Search Results (2,407)

Background: In high-risk and frail patients with multivessel coronary artery disease (MV CAD), guidelines indicated complete revascularization with or without the use of cardiopulmonary bypass (CPB) bears a high morbidity and mortality risk. In cases where catheter interventions were deemed unsuitable and conventional coronary artery bypass grafting (CABG) posed an unacceptable perioperative risk, patients were scheduled for minimally invasive direct coronary artery bypass (MIDCAB) grafting or minimally invasive multivessel coronary artery bypass grafting (MICS-CABG). We called this approach “palliative revascularization.” This study assesses the safety and impact of palliative revascularization on clinical outcomes and overall survival. Methods: A consecutive series of 57 patients undergoing MIDCAB or MICS-CABG as a palliative surgery between 2008 and 2018 was included. The decision for palliative surgery was met in heart team after carefully assessing each case. The patients underwent single or double-vessel revascularization using the left internal thoracic artery and rarely radial artery/saphenous vein segments, both endoscopically harvested. Inpatient data could be completed for all 57 patients. The mean follow-up interval was 4.2 ± 3.7 years, with a follow-up rate of 91.2%. Results: Mean patient age was 79.7 ± 7.4 years. Overall, 46 patients (80.7%) were male, 26 (45.6%) had a history of atrial fibrillation and 25 (43.9%) of chronic kidney disease. In total, 13 patients exhibited a moderate EuroSCORE II, while 27 were classified as high risk, with a EuroSCORE II exceeding 5%. Additionally, 40 patients (70.2%) presented with three-vessel disease, 17 (29.8%) suffered an acute myocardial infarction within three weeks prior to surgery and 50.9% presented an impaired ejection fraction. There were 48 MIDCAB and nine MICS CABG with no conversions either to sternotomy or to CPB. Eight cases were planned as hybrid procedures and only 15 patients (26.3%) were completely revascularized. During the first 30 days, four patients (7%) died. A myocardial infarction occurred in only one case, no patient necessitated immediate reoperation. The one-, three- and five-year survival rates were 83%, 67% and 61%, respectively. Conclusions: MIDCAB and MICS CABG can be successfully conducted as less invasive palliative surgery in high-risk multimorbid patients with MV CAD. The early and mid-term results were better than predicted. A higher rate of hybrid procedures could improve long-term outcome in selected cases. Full article

The Red River Jig is a traditional Métis dance practiced among Indigenous and non-Indigenous Peoples. While exercise improves physical health and fitness, the impacts of cultural dances on wholistic health are less clear. This study aimed to investigate the psychosocial (cultural and mental), social, physical function, and physical fitness benefits of a Red River Jig intervention. In partnership with Li Toneur Nimiyitoohk Métis Dance Group, Indigenous and non-Indigenous adults (N = 40, 39 ± 15 years, 32 females) completed an 8-week Red River Jig intervention. Social support, cultural identity, memory, and mental wellbeing questionnaires, seated blood pressure and heart rate, weight, pulse-wave velocity, heart rate variability, baroreceptor sensitivity, jump height, sit-and-reach flexibility, one-leg and tandem balance, and six-minute walk test were assessed pre- and post-intervention. Community, family, and friend support scores, six-minute walk distance (553.0 ± 88.7 m vs. 602.2 ± 138.6 m, p = 0.002), jump, leg power, and systolic blood pressure low-to-high-frequency ratio increased after the intervention. Ethnic identity remained the same while affirmation and belonging declined, leading to declines in overall cultural identity, as learning about Métis culture through the Red River Jig may highlight gaps in cultural knowledge. Seated systolic blood pressure (116.5 ± 7.3 mmHg vs. 112.5 ± 10.7 mmHg, p = 0.01) and lower peripheral pulse-wave velocity (10.0 ± 2.0 m·s⁻¹ vs. 9.4 ± 1.9 m·s⁻¹, p = 0.04) decreased after the intervention. Red River Jig dance training can improve social support, physical function, and physical fitness for Indigenous and non-Indigenous adults. Full article

Accurate fetal R-peak detection from low-SNR fetal electrocardiogram (FECG) signals remains a critical challenge as current NI-FECG methods struggle to extract high SNR FECG signals and conventional algorithms fail when signal quality deteriorates. We proposed a U-Net-based method that enables robust R-peak detection directly from low-SNR FECG signals (0–12 dB), bypassing the need for high-SNR inputs that are clinically difficult to acquire. The method was evaluated on both real (A&D FECG) and synthetic (FECGSYN) databases, comparing against ten state-of-the-art detectors. The proposed method significantly reduces false predictions compared to commonly used detection algorithms, achieving a PPV of 99.81%, an SEN of 100.00%, and an F1-score of 99.91% on the A&D FECG database and a PPV of 99.96%, an SEN of 99.93%, and an F1-score of 99.94% on the FECGSYN database. Further investigation of robustness in low-SNR conditions (0 dB, 5 dB, and 10 dB) achieved 87.38% F1-score at 0 dB SNR on real signals, surpassing the best-performing algorithm implemented in Neurokit by 13.58%. In addition, the algorithm showed ≤2.65% performance variation across tolerance windows (50 reduced to 20 ms), further underscoring its detection accuracy. Overall, this work reduces the reliance on high-SNR FECG signals by reliably extracting R-peaks from suboptimal signals, providing implications for the reliability of fetal heart rate variability analysis in real-world noisy environments. Full article

Background: Parkinson’s disease (PD) often involves autonomic dysfunction, most notably impaired baroreflex sensitivity (BRS), which disrupts cardiovascular homeostasis and contributes to orthostatic hypotension (OH). Pharmacological and invasive treatments, including deep brain stimulation, have yielded inconsistent benefits and carry procedural risks, highlighting the need for safer, more accessible alternatives. In this systematic review, we evaluated non-invasive interventions—spanning somatosensory stimulation, exercise modalities, thermal therapies, and positional strategies—aimed at improving cardiovascular autonomic function in PD. Methods: We searched PubMed, Embase, MEDLINE (Ovid), Google Scholar, ScienceDirect, and Web of Science for studies published between January 2014 and December 2024. Eight original studies (n = 8) including 205 participants met the inclusion criteria for analyzing cardiac sympathovagal balance. Results: Five studies demonstrated significant post-intervention increases in BRS. Most reported favorable shifts in heart rate variability (HRV) and favorable changes in the low-frequency/high-frequency (LF/HF) ratio. Across modalities, systolic blood pressure (SBP) decreased by an average of 5%, and some interventions produced benefits that persisted up to 24 h. Conclusion: Although sample sizes were small and protocols heterogeneous, the collective findings support the potential of non-invasive neuromodulation to enhance BRS and overall cardiovascular regulation in PD. Future research should focus on standardized, higher-intensity or combined protocols with longer follow-up periods to establish durable, clinically meaningful improvements in autonomic function and quality of life for people living with PD. Full article

Despite cognitive workload (CW) being a critical metric in several applications, no technology exists to seamlessly and reliably quantify CW. Previously, we demonstrated the feasibility of a wearable MagnetoCardioGraphy (MCG) sensor to classify high vs. low CW based on MCG-derived heart rate variability (mHRV). However, our sensor was unable to address certain critical operational requirements, resulting in noisy signals, often to the point of being unusable. In addition, test conditions for the participants were not decoupled from motion (i.e., physical activity (PA)), raising questions as to whether the noted changes in mHRV were attributed to CW, PA, or both. This study reports software and hardware advancements to optimize the MCG data quality, and investigates whether changes in CW (in the absence of PA) can be reliably detected. Performance is validated for healthy adults (n = 10) performing three types of CW tasks (one for low CW and two for high CW to eliminate the memory effect). Results demonstrate the ability to retrieve MCG R-peaks throughout the recordings, as well as the ability to differentiate high vs. low CW in all cases, confirming that CW does modulate the mHRV. A paired Bonferroni t-test with significance $\alpha =0.01$ confirms the hypothesis that an increase in CW decreases mHRV. Our findings lay the groundwork toward a seamless, practical, and low-cost sensor for monitoring CW. Full article

Background: Standard room temperature housing (~22 °C) represents a stress for laboratory mice, resulting in an increased metabolic rate, calorie consumption, heart rate, and catecholamine levels compared to thermoneutral conditions (29–32 °C). Using a recently established two-hit model of heart failure with preserved ejection fraction (HFpEF) (Angiotensin II + High-fat diet for 28 days; MHS), we investigated how housing temperature modulates cardiac remodelling and function in male and female C57Bl/6J mice. Methods: Using the MHS mouse model, we investigated cardiac remodelling and function in 8-week-old C57BL/6J mice of both sexes housed at 10 °C, 22 °C, and 30 °C for four weeks. Control mice were analyzed in parallel. Before the MHS, the animals were allowed to acclimate for a week before the MHS started. Results: Mice housed at 10 °C consumed more food and had increased fat mass compared to those at 22 °C or 30 °C. This was accompanied by increased heart weight, stroke volume, heart rate, and cardiac output. Mice housed at 22 °C and 30 °C were similar for these cardiac parameters. Following MHS, mice at 10 °C and 22 °C developed marked cardiac hypertrophy, whereas thermoneutral housing attenuated this response and reduced left atrial enlargement. Cold-exposed females showed more diastolic dysfunction after MHS (increased E’ wave, E/E’, and isovolumetric relaxation time) than those at 22 °C or 30 °C. Ejection fraction and cardiac output declined significantly at 10 °C after MHS but were preserved at 22 °C and 30 °C in females. Conclusions: Cold housing exacerbates cardiac dysfunction in mice subjected to HFpEF-inducing stress, with pronounced effects in females. In contrast, thermoneutrality limits the cardiac hypertrophic response. Full article

The barbel chub (Squaliobarbus curriculus) exhibits remarkable resistance to grass carp reovirus (GCRV), a devastating pathogen in aquaculture. To reveal the molecular basis of this resistance, we investigated complement factor D (DF)—a rate-limiting serine protease governing alternative complement pathway activation. Molecular cloning revealed that the barbel chub DF (ScDF) gene encodes a 1251-bp cDNA sequence translating into a 250-amino acid protein. Crucially, bioinformatic characterization identified a unique N-glycosylation site at Asn¹³⁹ in ScDF, representing a structural divergence absent in grass carp (Ctenopharyngodon idella) DF (CiDF). While retaining a conserved Tryp_SPc domain harboring the catalytic triad (His⁶¹, Asp¹⁰⁹, and Ser²⁰⁴) and substrate-binding residues (Asp¹⁹⁸, Ser²¹⁹, and Gly²²¹), sequence and phylogenetic analyses confirmed ScDF’s evolutionary conservation, displaying 94.4% amino acid identity with CiDF and clustering within the Cyprinidae. Expression profiling revealed constitutive ScDF dominance in the liver, and secondary prominence was observed in the heart. Upon GCRV challenge in S. curriculus kidney (SCK) cells, ScDF transcription surged to a 438-fold increase versus uninfected controls at 6 h post-infection (hpi; p < 0.001)—significantly preceding the 168-hpi response peak documented for CiDF in grass carp. Functional validation showed that ScDF overexpression suppressed key viral capsid genes (VP2, VP5, and VP7) and upregulated the interferon regulator IRF9. Moreover, recombinant ScDF protein incubation induced interferon pathway genes and complement C3 expression. Collectively, ScDF’s rapid early induction (peaking at 6 hpi) and multi-pathway coordination may contribute to barbel chub’s GCRV resistance. These findings may provide molecular insights into the barbel chub’s high GCRV resistance compared to grass carp and novel perspectives for anti-GCRV breeding strategies in fish. Full article

Background: Diabetes mellitus is associated with worse outcomes after cardiac arrest. Hyperglycemia, diabetes treatments and other long-term sequalae may contribute to this association. We sought to determine the acute effect of diabetes on the return of spontaneous circulation (ROSC) and post-arrest cardiac function in a rat cardiac arrest model. Methods: Eighteen male Wistar rats were utilized, and 12 underwent the induction of type II diabetes for 10 weeks through a high-fat diet and the injection of streptozotocin. The carotid artery flow and femoral arterial pressure were measured. Seven minutes of asphyxial cardiac arrest was induced. An external cardiac compression was performed via an automated piston. Post-ROSC, epinephrine was titrated to a mean arterial pressure (MAP) of 70 mmHg. Data was analyzed using the Mann–Whitney test. The significance was set at p ≤ 0.05. Results: The rate of the ROSC was significantly lower in animals with diabetes, 50% compared to 100% in non-diabetics. Additionally, it took significantly longer to achieve the ROSC in diabetics, p = 0.034. In animals who survived, the cardiac function was reduced, as indicated by an increased epinephrine requirement, p = 0.041, and a decreased cardiac output at the end of the experiment, p = 0.017. The lactate, venous and arterial pressures, heart rate and carotid flow did not differ between groups at 2 h. Conclusions: Diabetes negatively affects the survival from cardiac arrest. Here, the critical difference was the rate of the conversion to a life-sustaining rhythm and the achievement of the ROSC. The post-ROSC cardiac function was depressed in diabetic animals. Interventions targeted at improving defibrillation success may be important in diabetics. Full article

Large, high-quality patient datasets are essential for applications like economic modeling and patient simulation. However, real-world data is often inaccessible or incomplete. Synthetic patient data offers an alternative, and current methods often fail to preserve clinical plausibility, real-world correlations, and logical consistency. This study presents a patient cohort generator designed to produce realistic, statistically valid synthetic datasets. The generator uses predefined probability distributions and Cholesky decomposition to reflect real-world correlations. A dependency matrix handles variable relationships in the right order. Hard limits block unrealistic values, and binary variables are set using percentiles to match expected rates. Validation used two datasets, NHANES (2021–2023) and the Framingham Heart Study, evaluating cohort diversity (general, cardiac, low-dimensional), data sparsity (five correlation scenarios), and model performance (MSE, RMSE, R², SSE, correlation plots). Results demonstrated strong alignment with real-world data in central tendency, dispersion, and correlation structures. Scenario A (empirical correlations) performed best (R² = 86.8–99.6%, lowest SSE and MAE). Scenario B (physician-estimated correlations) also performed well, especially in a low-dimensions population (R² = 80.7%). Scenario E (no correlation) performed worst. Overall, the proposed model provides a scalable, customizable solution for generating synthetic patient cohorts, supporting reliable simulations and research when real-world data is limited. While deep learning approaches have been proposed for this task, they require access to large-scale real datasets and offer limited control over statistical dependencies or clinical logic. Our approach addresses this gap. Full article

(1) Background: Fatigue impacts neuromuscular performance, especially in endurance sports like rowing. The aim is to explore how continuous workload affects explosiveness and fatigue progression. This study examines acute fatigue during repeated race events by assessing vertical jump height, force output, and subjective fatigue over three consecutive days at the 2024 Hungarian National Rowing Championships. (2) Methods: Nine rowers (five women, four men; mean age 20.17 ± 1.73 years) competed in multiple 2000 m races over three days. Lower limb explosiveness was measured via countermovement jump (CMJ) using a Kistler force plate, pre- and post-race. Heart rate data were recorded with Polar Team Pro^®. Subjective fatigue was assessed using the ‘Daily Wellness Questionnaire’. (3) Results: We found a significant difference in the pattern of the medians of the force exerted by males during the jump between the results of the Thursday preliminaries (ThuQ_Me = 13.3) and the second final (ThuF2_Me = −75.5). Women showed no notable changes. (4) Conclusion: Repeated high-intensity races induce neuromuscular fatigue in men, reflected in reduced explosiveness and increased subjective fatigue. Future research should incorporate biochemical markers to deepen the understanding of fatigue mechanisms. Full article

Background: High-intensity gait training (HIT) is an evidence-based intervention recommended for stroke rehabilitation; however, its implementation in routine practice is inconsistent. This study examined the real-world implementation of HIT in an inpatient rehabilitation setting in Norway, focusing on fidelity, barriers, and knowledge translation (KT) strategies. Methods: Using the Knowledge-to-Action (KTA) framework, HIT was implemented in three phases: pre-implementation, implementation, and competency. Fidelity metrics and coverage were assessed in 99 participants post-stroke. Barriers and facilitators were documented and categorized using the Consolidated Framework for Implementation Research. Results: HIT was delivered with improved fidelity during the implementation and competency phases, reflected by increased stepping and heart rate metrics. A coverage rate of 52% was achieved. Barriers evolved over time, beginning with logistical and knowledge challenges and shifting toward decision-making complexity. The KT interventions, developed collaboratively by clinicians and external facilitators, supported implementation. Conclusions: Structured pre-implementation planning, clinician engagement, and external facilitation enabled high-fidelity HIT implementation in a real-world setting. Pragmatic, context-sensitive strategies were critical to overcoming evolving barriers. Future research should examine scalable, adaptive KT strategies that balance theoretical guidance with clinical feasibility to sustain evidence-based practice in rehabilitation. Full article

While personal thermal comfort is critical for well-being and productivity, it is often overlooked by traditional building management systems that rely on uniform settings. Modern data-driven approaches often fail to capture the complex interactions between various data streams. This pilot study introduces a high-accuracy, interpretable framework for thermal comfort classification, designed to identify the most significant predictors from a comprehensive suite of environmental, physiological, and anthropometric data in a controlled group of young adults. Initially, an XGBoost model using the full 24-feature dataset achieved the best performance at 91% accuracy. However, after using SHAP analysis to identify and select the most influential features, the performance of our ensemble models improved significantly; notably, a Random Forest model’s accuracy rose from 90% to 94%. Our analysis confirmed that for this homogeneous cohort, environmental parameters—specifically temperature, humidity, and CO₂—were the dominant predictors of thermal comfort. The primary strength of this methodology lies in its ability to create a transparent pipeline that objectively identifies the most critical comfort drivers for a given population, forming a crucial evidence base for model design. The analysis also revealed that the predictive value of heart rate variability (HRV) diminished when richer physiological data, such as diastolic blood pressure, were included. For final validation, the optimized Random Forest model, using only the top 10 features, was tested on a hold-out set of 100 samples, achieving a final accuracy of 95% and an F1-score of 0.939, with all misclassifications occurring only between adjacent comfort levels. These findings establish a validated methodology for creating effective, context-aware comfort models that can be embedded into intelligent building management systems. Such adaptive systems enable a shift from static climate control to dynamic, user-centric environments, laying the critical groundwork for future personalized systems while enhancing occupant well-being and offering significant energy savings. Full article

The mental and physical health of college students, especially in urban environments like Shanghai, is crucial given the high academic and urban stressors, which were intensified by the COVID-19 lockdown. Prior research has shown gender differences in health impacts during public health crises, with females often more vulnerable to mental health issues. Objective: This study aimed to comprehensively assess the physical and psychological health of Chinese college students post-lockdown, focusing on the relationship between stress, anxiety, depression, sleep patterns, and physical health, with a particular emphasis on gender differences. Methods: We conducted a cross-sectional study involving 116 students in Shanghai, utilizing psychological scales (HAMA, IPAQ, PSQI, SDS, FS 14, PSS, SF-36) and physical fitness tests (resting heart rate, blood pressure, hand grip, forced vital capacity, standing long jump, sit-and-reach, one-minute sit-up test and the one-minute squat test, single-leg stand test with eyes closed), to analyze health and behavior during the pandemic lockdown. All students have undergone the same life habits during the pandemic. Results: The HAMA scores indicated no significant levels of physical or mental anxiety. The PSS results (42.45 ± 8.93) reflected a high overall stress level. Furthermore, the PSQI scores (5.4 ± 2.91) suggested that the participants experienced mild insomnia. The IPAQ scores indicated higher levels of job-related activity (1261.49 ± 2144.58), transportation activity (1253.65 ± 987.57), walking intensity (1580.78 ± 1412.20), and moderate-intensity activity (1353.03 ± 1675.27) among college students following the lockdown. Hand grip strength (right) (p = 0.001), sit-and-reach test (p = 0.001), standing long jump (p = 0.001), and HAMA total score (p = 0.033) showed significant differences between males and females. Three principal components were identified in males: HAMA, FS14, and PSQI, explaining a total variance of 70.473%. Similarly, three principal components were extracted in females: HAMA, PSQI, and FS14, explaining a total variance of 69.100%. Conclusions: Our study underscores the complex interplay between physical activity (PA), mental health, and quality of life, emphasizing the need for gender-specific interventions. The persistent high stress, poor sleep quality, and reduced PA levels call for a reorganized teaching schedule to enhance student well-being without increasing academic pressure. Full article

Background/Objectives: Real-world evidence shows alarmingly suboptimal utilization of guideline directed medical therapy (GDMT) in heart failure with reduced ejection fraction (HFrEF). One of the barriers of GDMT implementation appears to be concerns about the potential development of drug-related adverse events (AEs), particularly in high-risk patients. This study aimed to evaluate whether advanced HFrEF (AHF) patients can be up-titrated safely and whether AHF predisposes individuals to the occurrence of putatively drug-related AEs. Methods: A total of 373 HFrEF patients with documented baseline, 2 months, and 12 months visits were analyzed for utilization and target dosages (TDs) of HF drugs. Successful up-titration and AEs were evaluated for different stages of HF reflected by N-terminal pro-B type natriuretic peptide (NT-proBNP) (<1000 pg/mL, 1000–2000 pg/mL, >2000 pg/mL). Results: A stepwise increase in HF medications was observed for all drug classes during follow-up. At 12 months, 73%, 75%, 62%, 86%, and 45% of patients received ≥90% of TDs of beta-blockers (BBs), renin–angiotensin system inhibitors (RASis), mineralocorticoid receptor antagonists (MRAs), sodium–glucose cotransporter-2 inhibitors (SGLT2 i), and triple-therapy, respectively. Predictors of successful up-titration in logistic regression were baseline HF drug TDs, estimated glomerular filtration rate (eGFR), and potassium, but not NT-proBNP or age. The development of AEs was rare, with hyperkalemia as the most common event (34% at 12 months). AEs were comparable in all stages of HF. However, the development of hyperkalemia was more frequent in patients with higher NT-proBNP and also accounted for most cases of incomplete up-titration. Conclusions: This study suggests that with dedicated protocols and frequent visits, GDMT can be successfully implemented across all stages of HFrEF, including patients with AHF. Full article

Background: Emerging evidence indicates that some individuals recovering from COVID-19 develop persistent symptoms, including fatigue, pain, cognitive difficulties, and psychological distress, commonly known as Long COVID. These symptoms often overlap with those seen in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME), underscoring the need for integrative, non-pharmacological interventions. This Phase II controlled trial aimed to evaluate the feasibility and preliminary efficacy of Heart Rate Variability Biofeedback (HRV-BF) in individuals with Long COVID who meet the diagnostic criteria for CFS/ME. Specific objectives included assessing feasibility indicators (drop-out rates, side effects, participant satisfaction) and changes in fatigue, depression, anxiety, pain, and health-related quality of life. Methods: Participants were assigned alternately and consecutively to the HRV-BF intervention or Treatment-as-usual (TAU), in a predefined 1:1 sequence (quasirandom assignment). The intervention consisted of 10 HRV-BF sessions, held twice weekly over 5 weeks, with each session including a 10 min respiratory preparation and 40 min of active training. Results: The overall drop-out rate was low (5.56%), and participants reported a generally high level of satisfaction. Regarding side effects, the mean total Simulator Sickness Questionnaire score was 24.31 (SD = 35.42), decreasing to 12.82 (SD = 15.24) after excluding an outlier. A significantly greater improvement in severe fatigue was observed in the experimental group (H = 4.083, p = 0.043). When considering all outcomes collectively, a tendency toward improvement was detected in the experimental group (binomial test, p < 0.0001). Conclusions: HRV-BF appears feasible and well tolerated. Findings support the need for Phase III trials to confirm its potential in mitigating fatigue in Long COVID. Full article