Search Results (2,942)

Background and Objective: Radiologically isolated syndrome (RIS) is characterized by magnetic resonance imaging (MRI) findings suggestive of multiple sclerosis (MS) in individuals without a history of clinical demyelinating events. Increasing evidence indicates that structural brain abnormalities may be present in RIS before the development of overt neurological symptoms. However, most previous studies have employed cross-sectional designs, limiting the ability to characterize the temporal evolution of neurodegenerative changes. This study aimed to investigate longitudinal changes in global, regional, and lobar brain volumes in individuals with RIS using serial MRI examinations obtained at least six months apart. Methods: Patients with RIS who had undergone two 3 Tesla (3T) brain MRI examinations separated by an interval of at least six months were retrospectively identified. Three-dimensional (3D) T1-weighted MRI scans obtained at both time points were analyzed using the volBrain pipeline of the volBrain platform to quantify global, regional, and lobar brain volumes. Longitudinal volumetric changes were expressed as annualized percentage volume changes. The number of T2 lesions and total T2 lesion volume were additionally assessed, and their associations with longitudinal brain volume changes were investigated. Results: A total of 28 patients with RIS were included. After correction for multiple comparisons using the Benjamini–Hochberg false discovery rate (FDR) procedure, significant annual volume loss was observed in total brain volume (p = 0.043), total cerebrum volume (p = 0.033), right cerebrum volume (p = 0.033), left cerebrum volume (p = 0.044), total thalamic volume (p = 0.033), right thalamic volume (p = 0.047), and left thalamic volume (p = 0.043). No significant associations were observed between annualized brain volume changes and follow-up duration, total or regional T2 lesion counts, or total T2 lesion volume. Similarly, annualized brain volume changes did not differ significantly between subgroups defined according to MRI progression, the presence of gadolinium-enhancing lesions, or the presence of spinal cord lesions. Conclusions: Longitudinal volumetric analysis demonstrated progressive brain volume loss involving both global and regional structures in patients with RIS. These findings provide further evidence of measurable longitudinal structural brain changes in RIS before the development of clinically overt demyelinating disease. Larger longitudinal studies incorporating appropriate control groups are warranted to further characterize the temporal trajectory of volumetric changes in RIS. Full article

Background/Objectives: Pulmonary artery (PA) dilatation and slow-flow are imaging features of pulmonary hypertension (PH), but their quantitative assessment on routine cardiovascular magnetic resonance (CMR) remains limited. This study aimed to develop and evaluate an automated CMR pipeline for quantifying PA size-based and slow-flow metrics from routine white-blood (WB) and black-blood (BB) acquisitions. Methods: A total of 205 CMR acquisitions (106 WB and 99 BB) were used for model development and independent testing. Separate deep learning nnU-Net-based segmentation models were developed for WB and BB acquisitions using a two-stage cascaded framework. Automated measurements included PA volume and PA slow-flow. The trained models were subsequently applied to a larger cohort of 1471 patients using available WB and BB acquisitions to assess automated measurement extraction and agreement with clinical reports. Results: Automated PA volumetric measurements demonstrated excellent agreement with manual reference measurements for both the WB and BB models (ICC 0.94 and 0.93, respectively), with high segmentation accuracy (Dice 0.86 and 0.80, respectively). Automated slow-flow measurements also demonstrated excellent volumetric agreement (ICC 0.94), despite lower spatial overlap (Dice 0.61). Automated slow-flow classification demonstrated 83% agreement with qualitative clinical reporting (κ = 0.58). Conclusions: Automated PA volumetric quantification from routine CMR is feasible. Automated slow-flow quantification showed promising performance but requires validation across scanner vendors and BB acquisition protocols before broader clinical application. Full article

Background/Objectives: Central neuropathic pain (CNP) is difficult to manage, and comparative evidence for non-invasive brain stimulation is limited. We explored the short-term efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) in CNP. Methods: In this randomized, sham-controlled crossover trial, 26 patients were allocated to active or sham stimulation and received high-frequency rTMS (10 Hz, 2000 pulses/session) and anodal tDCS (2 mA, 30 min) over the primary motor cortex for five days each, separated by a 4-week washout. The primary outcome was change in Numerical Rating Scale (NRS) pain intensity at 1 and 4 weeks, analysed using factorial linear mixed-effects models with and without age adjustment. Results: At 1 week, the difference between active and sham rTMS was 0.76 points (95% CI −0.005 to 1.53; p = 0.051) and 0.42 points after age adjustment (95% CI −0.37 to 1.21; p = 0.30). Active tDCS did not differ from sham tDCS, and active rTMS did not differ from active tDCS. No significant differences were found at 4 weeks or in responder analyses. No serious adverse events occurred. Conclusions: In this small exploratory trial, neither rTMS nor tDCS showed statistically significant superiority over modality-matched sham, and no difference between modalities was demonstrated. Adequately powered trials are needed. Full article

Verticillium wilt is a major soil-borne disease affecting eggplant production. Early detection before symptom manifestation can reduce yield losses. Compared with traditional destructive physiological assays, sensor-based technologies enable efficient, nondestructive monitoring. However, magnetized water irrigation may reduce phenotypic separability between healthy and diseased plants, complicating disease detection using single-source data. This study developed a multisource data fusion strategy that integrates multispectral reflectance, chlorophyll fluorescence parameters, and Soil Plant Analysis Development (SPAD) values to construct a weighted ensemble model combining extreme gradient boosting (XGBoost) and support vector machine (SVM). Based on a 28-dimensional multisource feature set collected one to seven days post-inoculation (DPI), the model achieved an overall accuracy of 88.1% and an area under the receiver operating characteristic curve (AUC) of 0.925, with accuracies of 90.1% and 86.0% under ordinary and magnetized water irrigation, respectively. Ablation experiments showed that spectral features alone achieved a recall of only 62.9% under magnetized water irrigation, whereas multisource fusion increased recall to 73.2%. Compared with visual inspection, which requires approximately 10 days for disease confirmation, the model identified diseased plants as early as DPI 3, achieving 91.8% accuracy and an AUC of 0.978. Overall, multisource data fusion improved early Verticillium wilt detection across irrigation regimes. This study demonstrates the novelty of utilizing this fusion strategy to overcome the reduced phenotypic separability induced by magnetized water irrigation, providing a robust and nondestructive diagnostic tool for agricultural disease management. Full article

Software-defined electric vehicles have reached micromobility, creating a growing need to evaluate how controller software shapes drive performance and energy use. This requires experimental platforms with quantified emulation fidelity and measurement performance. This paper presents a scenario-based hardware-in-the-loop platform combining a production e-scooter drive, a controlled magnetic particle brake, and a real-time road-load model. The platform reproduces rolling resistance, aerodynamic drag, and speed-gated inertial demand for a nominal 90 kg vehicle. Across eight repetitions of a scaled ECE-15 urban cycle, including a cold first run, the protective load cap retained 99.51% of the commanded load impulse. A post hoc sensitivity analysis of the seven warm runs gave 99.71%. Measured torque and speed tracking root-mean-square errors over all eight runs were 0.704 N·m and 0.593 km/h. Separate electrical characterization produced a machine efficiency map peaking at 86.3% and cycle-energy measurements with a coefficient of variation of 0.72%. Subsampling unfiltered 200 kHz recordings at every sampling offset gave a maximum absolute cycle-energy error of 0.14% at 2 kHz, a hundredfold reduction in retained samples under the tested conditions. These results provide a quantified experimental basis for micromobility drive testing and subsequent controller-software comparisons. Full article

Purpose: To develop and preliminarily evaluate a hyaluronic acid–1,4-butanediol diglycidyl ether (HA-BDDE)/polyethylene glycol–tyramine (PEG-Tyramine) dual-hydrogel designed as a transparent and injectable vitreous substitute with suitable optical, rheological, and cytocompatibility characteristics for potential application following vitrectomy. Methods: HA-BDDE and PEG-Tyramine were prepared separately and combined to form a dual-hydrogel formulation. The resulting hydrogel was characterized using attenuated total reflectance Fourier-transform infrared (ATR-FTIR) spectroscopy, proton nuclear magnetic resonance (¹H NMR) spectroscopy, oscillatory rheometry, and spectrophotometry to evaluate its chemical, rheological, and optical properties. Cytocompatibility was assessed using retinal pigment epithelial (RPE) cells through the methyl thiazolyl tetrazolium (MTT) assay and Live/Dead fluorescence staining. Ex vivo performance was evaluated following hydrogel injection into porcine eyes after vitrectomy, with assessment of macroscopic transparency, structural integrity, and retention within the vitreous cavity. Results: The HA-BDDE/PEG-Tyramine formulation formed a transparent and macroscopically homogeneous hydrogel phase. Spectroscopic analyses demonstrated the characteristic chemical functionalities and molecular environments associated with the HA- and PEG-containing components. Rheological analysis showed predominantly elastic, gel-like behavior, with the storage modules exceeding the loss modulus across the investigated frequency range. The hydrogel exhibited measurable and relatively stable visible-light transmission across the evaluated wavelength range. RPE cells maintained high metabolic activity during the culture period, while Live/Dead imaging demonstrated predominantly viable cells with limited dead-cell staining. In the ex vivo porcine model, the hydrogel remained within the vitreous cavity and maintained its macroscopic transparency and structural integrity during the observation period. Conclusions: The HA-BDDE/PEG-Tyramine dual-hydrogel exhibited favorable optical, rheological, cytocompatibility, and short-term ex vivo retention characteristics. These findings support further investigation of this dual-hydrogel system as a potential injectable vitreous substitute following vitrectomy. Full article

Background: Active surveillance (AS) is increasingly considered for selected patients with International Society of Urological Pathology (ISUP) Grade Group (GG) 2 prostate cancer. However, candidate selection remains controversial due to histological heterogeneity and the risk of harboring adverse pathology (AP). We aimed to identify preoperative clinical, multiparametric magnetic resonance imaging (mpMRI), and histological predictors of AP, biochemical recurrence (BCR), and postoperative PSMA PET/CT positivity in men with biopsy-confirmed ISUP GG 2 disease undergoing robotic-assisted radical prostatectomy (RARP). Methods: We retrospectively analyzed 127 consecutive patients with biopsy-proven ISUP GG 2 prostate adenocarcinoma from a prospective single-center RARP database (2012–2024). All patients underwent pre-biopsy 3T mpMRI and systematic plus software-fusion targeted biopsies, with diagnostic specimens strictly lacking cribriform architecture or intraductal carcinoma. AP was defined as pathological stage ≥ pT3 and/or ISUP GG upgrading to ≥ 3 in the final surgical specimen. BCR was defined as two consecutive postoperative PSA measurements ≥ 0.2 ng/mL. Patients with BCR underwent PSMA PET/CT restaging. Univariable and multivariable logistic regression analyses evaluated independent preoperative predictors of AP, incorporating separate models for ≥ 10% and ≥ 15 biopsy Gleason pattern 4 thresholds to prevent collinearity. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and Hosmer–Lemeshow calibration tests. Results: Median patient age was 63.2 years, median PSA was 7.6 ng/mL, and median PSA density (PSAD) was 0.18 ng/mL. PI-RADS ≥ 4 lesions were identified in 71.6% of patients, and median biopsy pattern 4 proportion was 21.1%. Overall, AP occurred in 39 of 127 patients (30.7%), driven by ISUP upgrading to GG ≥ 3 in 21.3% (n = 27) and upstaging to ≥ pT3 in 17.3% (n = 22). No undergrading was observed. On univariable analysis, PSA (p = 0.028), PSAD (p = 0.011), and biopsy pattern 4 proportion ≥ 10% (p = 0.042) and ≥ 15% (p = 0.027) were significantly associated with AP. On multivariable analysis, PSAD (OR 6.75, 95% CI 3.51–12.87, p = 0.005) and biopsy pattern 4 proportion ≥ 10% (OR 2.54, 95% CI 1.15–6.54, p = 0.036) or ≥ 15% (OR 2.74, 95% CI 1.06–6.06, p = 0.023) remained independent predictors of AP. The final multivariable model demonstrated solid discrimination (AUC = 0.78, 95% CI 0.71–0.85) and satisfactory calibration (p = 0.42). At a mean follow-up of 32.3 months, BCR occurred in 23 patients (18.1%; 3-year recurrence-free survival: 81.3%). Restaging PSMA PET/CT was positive in 8 of 23 recurrences (34.8%; three local, four regional nodal, one solitary bone). Neither clinical nor radiological parameters independently predicted BCR or PSMA PET/CT positivity. Conclusions: Biopsy Gleason pattern 4 extent (<10% and <15%) and PSAD are the strongest independent preoperative predictors of organ-confined, non-upgraded pathology in ISUP GG 2 prostate cancer. Combining a low pattern 4 burden (<10%, or up to 15% in highly selected cases) with a low PSAD provides objective parameters to refine “favorable intermediate-risk” stratification by identifying patients with a lower probability of adverse pathological features. Full article

Background/Objectives: Whether a unilateral posterior occlusal alteration produces bilateral temporomandibular joint (TMJ) changes, and how imaging findings relate to tissue-level alterations, remains incompletely characterised. This study aimed to characterise the bilateral TMJ response to a sustained unilateral posterior occlusal alteration in rats using longitudinal magnetic resonance imaging (MRI) and endpoint histological and histomorphometric assessment. Methods: Twenty-eight female Wistar rats were allocated to an experimental group (n = 12), a baseline control group (n = 4) and an age-matched control group (n = 12). Light-cured composite resin was applied to the three right maxillary molars of experimental animals and maintained for 16 weeks. Baseline MRI was obtained from the separate 8-week control group, whereas experimental and age-matched control animals underwent bilateral MRI at 16 and 24 weeks of age. Cartilage and disc structure, thickness and cell density were assessed histologically at the endpoint. Results: MRI demonstrated a progressive bilateral response. At 24 weeks, 11 of 12 experimental animals showed bilateral joint-space narrowing; condylar flattening affected 9 of 12 TMJs on each side, and reduced disc size was present in all experimental TMJs. Histology and histomorphometry showed a more intense ipsilateral response, with cartilage and disc thickening, loss of normal cartilage organisation and reduced cell density. Contralateral tissue architecture remained preserved, although disc thickness was greater than in age-matched controls. Conclusions: Unilateral posterior occlusal alteration produced a bilateral but asymmetric TMJ response: imaging abnormalities progressed in both joints, while tissue remodelling was most pronounced ipsilaterally. The combined findings support early load-related degenerative remodelling and show that unilateral occlusal disturbance can affect both TMJs to different degrees. Full article

The rapid expansion of the lithium industry has generated large quantities of lithium refinery residue (LRR), whose stockpiling and landfilling cause environmental risks and the loss of potentially recoverable resources. This review critically examines LRR generated from the processing of spodumene and lepidolite, with particular emphasis on how differences in their mineralogical and chemical characteristics affect subsequent utilization and resource-recovery strategies. Current utilization pathways are classified into bulk utilization and selective fractionation followed by product-oriented valorization. Bulk utilization mainly includes direct incorporation into construction materials, activated cementitious materials, and sintered products, offering high residue-consumption capacity but generally limited added value. Selective fractionation employs leaching, flotation, magnetic separation, and gravity separation to separate Si-Al, Ca-S, and Fe-bearing fractions and to recover residual valuable elements, including Li, Ta, Nb, Rb, and Cs. The removal or stabilization of hazardous constituents, particularly F, Be, and Tl, is also evaluated as a prerequisite for safe valorization. The recovered fractions can subsequently be converted into products such as aluminosilicate powders, porous ceramics, zeolites, glass-fiber feedstocks, high-strength α-hemihydrate gypsum, and anhydrite II. Finally, the reviewed pathways are critically compared in terms of technical feasibility, resource efficiency, environmental risks, economic potential, technological maturity, and scale-up constraints. Priority is given to integrated processing strategies that combine hazardous-element control, selective recovery of valuable components, and large-volume utilization of bulk fractions to improve the overall sustainability and industrial viability of LRR valorization. Full article

Cortisol is a key biomarker involved in the regulation of the hypothalamic–pituitary–adrenal axis and is widely used for assessing physiological stress and endocrine disorders. However, its small molecular size and low charge make its direct detection using field-effect transistor (FET)-based biosensors challenging. In this work, we present a competitive ImmunoFET biosensing platform combining a Si₃N₄-gated ion-sensitive field-effect transistor (ISFET) with anti-cortisol polyclonal antibody-functionalized magnetic nanoparticles (MNPs) for label-free cortisol detection. The sensing strategy relies on a competitive immunoassay in which cortisol in the sample competes with cortisol immobilized on the ISFET surface for antibody binding sites on the MNPs. Following a 45 min pre-incubation, magnetic separation, and redispersion, the MNPs were brought into contact with the cortisol-functionalized FET and analyzed by electrochemical impedance spectroscopy (EIS). The charge-transfer resistance decreased from 4.012 MΩ to 2.599 MΩ as the cortisol concentration increased from 0.02 to 0.6 ng/mL, confirming the expected competitive behavior. The sensor exhibited a concentration-dependent response over the 0.02–0.6 ng/mL cortisol range, with a limit of detection of 0.006 ng/mL. The platform also showed a stronger response toward cortisol than the investigated non-target biomarkers, including NT-proBNP, TNF-α, and IL-10. Its applicability was further demonstrated in real saliva using the standard addition method, yielding a cortisol concentration of 11.6 ng/mL, compared with an expected value of 10.2 ng/mL, corresponding to a 113.7% recovery. These preliminary results demonstrate the feasibility of the proposed MNP-assisted competitive FET for cortisol detection in biological samples and provide a basis for further development toward point-of-care applications. Full article

Anthraquinone-fused enediynes (AFEs) are a class of microbial natural products with remarkable cytotoxicity and exhibit promising application prospects in tumor therapy. Taking tiancimycins (TNMs) as an example, this class of compounds holds great potential against triple-negative breast and liver cancers. However, the low production titers of AFEs in actinobacterial hosts make their enrichment and separation processes both cumbersome and costly. Therefore, the main objective of this study was to develop a rapid and reusable magnetic platform for TNM enrichment and recovery. Inspired by the pi-pi stacking interactions between AFEs and their natural binding proteins in the producing strains, this study designed and prepared alizarin- and folic acid-co-modified magnetic nanoparticles (PNMP-AZ-FA). On the one hand, these nanoparticles can directly and specifically adsorb TNMs from the crude extract of Streptomyces sp. CB03234-S, enabling efficient separation. On the other hand, the folic acid modification was explored as a proof-of-concept delivery element for drug-loaded nanoparticles in folate receptor (FR)-expressing tumor models. PNMP-AZ-FA showed loading capacities of 87.8 and 106.7 mg/g for TNM A and TNM D, respectively, and retained high adsorption performance during 20 repeated cycles. Animal experiment results demonstrated that the TNM-loaded nanoparticle (PNMP-AZ-FA@TNM A) improved antitumor activity under the tested conditions, especially in the FR-high KB model; however, receptor-dependent uptake, biodistribution, and pharmacokinetic validation are still required. In summary, this nanoparticle holds great application prospects in the rapid separation and acquisition of AFEs, while its tumor-delivery application should be regarded as preliminary evidence. Full article

Peroxymonosulfate-based oxidation inevitably generates sulfate in the effluent, which may stimulate sulfate-reducing bacteria and pipeline corrosion. Sulfate-polishing adsorbents suitable for acidic effluent remain limited. Herein, we report an ethanol-assisted solvothermal strategy to tailor surface hydroxyl speciation on amorphous ZrO₂. The optimized material reached adsorption equilibrium within 10 min and showed an adsorption capacity of 110.6 mg/g. In fixed-bed operation using acidic sulfate-containing feed, the dynamic capacity was 82.9 mg/g, and the 50% breakthrough occurred at 3400 bed volumes. The terminal hydroxyl fraction increased from 15.2% to 59.8% as the ethanol/water volume ratio increased from 3:1 to 10:1. Ethanol addition is proposed to reduce hydrogen-bond-network connectivity, thereby suppressing condensation into bridging-hydroxyl. Terminal-hydroxyl abundance, estimated by thermogravimetric mass spectrometry (TG-MS) combined with solid-state ¹H magic-angle-spinning nuclear magnetic resonance (¹H MAS NMR) showed a positive trend with adsorption capacity. Site-blocking tests established an 87% terminal-hydroxyl-associated contribution to sulfate uptake. Zeta-potential and electrostatic-potential analyses supported preferential sulfate approach to terminal-hydroxyl-rich positive domains, whereas density functional theory (DFT) identified dual-site binding to terminal hydroxyls on separate Zr centers as the most stable configuration. These results identify regulation of hydroxyl speciation as a dopant-free strategy for sulfate polishing after peroxymonosulfate oxidation. Full article

Inductance-based self-sensing offers a potential means of reducing reliance on external displacement sensors in electromagnetic bearing systems. This study presents a rotor displacement self-sensing method based on a dual-stator electromagnetic bearing (DSEB) comprising a three-pole auxiliary stator and a six-pole main stator. In the main stator, the control poles generate the electromagnetic force required for rotor levitation, whereas the structurally separated sensing poles are used for displacement estimation without occupying the control-pole winding space. Permanent magnets and the sensing-coil bias current jointly establish the bias flux for partial rotor-weight compensation. To relate rotor displacement to sensing-coil inductance, a linearized mean-reluctance method is developed based on an equivalent magnetic circuit, and analytical models of the sensing-pole air-gap reluctance and sensing-coil inductance are derived. The models are evaluated through three-dimensional finite element analysis and nonrotating quasi-static displacement experiments. The maximum discrepancy between the analytical and finite element inductance results is 5.1%. Under a nominal unilateral air gap of 0.5 mm, a sensing-coil bias current of 0.2 A, and a peak-to-peak displacement range of 0.33 mm, the experimental MAPE values range from 2.09% to 4.42%, and the maximum absolute error relative to an eddy-current displacement sensor is 42.29 μm. These results validate the proposed reluctance–inductance model and demonstrate the feasibility of inductance-based rotor displacement self-sensing under the investigated quasi-static conditions, providing a basis for subsequent dynamic displacement estimation and closed-loop levitation studies. Full article

Wastewater systems can serve as reservoirs and dissemination pathways for Listeria spp., yet comparative data from municipal and agricultural wastewater remain limited. The objective of this study was to isolate Listeria monocytogenes from municipal wastewater and dairy-farm runoff for use as enrichment hosts in a subsequent and separate study on the isolation of bacteriophage from the same wastewater streams. During this process, additional Listeria spp. were recovered and characterized along with L. monocytogenes. Identification of Listeria sp. was accommodated using multilocus sequencing, LIPI-1-targeted PCR, and phenotypic confirmation. Wastewater samples were filtered, enriched with Demi-Fraser broth, treated with anti-Listeria magnetic beads, and plated on MOX agar. Bead-captured Listeria were later plated on Listeria Brilliance Agar to differentiate phospholipase-positive L. monocytogenes. Putative isolates were characterized by sequencing of 16S rRNA, sigB, and iap genes, and by PCR detection of four Listeria Pathogenicity Island 1 (LIPI-1) markers (hlyA, inlA, actA, prfA). Using this combined approach, 27 Listeria isolates were recovered from 21 wastewater samples during a 6-week sampling period: 13 samples of municipal wastewater yielded 5 isolates of L. monocytogenes (38% prevalence rate) and 11 other Listeria sp. (85% overall prevalence rate; 1 L. innocua, and 5 Listeria sp.); 8 samples of dairy wastewater yielded 2 isolates of L. monocytogenes (25% prevalence) and 9 other Listeria sp. (100% overall prevalence rate; 8 L. innocua and 1 Listeria sp.). Seven isolates from municipal and dairy wastewater were confirmed as L. monocytogenes based on concordant sigB and iap gene sequence identities, LIPI-1 gene presence, and phospholipase-positive reactions on chromogenic agar. Six isolates yielded discordant results across the multilocus sequencing markers and could not be confidently assigned to a species and were designated Listeria sp. These findings highlight the value of integrating chromogenic media with multilocus genetic markers for accurate identification of L. monocytogenes in complex environmental matrices. Full article

Background/Objectives: In cardiovascular-kidney-metabolic (CKM) syndrome, left atrium (LA) involvement begins early: reservoir function declines before the chamber dilates, and the resulting atrial cardiomyopathy (ACM) precedes atrial fibrillation (AF), heart failure with preserved ejection fraction (HFpEF), and cardioembolic stroke. How ACM is distributed across CKM stages has not yet been characterized in routine clinical practice. ATRIO-CKM aims to characterize ACM non-invasively across the range of CKM stages in patients assessed in an internal medicine and cardiology department and to identify the parameters most strongly associated with ACM within CKM syndrome. Methods: Single-center, prospective, observational study with cross-sectional phenotyping at the index visit. We will enroll consecutive adults at their first assessment in our department (target, 200; minimum, 150). The primary objective is to estimate the stage-specific prevalence of ACM among participants in sinus rhythm without documented AF, who form the main cohort and are grouped as CKM with versus without ACM. Patients in sinus rhythm are phenotyped with 12-lead electrocardiogram (P-wave duration, Bayés interatrial block), echocardiography with speckle-tracking of the left ventricle (LV), LA (biplane reservoir, conduit, and contractile strain), and right ventricular (RV) free wall, and biomarkers including MR-proANP, Fetuin-A, FGF-23, and NT-proBNP, with cardiac magnetic resonance in an exploratory subset. Participants with AF documented at any time, including previously documented paroxysmal AF, are allocated to a separate established-AF cohort irrespective of the rhythm at the index visit. Results: We will report ACM prevalence by CKM stage with confidence intervals, the profile separating the two groups, LA volume index across three groups of increasing severity (no ACM, ACM in sinus rhythm, and established AF), and the parameters associated with ACM. Conclusions: Using only measurements already available in routine cardiology, ATRIO-CKM will describe how ACM is distributed across CKM stages and identify the parameters most strongly associated with ACM within CKM syndrome, as candidates for a classification index to be developed and validated in a larger cohort. Full article