Search Results (456)

The removal of protein-bound uremic toxins (PBUTs) from the blood of kidney failure patients with conventional dialysis is limited. However, as their harmful effects and association with morbidity and mortality in dialysis patients are increasingly recognized, PBUTs have become important therapeutic targets. In this review, PBUT removal with current state-of-the-art dialysis technologies and future perspectives are discussed. Strategies to enhance PBUT clearance include methods that interfere with PBUT–albumin binding, such as chemical displacers, high ionic strength, pH changes, or electromagnetic fields, thereby increasing the free fraction available for dialysis. While these methods have shown promise in vitro, and some also in vivo, long-term safety data are lacking. PBUT removal can also be increased by adsorption, either directly via hemoperfusion, or indirectly, e.g., via sorbents incorporated in a mixed-matrix membrane or dissolved in the dialysate. In the kidney, PBUTs are secreted in the proximal tubules; hence, a cell-based bioartificial kidney (BAK) that secretes PBUTs is proposed as an add-on to current dialysis. Yet both PBUT adsorption strategies and, in particular, BAKs face considerable challenges in upscaling and mass production at acceptable costs. In conclusion, many novel technologies are under development, all requiring further (pre)clinical testing and upscaling before these strategies can be applied in the clinic. Full article

Background: Structural and functional adaptation of the heart to chronic exercise is dependent on multiple factors, including the volume and type of training, and has direct implications for pre-participation cardiac screening (PPCS). Sailing is a unique multi-training modality sport with limited prior description of cardiac adaptation to training. The aims of this study are (1) to describe electrocardiogram (ECG) changes in sailors, informing PPCS guidelines; (2) to assess structural and functional cardiac changes in sailors; and (3) to examine sex- or discipline-specific cardiac adaptations in sailors. Methods: Seventy elite sailors (33 females) underwent standard ECG and echocardiography. Echocardiographic data were compared to population norms and analysed by sex and sailing discipline based on training type: isometric (IG), pumping (PG), and movement (MG). Results: One sailor presented with abnormal ECG findings (T wave inversion) which warranted further investigation. Primary training-related ECG changes noted were early repolarisation (24%) and sinus bradycardia (30%). The left ventricular volume index was dilated in 18% of all sailors compared to reference values, with similar findings noted on right ventricular parameters for 22% of the study population, although in males only. The impact of predominant training stimulus (IG, PG, MG) did not mediate differences in the structure of any cardiac chambers (p > 0.05). Ejection fraction was lower in the PG (Δ4%, p ≤ 0.001), whereas global longitudinal strain was higher (Δ2%, p = 0.02) compared to MG and IG. Conclusions: Elite-level sailors present with electrical and structural cardiac phenotypes associated with exercise adaptation, with dilation of both left- and right-sided chambers. These data should be considered when interpreting results of PPCS in male and female sailors from different, specific disciplines. Full article

Background/Objectives: Sacubitril/Valsartan is a cornerstone therapy to improve outcomes in patients with heart failure with reduced ejection fraction (HFrEF). This study aimed to investigate the effect of Sacubitril/Valsartan on cardiac autonomic balance using physiological sensor data obtained from implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy defibrillators (CRT-Ds). Methods: This observational study involved 54 ICD and CRT-D patients who initiated Sacubitril/Valsartan therapy to treat HFrEF. The evaluated key parameters included heart rate variability (HRV), 24 h mean heart rate (24 h-HR), and nocturnal heart rate (nHR). Device electrical parameters and ventricular arrhythmias were also assessed. The data were collected by remote monitoring and averaged over a 7-day window at baseline (before treatment) and at 3 and 12 months after treatment initiation. Results: Sacubitril/Valsartan significantly improved HRV at 3 months (from 78.6 ms [interquartile range: 54.2–104.6] to 80.8 ms [60.8–108.0]; p = 0.041), reduced 24 h-HR (from 73.2 bpm [67.3–77.7] to 69.9 bpm [64.2–75.7]; p = 0.016), and reduced nHR (from 63.0 bpm [58.1–70.0] to 60.4 bpm [56.0–68.6]; p = 0.028). No significant changes in HRV, 24 h-HR, and nHR were observed between 3- and 12-month follow-up. The device electrical parameters were not influenced by the treatment. While the overall ventricular arrhythmia burden did not change post-treatment, patients with pre-treatment arrhythmias experienced a significant reduction in episodes from 2.97 (pre-treatment) to 0.82 (post-treatment) events per 100 patient years (p = 0.008). Conclusions: Sacubitril/Valsartan therapy in HFrEF patients was associated with statistically significant changes in cardiac autonomic indices, including a small increase in HRV and a slight reduction in heart rate, mainly during the first three months of treatment. Full article

Microplastic pollution is a growing global environmental and public health concern, driven by the increasing production and use of plastics. Due to their ubiquitous presence in the environment, humans and animals may be exposed to micro- and nanoplastics via several possible routes. For micro- and nanoplastics, the development of standardized and validated methods remains an important area of progress to support human health risk assessments. In order to monitor micro/nanoplastics’ occurrence in organisms and the environment, it is necessary to develop accurate and reliable methods to quantify and characterize micro/nanoplastics from various biological and environmental matrices. In this study, an analytical, multi-platform approach was established to characterize and quantify polystyrene nanoplastics in biological samples through a combination of sample pre-concentration, asymmetric flow field-flow fractionation, ultraviolet–visible light, dynamic light scattering detectors and pyrolysis–gas chromatography–mass spectroscopy. Several digestion methods on various rodent tissues were tested and modified, and these led to the development of tissue-specific protocols to maximize yield. These digestion protocols were then combined with a new method of concentrating and retaining plastics to prevent the loss of submicron particles. For identification and quantification, known amounts of polystyrene nanoplastics were spiked into rodent tissues (intestine, kidney and liver). This was followed up by a mouse in vivo study consisting of a single dose of PS-NPs, followed by tissue collection, digestion and analysis. Polystyrene particles were detected in the liver and kidney, but not reliably in the intestinal tissues. Full article

Quantitative Feedback Theory (QFT) enables the control system to guarantee stability and performance in the presence of plant uncertainty, thus offering a quantitative and less conservative framework for designing robust yet practical controllers. The presented work investigates a single-stage constraint optimization-based approach for synthesizing controllers for the ship roll stabilization. The typical QFT loop shaping is a manual two-stage procedure that demands a proficient understanding of loop-shaping principles on Nichols charts. The proposed procedure simplifies the QFT synthesis process by introducing a single-stage method that allows for concurrent synthesis of both the QFT controller and pre-filter. The present work considers the synthesis of fractional order controllers (using the FOMCON toolbox). The proposed method also enables the designer to pre-specify the controller architecture at the beginning of the design procedure. A comparative analysis with the controllers obtained using the QFT toolbox, Ziegler–Nichols, ${\mathcal{H}}_{\infty }$, IMC, and MPC have also been presented in the work. The implementation has been carried out for the ship roll stabilization, which is one of the critical problems in marine engineering, as it directly impacts the vessel safety, operational efficiency, and passenger comfort, wherein excessive roll can lead to reduced propulsion efficiency. The obtained results highlight that the proposed controller performs better than the benchmark controllers, and Monte Carlo simulations have also been included to support the results. Full article

Bioprocessing grape pomace (GP) presents a sustainable solution aligned with circular economic principles and transforms it into valuable functional ingredients for baked products. This review (2020–2025) synthesizes enzymatic and microbial strategies that modify the fiber–phenolic matrix and improve dough performance. Enzyme-assisted extraction, alone or combined with ultrasound or pressurized liquids, increases extractable polyphenols and antioxidant capacity in GP fractions used as flour substitutions or pre-ferments. Fungal solid-state and lactic fermentations liberate bound phenolic compounds and generate acids and exopolysaccharides. Among these routes, enzyme-assisted extraction and lactic sourdough-type fermentations currently appear the most compatible with bakery-scale implementation, offering substantial phenolic enrichment while relying on relatively simple, food-grade equipment. In current bakery applications, GP is mainly used as crude grape pomace powder, which typically shows higher total phenolics and antioxidant capacity. Moreover, in several models it lowers starch hydrolysis and predicted glycemic index. The practical substitution rate is between 5 and 10% of flour, which balances nutritional gains with processing disadvantages. These can be mitigated by fractionation toward soluble dietary fiber or co-fortification with flours rich in protein and fiber. An additional benefit of these methods includes reduced mycotoxin bioaccessibility in vitro. A key evidence gap is the absence of standardized comparisons between raw and bioprocessed GP in identical formulations. Overall, GP emerges as a promising ingredient for bakery products, while the added technological and nutritional value of bioprocessing remains to be quantified. Full article

Background/Objectives: Litsea glaucescens Kunth, commonly known as “laurel,” is a tree native to Mexico. The Codex Cruz-Badiano, from 1552, described it as the main ingredient of a topical anti-inflammatory recipe. This study aims to determine whether L. glaucescens leaf extract can reduce experimental inflammation, supporting its use in Aztec medicine. Methods: Methanolic extracts and fractions from the leaves of L. glaucescens were analyzed using techniques such as normal and reverse-phase TLC, 1H-NMR, HPLC-UV, MS, and GC-MS. The anti-inflammatory systemic activity of this methanolic extract was evaluated in mice using carrageenan-induced paw inflammation and TPA-induced ear topical inflammation models. Myeloperoxidase activity, DPPH, and TBARS assays were performed. L. guatemalensis, a closely related species, served as a positive control, as its biological activity has been demonstrated. Results: Thin-layer chromatography analysis reveals flavonoid-type compounds in the methanolic extract of L. glaucescens leaves, and when it was fractionated, pinocembrin and quercitrin were the main compounds found. L. glaucescens in mice significantly reduced carrageenan-induced paw swelling and TPA-induced ear inflammation. A decrease in myeloperoxidase activity and an increase in antioxidant activity were observed. Conclusions: Methanolic extract from L. glaucescens, administered systematically, produced significant in vivo anti-edematous effects and in vitro, antioxidant and anti-infiltrative/anti-neutrophilic activities, qualitatively like those of L. guatemalensis. Quercitrin and pinocembrin could contribute to these actions. It is unclear which of the two plant species was used in pre-Columbian times; However, our results show that both species contain phytochemicals with anti-inflammatory properties, suggesting that the Aztecs recognized this medicinal property. Full article

The integration of large-scale offshore wind power, facilitated by Flexible Fractional Frequency Transmission Systems (FFFTS), presents significant challenges for traditional transmission line protection. The fault current fed by the Modular Multilevel Matrix Converter (M3C) exhibits weak-infeed and controlled characteristics during faults, severely degrading the sensitivity of conventional current differential protection. Moreover, the stringent synchronization requirement for data from both line ends further compromises reliability. To address this issue, this paper proposes a novel differential protection scheme based on the Dynamic Time Warping (DTW) algorithm. The method leverages the DTW algorithm to quantify and compare the variation trends of current waveforms on both sides of the line before and after a fault. By utilizing the pre-fault current as a reference sequence, the scheme constructs a protection criterion that is inherently insensitive to synchronization errors. A key innovation is its capability for fault identification and phase selection under weak synchronization conditions. Simulation results demonstrate that the proposed scheme operates correctly within 0.5 ms, exhibits high sensitivity with a DTW ratio significantly greater than 2.0 during internal faults, and remains stable during external faults. It also shows strong robustness against high transition resistance, noise interference, and current transformer sampling errors. Full article

Background: Tight blood pressure control is a cornerstone of postoperative cardiac surgery patients. In addition, plasma lactate levels are frequently monitored in this setting as it is a marker for malperfusion, with early elevated levels being associated with increased morbidity and mortality. Elevations from malperfusion may be due to decreased cardiac output, hypovolemia, or persistent post-bypass vasoplegic response. Here, we investigate whether lower blood pressures, significant changes from baseline, and cardiac perfusion pressures delay the clearance of lactate after cardiac surgery. Methods: This is a retrospective cohort observational study of patients who have undergone coronary artery bypass graft (CABG) and valve replacement or repair surgeries at NYU Langone Long Island Hospital over a 6-month period. Postoperative blood pressures and lactate levels were examined over the first 16 h of care. Primary outcome: The relationship between blood pressure parameters and lactate clearance. Secondary outcomes: ICU length of stay, hospital length of stay, and mortality. Results: A total of 81 patients met inclusion criteria. The average pre-operative mean arterial blood pressure (MAP) was 95.4 mmHg and the average MAP in the first 6 h post-operatively was 78.4 mmHg. The average change in MAP from baseline was a decrease of 16.7%. The average cleared lactate fraction by 16 h postoperatively was 85.9%. Lactate clearance was associated in a statistically significant way only with the need for inotropic support on postoperative day 1, p = 0.03. There was a slight trend toward a delay in lactate clearance in those with lower early systolic blood pressures, p = 0.14. Conclusions: Lactate clearance appears to occur largely independently of postoperative blood pressures in the first 16 h after surgery but may be delayed in those requiring inotropic support through the morning or postoperative day one. Full article

(1) Background: Ventricular arrhythmias (VAs) are a leading cause of morbidity and mortality in ischemic and non-ischemic heart disease. While automated implantable cardioverter–defibrillators (AICDs) are standard treatment for high-risk patients, predicting future VA post-implantation remains limited. This study evaluated echocardiographic and strain parameters for predicting VA risk in AICD recipients. (2) Methods: This retrospective cohort study included patients who underwent AICD implantation at Westmead Hospital, New South Wales, Australia (January 2014–May 2024). Pre-implant transthoracic echocardiograms (TTEs) were analysed for structural and functional parameters, including left-ventricular (LV) ejection fraction (LVEF), LV global longitudinal strain (GLS), mechanical dispersion (MD), and delta contraction duration (DCD). VA events, defined as appropriate AICD shock or anti-tachycardia pacing, were identified from electronic medical records and device checks. Univariate and multivariate Cox regression analyses were performed. (3) Results: Among 242 patients, 98 experienced VA events. Increased LV end-diastolic diameter, indexed LV mass, and right-ventricular basal diameter were associated with VA events (p < 0.05), whilst LVEF and GLS were not. LV dyssynchrony was greater in affected patients (MD 69.2 ms vs. 63 ms, p = 0.036; DCD 288.8 ms vs. 246.4 ms, p = 0.010). DCD was an independent predictor of VA events (HR 1.003; 95% CI: 1.000–1.006; p = 0.022). (4) Conclusions: DCD may improve risk stratification in AICD patients. Full article

The Lunar Soil Volatile Measuring Instrument, a key payload of the Chang’e-7 mission, employs a quadrupole mass spectrometer (QMS) to directly analyze gases released from lunar regolith at different temperatures, aiming to determine the types and abundances of volatiles. However, the evolved gases are often complex mixtures, and their direct introduction into the mass spectrometer may compromise the measurement accuracy due to interactions among different species. To investigate the interference from gases on volatile quantification, systematic experiments were performed with one or two gases out of H₂, He, N₂, Ar, CO₂, and CO on a flight-like laboratory unit of the payload. Results show that the QMS exhibited excellent reproducibility and linear response (R² > 0.99) for all pure gases tested. Furthermore, the sensitivity of gases varied in mixtures and was jointly influenced by gas composition and volume fraction. For instance, compared with the sensitivity values obtained in pure gas measurements, the sensitivity of CO was slightly enhanced when mixed with Ar but was reduced when mixed with H₂ or He. A significant sensitivity enhancement of up to 4.6 folds was observed for H₂ when mixed with He. However, as its fraction increased, the sensitivity of a component in a binary mixture exhibited a decreasing deviation and was almost constant when its fraction was above 60%. Based on these findings, we developed a sensitivity correction method which employs an iterative algorithm to obtain more accurate partial pressures calculated from the gas measurement signals. Applications of the method on H₂–He mixtures and a pre-mixed CO–N₂ standard gas demonstrated that the relative errors of calculated pressures can be reduced to within ±10%. This method would significantly improve the accuracy of gas pressure calculated from in situ volatile measurement data and also provides a valuable reference for similar QMSs. Full article

Background/Objectives: Despite increasing use of upfront decompressive surgery for malignant epidural compression of the myelon (MESCC), a substantial number of affected patients still receive radiotherapy (RT) alone. Many of these patients would benefit from a personalized treatment approach including the most appropriate dose-fractionation regimen. The PRE-MODE trial (NCT03070431) compared precision RT with 5 × 5 Gy (prospective cohort, n = 40) to conventional RT with 5 × 4 Gy (historical control, n = 676)). After propensity-score matching, 5 × 5 Gy resulted in significantly increased local progression-free survival (LPFS) at 6 months than 5 × 4 Gy. The question arose whether this benefit is still present after a longer period of follow-up. Methods: For this additional study, supplementary data were retrospectively captured, resulting in prolongation of follow-up until 24 months. Results: 5 × 5 Gy resulted in LPFS of 80.9% at each investigated time point (12, 18, and 24 months) without reported radiation myelopathy. Moreover, 5 × 5 Gy showed a trend towards improved LPFS after 12 (p = 0.070), 18 (p = 0.060), and 24 (p = 0.054) months. Similarly to the original PRE-MODE trial, OS-rates were not significantly different in the dose groups of this supplementary study. Conclusion: Since 5 × 5 Gy resulted in excellent long-term LPFS and showed a trend towards better outcomes up to 24 months following RT, it appears preferable to 5 × 4 Gy and will contribute to the personalized treatment of patients with MESCC who are assigned to RT alone without upfront neurosurgical intervention. Full article

Waste printed circuit boards (WPCBs) are one of the fastest-growing waste streams and pose a significant environmental challenge while also representing a valuable secondary resource due to their rich metal content, particularly copper (Cu). Since effective recovery of metals requires mechanical pre-treatment and advanced characterization, WPCB boards were subjected to size reduction and then characterized through X-ray fluorescence (XRF), inductively coupled plasma optical emission spectroscopy (ICP-OES), scanning electron microscopy (SEM-EDS), and mineral liberation analysis (MLA). Results indicated that copper is predominantly found in coarser particle sizes due to its ductility, while glass fibers and ceramics dominate finer fractions. Liberation studies revealed that Cu is essentially free in fine particles (<100 μm) but tends to remain locked in coarser fractions. Based on these results, gravity separation methods were employed to concentrate the copper: coarse particles (>300 μm) were treated on a shaking table, achieving a Cu recovery of 95%, while fine particles (<300 μm) were processed using a multi-gravity separator (MGS), with recoveries of 94% for 100 × 300 μm and 81.5% for <100 μm size fractions. This study presents a gravity-based separation strategy that combines shaking tables and MGS to optimize Cu recovery from automotive WPCBs. To the authors’ knowledge, the MGS application for WPCBs has received little attention, despite its strong potential for separating this type of waste. The proposed methodology enhances the concentration and purity of the metallic fraction (in this case, Cu), especially in fine particles, which are challenging to work with, while reducing environmental impacts through minimal chemical use, thereby contributing to sustainable e-waste recycling. Full article

Background: Coronary artery disease remains the leading cause of morbidity and mortality in developed countries. Despite advances in treatment and standard rehabilitation, conventional programs may be monotonous and insufficiently engaging. Normobaric hypoxia, simulating high-altitude conditions, has emerged as a potential method to enhance cardiovascular adaptations in post-myocardial infarction (MI) patients. Objective: This study aimed to compare the efficacy and safety of exercise-based cardiac rehabilitation performed under normobaric hypoxia corresponding to altitudes of 2000 m and 3000 m above sea level in patients after MI treated with percutaneous coronary intervention (PCI). Methods: A total of 61 male post-MI patients (mean age 60.4 ± 8.9 years) were randomized into two groups: training under simulated altitudes of 2000 m (n = 35) or 3000 m (n = 26). The 22-day program consisted of interval ergometer sessions. Pre- and post-intervention assessments included cardiopulmonary exercise testing (CPET), echocardiography, and tissue Doppler imaging (TDI). Results: Both groups demonstrated significant improvements in exercise tolerance. Training at 2000 m significantly increased test duration (r = 0.735) and peak heart rate (r = 0.467). At 3000 m, additional benefits were observed, including improvements in metabolic equivalent (r = 0.861), peak oxygen consumption (d = 0.81), and reduction in respiratory exchange ratio (r = 0.682). Intergroup analysis revealed moderate differences favoring the 3000 m group in MET, breathing frequency, and RER. Echocardiography showed beneficial remodeling in both groups, with improvements in LV dimensions, ejection fraction, and MAPSE. Notably, training at 2000 m resulted in more consistent echocardiographic benefits compared to 3000 m. Conclusions: Cardiac rehabilitation under normobaric hypoxia is effective and safe in stable post-MI patients. Training at 3000 m provides greater improvements in exercise tolerance, while 2000 m confers more favorable effects on cardiac structure and function. These findings suggest that moderate hypoxic exposure (2000 m) may represent an optimal balance between efficacy and safety in post-MI rehabilitation. Full article

Background and Objectives: Heart failure (HF) represents a clinical syndrome characterized by symptoms and signs such as fatigue, dyspnea, edema of the lower limb, or pulmonary rales. It usually occurs in elderly individuals due to decreased cardiac pumping function and/or increased diastolic ventricular filling pressures. The COVID-19 pandemic deeply altered many daily life habits, and one of the most affected groups of people were those with chronic diseases because of their need for regular medical follow-up. Furthermore, SARS-CoV-2 infection itself has been shown to exacerbate cardiovascular diseases (CVDs). Materials and Methods: This retrospective, observational, and comparative study aimed to characterize and compare patients with chronic heart failure hospitalized in the Cardiology Department of Medical Clinic II, Mureș County Emergency Clinical Hospital, in Târgu Mureș, Romania, between January and December 2019 (pre-pandemic), January and December 2021 (pandemic), and January and December 2023 (post-pandemic). Results: A total of 406 patients were analyzed: 202 patients hospitalized in 2019, 101 patients hospitalized in 2021, and 103 patients hospitalized in 2023. Women with HF were significantly older (median age 72 years) than men (median age 65 years; p < 0.001). During the pandemic, the median length of hospitalization increased (8 days vs. 7 days in the other periods). The pandemic period was also associated with a decrease in left ventricular ejection fraction (LVEF), as reflected by a higher incidence of patients with HF with reduced ejection fraction (42% during the pandemic; p < 0.01). Conclusions: During and after the pandemic, men exhibited significantly higher rates of right and left bundle branch blocks, as well as chronic obliterating artery disease of the lower limb. Left ventricular function declined during the pandemic in both men and women. Throughout the years, we observed distinct patterns between male and female patients regarding associated diseases or behaviours, suggesting lifestyle and psychological changes due to the COVID-19 pandemic. Full article