Search Results (2,160)

Soccer is a complex sport with significant physical, physiological, psychological, technical, and tactical demands on players. This review presents an ergonomics-based model of soccer performance, emphasizing that no single component operates in isolation. Building on the foundational ergonomic framework, this review integrates contemporary evidence on training load monitoring, ecological dynamics, and cognitive-perceptual performance dimensions not systematically addressed in prior frameworks. Elite outfield players cover 9–14 km·h⁻¹ per match, with high-speed running (19.8–24.8 km·h⁻¹) making up about 20% of total distance and sprinting (>25 km·h⁻¹) around 2%. These outputs vary by playing position, tactical formation, possession dynamics, and environmental conditions. Longitudinal data from the English Premier League indicate a 35% increase in high-speed running over the past decade, suggesting intensifying physical demands. Physiological responses, including average heart rates of 156–175 bpm, reflect the aerobic and anaerobic demands on players. The review also examines benchmarks like VO₂max, sprint velocity, and anthropometry, highlighting their utility and limitations as performance indicators. Regarding training load management, the review evaluates frameworks such as the Acute:Chronic ratio and high-speed running exposure protocols, noting limitations and risks of over-relying on external load metrics. Periodization approaches, including tactical periodization, are discussed for integrating physical, technical, tactical, and psychological components in training. The proposed ergonomic model conceptualizes elite soccer performance as an emergent property of interacting physical, physiological, tactical, psychological, and environmental subsystems, with direct implications for training design, selection, and load management. Selection decisions should consider cognitive and perceptual competencies like decision-making, anticipation, and situational awareness, alongside physical and physiological profiles, aligned with the team’s game model. Full article

Introduction: The Melody transcatheter pulmonary valve (TPV) was the first percutaneous bioprosthetic valve approved for transcatheter pulmonary valve implantation (TPVI). We report our single-centre experience with Melody TPV implantation in patients with congenital heart disease (CHD). Methods: This retrospective observational single-centre study included all patients evaluated in the catheterization laboratory for Melody TPV implantation. Early outcomes included procedural failure, life-threatening adverse events, and mortality. Long-term outcomes assessed during follow-up included infective endocarditis, transcatheter reintervention, and surgical reintervention. Results: Between 2015 and 2025, 50 consecutive patients were evaluated for TPVI with the Melody TPV at our institution. In four patients (8%), the procedure was aborted because of coronary artery compression detected during balloon interrogation of the right ventricular outflow tract (RVOT). One patient (2%) died of septic shock following acute pulmonary oedema in the immediate post-procedural period. The remaining 45 patients (90%) underwent successful Melody TPV implantation and were discharged from hospital. In six patients, the Melody TPV was implanted off-label: in the tricuspid position (n = 2) and in small conduits (<16 mm) (n = 4). Mean follow-up duration was 5.8 ± 3.6 years. One patient was lost to follow-up. Among the remaining 44 patients, seven (15.9%; 2.7% per patient-year) developed infective endocarditis, seven (15.9%; 2.7% per patient-year) underwent transcatheter reintervention (six balloon dilatations of the Melody valve and one valve-in-valve implantation), and four (9.1%; 1.5% per patient-year) required surgical replacement of the Melody TPV. Conclusions: Transcatheter implantation of the Melody TPV is an effective treatment for RVOT dysfunction. At mid-term follow-up, the majority of implanted Melody valves demonstrated satisfactory function, and only a minority of patients required surgical valve replacement. Full article

Background: Heart transplantation (HTx) is a well-established therapy for pediatric patients with end-stage heart failure. Over the past decades, the field has considerably evolved, with noticeable changes in surgical techniques and post-transplant outcomes. This study presents our center’s experience over the past three decades. Methods: Between 1988 and 2024, we performed 256 heart transplants in pediatric patients (<18 years) with congenital heart defects (CHD) or myopathy. We divided our cohort into three periode, eras: Era1 (1988–1999), Era2 (2000–2011), and Era3 (2012–2024). We analyzed and reported baseline patient data, postoperative outcomes, and survival analysis. Results: In the first era, most HTx recipients were infants (75%), with CHD accounting for 75% of cases. In the latest era, older children and adolescents were transplanted more frequently with infants representing only 22%, and myopathies became a more predominant indication, representing 57% of patients. The use of mechanical circulatory support increased significantly (<0.001), and a complete shift towards the bi-caval surgical technique was achieved in the recent era. In terms of post-HTx outcomes, 30-day mortality and allograft vasculopathy significantly decreased in the recent era compared with previous periods (<0.001). Conversely, operative time and post-HTx hemodialysis were more frequently observed in the recent era (<0.001). Long-term survival numerically improved in the middle and recent eras compared with the early era; however, no statistically significant difference in Kaplan–Meier survival across eras was observed (log-rank p = 0.19). Conclusions: Over the past three decades, HTx in pediatric patients has evolved, with improvements in early survival and reduced allograft vasculopathy. Changes in patient demographics, surgical technique, and use of MCS in the recent era highlight the ongoing progress as well as the remaining challenges in this complex population. Full article

Background: Advances in diagnostic criteria for transthyretin cardiac amyloidosis (ATTR-CM) and expanded insurance coverage for bone scintigraphy have facilitated earlier detection of ATTR-CM. However, whether these changes have translated into improved clinical outcomes among patients receiving disease-modifying therapy remains uncertain, especially in non-high-volume centers. Methods: Consecutive patients with ATTR-CM who started disease-modifying therapy at our institute between May 2019 and March 2025 were retrospectively analyzed. Baseline characteristics and clinical outcomes were compared between the early period (2019–2021) and the late period (2021–2025). Results: A total of 31 patients (median age 77 years, 77% male) were included. Duration of heart failure was significantly shorter and the dose of loop diuretics at baseline was significantly lower in the late period (p < 0.05 for both). The prevalence of National Amyloid Center (NAC) stage I at baseline tended to be higher in the late period (75.0% versus 53.5%, p = 0.273). The cumulative incidence of worsening heart failure hospitalization and all-cause death was significantly lower in the late period (6.3% versus 44.2%, p = 0.024) during a median follow-up of 5 years. NAC stage I at baseline was independently associated with the lower primary outcome with an adjusted hazard ratio of 0.10 (95% confidence interval 0.01–0.90, p = 0.040). Conclusions: Patients with ATTR-CM in the late group experienced more favorable clinical outcomes after disease-modifying therapy, probably due to earlier diagnosis and therapeutic intervention, although further studies are warranted to verify the hypothesis. Full article

The physiological impact of climatic stress is well documented in ruminants, but the acute stress resulting from personnel rotation and its health and welfare consequences are poorly understood. The objective of this observational prospective longitudinal study was to assess the endocrine, inflammatory, behavioral, and cardiorespiratory responses of pre-weaned Zebu-cross calves (¾ Zebu x ¼ Holstein) to handler substitution and environmental variables in the Mexican humid tropics during the rainy season. Fourteen calves were monitored over a 68-day period. The initial behavioral (n = 14) and physiological (n = 5) assessments (S1) were conducted after a 30-day stabilization period with the familiar handler to ensure that animals had reached a physiological steady state, free from the influence of previous personnel rotations and from familiarization with two external observers, prior to the first assessment. Subsequently, the handler was replaced for 17 days (S2). The third (S3) and fourth (S4) samplings were conducted after the familiar handler was reinstated (21-day). There was a significant increase in plasma cortisol and abnormal suckling behaviors at S2 compared to S1 and S4, and a C-reactive protein increase in S3. Furthermore, strong correlations were found between calf handler and cortisol, heart rate, respiratory rate, latency to suckle, and cross-sucking, suggesting an acute stress response with a delayed inflammatory response secondary to the handler’s substitution. Environmentally, ambient temperature (AT, °C) showed no correlation with cortisol levels, indicating that the primary driver of the neuroendocrine and behavioral changes was handler substitution rather than climatic variations. Full article

Background: Menopausal hormone therapy (MHT) effectively relieves vasomotor symptoms, but its cardiovascular safety remains influenced by timing, formulation, and route of administration. Methods: This narrative review summarizes evidence from major randomized trials (WHI, HERS, ELITE, DOPS) and observational studies, along with mechanistic data on the vascular and metabolic effects of MHT. Results: Although early studies suggested cardioprotection, randomized trials showed no cardiovascular benefit, and in some cases, increased risks of coronary events, stroke, and venous thromboembolism, particularly in older women or those with established cardiovascular disease. The “timing hypothesis” indicates that early initiation after menopause may have neutral or modestly favorable effects, whereas late initiation is associated with adversity. Oral estrogen is linked to higher thromboembolic and stroke risk compared with transdermal formulations. Evidence on atrial fibrillation and heart failure remains limited. Conclusions: MHT should not be used for cardiovascular disease prevention. Current evidence suggests that younger women in the early postmenopausal period may derive the greatest benefit with the lowest risk from individualized hormone therapy regimens, particularly those using transdermal estrogen. Treatment decisions should be guided by careful cardiovascular risk assessment and targeted to symptom relief and osteoporosis prevention. Full article

Background and Objectives: Atrial fibrillation (AF) and atrial flutter are associated with significant morbidity. While electrical cardioversion (ECV) is a standard treatment for sinus rhythm restoration, early arrhythmia recurrence is common. Epicardial adipose tissue (EAT) is a metabolically active depot linked to atrial remodeling, yet its role in predicting post-ECV outcomes remains unclear. This study aimed to evaluate the association between EAT thickness measured by echocardiography and early arrhythmia recurrence following elective ECV in patients with and without heart failure (HF). Materials and Methods: A single-center observational study was conducted including 76 patients (38 with previously diagnosed HF) who underwent successful elective ECV (eECV) for AF or atrial flutter. Preprocedural transesophageal echocardiography was performed to exclude thrombi, while EAT thickness was assessed via transthoracic echocardiography (TTE). The primary outcome was early arrhythmia recurrence (within 30 days), and a secondary outcome was arrythmia recurrence in the HF subgroup. Data were analyzed using univariable and multivariable logistic regression, receiver operating characteristic (ROC) analysis, and subgroup analysis in patients with HF. Results: Arrhythmia recurrence occurred in 19 patients (25.0%) within the follow-up period. Mean EAT thickness did not differ significantly between patients with and without recurrence (3.74 ± 1.41 mm vs. 3.58 ± 1.78 mm; p = 0.42). EAT thickness did not emerge as a significant predictor of recurrence in univariable or multivariable models, demonstrating poor discriminative ability (AUC = 0.56). Similar findings were observed in the HF subgroup (OR = 0.94, p = 0.75; AUC = 0.49). Conversely, left atrial (LA) size was significantly associated with recurrence (OR = 2.76, p = 0.043). While EAT thickness correlated with body mass index and HF, it did not predict immediate rhythm outcomes. Conclusions: In our study, measurement of EAT thickness via TTE was not associated with early arrhythmia recurrence after eECV, including in patients with concomitant HF. These findings suggest that early post-cardioversion stability may depend more on established structural atrial remodeling, especially by LA enlargement, than on linear EAT thickness. Further research utilizing advanced volumetric imaging is warranted to clarify the role of epicardial adiposity in atrial arrhythmogenesis. Full article

Capacitive electrocardiography (cECG) enables non-contact heart rate monitoring through clothing, but motion artifacts remain a critical limitation for practical applications. We present a novel motion artifact removal method using non-contact floating electrodes as noise references combined with multi-reference Normalized Least Mean Squares (NLMS) adaptive filtering. The floating electrodes, positioned without skin contact, couple primarily to ambient 50 Hz mains interference, which becomes amplitude-modulated during motion due to changes in electrode–body capacitance. Six reference signals are derived from this noise electrode: band-pass-filtered signal and its derivative (capturing baseline-type artifacts), envelope and its derivative (capturing amplitude modulation patterns), and envelope asymmetry and its derivative (capturing non-linear electrode response during motion). The NLMS algorithm adaptively combines these references to estimate and remove motion artifacts while preserving QRS morphology through low-pass filtering of the correction signal. A hysteresis-based motion detector with minimum duration constraints enables selective application of artifact removal only during motion periods, leaving rest-period ECG unmodified. We present this as a proof-of-concept validation of a novel reference-electrode architecture for motion artifact suppression in non-contact ECG. The method was validated on 7 subjects across 24 recording sessions using two electrode configurations in two environments with different electromagnetic interference levels. Controlled axial rotation motion was induced at three frequencies using a custom apparatus with IMU-based gamification for protocol adherence. Performance was evaluated using R-peak detection F1 score against gel surface-contact electrodes ground truth and RMS reduction in motion regions. Results demonstrate consistent improvement in R-peak detection accuracy during motion periods with substantial artifact energy reduction. The proposed method is designed to address motion artifacts regardless of their physical source, though the present validation focused on subject-induced motion. Full article

Burden of diseases measured as disability-adjusted life years (DALYs) per 100,000 people can be mined from public domain data, when they are made available by population health surveillance systems. This can be analysed to allow insightful comparisons with the national average, and to understand differences in trends between the sexes, age groups, time periods, geographic regions, and sub-regions. In this illustrative case study, we have analysed the Scottish burden of disease database to understand what ailed the population of the Grampian region before the COVID-19 pandemic. We have identified that selected cancers, ischaemic heart disease, Alzheimer’s disease and other dementias are amongst the highest contributors to the burden; that drug use disorders and colorectal cancer are showing worsening trends and require health promotion and disease prevention measures from ages 15 and 25, respectively, especially in Aberdeen City; and that males are more vulnerable to atrial fibrillation and flutter, diabetes mellitus, oesophageal cancer, and self-harm, while females are more vulnerable to cerebrovascular and chronic obstructive pulmonary diseases. We demonstrate the usefulness of our analysis and methodology for the wider health system, allowing targeted medical research investments and coordinated response from public health and health service delivery. We also show the need for up-to-date surveillance data, forecasts, and evidence on the impact of interventions to be made available widely. Full article

The Apennine wolf (Canis lupus italicus) is a distinct subspecies whose ongoing population recovery in Italy has progressively increased the demand for live capture protocols validated for scientific monitoring and conservation management. Despite the widespread use of mechanical and chemical immobilization in European wolf management, no study has to date systematically evaluated the combined use of the Fremont™ humane foot snare with a medetomidine-ketamine-acepromazine (MKA) protocol in this subspecies, nor characterized the associated cardiorespiratory, thermal, and hematobiochemical parameters under operational field conditions. Between June 2010 and July 2017, thirteen free-ranging Apennine wolves were captured in Maiella National Park (central Apennines, Italy) using the Fremont™ snare and immobilized with a standardized MKA protocol; only animals immobilized with this protocol are reported here, as three additional capture events employed different drug combinations. Cardiorespiratory parameters, body temperature, peripheral oxygen saturation, venous blood gas values, and a comprehensive hematological and serum biochemical panel were recorded during immobilization. Mean heart rate was 100 ± 15 bpm, respiratory rate 24 ± 13 breaths/min, body temperature 38.1 ± 1.3 °C, and mean SpO₂ 88 ± 11% (range: 66–97%; n = 12). No clinically significant hyperthermia requiring active intervention was recorded in the cohort as a whole. Hematological and biochemical values were broadly consistent with published reference ranges for the species, with condition-specific deviations identified in two individuals—one pregnant female and one juvenile presenting signs of transient capture-related myopathy—both of which resolved without clinical sequelae. No capture-related mortality occurred. All thirteen individuals survived the minimum post-capture monitoring period. Preliminary GPS observations in a subset of individuals (n = 3) suggest a transient reduction in movement activity in the immediate post-release period. These findings support the safety and operational feasibility of the combined Fremont™ snare–MKA protocol for the Apennine wolf, and provide baseline physiological and hematobiochemical reference data for Canis lupus italicus relevant to future capture and conservation management programmes. Full article

Background/Objectives: Perforated peptic ulcer (PPU) represents a surgical emergency with substantial morbidity and mortality. Despite declining overall peptic ulcer disease (PUD) incidence, contemporary population-based data comparing outcomes between perforated and non-perforated PUD remain limited, particularly during the COVID-19 pandemic. This study aimed to characterize the clinical and economic burden of PPU and identify independent predictors of adverse outcomes. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (2016–2021), identifying 2,561,379 weighted hospitalizations for PUD. Hospitalizations were stratified by the presence (n = 207,970, 8.1%) or absence (n = 2,353,409, 91.9%) of perforation. The primary outcome was in-hospital mortality; secondary outcomes included sepsis, septic shock, acute kidney injury (AKI), prolonged length of stay (≥7 days), and high healthcare costs (≥$12,000). We performed 1:1 propensity score matching and multivariable logistic regression to assess independent predictors of adverse outcomes in the PPU cohort. Results: After propensity matching, PPU demonstrated significantly higher mortality than non-perforated PUD (7.2% vs. 3.0%, p < 0.001), along with increased rates of sepsis (21.8% vs. 8.2%, p < 0.001), septic shock (12.9% vs. 3.5%, p < 0.001), and AKI (29.5% vs. 22.8%, p < 0.001). Nearly half (45.6%) of PPU admissions exceeded 7 days, and 69.2% incurred costs ≥$12,000. Among PPU hospitalizations, multivariable analysis identified age ≥ 65 years (aOR 5.79, 95% CI 4.60–7.28), liver cirrhosis (aOR 1.93, 95% CI 1.62–2.30), chronic heart failure (aOR 1.73, 95% CI 1.56–1.92), and concurrent COVID-19 infection (aOR 4.35, 95% CI 3.46–5.47) as independent predictors of mortality. Chronic kidney disease strongly predicted AKI (aOR 2.81, 95% CI 2.64–2.98). Mortality increased from 6.9% (2016) to 8.0% (2021) in PPU hospitalizations (p < 0.001 for trend), with higher rates observed during the 2020 to 2021 period that coincided with the COVID-19 pandemic. Conclusions: Perforation complicates approximately 8% of hospitalized PUD cases but accounts for disproportionate mortality, sepsis, organ failure, and healthcare costs. Older age, cirrhosis, heart failure, and chronic kidney disease identify high-risk PPU patients requiring intensive monitoring and aggressive management. These findings support risk-stratified approaches focused on timely diagnosis, source control, and sepsis management to reduce the clinical and economic burden of PPU. Full article

Background: The aim of the study was to compare the effort intensity levels between various futsal training drills designed according to the non-linear pedagogy (NLP) approach and official female academic league matches. Methods: Nine female players representing a university futsal team participated in this study. The analysis involved four official league matches (OM), evaluated across both the first and second halves (H1 and H2), as well as eleven training drills. The drills were conducted using contemporary NLP methods and were classified as: CSD (drills without active opponents), STG (small tactical games with reduced complexity based on the constraints-led approach), and FG (drills based on the full futsal format). The recorded variables included the percentage of peak heart rate (%HRpeak) and average heart rate (HRavg) across five distinct intensity zones. To account for the repeated-measures design, data were aggregated and averaged for each participant within each drill category prior to the main analysis. Results: The overall pairwise comparisons regarding global activity-period intensity failed to reach statistical significance. Although differences in absolute mean values were observed between the training tasks and official match conditions, these variations were not statistically significant. Conclusions: The NLP approach in female academic futsal sessions elicited a comparable cumulative physiological load (expressed via HR metrics and time spent in different intensity zones) to match conditions. However, due to the small sample size and corresponding wide confidence intervals, this lack of significant differences must be interpreted cautiously as exploratory trends rather than definitive evidence of physiological equivalence. Future research with larger cohorts is warranted to evaluate the motor learning potential of these constraints. Full article

This pilot study aimed to examine autonomic nervous system responses in student-athletes using heart rate variability (HRV) and skin conductance level (SCL) during sequential cognitive stressors, including a modified Stroop test and a mental math task. Fifty-two university athletes (mean age = 21.7 ± 2.8 years) participated in this repeated-measures experimental study. HRV and SCL were recorded at baseline, during each stressor, and throughout the recovery periods following each task. Repeated-measures ANOVA revealed significantly elevated SCL across experimental conditions [F(2.09, 100.53) = 45.69, p < 0.001, η² = 0.488], which remained above baseline during recovery, indicating sustained sympathetic activation. HR also increased significantly during stress exposure, indicating increased autonomic activation during cognitive stress [F(2, 103.11) = 14.30, p < 0.001, η² = 0.230]. Contrary to the initial hypothesis, vagally mediated HRV indices, including RMSSD [F(2.73, 131.11) = 6.88, p < 0.001, η² = 0.125] and HF power [F(2.85, 136.99) = 16.86, p < 0.001, η² = 0.260], increased during cognitive stress, suggesting adaptive parasympathetic modulation rather than vagal withdrawal. These findings indicate that autonomic responses to cognitive stress in athletes may involve simultaneous sympathetic and parasympathetic activation rather than a simple vagal withdrawal response. Overall, the findings only partially supported the initial hypotheses. Despite limitations related to sample size and short recording periods, the present findings highlight the importance of evaluating HRV and SCL together when examining psychophysiological stress responses in athletic populations. Full article

Background: Myocardial infarction triggers a complex remodeling process involving inflammation, hypertrophy, fibrosis, and electrical adaptation, ultimately predisposing the heart to failure. Krüppel-like factors (KLFs) are transcriptional regulators implicated in cardiovascular development and disease; however, a comprehensive temporal characterization of their coordinated activity during post-injury remodeling remains lacking. Objective: To define the temporal orchestration of the KLF family during myocardial injury and hypertrophy, and to integrate these dynamics within regulatory networks associated with cardiac remodeling. Methods: Myocardial injury was induced in rats using intraperitoneal isoproterenol. Left ventricular tissue was collected over a 21-day period. Cardiac morphometry, histology, immunohistochemistry, and quantitative gene expression analyses were performed to evaluate structural and transcriptional changes. Publicly available human cardiac and fibroblast datasets were analyzed for translational comparison, and protein–protein interaction networks were constructed to identify functional associations. Results: Isoproterenol treatment induced progressive hypertrophy, structural disorganization, and sustained fibrotic remodeling. KLFs displayed coordinated, phase-specific regulation, characterized by early activation of inflammation-associated members, intermediate engagement of factors linked to transforming growth factor signaling and hypertrophy modulation, and late induction of regulators associated with apoptosis and scar formation. These temporal patterns paralleled changes in inflammatory mediators, cardiac transcription factors, and genes involved in electrical and calcium handling pathways. Human expression analyses supported tissue-specific specialization of key KLFs. Conclusions: KLFs exhibit a coordinated and temporally structured regulatory program during myocardial remodeling, functioning as a transcriptional network that integrates inflammation, fibrosis, hypertrophy, and electrical adaptation. These findings position KLFs as key regulatory nodes in cardiac remodeling and potential targets for therapeutic intervention. Full article

Background: The generation of quality metrics for paediatric heart centre programmes frequently relies on registry data, with all the known benefits and disadvantages. This retrospective monocentric study introduces an algorithm capable of processing unedited clinical data to identify mortality risk factors following paediatric cardiac surgery. Methods: Patients who had undergone cardiac surgery in the department during the period from 2011 to 2020 were included when aged < 18 years. Congenital heart disease (CHD) was categorised into four diagnosis groups through hierarchical integration of the index surgery and CHD diagnosis. We evaluated preoperative, demographic, periprocedural, and postsurgical risk factors. Results: A total of 1700 patients with 2157 hospitalization encounters were included. The risk factors for elevated mortality with the highest degree of significance were extracorporeal membrane oxygenation (hazard ratio 13.97, p < 0.001), weight < 2500 g, patients in the univentricular heart group I, and the creatinine ratio. Conclusions: Beyond confirming established predictors such as ECMO and low body weight < 2500 g, the present analysis highlights the creatinine ratio as a strong laboratory-based predictor of mortality. The applied framework serves as a foundational step towards enabling the real-time utilisation of raw datasets across multiple centres, thereby supporting privacy-preserving and efficient quality metric assessment as well as enhanced risk stratification. Full article