Search Results (35,849)

Cardiac sarcoidosis (CS) is a critical and frequently underdiagnosed phenotype of sarcoidosis, characterized by non-caseating granulomatous infiltration of the myocardium. This review synthesizes current knowledge regarding the pathogenesis, diagnosis, and management of CS. The disease manifests with a heterogeneous clinical spectrum ranging from asymptomatic conduction abnormalities to life-threatening ventricular arrhythmias and heart failure. Diagnosis remains challenging due to the patchy distribution of granulomas, which limits the sensitivity of endomyocardial biopsy. Consequently, a multimodal diagnostic approach is essential, integrating advanced imaging modalities such as cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) and ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET). These tools not only facilitate detection but also enable the differentiation of active inflammation from chronic fibrosis. Histopathological assessment, supported by specific immunophenotyping and electron microscopy, remains the gold standard for confirming diagnosis and excluding mimics like giant cell myocarditis or infectious granulomatous diseases. Management requires a multidisciplinary strategy combining immunosuppressive therapy, primarily corticosteroids and steroid-sparing agents, with guideline-directed cardiac care, including implantable cardioverter-defibrillators for arrhythmia risk stratification. Emerging biomarkers and artificial intelligence-driven imaging analysis promise to further refine risk stratification and therapeutic monitoring, advancing precision medicine in this complex disorder. Full article

Phonocardiogram (PCG) signals offer a non-invasive, low-cost screening tool for cardiovascular diseases. However, their noisy and non-stationary nature makes automated classification challenging, and traditional methods often fail to capture complex spectral-temporal patterns. This study proposes a multimodal deep learning architecture for the binary classification of heart sounds (Healthy vs. Unhealthy). The hybrid model integrates Convolutional Neural Networks (CNNs), Transformer encoders, and Bidirectional Long Short-Term Memory (BiLSTM) networks with an attention mechanism. It utilizes an early-fusion feature extraction pipeline combining MFCCs, Mel-spectrograms, and Chroma descriptors. To ensure robust evaluation and prevent data leakage, SMOTE is applied exclusively to the training folds within a strict zero-leakage, patient-wise 5-fold cross-validation protocol. The proposed framework demonstrates exceptional performance, achieving an average accuracy of 91.67%, a sensitivity of 80.95%, a specificity of 94.46%, and an AUC-ROC of 96.50%. An ablation study confirms that integrating Transformer and BiLSTM modules significantly enhances diagnostic stability over baseline CNNs. Furthermore, with exactly 858,434 parameters (3.27 MB) and interpretable attention maps, this highly optimized model provides a robust assistive solution suitable for deployment in digital stethoscopes and mobile telemedicine systems. Full article

Background: Advanced heart failure (HF) in very old patients follows an unpredictable trajectory marked by recurrent decompensations, progressive functional decline, and high mortality. In this population, decision-making regarding goals of care and treatment proportionality is particularly complex due to multimorbidity, frailty, cognitive vulnerability, and prognostic uncertainty, and remains insufficiently addressed by conventional disease-centred heart failure pathways. Methods: This narrative review synthesizes current evidence from heart-failure guidelines, geriatric medicine, and palliative care literature to propose a cardiogeriatric framework for end-of-life decision-making in advanced HF. Results: In older adults, functional decline and geriatric vulnerability often progress independently of cardiac parameters, limiting the relevance of prognosis-based thresholds. The palliative turning point should be understood as a multidimensional process resulting from converging cardiological, geriatric, organizational, and patient-reported signals. Therapeutic decisions should be guided by proportionality between expected benefit, treatment burden, and patient priorities. Longitudinal, iterative communication is essential to align care with evolving goals. Conclusions: A cardiogeriatric approach integrating cardiology, geriatrics, and palliative principles supports timely palliative integration, shared decision-making, and coordinated care in very old patients with advanced HF. Full article

Flexible piezoelectric materials demonstrate broad application potential in wearable health monitoring, human–machine interaction, and biosensing. However, the piezoelectric response of pure PVDF-TrFE is limited and insufficient to meet the requirements for highly sensitive sensing. In this study, ZnO/PVDF-TrFE composite films with varying ZnO doping contents (3–11 wt%) were fabricated and systematically characterized in terms of their structural, thermal, and electrical properties. The results indicate that ZnO significantly promotes the formation of the polar β-phase in PVDF-TrFE, with the maximum β-phase content (F_β = 24.76%) and optimal piezoelectric performance achieved at 9 wt% ZnO doping. Devices based on this optimal composition exhibited stable ultrasonic transmission and reception capabilities under high-frequency pulse excitation, enabling sensitive detection of minor static pressure variations (e.g., contact pressure) through changes in ultrasonic echo signals, thereby realizing wearable conformity monitoring. Moreover, a sensor designed with a three-channel flexible substrate successfully captured human wrist pulse signals with high accuracy, demonstrating the practical utility and reliability of the device in flexible bio-electronic sensing applications. Full article

The main distinction between open and laparoscopic ovariectomy (OVE) is pneumoperitoneum (PNP) and anesthesia management. The objective of this study was to evaluate the effect of laparoscopic and open OVE on plasma cortisol, oxidative stress (OS), and cardiorespiratory parameters in dogs under the same anesthesia protocol. Twenty healthy female dogs were assigned to laparotomy OVE (LPTOVE, n = 10) and laparoscopic OVE (LAPOVE, n = 10) groups. OS was assessed using the total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI). Blood samples were collected prior to sedation (T0); prior to surgical incision (T1); prior to surgical closure in the LPTOVE group; and prior to the deflation of CO₂ in the LAPOVE group (T2), 2 h after the surgery (T3). The monitored cardiorespiratory parameters were heart rate, respiratory rate, and end-tidal CO₂ (EtCO₂). Cortisol levels at T3 were markedly elevated in the LPTOVE group compared to the LAPOVE group. No substantial changes in TOS, TAS, or OSI between groups were detected. In the LAPOVE group, TOS diminished at T2, but TAS declined and OSI escalated at T3. EtCO₂ levels were elevated in the LAPOVE group at the end of the procedure. These findings support laparoscopic OVE as a less traumatic alternative to open surgery, with careful management of PNP and anesthesia recommended to minimize postoperative stress. Full article

Background and Objectives: To assess whether country-level changes in major cardiometabolic risk factors were associated with concurrent changes in age-standardized death rates (ASDR) from ischaemic heart disease (IHD) and stroke between 2000 and 2015. Materials and Methods: We conducted a multinational ecological analysis using harmonized data from WHO, NCD-RisC, and the World Bank across 157 countries (n = 157). Absolute changes in systolic blood pressure, obesity, diabetes, and total cholesterol were standardized to z-scores. Linear regression models examined change–change associations, adjusting for income group and behavioral factors. Income-stratified and quartile-based analyses were performed. Results: Between 2000 and 2015, IHD and stroke mortality declined, while obesity and diabetes increased. In adjusted models, change in total cholesterol showed the most consistent association with change in IHD ASDR (β = 13.09, 95% CIs = 4.58–21.60, p = 0.003), whereas the other risk factors did not show consistent independent associations. Significant associations were confined to high- and upper middle-income countries, where change in total cholesterol was associated with IHD mortality. Conclusions: Changes in total cholesterol showed the most consistent correspondence with concurrent changes in IHD mortality at the country level, whereas other cardiometabolic risk factors showed less consistent patterns. These patterns were observed mainly in high- and upper–middle-income countries, suggesting heterogeneity by socioeconomic context. Full article

Background/Objectives: Liver fat represents an early metabolic lesion in the development of diabetes and its cardiometabolic complications. Diets high in free sugars, particularly from sugar-sweetened beverages (SSBs), are associated with abdominal obesity and increased cardiometabolic risk, prompting global guidelines to limit SSBs as a major public health strategy. Low-fat cow’s milk is promoted as the preferred caloric replacement strategy for SSBs due to its high nutritional value and cardiometabolic advantages. Fortified soymilk is a plant-based alternative with approved health claims for cholesterol and coronary heart disease risk reduction that offers an equivalent nutritional value to cow’s milk. However, given concerns about its classification as an ultra-processed food (UPF), it is unclear whether soymilk offers comparable metabolic health benefits to milk as part of clinical and public health strategies to reduce SSB intake. The Soy Treatment Evaluation for Metabolic (STEM) health trial seeks to evaluate the impact of replacing SSBs with either 2% soymilk or 2% cow’s milk on liver fat and other cardiometabolic risk factors in habitual adult consumers of SSBs with obesity. Methods: The STEM trial is a 24-week, pragmatic, 3-arm, parallel, randomized trial. We recruited adults with obesity (high BMI plus high waist circumference based on ethnic specific cut-offs) consuming ≥1 SSB/day. Participants were randomized to one of three groups based on their usual SSB intake at baseline (servings/day): continued SSB (355 mL can) intake; replacement with fortified, sweetened 2% soymilk (250 mL); or replacement with 2% cow’s milk (250 mL). The primary outcome is the change in intrahepatocellular lipid (IHCL) measured by ¹H-MRS at 24 weeks. Hierarchical testing will be done to reduce the familywise error rate. The superiority of cow’s milk to SSBs will be assessed first to establish assay sensitivity. If superiority is established, then the non-inferiority of soymilk to cow’s milk will be assessed using a pre-specified non-inferiority margin of 1.5% IHCL units (assessed by difference of means using a 90% confidence interval [CI]). Analyses will be conducted according to the intention-to-treat (ITT) principle using inverse probability weighting (IPW) for superiority testing and per-protocol analyses for non-inferiority testing, using ANCOVA adjusted for age, sex, metabolic dysfunction-associated steatotic liver disease (MASLD) status, medication use, intervention dose, and baseline levels. We hypothesize that soymilk will be non-inferior to cow’s milk (Clinicaltrials.gov NCT05191160). Results: Recruitment began in November 2021. A total of 3050 individuals were screened. We randomized 186 participants (62 per group) between 19 April 2022 and 16 April 2024. Participants are 57% male; with a mean [SD] age of 39.9 [11.8] years; BMI of 34.6 [6.1] kg/m², waist circumference of 112.6 [13.8] cm; IHCL of 10.0 [8.2] % with 64.1% meeting the criteria for MASLD; and SSBs intake of 2.3 [1.3] servings/day. Conclusions: Baseline characteristics were balanced across the study arms, with participants representing adults with a high-risk metabolic phenotype, and 64.1% meeting the criteria for MASLD. Findings will contribute to evidence on the cardiometabolic benefits of soymilk, informing clinical practice guidelines and public health policy. Full article

Decision Transformers (DTs) reformulate reinforcement learning as a conditional sequence modeling problem and have demonstrated competitive performance in offline Reinforcement Learning (RL) scenarios. However, their behavior in card games, specifically partially observable imperfect-information, trick-taking games remains underexplored. In parallel, general-purpose card-game toolkits have shown the value of unified environments and standardized evaluation protocols for accelerating research in imperfect-information games. Motivated by the goal of creating a general card-game-playing framework, we present a unified RL pipeline for trick-taking card games using DTs. While classical learning methods have demonstrated strong performance in card games, transformer-based reinforcement learning remains comparatively underexplored in this domain. This paper studies the applicability of DTs to the core play-phase of trick-taking games and evaluates whether a single, reusable pipeline can be transferred across multiple games in this class with minimal game-specific engineering. We propose a unified framework integrating offline pretraining, online selective expert iteration, and inference-time legal-action filtering. Crucially, our proposed approach demonstrates two key advantages over standard implementations. First, the model successfully internalizes complex game rules (e.g., follow-suit constraints) implicitly from the empirical data distribution, completely eliminating the need for explicit action masking during training. Second, we introduce a selective expert iteration mechanism equipped with strict acceptance filtering, which effectively prevents distribution collapse and enables safe, monotonic offline-to-online policy refinement. Ultimately, we show that this single, reusable transformer-based pipeline achieves competitive performance across multiple trick-taking domains (Hearts, Whist, and Spades) with minimal game-specific engineering. Full article

Background/Objectives: Long-term chronic intermittent hypobaric hypoxia (CIHH) is a common occupational exposure among high-altitude workers, particularly miners in northern Chile. This condition consists of working several days above 2500 m followed by rest at sea level, maintaining this cycle for years, which generates physiological alterations. This study analyzed associations among anthropometric indices and biomedical conditions in miners chronically exposed to long-term CIHH. Methods: This study was a cross-sectional analysis of 120 healthy Chilean male miners working at altitudes above 4400 m under a 7-day work/7-day rest schedule. Eligibility required ≥5 years of CIHH exposure and absence of cardiopulmonary disease, hypertension, diabetes, or oxygen therapy use. The assessments at altitude included oxygen saturation (SpO₂), blood pressure, heart rate, hematological parameters, metabolic parameters, and waist-to-hip ratio (WHR); measurements were obtained 18 h after arrival at altitude. WHR, BMI, SpO₂, and biomedical variables were collected following standardized procedures. Descriptive statistics and group comparisons were performed with Student’s t-test or the Wilcoxon test, with statistical significance set at p < 0.05. Normality assumption was assessed using the Shapiro–Wilk test. The association between WHR and SpO₂ was estimated using linear regression, with WHR scaled so that one unit corresponds to a 0.1-unit increase. Adjusted models included BMI, age, and years working under CIHH. Effect sizes and 95% confidence intervals (CIs) were reported. All statistical analyses were performed in the R programming language. Results: Mean SpO₂ was 89.07 ± 0.50% and mean WHR was 0.94 ± 0.01. In unadjusted comparisons, workers with WHR > 0.94 had lower SpO₂ than those below the threshold (88.8 ± 0.54 vs. 90.41 ± 0.50; p = 0.031). In adjusted models, the WHR–SpO₂ association was small and imprecise (β per 0.1-unit WHR = −0.67 pp; 95% CI −2.08 to 0.74). Hemoglobin showed an independent association with SpO₂, while other metabolic variables did not materially contribute. Conclusions: SpO₂ showed a modest inverse association with WHR in long-term CIHH workers. Even small saturation decreases may matter at high altitude. Combined WHR–SpO₂ monitoring may aid occupational surveillance, though longitudinal studies are needed to establish meaningful risk thresholds. Full article

Ginger supplementation is proposed as a natural ergogenic aid due to its anti-inflammatory and antioxidant properties, but its effects on endurance performance remain unclear. Methods: In this randomized, double-blind, placebo-controlled crossover trial, 30 trained cyclists (27 male, 3 females, aged 36 ± 11 yr) completed three visits: a baseline 75 km time trial, a post-supplementation time trial, and a second post-supplementation trial under the alternate condition. Participants consumed either ginger or placebo for four weeks. Statistics: Performance outcomes (i.e., 75 km time, VO₂, power output, heart rate, and RPE) were analyzed using repeated-measures ANOVA, with repeated-measures ANCOVA to assess dietary and age influences (p < 0.05). Results: Energy and carbohydrate intake were consistent across trials and unrelated to performance. Protein intake per kg body mass predicted performance time in the placebo trial and average VO₂ in the ginger trial; other macronutrients were not associated with outcomes. No significant differences were observed between ginger and placebo conditions for time to completion, VO₂, power output, heart rate, or perceived muscle soreness. Conclusions: Four weeks of ginger supplementation does not improve prolonged cycling performance, recovery, or muscle soreness in trained cyclists when dietary intake is controlled. Future research should explore cellular mechanisms to determine whether ginger supplementation could influence performance or recovery in endurance athletes. Full article

Cardiologists consider degenerative or infectious causes when evaluating valvular heart disease. However, the role of autoimmune disorders, though less frequent, remains clinically significant. This report describes a young male patient presenting with persistent coronary disease and a suspected valvular cusp perforation initially attributed to infective endocarditis, which ultimately proved to be a manifestation of IgG4-related disease. IgG4-related disease is a rare condition, more prevalent in Asian populations, that typically affects the pancreas, salivary glands, lacrimal glands, and the retroperitoneum. Cardiac involvement, although uncommon, can present in various ways, including pericarditis, pulmonary arterial hypertension, valve dysfunction, cardiac pseudotumor, and coronary disease. Diagnosing and managing IgG4-related cardiac involvement requires heightened clinical suspicion, serological and histopathological assessment, and prompt interdisciplinary collaboration. Notably, involving rheumatologists in the management of these rare yet impactful autoimmune cardiac diseases is essential. Full article

Background: Simplified field tests have gained increasing interest for the assessment of functional capacity in patients with post-COVID-19 condition; however, direct comparisons of functional performance and physiological responses between the 1-min sit-to-stand test (1MSTST) and the 6-min walk test (6MWT) remain limited. This study aimed to examine the associations between the two tests by evaluating functional performance, cardiopulmonary responses, oxygen desaturation, perceived exertion, and peripheral muscle strength. Furthermore, we explored whether the 1MSTST can be used as a complementary assessment, particularly within telerehabilitation pathways and in contexts where resource-intensive testing is not feasible. Methods: We conducted a cross-sectional observational study of adults recovering from moderate to severe COVID-19 between May and July 2021. Participants performed both the 1MSTST and 6MWT on the same day. Functional performance, peak heart rate, nadir peripheral oxygen saturation (SpO₂), perceived exertion, and handgrip dynamometry were recorded. Associations between test performances were assessed using correlation and partial correlation analyses, including adjustment for peripheral muscle strength. Results: Fifty-four patients were included. A moderate correlation was observed between 1MSTST repetitions and 6MWT distance (Spearman’s ρ = 0.47, p < 0.001), which was attenuated after adjustment for muscle strength and demographic variables. Peak heart rate and nadir SpO₂ responses were strongly correlated between tests (r = 0.75 and ρ = 0.83, respectively; both p < 0.001), with no significant differences in magnitude. Exercise-induced oxygen desaturation (≥4% SpO₂ drop) occurred at similar frequencies during both tests. Perceived exertion increased similarly following the 1MSTST and the 6MWT. Conclusions: In post-COVID-19 patients, the 1 min sit-to-stand test shows moderate concordance with the 6 min walk test for functional performance and strong agreement in cardiopulmonary responses. These findings suggest that the two tests assess overlapping but distinct aspects of functional capacity. This supports the use of the 1MSTST as a pragmatic complementary assessment when standard walking tests are not feasible, particularly within telerehabilitation pathways, primary care, and resource-limited settings. Full article

For nearly two decades, 12 months of dual antiplatelet therapy (DAPT) after acute coronary syndrome (ACS) has been the standard recommendation. Recent evidence suggests that abbreviated DAPT durations may reduce bleeding without compromising ischemic protection in selected patients. This review synthesizes randomized controlled trials, meta-analyses, and guideline updates published between 2023 and 2025, evaluating abbreviated DAPT strategies after ACS with percutaneous coronary intervention. Immediate aspirin withdrawal after PCI increased early stent thrombosis in NEO-MINDSET and STOPDAPT-3. One-month DAPT followed by ticagrelor monotherapy reduced bleeding without increasing ischemic events in ULTIMATE-DAPT and T-PASS. Three-month strategies demonstrated the most consistent safety profile, with TWILIGHT showing 50% bleeding reduction without increased death, myocardial infarction, or stroke (noting that TWILIGHT included 35% chronic coronary syndrome patients). Clopidogrel monotherapy after abbreviated DAPT increased myocardial infarction in STOPDAPT-2 ACS, highlighting the importance of potent P2Y12 inhibition. Meta-analyses confirmed bleeding reductions with early P2Y12 inhibitor monotherapy across broader populations, though benefits were more pronounced in East Asian cohorts. Abbreviated DAPT strategies offer personalized alternatives to standard 12-month therapy. Three-month DAPT followed by ticagrelor monotherapy represents a reasonable and evidence-supported strategy in selected patients with ACS. Risk stratification tools and individual patient factors should guide therapy duration decisions. Full article

Background/Objectives: Although the Calvert formula has been widely used to guide carboplatin dosing, it may yield inaccurate dose predictions in certain patient populations. We aimed to evaluate the adequacy of the conventional Calvert formula and to propose structural modifications to enhance dosing accuracy in breast cancer patients with preserved renal function (CrCL ≥ 55 mL/min). Methods: A systematic review and meta-analysis were conducted to integrate published pharmacokinetic models in patients with breast cancer. Two retrospective datasets (n = 154) were combined into a single analysis dataset and used to calculate carboplatin doses based on the conventional formulas using creatinine clearance (CrCL) or estimated glomerular filtration rate (eGFR), as well as a modified formula incorporating an additional constant (α). Performance was assessed by the proportion of subjects achieving target area under the curve (AUC) attainment (4–6 mg·min/mL), underexposure (<4 mg·min/mL), and overexposure (≥7 mg·min/mL). All AUC metrics were derived from model-based predictions rather than measured carboplatin concentrations, and no clinical toxicities or efficacy outcomes were used for validation. Results: Meta-analysis yielded fixed-effect parameter estimates (CL: 131.8 mL/min, V₁: 15.39 L, K₁₂: 0.002 min⁻¹, and K₂₁: 0.003 min⁻¹) with a random effect model. The conventional CrCL-based formula yielded 66.0% target attainment, 22.1% underexposure, and 4.5% overexposure. Switching to eGFR improved attainment to 88.3%, reduced underexposure to 5.8%, and lowered overexposure to 0.65%. A modified formula with α = 1 further decreased underexposure (4.5%) while target attainment and overexposure remained unchanged. Conclusions: Replacing CrCL with Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)-derived eGFR in the Calvert formula markedly improved dosing accuracy, while modest structural modification offered additional benefit. The incremental benefit of α = 1 should be considered hypothesis-generating and requires prospective validation with measured carboplatin concentrations and clinical outcomes before applying it in practice. These findings support adopting eGFR-based dosing in breast cancer and suggest the need for future clinical validation. Full article

Background/Objectives: Prolonged postoperative length of stay (LOS) is associated with increased morbidity and healthcare utilization following surgery for acute cholecystitis. The prognostic value of skeletal muscle density (SMD), a marker of muscle quality, is unclear. We aimed to evaluate the association between SMD and prolonged LOS and to compare the predictive performance of SMD with that of skeletal muscle index (SMI). Methods: A retrospective study of 382 patients who underwent surgery for acute cholecystitis was conducted. LOS was defined using mean- and median-based cut-offs. Multivariate logistic regression was used to identify independent predictors. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) and Akaike information criterion (AIC). Robustness was assessed using count-based modeling, spline analysis, and model calibration. Results: Patients with prolonged LOS were older, had lower body mass index and serum albumin levels, higher inflammatory markers, and more comorbidities, and had significantly lower SMD. Higher SMD was independently associated with a reduced risk of prolonged LOS (adjusted OR per 1-HU increase, 0.93; 95% CI, 0.88–0.97; p = 0.002). The SMD-based model showed acceptable discrimination (AUC 0.78) and slightly better model fit than the SMI-based model (AIC 365.1 vs. 371.2). In secondary analyses, patients in the lowest SMD quartile had significantly higher postoperative complication rates than the remaining patients (10.5% vs. 2.8%; p = 0.004). Conclusions: Overall, lower SMD was independently associated with prolonged LOS after surgery for acute cholecystitis and may serve as a readily available imaging biomarker for perioperative risk stratification. Full article