivity, prolonged P-wave duration and QT dispersion, and deviations in non-invasive autonomic testing parameters. In iron overload states, these changes appear to be driven primarily by oxidative stress, whereas in iron deficiency they are likely mediated by tissue hypoxia. Importantly, several studies indicate that normalization of iron homeostasis may partially reverse autonomic dysfunction. This potentially reversible component underscores the clinical relevance of screening for and correcting iron imbalance not only to improve hematological status but also to reduce cardiovascular risk. Large-scale, multicenter studies using standardized autonomic assessment protocols are required to clarify prognostic implications and inform evidence-based clinical guidelines. Full article

The present Reply addresses the commentary by Pagnoni et al. on our recent study exploring explainable artificial intelligence (AI) for mortality risk prediction in pulmonary arterial hypertension (PAH). We acknowledge the importance of several key issues raised by the authors, including endpoint selection, calibration, decision thresholds, and external validation, all of which are central to translating AI-based prognostic models into clinical practice. Our original endpoint, defined as death by the next follow-up visit, was driven by the structure of nationwide registry data and reflects real-world clinical workflows, although we recognize the advantages of predefined time horizons and time-to-event approaches for future analyses. We discuss the trade-off between sensitivity and precision, emphasizing our deliberate prioritization of minimizing false-negative classifications in high-risk patients, while acknowledging the need for structured clinical pathways to manage false-positive results. We further address calibration and threshold selection, underscoring the necessity of additional clinical studies to support intervention-oriented recommendations. The role of phenotypic determinants and modifiable risk factors in enhancing personalization is highlighted as a key direction for future model development. We reaffirm the value of SHAP-based explainability for improving model transparency, while recognizing the need for continued refinement and clinical validation. Finally, we emphasize the strengths and challenges inherent to registry-based analyses, the importance of external validation, and the need for methodologically sound comparisons with established risk calculators. Overall, this exchange underscores the critical role of interdisciplinary collaboration in advancing clinically actionable and interpretable AI solutions for PAH. Full article

Background/Objectives: Chronic nonspecific neck pain is a common global health problem that diminishes people’s quality of life and functionality. Strengthening and mobility exercises are a fundamental tool in managing this condition. Combined treatment with electrotherapy appears to have promising results; however, the evidence is limited. The aim of this review was to compare the effectiveness of therapeutic exercise combined with electrotherapy versus the McKenzie method alone in improving pain and disability in adults. Methods: A systematic review and meta-analysis of randomized clinical trials was conducted following the PRISMA guidelines. Studies published up to June 2025 were extracted from major scientific databases. High-quality studies evaluating therapeutic exercise with or without electrostimulation and studies evaluating the McKenzie method alone were analyzed, measuring short-term pain and disability through meta-analysis using random-effects models. The risk of bias of the included studies was assessed using the Cochrane Collaboration tool. Results: Seven studies were included (N = 441). The combination of therapeutic exercise with electrotherapy showed a significant reduction in pain (SMD −0.76 [−1.36, −0.16] (p = 0.01; 95% CI)), without additional benefits for disability (SMD −0.94 [−2.08, 0.20] (p = 0.1; 95% CI)) compared to exercise alone. Similarly, the McKenzie method presented statistically significant differences compared to other active interventions in reducing pain (SMD −0.61 [−1.01, −0.21] (p = 0.003; 95% CI)), while no significant differences were found for disability (SMD −0.31 [−1.78, 1.15] (p = 0.67; 95% CI)). Heterogeneity among studies was generally high. The results show short-term effects measured after completion of the intervention. Conclusions: Electrotherapy combined with exercise may provide short-term relief of nonspecific chronic neck pain, although the certainty of evidence is very low. Interferential current plus exercise and isolated McKenzie exercises showed short-term pain improvements, with no consistent benefits for disability. The methodological limitations, heterogeneity, small samples, and short follow-up warrant cautious interpretation. High-quality trials with standardized protocols and longer follow-up are needed. Full article

Background: Haemodialysis (HD) superimposes additional circulatory stress on the microvasculature, leading to endothelial dysfunction, which plays a key role in the development of haemodialysis-associated multiorgan dysfunction. This study was undertaken to evaluate the effect of a single HD session on retinal and choroidal microcirculation, using optical coherence tomography angiography (OCTA) in relation to changes in the blood levels of selected biochemical modulators of endothelial function. Methods: The vessel density (VD) of 35 patients was evaluated before and after a single HD session, using OCTA in the superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris (CC). Retinal thickness (RT) and choroidal thickness (CT) were also assessed. Asymmetric dimethylarginine (ADMA), endothelin-1 (ET-1) and malondialdehyde (MDA) levels, oxidative stress (OS) status and systemic parameters were assessed before and after a single HD session. The correlation between changes in these parameters and changes in selected OCTA parameters was tested. Results: A single HD session resulted in a significant increase in RT and a decrease in CT. In addition to increased oxidative and osmotic stress resulting from a significant reduction in plasma osmolality, the HD session was associated with a significant increase in ET-1 levels and a decrease in ADMA levels. These biochemical changes correlated with changes in RT and CT, as well as with changes in VD in the retinal capillary plexuses and the CC. Increased ET-1 levels and decreased plasma osmolality were identified as predictors of RT increase, whereas increased MDA levels corrected serum creatinine-predicted CT reduction. Conclusions: Changes in ADMA and ET-1 and OS, as well as osmotic stress induced by a single HD session, affect the eye microcirculation and morphology of the retina and choroid. OCTA examination is a promising method for assessing microcirculation in HD patients. Full article

Background: Upper-limb rehabilitation is a decisive factor in improving the quality of life for patients who have experienced a stroke. Modern rehabilitation techniques promote the recovery of upper-limb functionality and prehension, contributing to a reduction in disability. Materials and Methods: This retrospective observational study aimed to highlight improvements in prehension through the application of current actual and modern rehabilitation techniques targeting key muscle groups involved in upper-limb recovery. Data from a total of 52 patients were identified and categorized into two groups based on the specific rehabilitation protocols they received during their hospitalization: a study group and a control group. Both groups underwent individualized rehabilitation, differing only in the type of electrotherapy applied: the study group received functional electrical stimulation (FES) and shock wave therapy (RSWT), while the control group received conventional electrical stimulation. Results: After adjusting for baseline differences in severity and time since stroke, patients in the study group demonstrated a significantly greater improvement in functional parameters compared to the control group. The results show us a significant improvement of functionality after RSWT and FES in the study group, with values from 0.28 ± 0.28 to 0.99 ± 0.36 (p-value < 0.001) regarding Hand Grip, suggesting that the treatment effect persists even when initial clinical advantages in the control group are accounted for. Muscle force increased from 0.39 ± 0.54 to 7.67 ± 3.89, p-value < 0.001. Conclusions: The combined application of functional electrical stimulation and shock wave therapy, as modern rehabilitation interventions, provided additional benefits in upper-limb and prehension rehabilitation compared to classical electrical stimulation alone. Our findings suggest that the combined application of RSWT and FES is strongly associated with improved upper-limb recovery, even after adjusting for baseline clinical imbalances. While these results support the integration of these modern techniques into stroke protocols, further prospective randomized controlled trials are needed to confirm the definitive treatment advantage over conventional methods. Full article

Background/Objectives: Low image quality reduces diagnostic accuracy. We wanted to develop a framework for assessing transthoracic echocardiography (TTE) image quality in apical 2-, 3-, and 4-chamber views, and to use this framework to characterise segment-level visualisation patterns in patients with heart failure (HF). Methods: In this cross-sectional study, 268 TTE examinations from 230 patients qualified for ICD/CRT implantation in primary prevention of sudden cardiac death were analysed. Patient demographic, electrocardiographic, echocardiographic, and clinical characteristics were collected, and apical 2-, 3-, and 4-chamber views were extracted for image quality evaluation. Mean scores for each segment were calculated. The proportion of well-visualised segments per view was also evaluated. Risk factors for poor image quality were assessed. Results: We internally assessed the reliability of the framework (intra-class correlation coefficient > 0.9). The anterior and anterolateral walls consistently demonstrated the poorest quality, and the inferior segments the best. Clear inner-edge-to-outer-edge delineation of ≥5 segmental borders was achieved in only 30% of studies, while ≥5 endocardial border segments were visualised in 65% of cases. Reduced quality was frequently observed in patients with higher BMI and BSA, presence of HF risk factors (diabetes, prior myocardial infarction, and atrial fibrillation), and heart abnormalities (increased left ventricular end-diastolic value and hypokinesis). Conclusions: The prevalence of imaging challenges in TTE examinations performed in patients qualified for CRT-D/ICD implantation is high. These findings underscore the need for thorough training of echocardiographers and for sustained attention to technical details affecting image quality to achieve consistently high-quality images in routine practice. Full article

Background/Objectives: The objective of this systematic review was to identify and analyze the available evidence on the indications and contraindications of physical and manual therapies in cancer survivors, including patients with metastatic disease and those with a history of neoplasia in follow-up. Methods: A literature search covering the period from 2017 to 2025 was conducted using the following databases: PubMed, NICE, NHS Evidence, PEDro, MEDLINE, and ScienceDirect. Systematic reviews and meta-analyses investigating manual or instrumental physiotherapy interventions in cancer survivors were identified and analyzed according to the PRISMA checklist. Results: Of the initial 2232 studies retrieved across the databases, 9 studies met the inclusion criteria. The available evidence suggests a positive effect of physiotherapy interventions on pain reduction in cancer survivors, both during and after chemotherapy. Conclusions: The clinical recommendation is to implement instrumental physical therapies and manual therapy as part of a multimodal approach rather than as isolated interventions. Close collaboration with the treating oncologist is recommended to determine whether the tumor type requires treatment to be performed away from the tumor site. No absolute contraindications to physiotherapy were identified, either during or after chemotherapy, including in patients with metastatic disease. Full article

Background. Cervical spondylosis is a degenerative disorder of the spine, frequently associated with chronic neck pain, reduced mobility, and functional impairment. Patients develop alterations in muscle tone, stiffness, and elasticity, which further contribute to disability. This study aimed to investigate the effects of a 14-day standardized rehabilitation program on the biomechanical and contractile properties of cervical and scapular muscles in patients with cervical spondylosis. Methods. This study used a single-group pre–post observational design on 23 patients (16 women, 7 men; mean age 61.1 ± 14.2 years) diagnosed with cervical spondylosis. All participants completed a standardized rehabilitation treatment that included cervical mobilization, stretching, isometric exercises, scapular stabilization, electrotherapy, ultrasound, thermotherapy, and balneotherapy. Muscle properties were evaluated bilaterally using the MyotonPRO^® device, measuring frequency, stiffness, decrement, relaxation time, and creep. Assessments were performed in a sitting position for the deltoid, upper trapezius and pectoralis major, both at baseline (T0) and after treatment (T1). Handgrip strength was assessed bilaterally with a handheld dynamometer. Results. The deltoid muscle showed a significant reduction in frequency (14.86 → 13.50 Hz, p = 0.034) and stiffness (306.4 → 256.1 N/m, p = 0.014) on the right side, suggesting normalization of tone and passive resistance. The upper trapezius had a significant bilateral decrease in decrement (p < 0.05), reflecting improved elasticity. The pectoralis major displayed the most consistent adaptations, with increased frequency (right side, p = 0.008), improved relaxation bilaterally (p < 0.05), and significant reductions in decrement and creep (p < 0.01). Handheld dynamometry confirmed increased handgrip strength, with a 5.4% improvement on the left side and 7.6% on the right side. Conclusions. In our study measurable changes in muscle parameters were observed following a rehabilitation program in patients with cervical spondylosis. The integration of myotonometry and dynamometry allowed objective assessment of muscle adaptations supporting the clinical value of individualized rehabilitation strategies. Full article

Background/Objectives: Despite the known benefits of cardiac rehabilitation, it remains underutilized among women. In particular, little is known about the effectiveness of hybrid comprehensive telerehabilitation (HCTR) in women with heart failure (HF). The purpose of this study was to assess effectiveness and safety of HCTR in women with HF. Methods: This analysis formed part of the TELEREH-HF multicenter, randomized trial that enrolled 850 HF patients (NYHA I-III, LVEF ≤ 40%). Patients were randomized 1:1 to HCTR plus usual care (UC) or UC alone. Patients underwent either HCTR (1 week in hospital and 8 weeks at home, five times weekly) or UC with observation. The effectiveness of HCTR was assessed by changes in peak oxygen consumption (VO₂peak), workload duration (t) in cardiopulmonary exercise test and quality of life (QoL) based on Medical Outcome Survey Short Form 36 Questionnaire (SF-36). Measurements were taken before and after intervention/observation. Results: Women constituted 11.5% of the TELEREH-HF study population. Forty women in the HCTR group and 44 women in the UC group completed program and observation, respectively. HCTR resulted in a significant improvement in VO₂peak (13.4 ± 4.3 vs. 14.3 ± 4.6; 95%CI 0.91 [0.05; 1.77], p = 0.038), workload duration (301 ± 162.3 vs. 334 ± 156.6; 95%CI 33 [5; 60], p = 0.022) and SF-36 overall score (85.9 ± 13.6 vs. 89.9 ± 13.5; 95%CI 4.0 [0.6; 7.4], p = 0.024). These favorable results were not observed in the UC group VO₂peak (14.2 ± 4.8 vs. 14.2 ± 4.8; 95%CI 0.02 [−1.20; 1.24], p = 0.971) and SF-36 overall score (89.1 ± 17.4 vs. 89.5 ± 15.8; 95%CI 4.0 [−2.1; 2.8], p = 0.796), except for an increase workload duration (268 ± 138.4 vs. 300 ± 130.1; 95%CI 32 [2; 62], p = 0.036). The HCTR group showed a significantly greater improvement in the physical component of QoL than the UC group. In neither group were there deaths nor major adverse events related to exercise training. Conclusions: Among women with heart failure, hybrid comprehensive telerehabilitation appears safe and leads to statistically significant although moderate improvements in physical capacity and quality of life. However, due to the small sample size, further studies in larger female populations are needed to confirm these findings. Full article

Background/Objectives: Hemodialysis (HD) is the commonest life sustaining form of kidney replacement therapy in the world; however, this method of treatment have many adverse effects, and even a single HD session affects many organs, including the eyes. The aim of this study was to assess the effect of a single HD session on the ophthalmologic findings in patients with End-stage Renal Disease (ESRD). The second aim of the study was to examine the correlation of these changes with each other and between changes in systemic stressors related to the HD session. Methods: This was a single-center cross-sectional observational study conducted on 32 patients undergoing HD. Selected parameters of the anterior and posterior segment of the eye as well as systemic parameters were assessed before and after a single HD session. Results: Best corrected visual acuity (BCVA) improved, and lens thickness (LT), axial length (AXL), average macular thickness (MT), central MT and total vessel density (VD) of the deep capillary plexus DCP increased significantly after a single HD session. The Schirmer test results, tear break up time (TBUT), anterior chamber depth (ACD), central and average choroidal thickness (CT) decreased significantly after HD. Body weight loss was the only significant systemic change. Decrease in TBUT correlated positively with Schirmer’s test results decrease. Increase in CCT correlated positively with AXL increase. Decrease in central and average CT correlated positively with IOP decrease. Increase in central MT correlated positively with increase in average MT. Decrease in central CT correlated positively with average CT decrease. Change in VD of the SCP correlated positively with change in VD of DCP. Apart from the positive correlation between SBP change and Schirmer’s test results change, there were no correlations between systemic and ophthalmic parameters changes. Conclusions: Our study showed that HD affected the parameters of the anterior and posterior segments of the eye. Numerous correlations between these changes suggest that they are interrelated and represent the complex response of the eye to the HD process. Full article

Background: Ticagrelor is a reversible, direct inhibitor of the platelet adenosine diphosphate (P2Y12) receptor, widely used in combination with acetylsalicylic acid (ASA) as dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS) to prevent cardiovascular events. Despite its well-established efficacy, ticagrelor may cause adverse effects ranging from common ones (e.g., bleeding, dyspnea) to rare but potentially serious reactions such as bradyarrhythmias. These rare events are likely related to elevated adenosine levels secondary to inhibition of the human equilibrative nucleoside transporter 1 (hENT1). Methods: We describe two clinical cases of ticagrelor-associated bradyarrhythmia observed in patients following ACS. Both cases were analyzed in terms of clinical presentation, ECG findings, management strategy, and outcomes after discontinuation of the drug. Results: The first case concerns a 67-year-old woman with non-ST-segment elevation myocardial infarction (NSTEMI) who developed complete atrioventricular block (third degree) with a 45 s asystolic pause and syncope. The second case involves a 67-year-old man with anterior ST-segment elevation myocardial infarction (STEMI) who experienced recurrent sinus pauses lasting up to 5 s. In both cases, symptoms resolved following ticagrelor discontinuation and theophylline administration. No recurrence of arrhythmia was observed after switching to prasugrel. Conclusions: Ticagrelor-induced bradyarrhythmias, although rare, represent an important and reversible adverse effect that clinicians should be aware of, particularly during the early post-ACS phase. Prompt recognition and drug withdrawal may prevent severe outcomes and avoid unnecessary interventions such as pacemaker implantation. Further studies are warranted to identify patient-specific risk factors predisposing to ticagrelor-related conduction disturbances. Full article

Background: Whilst COVID-19 mainly affects the lungs, multiple other organs were also involved—patients with COVID-19 were reported to be at higher risk of acute coronary syndromes (ACS). Importantly, results show that the risk of ACS may extend well beyond the acute phase of COVID-19 infection. In our study, we sought to investigate optical coherence tomography (OCT)-derived vascular changes, including the prevalence of plaque erosion in patients who had recent COVID-19. Methods: Patients with ACS were divided into two groups: those after COVID-19 infection during the past 12 months (post-COVID group) and those without known prior COVID infection (non-COVID group). We enrolled 35 patients in the post-COVID group and 35 patients in the non-COVID group. Results: The mean time from COVID infection to the imaging in the post-COVID group was 10 ± 1 months. There were no major differences in baseline demographic, clinical, or laboratory characteristics between the two groups. Erosion was the underlying pathology in one-third (34.3%) of the non-COVID group and in one-half (48.6%) of the post-COVID group, although the difference did not reach statistical significance. No calcified nodules were observed. The lipid core tended to be longer in the post-COVID group (9.1 ± 3.6 vs. 12.0 ± 1.9 mm; p = 0.005), and the prevalence of macrophages was higher in patients who had prior COVID-19 infection (48.6 vs. 74.3%; p = 0.027). Conclusions: Our OCT study demonstrated that patients with a prior COVID-19 infection tended to have a higher prevalence of plaque erosion and more vulnerable plaque morphology at the culprit lesion compared to those without a history of prior COVID-19 infection. Full article