Search Results (15,975)

High myopia is increasingly prevalent and complicates glaucoma diagnosis. Axial elongation remodels the optic nerve head (ONH) and parapapillary tissues, producing structural and functional changes that mimic glaucoma—termed myopic optic neuropathy (MON). We reviewed current concepts on the MON–glaucomatous optic neuropathy (GON) spectrum and practical implications for diagnosis, monitoring, and management. A focused PubMed search targeted high/pathologic myopia, glaucoma, ONH and parapapillary anatomy, optical coherence tomography (OCT)/OCT angiography, visual fields, and progression. Major reviews, population-based studies, and longitudinal investigations were prioritized and integrated into a clinician-oriented framework. Greater myopia severity is associated with higher glaucoma risk and, in some cohorts, greater treatment burden, including surgery. Disc tilt, torsion, parapapillary atrophy, and staphyloma-related curvature complicate structural assessment and reduce reliability of single-visit OCT due to magnification and segmentation artifacts. Visual fields may be atypical, and central defects are under-sampled by standard 24-2 testing. Progression-centered strategies—combining event- and trend-based analyses and confirmation rules—distinguish MON-predominant changes from true GON or overlap and guide follow-up. In highly myopic eyes, multimodal structure–function assessment anchored on reproducible progression enhances diagnostic confidence and guides individualized intraocular pressure–lowering therapy. Standardized reporting of myopia definitions and progression criteria is recommended. Full article

Background/Objectives: Nomophobia, the irrational fear of being without a mobile phone, is increasingly prevalent among university students and has emerged as a concerning form of digital dependence. Among nursing students, this condition is particularly relevant due to the emotional demands and cognitive challenges of healthcare education. Nomophobia has been linked with adverse psychological outcomes, sleep disturbances, and impaired academic and clinical performance. However, existing evidence remains fragmented and lacks an integrated conceptual synthesis. This review aimed to synthesize current evidence on the prevalence, correlates, and outcomes of nomophobia among nursing students. Methods: An integrative review was conducted following Whittemore and Knafl’s methodology and PRISMA guidelines. A systematic search was performed in PubMed, CINAHL, PsycINFO, PsycArticles, and Medline (between 2015 and 2025), supplemented by Google Scholar. Cross-sectional studies and literature focusing on nomophobia in nursing students were included. The primary studies and selected review articles were considered when no overlap with the included primary evidence was identified. Methodological quality appraisal was assessed using validated tools (QuADS and JBI). Results: Twenty-two studies were included (19 cross-sectional and 3 reviews). Four thematic areas emerged: prevalence and severity (50–90% moderate to severe); psychological correlates (anxiety, depression, stress, insomnia, alexithymia, fear of missing out); academic and cognitive outcomes (impaired performance, procrastination, reduced decision-making); and behavioural predictors (excessive smartphone use and emotional dysregulation). The Nomophobia Questionnaire (NMP-Q) was the most frequently used instrument. Conclusions: Nomophobia represents a relevant dimension of the mind–technology relationship in nursing education, with implications for students’ mental health, academic engagement, and clinical readiness. Addressing nomophobia may support healthier learning environments and contribute to the development of emotionally competent and safe future healthcare professionals. However, significant gaps remain, particularly regarding longitudinal evidence and intervention-based approaches. Full article

Global citrus exports rely heavily on temperature-controlled logistics to safeguard fruit quality and minimise postharvest losses. Temperature management remains a critical factor governing citrus quality throughout export logistics. Yet the extent to which historical shipment temperature data can meaningfully predict fruit condition at arrival has never been systematically assessed. This study presents a comprehensive review of how historical temperature records have been used to assess citrus quality within export supply chains, highlighting the lack of longitudinal temperature–quality correlations in existing research. Using PRISMA 2020 guidelines and Kitchenham’s three-phase review framework, 35 relevant peer-reviewed articles published between 2013 and 2025 were analysed. Bibliometric mapping identified dominant research concentrations in experimental cold chain studies and simulation-based approaches, with emerging themes around digital twins and virtual cold chain technologies. The review shows that current research predominantly employs controlled experimental designs and computational simulations to quantify temperature-driven deterioration, including chilling injury, decay rate, and weight loss. Although real-time temperature monitoring in commercial shipments is emerging, temperature deviations are rarely assessed alongside direct quality metrics. Although several studies have examined shipment temperatures alongside arrival-quality outcomes, these analyses are generally limited in duration, scope, or sensor resolution. Consequently, rigorous, multi-year, longitudinal datasets that pair detailed shipment temperature histories with standardised fruit-quality assessments remain largely unavailable, constraining the empirical validation of temperature–quality relationships in real export conditions. This gap significantly limits predictive capability in real-world export contexts. The review highlights the urgent need for a coordinated, long-term data infrastructure that integrates temperature and quality measurements across global citrus supply chains. Establishing such datasets, particularly in major exporting regions such as South Africa, would enable more robust modelling of temperature impacts, support the optimisation of cold chain practices, and contribute to international food loss-reduction goals. Full article

Chronic kidney disease (CKD) is a progressively worsening condition that erodes renal function over time, reduces quality of life, and can ultimately culminate in kidney failure with far-reaching systemic complications. In addition to reduced filtration, worsening kidney function disrupts mineral homeostasis and leads to CKD–mineral and bone disorder (CKD-MBD). Dysregulated calcium handling and maladaptive endocrine responses contribute to bone pathology and increase cardiovascular calcification risk; therefore, serial calcium monitoring remains clinically relevant for longitudinal CKD management. Conventional calcium measurements are typically obtained with centralized analyzers or laboratory assays (e.g., colorimetry and electrode/optical readouts). Despite high accuracy, the required instrumentation, controlled operating conditions, and pretreatment steps complicate rapid point-of-care deployment, especially when only microliter-scale biofluids are available. Accordingly, this study develops a finger-actuated microfluidic colorimetric platform capable of determining calcium ion concentrations in human biofluids, such as whole blood, serum, and urine. The platform integrates a three-dimensional PMMA/paper microchip with a compact reader that maintains stable temperature control while enabling CMOS-based optical detection. With just 6 μL of sample, a brief finger press propels the biofluid across an internal filtration layer, generating serum or cleaned urine that subsequently reacts with a pre-deposited murexide reagent. Under optimized conditions (1.6% reagent, 50 °C, 3 min), the signal follows a strong logarithmic relationship with calcium concentration (Y = 47.273 ln X + 28.890; R² = 0.9905), supporting quantification over 1–40 mg/dL and a detection limit of 0.2 mg/dL. Across 80 clinical CKD specimens spanning serum, whole blood, and urine, results aligned closely with the NM-BAPTA reference assay, with R² values exceeding 0.97. Full article

Background/Objectives: Advanced childhood cerebral X-linked adrenoleukodystrophy (cALD) is traditionally regarded as an irreversible terminal phase of neurodegeneration driven by inflammatory demyelination and axonal loss. Experimental evidence indicates that endogenous bioelectrical fields regulate central nervous system organisation, raising the possibility that functional network collapse in cALD may be biologically modifiable, even in the presence of persistent structural damage. This study examined whether longitudinal modulation of endogenous bioelectrical network organisation is associated with sustained clinical and neurophysiological stabilisation in advanced cALD. Methods: We performed a longitudinal observational analysis of two paediatric patients with advanced childhood cerebral X-linked adrenoleukodystrophy undergoing repeated neuroregenerative treatment cycles. Standardised scalp electroencephalography was recorded during spontaneous wakefulness and repeated over months under comparable vigilance conditions. Multimodal analysis included conventional EEG, quantitative EEG, independent component analysis, and standardised low-resolution electromagnetic tomography (sLORETA). Clinical function was assessed using validated measures of consciousness, swallowing, and voluntary motor behaviour. Results: Across patients, longitudinal recordings demonstrated sustained stabilisation of consciousness, swallowing, and voluntary motor function, accompanied by reproducible reorganisation of pathological brain rhythms. Delta and theta oscillations showed a consistent topographical redistribution from limbic–frontoinsular networks towards sensorimotor and parietal integrative cortices. These changes were observed across modalities and timepoints and are unlikely to reflect spontaneous fluctuation, delayed effects of haematopoietic stem cell transplantation, or state-dependent EEG variation. Conclusions: Advanced childhood cerebral X-linked adrenoleukodystrophy is associated with disorganisation of endogenous bioelectrical network activity. In this longitudinal analysis, large-scale network reorganisation was temporally associated with sustained clinical stabilisation, supporting a view of late-stage cALD as a dynamic disorder of network-level vulnerability, rather than a fixed terminal state. Full article

Background: Early childhood is a critical period for the development of motor competence, which is closely related to later physical activity, educational readiness, and broader developmental outcomes. However, the temporal dynamics of motor skill acquisition in preschool children, particularly the time required to reach initial and early refinement phases of learning, remain insufficiently described. The aim of this study was to examine whether different levels of previous participation experience in an organized kinesiology program are associated with differences in the speed and quality of novel motor skill acquisition in preschool children, and to explore the relationship between baseline motor proficiency and phase-based indicators of motor learning. Methods: A total of 161 preschool children aged 5–6 years participated in the study and were grouped according to their previous participation experience in an organized kinesiology program (0 h, ~120 h, ~350 h, and ~470 h). Following BOT-2 assessment, all participants completed a standardized 7-week motor learning program that included nine previously unfamiliar motor tasks. Using a phase-based video analysis protocol, three learning indicators were recorded: time to Phase 1 (F1; first successful execution), time to Phase 2 (F2; initial refinement of performance), and final performance quality (K). Group differences and associations were first examined descriptively and correlationally, after which additional multivariable regression models were performed to determine whether previous participation experience and baseline motor proficiency were independently associated with motor learning outcomes. Results: The findings showed consistent differences across groups, with children who had greater previous participation experience generally reaching F1 and F2 more rapidly and achieving higher final performance quality scores. Higher BOT-2 scores were also associated with shorter learning times and better final performance quality. In the multivariable models, both previous participation experience in an organized kinesiology program and BOT-2 total score were independently associated with Phase 1 attainment time and final performance quality, whereas only previous participation experience remained independently associated with Phase 2 attainment time. The applied phase-based observational protocol demonstrated good to excellent inter-rater reliability across the evaluated motor learning variables. Conclusions: These findings provide phase-based temporal indicators of motor learning progression in preschool children and suggest that previous participation experience in an organized kinesiology program and baseline motor competence are meaningfully associated with the speed and quality of acquiring new motor tasks. The findings also demonstrate the potential of phase-based approaches for quantifying motor learning dynamics in early childhood settings. Such indicators may offer useful reference information for instructional pacing and the planning of motor learning activities, while also serving as practically relevant predictors for adapting future kinesiology programs to children’s motor readiness. Future research should further examine these relationships using longitudinal and analytically expanded designs. Full article

Background and objectives: Odontogenic abscess represents a serious infection in the head and neck region with the necessity of immediate treatment. Due to the fast pacing and progression, as well possibly severe consequences of this condition, it is important to have a fast and reliable biomarker to adequately monitor these patients. Since serum procalcitonin and C-reactive protein (CRP) are the most commonly used clinical biomarkers to monitor serious infections, the aim of this study was to investigate their temporal profiles in hospitalized patients undergoing surgical management of odontogenic abscesses. Materials and methods: This longitudinal, multicentric study was conducted on 65 patients with odontogenic abscesses at the University Hospital of Split and Dubrava University Hospital. Biomarker levels were assessed at admission and at four time points during the early and middle postoperative periods to evaluate initial elevations, treatment-associated changes, and differences in kinetic behavior. Results: After converting real procalcitonin and CRP values to proportions, a Δ between the time points was calculated. There was a statistically significant difference in the Δ proportion between procalcitonin and CRP in the 0–6 h time frame (19.3 (10.6–27.8)% vs. 7.2 (−3.0–20.4)%, p < 0.001) and the 24–48 h time frame (30.8 (24.5–35.0)% vs. 51.7 (30.5–57.7)%, p < 0.001). Furthermore, multiple linear regression analysis showed that procalcitonin at time point 0 (p = 0.037), 6 h (p = 0.009) and 24 h (p = 0.038) significantly predicted hospitalization duration after model adjustment for age, gender, BMI and pre-admission antibiotic treatment. Conclusions: The findings of this study show that procalcitonin exhibits a faster and more pronounced decrease in the early postoperative period compared with the CRP values. Following the middle postoperative period both biomarkers decreased in association with clinical improvement; however, procalcitonin demonstrated an earlier and more consistent decline. The observed pattern indicates a rapid dynamic of procalcitonin values during the early postoperative phase and supports its potential value for early monitoring of surgical treatment response in odontogenic abscesses. Full article

Objective: To longitudinally investigate the effect of non-surgical periodontal therapy (NSPT) on the transcriptional and translational levels of Superoxide Dismutase (SOD) and Insulin Receptor Substrate type 2 (IRS2) in individuals with Type 2 Diabetes Mellitus (T2DM) and Periodontitis (P). Methods: This clinical study was registered at the Brazilian Clinical Trials Registry (ReBEC-RBR-5m3yxmb). Saliva, peripheral blood mononuclear cells (PBMCs), and gingival biopsies were collected from 156 individuals, distributed into five groups, each with at least 30 participants: T2DM_poorly_controlled+P, T2DM_well_controlled+P, T2DM_without_P, Periodontitis, and Control. Systemic levels of messenger RNA (mRNA) of Superoxide Dismutase 1 (SOD1) and IRS2 were measured using real-time polymerase chain reaction at baseline, 90, and 180 days after NSPT. SOD enzymatic activity in Saliva and IRS-2 immunohistochemistry in gingival biopsies were also assessed. Results: Higher SOD1 mRNA levels were observed in Control individuals at baseline. In contrast, higher IRS2 mRNA levels were detected in individuals with Periodontitis at baseline, followed by a significant reduction over time. A significant positive longitudinal correlation was identified between IRS2 and SOD1 gene expression in the groups without T2DM, indicating potential functional interaction between the molecules. Salivary SOD enzymatic activity was lower in individuals from the T2DM_poorly_Controlled+P and T2DM_well_Controlled+P groups. SOD concentration (U/g) normalized to the total protein content was higher in the saliva of individuals with Periodontitis. T2DM+P and Periodontitis groups showed extensive inflammatory infiltrate in the gingival biopsies, with predominant IRS-2 immunopositive cells in the T2DM+P groups, independently of the metabolic control. Conclusions: This study shows that non-surgical periodontal therapy (NSPT) is followed by longitudinal changes in IRS2 and SOD1 expression at the mRNA and protein levels in individuals with T2DM+P (poorly/well controlled) and periodontitis, reinforcing the clinical relevance of periodontal treatment in the systemic context of T2DM. Full article

Background: Sensorimotor differences have frequently been reported in children with developmental dyslexia, but are often considered secondary or comorbid to phonological deficits. Within an embodied cognition perspective, reading acquisition emerges from dynamic interactions between bodily regulation, multisensory integration, and learning-related neural plasticity. Proprioception contributes to spatial orientation, motor coordination, and perceptual stabilization, while sleep-dependent processes play a critical role in the consolidation and automatization of cognitive and motor skills. Objectives: Building on early clinical observations, including the hypothesis proposed by Martins da Cunha, this review explores whether variations in proprioceptive processing and sensorimotor regulation may influence multisensory stability and the conditions under which reading skills develop in some individuals with dyslexia. Methods: This narrative synthesis integrates clinical observations and experimental paradigms examining proprioceptive function in children with dyslexia, including studies conducted in our laboratory over the past two decades. These investigations address postural regulation under varying attentional demands, laboratory measures of proprioceptive acuity, visuospatial localization tasks, multisensory interactions, and exploratory observations concerning sleep–wake regulation. Results: Across studies, children with dyslexia often show differences in proprioceptive processing associated with variations in postural regulation, visuospatial stability, and multisensory tasks. Laboratory measurements suggest reduced proprioceptive acuity in some individuals, with moderate correlations observed between proprioceptive sensitivity and reading-related measures. Additional observations suggest that nocturnal physiological regulation—including respiratory dynamics and sleep architecture—may interact with daytime sensorimotor stability and attentional functioning. Conclusions: Taken together, these findings support the hypothesis that variations in sensorimotor regulation across the sleep–wake cycle may influence the stability of multisensory processing and attentional conditions relevant for reading acquisition. Within this perspective, proprioception is not proposed as an alternative explanation for dyslexia but as a complementary dimension that may contribute to the heterogeneity of dyslexic profiles. Further longitudinal and controlled studies are required to clarify the relationships between sensorimotor regulation, sleep-dependent plasticity, and learning processes. 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

The manipulation of vector beams (VBs) with longitudinally variant polarization states is an important research topic and has potential applications in classical and quantum fields. In this study, we propose a half-wave plate dielectric metasurface composed of two interleaved sub-metasurfaces to generate longitudinally separated dual-channel vectorial structured light fields. The propagation and Pancharatnam–Berry phases are employed to construct hyperbolic, helical, and opposite gradient phases for focusing wavefronts, generating circularly polarized (CP) vortices, and deflecting CP vortices with the same chirality in opposite directions. Consequently, dual-channel higher-order or hybrid-order Poincaré (HOP or HyOP) beams are generated along the optical axis under elliptically polarized illumination, and their polarization states evolve along an arbitrary pair of antipodal meridians on the HOP or HyOP sphere by varying the ellipticity of the incident light, the propagation-phase topological charge, and the rotation order of the meta-atom. The consistency between the theoretical and simulated results demonstrates the feasibility and practicability of the proposed method. This study is significant for compact, integrated, and multifunctional optical devices, and provides an innovative strategy to extend optical field manipulation from two-dimensional to three-dimensional space. Full article

Background/Objectives: Hidradenitis suppurativa (HS) is a chronic, immune-mediated inflammatory skin disease characterized by painful nodules, abscesses, sinus tracts, and progressive fibrosis. Vascular activation is becoming increasingly acknowledged as an important factor in HS pathogenesis; however, the effects of tumor necrosis factor alpha (TNF-α) blockade on vascular remodeling in HS remain poorly characterized. This study investigated the impact of TNF-α inhibition by adalimumab (ADA) on endothelial and fibroblast-associated markers in HS lesions. Methods: Formalin-fixed paraffin-embedded skin samples from 71 HS patients were analyzed, including treatment-naive (n = 38) and adalimumab-treated (n = 33) cases. Histopathology and immunofluorescence were performed using antibodies against CD31, von Willebrand factor (vWF), α-smooth muscle actin (αSMA), vimentin, Ki-67 (proliferation), and cleaved Caspase-3 (apoptosis). ImageJ software was used to determine the immunoexpression of selected markers and vascular density. Vascular density, assessed as vessel count per mm², was designated as the primary endpoint. Sex-related differences were analyzed as exploratory endpoints. Results: Adalimumab-treated tissue exhibited significantly reduced vascular density (p < 0.01) compared to the treatment-naive group. Conversely, vimentin immunoexpression was significantly higher (p < 0.01) in the adalimumab-treated group. No significant differences were found in endothelial Ki-67 or cleaved Caspase-3 expression between treatment groups, indicating that the observed reduction in vascular density is not associated with direct effects on endothelial cell proliferation or apoptosis, but rather may occur indirectly through attenuation of the pro-angiogenic inflammatory milieu. Exploratory sex-stratified analysis revealed that treatment-naive males had significantly higher endothelial proliferation (Ki-67; p = 0.031) and vimentin expression (p = 0.017) compared to treatment-naive females. In the ADA-treated group, males exhibited significantly lower vascular density (p = 0.036) and higher endothelial apoptosis (p = 0.039) compared to females, whereas females showed a significant increase in vimentin expression following treatment (p = 0.008), suggesting possible sex-dependent differences in vascular remodeling. Conclusions: TNF-α blockade is associated with reduced vascular density, consistent with indirect anti-angiogenic effects, suggesting that adalimumab exerts disease-modifying effects on the microenvironment beyond inflammatory cytokine suppression. Sex-dependent differences in vascular regression underscore the importance of considering sex as a biological variable in HS pathogenesis and treatment response. These results highlight the significance of vascular interactions in HS and support adalimumab as a disease-modifying treatment. These exploratory findings require confirmation in longitudinal studies with paired biopsies. Full article

Background/Objectives: Simulation-based education often lacks personalization, focusing on technical competence rather than individual student profiles. This protocol describes a study designed to evaluate whether adapting gamified narratives to nursing students’ personality profiles has the potential to support academic performance in obstetrics. This study aims to validate the integration of psychometric profiling and AI as a sustainable strategy for personalized clinical training. Methods: A cluster-randomized controlled longitudinal pilot trial will be conducted at the University of Atlántico Medio. The protocol has been submitted for registration at ClinicalTrials.gov (Registration Pending). Thirty-eight second-year nursing students meeting inclusion criteria (excluding repeaters or those with prior specialized training) will be assigned by natural practice to either a control group (generic gamification) or an experimental group (gamification adapted according to Player Personality and Dynamics Scale profiles using AI-generated content). The intervention comprises four clinical simulation sessions focusing on pregnancy and childbirth, which are managed via the Wix platform. The primary outcome is academic performance, measured as “Learning Gain” (post-test scores minus pre-test scores). Secondary outcomes include student satisfaction measured via the Gameful Experience Scale. Data will be analyzed using Mann–Whitney U tests to compare overall efficacy and intragroup evolution. To minimize observer bias, knowledge assessments will utilize automated, objective scoring, and participants will be blinded to the study hypothesis. Expected Outcomes: The study aims to establish the technical and pedagogical feasibility of integrating AI-adapted narratives into nursing curricula. It is anticipated that the personalized approach will show positive trends in learning gains and engagement patterns, providing a baseline for larger multicenter trials. Conclusions: This protocol presents a framework for “Precision Education” in nursing, shifting from “one-size-fits-all” simulations to student-centered adaptive training. The use of Generative AI makes such personalization sustainable and cost-effective for health science faculties. Full article

Experiential learning through simulations offers a unique but often underutilized opportunity to bridge the gap between pedagogy and empirical research. This study addresses this gap by transforming the Pemberton’s Dilemma simulation from a classroom exercise into a quantitative, empirical research project to investigate the dynamics of trust, cooperation, and opportunistic behavior. To address questions related to such trust interactions, the simulation was modified to include variable payout stakes, restricted and permitted communication phases, and an additional surprise round to measure long-term trust reputation effects. From 2017 through 2025, data was gathered from a convenience sample of 611 students from a large public university in the Northwestern United States. Results indicate that non-trusting behavior has a significantly greater mirroring effect than trusting behavior and that higher financial stakes frequently prime groups toward opportunistic hedging. While opportunistic strategies yielded greater short-term gains, longitudinal analysis revealed a significant positive correlation between consistent trust and monetary outcomes. Furthermore, the surprise round data confirmed that prior trust violations severely diminished cooperation and earnings in the future unknown round. The study supports the benefits of integrating quantitative research into pedagogical experiential tools to advance scholarly understanding (in this case of trust dynamics and the vital role of transparent communication and sustainability-compatible strategies), enhance student learning, and to provide data-driven recommendations for organizations. Full article

Background/Objectives: We assessed the prevalence of impaired coronary flow velocity reserve (CFVR) and aimed to identify echocardiographic and clinical predictors of coronary microvascular dysfunction in adolescents after neonatal arterial switch operation (ASO). Methods: This single-center, cross-sectional study included patients that underwent neonatal ASO for simple D-transposition of the great arteries (D-TGA) during 1998–2013. All patients were evaluated by echocardiography with global left ventricular strain measurement (GLS) and cardiac catheterization, including coronary angiography. Coronary flow velocity reserve was assessed by transthoracic Doppler echocardiography in the left anterior descending artery (LAD) using adenosine induced hyperemia. Patients were stratified into two groups according to CFVR: group with impaired CFVR (<2.5) and group with normal CFVR (≥2.5). Spearman correlation was used to assess the relationship between CFVR and echocardiographic variables. Binary logistic regression was used to determine independent predictors of impaired CFVR. Results: Out of 48 patients included (median age 16 years, age range 13 to 23 years, 71% male), impaired CFVR was found in 21 patients (44%). These patients had decreased longitudinal tricuspid annular plane systolic excursion (TAPSE), greater Z scores for left ventricular end-systolic dimensions and higher mean pulmonary artery pressures (mPAP). CFVR showed modest but significant positive correlations with tricuspid annular plane systolic excursion (TAPSE). Left pulmonary artery branch stenosis, reduced TAPSE and mPAP ≥ 20 mmHg, were significantly associated with impaired CFVR, while decreased TAPSE remained independent predictor in multivariable analysis (odds ratio 5.6, 95% confidence interval 1.24–25.26, p = 0.025). Conclusions: Impaired CFVR appears to be frequently observed in adolescents after uncomplicated neonatal ASO for simple D-TGA. Importantly, impaired CFVR is associated with right ventricular dysfunction. Full article